Skip to main content
Log in

Eye Movement Desensitization and Reprocessing in Young Children (Ages 4–8) with Posttraumatic Stress Disorder: A Multiple-Baseline Evaluation

  • Original Article
  • Published:
Child Psychiatry & Human Development Aims and scope Submit manuscript

A Correction to this article was published on 22 September 2021

This article has been updated

Abstract

To reduce the acute and long-term effects of trauma, early and effective treatment is necessary. Eye movement desensitization and reprocessing (EMDR) therapy is a brief treatment for posttraumatic stress disorder (PTSD), with a substantial evidence base for children and adolescents aged 8 to 18 years. In the present study we aimed to provide preliminary evidence of EMDR as a trauma treatment for young children. We studied 9 children, aged 4 to 8 years old with a DSM-5 diagnosis of PTSD. A non-concurrent multiple baseline experimental design was used combined with standardized measures. Participants received six 1-h sessions of EMDR. Results post-treatment showed that EMDR was effective in reaching diagnostic remission of PTSD (85.7%), and decreasing severity of PTSD symptoms and emotional and behavioral problems. All gains were maintained at follow-up 3 months after treatment. EMDR appears an effective treatment for PTSD in young children aged 4 to 8 years. Further research is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

Change history

Notes

  1. The Single-Case Reporting Guideline in Behavioural Interventions, SCRIBE [22] was applied in this article. The SCRIBE guideline describes a set of 26 items to guide and structure the reporting of SCED research.

  2. In the Netherlands, all children require a referral by the general practitioner, medical specialists or specialized youth teams in order to receive treatment.

  3. The design meets 12 of the 15 items, it was not possible to incorporate blinding of the therapists or assessor and inter-rater reliability, since only the primary caregiver filled in the daily diary.

References

  1. Beer R (2018) Efficacy of EMDR therapy for children with PTSD: a review of the literature. J EMDR Pract Res 12(4):177–195

    Article  Google Scholar 

  2. De Young AC, Kennardy JA, Cobham VE (2011) Trauma in early childhood: a neglected population. Clin Child Fam Psychol Rev 14(3):231–250

    Article  PubMed  Google Scholar 

  3. Lieberman AF, Van Horn P (2009) Giving voice to the unsayable: repairing the effects of trauma in infancy and early childhood. Child Adolesc Psychiatr Clin N Am 18(3):707–720

    Article  PubMed  Google Scholar 

  4. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau (2021) Child maltreatment 2019. https://www.acf.hhs.gov/cb/report/child-maltreatment-2019

  5. Milani ACC, Hoffmann EV, Fossaluza V, Jackowski AP, Mello MF (2017) Does pediatric post-traumatic stress disorder alter the brain? Systematic review and meta-analysis of structural and functional magnetic resonance imaging studies. Psychiatry Clin Neurosci 71:154–169. https://doi.org/10.1111/pcn.12473

    Article  PubMed  Google Scholar 

  6. Scheeringa MS, Zeanah CH, Myers L, Putman FW (2005) Predictive validity in a prospective follow-up of PTSD in preschool children. J Am Acad Child Adolesc Psychiatry 44(9):899–906

    Article  PubMed  Google Scholar 

  7. Meiser-Stedman R, Smith P, Yule W, Glucksman E, Dagleish T (2017) Posttraumatic stress disorder in young children three years post-trauma: prevalence and longitudinal predictors. J Clin Psychiatry 78(3):334–339

    Article  PubMed  PubMed Central  Google Scholar 

  8. Green JG, McLaughlin KA, Berglund PA, Gruber MJ, Sampson NA, Zaslavsky AM (2010) Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. Arch Gen Psychiatry 67(2):113–123

    Article  PubMed  PubMed Central  Google Scholar 

  9. Smith P, Meiser-Stedman R, Dagleish T (2019) Practitioner review: posttraumatic stress disorder and its treatment in children and adolescents. J Child Psychol Psychiatry 60(5):500–515. https://doi.org/10.1111/jcpp.12983

    Article  PubMed  Google Scholar 

  10. National Institute for Health and Care Excellence (2018). Posttraumatic stress disorder. NG116. Management of PTSD in children, young people and adolescents (1.6.13). https://www.nice.org.uk/guidance/ng116/resources/posttraumatic-stress-disorder-pdf-66141601777861

  11. World Health Organization (2013) Guidelines for the management of conditions that are specifically related to stress. WHO, Geneva

    Google Scholar 

  12. International Society for Traumatic Stress Studies (2019) Posttraumatic stress disorder prevention and treatment guidelines: methodology and recommendations. https://istss.org/getattachment/Treating-Trauma/New-ISTSS-Prevention-and-Treatment-Guidelines/ISTSS_PreventionTreatmentGuidelines_FNL-March-19-2019.pdf.aspx

  13. Cohen JA, Mannarino AP, Deblinger E (2006) Treating trauma and traumatic grief in children and adolescents. Guilford Press, New York

    Google Scholar 

  14. Shapiro F (2018) Eye movement desensitization and reprocessing (EMDR): basic principles, protocols and procedures, 3rd edn. Guilford Press, London

    Google Scholar 

  15. Cohen JA, Mannarino AP (1996) Factors that mediate treatment outcome in sexually abused preschool children. J Am Acad Child Adolesc Psychiatry 35:1402–1410

    Article  PubMed  Google Scholar 

  16. Deblinger E, Stauffer LB, Steer RA (2001) Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their non-offending mothers. Child Maltreat 6:332–343

    Article  PubMed  Google Scholar 

  17. Scheeringa MS, Weems CF, Cohen JA, Amaya-Jackson L, Gutrie D (2011) Trauma-focused cognitive–behavioral therapy for posttraumatic stress disorder in three though six year-old children: a randomized controlled trail. J Child Psychol Psychiatry 52(8):853–860

    Article  PubMed  Google Scholar 

  18. Salloum A, Wang W, Robst J, Murphy TK, Scheeringa MS, Cohen JA et al (2016) Stepped care versus standard trauma-focused cognitive behavioral therapy for young children. J Child Psychol Psychiatry 57(5):614–622

    Article  PubMed  Google Scholar 

  19. Hensel T (2009) EMDR with children and adolescents after single-incident trauma an intervention study. J EMDR Pract Res 3(1):2–9

    Article  Google Scholar 

  20. Lempertz D, Wichmann M, Enderle E, Stellermann-Strehlow K, Pawils S, Metzner F (2020) Pre–post study to asses EMDR-based group therapy for traumatized refugee preschoolers. J EMDR Pract Res 14(1):31–45

    Article  Google Scholar 

  21. Onghena P, Edgington ES (2005) Customization of pain treatments: single-case design and analysis. Clin J Pain 21(1):56–68

    Article  PubMed  Google Scholar 

  22. Tate RL, Perdices M, Rosenkoetter U, McDonald S, Togher L, Shadish W et al (2016) The single-case reporting guideline in behavioral interventions (SCRIBE) 2016: explanation and elaboration. Arch Sci Psychol 4:10–31

    Google Scholar 

  23. McDonald S, Quinn F, Vieira R, O’Brien N, White M, Johnston DW et al (2017) The state of the art and future opportunities for using longitudinal n-of-1 methods in health behavior research: a systematic literature overview. Health Psychol Rev 11(4):307–323

    Article  PubMed  Google Scholar 

  24. Kratochwill TR, Hitchcock JH, Horner RH, Levin JR, Odom SL, Rindskopf DM et al (2013) Single-case intervention research design standards. Remedial Spec Educ 34(1):26–38. https://doi.org/10.1177/0741932512452794

    Article  Google Scholar 

  25. American Psychiatric Association (2013) The Diagnostic and Statistical Manual of Mental disorders, 5th edn. APA, Washington, DC

    Book  Google Scholar 

  26. Scheeringa MS (2004) Diagnostic Infant and Preschool Assessment (DIPA). Tulane University, New Orleans

    Google Scholar 

  27. Tate RL, Perdices M, Rosenkoetter U, Wakim D, Godbee K, Togher L et al (2013) Revision of a method quality rating scale for single-case experimental designs and n-of-1 trials: the 15-item Risk of Bias in N-of-1 Trials (RoBiNT) Scale. Neuropsychol Rehabil 23(5):619–638. https://doi.org/10.1080/09602011.2013.824383

    Article  PubMed  Google Scholar 

  28. Shapiro F (2001) Eye movement desensitization and reprocessing (EMDR): basic principles, protocols and procedures, 2nd edn. Guilford Press, New York

    Google Scholar 

  29. Tinker RH, Wilson SA (1999) Through the eyes of a child: EMDR with children. Norton, New York

    Google Scholar 

  30. Greenwald R (1999) Eye movement desensitization and reprocessing (EMDR) in child and adolescent psychotherapy. Jaron Aronson, Northvale

    Google Scholar 

  31. De Roos C, Beer R, de Jongh A, ten Broeke E (2018) EMDR protocol voor kinderen en jongeren tot 18 jaar, versie 2018. http://www.emdr.nl/ledengedeelte/download/protocollen/kinderprotocol.pdf

  32. De Roos C, Beer R (2017) EMDR-verhalenmethode: traumaverwerking bij preverbaal trauma. In: De Roos C, Beer R (eds) Handboek EMDR bij kinderen en Jongeren. Lannoo Campus, Houten, pp 125–140

    Google Scholar 

  33. Lovett J (2015) Trauma-attachment tangle: modifying EMDR to help children resolve trauma and develop loving relationships. Routledge, New York

    Google Scholar 

  34. Gigengack MR, Hein IM, van Meijel EPM, Lindeboom R, van Goudoever JB, Lindauer RJL (2020) Accuracy of the Diagnostic Infant and Preschool Assessment (DIPA) in a Dutch sample. Compr Psychiatry 100:152177. https://doi.org/10.1016/j.comppsych.2020.152177

    Article  PubMed  Google Scholar 

  35. Briere J (2005) Trauma symptom checklist for young children: professional manual. Psychological Assessment Resources, Odessa

    Google Scholar 

  36. Tierolf B, Lamers-Winkelman F (2014) TSCYC Vragenlijst over traumasymptomen bij jonge kinderen. Hogrefe Uitgevers, Amsterdam

    Google Scholar 

  37. Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc 40:1337–1345

    Article  Google Scholar 

  38. Scoring the Strengths and Difficulties Questionnaire for age 4–17 (2016, June 20). https://sdqinfo.org/py/sdqinfo/c0.py

  39. Van Widenfelt BM, Goedhart AW, Treffers PDA, Goodman R (2003) Dutch version of the strengths and difficulties questionnaire (SDQ). Eur Child Adolesc Psychiatry 12:281–289

    Article  PubMed  Google Scholar 

  40. Heyvaert M, Onghena P (2014) Randomization tests for single case experiments: state of the art, state of the science and state of the application. J Context Behav Sci 3:51–64

    Article  Google Scholar 

  41. Edgington ES (1972) An additive method for combining probability values from independent experiments. J Psychol 80:351–363

    Article  Google Scholar 

  42. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, Hillsdale

    Google Scholar 

  43. Bulté I, Onghena P (2013) The Single-Case Data Analysis package: analyzing single-case experiments with R software. J Mod Appl Stat Methods 12(2):450–478

    Article  Google Scholar 

  44. Zeanah CH (2009) Handbook of infant mental health, 3rd edn. Guilford Press, New York

    Google Scholar 

  45. Wolpert M, Görzig A, Deighton J, Fugard AJ, Newman R, Ford T (2015) Comparison of indices of clinically meaningful change in child and adolescent mental health services: difference scores, reliable change, crossing clinical thresholds and ‘added value’—an exploration using parent rated scores on the SDQ. Child Adolesc Ment Health 20:94–101

    Article  PubMed  Google Scholar 

  46. Barron IG, Bourgaize C, Lempertz D, Swinden C, Darker-Smith S (2019) Eye movement desensitization and reprocessing for children and adolescents with posttraumatic stress disorder: a systematic narrative review. J EMDR Pract Res 13(4):270–283

    Article  Google Scholar 

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eline Olivier.

Ethics declarations

Conflict of interest

C.de.R. receives income for training postdoctoral professionals in EMDR. The other authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Medical Ethics Committee of the Erasmus Medical Centre NL66334.078.18.

Informed Consent

Informed consent was obtained from all individual caregivers included in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Eline Olivier: no longer employed at GGZ Delfland.

Appendix

Appendix

See Tables 4 and 5.

Table 4 Trauma Symptom Checklist for Young Children (TSCYC), T-scores determined pre-treatment, post-treatment and at 3-month follow-up, and reliable change indices (RCI), per participant
Table 5 Strength and Difficulties Questionnaire (SDQ): Total Difficulty Score determined at pre-treatment, post-treatment and 3-month follow-up and reliable change indices (RCI) at post-treatment and 3-month follow-up, compared to pre-treatment, per participant

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Olivier, E., de Roos, C. & Bexkens, A. Eye Movement Desensitization and Reprocessing in Young Children (Ages 4–8) with Posttraumatic Stress Disorder: A Multiple-Baseline Evaluation. Child Psychiatry Hum Dev 53, 1391–1404 (2022). https://doi.org/10.1007/s10578-021-01237-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-021-01237-z

Keywords

Navigation