Review of Childhood Trauma Literature

Three reviews:

1. Silverman, W.K., Oritz, C.O., Viswesvaran, C., Burns, B.J., Kolko, D.J., Putnam, F.W. (2008).
2. Stallard, P. (2006).
3. Wethington, et al. (2008).

1. Silverman, W.K., Oritz, C.O., Viswesvaran, C., Burns, B.J., Kolko, D.J., Putnam, F.W. (2008). Evidence-based psychological treatments for children and adolescents exposed to traumatic events.  Journal of Clinical Child and Adolescent Psychology, 37(1): 156-183.

*NOTE* This review contains studies relating to abuse and neglect, for details see page 160.

Implications for practice:
Populations studied: Studies in the review cover a range of trauma types and reactions to trauma.  Children aged 2 -18, who have experienced physical abuse, community violence, major hurricane, marital violence, or a motor vehicle accident.

Intervention types: mainly psychosocial treatments (CBT, EMDR, client-centred) in individual, group and family formats.

Intervention settings: Broad range of settings, including schools, hospitals and clinics.

Outcomes: Reviewed according to a set of criteria relating to the quality of the evidence: well-established, probably efficacious, and possibly efficacious.

Generalisability, representativeness and best practice recommendations: 11 out of the 21 treatment studies were conducted in community or hospital settings, most studies used active, alternative comparison conditions, 10 studies used therapists who were already working in the field, and these studies reported few exclusion criteria.  These study characteristics more closely mirror those characteristics of “real world” practice settings.  Ethnic minority populations composed more than 40% of the samples in 13 of the 21 studies.  Many studies included in the review used samples with relatively narrow age ranges, allowing for increased confidence about the treatment effects for that age group.

However, many of the studies included in the review are limited in terms of their ability to generalise the findings over time and across outcome measures.

 “…when working with youth exposed to traumatic events, the treatment with the most evidence for efficacy to date involves CBT…with trauma specific components.” (p. 177)

“...the extent to which the study findings generalise to the complex presentations in children who are affected by multiple traumas is not entirely clear...” (p. 177)

“...clinicians can be directed to carefully consider the use of a given intervention based on current evidence that reflects its ability to change a given outcome…such information may contribute to more optimal treatment selection and perhaps more effective intervention…” (p. 177)

2. Stallard, P. (2006). Psychological interventions for post-traumatic reactions in children and young people: A review of randomised controlled trials. Clinical Psychology Review, 26: 895-911.

*NOTE* This review contains studies relating to sexual abuse and violence, for details see pages 898-900.

Implications for practice:
Populations studied: children aged 2-14, who have experienced sexual abuse, violence, cancer and hurricane.

Intervention types: 
Psychotherapy, eye movement desensitisation and reprocessing (EMDR), and CBT (with preschool children, school aged children, children who have experienced violence and children who have experienced cancer). 

Intervention settings: Community-based and school-based.

Generalisability, representativeness and best practice recommendations:The review authors highlight a number of methodological problems in the studies that question the direct applicability of the findings to everyday clinical practice, including (a) the exclusion criteria used in the studies, (b) the age of the children studied, (c) the gender of the children studied, (d) problem severity, (e) acute vs chronic trauma, (f) abuse vs other trauma, and (g) study sample sizes.  

The review highlights the need for further research with children who have recently experienced trauma (i.e. within the last month).

“The relative contribution of, and balance between, the different components within trauma-focused CBT has not yet been determined. This wide variability highlights the need for deconstruction studies to determine the effective ingredients of these interventions.” (p. 908)

“…although parental involvement in trauma-focused CBT is recommended and widely advocated by clinicians, the effects upon the child's post-traumatic symptoms appear minimal. Further attention needs to be paid to the purpose, sequencing and way parents are involved in trauma-focused CBT in order to determine their optimal role.” (p. 908)

“…the majority of research has been undertaken with school-aged children, particularly girls, who have been sexually abused. In view of the potential differences between abuse and other forms of trauma it is important to substantiate the efficacy of trauma-focused CBT throughout the wider population of traumatised children. Research with young children is particularly lacking and at present there is comparatively little research that can inform the clinician's practice with this age group. Similarly studies involving children with multiple presentations residing within less supportive or more complex situations are required.”  (p. 908)

3. Wethington, H.R., Hahn, R.A., Fuqua-Whitley, D.S., Sipe, T.A., Crosby, A.E., Johnson, R.L., Liberman, A.M., Mościcki, E., Price, L.N., Tuma, F.K., Kalra, G., Chattopadhyay, S.K. and Task Force on Community Preventive Services (2008).

The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: A systematic review. American Journal of Preventive Medicine, 35(3): 287-313.

Implications for practice:

Populations studied: Wide range of traumas: Children and adolescents who have experienced natural disaster, suicide of a family member, sexual abuse, community trauma, mixed trauma, war, cancer, physical abuse, domestic violence, severe burn, motor vehicle accident.

Intervention types: Individual CBT, group CBT, play therapy, art therapy, psychodynamic therapy, pharmacologic therapy, psychological debriefing.

Generalisability, representativeness and best practice recommendations:Individual and group CBT: applicability to more disruptive children, children with severe mental health and behavioural problems and those at risk of suicide is unknown.

“Strong evidence of the effectiveness of individual and group CBT indicates that public and private organisations that provide assistance to traumatised people (e.g. social welfare agencies) should consider offering such treatments to their clients”. (p. 298)

“The need is great for dissemination of effective treatment approaches for children and adolescents exposed to trauma. Such exposures are common in the U.S. and around the world. Psychological treatment for the resulting symptoms is rarely given, which can result in their exacerbation. When treatment is provided, it could be improved by a greater emphasis on the use of and training in evidence-based practices such as CBT.  Effective means of treatment are at hand, and should be widely deployed and modified for use in underserved areas of need”. (pp. 297-298)

Studies included in the reviews:

1.   Silverman, W.K., Oritz, C.O., Viswesvaran, C., Burns, B.J., Kolko, D.J., Putnam, F.W. (2008). Evidence-based psychological treatments for children and adolescents exposed to traumatic events.  Journal of Clinical Child and Adolescent Psychology, 37(1): 156-183.

• Ahrens, J. and Rexford, L. (2002) Cognitive processing therapy for incarcerated adolescents with PTSD. Journal of Aggression, Maltreatment & Trauma, 6: 201-216.
• Berliner, L. and Saunders, B. (1996) Treating fear and anxiety in sexually abused children: Results of a controlled two-year follow-up study. Child Maltreatment 1: 294-309.
• Celano, M., Hazzard, A., Webb, C. and McCall, C. (1996) Treatment of traumagenic beliefs among sexually abused girls and their mothers: An evaluation study. Journal of Abnormal Child Psychology 24: 1-17.
• Chemtob, C., Nakashima, J. and Carlson, J. (2002) Brief treatment for elementary school children with disaster-related posttraumatic stress disorder: A field study. Journal of Clinical Psychology 58: 99-112.
• Cohen, J.A. and Mannarino, A. P. (1996b) A treatment outcome study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child and Adolescent Psychiatry 34: 42-50.
• Cohen, J.A. and Mannarino, A. P. (1997) A treatment study for sexually abused preschool children: Outcome during a one-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry 36: 1228-1235.
• Cohen, J. A. and Mannarino, A. P. (1998) Interventions for sexually abused children: Initial treatment outcome findings. Child Maltreatment 3: 17-26.
• Cohen, J.A., Deblinger, E.,  Mannarino, A. P. and Steer, R. A. (2004) A multisite randomized controlled study of sexually abused, multiply traumatized children with PTSD: Initial treatment outcome. Journal of the American Academy of Child and Adolescent Psychiatry 43: 393-402.
• Cohen, J.A., Mannarino, A. P. and Knudsen, K. (2005) Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse & Neglect 29: 135-145.
• Deblinger, E. and Heflin, A. H. (1996) Treating sexually abused children and their nonoffending parents: A cognitive behavioral approach Sage , Thousand Oaks, CA.
• Deblinger, E.,  Steer, R. and Lippmann, J. (1999) Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms. Child Abuse & Neglect 23: 1371-1378.
• Deblinger, E.,  Stauffer, L. and Steer, R. (2001) Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreatment 6: 332-343.
• Fantuzzo, J.,  Sutton-Smith, B.,  Atkins, M.,  Meyers, R.,  Stevenson, H. and Coolahan, K. (1996) Community-based resilient peer treatment of withdrawn maltreated preschool children. Journal of Consulting and Clinical Psychology 64: 1377-1386.
• Fantuzzo, J.,  Manz, P.,  Atkins, M. and Meyers, R. (2005) Peer-mediated treatment of socially withdrawn maltreated preschool children: Cultivating natural community resources. Journal of Clinical Child and Adolescent Psychology 34: 320-325.
• Jaberghaderi, N.,  Greenwald, R.,  Rubin, A.,  Zand, S. O. and Dolatabadi, S. (2004) A comparison of CBT and EMDR for sexually abused Iranian girls. Clinical Psychology and Psychotherapy 11: 358-368.
• Kataoka, S.H., Stein, B. D.,  Jaycox, L. H.,  Wong, M.,  Escudero, P. and Tu, W. (2003) A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry 42: 311-318.
• King, N.J., Tonge, B. J.,  Mullen, P.,  Myerson, N.,  Heyne, D. and Rollings, S. (2000) Treating sexually abused children with posttraumatic stress symptoms: A randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry 39: 1347-1355.
• Kolko, D.J. (1996) Individual cognitive behavioral treatment and family treatment and family therapy for physically abused children and their offending parents: A comparison of clinical outcomes. Child Maltreatment 1: 322-342.
• Lieberman, A.F., Van Horn, P. and Ippen, C. G. (2005) Toward evidence-based treatment: Child-parent psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child & Adolescent Psychiatry 44: 1241-1248.
• Stein, B. D.,  Jaycox, L. H.,  Kataoka, S.,  Rhodes, H. J. and Vestal, K. D. (2003) Prevalence of child and adolescent exposure to community violence. Clinical Child and Family Psychology Review 6: 247-264.
• Trowell, J.,  Kolvin, I.,  Weeramanthri, T.,  Sadowski, H.,  Berelowitz, M. and Glaser, D. (2002) Psychotherapy for sexually abused girls: Psychopathological outcome findings and patterns of change. British Journal of Psychiatry 180: 234-247.

2.   Stallard, P. (2006). Psychological interventions for post-traumatic reactions in children and young people: A review of randomised controlled trials. Clinical Psychology Review, 26: 895-911.

• Celano, M., Hazzard, A., Webb, C. and McCall, C. (1996) Treatment of traumagenic beliefs among sexually abused girls and their mothers: An evaluation study. Journal of Abnormal Child Psychology 24: 1-17.
• Chemtob, C, Nakashima, J., & Carlson, J. (2002). Brief treatment for elementary school children with disaster-related post traumatic stress disorder: A field study. Journal of Clinical Psychology, 58: 99–112.
• Cohen, J.A., Deblinger, E.,  Mannarino, A. P. and Steer, R. A. (2004) A multisite randomized controlled study of sexually abused, multiply traumatized children with PTSD: Initial treatment outcome. Journal of the American Academy of Child and Adolescent Psychiatry 43: 393-402.
• Cohen, J. A., & Mannarino, A. P. (1996). A treatment outcome study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child and Adolescent Psychiatry, 35: 42–50.
• Cohen, J., Mannarino, A.P., Berliner, L. and Deblinger, E. (2000). Trauma focused cognitive behaviour therapy for children and adolescents: An empirical update. Journal of Interpersonal Violence, 15: 1202–1223.
• Cohen, J. A., & Mannarino, A. P. (1997). A treatment study for sexually abused preschool children: Outcome during a one-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 36: 1228–1235.
• Cohen, J. A., & Mannarino, A. P. (1998). Interventions for sexually abused children: Initial treatment outcome findings. Child Maltreatment: Journal of the American Professional Society on the Abuse of Children, 3: 17–26.
• Cohen, J.A., Mannarino, A. P. and Knudsen, K. (2005) Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse & Neglect 29: 135-145.
• Deblinger, E., & Lippman, J. (1996). Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1: 310–322.
• Deblinger, E., Stauffer, L.B., and Steer, R.A. (2001). Comparative efficacies of supportive and cognitive behavioural group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreatment, 6(4): 332–343.
• Jaberghaderi, N., Greenwald, R., Rubin, A., Zand, S.O., & Dolatabadi, S. (2004).  A comparison of CBT and EMDR for sexually abused Iranian girls.  Clinical Psychology and Psychotherapy, 11: 358–368.
• Kazak, A. E., Alderfer, M. A., Streisand, R., Simms, S., Rourke, M. T., Barakat, L. P., et al. (2004). Treatment of post-traumatic stress symptoms in adolescent survivors of childhood cancer and their families: A randomised clinical trial. Journal of Family Psychology, 18(3): 493−504.
• King, N.J., Tonge, B.J., Mullen, P., Myerson, N., Heyne, D., & Rollings, S. et al. (2000). Treating sexually abused children with post-traumatic stress symptoms: A randomised clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 39(11): 1347–1355.
• Kolko, D.J. (1996) Individual cognitive behavioral treatment and family treatment and family therapy for physically abused children and their offending parents: A comparison of clinical outcomes. Child Maltreatment 1: 322-342.
• Stein, B. D.,  Jaycox, L. H.,  Kataoka, S.,  Rhodes, H. J. and Vestal, K. D. (2003) Prevalence of child and adolescent exposure to community violence. Clinical Child and Family Psychology Review 6: 247-264.
• Trowell, J., Kolvin, I., Weeramanthri, H., Sadowski, Berelowitz, M. & Galsser, D. et al. (2002). Psychotherapy for sexually abused girls: Psychopathological outcome findings and patterns of change. British Journal of Psychiatry, 180: 234–247.

3.   Wethington, H.R., Hahn, R.A., Fuqua-Whitley, D.S., Sipe, T.A., Crosby, A.E., Johnson, R.L., Liberman, A.M., Mościcki, E., Price, L.N., Tuma, F.K., Kalra, G., Chattopadhyay, S.K. and Task Force on Community Preventive Services. (2008). The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: A systematic review. American Journal of Preventive Medicine, 35(3): 287-313.

• Ahrens J, Rexford L. (2002). Cognitive processing therapy for incarcerated adolescents with PTSD. Journal of Aggression, Maltreatment & Trauma, 6: 201–16.
• Barbe RP, Bridge JA, Birmaher B, Kolko DJ, Brent DA. (2004). Lifetime history of sexual abuse, clinical presentation, and outcome in a clinical trial for adolescent depression. Journal of Clinical Psychiatry, 65:77– 83.
• Berliner L, Saunders BE. (1996). Treating fear and anxiety in sexually abused children: results of a controlled 2-year follow-up study. Child Maltreatment, 1: 294 –309.
• Celano, M., Hazzard, A., Webb, C. and McCall, C. (1996) Treatment of traumagenic beliefs among sexually abused girls and their mothers: An evaluation study. Journal of Abnormal Child Psychology 24: 1-17.
• Cohen, J.A., Deblinger, E.,  Mannarino, A. P. and Steer, R. A. (2004) A multisite randomized controlled study of sexually abused, multiply traumatized children with PTSD: Initial treatment outcome. Journal of the American Academy of Child and Adolescent Psychiatry 43: 393-402.
• Cohen, J. A., & Mannarino, A. P. (1997). A treatment study for sexually abused preschool children: Outcome during a one-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 36: 1228–1235.
• Cohen, J.A., Mannarino, A. P. and Knudsen, K. (2005) Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse & Neglect 29: 135-145.
• Deblinger, E., Stauffer, L.B., and Steer, R.A. (2001). Comparative efficacies of supportive and cognitive behavioural group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreatment, 6(4): 332–343.
• Deblinger, E.,  Steer, R. and Lippmann, J. (1999) Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms. Child Abuse & Neglect 23: 1371-1378.
• Ehntholt KA, Smith PA, Yule W. (2005). School-based cognitive-behavioural therapy group intervention for refugee children who have experienced war-related trauma. Clinical Child Psychology and Psychiatry, 10: 235–50.
• Goenjian AK, Walling D, Steinberg AM, Karayan I, Najarian LM, Pynoos RS. (2005). A prospective study of posttraumatic stress and depressive reactions among treated and untreated adolescents 5 years after a catastrophic disaster. American Journal of Psychiatry, 162: 2302–8.
• Goenjian AK, Karayan I, Pynoos RS, et al. (1997). Outcome of psychotherapy among early adolescents after trauma. American Journal of Psychiatry, 154: 536–42.
• Kataoka, S.H., Stein, B. D.,  Jaycox, L. H.,  Wong, M.,  Escudero, P. and Tu, W. (2003) A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry 42: 311-318.
• Kazak, A. E., Alderfer, M. A., Streisand, R., Simms, S., Rourke, M. T., Barakat, L. P., et al. (2004). Treatment of post-traumatic stress symptoms in adolescent survivors of childhood cancer and their families: A randomised clinical trial. Journal of Family Psychology, 18(3): 493−504.
• King, N.J., Tonge, B.J., Mullen, P., Myerson, N., Heyne, D., & Rollings, S. et al. (2000). Treating sexually abused children with post-traumatic stress symptoms: A randomised clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 39(11): 1347–1355.
• Kolko, D.J. (1996) Individual cognitive behavioral treatment and family treatment and family therapy for physically abused children and their offending parents: A comparison of clinical outcomes. Child Maltreatment 1: 322-342.
• Kot S, Landreth GL, Giordano M. (1998). Intensive child-centered play therapy with child witnesses of domestic violence. International Journal of Play Therapy, 7: 17–36.
• Lange A, van de Ven JP, Schrieken B, Emmelkamp PMG. (2001). Interapy, treatment of posttraumatic stress through the Internet: a controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 32: 73–90.
• Lieberman AF, Van Horn P, Ippen CG. (2005). Toward evidence-based treatment: child-parent psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44: 1241– 8.
• Lytle RA, Hazlett-Stevens H, Borkovec TD. (2002). Efficacy of eye movement desensitization in the treatment of cognitive intrusions related to a past stressful event. Journal of Anxiety Disorders, 16: 273– 88.
• Pfeffer CR, Jiang H, Kakuma T, Hwang J, Metsch M. (2002). Group intervention for children bereaved by the suicide of a relative. Journal of the American Academy of Child and Adolescent Psychiatry, 41: 505–13.
• Scheck MM, Schaeffer JA, Gillette C. (1998). Brief psychological intervention with traumatized young women: the efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress, 11: 25– 44.
• Ronan KR, Johnston DM. (1999) Behaviourally-based interventions for children following volcanic eruptions: an evaluation of effectiveness. Disaster Prevention and Management, 8: 169 –76.
• Schreier H, Ladakakos C, Morabito D, Chapman L, Knudson MM. (2005). Posttraumatic stress symptoms in children after mild to moderate pediatric trauma: a longitudinal examination of symptom prevalence, correlates and parent-child symptom reporting. Journal of Trauma, 58: 353– 63.
• Shen Y. (2002). Short-term group play therapy with Chinese earthquake victims: effects on anxiety, depression and adjustment. International Journal of Play Therapy, 11: 43–63.
• Smith N, Landreth G. (2003). Intensive filial therapy with child witnesses of domestic violence: a comparison with individual and sibling group play therapy. International Journal of Play Therapy, 12: 67– 88.
• Stallard P, Velleman R, Salter E, Howse I, Yule W, Taylor G. (2006). A randomised controlled trial to determine the effectiveness of an early psychological intervention with children involved in road traffic accidents. Journal of Child Psychology and Psychiatry, 47:10S):127–34.
• Stein, B. D.,  Jaycox, L. H.,  Kataoka, S.,  Rhodes, H. J. and Vestal, K. D. (2003) Prevalence of child and adolescent exposure to community violence. Clinical Child and Family Psychology Review 6: 247-264.
• Tyndall-Lind A, Landreth GL, Giordano MA. (2001). Intensive group play therapy with child witnesses of domestic violence. International Journal of Play Therapy, 10: 53– 83.