The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital‐attending children and a randomized controlled proof‐of‐concept trial of trauma‐focused cognitive therapy, for 3‐ to 8‐year‐olds

Abstract

Background: The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC. Method: Study 1 (N = 105) assessed ASD and PTSD-YC diagnosis in 3-to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3to 8-year-olds diagnosed with PTSD-YC. Results: In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures. Conclusions: The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted. Keywords: Posttraumatic stress disorder; young children; cognitive behavioral therapy; randomized control trial.Conflict of interest statement: See Acknowledgements for full disclosures.

App-Assisted TF-CBT-Based Intervention as Add-On to Inpatient Treatment Reduces Children’s Post-traumatic Stress Symptoms and Post-traumatic Cognitions

“…Addressing post-traumatic cognitions is fundamental in helping children recover from the impact of traumatic experiences, and TF-CBT intends to identify maladaptive cognitions and help children develop more adaptive thought patterns and coping mechanisms [10,[48][49][50][51][52][53]. Several clinical trials suggested that post-traumatic cognitions are important treatment targets [1,54,55]. However, it is not clear whether app-assisted TF-CBT-based intervention could substantially improve the cognitions of children hospitalized in psychiatry units.…”

“…Traumatic experiences like abuse, natural disasters, or loss of loved ones, may result in numerous harmful consequences on mental health [1][2][3][4], 2.6 times increasing the risk of depressive disorders [5], not to mention post-traumatic stress disorder (PTSD) [6,7].…”

Psychotherapeutic interventions for childhood posttraumatic stress disorder: an update

“…However, the studies identified were not comparable enough to recommend a particular treatment. In a recent development, Hitchcock et al [28] utilised CBT-3M, an adapted version of TF-CBT for adolescents and older children, in a pilot study of children aged 3–8 years. CBT-3M ( n = 18) was compared to a waitlist control ( n = 19).…”

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Cognitive Behavioral Intervention on Trauma in Schools (CBITS), and Other Promising Practices in the Treatment of Post-Traumatic Stress Disorder in Children and Adolescents: Evidence Evaluation

“…Follow-up studies have indicated profit sustainability for 6 months, 1 year, and 2 years after treatment. Therefore, TF-CBT is "supported and efficacious in PTSD, depressive and anxiety symptoms, conduct problems, sexualized behaviors, and shame, negative cognitions evoked by trauma, interpersonal trust, and social competence" [11,12,40,[51][52][53][54][57][58][59].…”

“…To be more specific, TF-CBT was applied to English-speaking and Hispanic populations after the terrorist attacks of September 11, 2001, and was effective in reducing PTSD symptoms [55,60]. An adapted model in two studies has also revealed significant improvement in both PTSD and grief symptoms [5,53]. Moreover, parents have also reported a significant reduction in their distress and depressive symptomatology and significant gains in their ability to support and deal with their children's behavioral difficulties [61].…”