As carers, guardians, mental health workers, psychologists, and foster carers, it is crucial to deepen our understanding of the challenges faced by children in foster care who have experienced attachment issues. While we are familiar with Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED), there is another disorder that deserves our attention: Developmental Trauma Disorder (DTD). In this thread, we will delve into the concept of DTD and its implications for children in foster care.
Developmental Trauma Disorder (DTD)
Despite not being officially recognised in the DSM-5 or International Statistical Classification of Diseases and Related Health Problems, 10th Edition, DTD has been proposed and is currently being studied and evaluated. DTD aims to provide a framework to identify and treat children who have been exposed to complex interpersonal trauma and exhibit patterns of dysregulation across different developmental stages. While more research is needed, the recognition of DTD could shed light on the specific needs of these vulnerable children.
Understanding Developmental Trauma Disorder:
Developmental Trauma Disorder is an integrative diagnosis exclusive to children, capturing an array of symptoms across domains such as emotion, cognition, behaviour, and interpersonal relationships. Behaviours observed within this disorder include habitual self-harm, pronounced distrust, and verbal or physical aggression towards others. DTD accounts for disturbances in development, stemming from sustained trauma during childhood, typically within the framework of familial relationships (van der Kolk, 2005).
Though DTD is a relatively new diagnostic framework and isn't officially documented in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the construct has been increasingly recognised in emerging research on developmental trauma presentations. In my opinion, this comprehensive framework has the potential to encapsulate the severity and wide range of difficulties experienced by children like Khloe, who despite treatment efforts, continues to grapple with these challenges due to her biopsychosocial predisposition and early trauma history.
However, it is worth noting that while DTD provides a promising framework, it remains an area of ongoing research and is not yet officially recognised. As such, while it may seem to better describe the presentations of some children than diagnoses such as Reactive Attachment Disorder (RAD) and Conduct Disorder, it generally is premature to formally update these diagnoses until DTD is more thoroughly investigated.
Misgivings with Current DSM Classifications:
Existing diagnoses within the DSM-5 often fall short of capturing the comprehensive and pervasive impact of sustained childhood trauma. According to the National Child Traumatic Stress Network, children who have experienced complex, multiple traumas often receive imperfect diagnoses that do not fully address their mental health needs. Diagnoses like Reactive Attachment Disorder, Conduct Disorder, Pervasive Developmental Disorders, and even Post Traumatic Stress Disorder each capture aspects of the child’s difficulties but often overlook crucial dimensions, leading to potential misdiagnoses (Ford, 2009).
DTD and Comorbidity:
A unique aspect of DTD is its potential to co-occur with other disorders. The vast spectrum of symptoms that DTD covers often intersects with the symptoms of other diagnoses, making it challenging to identify DTD as a distinct disorder. For instance, DTD symptoms may overlap with those of Borderline Personality Disorder (BPD), which involves intense emotional instability and disrupted relationships. However, BPD is an adult diagnosis and doesn't typically account for a child's physical complaints, extreme dysregulation in response to trauma reminders, or memories (Ford, 2009). This potential for comorbidity underscores the importance of a comprehensive, multi-faceted assessment for children presenting with complex trauma symptoms, ensuring they receive the most appropriate care possible.
Differentiating DTD from Other Disorders:
Comparisons between DTD and other diagnostic categories show distinct differences, and simultaneously highlight the unique contributions of DTD.
I welcome any thoughts, comments, or experiences you'd like to share about DTD and its application within your roles as carers, mental health workers, and guardians. Your insights will add valuable perspectives to this discussion.
Best,
Note: Always seek advice from a qualified healthcare provider before making decisions based on the information presented here. The details above are meant to inform and supplement discussions with healthcare providers, not to replace professional medical advice.
Developmental Trauma Disorder (DTD)
Despite not being officially recognised in the DSM-5 or International Statistical Classification of Diseases and Related Health Problems, 10th Edition, DTD has been proposed and is currently being studied and evaluated. DTD aims to provide a framework to identify and treat children who have been exposed to complex interpersonal trauma and exhibit patterns of dysregulation across different developmental stages. While more research is needed, the recognition of DTD could shed light on the specific needs of these vulnerable children.
Understanding Developmental Trauma Disorder:
Developmental Trauma Disorder is an integrative diagnosis exclusive to children, capturing an array of symptoms across domains such as emotion, cognition, behaviour, and interpersonal relationships. Behaviours observed within this disorder include habitual self-harm, pronounced distrust, and verbal or physical aggression towards others. DTD accounts for disturbances in development, stemming from sustained trauma during childhood, typically within the framework of familial relationships (van der Kolk, 2005).
Though DTD is a relatively new diagnostic framework and isn't officially documented in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the construct has been increasingly recognised in emerging research on developmental trauma presentations. In my opinion, this comprehensive framework has the potential to encapsulate the severity and wide range of difficulties experienced by children like Khloe, who despite treatment efforts, continues to grapple with these challenges due to her biopsychosocial predisposition and early trauma history.
However, it is worth noting that while DTD provides a promising framework, it remains an area of ongoing research and is not yet officially recognised. As such, while it may seem to better describe the presentations of some children than diagnoses such as Reactive Attachment Disorder (RAD) and Conduct Disorder, it generally is premature to formally update these diagnoses until DTD is more thoroughly investigated.
Misgivings with Current DSM Classifications:
Existing diagnoses within the DSM-5 often fall short of capturing the comprehensive and pervasive impact of sustained childhood trauma. According to the National Child Traumatic Stress Network, children who have experienced complex, multiple traumas often receive imperfect diagnoses that do not fully address their mental health needs. Diagnoses like Reactive Attachment Disorder, Conduct Disorder, Pervasive Developmental Disorders, and even Post Traumatic Stress Disorder each capture aspects of the child’s difficulties but often overlook crucial dimensions, leading to potential misdiagnoses (Ford, 2009).
DTD and Comorbidity:
A unique aspect of DTD is its potential to co-occur with other disorders. The vast spectrum of symptoms that DTD covers often intersects with the symptoms of other diagnoses, making it challenging to identify DTD as a distinct disorder. For instance, DTD symptoms may overlap with those of Borderline Personality Disorder (BPD), which involves intense emotional instability and disrupted relationships. However, BPD is an adult diagnosis and doesn't typically account for a child's physical complaints, extreme dysregulation in response to trauma reminders, or memories (Ford, 2009). This potential for comorbidity underscores the importance of a comprehensive, multi-faceted assessment for children presenting with complex trauma symptoms, ensuring they receive the most appropriate care possible.
Differentiating DTD from Other Disorders:
Comparisons between DTD and other diagnostic categories show distinct differences, and simultaneously highlight the unique contributions of DTD.
- Reactive Attachment Disorder (RAD) shares some symptoms and impairments with DTD. However, RAD is restricted to early childhood and must occur within the context of neglect or abandonment, which is not a requirement for DTD (Ford, 2009).
- Conduct Disorder and Oppositional Defiant Disorder share the manifestation of intense anger, distrust, and distorted beliefs about people and the world with DTD. However, these disorders do not encapsulate the guilt, shame, anxiety, dissociation, and depressed mood often seen in children with DTD (Ford, 2009).
- Post-Traumatic Stress Disorder (PTSD) and other Anxiety Disorders capture the fearfulness, worry, and avoidance involved in DTD. But these diagnoses miss the significantly changeable emotional states, negative self-beliefs, and disorganised attachment feelings and behaviors that DTD does (Ford, 2009).
I welcome any thoughts, comments, or experiences you'd like to share about DTD and its application within your roles as carers, mental health workers, and guardians. Your insights will add valuable perspectives to this discussion.
Best,
Note: Always seek advice from a qualified healthcare provider before making decisions based on the information presented here. The details above are meant to inform and supplement discussions with healthcare providers, not to replace professional medical advice.