World of hurt

There’s good news and, not surprisingly, bad news for children and teenagers grappling with the psychological aftermath of trauma. On the up side, research shows that certain interventions ease post-traumatic stress disorder and other trauma-related problems in young people. On the down side, most mental-health practitioners use trauma treatments for kids and teens that lack scientific support.

These conclusions come from an extensive research review conducted by the Task Force on Community Preventive Services, an independent group of 12 investigators partly funded by the federal government. Its findings appear in the September American Journal of Preventive Medicine.

To make matters worse, pediatricians and school officials rarely screen children for past exposure to traumatic events and resulting psychological symptoms, the task force notes. Efforts are underway to develop web-based guides for parents and teachers to identify and help kids experiencing trauma-related problems.

Although the review focuses on Western countries, research has also just started to explore the use of trained non-professionals to treat traumatized children in developing nations, where mental health workers are scarce.

Kids with trauma-related psychological problems tend to do poorly in school if they remain untreated or are inadequately treated, remarks psychologist and social worker Marleen Wong of the University of Southern California in Los Angeles.

An estimated one in eight children have experienced physical or sexual abuse, neglect, bullying and other types of maltreatment. More than one in three have witnessed violence or experienced it indirectly, such losing a parent to murder but not witnessing the crime. Children experiencing such traumas can develop PTSD or other mental disorders.

“In mental health as in education, trauma leaves children behind,” Wong says. Minority children’s regular exposure to violence in poor communities contributes to the academic achievement gap between black and white students, in her view.

Evidence indicates that individual and group cognitive-behavioral therapy reduces symptoms of PTSD, depression, anxiety and related behavior problems in traumatized children and adolescents, the task force reports. Cognitive-behavioral techniques include discussing or writing about traumatic experiences, learning relaxation techniques and replacing paralyzing fears with more realistic assessments. Weekly sessions can extend over one to three months.

The review finds insufficient evidence to recommend any of five other treatment approaches — play therapy, art therapy, drug therapy, psychodynamic therapy or psychological debriefing.

Play therapy and art therapy encourage youngsters to express and control traumatic experiences through these activities. Drug therapy typically prescribes antidepressant or anti-anxiety medication to young trauma victims who have PTSD. Psychodynamic therapy focuses on understanding and changing unconscious reactions to traumatic events. Debriefing consists of group discussions and education conducted one to three days after a traumatic event.

More than three-quarters of U.S. mental health professionals who treat children and teens with PTSD have reported using treatments that have not been scientifically reviewed or for which effectiveness could not be determined by the task force.

“That’s disappointing, but it’s encouraging that a substantial body of evidence supports both individual and group cognitive-behavioral therapy,” says task force member and epidemiologist Robert Hahn of the Centers for Disease Control and Prevention in Atlanta.

Several studies of eye-movement desensitization reprogramming, a controversial trauma treatment, were included in the task force’s review of cognitive-behavioral therapy. In EMDR, patients visually track a therapist’s back-and-forth hand movements. Treatment also includes confronting traumas and revising trauma-induced fears. It is these cognitive-behavioral components of EMDR, not the eye movements, that offer emotional relief to young trauma victims, Hahn says.

Although the new review provides “important confirmation” that cognitive-behavioral therapy quells PTSD and other problems in young trauma victims, it will be difficult to train enough practitioners to provide such treatment to large numbers of natural disaster and war survivors in developing countries, remarks psychologist Mark van Ommeren of the World Health Organization in Geneva.

Researchers should also examine social interventions, van Ommeren says. Disrupted social networks in the wake of disasters powerfully provoke psychological problems in children, he notes.

Social interventions include providing family reunification services, restarting formal or informal schooling, creating group activities for isolated children and recruiting teens for relief efforts. Such interventions show promise as ways to assist former child soldiers in Africa (SN: 6/7/08, p. 5).

Social strategies are much harder to study than clinical ones are. The task force evaluated all clinical treatment studies of children and teens exposed to various traumas published up to March 2007. Hahn’s team reviewed only studies that included non-treated comparison groups and met other qualifying criteria.

The final review consisted of 11 studies of individual cognitive-behavioral therapy, 10 studies of group cognitive-behavioral therapy, four studies of play therapy, one study of art therapy, two studies of psychodynamic therapy, two studies of drug therapy and one study of psychological debriefing.