Toward an empirically based Developmental Trauma Disorder diagnosis and semi‐structured interview for children: The DTD field trial replication

Abstract

Objective Developmental trauma disorder (DTD) is a childhood psychiatric syndrome designed to include sequelae of trauma exposure not fully captured by PTSD. This study aimed to determine whether the assessment of DTD with an independent sample of children in mental health treatment will replicate results from an initial validation study. Methods The DTD semi‐structured interview (DTD‐SI) was administered to a convenience sample in six sites in the United States (N = 271 children in mental health care, 8–18 years old, 47% female, 41% Black or Latinx) with measures of trauma history, DSM‐IV PTSD, probable DSM‐IV psychiatric diagnoses, emotion regulation/dysregulation, internalizing/externalizing problems, and quality of life. Confirmatory factor (CFA) and item response theory (IRT) analyses tested DTD’s structure and DTD‐SI’s information value. Bivariate and multivariate analyses tested DTD’s criterion and convergent validity. Results A three‐factor solution (i.e., emotion/somatic, attentional/behavioral, and self/relational dysregulation) best fit the data (CFI = 0.91; TLI = 0.89; BIC = 357.17; RMSEA = 0.06; SRMR = 0.05). DTD‐SI items were informative across race/ethnicity, gender, and age with three exceptions. Emotion dysregulation was the most informative item at low levels of DTD severity. Non‐suicidal self‐injury was rare but discriminative in identifying children with high levels of DTD severity. Results supported the criterion and convergent validity of the DTD construct. Conclusion This replication provides empirical support for DTD as a construct and potential psychiatric syndrome, and the DTD‐SI’s validity as a clinical research tool.

Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach

“…Each symptom was assessed with a descriptive statement followed by optional probe questions. Three Criterion B symptoms, two Criterion C symptoms and two Criterion D symptoms were identified as optimal for a diagnosis of DTD (Ford et al, 2018(Ford et al, , 2022. Inter-rater agreement across raters for a random sub-sample of interviews across all DTD-SI items was 87-100% (M = 93.0% agreement on child interviews: 93.5% agreement on parent/guardian interviews).…”

“…Two surveys of clinicians (DePierro et al, 2019; and two field trial studies have demonstrated DTD's construct, convergent and discriminant validity. In the field trial studies, a structured interview for DTD was validated, and threefactor analytically derived sets of symptoms have been identified and replicated (Ford et al, 2018;Ford et al, 2022). The first DTD domain is affective/ somatic dysregulation (Criterion B), based on research and theory demonstrating that maladaptive emotion processing and emotion dysregulation constitute a link between childhood adversity and psychopathology (Aldao et al, 2016;Beauchaine & Cicchetti, 2019;Conway et al, 2018;Heleniak et al, 2016;McLaughlin et al, 2020;Weissman et al, 2019).…”

“…attention deficit hyperactivity disorder, oppositional defiant disorder) disorders (Ford et al, 2021;van der Kolk et al, 2019). Although DTD and PTSD often were present in combination, each syndrome occurred separately from the other in 15-20% of the field trial sample (Ford et al, 2018;Ford et al, 2022).…”

“…We hypothesized that those distinct classes would be found and that the DTD-only and combined DTD + PTSD classes would be more strongly associated than a PTSD-only class (or a low DTD/PTSD symptoms class) with past victimization and attachment trauma and current externalizing disorder comorbidity in pair-wise comparisons. Based on item response theory analyses from the original and replication phase of this DTD field trial, which showed invariance in DTD symptoms across gender and race/ ethnicity (Ford et al, 2018(Ford et al, , 2022, we also hypothesized that the identified classes would not differ on gender or racial/ethnic composition.…”

Sequenced Relationship-Based Psychotherapy for Complex Posttraumatic Stress Disorder: Commentary on the Application of the Model to the Hybrid Case of "Chloe"

“…Chloe's intense bond with her younger sister was an understandable means of gaining some security on both their parts, but it apparently took the form of "two of us against the world" that left her with difficulty in forming other emotional attachments. These are precisely the traumatic features that characterize complex developmental trauma: a combination of ongoing victimization and a rupture or absence of secure emotional bonding with primary caregivers-both of which may occur, as apparently was the case for Chloe, not due to any intentional maltreatment or violence, but unintentionally or negligently by caregivers impaired by their own psychological, relational, and addictive problems (Ford et al, 2022;Ford et al, 2018). Although her mother's near suicide clearly was traumatic for Chloe, it occurred in a larger context of ongoing complex developmental trauma and past threats that involved all of Chloe's primary family members across three generations, and that evidently left her feeling relatively alone and detached from her family and friendships as well as primary romantic relationships (i.e., no close friends, repeated infidelity).…”