In the ever-evolving field of psychology, the understanding of trauma and its profound effects on human health and behavior has undergone significant transformations. The inclusion of Post-Traumatic Stress Disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders (3rd Ed.) in 1980 was a pivotal moment, recognizing the severe impact that harrowing experiences, such as violent combat or sexual assault, can have on individuals. However, as our comprehension of trauma deepens, it becomes evident that the current classification systems require updating to accurately reflect and address the complexities of developmental trauma.
The Evolution of Trauma Understanding
The criteria for a PTSD diagnosis are stringent, requiring exposure to a “Criterion A” stressor, which includes witnessing or experiencing threats to life, serious injury, or sexual violence. This must be coupled with a range of resultant symptoms like flashbacks, hypervigilance, and emotional distress. Complex PTSD (cPTSD), a related but distinct condition, may involve exposure to multiple Criterion A stressors or prolonged adverse experiences that may not meet the Criterion A threshold, such as emotional abuse or prolonged separation from a caregiver. The World Health Organization’s recognition of cPTSD in the International Statistical Classification of Diseases and Related Health Problems (ICD-11) in 2019 has led to increased acknowledgment of this condition in both children and adults.
What is Developmental Trauma in Children?
Developmental Trauma Disorder (DTD) represents a more nuanced diagnosis, specifically tailored for children. It encompasses a broad spectrum of symptoms across various domains including emotion, cognition, behavior, and relationships. Children with DTD may exhibit habitual self-harm, extreme distrust, and aggression, often stemming from sustained trauma experienced in relational contexts. DTD captures the developmental disruptions resulting from prolonged exposure to trauma, offering a more comprehensive understanding of these children’s experiences.
How Can A Misdiagnosis Of Trauma Impact Children?
Children with DTD are often misdiagnosed with behavioral or psychiatric disorders such as Oppositional Defiant Disorder (ODD), ADHD, bipolar disorder, or major depression. This misdiagnosis can lead to treatment plans that do not adequately address the root of the issue, often focusing on behavioral therapy and medications rather than trauma-informed approaches. As highlighted by Dr. Margaret Blaustein, a clinical psychologist and founder of the Center for Trauma Training, the accuracy of diagnosis is crucial as it influences approved treatments, insurance coverage, and research directions.
The Journey Toward Recognition
The journey to recognize and adequately classify DTD has been challenging. Despite advocacy from renowned professionals in the field, including Dr. Julian Ford, Dr. Joseph Spinazzola, and Dr. Bessel van der Kolk, DTD was not included in the DSM-V, with the 2011 rejection citing a lack of evidence linking trauma to developmental disruptions. However, a decade later, substantial evidence has been gathered, showcasing the undeniable connection between prolonged trauma and developmental challenges in children.
As we move forward, it is imperative for classification systems like the DSM to evolve in tandem with our deepening understanding of trauma and its diverse manifestations. Recognizing and accurately diagnosing developmental trauma is a critical step toward providing affected children with the informed and specialized care they need. The journey towards acknowledgment and inclusion in official diagnostic manuals may be fraught with challenges, but the amassed evidence and ongoing advocacy pave the way for a future where developmental trauma is accurately understood, diagnosed, and treated.
What Are the Best Practices and Evidence-Based Interventions for Treating Trauma in Children?
Recognizing and addressing complex trauma in children and adolescents is a vital component of effective mental health care. With an increasing understanding of Complex PTSD (cPTSD) and Developmental Trauma Disorder (DTD), there’s a growing urgency among child psychologists to establish and deliver trauma-informed treatments that truly meet the needs of young individuals.
cPTSD and DTD are complex conditions that require nuanced understanding and specific therapeutic approaches. The first step in providing appropriate care is gaining official recognition for these conditions, ensuring that affected children and adolescents are accurately diagnosed.
Leaders in the field, including Blaustein, Spinazzola, and Ford, have crafted a series of best practices tailored for treating complex trauma in youth. These practices emphasize the importance of creating a safe environment, teaching self-regulation, fostering self-reflection, and supporting the development of healthy relationships.
Programs such as Trauma Affect Regulation: Guide for Education and Therapy (TARGET) and Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) offer structured approaches to helping trauma survivors. TARGET focuses on teaching how the brain adapts to trauma and provides skills for shifting from a reactive state to one of focus and control. SPARCS, on the other hand, is a group treatment program for adolescents emphasizing problem-solving, mindfulness, and the development of self-regulatory skills.
How Can Families of Children Be Supported?
The Attachment, Self-Regulation, and Competence (ARC) framework extends the strategies used in individual therapy to a range of settings, including residential treatment programs and child welfare systems. It also involves caregivers in the therapeutic process, recognizing that stabilizing primary attachment relationships is crucial for effective treatment.
Adapting to Cultural and Linguistic Needs:
Providing culturally sensitive care is essential. Teresa Celada-Dalton, PhD, a trauma psychologist at Children’s Hospital Los Angeles, highlights the importance of adapting treatments to meet the cultural and linguistic needs of patients. This adaptation ensures that the therapeutic resources and interventions are accessible, relatable, and effective.
Exploring Nontraditional Interventions:
The field is also exploring non-traditional interventions, such as neurofeedback training and equine-facilitated psychotherapy, and art therapy as potential treatments for complex trauma. These innovative approaches offer new avenues for helping children and adolescents navigate and overcome the challenges posed by developmental trauma.
As our understanding of developmental trauma continues to grow, so does our responsibility to provide effective, trauma-informed treatments. Recognizing and diagnosing conditions like cPTSD and DTD is the first critical step, but it is equally important to ensure that the treatments provided are evidence-based, culturally sensitive, and tailored to the unique needs of each child and adolescent. With ongoing research and advocacy, we move closer to a world where every young person affected by complex trauma has access to the care and support they need to thrive.
Where Can you Find Trauma-Related Treatment for Children in Toronto?
Many psychotherapists and psychologists in Toronto are trained in providing trauma-related psychotherapy. In addition, art therapists in Toronto may be trained in working with children and teenagers with a history of childhood trauma.
At Therapedia Centre, our psychotherapists and art therapists are trained in helping children and teenagers process the emotions related to traumatic experiences. Trauma-based art therapy is an approach that allows children process their feelings and thoughts in a safe space while the emphasis is on finding a creative outlet to express the overwhelming emotions and thoughts.
Our psychotherapists are available in downtown Toronto, in the Annex and in the Greek Town neighborhood. Find out about their approach here. You can also find trained psychotherapists in Toronto and Ontario on Psychology Today.
Abrams, Z. (2021, July 1). Improved treatment for developmental trauma. (Vol. 52, No. 5)