Feasibility and potential effectiveness of an intensive trauma-focused treatment programme for families with PTSD and mild intellectual disability

Abstract

Background: Persons with mild intellectual disabilities or borderline intellectual functioning (MID-BIF; IQ 50-85) have a higher risk of being exposed to traumatic events and developing posttraumatic stress disorder (PTSD). EMDR therapy has shown to be applicable, safe and potentially effective for the treatment of PTSD in individuals with MID-BIF. However, in traumatized multi-problem families with MID-BIF and (impending) out of home placement of children, standard PTSD treatment in an outpatient setting may not be appropriate. Objective: To evaluate the feasibility and potential effectiveness of KINGS-ID, a six-week clinical trauma-focused treatment programme consisting of intensive EMDR therapy with parents and children, and parental skills training followed by two weeks of parent support at home. Method: Six families (nine parents of whom six had MID-BIF) and 10 children (all having MID-BIF) participated in the KINGS-ID programme. Seven parents and seven children had PTSD. Data were collected within a single case study design. For each family member data were collected during baseline (three measurements), treatment (seven weekly measurements), posttreatment (three measurements) and at follow-up (three measurements). Results: None of the family members dropped out. Within the first two treatment weeks all but one child and one parent no longer met PTSD symptom criteria. In both children and parents, trauma-related symptoms and daily life impairment significantly decreased following treatment and in parents a significant decrease in symptoms of general psychopathology and parental stress was found. Results were maintained at six-month follow-up. Conclusions: The findings of the current study are promising given that the treatment programme seems to offer new perspectives for traumatized multi-problem families with MID-BIF.

Effectiveness of an intensive treatment programme combining prolonged exposure and EMDR therapy for adolescents suffering from severe post-traumatic stress disorder

“…This is in sharp contrast with regular outpatient traumafocused treatment programmes (Ragsdale et al, 2020;ranging from 30% to 62%). The high retention level may be due to the condensed format of frequently scheduled sessions conducted within a shorter time frame (Mevissen et al, 2020;Ragsdale et al, 2020;Sciarrino et al, 2020;Silverstone et al, 2016), the clear view and perspective as to when treatment ends and the fact that the patients stayed in the clinic during the treatment days (van Woudenberg et al, 2018).…”

“…As a consequence, a significant number of patients ultimately do not receive treatment they could benefit from. There is evidence suggesting that retention in treatment decreases when treatment is intensified: that is, applying a higher frequency of therapy sessions within a shorter time frame (Mevissen, Ooms-Evers, Serra, de Jongh, & Didden, 2020;Ragsdale, Watkins, Sherrill, Zwiebach, & Rothbaum, 2020;Sciarrino, Warnecke, & Teng, 2020;Silverstone, Greenspan, Silverstone, Sawa, & Linder, 2016). For instance, Hendriks et al (2017) and her colleagues developed an intensive PE therapy programme and explored the effectiveness of this programme in 10 adolescent patients with severe PTSD and comorbid disorders following multiple interpersonal trauma.…”

Therapeutic Supports for Neurodiverse Children Who Have Experienced Interpersonal Trauma: a Scoping Review

“…Of the seven studies that assessed efficacy, reductions in post-traumatic symptomatology, general psychiatric challenges, behavioural difficulties and daily life impairment were reported. Two studies reported improved parent outcomes (Harley et al, 2014;Mevissen et al, 2020); however, in one study, scores on the majority of parental stress subscales remained elevated post intervention (Harley et al, 2014). Of note, the results of one study indicated that their TF-CBT intervention was largely ineffective in reducing internalising and externalising problems in children; however, aggressive behaviour and rule-breaking did decrease (Holstead & Dalton, 2013).…”

“…Eight of the studies that implemented a therapeutic support used nonverbal, sensory, and/or play-based therapeutic techniques (Guest & Ohrt, 2018;Harley et al, 2014;Horovitz, 1981;Kildahl et al, 2021;Mevissen et al, 2011Mevissen et al, , 2017Mevissen et al, , 2020Mohamed & Mkabile, 2015), and an additional study made an explicit attempt to integrate their participant's interests and preferred activities into the intervention process (Gerhardt & Smith, 2020). Efforts to modify language and match the communication abilities of participants were reported across five studies, which included the provision of clear instructions (Mevissen et al, 2011(Mevissen et al, , 2017(Mevissen et al, , 2020, simplified communication (Guest & Ohrt, 2018;Ooms-Evers et al, 2021), and the use of positive language (Harley et al, 2014). A further study emphasised the importance of reinforcing and validating verbal communication attempts (Kildahl et al, 2021).…”

“…Four studies reported on eye movement desensitisation and reprocessing therapy (EMDR), one of which had adjunctive elements that included prolonged exposure and physical activity (Mevissen et al, 2020) and another incorporated a dedicated parenting skills component (Ooms-Evers et al, 2021). Three studies delivered cognitive-behavioural support, namely, manualised Trauma Focused Cognitive Behavioural Therapy (TF-CBT; Holstead and Dalton), the trauma narrative component of TF-CBT in conjunction with family therapy (Gerhardt & Smith, 2020), and nonspecific CBT alongside pharmacological treatment (Lin et al, 2020).…”