Literature Review: Treatment of PTSD in Children

From Efficacy to Effectiveness: The Trajectory Of The Treatment Literature For Children With PTSD
Valentina Nikulina; Jeanean M Hergenrother; Elissa J Brown; Megan E Doyle; Beryl J Filton; Gabrielle S Carson

This review summarizes efficacious treatments for preschoolers, children and adolescents with post-traumatic stress disorder, with a focus on the advances made within the last 5 years.

There is considerable support for the use of trauma-specific cognitive-behavioral interventions, in both individual and group formats. The research on psychopharmacological treatments lags behind that of psychotherapy and is currently inconclusive.

Limitations of the studies are discussed and treatments that warrant further consideration are reviewed. The authors also review current advances in effectiveness and suggest future directions that are important in generalizing the interventions to underserved and hard to reach populations. The article concludes with the authors' projections for the evolution of the field within the upcoming 5 years.
Introduction

In the USA, approximately two thirds of children experience one or more traumatic events by the time they are 16 years of age.[1] Traumatic events include child sexual abuse (CSA), child physical abuse (CPA), community violence, witnessing domestic violence and natural/manmade disaster. Childrens' trauma-related mental health problems include post-traumatic stress disorder (PTSD), other anxiety disorders, depression and disruptive behavior disorders.[2] PTSD is the most common response to a traumatic event and is associated with later interpersonal, vocational and physical problems.[3-5]

The awareness of these pervasive consequences of PTSD has resulted in empirical advances in our understanding of its treatment. From randomized controlled trials, investigators have examined and found individual trauma-focused cognitive-behavioral interventions to be efficacious at reducing PTSD symptoms and other trauma sequelae. Current research is moving towards enhancing generalizability, or effectiveness, of treatments when applied to real-world settings.

This paper examines current literature on the treatment of PTSD in preschoolers, children and adolescents. First, we review the diagnostic criteria for PTSD and its prevalence in youth. Second, we discuss psychosocial and pharmacological treatments that demonstrated efficacy in treating PTSD, as well as other outcomes of trauma exposure. Third, we discuss effectiveness, including barriers to mental health, cultural background, trauma characteristics and psychiatric comorbidity. We conclude the paper with a discussion of the current status of research on PTSD treatment and a projection of the field's progress over the next 5 years. For full article see Expert Rev Neurother. 2008;8(8):1233-1246.