Tutorial 7 · Recognizing and Addressing Trauma in Infants, Young Children, and their Families
Two Types of Trauma Diagnoses
It is important to note that not all experiences of trauma lead to a trauma response or trauma-related disorder or diagnosis. There is a normal period of time, following a traumatic event or experience that we might expect to see trauma related responses or signs that do not necessarily develop into a post-traumatic stress disorder. However, when signs and symptoms of traumatic stress endure over time (one month or longer), disrupt a child's or adult's daily life, impact their social and emotional health, and meet specific diagnostic criteria, there are two types of trauma diagnoses.
Post Traumatic Stress Disorder
Post traumatic stress disorder (PTSD) describes symptoms associated with a traumatic event — such as a car accident, witnessing violence, natural disaster, etc (see list of types of traumatic experiences below). The symptoms may include recurrent bad dreams, physical reactions, flashbacks, startle reaction, loss of interest in usual activities, avoiding reminders of the event, etc. To address developmental influences, ZERO TO THREE has included language in their Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood Revised (DC:0-3 R) (ZERO TO THREE, 2005) that can supplement the adult focused Diagnostic and Statistical Manual of Mental Disorders (DSM IV). Currently, the diagnosis of Posttraumatic Stress Disorder in Preschool Children is under consideration for the DSM 5th edition which is due for publication in 2013 (American Psychiatric Association, 2010). The DC:0-3 and the proposed revised diagnosis include additional developmentally-based, diagnostic criteria for PTSD in young children. (More information)
The term complex trauma — also known as Complex PTSD — has been proposed as a potential new diagnostic category, Developmental Trauma Disorder, in the Diagnostic and Statistical Manual of Mental Disorders (DSM), 5th edition (van der Kolk, 2005; van der Kolk et al, 2009). Complex Trauma or Developmental Trauma Disorder — describes how children's exposure to multiple or prolonged traumatic events impacts their ongoing development. Typically, complex trauma exposure involves the simultaneous or sequential occurrence of child maltreatment and may include psychological maltreatment, neglect, physical and sexual abuse, and witnessing domestic violence.
Complex trauma is:
Exposure to these initial traumatic experiences, the resulting emotional dysregulation, and the loss of safety, direction, and the ability to detect or respond to danger cues may impact a child's development over time and can lead to subsequent or repeated trauma exposure in adolescence and adulthood without supports that might buffer the negative effects.
(Adapted from Blumenfeld, et al, 2010, used with permission)
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