In today’s installment of “Inside and Out,” we meet Mario — a young guy who grew up steeped in violence. He took two bullets at age nine, suffered abuse at home, was hit by a car, beaten with a brick, and forced to bury some of his closest relatives. Until just a few years ago, the way Mario coped with all that baggage was by dealing out violence of his own. He’s a case study in how trauma can affect the behaviors and brains of young people. The Illinois Department of Juvenile Justice is beginning to incorporate an understanding of those affects into its practices and programs.

It’s important to note that this science is relatively new — the brain research in particular has really flowered in just the last decade or so. As the science has advanced, so has an interesting controversy over how to diagnose this condition in young people. The closest thing to an established diagnosis is post-traumatic-stress-disorder. But that’s problematic for a kid like Mario. Trauma experts like Carl Bell and Bessel van der Kolk (fun fact — his son Nick works for Vocalo and blogs here regularly!) say PTSD better describes someone who has a “normal” state of development, which is then affected by a trauma — as in an adult soldier exposed to combat.

But in a young person, the brain is still developing and growing — all the way into his or her early 20s. Trauma — and here we’re mostly talking about neglect, extreme poverty and experienced or witnessed violence — can distort the way the brain organizes itself in the first place. The disorder is the “normal,” and there’s no unaffected state to try to go back to. And furthermore, experiencing “chronic” trauma over and over again, like living in a violent home, has different effects on a person than a single traumatic event does.

So consequently, clinicians say there’s not always a good diagnosis to give to these kids. Some meet the requirements for PTSD, many do not. So a lot of these kids either go undiagnosed, or misdiagnosed with some other mental health condition. That means they may go without treatment (most Medicaid services, for example, require an official diagnosis), or they get the wrong treatment.

Someone with symptoms of developmental trauma might be diagnosed, for instance, with bipolar disorder or oppositional-defiant disorder. That could set in motion a whole course of treatments that might not be right for a person who’s really responding to trauma. Northwestern University psychologist Gene Griffin says a traumatized kid who’s hyper-aroused (i.e. in constant “fight-or-flight” mode) might be diagnosed with ADHD and given Ritalin. But Ritalin is a stimulant — probably not what you’d want to give a kid who’s already coiled like a spring. Advocates like Brad Stolbach of La Rabida Children’s Hospital say misreading these kids could lead to more dangerous environments within the youth prisons, and ultimately more recidivism.

So there’s a camp of psychiatrists and child development experts trying to get a new childhood trauma diagnosis into the next Diagnostic and Statistical Manual of Mental Disorders — the canon of officially recognized diagnoses. The DSM-V is scheduled to come out next year. There seems to be wide agreement that some new diagnosis specific to juveniles is appropriate, but the science is new enough that it may take another round before it gets enshrined into the DSM. The argument is, to some extent, over terminology. But in this case, words really matter.