The relationship of posttraumatic stress disorder and developmental trauma disorder with childhood psychopathology: A network analysis.

OBJECTIVE: Potentially traumatic experiences are a major risk factor for mental disorders in children and adolescents. Posttraumatic psychopathology includes trauma-specific disorders such as posttraumatic stress disorder (PTSD) as well as other psychiatric disorders. Developmental Trauma Disorder (DTD) has been proposed as a developmentally sensitive diagnosis. We aimed to further illuminate the co-occurrence of psychiatric conditions with DTD and PTSD. METHOD: In a convenience sample of families of 507 children and adolescents (mean age = 12.11 years old, SD = 2.92; 48.5% female), we assessed DTD, PTSD, and screened for psychiatric disorders. We estimated network models including DTD, PTSD and ten psychiatric conditions. RESULTS: We found that DTD and PTSD share both common and differential comorbidity features on disorder-, domain-, and symptom-level. The differential comorbidity patterns of the DTD and PTSD domains placed DTD close to both externalizing and internalizing psychopathology while PTSD was primarily linked to internalizing conditions. CONCLUSIONS: Our study provides evidence for the complex clinical presentation of posttraumatic psychopathology over and above PTSD in children. DTD and PTSD provide useful and distinct diagnostic categories for children who are also experiencing internalizing conditions, and DTD may be especially relevant for children who are experiencing externalizing psychopathology.

Development of a Differential Assessment Guide to Improve Engagement with Youths & Families Living with Chronic Trauma.

Youths and parents/caregivers who have experienced multiple forms of severe interpersonal trauma may demonstrate severe and persistent symptoms of complex trauma including high-risk behaviors. Engagement, and sustaining engagement, of these youths and parents/caregivers in evidence-supported trauma treatment is a critical challenge, especially when youths or parents/caregivers have experienced chronic traumas that may be expected to continue into the foreseeable future. An extensive literature review was conducted leading to development of an assessment framework that could increase engagement of youths and parents/caregivers in trauma treatment based on research on chronic trauma, complex trauma, Developmental Trauma Disorder (DTD), and factors that promote engagement. A multi-dimensional assessment guide was developed to enable clinicians to differentiate types of chronic trauma based on a continuum of past, current and expected exposure over time and then to use this guide collaboratively with youths and parents/caregivers to develop priorities for treatment and service planning that matches their needs and strengths. The assessment guide incorporates exposure to intra-familial and community forms of interpersonal trauma, attachment disruptions, established symptoms of PTSD, Complex PTSD and DTD, as well as social-emotional development. The assessment and treatment planning guides proposed in this article expand applicability of evidence-supported trauma-informed therapy to youths and families who have not been engaged by programs offering treatments that are focused on past or single incident traumas or do not address disrupted attachments, multi-generational experiences of adversity, discrimination and community violence, life-threatening dangers or the impact of chronic trauma on youth, parent/caregiver and family development.

Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach.

Background: Developmental Trauma Disorder (DTD) is a proposed childhood psychiatric diagnosis for psychopathological and developmental sequela of victimization and attachment trauma extending beyond posttraumatic stress disorder (PTSD). Objective: To determine whether a sub-group of trauma-impacted children is characterized by symptoms of DTD that extend beyond, or co-occur with, the symptoms of PTSD. Method: Person-centred Latent Class Analyses (LCA) were done with data from 507 children (ages 7-18 years, (M = 12.11, SD = 2/92); 49% female) referred to the study by mental health or paediatric clinicians. Results: A four class solution was optimal (LMR = 398.264, p < .001; Entropy = .93): (1) combined DTD + PTSD (n = 150); (2) predominant DTD (n = 156); (3) predominant PTSD (n = 54); (4) minimal symptoms (n = 147). Consistent with prior research, the DTD + PTSD class was most likely to have experienced traumatic emotional abuse and neglect (X2 (3) = 16.916 and 28.016, respectively, p < .001), and had the most psychiatric comorbidity (F(3, 502) = 3.204, p < .05). Predominant DTD class members were most likely to meet criteria for Oppositional Defiant Disorder (ODD) (X2(3) = 84.66, p < .001). Conclusion: Symptoms of DTD may occur with, or separately from, PTSD symptoms. Children with high DTD|+PTSD symptoms had extensive psychiatric comorbidity, while those with high DTD symptoms and minimal PTSD symptoms were highly likely to meet criteria for ODD. In clinical and research assessment and treatment of children with complex psychiatric comorbidity or disruptive behaviour problems, symptoms of DTD should be considered, both along with, and in the absence of, PTSD symptoms.

Antecedentes: El trastorno traumático del desarrollo (DTD en su sigla en inglés) es un diagnóstico psiquiátrico infantil propuesto para las secuelas psicopatológicas y del desarrollo de la victimización y el trauma del apego que se extiende más allá del trastorno de estrés postraumático (TEPT).Objetivo: Determinar si un subgrupo de niños afectados por un trauma se caracteriza por síntomas de DTD que se extienden más allá o coexiste con los síntomas del trastorno de estrés postraumático (TEPT).Método: Se realizaron análisis de clase latente (LCA en su sigla en inglés) centrados en la persona con datos de 507 niños (de 7 a 18 años de edad, (M = 12.11, DS = 2/92); 49% mujeres) remitidos al estudio por médicos pediátricos o de salud mental.Resultados: Una solución de cuatro clases fue óptima (LMR = 398.264, p < .001; Entropía = .93): (1) combinado DTD + TEPT (n = 150); (2) DTD predominante (n = 156); (3) TEPT predominante (n = 54); (4) síntomas mínimos (n = 147). De acuerdo con investigaciones previas, la clase DTD + TEPT tenía más probabilidades de haber experimentado abuso emocional traumático y negligencia (X2 (3) = 16.916 y 28.016, respectivamente, p < .001), y tenía la mayor comorbilidad psiquiátrica (F(3, 502) = 3.204, p < .05). Los miembros de la clase DTD predominante tenían más probabilidades de cumplir los criterios para el trastorno oposicionista desafiante (ODD en su sigla en inglés) (X2 (3) = 84.66, p < .001).Conclusión: Los síntomas de DTD pueden ocurrir con, o por separado de, los síntomas de TEPT. Los niños con síntomas de DTD + TEPT altos tenían una comorbilidad psiquiátrica extensa, mientras que aquellos con síntomas de DTD altos y síntomas mínimos de TEPT tenían muchas probabilidades de cumplir con los criterios para ODD. En la evaluación y tratamiento clínico y de investigación de niños con comorbilidad psiquiátrica compleja o problemas de comportamiento disruptivo, se deben considerar los síntomas de DTD, tanto junto con, como en ausencia de, síntomas de TEPT.

The Latent Structure of Child and Adolescent Psychopathology and its Association with Different Forms of Trauma and Suicidality and Self-Harm : LATENT STRUCTURE OF PSYCHOPATHOLOGY.

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a multidimensional and hierarchical model of the latent structure of psychopathology. While HiTOP has received much support in child/adolescent community samples, fewer studies have assessed this model in clinical samples of children/adolescents. Here, we modelled the latent structure of 45 symptoms of psychopathology from a clinical sample of children/adolescents and assessed how dimensions of psychopathology were related to specific forms of trauma and suicidality/self-harm. Clinician-derived assessments were obtained from 507 people aged 7-18 years. Confirmatory factor analysis was used to determine the optimal fitting model, and structural equation modelling was used to estimate associations with trauma exposure and suicidality/self-harm. The best fitting model(s) included five first-order factors reflecting Fear, Distress, Externalizing, Thought Disorder, and Traumatic Stress, with a higher-order general factor (p) accounting for the covariation between these factors. Unique associations were identified between specific forms of trauma and each dimension of psychopathology. p was strongly associated with suicidality/self-harm, and of the first-order factors, Distress was most strongly associated with suicidality/self-harm. Findings support the predictions of HiTOP that the latent structure of child/adolescent psychopathology can be effectively described by a multidimensional and hierarchal model. Moreover, we found tentative evidence for a unique dimension of Traumatic Stress psychopathology. Our findings also highlight the unique associations between specific forms of early life trauma and specific dimensions of psychopathology, and the importance of Distress related psychopathology for suicidality/self-harm in children and adolescents.

Can Developmental Trauma disorder be distinguished from posttraumatic stress disorder? A confirmatory factor Analytic Test of Four Structural Models.

Developmental Trauma Disorder (DTD) is a proposed child psychopathology diagnosis with emotion/somatic, attention/behavioral, and self/relational dysregulation symptoms extending beyond posttraumatic stress disorder (PTSD). Confirmatory factor analyses (CFAs) tested four structural models with structured interview data for trauma history, PTSD, and DTD with 507 children receiving mental health or pediatric care ( N = 162, 32% diagnosed with DTD; N = 176; 35% with PTSD; N = 169, 33% with neither). A unidimensional model with a single latent variable had unacceptable fit (RMSEA = 0.094; CFI = 0.844). Compared to a model with PTSD and DTD as correlated first-order latent variables, a multidimensional model with correlated latent variables corresponding to the PTSD and DTD symptom clusters (Dc 2 =105.62, Ddf = 14, p < .001) and a hierarchical variant with correlated second order DTD and PTSD latent variables (Dc 2 =48.10, Ddf = 6, p < .001) fit the data better. The non-hierarchical multidimensional model was superior to the hierarchical variant (Dc 2 =66.05, Ddf = 8, p < .001). Stronger latent variable inter-correlations within PTSD and DTD domains than across domains, suggested that DTD and PTSD are distinguishable despite their inter-correlation. Exposure to family violence was the primary correlate of both the DTD and PTSD second-order latent variables. Results indicate that children's trauma-related symptoms involve six inter-correlated domains extend beyond PTSD's symptoms (i.e., re-experiencing, avoidance, arousal) to include DTD symptoms of emotional, cognitive-behavioral, and self-relational dysregulation. The inter-relationship of the DTD and PTSD latent variables suggest that DTD may constitute a component within a complex PTSD diagnosis paralleling the new adult CPTSD diagnosis.

Toward an empirically based Developmental Trauma Disorder diagnosis and semi-structured interview for children: The DTD field trial replication.

OBJECTIVE: Developmental trauma disorder (DTD) is a childhood psychiatric syndrome designed to include sequelae of trauma exposure not fully captured by PTSD. This study aimed to determine whether the assessment of DTD with an independent sample of children in mental health treatment will replicate results from an initial validation study. METHODS: The DTD semi-structured interview (DTD-SI) was administered to a convenience sample in six sites in the United States (N = 271 children in mental health care, 8-18 years old, 47% female, 41% Black or Latinx) with measures of trauma history, DSM-IV PTSD, probable DSM-IV psychiatric diagnoses, emotion regulation/dysregulation, internalizing/externalizing problems, and quality of life. Confirmatory factor (CFA) and item response theory (IRT) analyses tested DTD's structure and DTD-SI's information value. Bivariate and multivariate analyses tested DTD's criterion and convergent validity. RESULTS: A three-factor solution (i.e., emotion/somatic, attentional/behavioral, and self/relational dysregulation) best fit the data (CFI = 0.91; TLI = 0.89; BIC = 357.17; RMSEA = 0.06; SRMR = 0.05). DTD-SI items were informative across race/ethnicity, gender, and age with three exceptions. Emotion dysregulation was the most informative item at low levels of DTD severity. Non-suicidal self-injury was rare but discriminative in identifying children with high levels of DTD severity. Results supported the criterion and convergent validity of the DTD construct. CONCLUSION: This replication provides empirical support for DTD as a construct and potential psychiatric syndrome, and the DTD-SI's validity as a clinical research tool.

Beyond PTSD: Client presentations of developmental trauma disorder from a national survey of clinicians.

OBJECTIVE: The emergence of updated Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013) criteria for posttraumatic stress disorder (PTSD), which includes modified criteria for young children, raises questions regarding the need for developmentally appropriate standalone psychiatric diagnosis encompassing complex trauma presentations in children. The present study addresses these questions by examining how DSM-5 PTSD and proposed developmental trauma disorder (DTD) diagnoses relate to functional impairment and trauma exposure using clinician-report surveys. METHOD: We surveyed psychotherapists across the United States, and asked them to report on the symptom characteristics, functional impairment, and trauma exposure of children, adolescents, and young adults under their care (n = 210; age range = 2-21). We fit symptom data to the draft criteria for (1) DTD, a proposed trauma diagnosis for children and (2) existing criteria for adult and child/preschool PTSD. RESULTS: Results indicated that comorbidity between DTD and PTSD was high (52.4% and 59.9% for adult and child/preschool criteria, respectively). Comorbid DTD/PTSD and DTD-alone groups had more functional domains impacted and greater exposure to some types of trauma relative to the other groups. CONCLUSIONS: These findings speak to the relationship between trauma complexity and wide-ranging symptom presentations, provide support for research and clinical emphasis on a developmentally informed diagnosis, and may support existing treatment approaches. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychiatric comorbidity of developmental trauma disorder and posttraumatic Stress disorder: findings from the DTD field trial replication (DTDFT-R).

Background: Developmental Trauma Disorder (DTD) has extensive comorbidity with internalizing and externalizing disorders distinct from posttraumatic stress disorder (PTSD). Objective: To replicate findings of DTD comorbidity and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable DSM-IV psychiatric disorders were identified with KSADS-PL screening modules, in a multi-site sample of 271 children (ages 8-18 years old; 47% female) in outpatient or residential mental health treatment for multiple (M = 3.5 [SD = 2.4]) psychiatric diagnoses other than PTSD or DTD. Results: DTD (N = 74, 27%) and PTSD (N = 107, 39%) were highly comorbid and shared several DSM-IV internalizing and externalizing disorder comorbidities. Children with DTD with or without PTSD had more comorbid diagnoses (M = 5.7 and 5.2 [SD = 2.4 and 1.7], respectively) than children with PTSD but not DTD (M = 3.8[SD = 2.1]) or neither PTSD nor DTD (M = 2.1[SD = 1.9]), F[3,267] = 55.49, p < .001. Further, on a multivariate basis controlling for demographics and including all potential comorbid disorders, DTD was associated with separation anxiety disorder, depression, and oppositional defiant disorder after controlling for PTSD, while PTSD was associated only with separation anxiety disorder after controlling for DTD. Both DTD and PTSD were associated with suicidality. Conclusions: DTD is associated with psychiatric comorbidity beyond that of PTSD, and DTD warrants assessment for treatment planning with children in intensive psychiatric services.

Antecedentes: El Trastorno por Trauma del Desarrollo (TTD) tiene una amplia comorbilidad con trastornos internalizantes y externalizantes distintos del trastorno de estrés postraumático (TEPT).Objetivo: Replicar los hallazgos de la comorbilidad del TTD y determinar si esta comorbilidad es distinta y se extiende más allá de las comorbilidades del TEPT.Método: Se evaluó el TTD mediante una entrevista estructurada, y se identificaron probables trastornos psiquiátricos del DSM-IV con módulos de detección KSADS-PL, en una muestra multicéntrica de 271 niños (de 8 a 18 años de edad; 47% mujeres) en tratamiento en salud mental ambulatorio o residencial por múltiples (M = 3,5 [SD = 2,4]) diagnósticos psiquiátricos distintos del TEPT o el TTD.Resultados: El TTD (N=74, 27%) y el TEPT (N=107, 39%) fueron altamente comórbidos y compartían varias comorbilidades de trastornos internalizantes y externalizantes del DSM-IV. Los niños con TTD con o sin TEPT tenían más diagnósticos comórbidos (M = 5,7 y 5,2 [SD = 2,4 y 1,7], respectivamente) que los niños con TEPT pero sin TTD (M = 3,8 [SD = 2,1]) o sin TEPT ni TTD (M = 2,1 [SD = 1,9]), F[3,267] = 55,49, p < .001. Además, en una base multivariante que controlaba los datos demográficos e incluía todos los posibles trastornos comórbidos, el TTD se asoció con el trastorno de ansiedad por separación, la depresión y el trastorno oposicionista desafiante después de controlar el TEPT, mientras que el TEPT se asoció sólo con el trastorno de ansiedad por separación después de controlar el TTD. Tanto el TTD como el TEPT se asociaron con suicidalidad.Conclusiones: El DTD se asocia con comorbilidad psiquiátrica más allá del TEPT, y el DTD justifica una evaluación para la planificación del tratamiento con niños en servicios psiquiátricos intensivos.

Developmental Trauma Disorder: A Legacy of Attachment Trauma in Victimized Children.

Developmental trauma disorder (DTD) and posttraumatic stress disorder (PTSD) have been found to have both shared and unique traumatic antecedents. The present study was an independent replication, with the DTD Structured Interview and the Traumatic Events Screening Instrument administered to 271 children in mental health treatment in six U.S. sites. On an unadjusted basis, DTD (27.3% prevalence, N = 74) and PTSD (40.2% prevalence, N = 109) both were associated with traumatic physical assault or abuse, family violence, emotional abuse, caregiver separation or impairment, and polyvictimization. After controlling for PTSD, DTD was associated emotional abuse, OR = 2.9, 95% CI [1.19, 6.95], and traumatic separation from a primary caregiver, OR = 2.2, 95% CI [1.04. 4.60], both of which also were associated with caregiver impairment, physical assault/abuse, and witnessing family/community violence. Three traumatic antecedents associated with PTSD were not associated with DTD: noninterpersonal trauma, sexual trauma, and traumatic loss. Children exposed to both traumatic victimization and attachment trauma (36.2%) or attachment trauma alone (32.5%) were more likely than children exposed only to victimization (17.5%) or those with no history of victimization or attachment trauma (8.1%) to meet the symptom criteria for DTD, χ²(3, N = 271) = 17.68, p < .001. Study findings replicate and extend prior DTD field trial study results, showing that, although PTSD and DTD share traumatic antecedents, DTD is uniquely associated with traumatic emotional abuse and caregiver separation. Further research is needed to examine how specific trauma types contribute to the risk, course, and severity of DTD.

The impact of neurofeedback training on children with developmental trauma: A randomized controlled study.

OBJECTIVE: Developmental trauma or chronic early childhood exposure to abuse and neglect by caregivers has been shown to have a long-lasting pervasive impact on mental and neural development, including problems with attention, impulse control, self-regulation, and executive functioning. Its long-term effects are arguably the costliest public health challenge in the United States. Children with developmental trauma rarely have a satisfactory response to currently available evidence-based psychotherapeutic and pharmacological treatments. Neurofeedback training (NFT) is a clinical application of brain computer interface technology, aiming to alter electrical brain activity associated with various mental dysfunctions. NFT has shown promise to improve posttraumatic stress disorder (PTSD) symptoms. METHOD: This randomized controlled study examined the effects of NFT on 37 children, aged 6-13 years with developmental trauma. Participants were randomly divided into active NFT (n = 20) or treatment-as-usual control (n = 17). Both groups underwent 4 assessments during equivalent timelines. The active group received 24 NFT sessions twice a week. RESULTS: This pilot study demonstrated that 24 sessions of NFT significantly decreased PTSD symptoms, internalizing, externalizing, other behavioral and emotional symptoms, and significantly improved the executive functioning of children aged 6-13 years with severe histories of abuse and neglect who had not significantly benefited from any previous therapy. CONCLUSIONS: NFT offers the possibility to improve learning, enhance self-efficacy, and develop better social relationships in this hitherto largely treatment-resistant population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The effectiveness of trauma-informed wilderness therapy with adolescents: A pilot study.

Objective: Wilderness therapy (WT) is a complementary/integrative approach for treating struggling adolescents by using outdoor adventure activities to foster personal and interpersonal growth/well-being. Empirical support for the effectiveness of traditional WT is growing, but evidence supporting trauma-informed WT (TIWT) is lacking. This pilot study addresses that gap. Method: Between 2009 and 2019, 816 adolescents (Ages 13-17, Mage = 15.36, SD = 1.25; 41.1% female) completed the Youth-Outcome Questionnaire-SR 2.0 at intake and discharge (M = 75.02 days, SD = 28.77). Three-hundred seventy-eight adolescents also completed the Family Assessment Device-General Functioning (FAD-GF), and 253 adolescents completed two, 2.5-min segments of heart-rate-variability biofeedback (one while resting and one while using a coping skill). One-hundred eighty-nine caregivers completed the Youth-Outcome Questionnaire 2.01, and 181 caregivers completed the FAD-GF. Between 25 and 99 adolescents and caregivers also completed psychological and family measures at 6 months and 1 year postdischarge. Results: Adolescents reported experiencing improvements in psychological and family functioning. They also exhibited improvement in psychophysiological functioning (heart-rhythm coherence). Caregivers reported improvements in family functioning and their child's psychological functioning. Caregivers observed more persisting benefits in their child's psychological functioning, whereas adolescents reported more persisting benefits in family functioning. Changes in psychological and family functioning were related. There were very few differential effects on the basis of demographic factors, trauma exposure, or past and current treatment factors. Conclusion: Results of this pilot study suggest TIWT is a promising complementary/integrative intervention for improving the psychological, family, and psychophysiological functioning of struggling adolescents. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Network analysis of exposure to trauma and childhood adversities in a clinical sample of youth.

Categorizing and quantifying exposure to trauma and childhood adversities (CAs) presents a significant measurement and analytic challenge. The current study examined the co-occurrence of trauma and CA types using network analyses, an alternative to traditional measurement models. The Trauma History Profile, assessing lifetime exposure to 20 different trauma and CA types, was administered to 618 treatment-seeking children and youth ages 4 to 18 years (52.8% female). The generalized similarity model (Kovács, 2010) was used to construct a network of trauma/CA types to visualize relationships and detect cohesive groups. Four clusters of trauma/CA types emerged: overt forms occurring at the individual level (e.g., physical, sexual, and psychological maltreatment), environmental forms at the family level (e.g., neglect, impaired caregiving), environmental forms occurring at the community level (e.g., community and school violence), and acute forms (e.g., loss, medical trauma). Age of onset data indicated that neglect and psychological maltreatment were most predictive of later occurrences of other trauma and CAs. Structural equation modeling indicated that trauma/CA clusters displayed specific associations with posttraumatic stress, internalizing, and externalizing symptoms. Results demonstrate the potential utility of network analysis to understand the co-occurrence and temporal ordering of multiple types of trauma and CAs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Correction: A Randomized Controlled Study of Neurofeedback for Chronic PTSD.

[This corrects the article DOI: 10.1371/journal.pone.0166752.].

Comorbidity of developmental trauma disorder (DTD) and post-traumatic stress disorder: findings from the DTD field trial.

Background: Developmental trauma disorder (DTD) has been proposed to describe the biopsychosocial sequelae of exposure to interpersonal victimization in childhood that extend beyond the symptoms of post-traumatic stress disorder (PTSD). Objective: To characterize the psychopathology comorbid with DTD and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) psychiatric disorders were identified with screening modules on the Kiddie Schedule for Affective Disorders and Schizophrenia, Present/Lifetime version (K-SADS-PL), in a multi-site sample of 236 children (7-18 years old; 50% female) referred by paediatric or mental health providers. Results: DTD (N = 80, 34%) and PTSD (N = 69, 29%) were highly comorbid and shared several DSM-IV internalizing disorder and DSM, 5th Edition (DSM-5) dysregulation disorder comorbidities. However, DTD, but not PTSD, was associated with comorbid panic disorder and disruptive behaviour disorders. On a multivariate basis including all probable DSM-IV disorders and DSM-5 dysregulation disorders, DTD was associated with separation anxiety disorder and attention deficit hyperactivity disorder after controlling for PTSD, while PTSD was associated with major depression and generalized anxiety disorder after controlling for DTD. Conclusions: DTD's comorbidities overlap with but extend beyond those of PTSD to include panic, separation anxiety, and disruptive behaviour disorders. DTD warrants further investigation as a potential diagnosis or a complex variant of PTSD in children, similar to the adult symptoms of disturbances of self-organization in the proposed International Classification of Diseases, 11th revision (ICD-11) complex post-traumatic stress disorder subtype.

Antecedentes: El Trastorno Traumático del Desarrollo ha sido propuesto para describir las secuelas psicosociales de la exposición a la victimización interpersonal en la infancia que se extiende más allá de los síntomas del trastorno de estrés postraumático (TEPT).Objetivo: Caracterizar la comorbilidad psicopatológica con el DTD y determinar si esta comorbilidad es diferente de, y se extiende más allá, de las comorbilidades del TEPT.Método: El DTD fue evaluado por medio de una entrevista estructurada, y probables trastornos psiquiátricos bajo el DSM-IV fueron identificados con los módulos de tamizaje KSADS-PL (en sus siglas en inglés), en una muestra 236 niños (de edades entre 7 y 18 años de edad; 50% mujeres) provenientes de múltiples sitios y que fueron referidos por proveedores pediátricos y de salud mental.Resultados: El DTD (N=80, 34%) y el TEPT (N = 69, 29%) fueron altamente comórbidos y compartieron comorbilidades con el trastorno internalizado del DSM-IV y el trastorno de desregulación del DSM-5. Sin embargo, el DTD, pero no el TEPT, se asoció a comorbilidad con trastorno de pánico y trastornos de la conducta disruptiva. Sobre una base multivariada incluyendo todos los probables trastornos del DSM-IV y los trastornos de desregulación del DSM-5, el DTD se asoció con el trastorno de ansiedad por separación y con el trastorno de déficit atencional con hiperactividad luego de controlar el TEPT, mientras que el TEPT se asoció con la depresión mayor y el trastorno de ansiedad generalizada luego de controlar el DTD.Conclusiones: Las comorbilidades del DTD se superponen con, pero se entienden más allá del TEPT para así incluir pánico, ansiedad de separación, y los trastornos de la conducta disruptiva. El DTD garantiza las investigaciones futuras como un potencial diagnóstico o una variante compleja del TEPT en niños, similar a los síntomas adultos de las perturbaciones en la auto-organización en el subtipo del TEPT Complejo propuesto del CIE-11.

Screening for Trauma Symptoms in Child Welfare-Involved Young Children: Findings from a Statewide Trauma-Informed Care Initiative.

Young children who experience abuse, neglect, domestic violence, and other interpersonal forms of trauma are at risk for developing complex psychological trauma. Timely referrals by child welfare services for trauma evaluation and intervention is critical, particularly during the developmentally-sensitive period of birth to three. However, few screening instruments exist that are feasible for implementation in child welfare services and none have reported psychometric data for children under three. The aim of this exploratory, retrospective study was to examine developmental differences in detection rates of two brief trauma screening scales, comparing outcomes for toddlers (age 1 and 2 years) and preschoolers (age 3 to 6 years), using the evaluation data from a statewide child welfare demonstration project. The sample included 151 children ages 1 to 6 participating in evidence-based trauma treatment with their caregivers. More than 80% of children, regardless of age group, met the cut-off on one of the screeners; children who met the cut-off on either screener were significantly more likely to have experienced domestic violence, physical abuse or poly-victimization. Implications for future research are discussed.

The Complexity of Adaptation to Childhood Polyvictimization in Youth and Young Adults: Recommendations for Multidisciplinary Responders.

Exposure to violence is pervasive in our society. An abundance of research has demonstrated that individuals who experience polyvictimization (PV)-prolonged or multiple forms of traumatic victimizations-are at heightened risk for continuing to experience repeated victimizations throughout their lifetimes. The current article reviews several overlapping constructs of traumatic victimizations with the ultimate goal of providing a unifying framework for conceptualizing prolonged and multiple victimization (defined in this article as PV) as a precursor to complex post-traumatic biopsychosocial adaptations, revictimization, and in some instances reenactment as a perpetrator (defined as complex trauma [CT]). This model is then applied to three socially disadvantaged victim populations-lesbian, gay, bisexual, transgender, queer, or questioning; commercially sexually exploited individuals; and urban communities of color-who are at heightened risk for PV and for exhibiting complex clinical presentations to demonstrate how the PV-CT framework can destigmatize, reframe, and ultimately reduce health disparities experienced by these populations. Trauma-informed recommendations are provided to aid researchers and multidisciplinary providers working to reduce harm and improve the quality of life for polyvictims.

When Nowhere Is Safe: Interpersonal Trauma and Attachment Adversity as Antecedents of Posttraumatic Stress Disorder and Developmental Trauma Disorder.

Developmental trauma disorder (DTD) has been proposed as clinical framework for the sequelae of complex trauma exposure in children. In this study, we investigated whether DTD is associated with different traumatic antecedents than posttraumatic stress disorder (PTSD). In a multisite sample of 236 children referred from pediatric or mental health treatment, DTD was assessed using the DTD Structured Interview. Trauma history was assessed using the Traumatic Events Screening Instrument (TESI). On an unadjusted basis, both DTD, odds ratios (ORs) = 2.0-3.8, 95% CI [1.17, 7.19]; and PTSD, ORs = 1.8-3.0, 95% CI [1.04, 6.27], were associated with past physical assault and/or abuse, family violence, emotional abuse, neglect, and impaired caregivers; and DTD was associated community violence, OR = 2.7, 95% CI [1.35, 5.43]. On a multivariate basis after controlling for the effects of PTSD, DTD was associated with family and community violence and impaired caregivers, ORs = 2.0-2.5, 95% CI [1.09, 5.97], whereas PTSD was only associated with physical assault and/or abuse after controlling for the effects of DTD, OR = 2.4, 95% CI [1.07, 4.99]. Exposure to both interpersonal trauma and attachment adversity was associated with the highest DTD symptom count, controlling for the PTSD symptom count. Although childhood PTSD and DTD share several traumatic antecedents, DTD may be uniquely associated with pervasive exposure to violent environments and impaired caregiving. Therefore, DTD warrants further investigation as a framework for the assessment and treatment of children with histories of interpersonal victimization and attachment adversity.

Equine Facilitated Therapy for Complex Trauma (EFT-CT).

Emerging research suggests that Equine Facilitated Psychotherapy (EFP) may be beneficial for traumatized youth. In addition, complex trauma (i.e., multiple and/or prolonged developmentally adverse traumatic events which are typically interpersonal in nature) treatment research is still growing and there is a need for the development and examination of novel treatments for youth with complex trauma histories. The current article describes a promising EFP model for this population called Equine Facilitated Therapy for Complex Trauma (EFT-CT). EFT-CT embeds EFP practices within Attachment, Regulation and Competency (ARC), an extant evidence-based complex trauma treatment framework for children and adolescents. The authors provide three case studies using both observational data provided by clinicians, as well as longitudinal measures of psychosocial functioning, to illustrate the potential promise of EFT-CT. The article concludes with a discussion about implications for EFP treatment and research.

Toward an Empirically Based Developmental Trauma Disorder Diagnosis for Children: Factor Structure, Item Characteristics, Reliability, and Validity of the Developmental Trauma Disorder Semi-Structured Interview.

OBJECTIVE: Developmental trauma disorder (DTD) is an integrative syndrome for assessing the biopsychosocial sequelae of early life traumatization and attachment disruption. The psychometrics of a DTD Semi-Structured Interview (DTD-SI) and the validity and structure of the DTD construct were tested. METHODS: The DTD-SI was administered by research clinicians at 5 sites between September 2011 and August 2013 to a convenience sample of 236 children ages 7-17 years (50% female, 47% black or Latino/Hispanic, 91% with trauma histories) and/or a parent, recruited in pediatric or mental health services. Validity data were obtained from structured interviews for traumatic stressor and attachment disruption history (Traumatic Events Screening Instrument), DSM-IV disorders (Kiddie Schedule for Affective Disorders and Schizophrenia, Present/Lifetime Version), and potential alternative DSM-5 disorders; parent ratings on the Child Behavior Checklist; and child self-report on measures of emotion dysregulation and quality of life. RESULTS: Statistical analyses confirmed (a) the DTD-SI's item-level temporal and interrater reliability, informativeness, and absence (with 1 exception) of demographic bias and (b) DTD construct factor structure, unidimensionality, and convergent and discriminant validity. CONCLUSIONS: The DTD-SI yielded reliable, structurally meaningful, and valid item- and criterion-level data for the proposed DTD syndrome. Further clinical and scientific investigation of the clinical utility of DTD as a childhood psychiatric syndrome and diagnosis is warranted.

Maltreatment type, exposure characteristics, and mental health outcomes among clinic referred trauma-exposed youth.

Building upon prior research documenting differential effects of psychological maltreatment, physical, and sexual abuse on youth mental health outcomes (Spinazzola et al., 2014), the present study sought to clarify the relative predictive contributions of type of maltreatment compared to salient exposure characteristics. The sample included 5058 clinic-referred youth from the Core Dataset (CDS) of the National Child Traumatic Stress Network (NCTSN) with lifetime histories of exposure to one or more of three specific types of maltreatment: psychological maltreatment (PM), physical abuse (PA), and sexual abuse (SA). First, we examined variations in salient trauma characteristics (age of onset, duration of exposure, number of co-occurring trauma types, and perpetrator type and number) by maltreatment group. Second, we examined whether type of maltreatment remained associated with mental health measures after adjusting for demographic variables and trauma characteristics. Profiles for youth with PM were more severe than youth who experienced either PA or SA only. Co-occurring PM and PA was associated with the most severe trauma exposure profile and with severity of PTSD symptoms, even after adjusting for demographic and trauma characteristics. Youth exposed to SA only had a distinct trauma profile and greater PTSD symptom severity after adjusting for demographic and trauma characteristic variables. Study findings hold important implications for trauma screening, assessment, and intervention, as well as for traumatic stress research methods that extend beyond abuse-specific or cumulative-risk approaches.