When clinicians evaluate children for potential trauma, the DSM-5 gives them two choices. These are Post-Traumatic Stress Disorder (PTSD) or Unspecified Trauma- and Stress-Related Disorders. Neither of these disorders describes adverse childhood experiences. They leave out the one vital diagnosis that quantifies the behaviors in children that lead to consequences of functioning in adolescence and adulthood.
Dr. Bessel van der Kolk is a renowned psychiatrist and specialist in trauma for children and adults. In his book, The Body Keeps the Score, he discusses the concept of developmental trauma disorder (DTD). This disorder was proposed to be included in DSM-5 to capture the dysfunctions experienced by children and adolescents exposed to chronic traumatic stress. At the time of the DSM-5 publishing, the American Psychiatric Association indicated that not sufficient evidence existed to warrant it as a diagnosis.
However, for those clinicians who deal with children exposed to trauma, DTD is an essential part of their understanding of how trauma impacts someone at an early age. Among the criteria assigned to DTD are:
1. Exposure to episodes of violence or disruptions of caregivers
2. Affective and physiological dysregulation, such as the inability to modulate affect, regulate bodily functions, and diminished awareness of sensations.
3. Attentional and behavioral dysregulation as indicated by impaired coping with stress
4. Self and relational dysregulation is shown by lack of self-esteem, difficulty with separation, defiance, and other behaviors.
In Dr. van der Kolk’s study in 2019, he and others found that “DTD’s comorbidities overlap with but extend beyond those of PTSD to include panic, separation anxiety, and disruptive behavior disorders.”
As Martin Teicher in Scientific American indicated, “Research on the effects of early maltreatment tells a different story: that early maltreatment has enduring negative effects on brain development. Our brains are sculpted by our early experiences. Maltreatment is a chisel that shapes a brain to contend with strife, but at the cost of deep, enduring wounds. Childhood abuse isn’t something you ‘get over.’ It is an evil that we must acknowledge and confront if we aim to do anything about the unchecked cycle of violence in this country.”
For clinicians, these findings are significant to begin incorporating them into assessment and treatment. Although DTD cannot be used for diagnostic or insurance purposes, treating the child and adolescent becomes essential. Looking beyond the existing behaviors back to the original traumas can assist the clinician in finding the best approach to mitigate trauma triggers, re-traumatization, and their impacts on the child. Knowing their history and the events that shaped the child’s functioning or developmental delays at an early age, the clinician can shape interventions to mitigate trauma’s impact. In the future, DTD needs to be part of the existing training and discussion until DSM-6 includes it.
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PRAXES is a nationwide behavioral health software, consulting, and training company. No one in the behavioral health industry has a better reputation, and if you give us the chance, we’ll show you why! At PRAXES, our services improve the efficiency and structure of behavioral health agencies serving children and families nationwide. PRAXES brings over 45 years of administrative and clinical expertise. With more than 100 client companies nationwide, we offer the expertise to advance the quality of behavioral health services. We accomplish these goals through our new clinical decision software, our training of best practices, and helping companies meet regulatory standards. At PRAXES, we believe in being creative and fostering new ways to serve children and their families. Our vision is to empower the families our agencies serve with skills that not only improve their functioning, but help them to thrive in their everyday lives. When you give us the chance, you’ll be connected directly to our friendly staff, so you can expect immediate attention to your inquiry. So, don’t wait, call now!
Dan Thorne has unique perspectives on the field of mental health. As a clinician, he has had over 40 years of experience working with clients in the Southern California area. After obtaining his Bachelor’s degree from the University of California at Irvine, he worked with children in the Orange County Juvenile Hall. Here he honed his earliest techniques on at-risk children. After that, he obtained his Master’s degree in Counseling from California State University, Fullerton.
In the 1990’s, Dan turned his attention to the clinical and administrative side of behavioral health organizations. For three years, he was the Assistant Administrator of Starting Point, a chemical dependency facility in Costa Mesa, CA. In 2001, he took an opportunity to be the Director of Harbor View Community Services Center in Long Beach. When he arrived, the Center had only 80 clients and 13 staff. When he left, there were over 400 clients and 75 staff. Dan created several programs through their contract with the Los Angeles County Departments of Mental Health and Child and Family Services. Under his guidance, Harbor View became one of the leading providers of children’s services in Los Angeles County.
While improving the results of the client’s parents at the Center, Dan reflected on his experiences as a parent. His children themselves had special needs such as mental and intellectual challenges, and Dan knew the toll it takes on the parent. In order to help the child, the parent has to be healthy. From this concept, he created his parenting program. After years of refining it, teaching it to his staff at the Center, and then taking the results and comments from these efforts, he became the developer of the current PRAXES program. It is a culmination of Dan’s personal trials and tribulations as a parent along with empirical results and research of over 40 parenting programs.
Our vision at PRAXES is to advance the strength of parents and caregivers of children with special needs (mental health, intellectual, or physical) through education, support, and empowerment. Thus, they can live healthy and functional lives while caring for the child.
Apogee is a clinical decision software designed to help behavioral health practitioners with their treatment and patient engagement. It provides evidence-based and research-based components. Not only do they consist of elements from such practices as Cognitive Behavior Therapy, Seeking Safety, Dialectical Behavior Therapy, Motivational Interviewing, Functional Behavior Analysis, but also the Intensive Models for Parents, Youth, and Children.
PRAXES has over 30 years of accreditation experience. We know what it takes to get your organization accredited. Whether it’s Joint Commission, CARF, or COA, our team can provide an evaluation of your current status and review the standards which need improvements. We will assist you with the policies, documentation, and training required to be accredited.
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