The Alphabet Soup of Complex Trauma

by | Developmental Trauma

Complex trauma is complicated and messy. It also has so many acronyms associated with it that it often feels like we’re wading through a bowl of alphabet soup! Trying to make sense of it (and live through it) can be overwhelming, frustrating, and discouraging. 

Is it lack of knowledge or overwhelm?

I had a conversation with a friend of mine recently about our beloved “Trauma Mamas” (aka moms who are raising kids affected by early childhood trauma) and what more we might be able to do to keep them from drowning. As we were talking, she made a comment to me that she thought a lot of these moms don’t even know about early childhood trauma or how it affects kids.

Initially, I kind of disagreed with her. They say a worried mom does more research that the FBI. That is definitely true of most of the moms I know. My thought was that they do know, but they’re just overwhelmed by it. 

 It turns out she was 100% right. Actually, we both were…and I now have the numbers that prove it. I’ve recently been learning quite a bit about how the internet really works and how people find what they’re looking for when they search for things.

They really and truly don’t know!

Just for kicks and giggles, I did some research on how people might find information about the long term effects of developmental trauma exposure. Admittedly, I was quite shocked at what I found. No matter where I looked or what I looked for, the numbers were consistently very low. In fact, many of the things we often hear about in parent support circles all the time barely even registered on the internet search radars, especially compared to the number of families who are living day in and day out with traumatized kids.

Unfortunately, those numbers are consistent with what many of us parents have experienced and learned the hard way. So many of the professionals who are supposed to be able to help us don’t know about this stuff! Not only do they not know about it, but by and large, they aren’t even looking for answers.

When we parents go to them for help, they’re calling whatever “it” is that our kids are struggling with something different…if they’re even calling “it” anything at all. That means they’re also treating it as something different, too..and they’re barking up the wrong trees!  

We can and must do better!

We’ve gotta do something to change this trend, my friends! Whether you’re new to this lovely world of trauma or you’ve been around the block a few times like I have, I want to challenge you to brush up on your knowledge…and then keep learning. Things are constantly changing and new information is coming out all the time.

 Unfortunately, it is up to us as parents to learn all we can about our child’s issues and struggles and then educate the professionals that work with them. They may be really good people who are good at what they do. However, most of them know precious little about the long term effects of early childhood trauma. It’s not that they don’t want to know. It’s that they’ve never been taught and many of them don’t know that they don’t know anything about it!

We can’t rely on just one source for our information, either. Not everything you read on the internet is accurate or true. Some of it is outdated, incomplete, and inconsistent. Parent support groups are great, but verify what you learn in them. There is still a lot of confusion out there and many, many, many parents are still struggling to connect with their kids because they don’t understand them. There is also a lot of practices still being preached in some of those groups that don’t work for traumatized children.

 We MUST understand our child’s issues!

In order to be able to effectively parent and deal with our child’s issues, it is imperative that we understand what they really are, what they are called, how they affect our kids, and that we use tools and treatment methods that work for them.  

 I want to help you get started on the journey by outlining some of the more common issues related to developmental trauma exposure. I strongly encourage you to dig in and do some much deeper research on each of these issues if they sound like your child, consult multiple sources, and then encourage your providers to do the same. 

Complex PTSD (CPTSD)

Many people have heard of PTSD, especially as it relates to military service. Basically, it’s a psychiatric disorder that can occur in people who have witnessed or experienced a traumatic event such as terrorism or war combat, a serious car accident, domestic violence, sexual assault, or widespread natural disaster.

Complex PTSD is much more persistent and is the result of repeated trauma exposure that happens over several months or years, rather than just a single incident or type of trauma. 

CPTSD isn’t yet a perfect description for kids, simply because of how trauma exposure changes the hardwiring of their brains, but it’s closer than just “ordinary” PTSD. 

Check out this article to learn more about Complex PTSD.

Disruptive Mood Dysregulation Disorder (DMDD)

DMDD is a condition in which children struggle to regulate their emotions and behavior in age-appropriate ways. Children with DMDD are persistently irritable, have frequent temper outbursts and are often verbally or physically aggressive.

This condition probably comes closest to describing the extreme behavior issues many trauma kids have. Like most other diagnoses, it’s not a perfect fit for trauma kids, but it’s the best we currently have and many kids who have experienced severe early childhood trauma are diagnosed with it.

Check out this article to learn more about Disruptive Mood Dysregulation Disorder.

Reactive Attachment Disorder

While this is a popular term used to describe what is going on with our kids, the labeling and diagnostic criteria for this condition is an absolute mess. Prior to DSM-V (published in 2013), RAD was based on the criteria that the child had experienced abusive, neglectful, or frequently changing caregivers during their first 5 year of life. It was defined as an “uncommon” disorder in which children react to extreme neglect and/or abuse with “Markedly disturbed and developmentally inappropriate social relatedness in most contexts, as evidenced by either of two behaviors:

    1. Persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses.
    2. Diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers).

The powers that be should have left it alone. But they didn’t. They actually split it into two disorders, both of which I personally believe are less than helpful.

For the past 7 years, Reactive Attachment Disorder has been officially defined as the emotionally withdrawn/inhibited type of the disorder characterized by emotionally withdrawn behavior and social/emotional disturbances that include reduced responsiveness, limited affect &/or markedly increased irritability, sadness or fearfulness.

Disinhibited Social Engagement Disorder (DSES) is now the official diagnosis for the indiscriminate type of attachment disorder. Kids who struggle with this condition are the “mommy shoppers” who have limited or no resistance when interacting with unfamiliar adults and quickly become overly familiar either verbally or physically with relative strangers, but have diminished interactions with or concern for their real adult caregiver.

That’s it. Nothing more. Nothing less. It only covers a child’s attachment to their caregiver. 

Check out this post to learn more about the changes made to the RAD diagnosis and how they relate to developmental trauma. 

Fetal Alcohol Spectrum Disorders (FASD)

FASD itself isn’t a diagnosable condition, but rather an umbrella term used to describe a collection of 100% totally preventable issues caused by the mother consuming alcohol during pregnancy. While Fetal Alcohol Syndrome often comes with accompanying facial and physical anomalies, not all kids have them. In fact, only about 10-15% of kids affected by prenatal alcohol exposure have any physical markers. Thus, there is a set of other conditions that describe conditions related to fetal alcohol exposure, otherwise known as FASD.

Other FASD related conditions Partial FAS, Static Encephalopathy, and Neurobehavioral Disorders

Alcohol-Related Neurodevelopmental Disorders (ARND) and Fetal Alcohol Effects (FAE) used to also be included in that set, but they are being phased out (and no longer in the DSM. Again, this is not a great idea and I’m quite certain they don’t consult with the people who are actually living with these kids before they make these kinds of changes, but it is what it is.  You will, however, probably still find some good information by researching those terms as well. 

At least from what I’ve seen, FASD is often significantly downplayed or even completely dismissed when it comes to trauma kids. Just because there is no known history of exposure, or a birth mother “said” she didn’t drink, doesn’t mean it didn’t happen. 

While it’s not the only driver for problem behavior, FASD may well be contributing to the problem. This is especially true for kids who had a rough start in life. Reality is that if a parent was living a life that would cause trauma severe enough to result in RAD or Complex PTSD for a child, there is a very likely chance that alcohol was involved in that lifestyle as well. If your child is experiencing issues that can’t be explained by something else, consider FASD!

These are some good articles on the basics of FASD and current diagnostic options. Something many people don’t know is that a psychiatrist can diagnose some of these conditions. It’s definitely worth asking about rather than waiting months to get into a geneticist or other specialist who may or may not even be able to help you. 

Developmental Trauma Disorder (DTD)

I wish I could say Developmental Trauma Disorder is a real thing, but it’s not. Developmental Trauma Disorder was proposed by Dr. Bessel van der Kolk  and fought for as a diagnosis to be included in DSM-V (Diagnostic and Statistical Manual of Mental Disorders vol. 5). In case you’re not aware, the DSM is the generally accepted handbook used by healthcare professionals in the United States and much of the rest of the world to guide the diagnosis of mental disorders. 

Unfortunately, this particular diagnosis was rejected. Because it isn’t included in the current version of the DSM, there are no billing codes available, no established diagnostic criteria, and no recognized treatments.

If someone diagnoses your child with Developmental Trauma Disorder, it’s time to start asking a lot of questions. They may have some knowledge of trauma (which is a very good thing), but that isn’t what your child is being treated for and nor is it what they’re billing your insurance for.  

If you are researching this condition and what you find sounds good, please pay attention to the dates of publication. Most that describe this condition are dated prior to 2013 and before it was rejected.

Other related conditions

There are actually many different conditions related to developmental trauma exposure. Some can stand alone without a trauma connection, but can still be contributing to your child’s issues. Those might include:

  • ADHD (Research it! Not all kids with ADHD have hyperactive behavior.)
  • Sensory Processing Disorder (SPD)
  • Intermittent Explosive Disorder (IED)
  • Oppositional Defiant Disorder (ODD)

The challenge of complex developmental trauma

Here’s what makes all of this so challenging. Not all kids who struggle with these issues present the same way. First of all, each kid is a unique individual with their own story and experiences.  All these issues will also present themselves differently depending on the child’s age, the type and intensity of the trauma they’ve been exposed to, and the child’s own resiliency and personality.

Second, none of these conditions mentioned above are stand-alone conditions for trauma kids. The same things that cause RAD also cause CPTSD and can also drive other things like ADHD and SPD, especially prenatal drug or alcohol exposure was part of the mix. It’s often impossible to tell where one ends and the other begins.

Furthermore, while each of these conditions may have their own set of diagnostic criteria and treatment recommendations, they don’t account for early childhood trauma exposure. Trauma kids usually have 5-6 different diagnoses that all get mushed together and compound on each other and the recommended treatments for each piece often conflict with each other. 

Those 5-6 different things are also subjective and based on the provider’s knowledge, experience, and expertise. Many trauma kids are also diagnosed with things like autism, bipolar, and other forms of mental illness. Sometimes those diagnoses are correct. Sometimes they aren’t…and if they aren’t, the pieces that have been missed or misdiagnosed likely aren’t being properly or effectively treated.  

It is also common for symptoms not to show up for several months or even years, especially if a child was adopted when they were fairly young. Some issues such as FASD and ADHD don’t show up until a child is in school. Don’t misread that, though. These issues aren’t a disease like cancer. They will not be there one day and then suddenly appear out of nowhere down the road. They’re either there or they aren’t.

What often happens is that parents and professionals overlook the warning signs for a time or assume what they are seeing is really something else they are more familiar with. This is especially true if there aren’t a lot of details about the child’s history or neither the parents or the professionals understand what happens when all these issues compound on each other.

Knowledge is power

With all these different variables, it’s no wonder so many kids and families are struggling! No wonder so many adoptions fail and treatments don’t work. No wonder our schools are clueless and therapists don’t get it!

The only way we will be able to truly help our kids is if we take a proactive and assertive approach and we as parents learn everything we can about their issues and conditions. Simply put, we can’t fix or even treat or even appropriately parent what we don’t know about. Nor can we effectively advocate for our kids.

Free Developmental Trauma course!

If you’d like to learn more about this stuff, I have a FREE course available titled Understanding Developmental Trauma. This course offers a detailed look at what developmental trauma is, what is it not, and how early childhood trauma exposure affects kids and their ability to function in all areas of life…often for life! 

Diana
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The Alphabet Soup of Complex Trauma

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