![]() ![]() DTD covers adversity not described by PTSD, and it also accounts for the disruptions in development that result from sustained trauma during childhood, which typically occurs in the context of relationships. Symptoms include behaviors such as habitual self-harm, extreme distrust, and verbal or physical aggression toward others. cPTSD has gained traction in clinical settings for both children and adults since the World Health Organization added it to the International Statistical Classification of Diseases and Related Health Problems (ICD-11) in 2019.ĭTD is a more multifaceted diagnosis specific to children, encompassing 15 possible symptoms across several domains, including emotion, cognition, behavior, and relationships. Some have faced a combination of Criterion A stressors and other adverse events-for example, a child who was neglected by a parent with a substance use disorder, then sexually abused after entering foster care. Patients with cPTSD, on the other hand, may have faced either multiple Criterion A stressors or chronic adverse experiences that may not meet the Criterion A threshold, such as impaired caregiving, emotional abuse, or prolonged separation from a caregiver. To receive a PTSD diagnosis, patients must face a “Criterion A” stressor-witnessing or experiencing actual or threatened death, serious injury, or sexual violence-and exhibit a series of resulting symptoms, such as flashbacks, hypervigilance, and emotional distress. Since then, the field’s concept of trauma has evolved, and many say it is well past time for the DSM to catch up. The addition of PTSD to the Diagnostic and Statistical Manual of Mental Disorders (3rd Ed.) in 1980 sent a clear message that a harrowing experience, such as participating in violent combat or being sexually assaulted, can profoundly affect human health and behavior. We’re working to manage and contain their behaviors, but we’re not addressing the underlying factors driving those behaviors.” “In the absence of a trauma diagnosis, kids are getting left out. “These kids are often seen as a problem to their schools, caregivers, and society,” said psychologist Joseph Spinazzola, PhD, executive director of the Foundation Trust, a philanthropic organization that supports underserved groups, and co–principal investigator of two field studies of DTD. Now, they can point to a growing research base to support that claim. These experts argue that formalizing disorders such as complex PTSD (cPTSD) and developmental trauma disorder (DTD) enables better treatment for children like James, because those diagnoses account for the detrimental effects of chronic stressors such as neglect, emotional abuse, and family or community violence-and ensure that children receive trauma-informed care. To better serve children like James, a growing group of psychologists and psychiatrists is studying complex trauma-which can refer to exposure to multiple adverse events and the impacts of that exposure-and advocating for its inclusion in various classification systems. ![]() “Their trauma history just gets completely missed, and it’s such a disservice to them.” “So many of these kids are misdiagnosed, and as a result, they’re not getting the right treatment,” said Mandy Habib, PsyD, codirector of the Institute for Adolescent Trauma Treatment and Training at Adelphi University in New York. He takes a cocktail of medications, but neither his diagnoses nor his treatments address the effects of his tumultuous early years. ) By the time James started high school, he had been diagnosed with oppositional defiant disorder (ODD), bipolar disorder, borderline personality disorder, and generalized anxiety disorder. (More than 70% of children treated by the National Child Traumatic Stress Network do not meet the criteria. Despite all these difficulties, he did not meet the diagnostic criteria for post-traumatic stress disorder (PTSD) when he was assessed by clinicians at ages 5, 9, and 16. When James entered preschool, he faced significant mental and behavioral health problems, including aggressive behavior, difficulty regulating his emotions, and trouble forming healthy relationships with peers. At one point, James was temporarily removed from his mother’s care and placed in a foster home, where he witnessed family violence and experienced emotional abuse. As a result, he faced poverty, homelessness, and severe neglect throughout his childhood. She never physically abused him, but she could not provide consistent care. James* was born to a mother who suffered from chronic depression and a substance use disorder. ![]()
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