Abstract
This article reviews recent advances in empirically supported psychotherapeutic treatments for children and adolescents experiencing trauma and provides a brief summary of available interventions, as well as a context for their use. We highlight the American Academy of Child and Adolescent Psychiatry’s recent practice guidelines for trauma treatment and discuss their implications for clinicians, including the benefits of involving caregivers in treatment and the rationale for using practices that are specifically trauma-focused as first-line intervention. Finally, we discuss the status of research on the real-world implementation of these therapies and the need for further research, particularly regarding clinician knowledge and use of empirically supported practices, potential stepped-care approaches to trauma treatment, and the need to reduce attrition in child trauma research and practice.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
• Lang JM, Ford JD, Fitzgerald MM. An algorithm for determining use of trauma-focused cognitive-behavioral therapy. Psychother. 2010;47(4):554–69. doi:10.1037/a0021184. Provides a useful, evidence-supported algorithm to aid clinicians in deciding whether their client is appropriate for TF-CBT. Also reviews the evidence base supporting the use of TF-CBT with regard to client age, trauma type, caregiver involvement, and the presence of co-occurring disorders. Discusses the effectiveness of TF-CBT without a trauma narrative and in combination with other trauma-focused therapies.
Hamblen J, Barnett E. PTSD in children and adolescents. 2011. http://www.ptsd.va.gov/professional/pages/ptsd_in_children_and_adolescents_overview_for_professionals.asp. Accessed 2 August 2012.
National Child Traumatic Stress Network. Changing the course of children's lives. 2011.
American Psychiatric Association. Proposed draft revisions to DSM disorders and criteria. 2012. http://www.dsm5.org/proposedrevision/Pages/Default.aspx. Accessed 2 August 2012.
•• Cohen JA, Bukstein O, Walter H, et al. Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatr. 2010;49(4):414–30. Considerably updates the previous AACAP guideline, published in 1998. Discusses significant advances in the research-base and the strength of the evidence for assessing and treating child and adolescent PTSD. Provides evidence-supported recommendations for routine screening for trauma symptoms and history, formal assessment of PTSD and other disorders that may mimic PTSD, the use of trauma-focused evidence-based treatment, and the potential adjunctive use of psychopharmacologic medications.
Chowdhury U, Pancha A. Post-traumatic stress disorder in children and adolescents. Community Pract. 2011;84(12):33–5.
Foa EB, Keane TM, Friedman MJ, et al., editors. Effective treatments for PTSD: practice guidelines from the international society for traumatic stress studies. New York: Guildford Press; 2009.
McKay MM, Bannon Jr WM. Engaging families in child mental health services. Child Adolesc Psychiatr Clin N Am. 2004;13(4):905–21. doi:10.1016/j.chc.2004.04.001. vii.
• Bernardon S, Pernice-Duca F. A family systems perspective to recovery from posttraumatic stress in children. Fam J. 2010;18(4):349–57. doi:10.1177/1066480710376618. Especially helpful for family-based clinicians, this article summarizes the research regarding the impact of child PTSD within the family system and how contextual factors such as family functioning, family support, and the presence of PTSD in other family members can mitigate the development and treatment of child PTSD. Also describes the evidence supporting family systems interventions for child PTSD.
• Lieberman AF, Chu A, Van Horn P, et al. Trauma in early childhood: empirical evidence and clinical implications. Dev Psychopathol. 2011;23(02):397–410. doi:10.1017/s0954579411000137. An important article, given the potential inclusion of the pre-school PTSD subtype in the DSM-V, that explains the role of risk and protective factors and other diagnostic considerations in early childhood trauma and emphasizes the importance of the parent-child relationship to a child’s ability to recover from traumatic experiences. Additionally assists the clinician in conceptualizing the intergenerational transmission of trauma and advocates for routine assessment of trauma and the use of relationship-based treatments, such as CPP and TF-CBT.
Cohen JA, Mannarino A, Deblinger E. Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press; 2006.
Lieberman AF, Van Horn P. Don't hit my mommy: a manual for child-parent psychotherapy with young witnesses of family violence. Washington, DC: Zero to Three Press; 2005.
Runyon MK, Deblinger E, Steer RA. Group cognitive behavioral treatment for parents and children at-risk for physical abuse: an initial study. Child Fam Behav Ther. 2010;32(3):196–218.
• Scheeringa MS, Weems CF, Cohen JA, et al. Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: a randomized clinical trial. J Child Psychol Psychiatry. 2011;52(8):853–60. doi:10.1111/j.1469-7610.2010.02354.x. Examines the efficacy and feasibility of an important new Preschool PTSD intervention, adapted from TF-CBT, with children ages 3-6, experiencing a variety of traumas. Reports on outcomes, including significant decreases in PTSD symptoms, and high rates of treatment comprehension and completion. Provides clinicians with a helpful guide for using TF-CBT techniques with very young children.
Gilboa-Schechtman E, Foa EB, Shafran N, et al. Prolonged exposure versus dynamic therapy for adolescent PTSD: a pilot randomized controlled trial. J Am Acad Child Adolesc Psychiatr. 2010;49(10):1034–42. doi:10.1016/j.jaac.2010.07.014.
Field A, Cottrell D. Eye movement desensitization and reprocessing as a therapeutic intervention for traumatized children and adolescents: a systematic review of the evidence for family therapists. J Fam Ther. 2011;33(4):374–88. doi:10.1111/j.1467-6427.2011.00548.x.
Clausen JM, Ruff SC, Wiederhold WV, et al. For as long as it takes: relationship-based play therapy for children in foster care. Psychoanal Soc Work. 2012;19(1–2):43–53. doi:10.1080/15228878.2012.666481.
Ford JD, Steinberg KL, Hawke J, et al. Randomized trial comparison of emotion regulation and relational psychotherapies for PTSD with girls involved in delinquency. J Clin Child Adolesc Psychol. 2012;41(1):27–37. doi:10.1080/15374416.2012.632343.
Danielson CK, McCart MR, de Arellano MA, et al. Risk reduction for substance use and trauma-related psychopathology in adolescent sexual assault victims: findings from an open trial. Child Maltreat. 2010;15(3):261–8. doi:10.1177/1077559510367939.
Kiser LJ, Donohue A, Hodgkinson S, et al. Strengthening family coping resources: the feasibility of a multifamily group intervention for families exposed to trauma. J Trauma Stress. 2010;23(6):802–6. doi:10.1002/jts.20587.
Ellis BH, Fogler J, Hansen S, et al. Trauma systems therapy: 15-month outcomes and the importance of effecting environmental change. Psychol Trauma Theory Res Pract Policy. 2011. doi:10.1037/a0025192.
Kazak AE, Alderfer MA, Streisand R, et al. Treatment of posttraumatic stress symptoms in adolescent survivors of childhood cancer and their families: a randomized clinical trial. J Fam Psychol. 2004;18(3):493–504. doi:10.1037/0893-3200.18.3.493.
Salloum A, Overstreet S. Grief and trauma intervention for children after disaster: exploring coping skills versus trauma narration. Behav Res Ther. 2012;50(3):169–79. doi:10.1016/j.brat.2012.01.001.
Jaycox LH. Cognitive behavioral interventions for trauma in schools. Longmont: Sopris Educational Press; 2003.
Saltzman WR, Pynoos RS, Layne CM, et al. Trauma- and grief- focused intervention for adolescents exposed to community violence: results of a school-based screening and group treatment protocol. Group Dynamics Theor Res Pract. 2001;5(4):291–303.
Dorsey S, Briggs EC, Woods BA. Cognitive-behavioral treatment for posttraumatic stress disorder in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2011;20(2):255–69. doi:10.1016/j.chc.2011.01.006.
Cohen JA, Mannarino AP. Psychotherapeutic options for traumatized children. Curr Opin Pediatr. 2010;22(5):605–9. doi:10.1097/MOP.0b013e32833e14a2.
Cary CE, McMillen JC. The data behind the dissemination: a systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Child Youth Serv Rev. 2012;34(4):748–57. doi:10.1016/j.childyouth.2012.01.003.
Kowalik J, Weller J, Venter J, et al. Cognitive behavioral therapy for the treatment of pediatric posttraumatic stress disorder: a review and meta-analysis. J Behav Ther Exp Psychiatr. 2011;42(3):405–13. doi:10.1016/j.jbtep.2011.02.002.
Mannarino AP, Cohen JA, Runyon MK, et al. Trauma-focused cognitive-behavioral therapy for children sustained impact of treatment 6 and 12 months later. Child Maltreat. 2012. doi:10.1177/1077559512451787.
Deblinger E, Mannarino AP, Cohen JA, et al. A follow-up study of a multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. J Am Acad Child Adolesc Psychiatr. 2006;45(12):1474–84. doi:10.1097/10.chi.0000240839.56114.bb.
National Crime Victims Research and Treatment Center. Research support for TF-CBT. In: TF-CBT Web: a web-based learning course for trauma-focused cognitive behavioral therapy. Medical University of South Carolina Charleston. 2005. http://tfcbt.musc.edu/resources.php?p=5. Accessed 3 August 2012.
Hoagwood KE, Radigan M, Rodriguez J et al. Final report on the child and adolescent trauma treatment consortium (CATS) project. SAMHSA. 2006; Unpublished report.
Cohen JA, Mannarino AP, Iyengar S. Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: a randomized controlled trial. Arch Pediatr Adolesc Med. 2011;165(1):16–21. doi:10.1001/archpediatrics.2010.247.
Puccia E, Redding TM, Brown RS, et al. Using community outreach and evidenced-based treatment to address domestic violence issues. Soc Work Ment Health. 2012;10:104–26. doi:10.1080/15332985.2011.601704.
Weiner DA, Schneider A, Lyons JS. Evidence-based treatments for trauma among culturally diverse foster care youth: treatment retention and outcomes. Child Youth Services Rev. 2009;31(11):1199–205. doi:10.1016/j.childyouth.2009.08.013.
Cohen JA, Mannarino AP, Staron VR. A pilot study of modified cognitive-behavioral therapy for childhood traumatic grief (CBT-CTG). J Am Acad Child Adolesc Psychiatr. 2006;45(12):1465–73. doi:10.1097/01.chi.0000237705.43260.2c.
Cohen JA, Mannarino AP. Trauma-focused CBT for traumatic grief in military children. J Contemp Psychother. 2011;41(4):219–27. doi:10.1007/s10879-011-9178-0.
Schottelkorb AA, Doumas DM, Garcia R. Treatment for childhood refugee trauma: a randomized, controlled trial. Int J Play Ther. 2012;21(2):57–73. doi:10.1037/a0027430.
Ghosh Ippen C, Harris WW, Van Horn P, et al. Traumatic and stressful events in early childhood: can treatment help those at highest risk? Child Abuse Negl. 2011;35(7):504–13. doi:10.1016/j.chiabu.2011.03.009.
• Runyon MK, Deblinger E, Schroeder CM. Pilot evaluation of outcomes of combined parent-child cogntive-behavioral group therapy for families at risk for child physical abuse. Cogn Behav Pract. 2009;16:101–18. Reports on outcomes from the first trauma-focused multifamily-based intervention specifically designed to be implemented with caregivers who have engaged in an act of physical abuse or excessive physical punishment. Describes the treatment model, which teaches positive parenting strategies, increases positive parent–child interactions, and addresses abuse–related PTSD in children through gradual exposure therapy.
Kemp M, Drummond P, McDermott B. A wait-list controlled pilot study of eye movement desensitization and reprocessing (EMDR) for children with post-traumatic stress disorder (PTSD) symptoms from motor vehicle accidents. Clin Child Psychol and Psychiatr. 2010;15(1):5–25.
• Berkowitz SJ, Stover CS, Marans SR. The child and family traumatic stress intervention: secondary prevention for youth at risk of developing PTSD. J Child Psychol Psychiatry. 2011;52(6):676–85. doi:10.1111/j.1469-7610.2010.02321.x. Presents promising findings from one of the first large-scale trials of a four-session early intervention protocol for child PTSD. Describes the model, which is designed to be delivered within 30 days of a potentially traumatic event, such as a motor vehicle accident, abuse, witnessing, or being involved in community violence and reports on outcomes with 105 youth, including significant reductions in full or partial PTSD at 3-month follow-up.
Cicchetti D, Rogosch FA, Toth SL, et al. Normalizing the development of cortisol regulation in maltreated infants through preventive interventions. Dev Psychopathol. 2011;23(3):789–800. doi:10.1017/S0954579411000307.
Eyberg SM, Funderburk BW, Hembree-Kigin T, et al. Parent-child interaction therapy with behavior problem children: one- and two-year maintenance of treatment effects in the family. Child Fam Behav Ther. 2001;23(4):1–20.
Diamond GS, Wintersteen MB, Brown GK, et al. Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial. J Am Acad Child Adolesc Psychiatr. 2010;49(2):122–31.
DeRosa R, Pelcovitz D. Treating traumatized adolescent mothers: a structured approach. In: Boyd-Webb N, editor. Working with traumatized youth in child welfare. New York: Guilford Press; 2005. p. 219–45.
Allen B, Gharagozloo L, Johnson JC. Clinician knowledge and utilization of empirically-supported treatments for maltreated children. Child Maltreat. 2012;17(1):11–21. doi:10.1177/1077559511426333.
Allen B, Johnson JC. Utilization and implementation of trauma-focused cognitive-behavioral therapy for the treatment of maltreated children. Child Maltreat. 2012;17(1):80–5. doi:10.1177/1077559511418220.
Kolko DJ, Cohen JA, Mannarino AP, et al. Community treatment of child sexual abuse: a survey of practitioners in the National Child Traumatic Stress Network. Adm Policy Ment Health. 2009;36(1):37–49. doi:10.1007/s10488-008-0180-0.
Deblinger E, Mannarino AP, Cohen JA, et al. Trauma-focused cognitive behavioral therapy for children: impact of the trauma narrative and treatment length. Depress Anxiety. 2011;28(1):67–75. doi:10.1002/da.20744.
Nixon RD, Sterk J, Pearce A. A randomized trial of cognitive behaviour therapy and cognitive therapy for children with posttraumatic stress disorder following single-incident trauma. J Abnorm Child Psychol. 2012;40(3):327–37. doi:10.1007/s10802-011-9566-7.
Van der Oord S, Lucassen S, Van Emmerik AA, et al. Treatment of post-traumatic stress disorder in children using cognitive behavioural writing therapy. Clin Psychol Psychother. 2010;17(3):240–9. doi:10.1002/cpp.670.
Ruf M, Schauer M, Neuner F, et al. Narrative exposure therapy for 7- to 16-year-olds: a randomized controlled trial with traumatized refugee children. J Trauma Stress. 2010;23(4):437–45.
Saxe GN, Ellis BH, Fogler J, et al. Innovations in practice: preliminary evidence for effective family engagement in treatment for child traumatic stress-trauma systems therapy approach to preventing dropout. Child Adolesc Ment Health. 2012;17(1):58–61. doi:10.1111/j.1475-3588.2011.00626.x.
• Layne CM, Ippen CG, Strand V, et al. The core curriculum on childhood trauma: a tool for training a trauma-informed workforce. Psychol Traum Theor Res Pract Pol. 2011;3(3):243–52. doi:10.1037/a0025039. Discusses the conceptual framework for an impressive new curriculum-based training program to help clinicians expand their expertise in treating trauma-exposed children and adolescents and its significance in developing a more trauma-informed workforce. Also describes the curriculum’s pilot implementation, using problem-based learning and detailed clinical vignettes to improve the clinical judgment of 43 graduate social work students in field placements working with traumatized children.
Strawn JR, Keeshin BR, DelBello MP, et al. Psychopharmacologic treatment of posttraumatic stress disorder in children and adolescents: a review. J Clin Psychiatr. 2010;71(7):932–41.
Berkowitz SJ, Watson PJ, Brymer MJ. Early preventive interventions for adolescents exposed to a potentially traumatic event. Minerva Pediatr. 2011;63(3):201–15.
Disclosure
No potential conflicts of interest relevant to this article were reported.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Child and Adolescent Disorders
Rights and permissions
About this article
Cite this article
Schneider, S.J., Grilli, S.F. & Schneider, J.R. Evidence-Based Treatments for Traumatized Children and Adolescents. Curr Psychiatry Rep 15, 332 (2013). https://doi.org/10.1007/s11920-012-0332-5
Published:
DOI: https://doi.org/10.1007/s11920-012-0332-5
Keywords
- Posttraumatic stress disorder
- PTSD
- Child (children)
- Adolescent
- Trauma
- Evidence-based
- Empirically supported
- Treatment
- Therapy
- Intervention
- Outcome
- Trauma-focused cognitive behavioral therapy
- TF-CBT
- Child-parent psychotherapy
- CPP
- Combined parent-child cognitive behavioral therapy
- CPC-CBT
- Preschool PTSD treatment
- Eye movement desensitization and reprocessing
- EMDR
- Review
- Child and adolescent disorders
- Psychiatry