Developmental Trauma

Childhood trauma can be extremely impactful on neurodevelopment and can have lasting effects on mental health during developmental years into adulthood. For nearly two decades now, professor of Psychiatry at the Boston University Medical School, Bessel van der Kolk, has been an advocate for the inclusion of Development Trauma Disorder to the Diagnostic and Statistical Manual. As of 2013, the DSM-V was released and the American Psychological Association, responsible for inclusion and exclusion criteria, did not see a need for an extension of Post-traumatic stress disorder (PTSD). At present, the diagnosis of PTSD is an umbrella, one-size-fits-all for the diagnostic criteria and effects of trauma, although many would argue that developmental trauma deserves a separate diagnosis. Chronic trauma at a young age interferes with neurobiological development (Kolk, 2005) and causes measurable changes to social and emotional functioning. These may include interference with the capacity to integrate sensory information, unfocused responses to subsequent stress such as catastrophizing, heightened arousal, lower academic functioning and poor distress tolerance. According to van der Kolk (2005), most of this trauma begins at home and about 80 percent of maltreatment stems from the children’s parents. Examples of this maltreatment include physical, emotional and sexual abuse, having a caregiver who suffers from a prolonged mental health illness, witnessing domestic violence as well as substance abuse, addictions issues and neglect. Children tend to regulate their own behaviour from witnessing how their parents behave in response to stressful stimuli. This interconnected framework of parent and child dyad, serves as what Vygtotsky would refer to as zones of proximal development. When a child can observe positive coping strategies, they are likely to develop these same coping skills with more ease, than a child who witnesses an adult incapable of regulation (McLeod, 2012). Due to these experiences occurring in the context of brain development, social and neural developmental become inextricable intertwined (Kolk, 2005). Early attachment patterns serve a very important role in optimal social and emotional development. At times, the primary attachment may break down and a child experiences neglect, temporary placement in foster care or permanent adoption. The current diagnosis of PTSD does not always allow for a precise measurement of such dysregulation and often Reactive Attachment Disorder is used. Van der Kolk argues, that a label of Developmental Trauma would be more accurate in the diagnosis and treatment of these individuals. Addressing trauma through the lens of developmental trauma is certainly different from a practitioner’s perspective. Treatment may include dyad focused work, inclusive of both child and primary caregiver, psychoeducation around trauma response and arousal, as well as heightened awareness of safety. This sense of safety can be explored with Bronfenbrenner’s ecological systems model ie. the child’s family, friends, school system, community and so on (Oswalt, 2015). It is also important to address how children tend to idealize a destructive biological parent, believing they must have done something wrong to deserve their mistreatment. Developmental trauma treatment focuses on a shift away from this perspective, helping the child honour that primary attachment, but to not idealize or demonize it either. Lastly, the appreciation of their current primary caregiver and shared self awareness is also a heightened objective of this treatment.

References

Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Arlington, VA: American Psychiatric Association.

Kolk, B. A. (2005). Developmental Trauma Disorder: Towards a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35(5), 401-408. doi:10.3928/00485713-20050501-06

McLeod, S. A. (2012). Zone of proximal development. Retrieved from www.simplypsychology.org/Zone-of-Proximal-Development.html

Rosenthal, E. C. (2017). Developmental Trauma Disorder & Effective Therapeutic Interventions. Retrieved from https://pdxscholar.library.pdx.edu/honorstheses/472

Oswalt, A. (2015). Urie Bronfenbrenner And Child Development. Retrieved from https://www.mentalhelp.net/articles/urie-bronfenbrenner-and-child-development/