14-16 Respondents evaluated the proposed DTD stressor and symptom criteria as feasible, unique, and value-added 17-more parsimonious and accurate than other psychiatric diagnoses for characterizing treatment-refractory problems. 11 The proposed DTD stressor criterion and symptom criteria are described in Table 1.Īn international survey of child-serving mental health and pediatric professionals was conducted 12 as a first test of DTD’s incremental clinical utility, 13 with survey ratings paralleling those from prior clinical utility surveys. 1 DTD’s proposed symptom criteria B (affective/physiological dysregulation), C (cognitive/behavioral dysregulation), and D (self/relational dysregulation) parallel but differ from those proposed for adult complex PTSD. DTD criterion A requires exposure to both interpersonal trauma (eg, maltreatment, family or community violence) and disruptions in the child’s development of attachment bonds with primary caregivers-a combination that has been shown to interfere with children’s mastery of stage-salient developmental tasks, including emotion regulation, attentional focusing, behavioral self-control, autonomy, socialization, and learning. 1, 10 DTD was designed to differ from PTSD in content but parallel PTSD in structure, with a gateway criterion A representing stressor exposure followed by 3 symptom domains (criteria B, C, and D). Therefore, a developmentally adapted complex traumatic stress syndrome for children, developmental trauma disorder (DTD), has been proposed to guide assessment and treatment with victimized children. 8 However, trauma-focused treatments designed to remediate developmental deficits in self-regulation and relational security have demonstrated benefit with victimized children. 1-4 These children tend to be polydiagnosed in childhood 5, 6 and adolescence 7 and subsequently as adults. Ford, PhD, UCHC Department of Psychiatry MC1410, 263 Farmington Ave, Farmington, CT 06030 ( who experience potentially traumatic victimization (eg, maltreatment, family or community violence) are at risk for developing biopsychosocial and developmental problems that include, but extend beyond, posttraumatic stress disorder (PTSD). © Copyright 2018 Physicians Postgraduate Press, Inc.ĪDepartment of Psychiatry, University of Connecticut School of Medicine, Farmington, ConnecticutīThe Foundation Trust, Melrose, MassachusettsĬBoston University School of Medicine, Boston, Massachusetts ![]() ![]() 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. To cite: Ford JD, Spinazzola J, van der Kolk B, et al. Further clinical and scientific investigation of the clinical utility of DTD as a childhood psychiatric syndrome and diagnosis is warranted. 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.Ĭonclusions: The DTD-SI yielded reliable, structurally meaningful, and valid item- and criterion-level data for the proposed DTD syndrome. ![]() 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. 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. The psychometrics of a DTD Semi-Structured Interview (DTD-SI) and the validity and structure of the DTD construct were tested. ![]() Objective: Developmental trauma disorder (DTD) is an integrative syndrome for assessing the biopsychosocial sequelae of early life traumatization and attachment disruption.
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