Journal of Aggression, Maltreatment & Trauma, 22:611–625, 2013

Copyright © Taylor & Francis Group, LLC

ISSN: 1092-6771 print/1545-083X online
DOI: 10.1080/10926771.2013.804470

RESEARCH ON VICTIMS OF TRAUMA

Developmental Trauma Disorder: A Provisional

Diagnosis

COREY M. TEAGUE
Department of Psychology, Middle Tennessee State University,
Murfreesboro, Tennessee, USA

Developmental trauma disorder is a provisional disorder that char-

acterizes multiple trauma exposure that impairs certain domains
of human development. These domains are attachment, cognition,
behavior regulation, affect regulation, self-concept, dissociation,
and biological functioning and maturation. This article reviews
the literature and discusses the present understanding of these
7 domains. It discusses the effects of developmental trauma expo-
sure on each domain and alludes to the importance of clinicians
understanding the complexity and diversity of development trauma
outcomes.

KEYWORDS childhood trauma, complex trauma, developmental,

interpersonal trauma, trauma

Developmental trauma disorder (DTD) is a provisional disorder devel-

oped by van der Kolk (2005) and his team of researchers to address
the needs of children and adolescents with a history of traumatic events
(i.e., abuse, witnessing domestic violence, loss of parent due to divorce,
incarceration or death, unstable parental permanency, etc.) that take place
in primary relationships. The identified impairment domains (attachment,
cognition, affect regulation, self-concept, behavior regulation, dissociation,

Received 30 October 2011; revised 18 July 2012; accepted 30 August 2012.

Address correspondence to Corey M. Teague, Department of Psychology, Middle
Tennessee State University, MTSU Box 0087, Murfreesboro, TN 37132. E-mail: cteague@
mtsu.edu

611
612 C. M. Teague

and maturation/biological) found in children and adolescents experiencing

developmental trauma have the potential to have a negative effect on the
child or adolescent’s academic achievement (Blaustein et al., 2007; Teague,
2010; van der Kolk, 2007; van der Kolk et al., 2009). These impairments
seem to be connected to emotional and social issues presented by a trau-
matized child. According to Roth, Newman, Pelcovitz, van der Kolk, and
Mandel (1997), interpersonal trauma, early onset of the trauma, and duration
of the trauma predicts a higher risk of a child developing these impairments.
Betrayal trauma theory gives a supportive description and explanation for
DTD as it relates to trauma exposures and outcomes. The betrayal trauma
theory addresses the significance of the perception of betrayal as a motivator
to interpersonal trauma (e.g., trauma at the hands of the caregiver) and the
reponse to that trauma (DePrince, Chu, & Pineda, 2011; Tang & Freyd, 2011).
That is, DTD can be understood as the experince of severe betrayals (i.e.,
multiple sufferings) in a percieved trusting intimate childhood or adolescent
relationship that interferes with functioning.
Developmental trauma can consist of single or multiple traumas.
However, most children experiencing developmental trauma experience
multiple traumas. In a study completed by Spinazzola et al. (2003), 77.6%
of the children experiencing trauma had experienced multiple traumas.
These findings support the argument affirming the complexity and sever-
ity of childhood trauma. Green et al. (2000) explored symptom severity
associated with multiple and single exposures to trauma. This study not
only reassessed the outcomes of trauma but also assessed the severity of
these outcomes based on the number of trauma exposures experienced.
Green et al. found that individuals exposed to multiple traumas, exclud-
ing interpersonal trauma, had significantly more severe trauma symptoms.
These findings support the argument affirming the debate that developmen-
tal trauma can have more devastating effects on children than the current
mental health classifications can characterize. Margolin and Vickerman
(2007) went on to say that the ongoing nature of family violence expo-
sure for children can complicate the mental health diagnosis process due
to the multiple problems that emerge and the severity of those prob-
lems. When there is no classification that comprehensively characterizes
this issue, it forces treatment to focus on the identified behavior and not
underlying developmental impairments. Blaustein et al. (2007) argued the
following:

Although the narrowly defined PTSD diagnosis is often used, it rarely

captures the extent of the developmental impact of multiple and chronic
trauma exposure. Other diagnoses common in abused and neglected
children include Depression, Attention Deficit Hyperactivity Disorder
(ADHD), Oppositional Defiant Disorder (ODD), Conduct Disorder,
Generalized Anxiety Disorder, Separation Anxiety Disorder, and Reactive
 Developmental Trauma Disorder 613

Attachment Disorder. Each of these diagnoses captures an aspect of the

traumatized child’s experience, but frequently does not represent the
whole picture. As a result, treatment often focuses on the particular
behavior identified, rather than on the core deficits that underlie the
presentation of complexly traumatized children. (p. 6)

The studies and literature mentioned support the complexity and diver-
sity of the outcomes related to developmental trauma. Multiple and single
traumas seem to have complex and diverse outcomes if that trauma involves
primary relationships or environments. Much progress has been made
toward a new DTD diagnosis. However, there seem to be some factors
that have halted this progress. According to Weinhold and Weinhold (2010)
and Wylie (2010), these factors are (a) the perception that the symptoms of
DTD are too broad and possibly displaces current disorders, (b) the present
gap between academic research (quantitative) and clinical practice (qualita-
tive), and (c) the lack of funding to complete academic research specifically
related to DTD. Wylie went on to argue that the DTD research that has
already been done is more substantial compared to most provisional disor-
ders that have been proposed, accepted, and included in the Diagnostic and
Statistical Manual of Mental Disorders (American Psychiatric Association,
2000).
Several studies and theoretical and practical literature have been
reported that support the need for a new diagnosis that captures the effects
of developmental trauma on children (Briere & Spinazzola, 2005; Courtois,
2004; Luxenberg, Spinazzola, & van der Kolk, 2001). The contructs of
attachment, cognition, affect regulation, self-concept, behavior regulation,
dissociation, and maturation/biological development have been described,
understood, and influenced for many years. However, research is defin-
tely continuous in these areas and in the area of being able to predict
the normative and nonmormative (i.e., unexpected) development of each.
Nevertheless, it is very important for clinicians to understand the complexity
and diversity of developmental trauma when attempting to assess or treat
children and adolescents who have experienced this type of trauma. The
official recognition of DTD will allow mental health professionals to assess
and treat the underlying issues of developmental trauma and avoid provid-
ing treatment that only scratches the surface (Wylie, 2010). In the effort to
endorse or not endorse DTD, mental health professionals might benefit from
a continuous review and elaboration on studies and theoretical literature
published that address the impairments related to DTD in general and in
relation to trauma. This is an effort to review those studies and literature to
increase understanding of the seven impaired domains related to DTD, elab-
orate on the effects of developmental trauma exposure on each domain, and
state the importance of describing and understanding developmental trauma
as it relates to mental health professionals.
614 C. M. Teague

ATTACHMENT

Attachment refers to the powerful emotional bond that develops between

the child and his or her caregiver (Belsky, 2010; Bukatko, 2008; Rathus,
2010). Attachment develops first between the child and his or her primary
caregiver. This emotional bond that the child has with the primary caregiver
is the child’s initial enduring but variable internal representation of the care-
giver in relation to self and the environment. However, secondary emotional
bonds do develop, and these attachments usually take place with siblings,
extended family members, and teachers. These attachments that develop can
be secure or insecure. Secure attachment exists and is easier to develop when
the caregiver provides a receptive and sensitive environment for the child
(Blaustein et al., 2007). Children who have a secure attachment have fewer
challenges and adjust better in settings such as school. Academic achieve-
ment has been predicted by a secure working model of attachment (Cowan,
Cowan, & Mehta, 2010; Marcus & Sanders-Reio, 2001). Children have fewer
maladaptive thoughts and behaviors when they can sense that their attach-
ment figure is accessible, reliable, and sensitive (Bowlby, 1973; Cowan
et al., 2010). Therefore, children who experience inconsistent, insensitive, or
nonreceptive environments might have more challenges in daily functioning.
Developmental trauma can interfere with a child’s development of a
secure attachment with his or her caregiver and others in different environ-
ments. The absence of a caregiver who reliably and responsively protects
and nurtures the child is the greatest source of danger and unpredictability
(Blaustein et al., 2007). Interpersonal trauma exposures that involve primary
attachment figures could cause the child to mistrust his or her environment
and react in an insecure manner in stressful situations or situations perceived
to be stressful. This lack of trust and healthy experience can lead to ambiva-
lent or avoidant behaviors or poor decision making pertaining to building
relationships. When a child is traumatized by the caregiver, it interferes with
the child having an adequate mental representation of healthy interpersonal
interactions that cause the child to exert control by disconnecting from social
relationships, acting coercively toward others, or not being able to appropri-
ately discern the intentions of others (Blaustein et al., 2007; Luxenberg et al.,
2001). These negative outcomes have the potential to negatively influence a
child’s functioning in different life relationships and situations.

COGNITION

Cognitive development is a progressive process that includes attention,

perception, memory, language, problem solving, creativity, and decision
making. According to Sternberg (2006), cognition refers to how people
perceive, learn, remember, and think about information. This process is
 Developmental Trauma Disorder 615

also linked to the development of cognitive executive functions. Executive

functions are adaptive, goal-directed cognitive abilities that allow individuals
to override automatic or established thoughts and responses that might be
inappropriate or ineffective in presented situations (Garon, Bryson, & Smith,
2008). Individuals without adequate development of executive functions and
the other cognitive abilities will have problems adjusting socially and in dif-
ferent social experiences. In a study conducted by Nixon and Nishith (2005),
the findings supported the argument affirming that maladaptive cognitions
contribute to maladaptive adjustment. Understanding cognition helps us to
better understand why people do what they do. Therefore, a child’s cognitive
development informs the outcomes he or she will have in many settings.
Developmental trauma might interfere with a child’s development of
cognitive abilities. These cognitive challenges emerge and interfere with the
child’s life. In the developmental trauma study conducted by Spinazzola et al.
(2003), cognitive abilities were found to be one of the most frequent difficul-
ties experienced by a child experiencing developmental trauma. Crozier and
Barth (2005) conducted a study examining 2,368 school-age children and
found that maltreated children, on average, scored significantly below the
national norms on standardized tests of cognitive functioning. Nevertheless,
cognitive development does not stop due to interpersonal trauma. It seems
to take a different, less adaptive course and show some signs of delay.
A child experiencing developmental trauma demonstrates delays in expres-
sive and receptive language development and less flexibility and creativity
in problem-solving tasks and shows deficits in attention and abstract reason-
ing (Blaustein et al., 2007). These findings support the argument affirming
that impaired cognitive development will negatively affect the child’s social
functioning.

AFFECT REGULATION

Affect refers to an individual’s emotions from moment to moment. Regulating

our emotions from moment to moment takes a conscious effort. Affect
consciousness refers to the ability to adequately perceive, reflect on, and
express affect (Mohaupt, Holgersen, Binder, & Nielsen, 2006). It is the
ability to differentiate among states of arousal, interpret these states, and
apply appropriate labels (Blaustein et al., 2007). Therefore, adequate affect
regulation requires cognition. However, when an individual does not have
the ability to regulate affect this seems to be an unconscious phenomenon
and therefore no cognition is activated when certain emotions emerge. The
individual in this case is responding to what has been sensed and perceived
from the environment or from within without reflection or judgment. The
lack of affect regulation could definitely cause problems in the life of the
individual. The development of affect regulation takes place at an early
616 C. M. Teague

age. It is a progression from infancy to childhood to adulthood (Buckner,

Mezzacappa, & Beardslee, 2009). A child’s interaction with the environment
provided by the caregiver allows the child give each experience meaning.
Therefore, development of emotional self-regulation must be learned within
the interpersonal arena (Mohaupt et al., 2006).
Developmental trauma’s interpersonal nature might interfere with a
child’s development of his or her ability to regulate affect. According
to Courtois (2004), interpersonal traumas in children are associated with
alterations in the regulation of affective impulses, including difficulty with
modulation of anger and self-destructiveness. This potential outcome of
developmental trauma can have long-lasting effects on a child’s psychosocial
development due to maladaptive emotional overreaction, underreaction, or
both in critical and noncritical situations. That is, developmental trauma inter-
feres with the development of moment-to-moment emotional regulation and
causes long-term emotional dysregulation (Courtois & van der Kolk, 2005;
van der Kolk, 2005). In a study completed by Chang, Schwartz, Dodge,
and McBride-Chang (2003), it was found that children develop maladaptive
overreactions (i.e., easy to frustrate, sadden, and anger) to harsh parenting.
Maladaptive overreaction occurs when there is the absence of the ability to
self-soothe. Self-soothing takes place when the individual is conscious of and
makes meaning of the emotions that are connected to a certain stimuli from
the environment. Developmental trauma seems to interfere with the devel-
opment of appropriate meanings or overrides the previous learned meanings
of particular emotions, causing the individual to develop a confused frame-
work, which disrupts interpretation emotions. According to Kelly, Zuroff, and
Shapira (2009), self-soothing characteristics consist of being kind and under-
standing toward oneself at times of disappointment and distress. Barnard
and Curry (2011) went on to suggest that self-soothing is synonymous with
self-compassion, which entails being kind and understanding in the face of
stress, being able to put suffering into perspective, and being mindful of
painful thoughts and feelings. The disruption or retarding of these abilities
increases the chances for maladaptive emotional reactions. Emotional under-
reaction and overreaction to the environment would seem to disrupt a child’s
ability to be successful in different social settings.

SELF-CONCEPT

Self-concept is one of an individual’s internal and external measures of his

or her abilities and skills. This internal and external framework makes up
an individual’s self-concept (Dickhauser, 2005; Moller, Streblow, Pohlmann,
& Koller, 2006). Self-concept is based on cumulative judgments with a past
orientation. That is, individuals make global judgments about themselves
based on their past successes and failures. According to Burnholt (2005),
 Developmental Trauma Disorder 617

self-concept is conceptualized as thoughts one has about his or her sit-

uations. The internal framework of self-concept refers to the individual’s
internal comparison of situations and experiences. The external framework
of self-concept refers to the individual’s social comparison of situations and
experiences. Self-concept is connected to personal feelings based on pos-
itive and negative actions and reactions from the environment toward the
individual or how individuals perceive that they are perceived by others
(Bellmore & Cillessen, 2006). Therefore, our perceptions about our past (e.g.,
we are competent, we are industrious, or we are lovable) contribute to our
self-concept. Consequently, sometimes negative past situations might involve
experiencing trauma that might or might not adversely affect an individual’s
self-concept.
DTD has been associated with low self-concept in children. Traumatized
children can manifest alterations in their sense of self as early as early child-
hood (Blaustein et al., 2007). The family is the initial agent of socialization
for the child and therefore provides the child with sense of who he or she
is socially. These early relationships have a profound influence on a child’s
development of a coherent sense of self (Blaustein et al., 2007). An adverse
nature in these relationships could interfere with how children perceive
themselves and their abilities. Developmental trauma is definitely an adverse
situation for a child that could negatively alter his or her global self-concept
(e.g., powerlessness, incompetence). A study was conducted with trauma-
tized and nontraumatized toddlers to examine their self-concept, and it was
found that traumatized toddlers were more likely to respond with negative
emotion toward a self-recognition task (Blaustein et al., 2007). Problems in
this “self” domain have been implicated in the development of dysfunction
in social and life skills.

BEHAVIOR REGULATION

Behavioral regulation refers to the ability for an individual to control his or

her behavior. Internalized and externalized behaviors are the two dimensions
of children’s behavior problems (Henricsson & Rydell, 2006). Dysregulation
of behavior will involve internalizing tendencies, externalizing tendencies,
or both. Externalized behaviors are those behaviors that are direct in
nature; that is, these behaviors are directed toward another individual or
object. Externalized behaviors are a problem when they become disruptive.
According to Belsky (2007) and Henricsson and Rydell (2006), external-
ized problematic behaviors are characterized as being disruptive or harmful
to others. Therefore, these behaviors are easily observed. Dysregulation of
externalized behaviors are explicit expressions directed toward the environ-
ment. Internalized behaviors are more implicit in that they are not overt; that
is, internalized behaviors might present as withdrawal or somatic complaints
618 C. M. Teague

(Henricsson & Rydell, 2006). Belsky (2007) went on to say that internalizing
tendencies involve intense fear, social inhibition, and often behaviors seen
in depressed individuals. Nevertheless, internalized or externalized behavior
regulation allows for action inhibition where action inhibition is appropriate
for the situation. Inhibitory control involves the ability to plan and suppress
inappropriate behaviors toward themselves or the environment (Batum &
Yagmurlu, 2007). There have been many studies on the history of trauma in
children and how it affects the ability regulate behavior.
Developmental trauma is associated with children’s inability to plan
and suppress inappropriate behaviors toward themselves or the environ-
ment (Blaustein et al., 2007; van der Kolk, 2005). It is a human phenomenon
that behavior thoughts and plans are evoked in many situations. Children
experiencing developmental trauma find it hard to “put on the brakes”
when inappropriate behavior plans and thoughts are evoked. These behav-
iors take on different patterns and sometimes seem to be a comfort for the
child. According to Blaustein et al. (2007) and Briere and Spinazzola (2005),
children experiencing developmental trauma will exhibit rigidly controlled
behavior patterns, including compulsive compliance with adult requests,
resistance to changes in routine, inflexible bathroom rituals, and rigid control
of food intake. They can also exhibit behaviors that are not controlled, such
as aggression, oppositional defiance, and even conduct disorder. However,
these behaviors, controlled or not controlled, seem to be coping strategies
for the children. Blaustein et al. (2007) called the dysregulation of behavior
in traumatized children defense responses to extreme stress. The absence of
healthy and the aforementioned unhealthy coping strategies could lead to
more unhealthy coping strategies such as cutting or drugs use.

DISSOCIATION

Dissociation, in the field of mental health, is associated with feelings of

detachment. This detachment is a disconnection from oneself and the
environment. Dissociation has also been characterized as an individual
having blank spells, memory lapses, momentary confusion, hypnotic trance,
fugue states, or altered personality (Hansell & Damour, 2008; Thomas, 2005).
According to Blaustein et al. (2007), dissociation refers to the failure to
integrate or associate information with experience (e.g., cognition without
affect, affect without cognition, lack of awareness of somatic sensations, or
lack of awareness of behavioral repetitions). Unlike affect dysregulation,
dissociation is more than the lack of ability to inhibit emotion. Dissociation is
the loss of an individual’s global sense of complete connection with self and
the world. This loss of connection provides an escape from overpowering
situations. It causes the individual to “numb out” or feel like they are “in a
daze.” Different theorists agree with this notion and state that dissociation is
 Developmental Trauma Disorder 619

a defense mechanism that protects people from experiences that have been
perceived and judged as being too overwhelming (Briere & Spinazzola,
2005; Liotti, 2004; Thomas, 2005). These characteristics of dissociation
suggest that overwhelming, distressful, and overpowering experiences
interfere with the structure and function of consciousness. These types of
experiences are generally related to traumatic events.
Developmental trauma can lead to the overdevelopment of avoidance
activities such as dissociation (Briere & Spinazzola, 2005; Lawson, 2009).
Dissociation runs along a continuum from normal kinds of experiences, such
as getting lost in thoughts while driving (mild), to peritraumatic dissociation
during traumatic exposures (transient), to dissociative disorders (extensive;
Blaustein et al., 2007; Courtois, 2004). The progression of dissociation can
lead to problems for the child in the face of negative experiences as well
as positive experiences. According to Mauss et al. (2011), dissociation dur-
ing positive experiences impedes social connection, which can interfere
with well-being. Nevertheless, the overwhelming experience of interpersonal
trauma elicits this survival response that becomes part of the child’s life and
therefore withstands the problems that might arise because of it. Therefore,
dissociation has a function when the child has experienced interpersonal
trauma. According to Blaustein et al. (2007), dissociation has three functions:
(a) it provides an automatic response, (b) it allows the child to compartmen-
talize painful memories and feeling, and (c) it allows the child to detach from
himself or herself all in the face of extreme trauma. Developmental trauma
promotes the function of dissociation, which does not create an environment
of love and belonging, but allows the child to have a sense of safety during
traumatic experiences or when there is an emergence of painful memories
and feelings. This avoidance response to developmental trauma would seem
to have an adverse effect on a child’s functioning.

MATURATION

Maturation refers to the typical pathways of biological and physical devel-

opment that allow for successful interaction in the environment without
accommodation. From birth, children go through different sequences, stages,
and continuous biological and physical development. This development
includes the balance of chemicals and systems in the body, brain devel-
opment, mass to specific, proximodistal, head to toe (cephalocaudal)
development, and more. These typical pathways of maturation are influ-
enced by the environment and genetics. Dalton (2005) argued that adverse
outcomes in child development, even developmental disorders, should not
be attributed only to the maturation process, but also to the environment.
Rutter and O’Connor (2004) conducted a study in which they examined the
early biological programming and neural development of children reared in
620 C. M. Teague

an enriched environment versus children reared in a deprived environment,

and found that the children reared in the deprived environment showed
signs of biological programming or neural damage. Therefore, this “hard-
wired” process can be disrupted or modified by external stimuli. Disruption
and modification in the maturation process could interfere with developmen-
tal milestones and promote illness (Blaustein et al., 2007). This makes sense
because the maturation process responses to the environment are expected
or adaptive responses. That is, some outcomes are expected after certain
experiences (e.g., enriched environment leads to normal somatic develop-
ment), whereas other outcomes are adaptive after certain experiences (e.g.,
specifics of the experience lead to a particular form of somatic development;
Rutter & O’Connor, 2004).
Developmental trauma is an experience that elicits adaptive and
expected responses from the biological and physical maturation processes.
These responses not only take place in the social context (nurture) but
also within the body of the individual at a cellular and chemical level, and
seem to be implicated the other six impairment outcomes of developmental
trauma. A comprehensive review of brain structure and chemical interactions
is beyond the scope of this article; however, Henry, Sloan, and Black-
Pond (2007) provided information pertaining to specific biological structures,
shown in Table 1. Research shows that nurture can influence the develop-
ment of the brain’s sensory and motor systems. In a study in which rats were
subjected to developmental trauma, Uys et al. (2006) found that when the
rats were subjected to repeated stress they had higher basal levels of corti-
costerone (CORT), lower levels of brain-derived neutrophic factor (BDNF)
in the dorsal hippocampus, and lower levels of neurotrophin-3 (NT-3) in
dorsal and ventral hippocampus. Adequate levels of BDNF and NT-3 have
been shown to mediate responses to anxiety and depression-provoking sit-
uations; NT-3 contributes to neuron differentiation, synaptic plasticity, and
neuron survival; and high levels of CORT could lead to neuron loss in the
hippocampus (Uys et al., 2006).
Blaustein et al. (2007) concluded that trauma interferes with the inte-
gration of the left and right hemispheres, and that many studies, past and
present, show the negative effects of trauma on brain development. Lawson
(2009) affirmed this argument by positing that neurobiological development
and functioning are disrupted by intense and prolonged trauma, which
alters brain chemistry, hormonal activity, myelination, and size and sym-
metry of various brain structures. The distress from interpersonal trauma
also has been implicated as a catalyst of physical ailments, some of them
being connected with the disruption in biological maturation. According to
Luxenberg et al. (2001), the number of traumas has a positive relationship
with decreased physical health. Consequently, traumatized children might
complain of certain physical symptoms. Some symptoms are diagnosable
by a physician, whereas others might not be able to be diagnosed due to
 Developmental Trauma Disorder 621

TABLE 1 Central Nervous System Brain Structures That are Affected by Trauma and Prenatal
Alcohol Exposure

Region of brain Purpose

Attachment
Neurotransmitters Chemical messengers that allow different brain structures
to communicate
Hypothalamic–pituitary– Multiorgan network that allows the organism to respond
adrenal (HPA) axis swiftly and proficiently to perceived threat (fight/flight/
freeze response)
Amygdala Primary role in emotion and threat detection-initiates the
fight/flight/freeze response
Hippocampus Involved in new memory acquisition and learning;
involved in emotional regulation and smoothly
integrating the two halves of the brain
Fusiform face area (FFA) Necessary for facial recognition (e.g., infant recognition of
caregiver)
Affect regulation (control of
emotion)
Locus ceruleus Vital area in brain stem involved in alertness and arousal
Thalamus Central relay station in the middle of the brain, relays
sensory information to appropriate regions of the brain
Corpus callosum Connects the right and left hemispheres and allows
information to cross from one hemisphere to the other
Striatum, nucleus accumbens Reward center of the brain
Orbitofrontal cortex Regulates emotion, social behavior, planning and decision
making
Information processing
Amygdala and hippocampus Involved in new memory formation
Anterior cingulated Associated with conflict monitoring, conflict resolution,
and executive function (e.g., rehearsal, attention)
Orbitofrontal cortex Essential for conscious decision making
Note. Reprinted with permission from Table 1: Central nervous system brain structures affected
by trauma and prenatal alcohol exposure, from the article, “Neurobiology and neurodevelopmental
impact of childhood traumatic stress and prenatal alcohol exposure” by J. Henry, M. Sloane & C.
Black-Pond, published in Language, Speech, and Hearing Services in Schools, 38, 99–108. © 2007,
American-Speech-Language-Hearing Association. All rights reserved.

no obvious physical cause. Ailments such as irritable bowel, chronic pelvic

pain, headaches, and acid stomach are diagnosable, but temporary blindness,
tingling of the extremities, and seizure-like activity might not (Luxenberg
et al., 2001). The potential broad effects of developmental traumas on the
biological and physical processes have a clear impact on children.

DISCUSSION

Developmental trauma is characterized by a child’s exposure to a single

severe or multiple traumas in primary relationships and environments, and
the effects of the trauma on developmental tasks as opposed to a single
trauma with localized effects that does not affect developmental task. The
outcomes of localized (e.g., fearfulness) and developmental (e.g., the course
622 C. M. Teague

of developmental task) trauma are different, just as the outcomes of multiple

traumas and single trauma are different. Adult trauma seems to have more
localized outcomes compared to that of a child, whose trauma outcomes
tend to be more developmental.
The study of child victimization should differ conceptually from that
of adults with adequate childhood development because there are many
developmental processes in childhood that are sensitive to their personal
environment (Briere & Spinazzola, 2005; Finkelhor, 1995). That is, childhood
trauma can have much more complex outcomes compared to the trauma
outcomes of adults. However, some might argue the accomplishment of
developmental tasks does not stop after adolescence and therefore trauma
with an adult age onset can influence developmental tasks as well and be
just as complex. For instance, identity development might arise as an impor-
tant developmental task during adolescence but some people experience
an extended period beyond adolescence during which identity explorations
continue (Tanner, 2006), and having the ability to make adjustments in adult
situations is a task that is seen to be important in adulthood (Staudinger &
Kunzmann, 2005). However, trauma that takes place during early develop-
ment might impair the foundation of an individual’s development, which in
turn increases the chances of deficit in needed future developmental tasks.
Briere and Spinazzola (2005) concluded that trauma takes place on a com-
plexity continuum based on age at onset, the interpersonal nature of the
trauma, and number of traumatic incidents. Early-age onset, multiple, per-
sonal trauma is at the high side of trauma outcome complexity, whereas
later-age onset, single, nonpersonal trauma is at the low side of trauma
outcome complexity.
DTD characterizes the traumatic events in the lives of children while
diagnostically classifying the complex and severe potential outcomes associ-
ated with dysfunction. It describes the experience of multiple or chronic and
prolonged developmentally adverse traumatic events, most often of an inter-
personal nature and early-life onset, and dysfunctional outcomes on multiple
levels (van der Kolk, 2007). These outcomes impair certain developmental
tasks that allow the child to interact, adjust, and thrive in his or her envi-
ronment. Developmental trauma impairs the development or fine-tuning of
these tasks. According to Blaustein et al. (2007) and van der Kolk (2005), the
impairments associated with developmental trauma (attachment, maturation
or biological, affect regulation, dissociation, behavioral regulation, cognition,
and self-concept) interfere with different levels of the child’s life.

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