These unreliable, inappropriate, or simply absent caregiving styles function as traumatic experiences for the child. It is easy to infer that attachment failures may be damaging, but there is also neurobiological research that provides multilevel, affirmative support for this view. Convincing evidence backs up the theory that attachment failures fuel increased stress reactivity and the development of a dysfunctional stress regulation system (Mikulincer & Shaver, 2018). Additionally, a preponderance of research has shown that brain systems pivotal for emotion regulation and executive function are underdeveloped in children lacking healthy attachment relationships (Schore, 2019a). The persistent absence of healthy attachment interactions seems to impair “healthy physical, mental and emotional health” (Harvard University, Center on the Developing Child, 2022, p. 1). The compromising effects of traumatic attachment experiences can present in many ways for children. When children learn that their fear, pleading, crying, and general attempts to engage “do not register with the caregiver,” they are conditioned for defeat and a diminished sense of self that continues throughout adulthood (van der Kolk, 2014, p. 116), and they may not learn how to rely on social input and supports (Kerpelman & Pittman, Trauma Symptoms in Children D’Andrea and colleagues (2012) synthesize the research on child-specific trauma symptoms into the major domains of dysregulation of affect, disturbances of attention and consciousness, distortions in attribution, and interpersonal difficulties. ● Dysregulation of affect: Children with trauma histories may express a range of challenging emotions and atypical affective responses. One end of this range is a more passive perspective, with some children who may be overregulated displaying unresponsive or inappropriate affect, and becoming internalized or withdrawn (D’Andrea et al., 2012). The other, more active, end of the range includes children who may have unregulated or explosive affective expressions, be highly demonstratively reactive, and rely on more aggressive affective expressions in attempts to exert control over their emotions (D’Andrea et al., 2012). ● Disturbances of attention and consciousness: Childhood trauma “may manifest as dissociation, depersonalization, memory disturbance, inability to concentrate (regardless of whether the task evokes trauma reminders), and disrupted Diagnosing Childhood Trauma This chapter has emphasized the various ways in which childhood trauma symptoms elude existing diagnostic and assessment tools. Two major trauma-related diagnoses, however, are recognized in treating children. The DSM-5 lists specific posttraumatic stress disorder (PTSD) criteria for children age six or younger. The second diagnosis, developmental trauma disorder, although not included in the DSM-5, is widely accepted among national childhood trauma experts (National Child Traumatic Stress Network [NCTSN], 2017; van der Kolk, 2014; van der Kolk et al., 2009). Posttraumatic Stress Disorder in the DSM-5 The DSM-5 offers a new developmental subtype of PTSD for children age six years or younger (PTSD in preschool children; American Psychological Association [APA], 2013). This represents the “first developmental subtype of an existing disorder,” suggesting an increasing awareness of the unique experiences of children (Scheeringa, 2021, p. 1). The general criteria for this subtype are the same as for the adult diagnosis, with minor tweaks and subtle changes to be more “behaviorally Developmental Trauma Disorder Although the DSM-5 PTSD subtype for children age six or younger represents a step toward tailoring trauma diagnoses to the complexities of the developing child, many experts believe it still falls short (van der Kolk, 2014). The NCTSN reports that fewer than 25% of the children receiving trauma treatment meet
2018). Additionally, children who do not have their needs met learn to discount their inner needs and sensations and instead seek excessive input or unquestionably adopt the perspectives of others (Kerpelman & Pittman, 2018). This “Faustian bargain” means that these children close off a piece of their self-identity and are unable to rely on their bodies for feedback regarding purpose and direction (Fosha, 2013; van der Kolk, 2014). Finally, children who experience traumatic attachment failures may (van der Kolk, 2014, p. 120): ● Have “difficulty regulating their moods and emotional responses” ● Demonstrate more externalizing or internalizing symptoms ● Have poorer peer relationships ● Develop a range of psychiatric problems ● Demonstrate greater physiological arousal (e.g., a greater number of circulating stress hormones and lowered immune function) Ultimately, traumatic and problematic attachment serves as a risk factor for multiple trauma-related outcomes, whereas secure attachment seems to inoculate the individual with a kind of emotional resilience (van der Kolk, 2014). executive functioning (e.g., ability to plan, problem solve)” (D’Andrea et al., 2012, p. 189). ● Distortions in attribution: After traumatic experiences, children may experience distortions in worldviews and views of the self. They may engage in cognitive distortions regarding the attribution of their experiences, blaming themselves or generalizing the terrible acts of one adult with all adults. These children may engage in harmful self-talk that diminishes their sense of worth (D’Andrea et al., 2012) or perceive positive or neutral experiences as threatening. ● Interpersonal difficulties: Trauma symptoms may contribute to negative interpersonal interactions and social isolation. Certain symptoms may manifest in behaviors that alienate peers, such as callous or unemotional interactions, a lack of trust, limited empathy, a lack of boundaries, and abrasive and aggressive externalizing behaviors (D’Andrea et al., 2012). At times, these behavioral manifestations of trauma symptoms may result in antisocial behaviors, school disruptions, and legal troubles (D’Andrea et al., 2012). anchored and developmentally sensitive” (Scheeringa, 2021, p. 1). It is no longer required that children react with extreme distress to the traumatic event. This shift takes into account some children’s inability to verbalize their reactions in the same way as adults (APA, 2013; Scheeringa, 2021). Additionally, re- experiencing symptoms are not required to be “distressing,” as some children express trauma through play—which may not look distressing—and exhibit emotional numbness rather than distress (Scheeringa, 2021). Children age six or younger need only to display one symptom in either the avoidance or negative alterations criterion. Many of the symptoms within these domains are difficult to detect in children. For instance, many children are just starting to identify and shape their interests and affective vocabulary, so detecting true manifestations of symptoms such as “loss of interest” or “restricted range of affect” is challenging (Scheeringa, 2021). Similarly, the symptoms “sense of a foreshortened future” and “inability to recall an important aspect of the event” were deleted (Scheeringa, 2021).
criteria for PTSD (D’Andrea et al., 2012). Numerous trauma authorities contend that the simplicity of the DSM-5 criteria does not adequately address childhood trauma. Advocates of this position have proposed developmental trauma disorder (DTD) as a viable alternative diagnosis and solution to this issue (van der
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