RESEARCH REGARDING EFFECTS OF CHILDHOOD MALTREATMENT Constellations of Interpersonal Trauma and Symptoms in Child Welfare: Implications for a Developmental Trauma Framework Cassandra L. Kisiel & Tracy Fehrenbach & Elizabeth Torgersen & Brad Stolbach & Gary McClelland & Gene Griffin & Kristine Burkman Published online: 27 December 2013 # Springer Science+Business Media New York 2013 Abstract Patterns of trauma exposure and symptoms were examined in a sample of 16,212 children in Illinois child wel- fare. Data were collected on trauma histories, child and caregiver needs and strengths, and analyzed in light of the proposed Developmental Trauma Disorder diagnostic criteria. Youth ex- posed to both interpersonal violence and attachment-based (“non-violent”) traumas within the caregiving system had sig- nificantly higher levels of affective/physiological, attentional/ behavioral, and self/relational dysregulation in addition to post- traumatic stress symptoms compared to youth with either type of trauma alone or in relation to other trauma experiences. These complexly traumatized children exhibited higher levels of func- tional impairment and were more likely to have placement disruptions and psychiatric hospitalizations. Findings suggest a developmental trauma framework can more adequately capture the spectrum of needs of these multiply traumatized youth than existing diagnostic formulations. Utilizing this framework for assessment, treatment planning, and intervention can lead to more targeted and effective services for these children. Keywords Complex trauma . Developmental trauma disorder . Posttraumatic stress . Child . Youth . Caregiver Many children in the child welfare system have been exposed to multiple and chronic traumatic experiences. National sur- veys of child protection in the United States report the number of children who experience various types of abuse and neglect (e.g., U.S. Department of Health and Human Services [HHS], 2010), but tend not to report specific statistics on the number of children exposed to multiple, interpersonal traumas (e.g., combinations of abuse and neglect). Various studies with youth from child welfare have demonstrated that the experi- ence of combined forms of abuse and neglect is common (Greeson et al. 2011; Griffin et al. 2011; Jonson-Reid et al. 2003; Macdonald et al. 2010; Turner et al. 2010). In fact, researchers in the area of child trauma have proposed that between 46 % and 90 % of all children in child welfare have experienced multiple adverse and/or traumatic experiences (Lau et al. 2005). Exposure to multiple and chronic interpersonal trauma in childhood, typically occurring within the caregiving system— often referred to as complex trauma exposure—is associated with a complex range of symptoms and impairments across several areas of development. Studies have shown that expo- sure to complex, interpersonal trauma is linked to a greater number and severity of functional and mental health problems both in child welfare and in other service settings (D’Andrea et al. 2012; Finkelhor et al. 2009; Greeson et al. 2011; Kisiel et al. 2009b; Spinazzola et al. 2005). Existing empirical evi- dence indicates that children as well as adults exposed to multiple types of interpersonal trauma in childhood exhibit greater symptom complexity and more severe impairment overall (Briere et al. 2008; Cloitre et al. 2009; Ford et al. 2009; Ford et al. 2010; Greeson et al. 2011; Griffin et al. 2011; Kisiel et al. 2009b). Complex trauma responses include difficulties with affect and impulse regulation, self-perception, somatization, attachment and interpersonal relations, attention, and challenges with systems of meaning (Cook et al. 2003; C. L. Kisiel (*) : T. Fehrenbach : E. Torgersen : G. McClelland : G. Griffin Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, 12th floor, Chicago, IL 60611, USA e-mail: c-kisiel@northwestern.edu B. Stolbach Department of Pediatrics, The University of Chicago Priztker School of Medicine, Chicago, IL, USA K. Burkman Department of Psychology, San Francisco VA Medical Center, San Francisco, CA, USA J Fam Viol (2014) 29:1–14 DOI 10.1007/s10896-013-9559-0