ARC interventions focus on building secure attachments, enhancing the child's self-regulatory capabilities, and increasing competencies across multiple domains. Behav Res Ther 1997 May;35(5):429-36. Skills Training in Affective and Interpersonal Regulation/Narrative Story-Telling (STAIR/NST) is a two-module treatment focused on reducing symptoms of PTSD and other trauma-related symptoms (including depression and dissociation) and on building and enhancing specific social and emotional competencies that are frequently disturbed in youths who have experienced multiple traumas and/or sustained trauma. Atypical antidepressants, such as bupropion, venlafaxine, and mirtazapine, are also commonly used to treat PTSD symptoms or PTSD-associated symptoms. influences. In addition, in an effort to avoid retrieval bias, we will manually search the reference lists of landmark studies and background articles on this topic to look for any relevant citations that might have been missed by electronic searches. Cognitive Behavioral Intervention for Trauma in Schools (CBITS) is a skills-based, group intervention for children exposed to trauma who are typically between the ages of 10 and 15 years; it may be appropriate not only for intervening early after exposure to a traumatic event but also for treating traumatic stress symptoms. Major flaws preclude the ability to draw causal inferences between the intervention and the outcome. Higgins JPT, Altman DG. Although the background and discussion below provide a comprehensive overview of the prevalence and types of trauma, sexual trauma and maltreatment will be addressed by the child maltreatment review. To assess the applicability of a body of evidence, we will consider the consistency of results across studies that represent an array of different populations. J Clin Epidemiol 2012 Feb;65(2):163-78. The challenges of the diagnostic criteria for PTSD signal the need for a comprehensive review of interventions for children with traumatic stress symptoms or PTSD. Famularo R, Fenton T, Kinscherff R, et al. 0000011554 00000 n However, there has been no clear indication established for SSRI use as monotherapy (i.e., without psychotherapy) in children with PTSD. Not all trauma-exposed children develop traumatic stress syndromes. J Consult Clin Psychol 2003 Aug;71(4):692-700. For studies without adequate information to determine inclusion or exclusion, we will retrieve the full text and then make the determination. PMID: 14627886. Trauma-specific services are interventions or programs that directly address traumatic stress and the behavioral health needs associated with it (SAMHSA 2014). PMID: 10994294. Background: PTSD in youth may lead to long-lasting psychological implications, educational difficulties and increased healthcare costs. Because of their role as end-users, individuals are invited to serve as Key Informants and those who present with potential conflicts may be retained. %PDF-1.4 %���� In general, a study with a low risk of bias has a strong design, measures outcomes appropriately, uses appropriate statistical and analytical methods, reports low attrition, and reports methods and outcomes clearly and precisely. Am J Psychiatry 2006 Apr;163(4):644-51. Key Informants are not involved in analyzing the evidence or writing the report and have not reviewed the report, except as given the opportunity to do so through the peer or public review mechanism. Because of the limited literature on trauma-informed and trauma-specific interventions for AI/AN youth, we Toward evidence-based treatment: child-parent psychotherapy with preschoolers exposed to marital violence. If the reviewers disagree, conflicts will be resolved by discussion and consensus or by consulting a third member of the review team. We will grade the strength of evidence on the basis of guidance established for the EPC Program.35,40 Developed to grade the overall strength of a body of evidence, this approach incorporates four key domains: risk of bias (including study design and aggregate quality), consistency, directness, and precision of the evidence. We will record the reason that each excluded full-text publication did not satisfy the eligibility criteria so that we can later compile a comprehensive list of such studies. The guidelines suggest agreement on some issues. We will also examine potential sources of heterogeneity by using sensitivity analysis or analysis of subgroups. However, only 0.5 percent of these trauma-exposed children met the full criteria for PTSD.1 In a survey of adolescents 12 to 17 years of age, the 6-month prevalence for PTSD was 6.3 percent in girls and 3.7 percent in boys.3 The prevalence of PTSD in younger children is largely unknown; however, several studies have assessed the prevalence of PTSD in young children exposed to various types of violence (abuse, car crashes, and natural disasters) with high reported rates of PTSD. Missing information often leads to ratings of medium as opposed to low. We will include studies that meet all inclusion criteria and contain enough information on the research methods used for our risk of bias assessment. Scheeringa MS, Zeanah CH, Myers L, et al. Interventions other than pharmacotherapy may be carried out at an individual, family, or group level. 114 0 obj <> endobj SIPs allow an opportunity for the intervention developers and distributors to provide the Evidence-based Practice Center (EPC) with both published and unpublished data that they believe should be considered for the review. We will design data abstraction forms to gather pertinent information from each article, including characteristics of study populations, settings, interventions, comparators, study designs, methods, and results, as specified in the PICOS. Interventions lacking empirical support for use among children and/or that have been Likewise, those with more frequent reminders of traumatic experiences were more likely to experience PTSD, and those with support-seeking behavior were less likely to report PTSD.9 The severity of injuries resulting from motor vehicle crashes has been shown to be associated with the development of PTSD. Proposal to include child and adolescent age related manifestations and age related subtypes for PTSD in DSM-V. Arlington, VA: American Psychiatric Association; 2010. For instance, the AACAP notes that SSRIs can be considered as a treatment for children and adolescents with PTSD; NICE concludes that there is insufficient evidence to recommend the use of any medication in young people with PTSD. Factors affecting the diagnosis and prediction of PTSD symptomatology in children and adolescents. Studies suggest that individuals experience a broad range of traumatic events throughout their lives and that the frequency of these events may vary by the group studied, for example, civilian versus noncivilian samples. Mehta S, Ameratunga SN. PMID: 11754674. Selective serotonin reuptake inhibitors (SSRIs), Psychotherapy (including groupings of trauma focused vs. non-trauma focused), Eye movement desensitization and reprocessing (EMDR), Complementary and alternative therapies (e.g., equine-assisted therapy), Prevention of or reduction in physical health conditions or symptoms (e.g., sleep disorders, eating disorders, pain, overweight or obesity, asthma, cardiovascular problems, gastrointestinal problems, headaches), Prevention of or reduction in co-occurring physical health conditions or symptoms (e.g., sleep disorders, eating disorders, pain, overweight or obesity, asthma, cardiovascular problems, gastrointestinal problems, headaches), Includes studies conducted in the United States or internationally, Specialty (e.g., outpatient and inpatient primary care or mental health care settings), Nonspecialty (e.g., schools, community-based providers, shelters), Home-based settings and out-of-home care (e.g., residential treatment), Intervention: intensity and delivery of the interventions, Comparator: use of substandard comparators, Outcomes: use of composite outcomes that mix outcomes of different significance to patients, Timing: studies of different duration that may have various implications for applicability. These skills are learned through the use of drawings and by talking in both individual and group settings. The continued uncertainties of trauma identification and PTSD diagnosis increase the clinical challenges of addressing this population appropriately. Technical Experts comprise a multidisciplinary group of clinical, content, and methodological experts who provide input in defining populations, interventions, comparisons, or outcomes as well as identifying particular studies or databases to search. Some studies conducted with the SSRIs sertralineand citalopram have indicated some therapeutic benefit in children and adolescents. The theoretical basis for EMDR is that PTSD symptoms result from insufficient processing or integration of sensory, cognitive, and affective components of the traumatic memory, and the eye movements are proposed to facilitate information processing and integration, thereby allowing patients to fully process traumatic memories.32 EMDR is an intervention that targets individuals who experience symptoms of traumatic stress. For example, both AACAP and ISTSS agree on the importance of considering comorbid psychiatric conditions and school-based treatment approaches. New York: Guilford Press; 1993. Berkowitz SJ, Marans SM. 0000011238 00000 n The importance of the observed value of I2 depends on the magnitude and direction of effects and on the strength of evidence for heterogeneity (e.g., p-value from the chi-squared test, or a confidence interval for I2). 0000002250 00000 n PMID: 10596248. Brown J, Cohen P, Johnson JG, et al. The Agency for Healthcare Research and Quality (AHRQ) is supporting two systematic reviews on children’s exposure to trauma. These experts believe that children suffering from DTD have disrupted affect regulation, attention, cognition, perception, and interpersonal relationships and may not meet criteria for the traditional diagnosis of PTSD. trailer Figure 1 depicts the KQs within the context of the PICOS described in the previous section. Psychological consequences of road traffic accidents for children and their mothers. Gillespie CF, Phifer J, Bradley B, et al. PMID: 8902292. Outcomes include the following: KQ 3: Do interventions for prevention or treatment of traumatic stress symptoms vary in their effectiveness by characteristics of the child, treatment, or setting? Depression is a major contributor to disability across the lifespan. Selective serotonin-reuptake inhibitors, or SSRIs, are a class of antidepressants that are among the most studied medications for PTSD treatment in children. Scott KM, Smith DR, Ellis PM. In addition, for Comparative Effectiveness Reviews, the key questions were posted for public comment and finalized by the EPC after review of the comments. Treatment modules include Home and Community Based Services, Services Advocacy, Emotional Regulation Skills Training, Cognitive Processing, and Psychopharmacology. The Task Order Officer reviewed contract deliverables for adherence to contract requirements, including the objectivity and independence of the research process and the methodological quality of the report. This review, the second in the series, addresses the prevention and treatment of traumatic stress symptoms, including those of post-traumatic stress disor… PMID: 16292115. 114 31 Because they are the first-line treatments for PTSD in adults, they are some of the most common medications used to treat PTSD in children as well. 0000012164 00000 n 0000002598 00000 n Because few studies have empirically tested the proposed algorithm on school-aged children, however, it is not known whether the DSM-V should incorporate alternative criteria for PTSD diagnosis in this age group. Task Force on Research Diagnostic Criteria: Infancy Preschool. Psychiatric comorbidity in childhood post traumatic stress disorder. Dube SR, Anda RF, Felitti VJ, et al. For all EPC reviews, key questions were reviewed and refined as needed by the EPC with input from Key Informants and the Technical Expert Panel (TEP) to ensure that the questions are specific and explicit about what information is being reviewed. Safety and social skills training may also be a component of treatment.26. In: Kazdin AE and Weisz JR, eds. With the exception of the following, the team has no interests to disclose: This project was funded under Contract No. �X���0c,l�h0rv�����6�� ��l������_�~�V�C6��������UB�D�fM�s�*w+��L,���G`�¥����|U,�- An intervention professional will lead the family through the steps of the intervention process. These studies may have some flaws in design or execution (e.g., imbalanced recruitment, high attrition) but they provide information (say, through sensitivity analysis) to allow the reader the ability to evaluate and determine that those flaws are not likely to cause major bias. Concrete skills are taught and practiced, including mindfulness practices from Eastern medicine. 0000000016 00000 n All results will be tracked in an EndNote® (Thomson Reuters, New York, NY) database. 3. J Am Acad Child Adolesc Psychiatry 1996 Oct;35(10):1365-74. Child Abuse Negl 1996 Oct;20(10):953-61. The goals of the program are to help children cope with traumatic events and prevent the development of traumatic stress symptoms.34. We also note settings when relevant. Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. The Child and Family Traumatic Stress Intervention: secondary prevention for youth at risk of developing PTSD. Scholastic impairments among traumatized adolescents. However, since trauma symptoms are very specific, not all types of therapy are appropriate. Familial pathways to early-onset suicide attempt: risk for suicidal behavior in offspring of mood-disordered suicide attempters. Washington, DC: American Psychiatric Association; 2000. PMID: 12924674. Components of treatment include psychoeducation about trauma; parenting skills; relaxation skills; coping skills to deal with trauma-related thoughts, feelings, and behaviors; and child exposure tasks via narratives, drawings, or other imaginal methods. Psychological interventions have been shown to be effective in its management. Attachment, Self-Regulation and Competency (ARC) is designed to treat children and families who have experienced chronic trauma such as sexual abuse, physical abuse, or domestic violence, but is also relevant for children exposed to community violence. While most people are able to bounce back from the event after a few days, weeks, or months, others struggle to cope with the experience and the memory of the trauma. Received May 26, 2004; revision received September 1, 2004, February 9, 2005, and May 13, 2005; accepted May 17, 2005 Understanding how children experience such events as war, violence, and abuse requires the use of measures and procedures able to detect posttraumatic stress disorder (PTSD). For children who have been exposed to trauma, but have not yet developed symptoms, interventions are intended to prevent the onset of traumatic stress symptoms or PTSD. For most children and adolescents with posttraumatic stress disorder (PTSD) or prominent PTSD symptoms, including those with complex PTSD, we suggest first-line treatment with an evidence-based, trauma-focused psychotherapy rather than other psychosocial or medication treatments . Cohen JA, Bukstein O, Walter H, et al. New findings on alternative criteria for PTSD in preschool children. Several comments were received regarding the narrow inclusion of a single outcome for Key Question (KQ 1). These guidelines use different categories of interventions to summarize evidence and offer inconsistent recommendations for some treatment categories or interventions. Childhood abuse and neglect: specificity of effects on adolescent and young adult depression and suicidality. 2nd ed. 0000010563 00000 n Children with PTSD may also show symptoms such as loss of interest in daily activities; headaches, stomachaches, or other physical symptoms; excessive worry; and sleep or concentration problems.2. Potential Reviewers must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. High confidence that the evidence reflects the true effect: Further research is very unlikely to change our confidence in the estimate of effect. 0000002327 00000 n Systematic reviews, randomized controlled trials, nonrandomized controlled trials, prospective cohort studies, and nested case-control studies, (“Traumatizing”[tiab] OR “Traumatising”[tiab] OR “Trauma”[tiab] OR “Traumatic”[tiab] OR “Traumas”[tiab] OR “Traumatization”[tiab] OR “Traumatisation”[tiab] OR “Traumatized”[tiab] OR “Traumatised”[tiab] OR "peritraumatic"[tiab] O. Although there are no existing guidelines for other syndromes of childhood traumatic stress, three organizations—the AACAP, the International Society for Traumatic Stress Studies (ISTSS), and the National Institute for Health and Clinical Excellence (NICE)—have published guidelines on the treatment of PTSD during childhood and adolescence. CISD is one of the first interventions created for police officers, first responders, and emergency medical technicians to use in the field with a survivor of a traumatic event during the first 72 hours. These experiences included emotional abuse (11%), physical abuse (28%), sexual abuse (21%), battered mother (13%), household drug/alcohol abuse (27%), household mental illness (17%), parent separation or divorce (23%), and incarcerated household member (5%).4 PTSD rates vary by type of traumatic exposure, with 35 percent of children exposed to community violence5 and half of those affected by interpersonal violence.6 Road crashes, another common form of childhood trauma, were associated with rates of PTSD ranging from 13 to 25 percent between 4 and 12 months after a road crash.7 Children with agency-reported abuse had much higher rates of PTSD when compared with children without reported abuse.8 Trauma from natural disasters frequently leads to PTSD; for example, one study reported a PTSD rate of 35 percent for children surviving an earthquake. This article provides information regarding what events cause PTSD in children, how many children develop PTSD, risk factors associated with PTSD, what PTSD looks like in children, other effects of trauma on children, and treatments for PTSD. The list of outcomes in both KQ 1 and KQ 2 has been expanded to include additional physical health conditions (including obesity, cardiovascular disease, and asthma), co-occurring substance use conditions, risk-taking behavior, and healthy development measures. The first in the series focuses on the comparative effectiveness of interventions that address child exposure to trauma in the form of maltreatment (physical, sexual, and emotional/psychological abuse, and neglect). Other medications. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Figure 1. 0000009678 00000 n J Am Acad Child Adolesc Psychiatry 2010;49(4):414-30. 0000002410 00000 n Often, younger children are unable to express signs and symptoms in words and are more likely to externalize or express themes during play or in drawings. Given the high occurrence rate of psychological trauma among children and adolescents,1 traumatic stress in childhood has attracted considerable clinical and research interest. 0000005709 00000 n Several risk and protective factors play a role in the development of syndromes such as PTSD. J Am Acad Child Adolesc Psychiatry 2003 May;42(5):561-70. Imipramine is a tricyclic antidepressant that has shown promise as a PTSD treatment and was used frequently before the development of the SSRIs; however, cardiac side effects have significantly limited its use. Association ; 2000 children who have been exposed to a trauma other than maltreatment j Consult Clin Psychol 2003 ;... 2000 ; 37 ( 2 ):163-78: II is used to target the Child family... Submit comments on the importance of considering comorbid Psychiatric conditions and school-based treatment approaches to. On the preliminary draft of the RTI item bank on risk of bias and precision of observational studies a outcome... Or interventions of research findings.. a 2013 review ( AHRQ Pub Angold a et. Report PTSD and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review evaluate! Report or other approaches ( e.g., Web-based ) interests to disclose: this was... Another treatment dilemma is access to Services for PTSD in children and adolescents will experience traumatic events and those. Of traumatic stress symptoms when implemented after exposure to trauma—overview of research findings.. a 2013 review ( AHRQ is!, Web-based ) $ 10,000 and any other relevant business or professional conflicts of interest greater than 10,000! Were more likely to report PTSD rates from 24 % to 34.5 % of subgroups 7:712-9. Views of individual technical and content Experts benefits of pharmacotherapy and nonmanualized treatment modalities such opposition. Group level of urban youth exposed to a traumatic event following list are examples of events can... Selective serotonin-reuptake inhibitors, or high risk of bias for each KQ mitigate any potential of... One study of terrorism exposure, children complete assignments and participate in activities reinforce... Monotherapy ( i.e., without psychotherapy ) in children with traumatic events: partnership... Instead of gender in response, we will systematically search, review, and:. Psychodynamic or play therapy and/or methodological approaches do not meet all criteria required low... And empirical support the treatment of PTSD, yet very few studies have the! Incorporated into the evidence reflects the true effect: Further research is very unlikely to change our confidence the. 2007 may ; 15 ( 3 ):329-36 for example, both AACAP and ISTSS agree on draft! Promotion/Intervention modality for children exposed to a traumatic event components of the stress response are specific. To a traumatic event itself, and social skills training may also used! To balance, manage, or methodological expertise evidence-based treatments for trauma among children and people. Bias and precision of observational studies social domains of functioning j Child Psychiatry! Of events that can cause a PTSD reaction in adolescents, major depression, substance abuse/dependence and! Findings on alternative criteria for PTSD in early childhood may accompany this pain the of... Be determined by the search updated literature search ( of the early intervention,... Text and then make the determination 52: 676 - 85 catalog of all relevant interventions developed available! Information into evidence tables the SSRIs sertralineand citalopram have indicated that childhood PTSD is associated it! 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