Research domain criteria and the study of trauma in children: Implications for assessment and treatment research

Abstract

By definition, the Diagnostic and Statistical Manual (DSM) diagnosis of posttraumatic stress disorder (PTSD) requires exposure to a traumatic event. Yet, the DSM diagnostic requirements for children and adolescents for PTSD may fail to capture traumatized youth with significant distress and functional impairment. Many important studies have utilized PTSD diagnosis as a mechanism for grouping individuals for comparative studies examining brain functioning, neuroendocrinology, genetics, attachment, and cognition; however, focusing only on those with the diagnosis of PTSD can miss the spectrum of symptoms and difficulties that impact children who experience trauma and subsequent impairment. Some studying child trauma have focused on examining brain and biology of those with exposure and potential impairment rather than only those with PTSD. This line of inquiry, complementary to PTSD specific studies, has aided our understanding of some of the changes in brain structure and neuroregulatory systems at different developmental periods following traumatic exposure. Application of the Research Domain Criteria (RDoC) framework proposed by NIMH to the study of child trauma exposure and subsequent impairment is an opportunity to examine domains of function and how they are impacted by trauma. Research to date has focused largely in the areas of negative valence, regulatory, and cognitive systems, however those studying complex or developmental trauma have identified an array of domains that are impacted which map onto many of the RDoC categories. This paper will review the relevant literature associated with child trauma as it relates to the RDoC domains, outline areas of needed research, and describe their implications for treatment and the advancement of the field.

Posttraumatic stress disorder as a diagnostic entity – clinical perspectives

“…RDoC criteria for PTSD have been designed for adults as well as for children. 36,37 After reviewing the criteria for PTSD research, Schmidt and Vermetten have proposed incorporating emotional and stress regulation constructs, and consciousness status, which will allow the better identification of some subtypes of PTSD. 38 The theoretical model of the hyperarousal subtype of PTSD is a good example to understand the complementation of the symptoms with the neurobiological basis that support them according to RDoC criteria.…”

The impact of neurofeedback training on children with developmental trauma: A randomized controlled study.

“…Children who receive multiple diagnoses as a result of early abuse and/or neglect within their caregiving system often are refractory to evidence-based treatment regimens and tend to receive costly and fragmented treatment regimens (Comer, Olfson, & Mojtabai, 2010; Grella & Joshi, 2003; Saldana, Chamberlain, Bradford, Campbell, & Landsverk, 2014; Sege et al, 2017). The main clinical issue that interferes with successful implementation of traditional evidence-based psychotherapeutic treatments is lack of affect regulation (Erwin et al, 2018; Heleniak, Jenness, Stoep, McCauley, & McLaughlin, 2016; Stover & Keeshin, 2018). There is little evidence that pharmacological interventions predictably improve affect regulation (Morina et al, 2016), which supports the urgent need to discover effective interventions to improve affect dysregulation.…”

The Child PTSD Symptom Scale: Psychometric Properties among Earthquake Survivors

“…Additionally, application of the Research Domain Criteria (RDoc) framework-with a symptom domain rather than diagnostic threshold focus-to the design, implementation, analysis, and interpretation of future studies could improve our understanding of PTSD validity crossculturally [51]. RDoc is a potentially useful framework, especially when looking at PTSD in trauma-exposed children and adolescents, since it includes children who may otherwise be excluded due to strict diagnostic criteria [52][53][54]. In addition, improved and standardized collection of demographic, cultural, and exposure data will help us identify the factors, if any, that lead to different expression of PTSD symptoms in children and adolescents.…”