Treatments for Early Childhood Trauma: Decision Considerations for Clinicians

Individual psychological interventions and therapies for posttraumatic stress disorder and posttraumatic stress symptoms in young children: a systematic review

Context: Treatments for posttraumatic stress disorder (PTSD) in young children (ages 0-6) should be adapted to their developmental characteristics: to their cognitive, social, and emotional abilities, to their specific trauma reactions and adjustments, and finally, to their degree of dependency on adults. Due to the lack of official recommendations for the treatment of PTSD in young children and considering the high prevalence of PTSD among this population, there is a growing need for targeted psychological interventions and psychotherapies for the youngest children with PTSD or posttraumatic symptoms.Objective: To provide an update on effective psychological interventions available for the treatment of PTSD and posttraumatic symptoms in young children (under the age of 6).Design: Systematic review of automated searches conducted using the search engines Google Scholar, Science Direct, PsycInfo, and PubMed.Results: This review identified 17 articles reporting on the efficacy of an individual therapy for treating PTSD or posttraumatic stress symptoms in young children. The therapies identified are TF-CBT, CPP, PCIT, DET, early pathway, EMI and EMDR.Conclusion: No treatment can currently be identified as a level-one evidence-based treatment (Well-Established Treatment) in children younger than 6 years old with PTSD or posttraumatic symptoms. Further research is essential to validate existing findings on the effectiveness of trauma-focused therapies in young children in order to establish internationally recognized recommendations.

The role of childhood trauma and attachment state of mind in mothers' birth experiences

Negative birth experiences are common. It is yet unclear which women may be most at risk already before pregnancy. Childhood trauma and non-autonoumous/unresolved attachment state of mind may affect how women experience giving birth. This study used longitudinal data to test childhood trauma and attachment state of mind as predictors of birth experience in at-risk sample of primipara women (N = 193). The Adverse Childhood Experiences questionnaire and the Adult Attachment interview were administered during pregnancy, and women reported about their birth experience three months postpartum. Partial Least Square Structural Equation Modelling was applied to answer the research questions. Childhood physical neglect and parental substance abuse were predictive of a more negative birth experience, while attachment state of mind was not associated with how women experienced giving birth. Cross-validation suggests that these findings may be considered externally valid. Further research using validated measures on birth experience are needed.

Posttraumatic Stress Disorder in Our Migrant Youth

There is an ongoing diagnostic and treatment challenge for migrant youth with posttraumatic stress disorder (PTSD) that many clinicians face. Current studies have helped clinicians to develop a better understanding of the migrant youth's journey including potentially traumatic and adverse events they encounter. This includes determining if premigration, migration, and postmigration stressors have had an impact on the individual. This has also helped clinicians, educators, and legal advocates to use a collaborative approach to address the migrant youth's needs for managing the severity of PTSD symptoms.

Behavior Management in Young Children Exposed to Trauma: A Case Study of Three Evidence-Based Treatments

Young children are particularly vulnerable to traumatic events and the development of posttraumatic stress symptoms, including comorbid disruptive behaviors. Fortunately, several evidence-based interventions have been shown to be effective at decreasing both posttraumatic stress symptoms and disruptive behaviors in young children. This paper provides an overview of three such interventions-Child-Parent Psychotherapy (CPP), Parent-Child Interaction Therapy (PCIT), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). An illustrative case study is used to compare how each intervention addresses disruptive behaviors, with a focus on theoretical underpinnings, model similarities, and model differences. The models each have empirical evidence for the treatment of disruptive behavior in young children, and therefore, may be appropriate for treating children with a history of trauma exposure and comorbid disruptive behaviors. Child, caregiver, and environmental factors are essential to consider when identifying an evidence-based intervention for this population.

Predictors of Belief in Sexual Myths: An Examination in Terms of Gender, Demographic Characteristics, Religiosity, and Childhood Trauma

Objectives

Sexual myths are exaggerated beliefs that have no scientific basis. Buying into these beliefs can lead to any number of sexual dysfunctions and decreased quality of life. Therefore, it is necessary to uncover the factors associated with sexual myths and to provide remedial services for anyone struggling with them.

Methods

This study was conducted to determine the variables affecting sexual myths. Gender, demographic variables (family type, region of residence, and talking about sexuality with parents), religiosity, and childhood trauma were included as independent variables in the study. A total of 375 teacher candidates participated in the study. Data was collected using a personal information form, Sexual Myths Scale, Religiosity Scale, and Childhood Trauma Questionnaire.

Results

Descriptive analyses and linear multiple regression analysis were used in the study, and both adherence to sexual myths and experienced childhood trauma were found to be high in the teacher candidates who did not talk about sexuality with their families.

Conclusions

The results of the analysis showed that gender and religiosity were significant predictors of sexual myths. The findings were discussed in light of the literature.

Making Trauma Less Traumatic: Implementing Inpatient Pediatric Screening of Acute Stress Symptoms

OBJECTIVES

Pediatric patients hospitalized for physical injury and trauma are at increased risk of developing acute stress disorder. Routine identification and referral for treatment of patients with psychological sequelae of traumatic injury were added to the accreditation requirements of the American College of Surgeons for pediatric trauma centers in 2022. We aimed to use quality improvement methodology with iterative interventions to increase psychological screening consults for admitted pediatric trauma patients to 80% in 6 months.

METHODS

We planned a quality improvement intervention to increase identification of posttraumatic psychological symptoms in pediatric trauma patients. We created a Making Trauma Less Traumatic consultation service with a dedicated therapist to provide screening, treatment, and referral. Key interventions included education of key stakeholders and iterative improvements in consultation workflow. Our primary measure was frequency of eligible pediatric trauma patients who had consultation requests for posttrauma therapy during admission. We additionally monitored percent of patients with positive symptom screens and lost to follow-up.

RESULTS

From September 2020 through November 2021, consults for eligible pediatric trauma patients improved from a baseline of 4.1% to a weekly mean of 100%. Of those screened, 32.7% had at least 1 symptom of acute stress. No families declined screening or therapy, though 29.5% were lost to intended follow-up.

CONCLUSIONS

We present a successful model of implementing routine psychological screening of pediatric trauma patients utilizing a dedicated consultation service. A high number of admitted patients screened positive for symptoms during hospitalization. Families were accepting of the intervention though follow-up was challenging.

Utilizing Parent-Child Interaction Therapy with Trauma-Directed Interaction in a Young Male in Out of Home Care Who Had Experienced Trauma

Child abuse and neglect in young children can lead to trauma-related stress symptoms that can be challenging to manage. Parent-Child Interaction Therapy (PCIT), a strong evidence-based behavioral parent training program used for young children with behavior issues, has been used in its traditional form with increasing frequency with children and families who have trauma histories, with clinicians tailoring PCIT to use with children who have experienced trauma. Trauma-Directed Interaction (TDI) is a new systematic adaption to the standard PCIT parent training program that has the potential to help treat trauma in younger children. TDI includes several trauma-informed techniques that are added to a course of standard PCIT treatment including psychoeducation regarding trauma, recognition of feelings, and emotional regulation. This case study illustrates the use of a manualized trauma adaptation to PCIT (TDI) with a three-year-old boy who had a history of child maltreatment and his caregiver. This case provides a summary of the progression of this intervention and the results obtained. Results from the case indicated that TDI treatment was effective in not only reducing child trauma and behavioral symptoms but also in reducing mild caregiver mental health concerns. The next steps for TDI treatment and need for further research are discussed.

Evaluation of brain structure and metabolism in currently depressed adults with a history of childhood trauma

Structural differences in the dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), hippocampus, and amygdala were reported in adults who experienced childhood trauma; however, it is unknown whether metabolic differences accompany these structural differences. This multimodal imaging study examined structural and metabolic correlates of childhood trauma in adults with major depressive disorder (MDD). Participants with MDD completed the Childhood Trauma Questionnaire (CTQ, n = 83, n = 54 female (65.1%), age: 30.4 ± 14.1) and simultaneous positron emission tomography (PET)/magnetic resonance imaging (MRI). Structure (volume, n = 80, and cortical thickness, n = 81) was quantified from MRI using Freesurfer. Metabolism (metabolic rate of glucose uptake) was quantified from dynamic ¹⁸F-fluorodeoxyglucose (FDG)-PET images (n = 70) using Patlak graphical analysis. A linear mixed model was utilized to examine the association between structural/metabolic variables and continuous childhood trauma measures while controlling for confounding factors. Bonferroni correction was applied. Amygdala volumes were significantly inversely correlated with continuous CTQ scores. Specifically, volumes were lower by 7.44 mm³ (95% confidence interval [CI]: -12.19, -2.68) per point increase in CTQ. No significant relationship was found between thickness/metabolism and CTQ score. While longitudinal studies are required to establish causation, this study provides insight into potential consequences of, and therefore potential therapeutic targets for, childhood trauma in the prevention of MDD. This work aims to reduce heterogeneity in MDD studies by quantifying neurobiological correlates of trauma within MDD. It further provides biological targets for future interventions aimed at preventing MDD following trauma. To our knowledge, this is the first simultaneous positron emission tomography (PET) and magnetic resonance imaging (MRI) study to assess both structure and metabolism associated with childhood trauma in adults with MDD.

Early Adversity and Development: Parsing Heterogeneity and Identifying Pathways of Risk and Resilience

Adversity early in life is common and is a major risk factor for the onset of psychopathology. Delineating the neurodevelopmental pathways by which early adversity affects mental health is critical for early risk identification and targeted treatment approaches. A rapidly growing cross-species literature has facilitated advances in identifying the mechanisms linking adversity with psychopathology, specific dimensions of adversity and timing-related factors that differentially relate to outcomes, and protective factors that buffer against the effects of adversity. Yet, vast complexity and heterogeneity in early environments and neurodevelopmental trajectories contribute to the challenges of understanding risk and resilience in the context of early adversity. In this overview, the author highlights progress in four major areas-mechanisms, heterogeneity, developmental timing, and protective factors; synthesizes key challenges; and provides recommendations for future research that can facilitate progress in the field. Translation across species and ongoing refinement of conceptual models have strong potential to inform prevention and intervention strategies that can reduce the immense burden of psychopathology associated with early adversity.

Parent–Child Interaction Therapy for a 3-Year-Old Girl With Post-Traumatic Stress Disorder: Restoration to Her Father’s Care Following a Period in Out-of-Home Care

Child abuse and neglect in very young children can lead to trauma-related stress symptoms that can be challenging to treat. Children exposed to multiple traumas occurring in the context of a caregiving relationship are sometimes more severely affected, evidenced by diverse negative behavioral, physical, social, and emotional consequences. Some of these children go on to develop post-traumatic stress disorder (PTSD). Parent–child interaction therapy (PCIT) is a dyadic play-based treatment for children with behavior problems and their parents or caregivers. There is limited research relating to the application of PCIT with very young children with PTSD with some studies actively excluding families where PTSD was present (Herschell et al., 2017). Additionally, there are no articles relating to treatment of a child restored to the care of a parent following out-of-home care (OOHC) and fewer still relating to a child restored to the care of her father. This case study illustrates the use of PCIT with a 3-year-old girl with PTSD, recently restored to her father’s care. It highlights how the use of PCIT in this case not only improved behavioral indicators of traumatic stress, but also afforded this child permanency and stability. The case study provides a summary of the progression of this intervention and the results obtained throughout treatment and 4 years post-intervention. The results indicated that PCIT, with trauma-informed tailoring, was an effective treatment in this case and contributed to safe and permanent care for this child.