Child neglect and abuse are perhaps the most significant community health challenge in the United States.1 Mental health experts in trauma continue to investigate and apply a condition known as developmental trauma disorder (DTD), which is characterized by permanent changes in the neurobiologic system of children and adolescents who have been chronically exposed to various types of maltreatment during sensitive periods of childhood development.1 It is believed that a specific criterion is urgently needed to improve recognition of the unique profile DTD victims encompass and to avoid misdiagnosis or confusion with other psychological syndromes, such as posttraumatic stress disorder (PTSD).1
In addition, the effects of DTD continue in adulthood and tend to correlate with multiple health problems.1 Medical providers may consider DTD an underlying cause of several conditions, including depression, anxiety, attention-deficit disorder (ADD), borderline personality disorder (BPD), chronic pain or fatigue, various addictions, and eating disorders.1 During clinical assessment, identifying a history of childhood trauma may broaden therapeutic choices and improve patient outcomes.
This article describes some of the neurobiologic consequences of DTD, including cognitive, emotional, social, and somatic manifestations. Common treatment modalities for DTD are discussed, including reasons to support or oppose DTD as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Child maltreatment statistics
The National Child Abuse and Neglect Data System (NCANDS) is a federally supported organization that analyzes and records statistical data regarding claims of child maltreatment.2 For calculation purposes, duplicate counts indicate the frequency a child is deemed a victim of abuse, and unique counts represent one incident of abuse, despite the number of times a child was officially reported as maltreated.2
In 2014, the NCANDS revealed that from a population of 6.6 million children, approximately 3.6 million cases of alleged child maltreatment were referred to child protection services (CPS).2 Among 3.9 million reports considered as duplicate counts, a total of 2.1 million cases warranted CPS involvement.2 An additional 3.2 million reports assessed as unique counts also warranted further CPS investigation.2 A final analysis from these reviews concluded 702,000 children were considered victims of maltreatment. The alarming findings revealed millions of potential child maltreatment reports requiring social service’s attention.
In the majority of cases, maltreatment consisted of neglect (75.0%) and physical abuse (17.0%), occurring predominantly in children from birth to 1 year.2 Victim gender rates included females (50.6%) and males (48.9%). Racial frequency comprising more than 88% of reported victims involved Caucasians (44.0%), African Americans (21.4%), and Hispanics (22.7%).2 It was further estimated that 98.9% of child maltreatment acts are committed by a main caregiver; 54.1% of the perpetrators are women and 44.8% are men, and the average age of offenders is 18 to 44 years.2 Most complaints of maltreatment were reported by a professional (62.7%), such as a legal associate, or academic and social service employees.2
The national mortality rates occurring from 2010 to 2014 are shown in Table 12 and only involve children who died as a result of maltreatment committed by a parent (79.3%) or other major caregiver.3 Sadly, the latest victim fatality figures equated that more than four children die every day as the result of mainly neglect and/or physical abuse, or in conjunction with another type of maltreatment.3 The most vulnerable groups are children aged 4 years or younger, with 70.7% of deaths occurring in children aged younger than 3 years.3 A breakdown of ethnicity rates reveals that 88.4% of total deaths were Caucasian (43.0%), African American (30.3%), and Hispanic (15.1%).2 In addition, a shocking study regarding childhood mortality suggests that “50% of deaths reported as “unintentional injury deaths” are reclassified after further investigation by medical and forensic experts as deaths due to maltreatment.”3
It is certainly worth noting that only a fraction of child maltreatment cases and related deaths are referred to CPS, indicating formal statistics do not identify the other countless instances of neglect and abuse, or the inappropriate dismissal of child maltreatment by a social worker, healthcare provider, family member, or other bystander. Children are often unable to report mistreatment for many causes, such as insufficient language capability, self-blame, feelings of guilt, and/or fear of retribution from the perpetrator. For these, and many other reasons, child neglect and abuse can be considered a serious and silent epidemic.1