Brooks Keeshin, MD; Erna Olafson PhD, PsyD; and Judith Cohen, MD
Although there is some evidence for the efficacy of other modalities,1 Trauma Focused Cognitive Behavioral Therapy demonstrates the greatest evidence base for treatment of posttraumatic stress disorder in very young traumatized children2 and treatment of sexual abuse, exposure to domestic violence, and poly-victimization-related PTSD in older children.3,4 In addition, trauma focused cognitive behavioral therapies have been shown to be effective in traumatized children with non-PTSD related conditions such as behavioral problems,5 anxiety disorders,5 and depressive symptoms.6 With younger children, therapies that focus on enhancing the parent-child dyad such as Child Parent Psychotherapy and Parent Child Interaction Therapy have been demonstrated to be effective in children exposed to severe domestic violence7 as well as multiple stressful life events8 and physical abuse.9,10 School-based group therapies have successfully reduced symptoms of post-traumatic stress and depression11 as well as improved academic performance12 among violence-exposed children.
In children exposed to violence, there is a small but growing body of research that demonstrates that some interventions may be effective in either reducing the risk of future symptoms or in the prevention of subsequent abusive or violent experiences. Child Family Traumatic Stress Intervention has been demonstrated to be effective in reducing the risk of posttraumatic stress disorder among children exposed to accidental violence as well as sexually abused children.13 Parent Child Interaction Therapy has been demonstrated to be effective in reducing rates of recidivism for physically abusive parents9,14 and enhancing parental sensitivity15 among physically abused children. In addition, the use of standardized forensic interviews with abused children increases the probative information provided in a disclosure,16 thus enhancing the capacity of children’s services and law enforcement to effectively protect the child from subsequent abuse.
For adolescents with complex trauma presentations following polyvictimization and/or polytraumatization exposure including war zones, evidence-based interventions and promising practices are available for “at risk” youth in the community as well as in residential treatment centers or juvenile justice facilities. These interventions have been effective in improving behavior disorders, school performance, and post-traumatic and symptoms such as post-traumatic stress disorder, depression, and maladaptive grief reactions.17,18,19,20,21
Because research about assessment and treatment of traumatized children is developing rapidly, practitioners are also referred to National Child Traumatic Stress Learning Center to remain current with developments in this expanding field. Cohen and colleagues have also published guidelines for pediatricians to identify, treat, and refer traumatized children.22
1. Saunders B, Berliner L, Hanson R. Child Physical and Sexual Abuse: Guidelines for Treatment. Final Report. eric.ed.gov. 2003.
2. Scheeringa MS, Weems CF, Cohen JA, Amaya-Jackson L, Guthrie D. Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: a randomized clinical trial. J Child Psychol Psychiatry. 2011;52(8):853–60.
3. Cohen JA, Deblinger E, Mannarino AP, Steer RA. A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. J Am Acad Child Adolesc Psychiatry. 2004;43(4):393–402.
4. Cohen JA, Mannarino AP, Iyengar S. Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: a randomized controlled trial. Arch Pediatr Adolesc Med. 2011;165(1):16–21.
5. Cohen JA, Berliner L, Mannarino A. Trauma focused CBT for children with co-occurring trauma and behavior problems. Child Abuse Negl. 2010;34(4):215–24.
6. Nixon RDV, Sterk J, Pearce A. A randomized trial of cognitive behaviour therapy and cognitive therapy for children with posttraumatic stress disorder following single-incident trauma. J Abnorm Child Psychol. 2012;40(3):327–37.
7. Lieberman AF, Van Horn P, Ippen CG. Toward evidence-based treatment: child-parent psychotherapy with preschoolers exposed to marital violence. J Am Acad Child Adolesc Psychiatry. 2005;44(12):1241–8.
8. Ghosh Ippen C, Harris WW, Van Horn P, Lieberman AF. Traumatic and stressful events in early childhood: can treatment help those at highest risk? Child Abuse Negl. 2011;35(7):504–13.
9. Chaffin M, Silovsky JF, Funderburk B, Valle LA, Brestan EV, Balachova T, et al. Parent-child interaction therapy with physically abusive parents: efficacy for reducing future abuse reports. J Consult Clin Psych. 2004;72(3):500–10.
10. Thomas R, Zimmer-Gembeck MJ. Parent-child interaction therapy: an evidence-based treatment for child maltreatment. Child Maltreat. 2012;17(3):253–66.
11. Stein BD, Jaycox LH, Kataoka SH, Wong M, Tu W, Elliott MN, et al. A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial. JAMA. 2003;290(5):603–11.
12. Kataoka S, Jaycox LH, Wong M, Nadeem E, Langley A, Tang L, et al. Effects on school outcomes in low-income minority youth: preliminary findings from a community-partnered study of a school-based trauma intervention. Ethn Dis. 2011;21(3 Suppl 1):S1–71–7.
13. Berkowitz SJ, Stover CS, Marans SR. The Child and Family Traumatic Stress Intervention: Secondary prevention for youth at risk of developing PTSD. J Child Psychol Psychiatry. 2011;52(6):676–85.
14. Chaffin M, Funderburk B, Bard D, Valle LA, Gurwitch R. A combined motivation and parent-child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial. J Consult Clin Psych. 2011;79(1):84–95.
15. Thomas R, Zimmer-Gembeck MJ. Accumulating evidence for parent-child interaction therapy in the prevention of child maltreatment. Child Dev. 2011;82(1):177–92.
16. Lamb ME, Orbach Y, Hershkowitz I, Esplin PW, Horowitz D. A structured forensic interview protocol improves the quality and informativeness of investigative interviews with children: a review of research using the NICHD Investigative Interview Protocol. Child Abuse Negl. 2007;31(11-12):1201–31.
17. Layne CM, Saltzman WR, Poppleton L, Burlingame GM, Pasalic A, et al. Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: A randomized controlled trial. J Am Acad Child Adolesc Psych. 2008; 47(9):1048-62.
18. Saltzman WR, Layne CM, Pynoos RS, Steinberg AM, Aisenberg E. Trauma- and grief-focused intervention for adolescents exposed to community violence: Results of a school-based screening and group treatment protocol. Group Dynamics: Theory, Research and Practice. 2001;5(4):291-303.
19. Marrow MT, Knudsen KJ, Olafson E, Bucher SE. The value of implementing TARGET within a trauma-informed juvenile justice setting. J of Child & Adolesc Trauma. 2012;5(3):257-70.
20. Ford JD, Steinberg KL, Hawke J, Levine J, Zhang W. Randomized trial comparison of emotion regulation and relational psychotherapies for PTSD with girls involved in delinquency. J of Clin C & Adolesc Psychology 2012;41(1):27-37.
21. O’Callaghan P, McMullen J, Shannon C, Rafferty H, Black A. A Randomized Controlled Trial of Trauma-Focused Cognitive Behavioral Therapy for Sexually Exploited, War-Affected Congolese Girls. J Am Acad Child Adol Psychiatry 2013; 52(4): 359-369.
22. Cohen JA, Kelleher KJ, Mannarino AP. Identifying, treating and referring traumatized children. Arch Pediatr Adolesc Med. 2008;162(5): 447-52.
© 2015 by Academy on Violence and Abuse