This presentation will describe some of the key insights that I have gleaned over the last 35 years of treating child and adolescent dissociative disorders. Research suggests that dissociation is a highly predictive symptom in young people leading to potential disruption of placements, at risk behaviors, and hospitalizations. I will focus on a developmental understanding of dissociation and why that has great potential to yield treatment recommendations and how the development of dissociative identity fragmentation is consistent with what we understand about how trauma interferes with identity consolidation.The developmental understanding of dissociation relies on Putnam's Discrete Behavioral States theory, Tomkins affect theory, and Daniel Siegel's theories based on interpersonal neurobiology. Treatment insights that derive from this theory include the importance of identifying what is transpiring in transitional moments and the reciprocal role of the therapist in helping to shape a view of the self as being increasingly more integrated. Other insights include the way dissociative clients try to shape the reality of the therapist and the overriding importance of working on attachment to heal dissociative rifts in identity. Another key concept is the developmental inertia that propels progress when the therapist sets expectations and directions for change.A challenge that faces us in the future is the large gap in available services for dissociative children and teens leading to unnecessary consequences for adults living with these hard to treat disorders. I suggest that treatments focusing on brain pathology as well as identity formation may take prominence in the future such as neurofeedback. An additional challenge is the way that children are growing up with a different sense of reality due to the effects of virtual reality and social media on their socialization. The ongoing impact on identity formation is not really known. Ultimately, the importance of an attachment relationship and a therapeutic relationship of radical acceptance of the whole self is likely the element of treatment that will be enduring over time into the future no matter how the world around us changes.