What We Know about Trauma Treatment Outcomes for Children

Title:  A meta-analytic review of the treatment outcome literature for traumatized children and adolescents [dissertation]

Author:  Puttre, Jessica J

Source:  St. John's University (New York), 2010. 120 pp.

Abstract:

More than two thirds of children in the general population report exposure to at least one traumatic event by the age of 16.

In addition to high prevalence rates of PTSD, the children exposed to trauma have almost double the rates of developing psychiatric disorders such as affective and anxiety disorders than those not exposed.

Evidence-based psychological interventions are clearly needed to address these psychiatric difficulties; however, the treatment outcome literature for traumatized children is limited as compared to the breadth published for adults. Furthermore, research disseminating the treatment outcome literature is even sparser as only one meta-analysis has examined all trauma types and reactions in traumatized children.

Results from this meta-analysis revealed that Cognitive Behavioral Therapy resulted in statistically significant treatment effects for Post Traumatic Stress Symptoms (PTSS) (d = .50). Although, this research filled a gap in the treatment outcome literature for traumatized children, the strict article inclusion criteria left many studies out of the analysis. The present research attempts to build upon the research of Silverman et al. by widening the inclusion criteria and more than tripling the amount of research studies included in the analysis. In fact, this present meta-analysis identified 67 usable studies (61 published journal articles and 6 dissertations).

The most commonly utilized form of treatment was general CBT (20.9%), followed by TF-CBT (16.4%). In general, CBT interventions were more commonly used than non-CBT interventions (respectively, 58.2%, 41.8%). These interventions were more often conducted in a group format (40.3%); however, individual therapy was also a highly utilized form of treatment delivery (34.3%).

A large overall trauma within group unweighted effect size was found (M = 0.80; SD = 0.68) which indicates that after receiving treatment for trauma, children and adolescents demonstrated positive changes on the outcome measures. Effect sizes were also examined by treatment type, construct used to measure change, service delivery method, duration of treatment, and setting of treatment. This was the first meta-analysis of trauma with children and adolescents to examine effect size as a function of who was reporting change, and the largest effect sizes were found for ratings by structured interview, followed by clinician-report, self-report, parent report, and teacher report, with structured interview being the only significantly different rating. A medium to large positive effect size was found for the overall comparison of trauma treatment to control groups. A small to medium positive effect size was found for the overall comparison of TF-CBT to alternative groups. Limitations and implications for school psychologists are discussed.