![]() In this proposal, the history of formulating trauma disorders in children is reviewed. (2009) sent in their proposal to the DSM V editors advocating that developmental trauma disorder be included. In an attempt to forward this ‘moment of opportunity’, van der Kolk et al. 2008), together totaling over 17,000 children who experienced multiple forms of trauma) and, (3) much greater knowledge of the effect upon neurobiology and developmental psychopathology, following chronic interpersonal trauma. (2007 2008), which so clearly identifies the genesis of chronic medical illness (2) the imprecision of DSM PTSD criteria for developmental trauma (our only present diagnostic option), which captures only a minority of these trauma cases, as low as 5 to 25% on two large data bases…CANS dataset (Illinois DCFS screen of 7,668 foster children) and NCTSN dataset ( Pynoos et al. This confluence includes: (1) adverse childhood experiences (ACE) outcomes as reported by Felitti et al. We see a clear convergence of events currently upon us as to why this field of trauma in children is an important opportunity we must properly conceptualize in order to forward this area of medicine. We would suggest that a developmental trauma disorder could be conceived along a ‘spectrum diagnosis,’ a notion DSM is currently embracing (see autism disorders), but with the domain of trauma encompassing all age groups. layered over decades), still revealed in living World War II vets in their nineties. The natural prognosis of trauma reveals ongoing disruption over multiple time periods (i.e. The evolution of trauma diagnoses began with ‘battle fatigue’ springing from the first and second WW veterans and evolved into DSM criteria of post-traumatic stress disorder (PTSD) in DSM II (ICD-8), III (ICD-9), IV and remains little changed in DSM V. In children and youth, the altered trajectory of development from ongoing trauma from caregivers over several developmental periods is simply more profound and evident across a wider spectrum of developmental domains than adults. Further, a developmental approach would appropriately recognize the interactive effect of such dynamics of familial systems, as well as cultural and societal expectations. A developmental approach to understanding disorders of trauma would support the imperative notion that such a diagnosis is complicated, in that there are constant changes with the individual child/youth/adult (genetically and otherwise) that are further complicated by the individual’s interaction with his/her environment. Through clinical experience, it is known that even a single event of trauma in adulthood can significantly alter the ongoing developmental trajectory of that adult brain and mind, which may impact the individual in various bio-psycho-social-spiritual ways. ![]() If we are to still use DSM V, we might go as far to say that if the Editors of DSM V wanted only one trauma diagnosis, then arguably it should have been developmental trauma disorder. Furthermore, Carrey and Gregson (2008) critically point out that there is need for a more flexible diagnostic system to consider emerging data from both genetic and environment interactional studies within the framework of attachment, developmental and systems theory. ![]() Diagnosis in children should clearly consider developmental psychopathology, attachment theory, neuropsychology and plasticity, as well as resiliency factors ( Carrey 2008). We are thus obliged to acquire a new model, based on the arguments of many researchers and clinicians. By definition, these do not capture the: (a) developmental (b) progressive (c) strength based and (d) resilient contexts that children require. These were previously referred to as research diagnostic criteria. DSM constructs were originally formed from fixed or static psychopathology states in adulthood, mostly aimed at studying epidemiology. Relatedly, George Box (a well known figure in the area of diagnostic model building) famously stated that “All models are wrong but some are useful” ( Box & Draper, 1987). ![]() He summarized, “Categories can hide the realities of things”…something we see in everyday clinical practice. The professor went onto to define ‘disease’ as ‘ that something’ which underlies signs and symptoms…versus ‘classification,’ which deals in categories and dimensions. We certainly need that same momentum now in child psychiatry. It was Professor Assen Jablensky (1987, 2001) who reminded us that the very word ‘diagnosis’ is from the Greek ‘Gnostic’ – meaning ‘relating to knowledge’ (interestingly, as it related to a 2 nd or 3 rd century Greek movement created to challenge the orthodox of the time).
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