Treatment of Traumatic Stress Disorder in Children and Adolescents

Assessment and Treatment Strategies

By Victor G. Carrion, MD and Hilit Kletter, PhD | October 29, 2012

Dr Carrion is Professor in the department of psychiatry and behavioral sciences and Director of the Stanford Early Life Stress Program. Dr Kletter is Master Clinician and Lab Director of the Stanford Early Life Stress Program at Stanford University School of Medicine in California. The authors report no conflicts of interest concerning the subject matter of this article.

Data on the efficacy of SSRIs have been mixed. A study that compared 24 youths with PTSD with 14 adults with PTSD found that citalopram(Drug information on citalopram) resulted in equivalent improvement.⁴³An open trial of fluoxetine(Drug information on fluoxetine) demonstrated that it was effective in improving earthquake-related PTSD symptoms in 26 youths.⁴⁴However, some studies have found SSRIs to be of no benefit in treating childhood PTSD.

A randomized controlled trial of children with PTSD found no difference between sertraline(Drug information on sertraline) and placebo in treatment outcome.⁴⁵ A study that compared TF-CBT plus sertraline with TF-CBT plus a placebo in sexually abused youths with PTSD found that all youths improved with no group-by-time differences except on the Children’s Global Assessment Scale.⁴⁶The study concluded that while use of sertraline combined with psychotherapy may benefit some children, it is generally better to start psychotherapy alone and add an SSRI only if symptom severity or lack of a response indicates the need.

SSRI use is also associated with certain risks in youths.^47,48 For some children, SSRIs may be overly activating and may lead to irritability, poor sleep, and inattention. In addition, there is an FDA black box warning for increased suicidal ideation or behaviors for all antidepressant medications in individuals younger than 24 years.

Other medications that have been researched for use in treatment of children with PTSD include non-SSRI antidepressants, blocking agents, novel antipsychotics, mood stabilizers, and opiates. A study of hospitalized children with acute stress disorder secondary to burns found that PTSD was less likely to develop after 6 months in patients who received imipramine(Drug information on imipramine) compared with those who received chloral hydrate(Drug information on chloral hydrate).⁴⁹ However, TCAs are associated with rare but serious cardiac adverse effects and therefore are not recommended as a first-line treatment for children with PTSD.

Adrenergic blocking agents have also been used with some success in youths with PTSD. Two studies found that clonidine(Drug information on clonidine) decreased basal heart rate, anxiety, impulsivity, and hyperarousal symptoms.^50,51 In addition, a case study of a child with PTSD found clonidine to improve sleep and neural integrity of the anterior cingulate, a brain region responsible for modulation of emotional responses that is often impaired in PTSD.⁵² Propranolol(Drug information on propranolol) has also been found effective in reducing reexperiencing and hyperarousal symptoms in children with PTSD.⁵³ Novel antipsychotics such as risperidone(Drug information on risperidone) have been used effectively to stabilize mood in severe cases and to treat comorbid symptoms of childhood PTSD.⁵⁴ Finally, higher doses of morphine(Drug information on morphine) were found to prevent PTSD secondary to burns in hospitalized preschool children, school-aged children, and adolescents.^55,56

Conclusions

Although treatments exist for children who experience traumatic stress, the heterogeneous manifestation of symptoms supports the need for development of further treatments. Children who experience trauma need an ecological approach during assessment and a biopsychosocial approach to their treatment. The role of prevention of trauma and prevention of functional impairment after trauma is paramount, because this may disrupt the accumulated physiological and psychological effect of stressors in the individual. Treatments should be tailored to the specific circumstances and characteristics of the particular child or family.

Pages: 1 2 3 4

by susan kweskin | April 08, 2013 9:25 AM EDT

Dear Ms. Sochinm,

All the references appear at the very end (page 4) of this article. Here are references 4 and 5:

5. De Bellis M, Baum AS, Birmaher B, et al. A.E. Bennett Research Award. Developmental traumatology. Part I: biological stress systems. Biol Psychiatry. 1999;45:1259-1270.
6. Gabbay V, Oatis MD, Silva RR, Hirsch G. Epidemiological aspects of PTSD in children and adolescents. In: Silva RR, ed. Posttraumatic Stress Disorder in Children and Adolescents: Handbook. New York: WW Norton & Co; 2004:1-17.

I hope this is helpful.

Susan

by Jackie Sochin | April 05, 2013 12:30 AM EDT

Is it possible to get the citations for numbers five (5) and six (6) from the author?

Thank you.

Jackie Sochinm, CRNP
mejackie@frontiernet.net

Also in this Special Report

Treatment of Traumatic Stress Disorder in Children and Adolescents

The Adolescent Brain Is Different

Traumatic Brain Injury in Children and Adolescents

Developmental Psychopathology Comes of Age

Autism Spectrum and Neurodevelopmental Disorders

Photo by Flickr/PotatoJunkie

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Treatment of Traumatic Stress Disorder in Children and Adolescents

Assessment and Treatment Strategies

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