The early course and treatment of posttraumatic stress disorder in very young children: Diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3-8 year olds

Caitlin Hitchcock, Benjamin Goodall, Isobel M. Wright, Adrian Boyle, David Johnston, Darren Dunning, Julia Gillard, Kirsty Griffiths, Ayla Humphrey, Anna McKinnon, Inderpal K. Panesar, Aliza Werner-Seidler, Peter Watson, Patrick Smith, Richard Meiser-Stedman, Tim Dalgleish

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Abstract

Background:
The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC.

Method:
Study 1 (N = 105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC.

Results:
In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures.

Conclusions:
The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted.
Original languageEnglish
Pages (from-to)58-67
Number of pages10
JournalJournal of Child Psychology and Psychiatry
Volume63
Issue number1
Early online date14 Jun 2021
DOIs
Publication statusPublished - Jan 2022

Keywords

  • Posttraumatic stress disorder
  • cognitive behavioral therapy
  • randomized control trial
  • young children

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