Abstract
Developmental Trauma Disorder (DTD) is a proposed child psychopathology diagnosis with emotion/somatic, attention/behavioral, and self/relational dysregulation symptoms extending beyond posttraumatic stress disorder (PTSD). Confirmatory factor analyses (CFAs) tested four structural models with structured interview data for trauma history, PTSD, and DTD with 507 children receiving mental health or pediatric care ( N = 162, 32% diagnosed with DTD; N = 176; 35% with PTSD; N = 169, 33% with neither). A unidimensional model with a single latent variable had unacceptable fit (RMSEA = 0.094; CFI = 0.844). Compared to a model with PTSD and DTD as correlated first-order latent variables, a multidimensional model with correlated latent variables corresponding to the PTSD and DTD symptom clusters (Dc 2 =105.62, Ddf = 14, p < .001) and a hierarchical variant with correlated second order DTD and PTSD latent variables (Dc 2 =48.10, Ddf = 6, p < .001) fit the data better. The non-hierarchical multidimensional model was superior to the hierarchical variant (Dc 2 =66.05, Ddf = 8, p < .001). Stronger latent variable inter-correlations within PTSD and DTD domains than across domains, suggested that DTD and PTSD are distinguishable despite their inter-correlation. Exposure to family violence was the primary correlate of both the DTD and PTSD second-order latent variables. Results indicate that children’s trauma-related symptoms involve six inter-correlated domains extend beyond PTSD’s symptoms (i.e., re-experiencing, avoidance, arousal) to include DTD symptoms of emotional, cognitive-behavioral, and self-relational dysregulation. The inter-relationship of the DTD and PTSD latent variables suggest that DTD may constitute a component within a complex PTSD diagnosis paralleling the new adult CPTSD diagnosis.
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Notes
We propose that the high SRMR is attributable to local misfit rather than global model misfit as the post-hoc addition of a single parameter could lower the SRMR to acceptable limits. For example, adding a correlated residual between D5 DTD (Psychological boundary deficits) and D6 DTD (Impaired capacity to regulate empathic arousal) results in improved fit (χ2 = 942.074, df = 448, p < .001; RMSEA = 0.047 (90%CI = 0.042, 0.051); CFI = 0.962; TLI = 0.958; SRMR = 0.079).
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Acknowledgements
The study was funded by the Lookout Foundation, Joseph Spinazzola, Ph.D., and Julian Ford, Ph.D., Principal Investigators. The authors gratefully acknowledge the contributions of the National Child Traumatic Stress Network Developmental Trauma Disorder Work Group, co-led by Robert Pynoos, M.D. (UCLA Department of Psychiatry) and Bessel van der Kolk, M.D., to the conceptual framework and initial item development of the Developmental Trauma Disorder Semi-structured Interview (DTD-SI), and the field site coordinators and interviewers who accomplished the data collection for this study.
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Ford, J.D., Shevlin, M., Karatzias, T. et al. Can Developmental Trauma disorder be distinguished from posttraumatic stress disorder? A confirmatory factor Analytic Test of Four Structural Models. Res Child Adolesc Psychopathol 50, 1207–1218 (2022). https://doi.org/10.1007/s10802-022-00916-2
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DOI: https://doi.org/10.1007/s10802-022-00916-2