Treatment of Traumatic Stress Disorder in Children and Adolescents

Therapeutic interventions

Trauma affects youths on multiple levels, including individual, family, community, society, and culture. These levels act as either risk or protective factors and may influence the child directly and through interaction with each other.⁹ Thus, to fully comprehend the effects of trauma on the child, treatment models ought to consider each of these levels. There is growing support in the childhood trauma literature for a comprehensive treatment model within an ecological context.^10,11 Bronfenbrenner^9,12 conceptualized such an ecological framework that takes into account environmental influences on children’s development. This framework consists of 4 nested systems around the individual child:

• Microsystem: direct environmental experiences of the child (family, school)

• Mesosystem: interrelations among 2 or more of these environments (relationship between child and peer group)

• Exosystem: community influences (neighborhoods, peers, schools)

• Macrosystem: societal beliefs and values (public policy)

Treatments for childhood trauma include individual, group, family, school-based, and biological interventions. Some treatments enhance resiliency and prevent symptom development, while others reduce symptoms and improve functioning. Although a variety of treatments exist, it is important to use evidence-based interventions because they provide clear guidelines about what treatment components are necessary and help determine treatment efficacy. Consider cultural and linguistic factors when selecting an intervention. Table 1 provides additional treatment considerations. (A complete review of best-practice interventions can be found in Foa et al.¹³)

Table 1

Important factors to consider when choosing a treatment for childhood trauma

Cognitive-behavioral therapy . CBT is the most widely used and researched treatment for childhood trauma.¹⁴Various trauma-oriented CBT interventions exist and all share components summarized by the acronym PRACTICE (Table 2).¹⁵ Trauma-focused (TF)-CBT combines individual and parent-child sessions. TF-CBT has proved to be efficacious in numerous randomized controlled trials for reduction of PTSD symptoms, depression, and other emotional and behavioral difficulties for single-event and multiple-event traumas.^16-18 It is superior to child-centered therapy in reducing PTSD symptoms, especially hyperarousal and avoidance in youths exposed to intimate partner violence.¹⁹

Trauma systems therapy (TST) is an individual treatment that addresses trauma-related symptoms and the environmental factors that perpetuate them.²⁰ TST has shown improvements in PTSD symptoms, environmental stability, and functioning.

Table 2

Trauma-focused CBT components

Many CBT interventions for youths are school-based. The multi-modality trauma treatment (MMTT) protocol, an intervention that uses developmentally sensitive methods, has been successfully implemented in school and community mental health settings.^21,22 The Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) is a 10-session treatment that has been shown to improve psychosocial functions in youths exposed to violence.²³ Finally, several studies of earthquake survivors, victims of the Bosnian war, and victims of community violence have found that trauma/grief-focused therapy resulted in significant reduction of PTSD symptoms.^24-26