There's some debate among experts about whether kids who experience traumatic events like Sandy Hook school shootings in Newtown, Conn. need to be treated differently than those who are abused.
(Photo: Jason DeCrow, AP)
Although most children exposed to traumatic events such as natural disasters or school shootings never suffer post-traumatic stress symptoms, there is insufficient hard evidence on the best interventions to help kids who do suffer from these exposures, a new government-sponsored review concludes.
In the analysis of 6,647 research abstracts on psychological and pharmacological therapies, only a few psychological treatments were shown to help kids 17 and under in the short term, and no medications were shown to have benefit.
Just 21 trials and one study reported in 25 abstracts met the reviewers' standards for quality and strength of evidence, says Adam Zolotor, an associate professor of family medicine at the University of North Carolina-Chapel Hill and a co-author of the study, published Monday in Pediatrics.
None of the studies attempted to replicate findings of effective interventions, and none provided insight into how therapeutic interventions may influence children's long-term development, Zolotor says.
The findings underscore, he says, "how limited our good clinical trial information is on the subject."
The Agency for Healthcare Research and Quality, operated by the U.S. Department of Health and Human Services, commissioned the study "to identify gaps in the current scientific literature and highlight important areas for future research," according to the journal report.
There does exist a strong body of research on the benefits of psychotherapies that contain elements of cognitive-behavioral therapy (CBT) as an effective treatment for children who have been exposed to physical abuse, sexual abuse and other forms of maltreatment or "relational" trauma, says Zolotor. (A type of talk therapy, CBT aims to help patients understand the thoughts and feelings that influence their behaviors. It is commonly used to treat a wide range of disorders, including phobias, depression and anxiety.)
This type of intervention may be better than no treatment at all for children facing "non-relational" or non-interpersonal trauma, Zolotor says, but more research is needed to determine "the best type of approaches for either the prevention of post-traumatic stress symptoms or the treatment of symptoms once they've occurred."
This study is not about the debriefing programs that counselors and mental-health professionals often conduct soon after a shooting or other critical incident; rather, it addresses "therapies for kids who are having (chronic) traumatic stress," notes Denise Dowd, a pediatric emergency physician and director of research in the Division of Emergency and Urgent Care at Children's Mercy Hospitals and Clinics in Kansas City, Mo.
Although the majority of kids exposed to traumatic events rebound with the support of loving and caring family relationships, only a few kids start to have problems and develop signs of post-traumatic stress disorder, says Dowd, author of an accompanying commentary in Pediatrics.
A 2007 longitudinal study of 1,420 children ages 9-16, published in the Archives of General Psychiatry, found that potentially traumatic events are common in children but do not typically result in post-traumatic stress symptoms or disorder.
That study found that two-thirds of children reportedly experienced at least one traumatic event by age 16, including 31% with exposure to one event and 37% to multiple events.
Of those, about 13% developed some post-traumatic stress symptoms by age 16, but less than half a percent met the criteria for post-traumatic stress disorder.
Some experts take issue with the new study's premise that there are critical differences between trauma from personal maltreatment and other types of trauma that necessitate different types of intervention, and the need for expensive studies to validate them.
"Our current understanding of how child trauma works is that there's more commonalities than there are differences in how children respond to trauma," says psychiatrist Judith Cohen, medical director of Allegheny General Hospital Center for Traumatic Stress in Children and Adolescents in Pittsburgh.
And "most kids who actually come for treatment have experienced multiple kinds of trauma," whether it's from abuse or exposure to a devastating accident or shooting, says Cohen.
"It's likely that the same kind of treatment that works for one type of trauma is going to work for another kind," she says.
Michelle Healy, USA TODAY