Even though it is well-recognized that children are victims in the vast majority of dog attacks, what has not been fully recognized is the psychological and neurological damage that may happen as a result from a traumatic stressful event such as a dog bite.
In particular, children who sustain severe dog bites, particularly to the face, are prone to developing posttraumatic stress disorder (PTSD). This was first recognized in a 2004 study which found that over half the victims studied had symptoms of post-traumatic stress disorder 2 to 9 months after sustaining a dog bite injury (Peters, V. et. al. Post-traumatic stress disorder after dog bites in children. J. Pediatrics, 2004, 144, 121-122).
The Mayo Clinic estimates that the incidence PTSD, as a result of any kind of serious trauma, happens in as many as 15% of girls and 6% percent of boys. Typically, symptoms start within three months of a traumatic event, and include symptoms such as such as generalized anxiety,hightened emotional arousa, impulsivity, aggression, and “post-traumatic play” in which a child repeats aspects of the trauma.
A recent study examined the psychological adjustment of 57 children (3 to 12 years) who suffered disfiguring injuries to the face or extremities as a result of a traumatic event such as a dog bite (Rusch, M., et. al. Psychological adjustment in children after traumatic disfiguring injuries: a 12-month follow-up. Plastic Reconstructive Surgery 2000,106,1451-458). Results showed that within 5 days of the traumatic event, 98 percent of the children were symptomatic for post-traumatic stress disorder, depression, or anxiety. One month after the injury, 82 percent continued to display symptoms, and 42% of the patients continued to report symptoms at 12-month follow-ups. Persistent symptoms typically included flashbacks, fear of re-injury, mood disorders, body-image changes, sleep disturbances, and anxiety.
Even more alarming, however, is other research indicating that traumatizing events in children (not necessarily the result of a dog bite) result in neurological damage. For example, a study out of Stanford University (Carrión, V. et. al., Reduced hippocampal activity in youth with post-traumatic stress symptoms: An MRI study, J. Pediatric Psychology, 2010, in press) found that children with symptoms of PTSD had an abnormal hippocampus. The hippocampus is the main part of the brain dealing with memory. In this study, children between the ages of 10 and 17 were divided into a group with a confirmed diagnosis of post traumatic stress disorder (arising from a a variety of traumatizing events) and compared with a group of children with no post traumatic stress disorder. Brain scans (e.g. MRI) were taken simultaneously when subjects completed a test for verbal memory. The test consisted of having subjects read a list of words from one list, then read an additional set of words from another list, and then had to remember which words were on the original list. Compared with children without posttraumatic stress disorder, those with PTSD did poorly on this test, and during testing these subjects also showed considerably less electrical activity in their hippocampus.
The conclusion from this is that an individual must have a neurologically healthy hippocampus for memory to work properly. If the hippocampus is compromised then memory will be compromised as well. The mechanisms through which traumatic events impact the hippocampus are not entirely clear, although speculation is that certain hormones, specifically glucocorticoids, secreted during a stressful, traumatic events may be neurotoxic to the hippocampus.
Further, this research shows that posttraumatic stress disorder, long considered a “soft” disorder, may now have objective biological means to substantiate its presence. New technologies are also currently being used to objectively substantiate the presence of post traumatic stress disorder, such as a technique called magnetoencephalography (MEG), a brain imaging method that measures how the brain processes information, a technique which contrasts with the traditional MRI.
In conclusion, personal injury attorneys, physicians, and psychologists now need to consider the above mentioned findings along with the new technological developments in this field, in litigation and also in the treatment of children traumatized by severe dog bites.
Carrion V., et. al. Stress predicts brain changes in children: a pilot longitudinal study on youth stress, post-traumatic stress disorder, and the hippocampus. Pediatrics, 2007. 119, 509-16. Study concludes that post-trumatic stress is associated with and has a causal effect upon hippocampal reduction in children. The mechanism of action is hypothesized to be increased level of stress hormones, such as cortisol, which may be neurotoxic to the hippocampus.
Rossman, B., et al. Symptomatology and adaptive functioning for children exposed to normative stressors, dog attack, and parental violence. J.American Academy Child Adolescent Psychiatry. In this study was found that girls are more likely to suffer from post-traumatic stress when compared with boys, a finding consistent with other studies. A single traumatic event suffices to cause a post-traumatic stress disorder.