Clinical psychologist and founder of Psych Connect DR SANVEEN KANG sheds some light on developmental trauma disorder (DTD), a term used to describe childhood trauma, and why it’s worthy of parents’ attention. Understanding the difference between post-traumatic stress disorder(PTSD) and DTD is also important in getting the right treatment for your child.
What is developmental trauma?
Developmental trauma refers to a type of stressful event that occurs repeatedly and cumulatively, usually over a period of time, and within specific relationships and contexts – for example, maltreatment and chronic family dysfunctions such as domestic violence, sexual abuse, addiction, divorce and mental illness.
How does DTD develop?
In the first years of life, infants and toddlers need safe, predictable, accessible and attuned caregivers in order for their brains to develop in a sequential, normal manner. Any kind of childhood trauma that occurs repeatedly disturbs this development. Such developmental trauma can arise from maltreatment, neglect and chronic family dysfunctions such as domestic violence, addiction, divorce and mental illness. Complications during birth or early medical interventions can also give rise to traumatic experiences. This leads to DTD, also known as reactive attachment disorder.
How does DTD differ from post-traumatic stress disorder (PTSD)?
Both are associated with physical and emotional abuse, family violence, neglect and impaired caregivers. However, DTD is uniquely associated with cumulative exposure to interpersonal – either family or community – violence and impaired primary caregivers. PTSD often occurs after a single traumatic event.
Both also involve a lack of trust. But, while hypervigilance is one of the most common signs of PTSD, individuals with DTD may have more blurred boundaries and lack a self-protective instinct; they may have more trouble identifying red flags and standing up for themselves when faced with triggers.
Studies have shown that up to 82 percent of the traumatised children seen in trauma specialist centres in the US do not meet diagnostic criteria for PTSD because they are often aggressive or “shut down”. Instead, they are very often diagnosed with behavioural issues or neurodevelopmental disorders such as ADHD or autism. Experts found that DTD was a better explanation for their behaviour, and that it had a significant impact on relationships throughout adolescence and childhood.
What does developmental trauma lead to?
Typical development consists of learning to master and “own” one’s experiences and learning to experience the present as part of one’s personal experience over time. DTD has very complex emotional, behavioural and neurobiological effects, typically reflected by a child’s lack of continuous sense of self, and poorly modulated impulse control. This includes aggression, and uncertainty about the reliability and predictability of others, often expressed with distrust, suspiciousness and intimacy issues – all of which can make it difficult to maintain healthy interpersonal relationships.
Recent studies have shown that children with DTD are more likely to experience symptoms that may look like panic disorder, separation anxiety, ADHD and disruptive behaviour disorders such as oppositional defiant disorder. It’s also common for many who have undergone childhood trauma to grow up to struggle with alcoholism, drug use, obesity and health conditions such as diabetes, heart disease, stroke and sexually transmitted diseases.
Some patients experience distinct alterations in states of consciousness including amnesia and hypermnesia, dissociation, flashbacks and nightmares of specific events, school problems, difficulties in regulation, disorientation in time and space, and sensorimotor developmental disorders.
How do you assess for DTD?
To make a diagnosis, a mental health professional will evaluate whether or not the patient meets the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The majority of traumatised children who develop DTD do not meet diagnostic criteria for PTSD. This is because PTSD cannot capture the multiplicity of exposures over critical development periods.
Many forms of DTD such as interpersonal trauma, particularly psychological maltreatment, neglect, separation from caregivers, traumatic loss and inappropriate sexual behaviour, do not meet the DSM-5 criteria definition for a traumatic event. Criteria for a traumatic event requires, in part, an experience involving “actual or threatened death or serious injury, or a threat to the physical integrity of self or others.”
That said, it’s important for a clinician to have a trauma- and attachment-informed lens. He or she must be able to get a comprehensive clinical history that may extend beyond the child.
At Psych Connect, our trauma team will assess your family as a whole. This includes individualised assessments of children and parents, followed by assessment of the parent-child interaction. Our clinicians use a variety of tools and specialised methods including Child Attachment and Play Assessment (CAPA), and the Marschak Interaction Method (MIM).
How is DTD treated?
Establishing safety, dealing with traumatic re-enactments, and integration and mastery of the body and mind are all key to treatment. However, there is no one-size-fits-all approach for trauma treatment. Instead, an eclectic approach that includes bottom-up regulation strategies, and introducing rituals, routines and rhythms with a focus on strength and resilience, ensures that children and parents build skills to help them move in a positive direction.
At Psych Connect, we’ve developed our own integrated treatment approach toward working with trauma, called The Connected Self. It brings together evidence-based treatment approaches as well as brain development, and incorporates allied health involvement. The aim is not only to process trauma but also rectify the areas of the brain and central nervous system, such as the vagus nerve, that are impacted by childhood trauma so that the patient is able to feel safe and lead a happy, fulfilling and socially connected life.
Can DTD be treated by any mental health practitioner?
Many clinicians claim to work with trauma when, sadly, that is not the case. It’s important to acknowledge that attending a one-off training or workshop may not suffice in being able to understand and treat children who may be experiencing trauma. And it is crucial for patients with DTD to receive trauma-informed care, which is a framework that incorporates Trauma Theory and Design Service Systems into its practices.
Our treatment team at Psych Connect is trauma-informed, which means that clinicians are well-versed in understanding the prevalence and impact of trauma. They give choices and empowerment to patients – key to trauma-informed service delivery – and can facilitate healing without causing retraumatisation. Clinical practice is also supported with triaging services such as screening and intervals of assessments. There are also components in which parents are involved as well.
Why is understanding DTD trauma important as a parent?
When parents don’t understand the effects of childhood trauma, they may misinterpret their child’s behaviour and end up feeling frustrated or resentful. Instead of being the source of emotional dwelling for their child, they may be further rupturing the relationship.
Learn more about Psych Connect’s services and trauma specialist programme, The Connected Self, by calling 6493 0244 or visiting psychconnect.sg.
This article first appeared in the October 2022 edition of Expat Living. You can purchase the latest issue or subscribe, so you never miss a copy!
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If you found this article helpful, then read Counselling for Kids to find out where else you can get support for your child.
