Esther Deblinger

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

OBJECTIVE To 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. METHOD Two 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. RESULTS A 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. CONCLUSIONS This 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.

Sexually Abused Children Suffering Posttraumatic Stress Symptoms: Initial Treatment Outcome Findings

This study examined the differential effects of child or non-offending mother participation in a cognitive behavioral intervention designed to treat posttraumatic stress disorder (PTSD) and other behavioral and emotional difficulties in school-aged sexually abused children. The 100 participating families were randomly assigned to one of three experimental treatment conditions—child only, mother only, or mother and child—or to a community control condition. Pre- and post-treatment evaluation included standardized measurement of childrens behavior problems, anxiety, depression, and PTSD symptoms as well as of parenting practices. Two-by-two least-squares analyses of covariance were used to compare outcome measures. Results indicated that mothers assigned to the experimental treatment condition described significant decreases in their childrens externalizing behaviors and increases in effective parenting skills; their children reported significant reductions in depression. Children who were assigned to the experimental intervention exhibited greater reductions in PTSD symptoms than children who were not. Implications for treatment planning and further clinical research are discussed.

Comparative Efficacies of Supportive and Cognitive Behavioral Group Therapies for Young Children Who have been Sexually Abused and their Nonoffending Mothers

The differential efficacies of supportive and cognitive behavioral group therapy models designed for young children (ages 2 to 8) who have experienced sexual abuse and their nonoffending mothers were compared. Forty-four mothers and their respective children participated in either supportive or cognitive behavioral therapy groups with the group format being randomly determined. Repeated measures MANOVAs indicated that compared to mothers who participated in the support groups, the mothers who participated in cognitive behavioral groups reported greater reductions at posttest in (a) their intrusive thoughts and (b) their negative parental emotional reactions regarding the sexual abuse. The children treated with cognitive behavioral therapy demonstrated greater improvement in their knowledge regarding body safety skills at posttest than did the children who received supportive therapy.

Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms

OBJECTIVE The present study sought to determine whether the 12-session pre- to posttest therapeutic gains that had been found by Deblinger, Lippmann. and Steer (1996) for an initial sample of 100 sexually abused children suffering posttraumatic stress disorder (PTSD) symptoms would be sustained 2 years after treatment. METHOD These sexually abused children, along with their nonoffending mothers, had been randomly assigned to one of three cognitive-behavioral treatment conditions, child only, mother only, or mother and child, or a community comparison condition, and were followed for 3 months, 6 months, 1 year, and 2 years after treatment. RESULTS A series of repeated MANCOVAs, controlling for the pre-test scores, indicated that for the three measures of psychopathology that had significantly decreased in the original study (i.e., externalizing behavior problems, depression, and PTSD symptoms), these measures at 3 months, 6 months, 1 year, and 2 years were comparable to the posttest scores. CONCLUSIONS These findings suggest that the pre- to post-treatment improvements held across the 2-year follow-up period. The clinical and research implications of these findings 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.

Sexually Abused Children at High Risk for Post-traumatic Stress Disorder

Ninety-two sexually abused children were studied using structured interviews and standardized instruments to determine the frequency of post-traumatic stress disorder (PTSD) and associated symptoms. Of these sexually abused children, 43.9% met DSM-III-R PTSD criteria; 53.8% of children abused by fathers, 42.4% abused by trusted adults, and 10% of those abused by strangers met criteria as opposed to none of the children abused by an older child. No relationship was observed between the time lapsed since last abusive episode and the presence of PTSD. Many children not meeting full criteria exhibited partial PTSD symptoms. Only one standardized instrument (Child Behavior Checklist) detected group differences with PTSD children exhibiting more symptoms. This study replicates an earlier pilot study and underscores the need for further PTSD research.

Cognitive Behavioral Groups for Nonoffending Mothers and their Young Sexually Abused Children: A Preliminary Treatment Outcome Study:

The purpose of the current study was to evaluate the effectiveness of concurrent 11-week cognitive behavioral groups for 19 nonoffending mothers and their young sexually abused children. Evaluation included standardized assessment of maternal distress levels and maternal reports of childrens behavioral functioning at initial contact, pretreatment, post-treatment, and 3-month follow-up. A series of one-way repeated measures ANOVAs indicated significant decreases in parental distress and childrens sexual behaviors across evaluations. Post-hoc analyses suggest that these improvements occurred as a function of group participation and were maintained at follow-up.

Psychosocial Characteristics and Correlates of Symptom Distress in Nonoffending Mothers of Sexually Abused Children.

Three groups of nonoffending mothers of sexually abused children were compared on 17 psychosocial characteristics. The groups were composed of 36 (36.4%) mothers of children abused by partners (i.e., incest victims), 30 (30.3%) mothers of children abused by other relatives, and 33 (33.3%) mothers of children abused by nonrelatives. Only physical abuse by a partner differentiated the groups; mothers of children sexually abused by a partner were more likely to report a history of domestic violence than mothers in either of the two other groups. Maternal self-reported symptom distress was measured across all three groups using the SCL-90-R. A multiple-regression analysis of the psychosocial characteristics on the SCL-90-Rs Global Severity Index indicated that a mothers perceived aloneness in facing this crisis and a personal history of adult sexual assault were positively related to current symptom distress. The implications of the present findings are discussed with respect to future research and clinical work with nonoffending mothers of sexually abused children.

Understanding and Treating Feelings of Shame in Children Who Have Experienced Maltreatment

Feelings of shame have been found to be an important mediating factor in influencing a childs recovery from abuse. This article conceptualizes the development and maintenance of shame in the aftermath of experiencing child sexual and/or physical abuse. Research is reviewed that may shed light on the impact of shame and dysfunctional attributions with a view toward understanding how this type of painful emotional suffering can be prevented and/or treated. Trauma-focused interventions that have demonstrated efficacy in helping children overcome feelings of shame are described. Directions for future research that may further our understanding of the development, impact, and treatment of feelings of shame are suggested.

An overview of child physical abuse: developing an integrated parent-child cognitive-behavioral treatment approach.

This article reviews and summarizes the extant literature regarding child physical abuse (CPA). Literature is summarized that describes the wide range of short-and long-term effects of CPA on children as well as the documented characteristics of parents/caregivers who engage in physically abusive parenting practices. Although the reviewed research documents that interventions geared only toward the parent have been found to produce significant improvements with respect to parenting abilities, parent-child interactions, and children’s behavior problems, there is a paucity of research examining the efficacy of interventions developed specifically to target the child’s emotional and behavioral difficulties. Based on the few studies that have shown emotional and behavioral gains for children who have participated in treatment, an integrated parent-child cognitive-behavioral therapy (CBT) approach is proposed here to address the complex issues presented by both parent and child in CPA cases. The direct participation of the child in treatment also may improve our ability to target posttraumatic stress disorder (PTSD), depressive symptoms as well as anger control and dysfunctional abuse attributions in the children themselves. Implications for practice, public policy, and research are also addressed.