Navigating Between PTSD, ADHD and DTD

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Newsletter #158 for Internationally Adopting Parents
March 13, 2012
PAL Center Inc.

Internet Digest

Notions we live with

Janae B. Weinhold &
Barry K. Weinhold
What is Developmental Trauma?
Developmental trauma is a breakthrough term with roots in both developmental psychology and traumatology. Developmental trauma is inflicted on infants and children unconsciously and most often without malicious intent by adult caregivers who are unaware of children’s social and emotional needs. Infants and children require energetic attunement, skin-to-skin and eye-to-eye contact, kind and comforting words, protection and safety from their mother during gestation, birth and the first years of life.

What is ADHD?
Attention-deficit hyperactivity disorder (ADHD) is a medical condition characterized by difficulties with inattention or hyperactivity and impulsivity. Symptoms of inattention, or hyperactivity and impulsivity must be severe enough to cause impairment in the daily functioning of the person in at least two settings: at home, in school, in the community or in the workplace.

What is PTSD?
Child protection services in the U.S. get around 3 million reports each year. This involves 5.5 million children. Of the reported cases, there is proof of abuse in about 30%. From these cases, we have an idea how often different types of abuse occur:

Sam McLure
When does an internationally adopted child become a United States Citizen?

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Internationally Adopted Child: Navigating Between PTSD, ADHD and DTD

B. Gindis Ph.D.

Identification of the causes and nature of developmental delays and disorders in internationally adopted children is critically important for selecting effective remedial approaches and timely intervention for them, and it remains a complicated and many-folded task for a child psychologist. In one of my articles on the effects of traumatic background of internationally adopted children on their development Developmental Delays in Internationally Adopted Children I spoke already about Developmental Trauma Disorder (DTD) and Cumulative Cognitive Deficit (CCD) as two major self-propelling causes and effects of prolonged developmental delays in international adoptees. In this discussion I would like to dwell more on the difference between Post-Traumatic Stress Disorder (PTSD), Attention Deficit Hyperactivity Disorder (ADHD), and Developmental Trauma Disorder (DTD) that are so typical for internationally adopted children.

PTSD is a condition in which victims of overwhelming negative experiences are affected by intense feelings of fear, helplessness, and vulnerability. PTSD is well researched in adults: clinical description and medical diagnostic criteria are presented in current DSM-lV-TR and ICD-10 publications. It is recognized that this medical condition causes severe anxiety that can develop after exposure to a traumatic event.

Within the last 30 years significant research was done on the same condition in children. It was found that PTSD in children and adults, although common in many aspects, has important differences in clinical picture and means of recovery from this disorder.

In both adults and children PTSD symptoms may last for a long time, and may include disturbing memories or flashbacks (nightmares and fear of re-experiencing traumatic event), avoidance behavior (avoiding thoughts, feelings, conversations regarding an event), hyper-arousal (hyper-vigilance, exaggerated startle response) and hypo-arousal (withdrawn, depression-like behavior).

PTSD is diagnosed in many internationally adopted post-institutionalized children. Moreover, there is an opinion that all international adoptees have PTSD to some degree. This view is somewhat speculative because it is based not on clinical or research data, but rather on the assumption that if institutionalization (and previous life in a neglectful and abusive family) is so traumatic, it must result in PTSD. However, even hypothetically, this is not accurate, because we know that PTSD is the product of the interplay between the nature of a specific traumatic experience and the psychological makeup of the recipient. In other words, the same experience may lead to PTSD in some individuals but not in the others. Vulnerability to PTSD depends on many factors, such as age, previous experiences, general sensitivity, pre-existing medical and psychological conditions, etc.

From the educational and mental health perspectives, it is not productive to accept a notion that all former orphanage-raised children have PTSD as part of their psychological makeup. Although it is true that they as a group are more at risk for PTSD than their peers at large, this diagnosis must be made on an individual basis by a trained mental health professional because the triggers of PTSD reactions in international adoptees may be so diverse and so different from our cultural background that it takes a specialist in psychological issues of international adoption to figure it out. Thus, some of the triggers could be as common as threat of physical punishment: it was reported by many adoptive parents that any action that had even remote resemblance to corporal punishment may trigger a reaction that can only be explained by previous traumatic experiences.

At the same time some triggers could be rather "exotic", such as the sight of falling snow flakes or the sound of the child's native language.

Once the clients in my office mentioned, among other problems with their 8 year old daughter adopted from Russia 4 years ago, that she cannot use hot or even warm water, and her bathing is a "big deal" in their family: she cries and screams every time and looks horrified. At that moment I was unable to explain this phenomenon, just mentioned that this looks like PTSD type behavior. Only next day, reviewing the original (in the Russian language) court documents, related to adoption and not translated to the adoptive parents, I found that the biological mother of the girl was incarcerated for spraying her daughter with boiling water. The child was rescued by the relatives, the burn marks on her skin were barely noticeable by now and could not be explained to the adoptive parents - the girl was only 8 months old at the time of this incident. She, of course, did not remember this experience consciously, but her body did remember the trauma and hot water was a real trigger of PTSD in her.

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