It would surprise no one that children who have been mistreated or have been subjected to another form of trauma would experience repercussions. It makes sense that trauma can result in symptoms that look like behavioral disorders, oppositional defiant disorders, anxiety, depression, or ADHD.
Yet, for many children the symptoms are treated as not being related to their traumatic experiences.
As part of an on-going research project, Julian D. Ford, Ph.D, A.B.P.P., professor of psychiatry and law at the University of Connecticut and director of the Center for Trauma Recovery and Juvenile Justice, and colleagues Joseph Spinazzola, Ph.D. and Bessel van der Kolk, M.D., have developed a questionnaire aimed at pinpointing a disorder known as developmental trauma disorder, or DTD.
They have been conducting an on-going research study on its efficacy.Ford spoke with New England Psychologist’s Catherine Robertson Souter about the study and the need to understand that children’s reactions to trauma should be both more fully understood and addressed.
Tell us about DTD.
The idea is that children who experience traumatic stress and adversity often develop symptoms that go beyond or don’t quite meet diagnostic criteria for post traumatic stress disorder (PTSD).
Those children and adolescents often are diagnosed as having other psychiatric and behavioral disorders, sometimes multiple diagnoses.
We really needed to have a way of helping clinicians and families to recognize when kids are experiencing trauma-related symptoms that don’t fit PTSD and not just try to treat them for other disorders.
In this study, we are testing out this potential syndrome.
We found that there are certain kinds of trauma experiences that are particularly related to developmental trauma disorder and not so much to PTSD, including exposure to violence in the family or community and disruptions in bonding with primary caregivers.
It does indeed look like there is a subset of kids who can best be understood and probably, and this is the next step in our research, can be best treated for these symptoms of developmental trauma disorder either in addition to PTSD or separately from PTSD.
Does it matter if symptoms that look like, say depression, are treated as depression?
There is evidence-based treatment for childhood trauma that would be more suitable for these children.
What phase are you in now and what is next with the study?
It is a two-phase study and we are currently reporting on the results of the first phase, which is about half of the sample.
We will be reporting soon on the second phase to see if the findings hold up, so basically a replication. That will bring us up to about 500 kids total.
We have developed an interview with questions about 15 symptoms of developmental trauma disorder. If we find that DTD syndrome has some utility in addition to what PTSD can provide for clinicians who are assessing and treating children, the next step will be to find ways for clinicians to be able to use this questionnaire.
We will disseminate the interview we developed and start research on where it can be used in addition to PTSD interviews to assess the outcome of different forms of treatment.
That is the goal, to be able to see if a variety of trauma-focused treatments are beneficial in terms of not just improving PTSD symptoms but also helping kids overcome these developmental trauma symptoms.
In some ways this seems obvious that kids would have effects of trauma even if they don’t strictly define as PTSD. Is it something that was understood but not formalized before?
Yes, I think that’s a very good way to put it: it’s been understood but not formalized. We now just need a way to describe it carefully and really identify what are the key symptoms so we are not just saying any problem could be related to trauma but we are honing in on specific symptoms.
One reason why this is happening now is because the National Child Traumatic Stress Network (NCTSN) was first funded by the federal government in 2001.
Over the last 17 years, there have been several hundred centers nationally that have been funded to provide treatment and services to children who have experienced trauma.
As that network has grown, it has become increasingly evident that there are hundreds of thousands of children who experience traumatic stress every year just in this country and millions in the world and only a small fraction get the treatment that enables them to recover.
The separation of children from families by the US government – would you care to comment?
I don’t have any direct contact with children or families who have been separated at our borders but what I know from colleagues and through the media is that this kind of coercive, unexpected separation is deeply frightening for children of all ages.
It cuts them off from their primary source of care and protection and that is a traumatic shock. Most of these kids will probably not develop PTSD as a full diagnosis but will develop signs of post-traumatic stress difficulties and should be provided with help so those reactions, which are normal healthy reactions to cope with the shock of separation, do not become PTSD.
That is the responsibility we have as a community and society to these children and their families.
In some cases, these kids have already experienced trauma, from a situation that they left behind. Wouldn’t it be beneficial for the people on the front lines at our borders to have this information in any and all cases?
I do know there are centers in the NCTSN that are located near or in border communities or are working in communities where these people have been sent after they arrived in the U.S.
Those centers are making massive efforts to get information out to the families and to the frontline workers so that they understand traumatic stress reactions and how to help children recover.
You are also the director of the Center for Treatment of Developmental Trauma Disorders (CTDTD). How is this related to the NCTSN?
A couple of years ago we were funded through NCTSN to start the CTDTD, a virtual center with reach all over the country. It involves a rich array of expertise focused on helping therapists and counselors recognize DTD and develop the skills needed to provide individualized treatment for children.
One of our major projects is a webinar series which can be accessed at no cost through the learning center of NCTSN. The series is designed to inform mental health providers about the issues they may face when they are working with kids experiencing DTD and ways to be prepared so they can understand why it is happening, how it is an outgrowth of developmental trauma reaction and what they can do about it.
Why is this work important?
Because there are tens of thousands of children and adolescents who are experiencing posttraumatic stress reactions who are not receiving the best available treatment.
We need to make sure we are reaching those children.
I think we have responsibility to help kids and families and communities understand that posttraumatic stress reactions are not a pathology or a disease. PTSD is a healthy adaptation to extreme adversity that then has to be gradually shifted once the adversity is no longer an immediate threat.
That is the challenge of DTD and PTSD, helping kids and families to not stay in survival mode. People deserve to have a road map on how to shift back to ordinary, safe, day-to-day living. It is a difficult shift but one that can be done if the right education and skills are provided.
Catherine Robertson Souter is a freelance writer and social media agent based in New Hampshire. A contributor to New England Psychologist since its inception, she previously wrote for Massachusetts Psychologist among other media outlets.