The challenges of treating developmental trauma disorder in a residential agency for youth

In recent years the task of psychiatrists serving youth in residential programs has largely shifted to rendering diagnostic evaluations and prescribing medications. Children in residential facilities are often misdiagnosed and treated with high doses of multiple medications drawn from several different classes of psychopharmaceuticals. The more accurate diagnosis for many of these children, Developmental Trauma Disorder (DTD), reconceptualizes the treatment approach and leads to substantial clinical benefit. Initiating treatment through application of milieu and dynamic psychotherapy and the tapering of medication very likely will encounter the challenges of staff resistance and the modification of the residence's institutional culture. The number of children receiving medication, the amount and number of medications used, and the number of aggressive incident reports fell dramatically over a 2-year period. Regarding mood and conduct disorders as manifestations of past trauma, rather than as biochemical imbalances, is the dominant focus of an analytically-informed treatment of DTD.