Author ORCID Identifier

https://orcid.org/0000-0001-7652-4503

Year of Publication

2022

Degree Name

Doctor of Social Work (DSW)

Abstract

Approximately two-thirds of U.S. children and adolescents report having experienced a traumatic event. A posttraumatic stress disorder (PTSD) diagnosis requires that the youth has directly experienced a traumatic event, witnessed a traumatic event occur to others, or learned that a traumatic event has occurred to someone close. The clinician is in a diagnostic quandary, however, when the youth presents with the PTSD hallmarks of hyperarousal, avoidance, and emotional dysregulation, in absence of such life experiences. The answer to this quandary lies in an understanding of developmental trauma disorder (DTD). Clinical interventions for DTD are the focus of this capstone.

Product one was a systematic literature review that explored therapeutic intervention for children and adolescents with PTSD, complex PTSD, or DTD. Articles identified 50 treatment approaches. Quantitative studies confirmed a dichotomy between cognitive and somatic therapies; however, many studies endorsed a synthesis of both approaches. Patterns also emerged around therapeutic components and the importance of caregiver involvement.

The results of this review informed product two, a conceptual paper, that synthesized attachment theory and the identified approaches to propose guideposts for the treatment of DTD. A multiphasic treatment approach was developed that begins with attachment work and establishing safety, moving to self-regulation skills, and finally addressing relational- or self- dysregulation. The conceptual paper offered a flexible, client-driven model that addresses the whole child – brain, body, and mind – with attachment central to the work.

The study concluded with product three, a practice application, that brought new knowledge into the therapy room. Two composite clinical cases illustrated treatment episodes with a young child and an adolescent. Given the importance of attachment in this work, vignettes include an involved caregiver and an absent caregiver.

These three products actualize knowledge and theory, applying them in the therapy room. Despite its exclusion from the DSM-5, DTD is relevant to daily practice. Clinicians will recognize the echoes of cumulative trauma during the critical stages of development, exposure to interpersonal victimization, and disrupted attachment. Findings reveal best outcomes require caring adults, caregiver or therapist, consistently and patiently meeting the needs of traumatized youth. The importance of relationship cannot be understated. It is within these relationships that the clinical work occurs. Regardless of cognitive or somatic therapeutic inclinations, attachment is of critical importance – without it, all treatment approaches will fall short. Clinicians would be well-served to ask youth about their adults and the quality of those relationships. While the presenting issue may be depression or anxiety, the treatment may be found in attachment.

Available for download on Monday, May 13, 2024

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