Recently, child and adolescent psychiatric practice in Japan has increasingly provided psychiatric treatment for children with different problems who grew up in an adverse environment. Children with such adverse experiences often present with symptoms of complex posttraumatic stress disorder, especially disturbance in self-organization, and they exhibit a combination of aggressiveness toward others and self-destructiveness upon referral. When becoming involved in such cases, assessment for case-formulation should be carried out. When assessing, a bio-psycho-social model that pertains to the onset of mental illnesses should be employed and all relevant factors must be evaluated comprehensively. It is especially important when formulating the case of a child who grew up in an adverse environment to emphasize evaluation of the nurturing environment, including the presence of abuse and familial dysfunction, developmental characteristics, including the developmental history and neurodevelopmental disorders, and characteristics relevant to the development of self and personality, including attachment styles and effects of adverse experiences such as child abuse. Treatment provided based on the results of such case formulation takes into account the following four points of action and combines therapeutic techniques for each: biological factors, interactive effects between the child and caregiver, the child's personality and stress-coping style, and stress factors outside the home. Treatment for children who grew up in an adverse environment promotes three therapeutic aspects: stopping and preventing aggression and self-destructiveness, protection, and providing them care and nurturing, promoting spontaneous self-nurturing. Treatment helps the children experience these aspects continuously.
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