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Kids and trauma: When does it require treatment?

When children experience serious trauma, a significant minority are at risk for developing Post-Traumatic Stress Disorder— a severe and often chronic anxiety disorder.

A child watches her father kill her mother. A tween has a medical emergency and nearly dies. A teen is sexually assaulted.

When children experience a serious trauma, most will show a visible change in behavior and emotions but will recover within a few months. A significant minority, however, go on to develop Post-Traumatic Stress Disorder— a severe and often chronic anxiety disorder whose symptoms include nightmares, intense fearfulness, preoccupation with avoiding memories of the trauma, and decreased interest in formerly enjoyed activities.

Is there any hope for them? It appears so. Psychological interventions – particularly cognitive-behavioral therapies (CBT) – are effective in treating PTSD in children, concludes recent research from Clinical Psychology Review.  A round of psychotherapy for PTSD may even alleviate the additional depression that frequently co-occurs with PTSD in children.

One review estimated at 16 percent – about one in six children will develop PTSD from experiencing trauma. Rates appear to be lowest for boys exposed to non-interpersonal traumas such as life-threatening accidents or natural disasters (8 percent) and highest for girls who are exposed to interpersonal traumas such as assault or sexual abuse (33 percent).

This latest study is an important one because it is a well-designed meta-analysis in which the authors carefully selected 39 already-published studies of treatments for childhood PTSD and combined the results using sophisticated mathematical techniques.

CBT was defined by the authors as psychotherapy that focuses on the memory of the trauma and/or its meaning.  Examples include TF-CBT (Trauma-Focused CBT) and Prolonged Exposure. CBT for PTSD might also include helping clients to approach the memories and triggers they have been avoiding, such as by telling the story of the trauma, drawing pictures of it, or visiting safe places that remind them of the trauma like the site of their car accident or the hospital at which they were treated.

You might be having a "well, duh" moment, assuming that any therapist who treats PTSD would necessarily have the client speak directly about the original trauma.

You would be incorrect. Other research with adults has shown that therapists are often reluctant to encourage patients to approach memories and other trauma-related triggers for fear that this might be too upsetting, make the PTSD permanently worse, or somehow erode the trusting relationship between therapist and client.

But, as the current study and many others have shown, in the hands of a trained therapist, focusing the treatment on the remembering and processing of the trauma can help a lot, even with children and teens.

My own experience as a clinician providing CBT to traumatized children is in line with the published research: Helping the child gradually to tell me about the trauma in detail helps them, even when a child is reluctant at first.  Over a course of therapy, the memories become less scary and the child more willing to talk about them.  Parents, too, are helped, and report exhilaration at watching their child emerge from the aching fog of PTSD.

Two major hurdles for parents are finding a trustworthy source of information about what psychotherapies have scientific backing and then locating a therapist who has been trained in these evidence-based interventions.  One online resource I highly recommend for both is Effective Child Therapy, a website maintained by the Society of Clinical Child and Adolescent Psychology of the American Psychological Association.  The National Center for PTSD has lots more about the disorder in both children and adults. The Philadelphia Department of Behavioral Health and Intellectual disAbility Services website has information on accessing evidence-based treatments for PTSD locally.

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