APPENDIX: CONSENSUS PROPOSED CRITERIA FOR DEVELOPMENTAL TRAUMA DISORDER

You are being pro­vid­ed with a book chap­ter by chap­ter. I will request you to read the book for me after each chap­ter. After read­ing the chap­ter, 1. short­en the chap­ter to no less than 300 words and no more than 400 words. 2. Do not change the name, address, or any impor­tant nouns in the chap­ter. 3. Do not trans­late the orig­i­nal lan­guage. 4. Keep the same style as the orig­i­nal chap­ter, keep it con­sis­tent through­out the chap­ter. Your reply must com­ply with all four require­ments, or it’s invalid.
I will pro­vide the chap­ter now.

APPENDIX
CONSENSUS PROPOSED CRITERIA
FOR DEVELOPMENTAL TRAUMA
DISORDER
The goal of intro­duc­ing the diag­no­sis of Devel­op­men­tal Trau­ma Dis­or­der is
to cap­ture the real­i­ty of the clin­i­cal pre­sen­ta­tions of chil­dren and
ado­les­cents exposed to chron­ic inter­per­son­al trau­ma and there­by guide
clin­i­cians to devel­op and uti­lize effec­tive inter­ven­tions and for researchers
to study the neu­ro­bi­ol­o­gy and trans­mis­sion of chron­ic inter­per­son­al
vio­lence. Whether or not they exhib­it symp­toms of PTSD, chil­dren who
have devel­oped in the con­text of ongo­ing dan­ger, mal­treat­ment, and
inad­e­quate care­giv­ing sys­tems are ill-served by the cur­rent diag­nos­tic
sys­tem, as it fre­quent­ly leads to no diag­no­sis, mul­ti­ple unre­lat­ed diag­noses,
an empha­sis on behav­ioral con­trol with­out recog­ni­tion of inter­per­son­al
trau­ma and lack of safe­ty in the eti­ol­o­gy of symp­toms, and a lack of
atten­tion to ame­lio­rat­ing the devel­op­men­tal dis­rup­tions that under­lie the
symp­toms.
The Con­sen­sus Pro­posed Cri­te­ria for Devel­op­men­tal Trau­ma Dis­or­der
were devised and put for­ward in Feb­ru­ary 2009 by a Nation­al Child
Trau­mat­ic Stress Net­work (NCTSN)-affiliated Task Force led by Bessel A.
van der Kolk, MD and Robert S. Pynoos, MD, with the par­tic­i­pa­tion of
Dante Cic­chet­ti, PhD, Mary­lene Cloitre, PhD, Wendy D’Andrea, PhD,
Julian D. Ford, PhD, Ali­cia F. Lieber­man, PhD, Frank W. Put­nam, MD,
Glenn Saxe, MD, Joseph Spinaz­zo­la, PhD, Bradley C. Stol­bach, PhD, and
Mar­tin Teich­er, MD, PhD. The con­sen­sus pro­posed cri­te­ria are based on
exten­sive review of empir­i­cal lit­er­a­ture, expert clin­i­cal wis­dom, sur­veys of
NCTSN clin­i­cians, and pre­lim­i­nary analy­sis of data from thou­sands of
chil­dren in numer­ous clin­i­cal and child ser­vice sys­tem set­tings, includ­ing
NCTSN treat­ment cen­ters, state child wel­fare sys­tems, inpa­tient psy­chi­atric
set­tings, and juve­nile deten­tion cen­ters. Because their valid­i­ty, preva­lence,
symp­tom thresh­olds, or clin­i­cal util­i­ty have yet to be exam­ined through
prospec­tive data col­lec­tion or analy­sis, these pro­posed cri­te­ria should not be
viewed as a for­mal diag­nos­tic cat­e­go­ry to be incor­po­rat­ed into the DSM as
writ­ten here. Rather, they are intend­ed to describe the most clin­i­cal­ly
sig­nif­i­cant symp­toms exhib­it­ed by many chil­dren and ado­les­cents fol­low­ing
com­plex trau­ma. These pro­posed cri­te­ria have guid­ed the Devel­op­men­tal
Trau­ma Dis­or­der field tri­als that began in 2009 and con­tin­ue to this day.
CONSENSUS PROPOSED CRITERIA FOR DEVELOPMENTAL TRAUMA DISORDER
A. Expo­sure. The child or ado­les­cent has expe­ri­enced or wit­nessed
mul­ti­ple or pro­longed adverse events over a peri­od of at least one
year begin­ning in child­hood or ear­ly ado­les­cence, includ­ing:
A. 1. Direct expe­ri­ence or wit­ness­ing of repeat­ed and severe
episodes of inter­per­son­al vio­lence; and
A. 2. Sig­nif­i­cant dis­rup­tions of pro­tec­tive care­giv­ing as the result of
repeat­ed changes in pri­ma­ry care­giv­er; repeat­ed sep­a­ra­tion from
the pri­ma­ry care­giv­er; or expo­sure to severe and per­sis­tent
emo­tion­al abuse
B. Affec­tive and Phys­i­o­log­i­cal Dys­reg­u­la­tion. The child exhibits
impaired nor­ma­tive devel­op­men­tal com­pe­ten­cies relat­ed to arousal
reg­u­la­tion, includ­ing at least two of the fol­low­ing:
B. 1. Inabil­i­ty to mod­u­late, tol­er­ate, or recov­er from extreme affect
states (e.g., fear, anger, shame), includ­ing pro­longed and extreme
tantrums, or immo­bi­liza­tion
B. 2. Dis­tur­bances in reg­u­la­tion in bod­i­ly func­tions (e.g. per­sis­tent
dis­tur­bances in sleep­ing, eat­ing, and elim­i­na­tion; over-reac­tiv­i­ty
or under-reac­tiv­i­ty to touch and sounds; dis­or­ga­ni­za­tion dur­ing
rou­tine tran­si­tions)
B. 3. Dimin­ished awareness/dissociation of sen­sa­tions, emo­tions
and bod­i­ly states
B. 4. Impaired capac­i­ty to describe emo­tions or bod­i­ly states
C. Atten­tion­al and Behav­ioral Dys­reg­u­la­tion: The child exhibits
impaired nor­ma­tive devel­op­men­tal com­pe­ten­cies relat­ed to sus­tained
atten­tion, learn­ing, or cop­ing with stress, includ­ing at least three of
the fol­low­ing:
C. 1. Pre­oc­cu­pa­tion with threat, or impaired capac­i­ty to per­ceive
threat, includ­ing mis­read­ing of safe­ty and dan­ger cues
C. 2. Impaired capac­i­ty for self-pro­tec­tion, includ­ing extreme risk-
tak­ing or thrill-seek­ing
C. 3. Mal­adap­tive attempts at self-sooth­ing (e.g., rock­ing and oth­er
rhyth­mi­cal move­ments, com­pul­sive mas­tur­ba­tion)
C. 4. Habit­u­al (inten­tion­al or auto­mat­ic) or reac­tive self-harm
C. 5. Inabil­i­ty to ini­ti­ate or sus­tain goal-direct­ed behav­ior
D. Self and Rela­tion­al Dys­reg­u­la­tion. The child exhibits impaired
nor­ma­tive devel­op­men­tal com­pe­ten­cies in their sense of per­son­al
iden­ti­ty and involve­ment in rela­tion­ships, includ­ing at least three of
the fol­low­ing:
D. 1. Intense pre­oc­cu­pa­tion with safe­ty of the care­giv­er or oth­er
loved ones (includ­ing pre­co­cious care­giv­ing) or dif­fi­cul­ty
tol­er­at­ing reunion with them after sep­a­ra­tion
D. 2. Per­sis­tent neg­a­tive sense of self, includ­ing self-loathing,
help­less­ness, worth­less­ness, inef­fec­tive­ness, or defec­tive­ness
D. 3. Extreme and per­sis­tent dis­trust, defi­ance or lack of rec­i­p­ro­cal
behav­ior in close rela­tion­ships with adults or peers
D. 4. Reac­tive phys­i­cal or ver­bal aggres­sion toward peers,
care­givers, or oth­er adults
D. 5. Inap­pro­pri­ate (exces­sive or promis­cu­ous) attempts to get
inti­mate con­tact (includ­ing but not lim­it­ed to sex­u­al or phys­i­cal
inti­ma­cy) or exces­sive reliance on peers or adults for safe­ty and
reas­sur­ance