Developmental Trauma Disorder: A Modified Approach to Attachment Disorders

Developmental Trauma Disorder: A Modified Approach to Attachment Disorders

For going on a decade now, a large segment of mental health professionals have advocated for a switch from “attachment disorder” to “developmental trauma disorder” in the psychiatric manual of mental disorders. What’s the difference, you ask? Right now, reactive attachment disorder and disinhibited disorder are the only two classifications of childhood-based trauma disorder. (This isn’t to say that children can’t suffer from PTSD or acute stress disorder.) These two categories represent the two poles that occur when attachment goes wrong—either the child has trouble feeling safe around anyone (reactive attachment) or the child freely attaches (disinhibited) to almost any adult sometimes with disastrous consequences.

What the Professionals Think

Now, there’s nothing wrong with these categories. Psychologists and therapists who work with children witness this pattern of reactive attachment over and over again. The objection, rather, is that the two categories are woefully incomplete to describe the range of behaviors and psychological effects that can result from childhood trauma.

Put another way, hardly any mental health professional wants to do away with reactive attachment disorder altogether. Instead, they see reactive attachment disorder as one subtype of developmental trauma. In fact, some mental health researchers have even come with a proposal of what the diagnostic criteria might look like for developmental trauma disorder. Other researchers have pointed out that the clinical research isn’t robust enough to establish this criteria, but they also point out that a similarly descriptive approach to childhood trauma would be beneficial in creating “improved sensitization to trauma outcomes and more tailor-made treatment options.”

A Brief Look at Childhood Attachment

There are several crucial ways that we learn to attach to our caregivers as infants. The most obvious one is touch, but skin-to-skin attachment is far from the only type of childhood attachment. We’re also born with the instinct to seek out and recognize the faces of others, for example. Our cute baby faces have evolved to lure adults into loving us and, in turn, to love babies’ faces ourselves. In profound ways that we’re still struggling to fully understand, we learn to feel by looking at the faces of our primary caregivers.

Another part of healthy attachment is the infant learning to prefer their primary caregivers over other adults. The orphanage system has largely become a relic because, as imperfect as the foster care system is, studies consistently show that infants do not respond well when passed around among too many adult caregivers.

The point here is that if you talk to the mental health professionals who assess and treat these children, they’ll tell you that children tend to respond in distinct ways to different types of trauma. In this light, developmental trauma disorder is a way of approaching these children in which the nature of the trauma—rather than attachment theory—is the primary guide for diagnosis and treatment.

A Better Understanding of Developmental Trauma Disorder for Your Child

It’s also easy to think of developmental trauma disorder as a simpler, clearer approach to childhood trauma. But that’s letting ourselves off the hook. Even as we recognize that prevention is the most effective type of intervention overall, we must continue to look for more nuanced ways to treat the different types of trauma that play out in the mind and body of our children.

With this in mind, here’s a practical piece of advice for those foster, adoptive, and biological parents who are tasked with raising a child with developmental trauma: Talk to a qualified professional in the beginning about how to modify your parenting for the needs of the child. But then also keep a sharp eye and take notes about the behaviors you witness including dates. Along with ongoing consultation with a mental health professional, this can help you continue to customize the home environment and parenting strategies in the years ahead.

Traumatized Individuals and Communities

Why does the distinction between attachment disorder and developmental trauma disorder matter to people in Utah? It matters because just like anywhere else, we have a lot of different kinds of trauma. Substance addiction is a huge source of developmental trauma in pretty much every state. Likewise, no matter you live, you’re bound to hear heart-wrenching stories of adults who, beyond all understanding, don’t seem to get it that very young children are to be protected and cared for. (You’d think if anywhere could root out this type of behavior it would be Utah’s family-first culture.)

And yet—from the prescription-pills-to-street-drugs addiction pipeline to the abuse suffered in fundamentalist communities—many of the personal histories of children with developmental trauma disorder are unique to Utah. The upside is that mainstream Utah culture knows how to bring the volunteerism and childcare services, like very few social groups can.

Experienced Treatment Providers in Utah

The different approaches to developmental trauma and attachment disorder can also help families choose a therapy provider. Maybe there’s something about your child’s behavior that is especially relevant to attachment theory, but for most families, we recommend placing slightly more emphasis on a clinician’s experience with clients with similar trauma histories, rather than their familiarity with the literature on attachment theory. That said, know that any mental health professional worth their salt is going to be well-versed in attachment theory, while also carefully considering the client’s personal history. If you’re able to make a connection and feel comfortable with a therapist you talk to, this isn’t something to dismiss lightly.

Again, whether you’re just now recognizing a developmental trauma or you’ve talked to a mental health professional in the past, it’s a great idea to check in with an experienced therapist who can help your family make things better.

Marcus Pickett

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