Understanding Developmental Trauma

Developmental Trauma refers to the psychological impact of prolonged and repetitive trauma experienced in-utero or in early childhood. 

• Developmental trauma occurs when a child's earliest emotional, physical, and psychological needs are consistently negatively influenced, unmet, or ignored.

• Familiar sources of developmental trauma include exposure to drugs or alcohol in utero, chronic neglect, abuse (emotional, physical, or sexual), living in a severely dysfunctional, neglectful, or violent household, detached or abandoned parenting, or growing up in an environment of ongoing fear and instability.

• The effects of developmental trauma, with profound and enduring brain response and negative impact, can be long-lasting, significantly affecting a person's mental and emotional health well into adulthood.

Those with developmental trauma may struggle with the following:

• Attachment Struggles: Difficulty forming healthy, stable relationships due to mistrust and fear of abandonment.

• Emotional Dysregulation: Challenges in managing emotions, leading to mood swings, intense anger, or depression.

• Dissociation: A coping mechanism where the person disconnects from their current thoughts, feelings, or sense of identity.

• Low Self-Esteem: Persistent feelings of worthlessness, guilt, and shame.

• Behavioral Problems: Engaging in risky or self-destructive behaviors.

• Mental Health Disorders: Increased risk of developing disorders like PTSD, anxiety, depression, and substance abuse.

• Learning: Increased likelihood that the ability to learn is negatively impacted.

Reactive Attachment Disorder (RAD)

Reactive Attachment Disorder (RAD) is a diagnosable condition differentiated by the nature of a child's attachment behaviors and interactions with caregivers and strangers. RAD is characterized by a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers. Children with RAD rarely seek or respond to comfort when distressed. The root of RAD is often extremely insufficient care, such as severe emotional neglect, frequent changes in primary caregivers, or rearing in unusual settings that limit opportunities to form selective attachments (e.g., institutions).

 The primary interventions focus on establishing stable, caring relationships with caregivers to promote secure attachment.

Disinhibited Social Engagement Disorder (DSED)

Disinhibited Social Engagement Disorder (DSED) involves a pattern of behavior where a child actively approaches and interacts with unfamiliar adults in an overly familiar way, without usual hesitation or the typical checking back with a familiar caregiver in new situations.

 Children with DSED do not show the age-typical selectivity in their attachments; they may be overly friendly and may not exhibit fear of strangers. DSED is also associated with experiences of extreme insufficient care. The primary intervention involves establishing a stable, emotionally available, and attuned caregiving relationship to support the child's development of appropriate attachments.

The Difference Between RAD and DSED

The critical difference between RAD and DSED lies in a child's social interactions and attachment behaviors—RAD is characterized by withdrawal and a failure to seek comfort from caregivers. In contrast, DSED is characterized by indiscriminate sociability and a lack of appropriate reticence with strangers. The interventions for both disorders aim at improving the child's care environment, with a strong emphasis on developing secure, stable, and emotionally fulfilling relationships with caregivers.

Differentiating RAD and DSED from Conduct Disorder (CD) or Oppositional Defiant Disorder (ODD)

RAD and DSED are distinct from Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD), which involve more explicit behavioral problems. Conduct Disorder is a pattern of behavior that violates the rights of others or ignores significant societal norms, including aggression toward people and animals, destruction of property, deceitfulness or theft, and serious rule violations. 

Oppositional Defiant Disorder (ODD) involves angry and irritable mood patterns, argumentative, defiant behaviors, or vindictive behaviors.

Their Puzzling Behavior Struggles

Emotional Impairment & Survival Behavior

1. Survivor Brain

Survival behavior in the brain of a child who has experienced trauma, neglect, or insecure attachment is best understood as a developmental response to perceived threats. These behaviors are rooted in the brain's fundamental drive to protect itself and ensure survival. 

2. Fight, Flight, Freeze, Fawn Responses

The amygdala, a key region in emotion processing and fear responses, is central to these survival responses. When a child senses a threat, the amygdala triggers the body's fight, flight, freeze, or fawn response. This can show up as aggressive behavior (fight), avoidance or withdrawal (flight), immobilization (freeze), or fawning - as in making oneself appear as small as possible or invisible if possible. It's important to remember that these responses are not conscious choices but rather automatic survival mechanisms. 

3. Hypervigilance

Children with trauma may develop a heightened awareness of potential threats, known as hypervigilance. The brain is on alert. The prefrontal cortex, a key player in attention and decision-making, may become overly attuned to cues to danger, often at the expense of learning or playing. This can significantly impact the child's ability to focus and engage in normal childhood activities. 

4. Dysfunctional Attachment and Social Engagement

The brain's social engagement system, involving the prefrontal cortex and limbic system, is crucial for interpreting social cues and forming attachments. In children with insecure attachment or those who have experienced trauma, this system may prioritize survival over social engagement. This can lead to difficulty forming healthy relationships, as the brain may interpret closeness or attachment-seeking behaviors as potentially threatening.

5. Significant Emotional Regulation Challenges

The brain's signaling regulates their emotions. Traumatic experiences may lead to difficulties in managing emotions. A child may respond to minor triggers with intense fear, anger, or sadness as the brain defaults to survival mode, perceiving these triggers as threats.

6. Altered Stress Hormone Regulation

The brain's response to stress triggers a flood of cortisol, a stress hormone. In children exposed to prolonged stress or trauma, their response may become totally dysregulated, resulting in either heightened or blunted cortisol responses to stress, and shaping their ability to adapt to future stressors.

7. Neuroplasticity and Adaptation

While the brain's survival responses can be challenging, it has a great capacity for neuroplasticity—the ability to form new neural connections in response to experiences. Positive, supportive, and therapeutic interventions can help rewire the brain's stress responses, promoting more adaptive coping and healthier attachment patterns.

Understanding survival behavior in a child's brain requires a compassionate approach that recognizes these behaviors as adaptations to past experiences rather than as willful defiance, misbehavior, or flawed character. Therapeutic interventions, supportive relationships, and stable, safe environments can significantly contribute to the healing and reorganization of the brain's response mechanisms, allowing for more functional and healthy development.

Seeking Safety Through Control

 Parents report a number of  different controlling behaviors present in children with attachment disruptions:

• Food or eating: Eats alone, eats in the room, steals food, and then doesn't eat it, hides food, eats as if food is not readily available when it is.

• Issues with hoarding: Odd hoarding habits, crossing boundaries to take from others, then giving them away, or hiding them without using them. Collects odd things.

• Incessant lying: Not just to get out of trouble, but lying for no reason, lying to cause others more trouble, extreme lying to manipulate, lying to therapists, lying to CPS, lying to authorities, lying at school, and they may believe their own lies.

• Incessant stealing: Steals things and then doesn't have any use for them; steals; Doesn't respect boundaries or rules about access to what belongs to others—behavioral extremes, crosses boundaries without regard.

• Extreme anger: Also passive-aggressive behavior, especially toward mom (seen in the home but not in public, and sometimes not seen by dad).

• Extreme sexualized behaviors:  May also have strong attachments to electronics like gaming or porn.

• Extreme social problems: Makes friends but then can't keep them, has few friends; immature and developmentally behind his peers, and has social media extremes.

• Substance use and abuse

• Highly manipulative:  often adept at manipulation, including adults, therapists, and teachers.

Mental Health Concerns

• Suicidal ideation, or suicide threat, suicide attempts

• Cutting/Burning/Self-Harm/Suicidal Ideation/Suicide Attempts

• Eating disorders

• Sexualized engagement, Sexual Acting Out, Inappropriate Friendships

• Runaway/Grooming or Trafficking

• Verbal or physical fits of aggression in the home (but not always elsewhere)

• Academic failure – Extreme Academic Struggles

• Extreme Instances of drug or alcohol abuse

• Manipulates parents or other professionals, including trained therapists.

• Mislabeled as ADHD, Bipolar, Borderline Personality Disorder, Conduct Disorder, Dissociative Disorder, though they may be present or develop alongside RAD.

Early Help and Treatment Goals