Embedded Files
New Research in Treating Child and Adolescent Trauma Judith A. Cohen, MD Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, PA Research into the effective treatment of child and adolescent PTSD continues to blossom. The expanding quality and scope of child PTSD randomized controlled trials (RCT) published or in press between January 2012 and June 2015 are the primary focuses of this commentary. Increasingly, researchers are attempting to prevent the development of pediatric PTSD. The only existing such evidence-based intervention prevents the development of chronic PTSD (Berkowitz et al., 2011). In 2014, Kramer & Landolt compared an early, two session cognitive behavioral therapy (CBT) to treatment as usual (TAU) for two 16-yearold children at elevated risk for developing PTSD following road accidents or burns. Preschool children did not show significant benefit from the intervention, but school-aged children who received the intervention had significantly fewer internalizing symptoms and marginally lower PTSD intrusion symptoms at a 3-month follow-up compared to children in the TAU condition. This is the first study that provided an entire intervention within the first month after trauma exposure. The extreme brevity of the intervention and promising results suggest the potential for very early brief CBT interventions to prevent the development of PTSD in children and adolescents. More studies like this are needed; especially as new methods (e.g., biomarkers) become available to identify high-risk children. Kassam-Adams and colleagues (2013) provide an excellent overview of preventive intervention models including risk factors, likely effective components and the need for early identification and referral. Since children are typically brought to treatment by caregivers who are seeking treatment for negative child behaviors rather than children’s trauma experiences per se, engaging families in trauma treatment can be challenging. Two recent studies provide insight into successful strategies for retaining families in trauma treatment. In the Continued on page 2 first, Dorsey and colleagues (2014) randomized 47 children and adolescents in foster care with one of their foster parents to receive either standard Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); or TF-CBT with enhanced evidence-based engagement strategies. Youth and foster parents who received the enhanced engagement strategies were significantly more likely to be retained in therapy through four sessions and were less likely to drop out of treatment prematurely. In a smaller study, Saxe and colleagues (2012) randomized 20 youth with prominent PTSD symptoms to Trauma Systems Therapy (TST) or care as usual (CAU). At threemonth assessment, 90% of the youth in the TST condition were still in treatment while only 10% of the CAU youth remained in treatment, documenting the effectiveness of TST for retaining youth in treatment. Together these studies provide therapists with important information about how to successfully engage families in evidence-based trauma treatment. Several international studies are evaluating evidence-based treatments across cultures, settings and trauma experiences. Jensen and colleagues (2014) randomized 156 Norwegian youth ages 10-18 years who had experienced diverse traumas, to TF-CBT or TAU in eight community treatment centers across Norway. Results indicated that youth receiving TF-CBT experienced significantly greater improvement in PTSD, depression and general mental health symptoms and significantly greater improvement in functional impairment compared to youth receiving TAU. Interestingly, the authors found that therapeutic alliance predicted positive child outcomes only in the TF-CBT condition (Ormhaug et al., 2014). Murray and colleagues (2015) randomized 257 orphans and vulnerable Zambian children (OVC) Published by: National Center for PTSD VA Medical Center (116D) 215 North Main Street White River Junction Vermont 05009-0001 USA (802) 296-5132 FAX (802) 296-5135 Email: ncptsd@va.gov All issues of the PTSD Research Quarterly are available online at: www.ptsd.va.gov Editorial Members: Editorial Director Matthew J. Friedman, MD, PhD Bibliographic Editor Victoria Bedi, MIS Managing Editor Heather Smith, BA Ed National Center Divisions: Executive White River Jct VT Behavioral Science Boston MA Dissemination and Training Menlo Park CA Clinical Neurosciences West Haven CT Evaluation West Haven CT Pacific Islands Honolulu HI Women’s Health Sciences Boston MA VOLUME 26/NO. 3 • ISSN: 1050 -1835 • 2015 Author’s Address: Judith A. Cohen, MD is affiliated with the Allegheny General Hospital, Drexel University College of Medicine, 4 Allegheny Center, 8th Floor, Pittsburgh, PA 15212. Email Address: JCOHEN1@wpahs.org. PAGE 2 PTSD RESEARCH QUARTERLY Continued from cover ages 5-17 years to TF-CBT provided by trained lay counselors, or to TAU. The TF-CBT group experienced significantly greater improvement in PTSD and functional impairment than the TAU group. This study
Google Sites
Report abuse