When Diagnostic Labels Mask Trauma

A growing body of research shows that many seriously troubled children and adolescents are reacting to adverse life experiences. Yet traditional diagnostic labels are based on checklists of surface symptoms. Distracted by disruptive behavior, the common response is to medicate, punish, or exclude rather than respond to needs of youth who have experienced relational trauma. Among the most traumatized youth are those removed from family, school, and community and placed in residential settings. Whether in treatment or juvenile justice programs, the focus is more on managing disruptive behavior rather than fostering healing and growth. As trauma expert Sandra Bloom (1997) suggests, the question should not be "What is wrong with you?" but rather "What has happened to you?" This article describes findings from the Adolescent Subjective Experience of Treatment (ASET) study of youth in residential treatment settings. Their exposure to Adverse Childhood Experiences was surveyed. While a majority of youth had experienced serious trauma, the diagnoses they were given usually failed to acknowledge these experiences.