About two out of every three children will experience at least one traumatic event before they turn 18. Despite this high rate of exposure, little is known about the effectiveness of treatments aimed at preventing and relieving traumatic stress symptoms that children may experience after such events, according to researchers at RTI International, the University of North Carolina School of Medicine, the RTI-UNC Evidence-based Practice Center and the Boston Medical Center.
The article, published February 11 in the journal Pediatrics, summarizes the results of a systematic review of clinical interventions for children under age 18 exposed to at least one traumatic event such as an accident, natural disaster, community violence, war or political instability. Child abuse and neglect were not included in this research; a separate review covers interventions for these types of traumas. The U.S. Agency for Healthcare Research and Quality funded the review.
After reviewing 6,647 abstracts, the investigators found 21 trials and one cohort study that met the criteria for inclusion in the review. Only a few psychotherapeutic treatments showed possible benefits for children exposed to trauma. The most promising interventions were school-based psychotherapy interventions that included cognitive behavior therapy. These interventions were associated with changes in symptoms of post-traumatic stress, anxiety, depression and anger. The review did not find evidence of effectiveness for any of the pharmacologic interventions.
"The current body of evidence provides only a little insight into best practices in treating children exposed to trauma, some of whom already have symptoms," said Valerie Forman-Hoffman, Ph.D., a research epidemiologist at RTI International and lead author of the study. "This is particularly discouraging given recent shootings at schools and other places where children have been victims. We simply don't have much of an evidence-base to be able to recommend best treatment practices."
Adam Zolotor, M.D., a family physician at the University of North Carolina and a co-author of the review, agrees, "These findings serve as a call to action: psychotherapeutic intervention can provide some benefit to children exposed to traumatic events, but far more research is needed to make definitive conclusions. Because trauma is a common and costly source of childhood psychological distress, it is critical to understand effective forms of treatment."
The authors recommend immediate attention from funding agencies, clinicians, researchers, policymakers and other public health authorities to support further, well-designed research that can broaden the evidence base. They suggest that future studies expand their examination of the impact of trauma interventions to a wider range of outcomes such as risk-taking behaviors and suicidality and focus on longer-term indicators of development and functioning.
- Katia Noyes, Alina Bajorska, Susan Fisher, Joseph Sauer, Maria Fagnano, and Jill S. Halterman. Cost-Effectiveness of the School-Based Asthma Therapy (SBAT) Program. Pediatrics, February 11, 2013 DOI: 10.1542/peds.2012-1883
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