The role of hippocampus-based developmental changes in paediatric post-traumatic stress disorder

Abstract

Current evidence-based psychosocial treatments for paediatric post-traumatic stress disorder are not successful for a substantial proportion of young patients. These treatments are mainly based on principles of cued fear reduction and cortico-amygdala circuitry, but overlook alterations in other forms of learning and memory that are centrally implicated in the aetiology of this disorder. In this Perspective, we focus on hippocampus-dependent processes of contextual fear conditioning and generalization — specifically statistical learning, category-based induction and schema learning — and describe their role in paediatric post-traumatic stress disorder. Our synthesis of research on developmental changes supports the view that hippocampal structure and function, along with the related contextual fear-learning processes, are core neurobehavioural mechanisms underlying the onset and maintenance of this disorder in youth. Current and future knowledge of the developmental trajectories of these hippocampus-dependent higher-order learning and memory processes can help to augment the effects of existing clinical interventions. The treatment of paediatric post-traumatic stress disorder currently focuses on associative processes that have primarily been studied in adults. In this Perspective, Foster et al. spotlight higher-order learning processes that typically develop during childhood to specify intervention targets for young patients.