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In the aftermath of traumatic events like the Newtown massacre, Superstorm Sandy and Hurricane Katrina, children need to heal, just as adults do. But in turning to research to find out what approaches work best for young people, one finds little guidance, according to a research review published February 11 in Pediatrics.
The study focused on non-interpersonal trauma, such as natural disasters, terrorism and community violence, and excluded sexual abuse and domestic violence. A total of 22 trials meeting the criteria provided evidence on interventions for children exposed to trauma. The criteria required studies to have low or medium risk of bias, to compare at least two groups of children and to measure at least one outcome related to post traumatic stress symptoms that children may experience after such events, such as depression, anxiety attacks, psychosomatic symptoms (headaches, stomachaches, general pains), poor grades, nightmares and similar symptoms.
Among the 20 treatments included in those trials were various psychotherapies focusing on trauma or grief, school-based programs, group therapy and three medication trials: imipramine (Tofranil) , fluoxetine (Prozac) and sertraline (Zoloft).The results are sobering: researchers don't know if any medications help and if anything works long-term, and don't know much about possible harms from interventions.
"I thought we were going to find a lot of studies on different interventions and make clinical recommendations," says Valerie Forman-Hoffman, the study's lead researcher and a psychiatric epidemiologist for RTI International in Research Triangle Park, N.C. Many of the excluded studies failed to include comparison groups, which are important because children may recover without treatment, she added. "It's depressing. The evidence base is just lacking."
Many children do heal on their own from one-off events, especially with good support systems. Yet, about 30 percent will continue to experience nightmares, anxiety attacks, stomachaches and other post traumatic stress symptoms more than a month later, according to the American Academy of Child and Adolescent Psychiatry. Past research has also shown children can develop post-traumatic stress disorder (PTSD) symptoms simply in response to watching news coverage of traumatic events.
A variety of treatment approaches showed some evidence for effectiveness, but not enough studies compared approaches or replicated other results. "That's not saying that no treatment works," Forman-Hoffman says, "but based on the evidence, we don't know what works."
What we do know
One reason for the limited findings may be the review's exclusion of studies about relational trauma, such as sexual abuse or domestic violence. A companion review awaiting publication did review that evidence, but separating the two types of trauma may have made it harder to see a big picture.
"Had they looked at all of the research done on trauma exposure for kids, you would have seen replications for some of the intervention models," says Todd Sosna, the senior vice president in charge of program evaluation at the Children's Institute in Los Angeles. "The research does give some directions for treatments that can be helpful, and they tend to be the ones that are cognitive behavioral and involve trauma narratives."
With trauma-focused cognitive behavioral therapy (TF-CBT), clinicians spend 12 to 18 weeks with a child and parent to help them understand the effects of trauma, how to cope and how to retrain their thoughts and behavior responses. TF-CBT (pdf) also uses trauma narratives—stories children tell about an event while reprocessing it in a healthy way. Put another way, it's telling the story while getting back on the horse. This study and another recent review both found some evidence for reduced symptoms with TF-CBT, but the studies were small and short-term. TF-CBT studies also often involve only children who were sexually abused, providing less specific guidance regarding survivors of a school shooting or hurricane.
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5 Comments
Add CommentSomeone needs to evaluate the therapeutic value of a hugs regimen from a caring, gentle, protective person or person. Hugs can have residual effects and even recalling them can calm a person down.
Reply | Report Abuse | Link to thisI would like to introduce everyone to a pretty excellent DVD interview by Michael Mendosa with Dr. James W. Prescott, Ph.D on the Origins of Love and Violence. There is a whole series of these, but see the one on Sensory Deprivation. It is very incisive and describes what are wholesome *mammalian* behaviors before and at birth. There are clips of what happens to chimps--violent behaviors--with particular types of deprivation and how severing three nerves in the back of their necks makes them docile as can be. Also read the Continuum Concept by anthropologist Jean Liedloff. She lives among a matriarchal South American tribe whose babies take off walking and socializing after one year.
Reply | Report Abuse | Link to thisThe two pieces of research kinda read the same. Women need control of their birthing process,not doctors--on your back is very dysfunctional, un-mammalian and unnatural! Carry babies on the skin for a year for attachment/bonding and social development. Movement is a key factor in neurological development of infants.
I wanna put in my 50 cents worth here. You gotta treat women better or her stress goes right into her child's chemistry. We should be paying Moms to carry, bear, and raise kids. That would be respect. It's no teacup. And if you feel you are more important than that process, DO NOT BEAR CHILDREN, period.
Today Western women have the choice of whether to get pregnant or not.
Reply | Report Abuse | Link to thisTheir choice, their responsibility for the suffering of their offspring !
Having 'babies' just to satisfy your own feelings. Is the most selfish act possible.
Bringing another life into the world is NOT a RIGHT, but an enormous responsibility.
Tony, the tone of your reply does not offer me a sense that you have concern either for the children or the women involved. The strong sense of blame in your post gives me the sense you are struggling instead with your rapport with women and the power involved. I know for me, working out my rapport with women has involved many different experiences including heartache and feeling bullied.
Reply | Report Abuse | Link to thisI'll wish you the best with your journey and hope for your sake and all of us that you can get some perspective instead of posting messages that you'll just regret one day.
All the best,
Paledin
As an Eye Movement Desensitization and Reprocessing (EMDR) clinician, I believe that EMDR is the most effective trauma resolution method for adults and children. It deserves more research
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