Relational and Developmental Trauma and Schools

by

Fiona Peacock, Carol Holliday

• LAST REVIEWED: 12 January 2021
• LAST MODIFIED: 12 January 2021
• DOI: 10.1093/obo/9780199756810-0270

Introduction

The use of the term trauma has become widespread in the discourse on mental well-being, mental health, and mental illness. Authors employ a proliferation of terms, such as complex trauma, emotional trauma, historical trauma, and community trauma, including racism and other institutionalized discrimination, interpersonal trauma, and relational and developmental trauma. Other bodies of knowledge, such as the literature about adverse childhood experiences (ACEs), neurobiological understanding of human development, and attachment theory, all interrelate. Exposure to ACEs may increase the risk of trauma responses occurring in individuals, but individual resilience factors can mitigate the long-term mental health impact of such exposure. A felt sense of safety/security developed through early caring relationships underpins personal resilience. Equally disharmonious and neglectful early relationships set an early foundation for vulnerability to the traumatizing impact of ACEs. Thus, in considering the needs of children and young people in the school context, the terms relational trauma and developmental trauma seem the most appropriate to foreground within this review of the literature, as without addressing this form of trauma children will find it difficult to access both general well-being support and/or academic learning opportunities. However, having a broad understanding of the interrelated terms supports the critical evaluation of the appropriateness of various interventions for particular populations within the education system. While some approaches aimed at addressing the roots and impacts of developmental and interpersonal trauma may be suitable for the school setting delivered by skilled educationalists, others are more suited to a clinical setting delivered by counselors, psychotherapists, or other mental health practitioners or by counselors/psychotherapists in the school setting.

General Overviews

Despite the widespread use of the term trauma, it is difficult to offer a single, precise definition of its meaning. Frazier, et al. 2019 gives an overview of the symptoms people show in response to exposure to traumatic material that lead to the fulfilment of the diagnostic criteria of post-traumatic stress disorder (PTSD). The authors acknowledge that this provides a somewhat narrow definition of trauma. Van der Kolk 2015 shows that events that occur in childhood that lead to traumatized responses may not meet these narrow criteria for diagnosis of PTSD yet still have a significant impact on children’s abilities to fully engage with the opportunities that life and education present to them. Formal diagnosis for trauma and stress-related disorders in the Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (American Psychiatric Association 2013) acknowledges that social neglect in the early stages of infancy is significant in the formation of diagnosable disorders. The International Statistical Classification of Diseases and Related Health Problems (ICD-11) of the World Health Organization (World Health Organization 2018) indicates that the diagnosis of complex post-traumatic stress disorder develops from the impact of prolonged, inescapable trauma that is likely to be interpersonal in nature. Ford and Courtois 2016 highlights various approaches to treating complex stress disorders. Struik 2014 provides another approach to the treatment of trauma from the author’s definition of “chronic trauma.” Van der Kolk 2005 suggests that the term developmental trauma disorder is more appropriate for children. The authors of D’Andrea, et al. 2012 use the term interpersonal trauma. The authors of Felitti, et al. 1998 do not use the term trauma, but ACEs are now widely seen as underpinning trauma symptomology and supporting nonsocial behaviors. However, simply experiencing ACEs does not always result in trauma if the environment around the child is appropriately supportive and can provide a felt sense of security through relationships. Stepping away from the medical frame of reference, Sieff 2015 discusses emotional trauma from the perspective of multiple disciplines. While exposure to a single life-threatening incident can lead to post-traumatic stress disorder, a pathway to managing such impact may be different from pathways that address the trauma responses children develop in adapting to developmental and relational trauma where the traumatic material is embedded in the everyday experience of relationship. The common theme in the various terms connected to the forms of trauma that we are focusing on here and we are naming as relational and developmental trauma is that children were repeatedly exposed to experiences that, given the age and developmental stage of the child, would have been felt as relentlessly overwhelming to the child. Exposures that occur before the infant develops a coherent sense of self, where there is insufficient external support to process the overwhelming experience, lead to children developing a response to the world that might become entrenched, asocial, and seemingly disconnected from the drive to form and sustain relationships with others in the absence of reliance and protective factors. The impact of everyday relationships being both the source of threat and the route of processing, the impact of trauma presents particular challenges in the educational setting where the pace of change the child can manage may be at odds with the expectations of the educational environment.

• American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Falls Church, VA: American Psychiatric Association.

  Provides the current DSM-5 categories for trauma and stress-related disorders. The DSM recognizes the close relationship among trauma, stress-related disorders, anxiety, obsessive compulsive disorder (OCD), and dissociative disorders.

• D’Andrea, Wendy, Julian Ford, Bradley Stolbach, Joseph Spinazzola, and Bessel A. van der Kolk. 2012. Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry 82.2: 187–200.

  DOI: 10.1111/j.1939-0025.2012.01154.x

  This paper argues for a wider definition of trauma for children as the diagnostic criteria included in DSM-4 meant that children, presenting with a cluster of symptoms that can occur post exposure to traumatic material in childhood, often received co-morbid diagnosis. This can further pathologize children’s experiences as well as obscure thinking on the best way to support them. The key thrust and critique of this paper is that developing an appropriate diagnosis is not purely a task of definitions but impacts on the development of treatments that are appropriate and effective.

• Felitti, Vincent J., Robert F. Anda, Dale Nordenberg, et al. 1998. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine 14.4: 245–258.

  DOI: 10.1016/S0749-3797(98)00017-8

  This is the seminal work that introduced the idea of adverse childhood experiences (ACEs). The term abuse is used in the paper but not the term trauma. By identifying the correlation between exposure to ACEs and early death Felitti states that more research and training is needed to understand the relationship among social, emotional, and medical problems across the lifespan.

• Ford, Julian D., and Christine A. Courtois, eds. 2016. Treating complex traumatic stress disorders in children and adolescents: Scientific foundations and therapeutic models. New York: Guilford.

  An edited book that looks at a range of approaches to understanding complex trauma in childhood and adolescence. This book is not specifically written for researchers in the field of education but does contain several chapters that present systemic models of treating complex trauma. As such, it may help the researcher to situate education-based interventions in an overarching understanding of theory, individual l treatment models, and systemic treatment models.

• Frazier, Patricia A., Emily M. Abramowski, Viann Nguyen-Feng, Addie Merians, and McKenzie Kaubrys. 2019. Trauma psychology. In Oxford Bibliographies in Psychology. New York: Oxford Univ. Press.

  DOI: 10.1093/OBO/9780199828340-0241

  This Oxford Bibliographies article provides an overview of how trauma is understood from a psychological or medical model perspective. The authors provide a helpful way of thinking about how diagnosis, conceptualization, and language may differ between contexts such as health-related fields and education fields.

• Sieff, Daniela F., ed. 2015. Understanding and healing emotional trauma: Conversations with pioneering clinicians and researchers. New York: Routledge.

  This edited volume gives a multidisciplinary overview of emotional trauma. It brings together these multiple perspectives in offering a stimulating forum to consider trauma across disciplines, which may be beneficial in considering how to respond to trauma in the socially constructed education setting.

• Struik, Arianne. 2014. Treating chronically traumatized children: Don’t let sleeping dogs lie! London: Routledge.

  Using the term chronic trauma, the author in this treatment manual offers a comprehensive approach to understanding and addressing the needs of traumatized children, specifically that there needs to be a proactive and staged approach. As such it is valuable in considering when “chronic trauma” is at a level such that intervention offered within an education setting may need to be integrated with mental health intervention.

• van der Kolk, Bessel A. 2005. Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals 35.5: 401–408.

  DOI: 10.3928/00485713-20050501-06

  This paper argues that diagnostic criteria are not serving traumatized children well and that a diagnosis of developmental trauma disorder is a better fit for the very complex behavioral, emotional, and neurobiological disorders that result from the exposure to traumatizing experiences in childhood.

• van der Kolk, Bessel A. 2015. The body keeps the score: Mind, brain and body in the transformation of trauma. New York: Penguin.

  This book gives a good overview of the impact of trauma on the brain and body. While the book does not define relational or developmental trauma, it implies that the behaviors/symptoms that indicate a child has been “traumatized” develop from the experiences the child has in relationships with primary caregivers.

• World Health Organization. 2018. International classification of diseases (ICD-11). 11th rev. ed. Geneva, Switzerland: World Health Organization.

  ICD-11 distinguishes between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD), the latter developing from stressors that are prolonged, repetitive, and from which escape is difficult or impossible. The stressors are likely to be interpersonal in nature and can result in persistent long-term impairments in affective and relational functioning.