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Wednesday, 26 June 2013

Treating traumatised kids

Are the current approaches to treating traumatized kids actually making them better?  

More and more research is telling us about the long-term negative consequences of trauma and adversity in childhood with correlations between childhood trauma and poor mental and physical health outcomes across the lifespan. So, it makes sense that there should be a good evidence base for treating the effects of childhood trauma.

In February this year, researchers in the United States undertook a Comparative Effectiveness Review (CER) examining the evidence for interventions that target traumatic stress symptoms and syndromes associated with nonrelational trauma, such as exposure to war, disasters and accidents. The review was sponsored by the Agency for Healthcare Research and Quality (AHRQ). CER’s are designed to guide health care decisions by providing evidence on the effectiveness, benefits and harms of different types of interventions.

The authors noted in their paper – although several guidelines on the treatment of PTSD in childhood and adolescence exist, the recommendations are inconsistent and largely not based on evidence from high-quality clinical trials or comparative effectiveness reviews (CER’s).

·       The literature, including the grey literature, was systematically reviewed to identify 21 trials and 1 observational study that evaluated 6 different types of interventions. These studies included 7 studies that targeted children identified as exposed to trauma and 15 studies targeting children with trauma exposure who already had symptoms. These interventions included psychological as well as pharmacological treatments.
·      The researchers used qualitative rather than quantitative analysis methods, which they stated was due to there being insufficient numbers of similar studies, variation in outcome reporting and statistical heterogeneity (the level of differences present in the data).
·       At least 1 outcome in the studies included in this CER had to relate to the assessment of traumatic stress symptoms or syndromes.

·       Interventions that included trauma-focused CBT, child and family traumatic stress intervention and 2 different school interventions with elements of CBT reported some improvement in outcomes.
·       Studies that included early psychological intervention and medication with propanonol showed no improvement in any outcomes.
·       The child and family traumatic stress intervention was the only study that showed evidence of benefit with an active group comparator.
·       School based interventions with elements of CBT were promising based on the magnitude and precision of effects.

Overall the study found that there was very little evidence to support the current interventions that are being used to treat children presenting with adverse symptoms as a result of nonrelational trauma.

In their systematic review of the literature the authors were able to identify many more studies assessing interventions than those that were included here. Most of these studies were not included in this review as they did not meet the inclusion criteria for the CER or the interventions had only been trialed with children exposed to relational traumas, such as child maltreatment or sexual abuse. This raises the obvious point that there is a need for a more consistent and evidence based approach and also the need for research that is embedded in practice in order to collate evidence about those interventions that are being used to treat trauma in children. However, as the authors note, studying traumatized children is a particularly sensitive area and one that can be difficult to recruit participants into.

The authors concluded that:
Psychotherapeutic intervention may provide benefit relative to no treatment in children with traumatic stress symptoms or exposed to traumatic events and appears not to have associated harms.

For practitioners working with children who have been exposed to trauma, it is worth noting that the CER found that interventions with components of CBT were amongst those that demonstrated some efficacy. A review and meta-analysis of CBT for the treatment of posttraumatic stress disorder (PTSD) in children (Kowalk et al) also found that interventions that incorporated CBT were the most effective in treating trauma in children.

Another point to note is that many of the current interventions and much of the research only focuses on the short to medium term outcomes of trauma in children, when we know that the experience of traumatic is likely to have long term negative impacts on development. This leaves us with a large gap of knowledge about what actually helps children and young people over time.

Given what we now know regarding the poor outcomes of many children and young people who are exposed to trauma, it is essential that the knowledge base continues to be developed in order ensure the wellbeing of children, young people and their families.

This article has also appeared on The Mental Elf blog

Valerie L. Forman-Hoffman, Adam J. Zolotor, Joni L. McKeeman, Roberto Blanco, Stefanie R. Knauer, Stacey W. Lloyd, Jenifer Goldman Fraser , Meera Viswanathan. Comparative effectiveness of interventions for children exposed to nonrelational traumatic events. Peadiatrics; originally published online February 11, 2013.

Joanna Kowalik, Jennifer Weller, Jacob Venter, David Drachman. Cognitive behavioral therapy for the treatment of pediatric posttraumatic stress disorder: A review and meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry. 2011 42 405 – 413.

Monday, 17 June 2013

A little bit about trauma and adversity and Australian kids.....

Someone asked me a question today. They wanted to know why talking about childhood trauma and adversity was so important. This person knew that bad things happened to children and they also knew that these things could be really damaging to kids. But they didn't know much more than that. 

About two thirds of children, by the time they reach 18, will have been exposed to a traumatic event or adversity. Now, it is not necessarily true that these traumatic experiences or adversities will lead to negative outcomes for all children. 35 - 65% of children are likely to be resilient to these potentially traumatic events 2 years after they occur.  We know that most children are resilient in the face of adversity. But we can say that most children will encounter potentially traumatic events at some time in their childhood or adolescence. 

What are these potentially traumatic events?
There are a long list of stressful events or adversities that may occur in a child's life. There are the traumatic events such as child abuse and neglect and exposure to domestic violence that we know causes great distress and disruption to the lives of children. Then there are the adversities or difficulties that may be present in the lives of many children. And these are events such as a disaster (such as floods or fires); a death in the family; legal problems in the family; a serious injury or assault in the family; family financial hardship; the child experiencing an injury or an accident; substance abuse problems in the household where the child lives; single parent households; arguementative or hostile relationships between parents; hostile parenting; children residing in foster care or other out of home care; parental mental health difficulties; the child having a chronic health or developmental difficulty; parents separated or divorced; and being bullied. There are also the adversities that are associated with different communities, such at the experience of being a refugeee or asylum seeker; living in a rural or remote area; and being Indigenous

An important Australian study, the Longitudinal Study of Australian Children (LSAC), has been tracking the lives of around 9000  children over the past 8 years and has been able to provide us with some valuable insight into just how many of our children are experiencing these potentially traumatic events in their lives. Just over 47% of children included in the LSAC have been bullied at school; over 24% have a chronic health or developmental condition; over 20% have parents who have separated or divorced; and over 12% have been exposed to parental violence. Now, we know that children who are exposed to 3 or more adversities are likely to have poorer outcomes in terms of mental health and wellbeing, and it seems that there are around 20% of children who fall into this group. 

What are the negative outcomes of childhood trauma and adversity? 
There has been a great deal of research into the impact of childhood trauma and adversity over the past 10 years. As a result of many, many studies we now know that early trauma and adversity leads to poor mental health AND physical health outcomes in childhood, adolescence and adulthood. Childhood trauma and adversity has been reported to contribute to 44.6% of childhood onset mental health disorders and 32.4% of adult psychiatric disorders. This includes depression and other mood disorders, anxiety disorders and psychotic disorders. 

There has also been a great deal of research that can demonstrate that exposure to adverisity and trauma in childhood can increase the likelihood of a range of poor physical health outcomes as an adult and this includes increasing vulnerability to heart disease, stroke and diabetes. 

Talk more about trauma and adversity
The impact of poor mental and physical health is a huge burden on individuals and families as well as the community. This is why it is essential that we talk more about the trauma and adversity that children face. Learning more about the impact of trauma and adversity on children and helping parents, carers and the community to recognise when kids are going through tough times, and how they can help, are the first steps towards protecting our kids, looking after their wellbeing and helping them to have a better future! 

Tuesday, 4 June 2013

Hello and welcome to our blog! 

Here at the Australian Child & Adolescent Trauma, Loss & Grief Network (or ACATLGN for short) we really want to make as much information about kids, trauma and adversity as accessible as possible for everyone. 

We really believe that the traumatic experiences and the adversities that kids face has a lasting impact on many of them. It is definitely true that many kids will be resilient when faced with trauma and adversity, but what about the ones who are not? Did you know that childhood trauma and adversity can lead to poor mental health outcomes such as depression, anxiety, post traumatic stress disorder, suicide, substance abuse and even psychosis? In fact, lots of kids who are being taken to psychologists, GP's, counsellors and paediatricians with mental health difficulties have been exposed to trauma and adversity. 

On this blog we will be posting links to news, resources and research that focuses on childhood trauma and adversity. We will also be providing you with summaries of the latest research, so that it is easier for you to quickly catch up on new developments in the field. 

If you have any suggestions on what you would like to see in this blog - remember it is for you! - then feel free to send us an email at