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MAP-D

A trauma informed lens for understanding neurodivergence

Medical: Incorporates physical and neurological data, including neuroimaging, lab work, sleep studies, and any objective indicators that connect biology to behavior.

Advocacy: Centers patient voice, self-knowledge, and social context (including trauma, discrimination, and access to care)

Psychological: Captures emotional regulation, mental health history, trauma exposure, mood patterns, and relational dynamics through a clinical lens.

Developmental: Acknowledges neurodivergence, childhood environment, and lifespan factors that shape expression and resilience

What is MAP-D?

MAP-D is a trauma-informed developmental framework for assessing neurodivergent individuals, especially those with developmental delays, behavioral challenges, and mood disorders. It was designed to reduce misdiagnosis and vague labeling by combining physical, behavioral, and experiential data to create holistic, accurate treatment plans that consider both mind and body.

Why MAP-D is Needed

Many current tools overlook trauma or reduce people to symptom clusters
MAP-D fills the gap with a multi-dimensional compassionate lens
Designed to honor complexity and individuality in care.

MAP-D Framework

Medical & Physical Assesment

We begin with objective, body-based data to ground our understanding. This may include neuroimaging, genetic testing, or other physiological evaluations that can highlight patterns in brain structure, nervous system function, or biomarkers. By starting with the body, we identify real, measurable traits that are often overlooked in traditional assessments.

Behavioral Insight & Clinical Observation

Next, we gather input from therapists, teachers, caregivers over time, not just during isolated clinical moments. This includes patterns in regulation, interaction, motor planning, and executive functioning. These observations help us understand how symptoms show up day-to-day, in real-world environments, and guide the development of informed hypotheses.

Lived Experience & Narrative Tracking

Finally, we prioritize the voice of the individual. Through symptom journals, sensory mapping, interviews, and story-based input, we access the internal world that data can't measure. This layer honors trauma history, personal insight, and identity, ensuring the plan reflects the full human, not just the diagnosis.

The three pillars create a multidimensional profile that supports accurate diagnosis and a treatment plan that addresses both mind and body. MAP-D doesn't just describe what is wrong, it creates pathways for recovery.

Research At A Glance

Trauma’s Impact on Executive Function

Trauma, especially in early development, disrupts the brain’s executive functioning, affecting memory, attention, decision-making, and emotional regulation. Studies have shown that childhood trauma alters the structure and connectivity of the prefrontal cortex, hippocampus, and amygdala, leading to long-term cognitive and behavioral challenges (Teicher et al., 2016). These changes can mimic or mask neurodevelopmental conditions like ADHD or autism, making it difficult to distinguish between trauma responses and baseline neurodivergence. MAP-D addresses this by making trauma exposure and context a core part of developmental assessment, never a footnote.

Overlap Between ADHD, PTSD, and Mood Disorders

ADHD, PTSD, anxiety, and depression frequently overlap in both symptoms and brain patterns. Executive dysfunction, emotional lability, and impulsivity are common across these diagnoses, but are often treated as separate entities. A person with trauma-induced hypervigilance might be misdiagnosed with ADHD. A child with ADHD may also develop trauma due to years of mislabeling or punishment. MAP-D uses a transdiagnostic lens that doesn’t force complex experiences into narrow labels. Instead, it maps patterns across time and domains, improving clarity and reducing misdiagnosis.

The Case for Neuroimaging—And Its Limits

Neuroimaging tools like fMRI, EEG, and DTI have expanded our understanding of mental health, but alone, they’re not enough. Structural differences are often found across multiple diagnoses, and studies rarely control for trauma history, socioeconomic context, or comorbidity. This leads to overgeneralized findings that don't translate to accurate treatment. MAP-D proposes a multi-modal approach, using imaging in tandem with behavioral observation, lived experience, and symptom tracking. We don’t rely on any single tool. Instead, we treat data as one piece of a person’s story, allowing for more individualized and meaningful conclusions.

Beyond the DSM: Rethinking Labels

The DSM, while useful for standardization, has major limitations. It was never designed to account for the nuances of trauma, environmental stress, or mixed presentations. Many individuals receive vague or shifting diagnoses, such as "emotional dysregulation" or "behavioral disorder", when in reality, they’re navigating complex biopsychosocial realities. MAP-D moves beyond static labeling by using layered profiles that reflect change over time, interdisciplinary input, and functional challenges. Our framework echoes the movement toward dimensional models, like the NIMH’s RDoC, which focus on brain-behavior-environment interactions rather than checklists.

Sample MAP-D Profile: Jordan R.

Client ID: MAPD-0119

Age: 11

Evaluator: Jane Doe, Behavioral Therapist
Date of Evaluation: August 2025

Setting: School observation, clinic-based assessment, caregiver interviews

Medical Domain: Objective Insights

Jordan presents with overlapping neurobiological and sensory challenges that were not captured by standard behavioral screens.

qEEG results reveal elevated frontal theta-to-beta ratio, consistent with attention dysregulation but also observed in trauma-exposed populations.
fNIRS imaging shows reduced prefrontal oxygenation during tasks requiring inhibition, suggesting executive fatigue.
Blunted cortisol curve indicates chronic stress exposure with possible HPA axis disruption.
Sensory profile highlights auditory and tactile hypersensitivity with observable sensory-driven distress.

Interpretation:
While Jordan initially screened positive for ADHD, MAP-D findings point to sensory-integrated stress responses and trauma-related executive overload—patterns frequently missed in conventional diagnostic protocols.

Advocacy Domain: System Navigation

Jordan’s caregivers report significant challenges obtaining services despite ongoing behavioral concerns.

School support has been minimal, with IEP services delayed or denied despite documented need.
Caregivers were not informed of restraint incidents and have struggled to access neuropsychological evaluation due to insurance barriers.

Recommendations:

Submit MAP-D findings as supplemental evidence for IEP eligibility review.
Refer caregivers to local advocacy resources with trauma-informed training.
Initiate a coordinated care team involving school, pediatrician, and therapist to ensure follow-through.

MAP-D highlights the importance of advocacy literacy in navigating structural gaps in care access, especially for trauma-impacted youth.

Psychological Domain: Emotional & Behavioral Profile

Jordan exhibits symptoms often mislabeled as oppositional but are better understood through a trauma-informed lens.

Behavior is marked by high arousal, rigidity, and explosive reactions in response to perceived threat or overwhelm.
Emotional regulation is severely compromised, but empathy, narrative memory, and moral reasoning are preserved.
Trauma screen (UCLA PTSD Index) exceeds clinical threshold, and attachment style is disorganized with variable trust in adults.

Interpretation:
Rather than oppositional defiant disorder (ODD), Jordan’s profile reflects complex developmental trauma and sensory-linked emotional dysregulation requiring a relational, not punitive, intervention model.

Developmental Domain: Learning & Social Processing

Early history includes delayed expressive language and motor coordination difficulties.
Current academic struggles include working memory, flexible thinking, and task initiation, despite strong verbal reasoning.
Social misattunement and peer isolation are compounded by sensory overwhelm and black-and-white thinking.

Interpretation:
Jordan displays asynchronous development—a spiky profile where strengths mask critical areas of need. His academic and social-emotional challenges are deeply intertwined, requiring a coordinated and context-aware response.

MAP-D Summary & Reframe

Traditional Labels Assigned: ADHD, ODD
MAP-D Integrated Interpretation:
Jordan’s difficulties are best understood as the result of trauma-related neurodevelopmental disruption, not fixed pathology. His symptoms reflect chronic stress exposure, under-identified sensory processing differences, and executive function deficits masked by strong language skills.

Recommendations Include:

Trauma-focused CBT
Occupational therapy targeting sensory integration
Executive function coaching
Strengths-based, restorative behavioral plans
IEP review with integrated MAP-D report
Reassessment biannually

MAP-D offers a reframing that validates lived experience, strengthens clinical accuracy, and leads to more targeted, effective interventions.

MAP-D Resources

Impact of Trauma on Executive Functioning

Op den Kelder, Rosanne, et al. “Executive Functions in Trauma-Exposed Youth: A Meta-Analysis.” European Journal of Psychotraumatology, vol. 9, no. 1, 2018, article 1450595.
https://www.tandfonline.com/doi/full/10.1080/20008198.2018.1450595
Johnson, Dylan, et al. “Associations of Early-Life Threat and Deprivation With Executive Functioning in Childhood and Adolescence: A Systematic Review and Meta-Analysis.” JAMA Pediatrics, vol. 175, no. 11, 2021, e212511.
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2782621
Matte-Landry, Alexandra, et al. “Cognitive Outcomes of Children With Complex Trauma: A Systematic Review and Meta-Analyses of Longitudinal Studies.” Trauma, Violence, & Abuse, vol. 24, no. 4, 2023, pp. 2743–2757.
https://journals.sagepub.com/doi/10.1177/15248380221111484
Malarbi, Stephanie, et al. “Neuropsychological Functioning of Childhood Trauma and Post-Traumatic Stress Disorder: A Meta-Analysis.” Neuroscience & Biobehavioral Reviews, vol. 72, 2017, pp. 68–86.
https://doi.org/10.1016/j.neubiorev.2016.11.004

Overlap Between ADHD, PTSD, Autism, and Mood Disorders

Magdi, Hussein M., et al. “Attention-Deficit/Hyperactivity Disorder and Post-Traumatic Stress Disorder Adult Comorbidity: A Systematic Review.” Systematic Reviews, vol. 14, no. 1, 2025, article 41.
https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-025-02774-7
Hours, Camille, et al. “ASD and ADHD Comorbidity: What Are We Talking About?” Frontiers in Psychiatry, vol. 13, 2022, article 837424.
https://www.frontiersin.org/articles/10.3389/fpsyt.2022.837424/full
Kirsch, Alexandra C., et al. “Association of Comorbid Mood and Anxiety Disorders With Autism Spectrum Disorder.” JAMA Pediatrics, vol. 174, no. 1, 2020, pp. 63–70.
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2757487
Gnanavel, Sundar, et al. “Attention Deficit Hyperactivity Disorder and Comorbidity: A Review of Literature.” World Journal of Clinical Cases, vol. 7, no. 17, 2019, pp. 2420–2426.
https://www.wjgnet.com/2307-8960/full/v7/i17/2420.htm
Kerns, Connor M., et al. “Traumatic Childhood Events and Autism Spectrum Disorder.” Journal of Autism and Developmental Disorders, vol. 45, no. 11, 2015, pp. 3475–3486.
https://link.springer.com/article/10.1007/s10803-015-2392-y

Limitations of DSM-Based Diagnoses

Hyman, Steven E. “The Diagnosis of Mental Disorders: The Problem of Reification.” Annual Review of Clinical Psychology, vol. 6, 2010, pp. 155–179.
https://doi.org/10.1146/annurev.clinpsy.3.022806.091532
Wakefield, Jerome C. “DSM-5, Psychiatric Epidemiology and the False Positives Problem.” Epidemiology and Psychiatric Sciences, vol. 24, no. 3, 2015, pp. 188–196.
https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/dsm5-psychiatric-epidemiology-and-the-false-positives-problem/A1BD4A1A843ACF07D8F92C589542F63B
Kapadia, Munira, et al. “Fractures in the Framework: Limitations of Classification Systems in Psychiatry.” Dialogues in Clinical Neuroscience, vol. 22, no. 1, 2020, pp. 17–26.
https://www.dialogues-cns.org/articles/fractures-in-the-framework-limitations-of-classification-systems-in-psychiatry/
Cuthbert, Bruce N. “The RDoC Framework: Facilitating Transition from ICD/DSM to Dimensional Approaches.” World Psychiatry, vol. 13, no. 1, 2014, pp. 28–35.
https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20087
Kozak, Michael J., and Bruce N. Cuthbert. “The NIMH Research Domain Criteria Initiative.” Psychophysiology, vol. 53, no. 3, 2016, pp. 286–297.
https://onlinelibrary.wiley.com/doi/full/10.1111/psyp.12518

Neuroimaging and Objective Testing

Drysdale, Andrew T., et al. “Resting-State Connectivity Biomarkers Define Neurophysiological Subtypes of Depression.” Nature Medicine, vol. 23, no. 1, 2017, pp. 28–38.
https://www.nature.com/articles/nm.4246
Zhang, Hanyi, et al. “The Value of Multimodal Neuroimaging in PTSD Diagnosis and Treatment.” Translational Psychiatry, vol. 15, article 208, 2025.
https://www.nature.com/articles/s41398-025-03416-1
Alves, Caroline L., et al. “Multiclass Classification of ASD, ADHD, and Neurotypical Youth Using fMRI.” PLOS ONE, vol. 19, no. 10, 2024, e0305630.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0305630
Hollis, Chris, et al. “Impact of QbTest on ADHD Diagnostic Decision-Making.” Journal of Child Psychology and Psychiatry, vol. 59, no. 12, 2018, pp. 1298–1308.
https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.12921

Whole-Person and Interdisciplinary Models

Cicchetti, Dante, and Sheree L. Toth. “A Developmental Psychopathology Perspective on Child Maltreatment.” Child Maltreatment, vol. 18, no. 3, 2013, pp. 135–139.
https://journals.sagepub.com/doi/10.1177/1077559513497516
Jonas, Wayne B., and Elena Rosenbaum. “The Case for Whole-Person Integrative Care.” Medicina, vol. 57, no. 7, 2021, article 677.
https://www.mdpi.com/1648-9144/57/7/677
Kotov, Roman, et al. “The Hierarchical Taxonomy of Psychopathology (HiTOP).” Journal of Abnormal Psychology, vol. 126, no. 4, 2017, pp. 454–477.
https://psycnet.apa.org/doi/10.1037/abn0000258