Childhood trauma, including abuse and neglect, is probably the single most important public health challenge in the United States – a challenge that has the potential to be largely resolved by appropriate prevention and intervention. Each year over 3 million children are reported for abuse and/or neglect in the United States (Wang & Daro, 1997). The effects of abuse and neglect are well documented to persist over time. Although posttraumatic stress disorder (PTSD) has received much attention in the research and clinical literature, it is not the most common psychiatric diagnosis in children with histories of abuse and neglect (Putnam, 2003).Separation anxiety disorder, oppositional defiant disorder, and phobic disorders may all be more frequent diagnoses than PTSD in abused children, and attention-deficit hyperactivity disorder (ADHD) is common as well (Ackerman, Newton, McPherson, Jones, & Dykman, 1998).
Because there is only one trauma-related diagnosis in the fourth edition of the Diagnostic and Statistical Manual (DSM–IV), the effects of trauma on children are generally described under the rubric of PTSD, with numerous additional comorbid diagnoses to describe the many other psychological and biological functions that are disturbed by life experiences that may overwhelm the coping mechanisms of the growing human organism. When the DSM–IV was under development, extensive research was conducted to support the introduction of complex PTSD or disorders of extreme stress not otherwise specificed (DESNOS) as an extended diagnosis for children and adults who were victims of prolonged interpersonal abuse (Herman, 1992; van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005).