Treating Children With PTSD

Treating Children With PTSD

Although some children show a natural remission in symptoms over a few months, a significant number continue to exhibit symptoms for years if left untreated. Few studies have examined which treatments are most effective for children and adolescents.
 
A review of the adult treatment studies of PTSD shows that cognitive behavioral therapy (CBT) is the most effective approach. For children, this generally includes the child directly discussing the traumatic event (exposure), anxiety management techniques (such as relaxation and assertiveness training), and correction of inaccurate or distorted trauma-related thoughts.
 
Although there is some controversy regarding exposing children to the events that scare them, exposure-based treatments seem to be most relevant when memories or reminders of the trauma distress the child. Children can be exposed gradually and taught relaxation techniques so that they can learn to relax while recalling their experiences. Through this procedure, they learn that they do not have to be afraid of their memories.
 
CBT also involves challenging children's false beliefs, such as, "The world is totally unsafe." The majority of studies have found that it is safe and effective to use CBT for children with PTSD.
 
CBT is often accompanied by psychoeducation and parental involvement. Psychoeducation is education about symptoms of PTSD and their effects. It is as important for parents and caregivers to understand the effects of the condition as it is for children to understand this. Research shows that the better parents cope with the trauma and the more they support their children, the better their children will function.
 
Therefore, it is important for parents to seek treatment for themselves in order to develop the necessary coping skills that will help their children.
 
Several other types of therapy have been suggested for adolescents and children with PTSD. Play therapy can be used to treat young children with the disorder who are not able to deal with the trauma more directly. The therapist uses games, drawings, and other techniques to help the child process his or her traumatic memories.
 
Psychological first aid has been prescribed for children exposed to community violence, and can be used in schools and traditional settings. Psychological first aid involves:
 
  • Clarifying trauma-related facts
  • Normalizing the children's PTSD reactions
  • Encouraging the expression of feelings
  • Teaching problem-solving skills
  • Referring the most symptomatic children for additional treatment.
     
Twelve-step approaches have been prescribed for adolescents with substance abuse problems and PTSD. Another therapy, eye movement desensitization and reprocessing (EMDR), combines cognitive therapy with directed eye movements. While EMDR has been shown to be effective in treating both children and adults with PTSD, studies indicate that it is the cognitive intervention rather than the eye movements that accounts for the change.
 
Medications have also been prescribed for some children with PTSD. However, due to the lack of research in this area, it is too early to evaluate the effectiveness of drug therapy.
 
Finally, specialized interventions may be necessary for children exhibiting particularly problematic behaviors or symptoms. For example, a specialized intervention might be required for inappropriate sexual behavior or extreme behavioral problems.
 
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