When you’re the parent of a child who receives a diagnosis for posttraumatic stress disorder, the first thing you do is find out all you can about the latest and most effective treatment for child or pediatric posttraumatic stress disorder (PTSD).
While the diagnosis is probably not what you wanted for your child, there is encouraging news associated regarding your search for treatment. Effective therapeutic modes for addressing child or pediatric posttraumatic stress disorder are available from qualified mental health professionals around the country.
We’ll review those therapeutic modes in this article, based on the latest research on treatment for child or pediatric PTSD, published in December 2024.
New Evidence for Treatment of Child or Pediatric PTSD
In a paper called “Psychological Interventions for Pediatric Posttraumatic Stress Disorder: A Systematic Review and Network Meta-Analysis,” a group of researchers conducted an extensive examination of all available research in order to answer the following question:
How do psychological treatments compare in terms of alleviating pediatric posttraumatic stress disorder (PTSD)?
To answer this question, researchers collected data from 70 studies including over 5,000 patients.
Most RCTs (n = 52 [74%]) examined trauma-focused cognitive behavior therapies (TF-CBTs).
At treatment end point, the researchers identified four types of treatment associated with improved outcomes:
- Trauma-focused cognitive behavior therapies (TF-CBTs).
- Eye movement desensitization and reprocessing (EMDR)
- Multidisciplinary treatments (MDTs)
- Non-trauma-focused interventions
Before we examine the results of the study further, we’ll take a moment to describe these four approaches.
About Treatment for Child or Pediatric PTSD: Safety and Trust First
There are two essential aspect of trauma-focused therapies: safety and trust. First, a child needs to feel safe – emotionally and physically – in the therapeutic milieu. Next, a child needs to trust the therapist one hundred percent. When a therapist establishes a safe environment and creates a positive therapeutic alliance with a child, healing can begin.
Note: all the approaches below include and require a foundation of safety and trust.
We’ll start with the last two approaches on the list above:
Multidisciplinary treatments are modalities in which clinicians use a combination of treatment approaches to help patients address the symptoms of PTSD. Combinations may include psychotherapy + medication, psychotherapy + lifestyle changes, psychotherapy + lifestyle changes + peer/community support, psychotherapy + family therapy, or combinations created as a result of cooperation and collaboration between providers, patients, and families.
Non-trauma-focused interventions include traditional cognitive-behavioral psychotherapy, family therapy, lifestyle changes, and complementary supports such as yoga/meditation/mindfulness.
Now let’s look at the first two approaches on the list above:
About TF-CBT: Core Components
Trauma-focused cognitive behavior therapies help children with PTSD understand and process emotional, psychological, and behavioral symptoms associated with trauma. Experts in TF-CBT use and acronym – PRACTICE – to organize, guide, and conceptualize the TF-CBT process. Here’s what the acronym means:
- Psychoeducation for children and parents about the consequences of childhood trauma.
- Parenting skills help parents help children process emotions and modify behavior.
- Relaxation and stress management skills tailored for children and parents help mitigate the emotional consequences of trauma.
- Affective expression, or the experience of emotions, is often negatively impacted by trauma: a TF-CBT therapist helps children and parents understand the various types of emotional expression, what they mean, and how they’re related to trauma.
- Cognitive coping and processing helps children and parents identify false, counterproductive, or inaccurate ideas related to their trauma, and restructure those thoughts so they no longer exacerbate symptoms of PTSD.
- Trauma narration helps children describe their experiences in a safe environment that prevents risk of re-traumatization.
- In vivo mastery of triggers helps children overcome unhealthy avoidance of situations that once exacerbated their PTSD symptoms.
- Combined parent-child therapy helps children and parents communicate about trauma and traumatic experiences in order to understand and process them in productive and healthy ways.
- Enhancing future safety helps children rebound, rejoin typical daily activities, rediscover their developmental trajectory. At the end of the treatment process, the child, the therapist, and the parent work to reinforce the skills needed to manage and process difficult emotions associated with trauma on a long-term, ongoing basis.
Eye movement desensitization and reprocessing (EMDR), like TF-CBT, follows a specific, structured, stepwise process to help pediatric patients learn to process traumatic memories and experiences. There are eight phases in EMDR.
EMDR: About the Eight Phases
- Patient history and treatment planning. The therapist, patient, and parents meet, determine whether EMDR is appropriate, and establish treatment goals.
- Preparation/education. The therapist teaches the patient about EMDR and prepares them for treatment.
- The therapist and patient identify target memories and thoughts to process using EMDR.
- While the patient holds memories/thoughts identified in the assessment phase I their mind, the therapist guides their eyes through a series of movements, sometimes accompanied by tactile or auditory cues, in order to separate the thought/memory from negative/unwanted emotional states.
- Once the therapist and patient separate or decouple thoughts from trauma, they can replace them – or install – desired thoughts identified in the first three phases of treatment.
- Body scan. This phase repeats phase 4, but with a focus on decoupling physical sensations from memories of trauma/past traumatic experiences.
- Closure/stabilization. This occurs at the end of every session. During closure, the therapist ensures the child feels safe after the session, gives them suggestions for strategies to use until the next session, and previews what’s coming up in the next session.
- At the end of the EMDR process, the therapist, the patient, and the parent measure progress against treatment goals established during
Now we’ll share the results of the study, which examined data to determine the most effective treatment for child or pediatric PTSD. Here are the primary findings:
- Short-term reductions in PTSD symptoms (less than one month): TF-CBTs associated with largest reductions.
- Midterm reductions in PTSD symptoms (1-5 months): TF-CBTs associated with largest reductions.
- Long-term reductions in PTSD symptoms (6-24 months): TF-CBTs also associated with largest reductions.
That’s the outcome: among the four types of treatment examined in the study, TF-CBT was the most effective at reducing the symptoms of pediatric/child PTSD.
We’ll discuss these results further, below.
How Trauma-focused Cognitive Behavioral Therapy Helps Children with PTSD
The goal of treatment for child PTSD is symptom reduction to the point where a child can rejoin daily activities and fully participate in school, social activities, and extracurricular activities.
This study shows that TF-CBT can effectively reduce typical PTSD symptoms, which include:
- Intrusive memories of trauma
- Avoidance of any reminders of trauma
- Emotional problems associated with trauma, such as emotional flatness/no affect
- Hyperarousal
- Problems concentrating
- Irritability
Children with a history of trauma, but who do not meet criteria for clinical PTSD, can benefit from TF-CBT. Evidence shows TF-CBT is associated with improvements in symptoms of depression, anxiety, and behavioral disorders. In addition, evidence shows F-CBT can reduce sexualized behavior and shame associated with trauma while increasing levels of social competence expanding capacity for interpersonal trust.
All of that is a fancy way of saying TF-CBT can help a child with PTSD process their traumatic memories and get back to what’s most important: being a kid and doing kid things.
Finding Help: PTSD Resources
To learn more about PTSD and treatment for PTSD, please consult these resources:
- The National Center for PTSD
- The Anxiety and Depression Association of America (ADAA) maintain this PTSD Info Page
- The ADAA Therapist Finder
- National institute of Mental Health catalog of peer-reviewed journal articles on PTSD
