Friday, November 27, 2015

The best way to treat traumatized kids still not clear

W. Douglas Tynan, Ph.D., a clinical psychologist at Nemours/Alfred I. duPont Hospital for Children, discusses how to help children who experience trauma while the research is ongoing to find the best treatments.

The best way to treat traumatized kids still not clear


What type of treatments help kids who have witnessed shootings, been caught in a storm, or who have been abused themselves? What treatments help kids cope with a serious illness? What treatments have serious side effects? Therapists deal with these issues every day and desperately need help in deciding what to do for their young patients suffering from post-traumatic stress disorder symptoms.

A review was published in Pediatrics earlier this week that looked at 6,647 studies that asked the question “what helps kids after a terrible thing has happened?”. The government-sponsored review concluded that there was insufficient hard evidence on the best interventions to help kids who experience PTSD.

This review first points out how difficult it is to do a study with a vulnerable population. Results can be biased, families can drop out, the clinics might not gather the right data, and often everyone gets treated so its difficult to compare treatments. Often results are biased in favor of the treatment under study. Thus, out of the 6647 papers reviewed, only 25 were found worthy of a further look and evaluation of their results. Of those 25 unbiased papers, 22 had sufficient data for analysis.

The results are quite striking, and I am not as negative about the results as the authors here. There has been good research, just not enough of it. First, medications that are commonly used, mostly anti-depressants, don’t seem to help. The few studies in which they were systematically evaluated had few or no results. Second, a particular type of psychotherapy, cognitive behavior therapy in which children and parents are taught to recognize and label their feelings, and learn coping skills, such as relaxation, meditation, to deal with those feelings, showed up repeatedly in the few good studies as a treatment with positive effects. These are studies in which children are taught to manage the overwhelming feelings so they can cope and move on with their lives .

While the authors of the review say the evidence is low for these therapies, they mean that there are not a lot of studies. But when you look at the results, they are powerful. There are also a few studies that look at another technique called eye movement desensitization, that therapy shows mixed results with some studies showing good results, other not very much benefit.

Given the level of trauma our children are exposed to, we certainly need more research on what works. However, the data on cognitive therapies indicate that therapists should know where to start, and medication should probably not be the first treatment offered. The studies that show best results are for those children who have having PTSD symptoms, persistent emotional upset weeks after an event. The children of Sandy Hook who will have PTSD will be starting to show it now.

A child with PTSD may show the following symptoms, according to the American Academy of Child and Adolescent Psychiatry:

  • worry about dying at an early age
  • losing interest in activities
  • having physical symptoms such as headaches and stomachaches
  • showing more sudden and extreme emotional reactions
  • having problems falling or staying asleep                  
  • showing irritability or angry outbursts
  • having problems concentrating
  • acting younger than their age (for example, clingy or whiny behavior, thumbsucking)
  • showing increased alertness to the environment
  • repeating behavior that reminds them of the trauma

We still don’t know quite what to do in the acute phase, the day of and the day after the traumatic event. For now, our best advice on those terrible days is to keep your children close, let them know they are safe, let them talk if they wish, or play if they wish, and keep things as routine as possible.

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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

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Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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