In 2009, professionals researching and treating Complex Trauma in children proposed a new diagnosis of Developmental Trauma Disorder be included in the Diagnostic and Statistical Manual to capture the dysfunctions experienced by children and adolescents exposed to chronic traumatic stress. Some of these children did not meet the criteria for Post-Traumatic Stress Disorder (PTSD), the disorder in the DSM-IV that most closely relates. Others had been diagnosed with a laundry list of unrelated disorders because their symptoms and behaviors meet the criteria for everything from Oppositional Defiance Disorder to Autism Spectrum Disorders. Yet these children’s problems have developed in the context of trauma and developmental disruptions. Because no other diagnostic options are available, the symptoms professionals see often lead them to diagnosing unrelated disorders such as bipolar disorder, ADHD, conduct disorder, RAD, autism, and a host of anxiety disorders.

Dr. Bessel van der Kolk and the staff at The Trauma Center at JRI have been researching “Disorders of Extreme Stress” in children for a decade. Together with the National Child Traumatic Stress Network, they proposed the inclusion of Developmental Trauma Disorder into the DSM-5, to be published in 2012. At this point the proposal is being considered and research trials are underway. The disorder has not yet been included in the drafts of this manual. However, professionals treating attachment disorder and trauma in children are supporting this diagnosis and are more frequently using it to describe what they see in many clients.

Below Is the “Consensus Proposed Criteria for Developmental Trauma Disorder”

A. Exposure. The child or adolescent has experienced or witnessed multiple or prolonged adverse events over a period of at least one year beginning in childhood or early adolescence, including:

B.  Affective and Physiological Dysregulation. The child exhibits impaired normative developmental competencies related to arousal regulation, including at least two of the following:

C. Attentional and Behavioral Dysregulation: The child exhibits impaired normative developmental competencies related to sustained attention, learning or coping with stress, including at least three of the following:

D. Self and Relational Dysregulation. The child exhibits impaired normative developmental competencies in their sense of personal identity and involvement in relationships, including at least three of the following:

E. Posttraumatic Spectrum Symptoms. The child exhibits at least one symptom in at least two of the three PTSD symptom clusters (B, C, & D).

F. Duration of disturbance (symptoms in DTD Criteria B, C, D. and E) at least 6 months.

G. Functional Impairment. The disturbance causes clinically significant distress or impairment in at least two of the following areas of functioning:

To learn more about Developmental Trauma Disorder and Dr. van der Kolk’s research:

Understanding Interpersonal Trauma in Children: Why We Need a Developmentally Appropriate Trauma Diagnosis –  D’Andrea, Ford, Stolbach, Spinazzola & van der Kolk, 2012

When Age Doesn’t Match Stage:  Challenges and Considerations in Services for Transition-Age Youth with Histories of Developmental Trauma -Blaustein, Kinniburgh, Focal Point: Youth, Young Adults, & Mental Health. Trauma-Informed Care, 29, 17-20, 2015

Commentary:  Developmental Trauma Disorder: A Missed Opportunity in DSM V – J Can Acad Child Adolesc Psychiatry

Developmental Trauma Disorder defined