Evidence Supports Psychological Therapies for PTSD Kids

Pam Harrison

December 11, 2012

There is fair evidence to support the effectiveness of psychological therapies for the treatment of posttraumatic stress disorder (PTSD) in children and adolescents, new research shows.

In the first systematic review of PTSD in youth, Donna Gillies, PhD, Western Sydney Local Health District, Westmead, Australia, and colleagues found that children and teens diagnosed with PTSD showed signs of improvement up to 3 months following psychological therapy, and they called for more studies to assess its long-term benefits.

The psychological therapy for which there was the best evidence of effectiveness was cognitive behavioral therapy (CBT), through which improvement was significantly better for up to 1 year following treatment.

PTSD symptom scores were also significantly lower up to 1 year following CBT therapy, and depression scores were also lower for up to 1 month in CBT recipients compared with control participants.

"There is existing evidence for the effectiveness of psychological therapies in adults with PTSD, but this may not be applicable to children and adolescents," Dr. Gillies told Medscape Medical News.

For example, children may not have the requisite skills to engage as effectively in some forms of psychological therapy as adults, she noted.

In addition, children may respond to trauma differently from adults.

"There is fair evidence for the effectiveness of psychological therapies, particularly cognitive behavioral therapy, in treating posttraumatic stress disorder in children," Dr. Gillies said in a release.

"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," she added.

The article was published online December 12 in the Cochrane Database of Systematic Reviews.

Although PTSD is highly prevalent in children and adolescents who have experienced trauma, to date, there have been no systematic reviews of psychological therapies for the treatment of PTSD in this population.

To examine the effectiveness of psychological therapies in youth diagnosed with PTSD, investigators searched all randomized, controlled trials of psychological therapies compared with a control, pharmacologic therapy or other treatments in children or adolescents aged 3 to 18 years who were exposed to a traumatic event or who had been diagnosed with PTSD.

The types of trauma included sexual abuse, civil violence, natural disaster, domestic violence, and motor vehicle accidents.

Fourteen studies involving 758 patients were included in the review.

The psychological therapies in the studies included CBT, exposure-based, psychodynamic, narrative, supportive counseling, and eye movement desensitization and reprocessing.

No study compared psychological therapies with pharmacologic therapies alone or as an adjunct to a psychological therapy.

In 3 studies, improvement across all psychological therapies was 4.2 times better within 1 month for those who completed the psychological therapy compared with the control group.

Improvement following CBT was 8.6 times better for up to 1 month in 2 studies and 8 times better for up to 1 year in 1 study compared with a control group.

PTSD and depression scores following CBT therapy also declined compared with a control group for up to 1 year following treatment, the authors add.

The authors note that no one type of psychological treatment was found to be more effective than any other.

However, the benefits of CBT therapy were supported by better evidence.

"More trials comparing the various psychological therapies are required to find out whether specific psychological therapies are more effective for the treatment of PTSD in children and adolescents," Dr. Gillies said.

"We hoped to identify studies which compared psychological therapies to drug treatments or combined drug treatments with psychological therapies, but no trials which could inform recommendations for the use of drugs in these children were identified," Dr. Gillies noted.

"So there remains a need for the systematic evaluation of drug therapy for PTSD in children and adolescents."

The authors have disclosed no relevant financial relationships.

Cochrane Database Syst Rev. 2012;12:CD006726. Abstract