Only cognitive-behavioral therapy, of all the major interventions being used to reduce psychological harm in children and adolescents who have witnessed or been victims of trauma or violence, has strong evidence to show it is effective, according to a review.
Evidence was scant for the effectiveness of play therapy, art therapy, psychodynamic therapy, pharmacologic therapy, or psychological debriefing, which were also reviewed—in reducing depressive disorders, posttraumatic stress disorder (PTSD), anxiety and other adverse sequelae in this population, said Holly R. Wethington, Ph.D., and associates of the task force on community preventive services at the Centers for Disease Control and Prevention.
For the report, electronic searches for literature used databases including Medline and PsycINFO, and looked for articles written in English on the particular treatments up to March 2007. Types of trauma included physical or sexual abuse, community violence, suicide of a family member, juvenile cancer and treatment, traffic accidents, and natural disasters. Eleven studies were deemed appropriate for consideration for individual cognitive-behavioral therapy (CBT) and 10 for group CBT. Four studies were identified for play therapy, one for art therapy, two each for psychodynamic and pharmacologic therapy, and one for psychological debriefing (Am. J. Prev. Med. 2008;35:287–313).
Task force member Robert A. Hahn, Ph.D., said that children and adolescents in the United States are exposed to multiple trauma rates that were surprising to him because they were so high. It is important that physicians treat these children appropriately, with therapy that is effective. “Except for cognitive-behavioral therapy, the evidence was lacking for all the other interventions we reviewed, even for pharmaceutical therapy, which is important because it is used by many psychiatrists,” he said.
A “major challenge is that children and adolescents who have been traumatized and may need treatment for PTSD or other psychological conditions generally do not receive that treatment,” according to the task force.
The task force recommended that children and teens be screened, lest their trauma symptoms go undetected. The work of Dr. Wethington and two other members of the task force was supported by funding from the Oak Ridge Institute for Science and Education.
It is important that physicians treat these children appropriately, with therapy that is effective. DR. HAHN