Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
Please can you give a brief introduction to post-traumatic stress disorder (PTSD) in children?
Children with PTSD suffer significant distress or negative impacts on their daily lives. Estimates of the prevalence of PTSD in children and adolescents experiencing trauma are generally very high, at 30% to 40%. PTSD is also strongly associated with a range of other mental health disorders such as depression, anxiety disorders, and substance abuse.
What are the main symptoms of PTSD in children?
As with PTSD in adults, PTSD is diagnosed in children by the presence of three main symptom groups for at least a month:
recurrent and intrusive recollections of the trauma
avoidance of stimuli such as thoughts, feelings or conversations associated with the trauma
symptoms of anxiety
However, PTSD may be more difficult to diagnose in children as their reactions can differ from adults. Symptoms of PTSD may be expressed in children as behavioural problems, developmental regression, physical symptoms and more generalised fears.
What causes PTSD in children?
The types of traumatic events that can cause PTSD include:
exposure to war
physical or sexual abuse
violence to themselves or others
serious injury or life threatening injury or illness
What are the main treatments for PTSD in children?
A number of psychological therapies have been used in the treatment of PTSD for children:
Cognitive behavioural therapy (CBT) challenges the negative thinking patterns associated with the trauma
Exposure therapy aims to overcome PTSD symptoms by exposing them to cues or memories related to the trauma
In psychodynamic psychotherapy the therapist helps the child to develop a better understanding of their responses to the trauma and how it impacts on them
In supportive counselling, counsellors listen and help them to talk over their problems
In eye movement desensitisation and reprocessing (EMDR) the individual focuses on a disturbing image, memory, emotion or cognition associated with the trauma while the therapist initiates rapid voluntary eye movements
The major alternative to psychological therapies is pharmacological treatments but at the present time there is not enough evidence to recommend their use, either as an alternative or addition to psychological therapies.
What did your recent research involve and what did you find?
The aim of this review was to examine the effectiveness of all psychological therapies for the treatment of PTSD in children and adolescents. We searched for all randomised controlled trials comparing psychological therapies to a control, other psychological therapies or other therapies for the treatment of PTSD in children and adolescents aged 3 to 18 years.
We identified 14 studies with a total of 758 child and adolescent participants. The types of trauma they were exposed to were sexual abuse, civil violence, natural disaster, and domestic violence and motor vehicle accidents.
The psychological therapies used in the included studies were CBT, exposure-based, psychodynamic, narrative, supportive counselling, and EMDR. No study compared psychological therapies to medications or medications in combination with a psychological therapy.
There was fair evidence for the effectiveness of psychological therapies, particularly CBT, for the treatment of PTSD in children and adolescents for up to a month following treatment. More evidence is required for the effectiveness of psychological therapies in the longer term and to be able to compare the effectiveness of one psychological therapy to another.
These findings are limited because most therapies were compared to a control group where children, their families and therapists were aware who was receiving treatment and who was not. Therefore, the apparent effectiveness may have been due to some extent to a placebo effect.
What impact do you think your work will have?
It will confirm that these psychological therapies, in particular CBT, appear to be effective in the short-term with children who have PTSD. However, I think the major impact of this review is to establish a systematic analysis of all of the trials that have been done in this area and therefore what work needs to be done so that we can most effectively treat PTSD in children and adolescents.
How do you think the efficacy of psychological therapies differs between children and adults with PTSD?
Because of the differing developmental levels of children, psychological therapies used with adults with PTSD may not be appropriate or need to be tailored for the particular child or for particular age groups. For younger children in particular, psychological therapies which work in partnership with the parent may be more appropriate.
Would you like to make any further comments?
This review concentrated on psychological therapies as a treatment for children and adolescents clinically diagnosed with PTSD. We are currently completing a review on psychological therapies as preventive interventions for children exposed to trauma. Because there is a broader body of studies in this area we expect this will inform additional recommendations on the use of psychological therapies in children who have undergone trauma.
Where can readers find more information?
They can find our paper here: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006726.pub2/abstract
About Donna Gillies
Donna studied Biochemistry and Pharmacology at the University of Technology Sydney and the University of Sydney, obtaining her PhD investigating the neuropharmacology of schizophrenia in 1996.
For the past fifteen years, she has worked with clinicians as a researcher and research methodologist; the past eight of those in the Western Sydney Mental Health network.
She has extensive experience in managing research projects, published widely in international peer-reviewed journals, and has been a statistical and topic reviewer for a range of international publications.
Donna has a strong interest in systematic reviews and evidence-based practice and has published systematic reviews and meta-analyses in a range of areas. She was the elected Author Representative for the Cochrane Collaboration Steering Group for six years, and a member of other key groups within the Cochrane Collaboration.
Donna’s major research interest is in Mental Health but she has worked as a researcher on a range of other health-related areas.