Treatment for Posttraumatic Stress Disorder in Children

Tulane University Of Louisiana, New Orleans LA

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Abstract

DESCRIPTION (provided by applicant): The aims of this research plan are (1) to demonstrate the successful adaptation and implementation of a theoretically-based manualized cognitive-behavioral treatment (CBT) for preschool-age children (3-6 years) with PTSD, and (2) to demonstrate that PTSD symptoms in the children and level of distress in the parents can be meaningfully reduced. No studies have attempted to show effectiveness of any psychosocial treatment in preschool children who have suffered interpersonal traumas, except for sexual abuse. This application is meant to fill that gap. The manualized protocol utilizes the CBT techniques of graded exposure, anxiety management training, and developing a coherent narrative of the trauma free of cognitive distortions. This is combined with parent-child relational treatment techniques focused on supportive therapy, parent management training, and enhancement of parent compliance. The subjects will be heterogeneous in regard to type of trauma, including children who have witnessed severe domestic violence, and those that have suffered acute accidental injuries. In Phase 1, 8 children with PTSD will be recruited and enrolled in the treatment. We will use systematic checklists, consensus panel reviews, and expert consultation from individual cases to guide the developmental adaptation and implementation of this intervention. Multiple indices of success will be assessed including therapist adherence, child compliance, parent compliance, parent reluctance, and parent acceptance. Repeated feedback mechanisms will be used to revise the manual/protocol to eventually achieve 90% completion of CBT tasks and 90% therapist adherence to the manual. In Phase 2, 38 children with PTSD will be recruited and randomized for intervention into either immediate treatment or a 12-week wait-list condition to control for the passage of time. We will measure the change in children's symptoms, and change in parents' symptoms and distress levels, in addition to the adaptation and implementation measures from Phase 1.