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Empirically Supported Treatment Options for Children and Adolescents with Posttraumatic Stress Disorder: Integrating Network Models and Treatment Components

  • Child and Adolescent Psychiatry (M Singh and M Goldsmith, Section Editors)
  • Published:
Current Treatment Options in Psychiatry Aims and scope Submit manuscript

Abstract

Purpose of review

This review aims to provide an overview of recent neurodevelopmental network models of PTSD in youth as an avenue towards a better understanding of treatment options for this group. Present empirically supported psychosocial intervention components for youth exposed to trauma in the context of the neurodevelopmental network model of PTSD in youth.

Recent findings

Key brain regions and regional connections implicated in childhood trauma may be targeted by the specific components taught in interventions. Intervention components may have differential use and effectiveness by community therapists and depending on patient presentation.

Summary

Treatments for PTSD in youth are effective with cognitive behavior therapy (CBT) and eye movement desensitization and reprocessing (EMDR) techniques among the psychosocial treatment options endorsed for use. Researchers have begun to identify the most successful and commonly used components of treatments. The current review identifies components of CBT and EMDR, their potential for packaging to meet patient profiles and main presenting issues, and also discusses the augmentation of exposure techniques with D-cycloserine (DCS) and other options such as cue-centered therapy.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry. 2005;162(2):214–27.

    Article  PubMed  Google Scholar 

  2. Cohen JA, Mannarino AP, Deblinger E. Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press; 2006.

    Google Scholar 

  3. Chambless DL, Hollon SD. Defining empirically supported therapies. J Consult Clin Psychol. 1998;66(1):7–18.

    Article  CAS  PubMed  Google Scholar 

  4. American Psychological Association. Evidence-based practice in psychology. Am Psychol. 2006;61(4):271–85.

    Article  Google Scholar 

  5. Costello EJ, Erkanli A, Fairbank JA, Angold A. The prevalence of potentially traumatic events in childhood and adolescence. J Trauma Stress. 2002;15(2):99–112.

    Article  PubMed  Google Scholar 

  6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edition: DSM-5 ed. Washington: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  7. Bonanno GA, Brewin CR, Kaniasty K, Greca AML. Weighing the costs of disaster: consequences, risks, and resilience in individuals, families, and communities. Psychol Sci Public Interest. 2010;11(1):1–49.

    Article  PubMed  Google Scholar 

  8. Kendall-Tackett KA, Williams LM, Finkelhor D. Impact of sexual abuse on children: a review and synthesis of recent empirical studies. Psychol Bull. 1993;113(1):164–80.

    Article  CAS  PubMed  Google Scholar 

  9. Weems CF, Graham RA. Resilience and trajectories of posttraumatic stress among youth exposed to disaster. J Child Adolesc Psychopharmacol. 2014;24(1):2–8.

    Article  PubMed  Google Scholar 

  10. Calhoun LG, Tedeschi RG. The foundations of posttraumatic growth: An expanded framework. In: In: Handbook of posttraumatic growth: research and practice. New York: Routledge; 2006. p. 17–37.

    Google Scholar 

  11. Prati G, Pietrantoni L. Optimism, social support, and coping strategies as factors contributing to posttraumatic growth: a meta-analysis. J Loss Trauma. 2009;14(5):364–88.

    Article  Google Scholar 

  12. Haskett ME, Nears K, Ward CS, McPherson AV. Diversity in adjustment of maltreated children: Factors associated with resilient functioning. Clin Psychol Rev. 2006;26(6):796–812.

    Article  PubMed  Google Scholar 

  13. Kerig PK. Linking childhood trauma exposure to adolescent justice involvement: the concept of posttraumatic risk-seeking. Clin Psychol Sci Pract. 2019;26:e12280.

    Article  Google Scholar 

  14. • Russell JD, Neill EL, Carrión VG, Weems CF. The network structure of posttraumatic stress symptoms in children and adolescents exposed to disasters. J Am Acad Child Adolesc Psychiatry. 2017;56(8):669–77 Provides a review and first empirical study of the network structure of PTSD symptoms in youth.

    Article  PubMed  Google Scholar 

  15. • Weems CF, Russell JD, Neill EL, McCurdy BH. Annual research review: pediatric posttraumatic stress disorder from a neurodevelopmental network perspective. J Child Psychol Psychiatry. 2019;60(4):395–408 Presents the neurodevelopmental network perspective.

    Article  PubMed  Google Scholar 

  16. Cicchetti D, Rogosch FA. Equifinality and multifinality in developmental psychopathology. Dev Psychopathol. 1996;8(4):597–600.

    Article  Google Scholar 

  17. • Carrión VG, Weems C. Neuroscience of pediatric PTSD. Oxford University Press; 2017. Summary of the literature on the neuroscience of pediatric PTSD.

  18. Weems CF, Saltzman KM, Reiss AL, Carrion VG. A prospective test of the association between hyperarousal and emotional numbing in youth with a history of traumatic stress. J Clin Child Adolesc Psychol. 2003;32(1):166–71.

    Article  PubMed  Google Scholar 

  19. • Herringa RJ. Trauma, PTSD, and the developing brain. Curr Psychiatry Rep. 2017;19(10):69–85 Summary of research on Trauma and the developing brain.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Menon V. Large-scale brain networks and psychopathology: a unifying triple network model. Trends Cogn Sci. 2011;15(10):483–506.

    Article  PubMed  Google Scholar 

  21. Carrion VG, Kletter H, Weems CF, Berry RR, Rettger JP. Cue-centered treatment for youth exposed to interpersonal violence: a randomized controlled trial. J Trauma Stress. 2013;26(6):654–62.

    Article  PubMed  Google Scholar 

  22. Scheeringa MS, Weems CF. Randomized placebo-controlled D-Cycloserine with cognitive behavior therapy for pediatric posttraumatic stress. J Child Adolesc Psychopharmacol. 2014;24(2):69–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Scheeringa MS, Weems CF, Cohen JA, Amaya-Jackson L, Guthrie D. Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: a randomized clinical trial. J Child Psychol Psychiatry. 2011;52(8):853–60.

    Article  PubMed  Google Scholar 

  24. Taylor LK, Weems CF. Cognitive-behavior therapy for disaster-exposed youth with posttraumatic stress: results from a multiple-baseline examination. Behav Ther. 2011;42(3):349–63.

    Article  PubMed  Google Scholar 

  25. Weems CF, Taylor LK, Costa NM, Marks AB, Romano DM, Verrett SL, et al. Effect of a school-based test anxiety intervention in ethnic minority youth exposed to Hurricane Katrina. J Appl Dev Psychol. 2009;30(3):218–26.

    Article  Google Scholar 

  26. • ISTSS Guidelines Committee. Posttraumatic stress disorder prevention and treatment guidelines: methodology and recommendations [Internet]. Oakbrook Terrace, IL: International Society for Traumatic Stress Studies; 2018 [cited 2019 May 31]. Available from: http://www.istss.org/getattachment/Treating-Trauma/New-ISTSS-Prevention-and-Treatment-Guidelines/ISTSS_PreventionTreatmentGuidelines_FNL-March-19-2019.pdf.aspx. Treatment Guidelines for PTSD.

  27. Silverman WK, Ortiz CD, Viswesvaran C, Burns BJ, Kolko DJ, Putnam FW, et al. Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. J Clin Child Adolesc Psychol. 2008;37(1):156–83.

    Article  PubMed  Google Scholar 

  28. Ramirez de Arellano MA, Lyman DR, Jobe-Shields L, George P, Dougherty RH, Daniels AS, et al. Trauma-focused cognitive-behavioral therapy for children and adolescents: assessing the evidence. Psychiatr Serv. 2014;65(5):591–602.

    Article  PubMed Central  Google Scholar 

  29. Foa EB, Keane TM, Friedman MJ, Cohen JA, editors. Effective treatments for PTSD: practice guidelines from the International Society for Traumatic Stress Studies. New York: Guilford Press; 2009.

    Google Scholar 

  30. Schubert S, Lee CW. Adult PTSD and its treatment with EMDR: a review of controversies, evidence, and theoretical knowledge. J EMDR Pract Res. 2009;3(3):117–32.

    Article  Google Scholar 

  31. van der Kolk BA, Spinazzola J, Blaustein ME, Hopper JW, Hopper EK, Korn DL, et al. A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance. J Clin Psychiatry. 2007;68(1):37–47.

    Article  PubMed  Google Scholar 

  32. Mowrer OH. Learning theory and behavior. Hoboken: John Wiley & Sons, Inc.; 1960.

    Book  Google Scholar 

  33. Kowalik J, Weller J, Venter J, Drachman D. Cognitive behavioral therapy for the treatment of pediatric posttraumatic stress disorder: a review and meta-analysis. J Behav Ther Exp Psychiatry. 2011;42(3):405–13.

    Article  PubMed  Google Scholar 

  34. Cohen JA, Deblinger E, Mannarino A. Trauma-focused cognitive-behavioral therapy for sexually abused children. Psychiatr Times. 2004;21(10):109–21.

    Google Scholar 

  35. Cohen JA, Deblinger E, Mannarino AP, Steer RA. A multisite, randomized controlled trial for children with sexual abuse–related PTSD symptoms. J Am Acad Child Adolesc Psychiatry. 2004;43(4):393–402.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cohen JA, Mannarino AP. A treatment outcome study for sexually abused preschool children: Initial findings. J Am Acad Child Adolesc Psychiatry. 1996;35(1):42–50.

    Article  CAS  PubMed  Google Scholar 

  37. Cohen JA, Mannarino AP. Factors that mediate treatment outcome of sexually abused preschool children. J Am Acad Child Adolesc Psychiatry. 1996;35(10):1402–10.

    Article  CAS  PubMed  Google Scholar 

  38. Cohen JA, Mannarino AP. A treatment study for sexually abused preschool children: outcome during a one-year follow-up. J Am Acad Child Adolesc Psychiatry. 1997;36(9):1228–35.

    Article  CAS  PubMed  Google Scholar 

  39. Deblinger E, Lippmann J, Steer R. Sexually abused children suffering posttraumatic stress symptoms: initial treatment outcome findings. Child Maltreat. 1996;1(4):310–21.

    Article  Google Scholar 

  40. Deblinger E, Stauffer LB, Steer RA. Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreat. 2001;6(4):332–43.

    Article  CAS  PubMed  Google Scholar 

  41. Deblinger E, Steer RA, Lippmann J. Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms. Child Abuse Negl. 1999;23(12):1371–8.

    Article  CAS  PubMed  Google Scholar 

  42. King NJ, Tonge BJ, Mullen P, Myerson N, Heyne D, Rollings S, et al. Treating sexually abused children with posttraumatic stress symptoms: a randomized clinical trial. J Am Acad Child Adolesc Psychiatry. 2000;39(11):1347–55.

    Article  CAS  PubMed  Google Scholar 

  43. Pollio E, McLean M, Behl LE, Deblinger E. Trauma-focused cognitive behavioral therapy. In: Reece RM, Hanson RF, Sargent J, editors. Treatment of child abuse: common ground for mental health, medical, and legal practitioners. 2nd ed. Baltimore: Johns Hopkins University Press; 2014. p. 31–8.

    Google Scholar 

  44. Shapiro F. Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. 2nd ed. New York: Guilford Press; 2001.

    Google Scholar 

  45. Oren E, Solomon R. EMDR therapy: an overview of its development and mechanisms of action. Rev. Eur Psychol AppliquéeEuropean Rev. Appl Psychol. 2012;62(4):197–203.

    Google Scholar 

  46. Aubert-Khalfa S, Roques J, Blin O. Evidence of a decrease in heart rate and skin conductance responses in PTSD patients after a single EMDR session. J EMDR Pract Res. 2008;2(1):51–6.

    Article  Google Scholar 

  47. Neill EL. The use of empirically supported treatment components for trauma exposure: the role of therapist training and characteristics [Dissertation]. Ames: Iowa State University; 2019.

    Google Scholar 

  48. Neill EL. Therapists’ experiences with eye movement desensitization and reprocessing (EMDR). Iowa: Ames; 2016.

    Google Scholar 

  49. Gomez AM. Thought kits for kids [Internet]. Ana M. Gomez. 2020 [cited 2020 Jan 30]. Available from: https://www.anagomez.org

  50. Solomon RM, Shapiro F. EMDR and the adaptive information processing model: potential mechanisms of change. J EMDR Pract Res. 2008;2(4):315–25.

    Article  Google Scholar 

  51. Shapiro F. Eye movement desensitization and reprocessing: basic principles, protocols, and procedures. New York: Guilford Press; 1995.

    Google Scholar 

  52. Högberg G, Nardo D, Hällström T, Pagani M. Affective psychotherapy in post-traumatic reactions guided by affective neuroscience: memory reconsolidation and play. Psychol Res Behav Manag. 2011;4:87–96.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Dudai Y. The neurobiology of consolidations, or, how stable is the engram? Annu Rev Psychol. 2004;55:51–86.

    Article  PubMed  Google Scholar 

  54. Nader K, Schafe GE, Le Doux JE. Fear memories require protein synthesis in the amygdala for reconsolidation after retrieval. Nature. 2000;406(6797):722–6.

    Article  CAS  PubMed  Google Scholar 

  55. Weems CF, Russell JD, Banks DM, Graham RA, Neill EL, Scott BG. Memories of traumatic events in childhood fade after experiencing similar less stressful events: results from two natural experiments. J Exp Psychol Gen. 2014;143(5):2046–55.

    Article  PubMed  Google Scholar 

  56. Weisz JR, Krumholz LS, Santucci L, Thomassin K, Ng MY. Shrinking the gap between research and practice: tailoring and testing youth psychotherapies in clinical care contexts. Annu Rev Clin Psychol. 2015;11:139–63.

    Article  PubMed  Google Scholar 

  57. Borntrager CF, Chorpita BF, Higa-McMillan CK, Daleiden EL, Starace N. Usual care for trauma-exposed youth: are clinician-reported therapy techniques evidence-based? Child Youth Serv Rev. 2013;35(1):133–41.

    Article  Google Scholar 

  58. Beidas RS, Kendall PC. Training therapists in evidence-based practice: a critical review of studies from a systems-contextual perspective. Clin Psychol Sci Pract. 2010;17(1):1–30.

    Article  Google Scholar 

  59. Garland AF, Bickman L, Chorpita BF. Change what? Identifying quality improvement targets by investigating usual mental health care. Adm Policy Ment Health Ment Health Serv Res. 2010;37(1–2):15–26.

    Article  Google Scholar 

  60. Holmes SC, Johnson CM, Suvak MK, Sijercic I, Monson CM, Stirman SW. Examining patterns of dose response for clients who do and do not complete cognitive processing therapy. J Anxiety Disord. in press;

  61. Wamser-Nanney R, Scheeringa MS, Weems CF. Early treatment response in children and adolescents receiving CBT for trauma. J Pediatr Psychol. 2016;41(1):128–37.

    Article  PubMed  Google Scholar 

  62. Chorpita BF, Daleiden EL, Weisz JR. Identifying and selecting the common elements of evidence based interventions: a distillation and matching model. Ment Health Serv Res. 2005;7(1):5–20.

    Article  PubMed  Google Scholar 

  63. Chorpita BF, Daleiden EL. Mapping evidence-based treatments for children and adolescents: application of the distillation and matching model to 615 treatments from 322 randomized trials. J Consult Clin Psychol. 2009;77(3):566–79.

    Article  PubMed  Google Scholar 

  64. EMDR Humanitarian Assistance Programs. Answers to training questions. [Internet]. Trauma Recovery: EMDR Humanitarian Assistance Programs. 2017 [cited 2017 Dec 14]. Available from: https://www.emdrhap.org/content/events/answers-to-training-questions/

  65. Becker CB, Zayfert C, Anderson E. A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behav Res Ther. 2004;42(3):277–92.

    Article  PubMed  Google Scholar 

  66. Cook JM, Schnurr PP, Foa EB. Bridging the gap between posttraumatic stress disorder research and clinical practice: the example of exposure therapy. Psychother Theory Res Pract Train. 2004;41(4):374–87.

    Article  Google Scholar 

  67. Foy DW, Kagan B, McDermott C, Leskin G, Sipprelle RC, Paz G. Practical parameters in the use of flooding for treating chronic PTSD. Clin Psychol Psychother. 1996;3(3):169–75.

    Article  Google Scholar 

  68. Whiteside SP, Deacon BJ, Benito K, Stewart E. Factors associated with practitioners’ use of exposure therapy for childhood anxiety disorders. J Anxiety Disord. 2016;40:29–36.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Davis M, Ressler K, Rothbaum BO, Richardson R. Effects of D-cycloserine on extinction: translation from preclinical to clinical work. Biol Psychiatry. 2006;60(4):369–75.

    Article  CAS  PubMed  Google Scholar 

  70. Hofmann SG, Meuret AE, Smits JA, Simon NM, Pollack MH, Eisenmenger K, et al. Augmentation of exposure therapy with D-cycloserine for social anxiety disorder. Arch Gen Psychiatry. 2006;63(3):298–304.

    Article  CAS  PubMed  Google Scholar 

  71. Kushner MG, Kim SW, Donahue C, Thuras P, Adson D, Kotlyar M, et al. D-cycloserine augmented exposure therapy for obsessive-compulsive disorder. Biol Psychiatry. 2007;62(8):835–8.

    Article  CAS  PubMed  Google Scholar 

  72. Ressler KJ, Rothbaum BO, Tannenbaum L, Anderson P, Graap K, Zimand E, et al. Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry. 2004;61(11):1136–44.

    Article  PubMed  Google Scholar 

  73. Andersson E, Hedman E, Enander J, Djurfeldt DR, Ljótsson B, Cervenka S, et al. D-cycloserine vs placebo as adjunct to cognitive behavioral therapy for obsessive-compulsive disorder and interaction with antidepressants: a randomized clinical trial. JAMA Psychiatry. 2015;72(7):659–67.

    Article  PubMed  Google Scholar 

  74. Hofmann SG, Smits JA, Rosenfield D, Simon N, Otto MW, Meuret AE, et al. D-Cycloserine as an augmentation strategy with cognitive-behavioral therapy for social anxiety disorder. Am J Psychiatry. 2013;170(7):751–8.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Alpert J. D-cycloserine augmentation of behavioral therapy for the treatment of anxiety disorders: a meta-analysis. Neuropsychiatry. 2012;2(4).

  76. Ori R, Amos T, Bergman H, Soares-Weiser K, Ipser JC, Stein DJ. Augmentation of cognitive and behavioral therapies (CBT) with d-cycloserine for anxiety and related disorders. Cochrane Database Syst Rev. 2015;(5).

  77. Rodrigues H, Figueira I, Lopes A, Gonçalves R, Mendlowicz MV, Coutinho ESF, et al. Does D-cycloserine enhance exposure therapy for anxiety disorders in humans? A meta-analysis. PLoS One. 2014;9(7):e93519.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  78. Xia J, Du Y, Han J, Liu G, Wang X. D-cycloserine augmentation in behavioral therapy for obsessive-compulsive disorder: a meta-analysis. Drug Des Devel Ther. 2015;9:2101–17.

    CAS  PubMed  PubMed Central  Google Scholar 

  79. Otto MW, Kredlow MA, Smits JA, Hofmann SG, Tolin DF, de Kleine RA, et al. Enhancement of psychosocial treatment with d-cycloserine: models, moderators, and future directions. Biol Psychiatry. 2016;80(4):274–83.

    Article  CAS  PubMed  Google Scholar 

  80. • Mataix-Cols D, De La Cruz LF, Monzani B, Rosenfield D, Andersson E, Pérez-Vigil A, et al. D-cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders: a systematic review and meta-analysis of individual participant data. JAMA Psychiatry. 2017;74(5):501–10 Summary of DCS augmentation trials.

    Article  PubMed  Google Scholar 

  81. Koopman C, Carrion V, Butler LD, Sudhakar S, Palmer L, Steiner H. Relationships of dissociation and childhood abuse and neglect with heart rate in delinquent adolescents. J Trauma Stress Off Publ Int Soc Trauma Stress Stud. 2004;17(1):47–54.

    Article  Google Scholar 

  82. • Garrett A, Cohen JA, Zack S, Carrion V, Jo B, Blader J, et al. Longitudinal changes in brain function associated with symptom improvement in youth with PTSD. J Psychiatr Res. 2019;114:161–9 Shows the effect of CBT for pediatric PTSD in decreasing activation to emotional faces in the posterior cingulate, mid-cingulate, and hippocampus.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Department of Human Development and Family Studies, Iowa State University, Ames, IA, USA

    Carl F. Weems Ph.D & Erin L. Neill Ph.D

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  1. Carl F. Weems Ph.D
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Weems, C.F., Neill, E.L. Empirically Supported Treatment Options for Children and Adolescents with Posttraumatic Stress Disorder: Integrating Network Models and Treatment Components. Curr Treat Options Psych 7, 103–119 (2020). https://doi.org/10.1007/s40501-020-00206-y

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