Anthony P. Mannarino

A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms.

OBJECTIVEnTo examine the differential efficacy of trauma-focused cognitive-behavioral therapy (TF-CBT) and child-centered therapy for treating posttraumatic stress disorder (PTSD) and related emotional and behavioral problems in children who have suffered sexual abuse.nnnMETHODnTwo hundred twenty-nine 8- to 14-year-old children and their primary caretakers were randomly assigned to the above alternative treatments. These children had significant symptoms of PTSD, with 89% meeting full DSM-IV PTSD diagnostic criteria. More than 90% of these children had experienced traumatic events in addition to sexual abuse.nnnRESULTSnA series analyses of covariance indicated that children assigned to TF-CBT, compared to those assigned to child-centered therapy, demonstrated significantly more improvement with regard to PTSD, depression, behavior problems, shame, and abuse-related attributions. Similarly, parents assigned to TF-CBT showed greater improvement with respect to their own self-reported levels of depression, abuse-specific distress, support of the child, and effective parenting practices.nnnCONCLUSIONSnThis study adds to the growing evidence supporting the efficacy of TF-CBT with children suffering PTSD as a result of sexual abuse and suggests the efficacy of this treatment for children who have experienced multiple traumas.

A treatment outcome study for sexually abused preschool children: initial findings.

OBJECTIVEnTreatment outcome for sexually abused preschool-age children and their parents was assessed, comparing the effectiveness of a cognitive-behavioral intervention to nondirective supportive treatment.nnnMETHODnSixty-seven sexually abused preschool children and their parents were randomly assigned to either (1) cognitive-behavioral therapy adapted for sexually abused preschool children (CBT-SAP) or (2) nondirective supportive therapy (NST). Treatment consisted of 12 individual sessions for both the child and parent, monitored for integrity with the therapeutic model through intensive training and supervision, use of treatment manuals, and rating of audiotaped sessions. Parents completed the Child Behavior Checklist, the Child Sexual Behavior Inventory, and the Weekly Behavior Report to measure a variety of emotional and behavioral symptoms.nnnRESULTSnWithin-group comparison of pretreatment and posttreatment outcome measures demonstrated that while the NST group did not change significantly with regard to symptomatology, the CBT-SAP group had highly significant symptomatic improvement on most outcome measures. Repeated-measures analyses of variance demonstrated group x time interactions on some variables as well. Clinical findings also supported the effectiveness of the CBT-SAP intervention over NST.nnnCONCLUSIONSnFindings provide strong preliminary evidence for the effectiveness of a specific cognitive-behavioral treatment model for sexually abused preschool children and their parents.

A treatment study for sexually abused preschool children: outcome during a one-year follow-up

OBJECTIVEnTreatment outcome in sexually abused preschool children was evaluated 6 and 12 months after treatment.nnnMETHODnForty-three sexually abused preschool children and their parents were evaluated 6 and 12 months after completion of either Cognitive-Behavioral Therapy for Sexually Abused Preschoolers (CBT-SAP) or nondirective supportive therapy (NST). Parents completed the Child Behavior Checklist, Child Sexual Behavior inventory, and Weekly Behavior Report to measure a variety of symptoms in their children.nnnRESULTSnRepeated-measures analyses indicated that there were significant group by time interactions on several outcome measures from the beginning of the study to the end of the 12-month follow-up period, with the CBT-SAP group exhibiting significantly more improvement over time than the NST group. Clinical findings also indicated the superior effectiveness of CBT-SAP over NST in reducing sexually inappropriate behavior.nnnCONCLUSIONSnFindings support the superior efficacy of CBT-SAP over NST in maintaining symptom reduction in the year after treatment completion. The importance of using cognitive-behavioral interventions for sexually inappropriate behaviors and including nonoffending parents in the treatment of sexually abused preschool children is discussed.

Predictors of treatment outcome in sexually abused children

PROBLEMnThis study evaluated the impact of child and family characteristics on treatment outcome of sexually abused children.nnnMETHODnForty-nine recently sexually abused 7- to 14-year-old children were randomly assigned to either abuse-focused cognitive behavioral therapy or nondirective supportive therapy, and assessed pre- and post-treatment using several standardized instruments. These included five measures of psychological symptomatology and four measures of child and family characteristics hypothesized to mediate treatment response. Correlational and multiple regression analyses were utilized to evaluate the impact of the following mediating factors on treatment outcome: Childrens abuse-related attributions and perceptions; family cohesion and adaptability; parental support of the child; and parental emotional reaction to the childs abuse.nnnRESULTSnChildrens abuse-related attributions and perceptions and parental support of the child were strong predictors of treatment outcome in this population.nnnCONCLUSIONSnTherapeutic attention to childrens sexual abuse-related attributions and to enhancing parental support may be important factors in optimizing treatment outcome in 8- to 14-year-old sexually abused children.

Interventions for Sexually abused Children: Initial Treatment Outcome Findings:

This study evaluated treatment outcome for 49 recently sexually abused children aged 7-14, who were randomly assigned to receive either sexual abuse-specific cognitive behavioral therapy (SAS-CBT) or nondirective supportive therapy (NST). Respondents and their nonoffending parent were provided with 12 individual treatment sessions, which were closely monitored for adherence to the assigned treatment modality. Participants and parents completed several standardized assessment instruments pre- and posttreatment. Results indicated that there was a significant group-by-time interaction on the Childrens Depression Inventory and the Child Behavior Checklist Social Competence Scale, with the SAS-CBT group improving more than the NST group on both of these instruments. Clinical findings also suggested that SAS-CBT was more effective than NST in treating sexually inappropriate behaviors. Implications for clinical practice and future research are discussed.

TRAUMA-FOCUSED COGNITIVE BEHAVIORAL THERAPY FOR CHILDREN: IMPACT OF THE TRAUMA NARRATIVE AND TREATMENT LENGTH

Background: Child sexual abuse (CSA) is associated with the development of a variety of mental health disorders, and Trauma‐Focused Cognitive Behavioral Therapy (TF‐CBT) is an established treatment for children who have experienced CSA. However, there are questions about how many TF‐CBT sessions should be delivered to achieve clinical efficacy and whether a trauma narrative (TN) component is essential. This study examined the differential effects of TF‐CBT with or without the TN component in 8 versus 16 sessions. Methods: Two hundred and ten children (aged 4–11 years) referred for CSA and posttraumatic stress disorder symptoms were randomly assigned to one of the four treatment conditions: 8 sessions with no TN, 8 sessions with TN, 16 sessions with no TN, and 16 sessions with TN. Results: Mixed‐model ANCOVAs demonstrated that significant posttreatment improvements had occurred with respect to 14 outcome measures across all conditions. Significant main and interactive effect differences were found across conditions with respect to specific outcomes. Conclusions: TF‐CBT, regardless of the number of sessions or the inclusion of a TN component, was effective in improving participant symptomatology as well as parenting skills and the childrens personal safety skills. The eight session condition that included the TN component seemed to be the most effective and efficient means of ameliorating parents abuse‐specific distress as well as childrens abuse‐related fear and general anxiety. On the other hand, parents assigned to the 16 session, no narrative condition reported greater increases in effective parenting practices and fewer externalizing child behavioral problems at posttreatment. Depression and Anxiety, 2011.

Treatment for sexually abused children and adolescents.

The authors review research demonstrating the variable effects of childhood sexual abuse, the need for intervention, and the effectiveness of available treatment models. The well-controlled treatment-outcome studies reviewed do not focus on sensationalistic fringe treatments that treat sexually abused children as a special class of patients. Instead, studies demonstrate empirical evidence for extending and modifying treatment models from mainstream clinical child psychology to sexually abused children. The authors propose a continuum of interventions to meet the needs of this heterogeneous group. Interventions range from psychoeducation and screening, to short-term, abuse-focused cognitive-behavioral therapy with family involvement, to more comprehensive long-term plans for multiproblem cases. Last discussed are gaps in the research and suggestions for future research to address the pressing dilemmas faced by clinicians and policymakers.

Community Treatment of Posttraumatic Stress Disorder for Children Exposed to Intimate Partner Violence: A Randomized Controlled Trial

OBJECTIVEnTo evaluate community-provided trauma-focused cognitive behavior therapy (TF-CBT) compared with usual community treatment for children with intimate partner violence (IPV)-related posttraumatic stress disorder (PTSD) symptoms.nnnDESIGNnRandomized controlled trial conducted using blinded evaluators.nnnSETTINGnRecruitment, screening, and treatment were conducted at a community IPV center between September 1, 2004, and June 30, 2009.nnnPARTICIPANTSnOf 140 consecutively referred 7- to 14-year-old children, 124 participated.nnnINTERVENTIONSnChildren and mothers were randomly assigned to receive 8 sessions of TF-CBT or usual care (child-centered therapy).nnnMAIN OUTCOME MEASURESnTotal child PTSD symptoms assessed using child and parent structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version [K-SADS-PL]) and self-report (University of California at Los Angeles PTSD Reaction Index [RI]). Secondary child outcomes were scores on the K-SADS-PL (PTSD symptom clusters), Screen for Child Anxiety Related Emotional Disorders (SCARED) (anxiety), Childrens Depression Inventory (depression), Kaufman Brief Intelligence Test (cognitive functioning), and Child Behavior Checklist (total behavior problems).nnnRESULTSnIntent-to-treat analysis using last observation carried forward showed superior outcomes for TF-CBT on the total K-SADS-PL (mean difference, 1.63; 95% confidence interval [CI], 0.44-2.82), RI (mean difference, 5.5; 95% CI, 1.37-9.63), K-SADS-PL hyperarousal (mean difference, 0.71; 95% CI, 0.22-1.20), K-SADS-PL avoidance (0.55; 0.07-1.03), and SCARED (mean difference, 5.13; 95% CI, 1.31-8.96). Multiple imputation analyses confirmed most of these findings. The TF-CBT completers experienced significantly greater PTSD diagnostic remission (χ(2) = 4.67, P = .03) and had significantly fewer serious adverse events.nnnCONCLUSIONSnCommunity TF-CBT effectively improves childrens IPV-related PTSD and anxiety.nnnTRIAL REGISTRATIONnclinicaltrials.gov Identifier: NCT00183326.

Children’s Mental Health Care following Hurricane Katrina: A Field Trial of Trauma-Focused Psychotherapies

New Orleans school children participated in an assessment and field trial of two interventions 15 months after Hurricane Katrina. Children (N = 195) reported on hurricane exposure, lifetime trauma exposure, peer and parent support, posttraumatic stress disorder (PTSD), and depressive symptoms. Teachers reported on behavior. At baseline, 60.5% screened positive for PTSD symptoms and were offered a group intervention at school or individual treatment at a mental health clinic. Uptake of the mental health care was uneven across intervention groups, with 98% beginning the school intervention, compared to 37% beginning at the clinic. Both treatments led to significant symptom reduction of PTSD symptoms, but many still had elevated PTSD symptoms at posttreatment. Implications for future postdisaster mental health work are discussed.

Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents An Empirical Update

This article reviews the four major components of trauma-focused cognitive behavioral therapy (CBT) for children and adolescents: exposure, cognitive processing and reframing, stress management, and parental treatment. For each component, background, description, and the current empirical support for including each of these components in the treatment of traumatized children is presented. Although there is growing empirical support for the efficacy of traumafocused CBT in decreasing psychological symptomatology, there are inadequate data to indicate the relative contribution of the individual CBT components. Suggestions for future clinical and research directions are also discussed.