A severely traumatic event like sexual abuse or a natural disaster leaves its scars on children. They may go on to develop post-traumatic stress disorder (PTSD).
However, there is little evidence about how to treat children with PTSD. Even treatment in adults is not always effective.
A recent review of the research looked at whether psychotherapy might help children with PTSD. It found reasonable evidence that therapy does help kids' PTSD symptoms, especially cognitive behavioral therapy.
However, the studies were limited by size and duration, so more research is necessary.
The study, led by Donna Gillies, a senior researcher at Western Sydney Mental Health Network, involved reviewing 14 studies with a total of 758 children. The children, from ages 3 to 18, all had been diagnosed with PTSD following various traumas, including sexual abuse, violence, car accidents or natural disasters.
The researchers found that, overall, psychological therapy was effective in improving children's PTSD symptoms. However, many of the studies were small, involving only about 24 to 80 children each.
Most were also short-term, providing information on the children's outcomes typically up to a month after the kids received treatment. For example, in one study, 15 children were treated with psychotherapy and 10 received usual care. Ten of the 15 children receiving therapy had improved symptoms compared to two of the usual-care children.
In another study, 10 of 12 children receiving psychotherapy improved while 4 of 13 children receiving usual care had improved symptoms.
Other analyses showed overall reduced symptoms for depression and anxiety with psychotherapy, though the evidence for reduced depression was weaker and less conclusive.
The strongest evidence in the studies was for the effectiveness of cognitive behavioral therapy (CBT), a kind of talk therapy that involves helping patients recognize thought process "traps" that contribute to their emotions and behaviors.
During CBT, patients learn to re-program the way they think to help improve the way they deal with and react to their emotions and events in their lives.
"Cognitive behavioral therapy has been known for years to help both adults and children in reducing symptoms of anxiety and depression," said Seanna Crosbie, LCSW, director of the Austin Child Guidance Center and a dailyRx Contributing Expert. "And more research does need to be done in the area of trauma, both to protect children against developing trauma symptoms following an event as well as those who have already exhibited problems associated with post-traumatic stress disorder."
Crosbie said that one emerging treatment that is specifically aimed at helping individuals deal with trauma is trauma-focused cognitive behavioral therapy (TF-CBT).
"Kauffman’s Best Practices Project rated TF-CBT as the only 'well supported efficacious treatment' for children who have experienced trauma-related symptoms," Crosbie said. "This evidence-based treatment is also supported by the National Child Trauma Stress Network as well as the Substance Abuse and Mental Health Services Administration. Austin Child Guidance Center is one of the few Centers in Central Texas that offers this type of treatment for children who have experienced a variety of issues from witnessing domestic violence to natural disasters to child abuse."
Because of the limited research available, the small size of the studies and the limited time in each study, the researchers in this study recommended that more research be conducted into the effectiveness of specific therapies for children with PTSD.
"There is fair evidence for the effectiveness of psychological therapies, particularly cognitive behavioral therapy, in treating post-traumatic stress disorder in children," Gillies said in a news release about the review. "However, more effort needs to be devoted to increasing follow-up in children so we can understand whether these therapies are making a difference in the long term."
Psychotherapy can be expensive, running from $60 and up per hour of service, and a therapy treatment could run for ten or more sessions.
The study was published December 11 in the The Cochrane Database of Systematic Reviews. The research was internally funded through Sydney West Area Health Service and the University of Western Sydney in Australia. No conflicts of interest were noted.