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Treatment of Post-traumatic Stress Disorder

Risks and Development

Individuals with developmental disabilities have an increased risk of developing post-traumatic stress disorder compared to the general population due to heightened vulnerability to negative life experiences, including:


 * Interpersonal trauma
 * Abuse
 * Dependence on caregivers
 * Lack of autonomy
 * Diminished social support
 * Harassment
 * Stigma and prejudice

Post-traumatic stress disorder is a psychological disorder that can develop after experiencing or witnessing trauma and is characterized by negative thoughts, memories, or dreams about the trauma, avoidance of reminders of the trauma, adverse changes in thinking and mood, and heightened acute stress response. Post-traumatic stress disorder often goes undiagnosed among individuals with developmental disabilities due to providers' and caregivers' lack of understanding and communication.

Individuals with developmental disabilities may develop more intense symptoms of post-traumatic stress disorder when compared to the general population due to maladaptive coping and neurological differences. . These symptoms may manifest differently depending on the severity of the disability; post-traumatic stress disorder may present as challenging behaviors such as aggression and self-harm, and communication of symptoms may be limited by verbal ability. Mental health problems are often reported by proxy rather than self-report, which can increase the risk of underreporting and of psychological symptoms going undiagnosed.

Psychological Treatment

Diagnosis, assessment, and treatment approaches for post-traumatic stress disorder typically require verbal communication and insight into cognitions, emotions, and functioning. Individual differences in communication and intellectual ability among individuals with developmental disabilities can limit identification and treatment of post-traumatic stress disorder symptoms. Thus, diagnosis and treatment approaches should be modified to fit the individual.

Individuals with developmental disabilities may have difficulty understanding and articulating negative thought processes and emotions associated with traumatic events. Metaphors, simplified explanations, and explicit examples may help elucidate symptoms of post-traumatic stress disorder and improve understanding of treatment approaches. Frequent prompting, repetition of explanations, and developing detailed timelines of life events may also improve focus and engagement in psychological treatment. Providers should clearly understand individual needs and abilities and ensure that expectations for treatment are consistent with individual abilities and functioning.

The following trauma-specific treatments have demonstrated efficacy among individuals with developmental disabilities, particularly when tailored to individual needs and presentation.

Child-Parent Psychotherapy

Child-parent psychotherapy is a relational treatment that focuses on improving child-parent relationships and functioning following a young child's exposure to one or more traumatic experiences. This treatment is designed to enhance the attachment relationships between children and their caregivers, eliciting a sense of safety and improving emotional regulation and behavior. Children with developmental disabilities have a higher risk of exposure to traumatic events than children within the general population. Child-parent psychotherapy can be adapted to accommodate non-verbal communication, making it a good fit for children with a wide range of developmental disabilities. Child-parent psychotherapy has been demonstrated to reduce symptoms of post-traumatic stress disorder in children with developmental disabilities and may help enhance caregivers' understanding of their children's disabilities and individual needs.

Exposure Therapy

Exposure-based therapies are the most common treatments for post-traumatic stress disorder. Exposure therapy involves exposing a patient to a source of stress (such as a memory or reminder of a traumatic event) to increase tolerance to feared stimuli, overcome avoidance, and gradually reduce acute stress response symptoms of post-traumatic stress. Exposure therapy should be carefully tailored to the individual when treating individuals with developmental disabilities to reduce the risk of re-traumatization. There is evidence that exposure therapy paired with relaxation techniques, cognitive restructuring, and problem-solving can reduce symptoms of post-traumatic stress disorder among individuals with developmental disabilities.

Trauma Focused Cognitive Behavioral Therapy

Trauma focused cognitive behavioral therapy is a short-term treatment that focuses on reducing and changing negative and unhelpful thought processes related to traumatic experiences and processing and managing associated negative emotions. Differences in language and thinking can make cognitive-based interventions challenging for individuals with developmental disabilities. Still, there is evidence that trauma focused cognitive behavioral therapy can be adapted to be accessible and beneficial for individuals with mild developmental disabilities.

Eye-Movement Desensitization and Reprocessing

Eye-movement desensitization and reprocessing is a psychological treatment in which the patient's stress is reduced by associating traumatic experiences with bilateral stimulation such as rapid, rhythmic eye movements or tapping. Eye-movement desensitization is demonstrated to be highly effective at reducing symptoms of post-traumatic stress disorder across individuals with varrying severity of intellectual disabilities. Eye-movement desensitization can be adapted for individuals with limited language abilities, making it accessible to a wide range of developmental disabilities.