Pediatric PTSD - Can CBT Help?

Little girl kneeling at gravesite 

PTSD Affecting Children

Most of us associate Post Traumatic Stress Disorder (PTSD) with the adult population. But did you know that, for a long time, clinicians also shared this belief and were reluctant to see PTSD as a pediatric disorder as well? More research and clinicians now, however, are reporting it as a frequently occurring disorder within the child and adolescent population. What changed? According to recent studies from the National Child Traumatic Stress Network, up to 25% of youth have experienced some type of trauma by the time they turn 16 years old. Data on the prevalence of these children and adolescents developing PTSD are not definitive; yet, some studies suggest that up to 40% of this population might develop PTSD or symptoms strongly associated with the disorder.

 

Trauma in Childhood

How does it affect our children? PTSD is a complex disorder that can be extremely disabling. In particular, severe trauma that might lead to PTSD has a widespread effect in child development. The damage to a child's sense of security about the world they live in, as well as to their belief that their caretakers are able to protect them from harm, can have profound negative consequences. Symptoms of pediatric PTSD are generally similar to those seen in the adult population. Following the traumatic experience, the child or adolescent might show some of the following behaviors:

 

·        Recurrent and/or intrusive memories about the event

·        Frightening dreams

·        Intense reactions to symbolic or literal reminders of the trauma

·        Avoidance behaviors regarding anything and everything related to the trauma

·        General symptoms of anxiety and depression (irritability, insomnia, outbursts of rage, emotional numbing, diminished interest in life, etc.)

           

The Consequences

All of the aforementioned symptoms are likely to be associated with negative cognitive, emotional, social, and/or physical consequences for children and adolescents.

           

CBT Effective for Pediatric PTSD

The good news is that research suggests that psychotherapy, especially Cognitive Behavioral Therapy (CBT), does help treat the symptoms of PTSD. The University of Arizona College of Medicine recently conducted a meta-analysis to evaluate outcomes from randomized clinical trials of CBT for the treatment of internalizing (anxiety and depression) and externalizing (aggression and rule breaking) symptoms of PTSD in the pediatric population. Their study suggests that CBT is an effective form of treatment for pediatric PTSD, particularly for addressing the internalizing symptoms of the disorder.

 

How CBT Works for PTSD

Clinicians using this approach focus on working with the associations clients have between stimuli and conditioned fear responses, examining the influence of environmental factors on symptom expression, and practicing cognitive and affective regulation with clients. Studies also suggest that this population might sometimes require a combination therapy of group or individual CBT along with pharmacotherapy. What do you think about the combination approach for children and adolescents?

 

References

 

Kowalik, J., Weller, J., Venter, J., Drachman, D. (2011). Cognitive behavioral therapy for the treatment of pediatric post traumatic stress disorder: A review and meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry. Vol 42(3), 405-413.

 

Lubit, R.H. (2011). Post traumatic stress disorder in children. Medscape Refrences. Retrieved from http://emedicine.medscape.com/article/918844-overview.