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Review
. 2016 Oct 11;10(10):CD012371.
doi: 10.1002/14651858.CD012371.

Psychological therapies for children and adolescents exposed to trauma

Donna Gillies  1 , Licia Maiocchi, Abhishta P Bhandari, Fiona Taylor, Carl Gray, Louise O'Brien
Affiliations
Review

Psychological therapies for children and adolescents exposed to trauma

Donna Gillies et al. Cochrane Database Syst Rev. .

Abstract

Background: Children and adolescents who have experienced trauma are at high risk of developing post-traumatic stress disorder (PTSD) and other negative emotional, behavioural and mental health outcomes, all of which are associated with high personal and health costs. A wide range of psychological treatments are used to prevent negative outcomes associated with trauma in children and adolescents.

Objectives: To assess the effects of psychological therapies in preventing PTSD and associated negative emotional, behavioural and mental health outcomes in children and adolescents who have undergone a traumatic event.

Search methods: We searched the Cochrane Common Mental Disorders Group's Specialised Register to 29 May 2015. This register contains reports of relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We also checked reference lists of relevant studies and reviews. We did not restrict the searches by date, language or publication status.

Selection criteria: All randomised controlled trials of psychological therapies compared with a control such as treatment as usual, waiting list or no treatment, pharmacological therapy or other treatments in children or adolescents who had undergone a traumatic event.

Data collection and analysis: Two members of the review group independently extracted data. We calculated odds ratios for binary outcomes and standardised mean differences for continuous outcomes using a random-effects model. We analysed data as short-term (up to and including one month after therapy), medium-term (one month to one year after therapy) and long-term (one year or longer).

Main results: Investigators included 6201 participants in the 51 included trials. Twenty studies included only children, two included only preschool children and ten only adolescents; all others included both children and adolescents. Participants were exposed to sexual abuse in 12 trials, to war or community violence in ten, to physical trauma and natural disaster in six each and to interpersonal violence in three; participants had suffered a life-threatening illness and had been physically abused or maltreated in one trial each. Participants in remaining trials were exposed to a range of traumas.Most trials compared a psychological therapy with a control such as treatment as usual, wait list or no treatment. Seventeen trials used cognitive-behavioural therapy (CBT); four used family therapy; three required debriefing; two trials each used eye movement desensitisation and reprocessing (EMDR), narrative therapy, psychoeducation and supportive therapy; and one trial each provided exposure and CBT plus narrative therapy. Eight trials compared CBT with supportive therapy, two compared CBT with EMDR and one trial each compared CBT with psychodynamic therapy, exposure plus supportive therapy with supportive therapy alone and narrative therapy plus CBT versus CBT alone. Four trials compared individual delivery of psychological therapy to a group model of the same therapy, and one compared CBT for children versus CBT for both mothers and children.The likelihood of being diagnosed with PTSD in children and adolescents who received a psychological therapy was significantly reduced compared to those who received no treatment, treatment as usual or were on a waiting list for up to a month following treatment (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.34 to 0.77; number needed to treat for an additional beneficial outcome (NNTB) 6.25, 95% CI 3.70 to 16.67; five studies; 874 participants). However the overall quality of evidence for the diagnosis of PTSD was rated as very low. PTSD symptoms were also significantly reduced for a month after therapy (standardised mean difference (SMD) -0.42, 95% CI -0.61 to -0.24; 15 studies; 2051 participants) and the quality of evidence was rated as low. These effects of psychological therapies were not apparent over the longer term.CBT was found to be no more or less effective than EMDR and supportive therapy in reducing diagnosis of PTSD in the short term (OR 0.74, 95% CI 0.29 to 1.91; 2 studies; 160 participants), however this was considered very low quality evidence. For reduction of PTSD symptoms in the short term, there was a small effect favouring CBT over EMDR, play therapy and supportive therapies (SMD -0.24, 95% CI -0.42 to -0.05; 7 studies; 466 participants). The quality of evidence for this outcome was rated as moderate.We did not identify any studies that compared pharmacological therapies with psychological therapies.

Authors' conclusions: The meta-analyses in this review provide some evidence for the effectiveness of psychological therapies in prevention of PTSD and reduction of symptoms in children and adolescents exposed to trauma for up to a month. However, our confidence in these findings is limited by the quality of the included studies and by substantial heterogeneity between studies. Much more evidence is needed to demonstrate the relative effectiveness of different psychological therapies for children exposed to trauma, particularly over the longer term. High-quality studies should be conducted to compare these therapies.

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Conflict of interest statement

None known.

Figures

1
1
PRISMA study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Funnel plot of comparison: 1 All psychotherapies versus control (short‐term), outcome: 1.2 PTSD total symptoms.
1.1
1.1. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 1 PTSD diagnosis.
1.2
1.2. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 2 PTSD total symptoms.
1.3
1.3. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 3 PTSD avoidance.
1.4
1.4. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 4 PTSD hyperarousal.
1.5
1.5. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 5 PTSD intrusion.
1.6
1.6. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 6 Anxiety total symptoms.
1.7
1.7. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 7 Anxiety ‐ state.
1.8
1.8. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 8 Anxiety ‐ trait.
1.9
1.9. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 9 Depression.
1.10
1.10. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 10 Behaviour ‐ total.
1.11
1.11. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 11 Behaviour ‐ internalising.
1.12
1.12. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 12 Behaviour ‐ externalising.
1.13
1.13. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 13 Functional impairment.
1.14
1.14. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 14 Quality of life.
1.15
1.15. Analysis
Comparison 1 All psychotherapies versus control (short‐term), Outcome 15 Loss to follow‐up.
2.1
2.1. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 1 PTSD diagnosis.
2.2
2.2. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 2 PTSD total symptoms.
2.3
2.3. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 3 PTSD ‐ avoidance.
2.4
2.4. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 4 PTSD ‐ hyperarousal.
2.5
2.5. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 5 PTSD ‐ intrusion.
2.6
2.6. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 6 Anxiety total symptoms.
2.7
2.7. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 7 Anxiety ‐ state.
2.8
2.8. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 8 Anxiety ‐ trait.
2.9
2.9. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 9 Depression.
2.10
2.10. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 10 Behaviour ‐ total.
2.11
2.11. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 11 Behaviour ‐ internalising.
2.12
2.12. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 12 Behaviour ‐ externalising.
2.13
2.13. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 13 Function.
2.14
2.14. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 14 Quality of life.
2.15
2.15. Analysis
Comparison 2 All psychotherapies versus control (medium‐term), Outcome 15 Loss to follow‐up.
3.1
3.1. Analysis
Comparison 3 All psychotherapies versus control (long‐term), Outcome 1 PTSD diagnosis.
3.2
3.2. Analysis
Comparison 3 All psychotherapies versus control (long‐term), Outcome 2 PTSD total symptoms.
3.3
3.3. Analysis
Comparison 3 All psychotherapies versus control (long‐term), Outcome 3 Anxiety.
3.4
3.4. Analysis
Comparison 3 All psychotherapies versus control (long‐term), Outcome 4 Depression.
3.5
3.5. Analysis
Comparison 3 All psychotherapies versus control (long‐term), Outcome 5 Behaviour ‐ total.
3.6
3.6. Analysis
Comparison 3 All psychotherapies versus control (long‐term), Outcome 6 Behaviour ‐ internalising.
3.7
3.7. Analysis
Comparison 3 All psychotherapies versus control (long‐term), Outcome 7 Behaviour ‐ externalising.
3.8
3.8. Analysis
Comparison 3 All psychotherapies versus control (long‐term), Outcome 8 Loss to follow‐up.
4.1
4.1. Analysis
Comparison 4 CBT versus other therapies (short‐term), Outcome 1 PTSD diagnosis.
4.2
4.2. Analysis
Comparison 4 CBT versus other therapies (short‐term), Outcome 2 PTSD total symptoms.
4.3
4.3. Analysis
Comparison 4 CBT versus other therapies (short‐term), Outcome 3 PTSD avoidance.
4.4
4.4. Analysis
Comparison 4 CBT versus other therapies (short‐term), Outcome 4 PTSD hyperarousal.
4.5
4.5. Analysis
Comparison 4 CBT versus other therapies (short‐term), Outcome 5 PTSD intrusion.
4.6
4.6. Analysis
Comparison 4 CBT versus other therapies (short‐term), Outcome 6 Anxiety total symptoms.
4.7
4.7. Analysis
Comparison 4 CBT versus other therapies (short‐term), Outcome 7 Depression.
4.8
4.8. Analysis
Comparison 4 CBT versus other therapies (short‐term), Outcome 8 Behaviour ‐ total.
4.9
4.9. Analysis
Comparison 4 CBT versus other therapies (short‐term), Outcome 9 Behaviour ‐ internalising.
4.10
4.10. Analysis
Comparison 4 CBT versus other therapies (short‐term), Outcome 10 Behaviour ‐ externalising.
4.11
4.11. Analysis
Comparison 4 CBT versus other therapies (short‐term), Outcome 11 Function.
4.12
4.12. Analysis
Comparison 4 CBT versus other therapies (short‐term), Outcome 12 Loss to follow‐up.
5.1
5.1. Analysis
Comparison 5 CBT versus other therapies (medium‐term), Outcome 1 PTSD total symptoms.
5.2
5.2. Analysis
Comparison 5 CBT versus other therapies (medium‐term), Outcome 2 Anxiety total symptoms.
5.3
5.3. Analysis
Comparison 5 CBT versus other therapies (medium‐term), Outcome 3 Depression.
5.4
5.4. Analysis
Comparison 5 CBT versus other therapies (medium‐term), Outcome 4 Behaviour ‐ total.
5.5
5.5. Analysis
Comparison 5 CBT versus other therapies (medium‐term), Outcome 5 Behaviour ‐ internalising.
5.6
5.6. Analysis
Comparison 5 CBT versus other therapies (medium‐term), Outcome 6 Behaviour ‐ externalising.
5.7
5.7. Analysis
Comparison 5 CBT versus other therapies (medium‐term), Outcome 7 Loss to follow‐up.
6.1
6.1. Analysis
Comparison 6 CBT versus other therapies (long‐term), Outcome 1 Behaviour ‐ internalising.
6.2
6.2. Analysis
Comparison 6 CBT versus other therapies (long‐term), Outcome 2 Behaviour ‐ externalising.
6.3
6.3. Analysis
Comparison 6 CBT versus other therapies (long‐term), Outcome 3 Loss to follow‐up.
7.1
7.1. Analysis
Comparison 7 Subgroup analysis: Individual versus group therapy, Outcome 1 PTSD total symptoms.
8.1
8.1. Analysis
Comparison 8 Subgroup analysis: Child versus mother and child therapy, Outcome 1 PTSD total symptoms.
9.1
9.1. Analysis
Comparison 9 Subgroup analysis: type of trauma, Outcome 1 PTSD diagnosis.
9.2
9.2. Analysis
Comparison 9 Subgroup analysis: type of trauma, Outcome 2 PTSD total symptoms.
10.1
10.1. Analysis
Comparison 10 Subgroup analysis: symptomatic participants, Outcome 1 PTSD diagnosis.
10.2
10.2. Analysis
Comparison 10 Subgroup analysis: symptomatic participants, Outcome 2 PTSD total symptoms.
11.1
11.1. Analysis
Comparison 11 Sensitivity analysis: type of control, Outcome 1 PTSD diagnosis.
11.2
11.2. Analysis
Comparison 11 Sensitivity analysis: type of control, Outcome 2 PTSD total symptoms.
12.1
12.1. Analysis
Comparison 12 Sensitivity analysis: best‐/worst‐case analysis, Outcome 1 PTSD diagnosis.
13.1
13.1. Analysis
Comparison 13 Sensitivity analysis: cluster‐randomisation, Outcome 1 PTSD diagnosis.
13.2
13.2. Analysis
Comparison 13 Sensitivity analysis: cluster‐randomisation, Outcome 2 PTSD total symptoms.
14.1
14.1. Analysis
Comparison 14 Sensitivity analysis: performance bias, Outcome 1 PTSD diagnosis.
14.2
14.2. Analysis
Comparison 14 Sensitivity analysis: performance bias, Outcome 2 PTSD total symptoms.
15.1
15.1. Analysis
Comparison 15 Sensitivity analysis: detection bias, Outcome 1 PTSD diagnosis.
15.2
15.2. Analysis
Comparison 15 Sensitivity analysis: detection bias, Outcome 2 PTSD total symptoms.
16.1
16.1. Analysis
Comparison 16 Sensitivity analysis: attrition bias, Outcome 1 PTSD diagnosis.
16.2
16.2. Analysis
Comparison 16 Sensitivity analysis: attrition bias, Outcome 2 PTSD total symptoms.
17.1
17.1. Analysis
Comparison 17 Sensitivity analysis: selection bias, Outcome 1 PTSD diagnosis.
17.2
17.2. Analysis
Comparison 17 Sensitivity analysis: selection bias, Outcome 2 PTSD total symptoms.
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    1. Reddy SD, Negi LT, Dodson‐Lavelle B, Ozawa‐de Silva B, Pace TW, Cole SP, et al. Cognitive‐based compassion training: a promising prevention strategy for at‐risk adolescents. Journal of Child and Family Studies 2013;22(2):219‐30.
Qouta 2012 {published data only}
    1. Diab M, Punamaki R‐L, Palosaari E, Qouta SR. Can psychosocial intervention improve peer and sibling relations among war‐affected children? Impact and mediating analyses in a randomized controlled trial. Social Development 2014;23:215‐31.
    1. Punamaki R‐L, Peltonen K, Diab M, Qouta SR. Psychosocial interventions and emotion regulation among war‐affected children: randomized control trial effects. Traumatology 2014;20:241‐52.
    1. Qouta SR, Palosaari E, Diab M, Punamaki R‐L. Intervention effectiveness among war‐affected children: a cluster randomized controlled trial on improving mental health. Journal of Traumatic Stress 2012;25(3):288‐98. - PubMed
Raider 2008 {published data only}
    1. Raider M C, Steele W, Delillo‐Storey M, Jacobs J, Kuban C. Structured sensory therapy (SITCAP‐ART) for traumatized adjudicated adolescents in residential treatment. Residential Treatment for Children and Youth 2008;25(2):167‐85.
Salloum 2008 {published data only}
    1. Salloum A. Group therapy for children after homicide and violence: a pilot study. Research on Social Work Practice 2008;18(3):198‐211.
    1. Salloum A, Overstreet S. Evaluation of individual and group grief and trauma interventions for children post disaster. Journal of Clinical Child and Adolescent Psychology 2008;37(3):495‐507. - PubMed
Salloum 2012 {published data only}
    1. Salloum A, Overstreet S, Salloum A, Overstreet S. Grief and trauma intervention for children after disaster: exploring coping skills versus trauma narration. Behaviour Research and Therapy 2012;50(3):169‐79. - PubMed
Schottelkorb 2012 {published data only}
    1. Schottelkorb AA, Doumas DM, Garcia R. Treatment for childhood refugee trauma: a randomized, controlled trial. International Journal of Play Therapy 2012;21(2):57‐73.
Shechtman 2010 {published data only}
    1. Shechtman Z, Mor M. Groups for children and adolescents with trauma‐related symptoms: outcomes and processes. International Journal of Group Psychotherapy 2010;60(2):221‐44. - PubMed
Shirk 2014 {published data only}
    1. Shirk SR, DePrince AP, Crisostomo PS, Labus J. Cognitive behavioral therapy for depressed adolescents exposed to interpersonal trauma: an initial effectiveness trial. Psychotherapy 2014;51:167‐79. - PubMed
Stallard 2006 {published data only}
    1. Stallard P. A randomised controlled trial to determine whether mental health problems and significant psychological distress in children involved in everyday road traffic accidents can be prevented. National Research Register 2003.
    1. Stallard P, Velleman R, Salter E, Howse I, Yule W, Taylor G. A randomised controlled trial to determine the effectiveness of an early psychological intervention with children involved in road traffic accidents. Journal of Child Psychology and Psychiatry and Allied Disciplines 2006;47(2):127‐34. - PubMed
    1. Stallard P, Velleman R, Salter E, Howse I, Yule W, Taylor G, et al. A randomised controlled trial to determine the effectiveness of an early intervention with child trauma victims. 31st Annual Conference of the British Association for Behavioural and Cognitive Psychotherapies; 2003 July 16 ‐ 19, York. 2003:83.
    1. Stallard P, Velleman R, Salter W, Howse I, Yule W, Taylor G, et al. Does early intervention prevent psychological distress in children involved in road traffic accidents? The results of a randomised controlled trial. 32nd Congress of the British Association for Behavioural and Cognitive Psychotherapies (jointly with the European Association of Behavioural and Cognitive Therapies); 2004 September 7 ‐ 11; Manchester. 2004:111.
Stein 2003 {published data only}
    1. Kataoka S, Jaycox LH, Wong M, Nadeem E, Langley A, Tang L, et al. Effects on school outcomes in low‐income minority youth: preliminary findings from a community‐partnered study of a school‐based trauma intervention. Ethnicity and Disease 2011;21(3 Suppl 1):S1‐71‐7. - PMC - PubMed
    1. Stein BD, Jaycox LH, Kataoka SH, Wong M, Tu W, Elliott MN, et al. A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial. JAMA 2003;290(5):603‐11. - PubMed
Taussig 2010 {published data only}
    1. Taussig HN, Culhane SE. Impact of a mentoring and skills group program on mental health outcomes for maltreated children in foster care [NCT00809315]. Archives of Pediatrics and Adolescent Medicine 2010;164(8):739‐46. - PMC - PubMed
    1. Taussig HN, Culhane SE, Garrido E, Knudtson MD. RCT of a mentoring and skills group program: placement and permanency outcomes for foster youth. Pediatrics 2012;130(1):e33‐9. - PMC - PubMed
    1. Taussig HN, Culhane SE, Hettleman D. Fostering healthy futures: an innovative preventive intervention for preadolescent youth in out‐of‐home care. Child Welfare 2007;86(5):113‐31. - PMC - PubMed
Tol 2008 {published data only}
    1. Tol WA, Komproe IH, Jordans MJ, Susanty D, Jong JT. Developing a function impairment measure for children affected by political violence: a mixed methods approach in Indonesia. International Journal for Quality in Health Care 2011;23(4):375‐83. - PubMed
    1. Tol WA, Komproe IH, Jordans MJD, Gross AL, Susanty D, Macy RD, et al. Mediators and moderators of a psychosocial intervention for children affected by political violence. Journal of Consulting and Clinical Psychology 2010;78(6):818‐28. - PubMed
    1. Tol WA, Komproe IH, Susanty D, Jordans MJ, Macy RD, Jong JT. School‐based mental health intervention for children affected by political violence in Indonesia: a cluster randomized trial. JAMA 2008;300(6):655‐62. - PubMed
Tol 2012 {published data only}
    1. Tol WA, Komproe IH, Jordans MJ, Vallipuram A, Sipsma H, Sivayokan S, et al. Outcomes and moderators of a preventive school‐based mental health intervention for children affected by war in Sri Lanka: a cluster randomized trial. World Psychiatry 2012;11(2):114‐22. - PMC - PubMed
Tol 2014 {unpublished data only}
    1. Tol WA, Komproe IH, Jordans MJD, Ndayisaba A, Ntamutumba P, Sipsma H, et al. School‐based mental health intervention for children in war‐affected Burundi: a cluster randomized trial. BMC Medicine 2014;12:56. - PMC - PubMed
    1. Jong J. Efficacy of a School‐Based Psychosocial Intervention to Deal With the Psychosocial Impact of Armed Conflict on School‐Aged Children in Burundi. http://www.controlled‐trials.com/ISRCTN42284825.
Trowell 2002 {published data only}
    1. McCrone P, Weeramanthri T, Knapp M, Rushton A, Trowell J, Miles G, et al. Cost‐effectiveness of individual versus group psychotherapy for sexually abused girls. Child and Adolescent Mental Health 2005;10(1):26‐31. - PubMed
    1. Trowell J, Kolvin I. Lessons from a psychotherapy outcome study with sexually abused girls. Clinical Child Psychology and Psychiatry 1999;4(1):79‐89.
    1. Trowell J, Kolvin I, Weeramanthri T, Sadowski H, Berelowitz M, Glasser D, et al. Psychotherapy for sexually abused girls: psychopathological outcome findings and patterns of change. British Journal of Psychiatry 2002;180:234‐47. - PubMed
    1. Trowell JA, Berelowitz M, Kolvin I. In: Aveline M, Shapiro DA editor(s). Design and Methodological Issues in Setting Up a Psychotherapy Outcome Study With Girls Who Have Been Sexually Abused. Chichester: John Wiley, 1995.
Zehnder 2010 {published data only}
    1. Zehnder D, Meuli M, Landolt MA. Effectiveness of a single‐session early psychological intervention for children after road traffic accidents: a randomised controlled trial [NCT00296842]. Child and Adolescent Psychiatry and Mental Health 2010;4:7. - PMC - PubMed

References to studies excluded from this review

Berger 2007 {published data only}
    1. Berger R, Pat‐Horenczyk R, Gelkopf M. School‐based intervention for prevention and treatment of elementary‐students' terror‐related distress in Israel: a quasi‐randomized controlled trial. Journal of Traumatic Stress 2007;20(4):541‐51. - PubMed
Bolton 2007 {published data only}
    1. Betancourt T, Bolton P, Bass J, Murray L, Verdeli H, Clougherty K, et al. Phase III: a randomized controlled trial of mental health interventions for Acholi war‐affected youth in Gulu, Northern Uganda. 22nd Annual Meeting, International Society for Traumatic Stress Studies, November 4 ‐ 7 2006, Hollywood, CA. 2006:114.
    1. Bolton P, Bass J, Betancourt T, Speelman L, Onyango G, Clougherty K, et al. Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial. JAMA 2007;298(5):519‐27. - PubMed
Burke 1988 {published data only}
    1. Burke MM. Short‐term group therapy for sexually abused girls: a learning theory based treatment for negative affect. PhD, University of Georgia, 1988.
Catani 2009 {published data only}
    1. Catani C, Kohiladevy M, Ruf M, Schauer E, Elbert T, Neuner F. Treating children traumatized by war and tsunami: a comparison between exposure therapy and meditation‐relaxation in North‐East Sri Lanka. BMC Psychiatry 2009;9:22. [DOI: 10.1186/1471-244X-9-22] - DOI - PMC - PubMed
Chen 2014 {published data only}
    1. Chen Y, Shen WW, Gao K, Lam CS, Chang WC, Deng H. Effectiveness RCT of a CBT intervention for youths who lost parents in the Sichuan, China, earthquake. Psychiatric Services 2014;65:259‐62. - PubMed
Cohen 2004 {published data only}
    1. Cohen J, Mannarino A, Deblinger E, Steer R. A multisite treatment study for PTSD in sexually abused children. 19th Annual Meeting, International Society for Traumatic Stress Studies, October 29 ‐ November 1, Chicago, IL. 2003.
    1. Cohen JA, Deblinger E, Mannarino AP, Steer RA. A multisite, randomized controlled trial for children with sexual abuse‐related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry. 2004;43(4):393‐402. - PMC - PubMed
    1. Deblinger E, Mannarino AP, Cohen JA, Steer RA. A follow‐up study of a multisite, randomized, controlled trial for children with sexual abuse‐related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry 2006;45(12):1474‐84. - PubMed
Cooley‐Strickland 2011 {published data only}
    1. Cooley MR. Community Violence and Youth: Preventing Anxiety Disorders. http://clinicaltrialsgov/show/NCT00073619 2001. [NCT00073619]
    1. Cooley‐Strickland MR, Griffin RS, Darney D, Otte K, Ko J. Urban African American youth exposed to community violence: a school‐based anxiety preventive intervention efficacy study. Journal of Prevention and Intervention in the Community 2011;39(2):149‐66. - PMC - PubMed
Dybdahl 2001 {published data only}
    1. Dybdahl R. Children and mothers in war: an outcome study of a psychosocial intervention program. Child Development 2001;72(4):1214‐30. - PubMed
Ehntholt 2005 {published data only}
    1. Ehntholt KA, Smith P, Yule W. School‐based CBT group intervention for refugee children who have experienced war‐related trauma. 31st Annual Conference of the British Association for Behavioural and Cognitive Psychotherapies; 2003 July 16 ‐ 19, York. 2003, issue 83.
    1. Ehntholt KA, Smith PA, Yule W. School‐based cognitive‐behavioural therapy group intervention for refugee children who have experienced war‐related trauma. Clinical Child Psychology and Psychiatry 2005;10(2):235‐50.
Ensink 2004 {published data only}
    1. Ensink K, Normandin L, Kernberg PF. Efficacy of a Reflective Functioning Treatment (RFT) for young sexually abused children. Society for Psychotherapy Research 35th Annual General Meeting Book of Abstracts. Rome, Italy, June 16 ‐ 19, 2004.
Ertl 2011 {published data only}
    1. Ertl V, Pfeiffer A, Schauer E, Elbert T, Neuner F. Community‐implemented trauma therapy for former child soldiers in Northern Uganda: a randomized controlled trial. JAMA 2011;306(5):503‐12. - PubMed
Gelkopf 2009 {published data only}
    1. Gelkopf M, Berger R. A school‐based, teacher‐mediated prevention program (ERASE‐Stress) for reducing terror‐related traumatic reactions in Israeli youth: a quasi‐randomized controlled trial. Journal of Child Psychology and Psychiatry, and Allied Disciplines 2009;50(8):962‐71. - PubMed
Gellman 2001 {published data only}
    1. Gellman AR. Guided imagery: exploring an alternative adjunctive intervention with traumatized adolescents in residential foster care. PhD dissertation, New York University, 2001.
Goenjian 1997 {published data only}
    1. Goenjian AK, Karayan I, Pynoos RS, Minassian D, Najarian LM, Steinberg AM, et al. Outcome of psychotherapy among early adolescents after trauma. American Journal of Psychiatry 1997;154(4):536‐42. - PubMed
Graham‐Bermann 2013 {published data only}
    1. Graham‐Bermann SA, Lynch S, Banyard V, DeVoe ER, Halabu H. Community‐based intervention for children exposed to intimate partner violence: an efficacy trial. Journal of Consulting and Clinical Psychology 2007;75:199‐209. - PubMed
    1. Graham‐Bermann SA, Miller LE. Intervention to reduce traumatic stress following intimate partner violence: an efficacy trial of the Moms' Empowerment Program (MEP). Psychodynamic Psychiatry 2013;41(2):329‐49. - PubMed
    1. Howell KH, Miller LE, Lilly MM, Graham‐Bermann SA. Fostering social competence in preschool children exposed to intimate partner violence: evaluating the preschool kids' club intervention. Journal of Aggression, Maltreatment and Trauma 2013;22(4):425‐45.
Hardin 2002 {published data only}
    1. Hardin SB, Weinrich S, Weinrich M, Garrison C, Addy C, Hardin TL. Effects of a long‐term psychosocial nursing intervention on adolescents exposed to catastrophic stress. Issues in Mental Health Nursing 2002;23(6):537‐51. - PubMed
Jacob 2014 {published data only}
    1. Jacob N, Neuner F, Maedl A, Schaal S, Elbert T. Dissemination of psychotherapy for trauma spectrum disorders in postconflict settings: a randomized controlled trial in Rwanda. Psychotherapy and Psychosomatics 2014;83:354‐63. - PubMed
    1. Schaal S. Phase 2: A Randomized Controlled Clinical Trial With Orphans and Widows Who Experienced the Genocide Carried Out by Trained Local Psychologists ‐ NET/IPT Versus Waiting List. ClinicalTrialsgov [wwwclinicaltrialsgov] 2007.
Jeffres 2004 {published data only}
    1. Jeffres MJ. The efficacy of EMDR with traumatized children. Dissertation Abstracts International 2004:4042.
Jensen 2014 {published data only}
    1. Jensen TK. Trauma‐Focused Cognitive‐Behavioural Therapy for Children: A Study of Process and Outcome. http://www.clinicaltrials.gov/ct2/show/NCT00635752 issue accessed 1‐10‐13.
    1. Jensen TK, Holt T, Ormhaug SM, Egeland K, Granly L, Hoaas LC, et al. A randomized effectiveness study comparing trauma‐focused cognitive behavioral therapy with therapy as usual for youth. Journal of Clinical Child and Adolescent Psychology 2014;43:356‐69. - PMC - PubMed
    1. Ormhaug SM, Jensen TK, Wentzel‐Larsen T, Shirk SR. The therapeutic alliance in treatment of traumatized youths: relation to outcome in a randomized clinical trial. Journal of Consulting and Clinical Psychology 2014;82:52‐64. - PubMed
Jordans 2010 {published data only}
    1. Jordans MJ, Komproe IH, Tol WA, Kohrt BA, Luitel NP, Macy RD, et al. Evaluation of a classroom‐based psychosocial intervention in conflict‐affected Nepal: a cluster randomized controlled trial [ISRCTN48004304]. Journal of Child Psychology and Psychiatry, and Allied Disciplines 2010;51(7):818‐26. - PubMed
Kassam‐Adams 2011 {published data only}
    1. Kassam‐Adams N, Garcia‐Espana JF, Marsac ML, Kohser KL, Baxt C, Nance M, et al. A pilot randomized controlled trial assessing secondary prevention of traumatic stress integrated into pediatric trauma care. Journal of Traumatic Stress 2011;24(3):252‐9. - PMC - PubMed
Kataoka 2003 {published data only}
    1. Kataoka SH, Stein BD, Jaycox LH, Wong M, Escudero P, Tu W, et al. A school‐based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry 2003;42(3):311‐8. - PubMed
Kenardy 2008 {published data only}
    1. Kenardy J, Thompson K, Brocque R, Olsson K. Information provision intervention for children and their parents following pediatric accidental injury. European Child and Adolescent Psychiatry 2008;17(5):316‐25. - PubMed
King 2000 {published data only}
    1. 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. Journal of the American Academy of Child & Adolescent Psychiatry 2000;39(11):1347‐55. - PubMed
Krueger 2013 {published data only}
    1. Krueger SJ. Cognitive behavioral and integrative treatment of abused children: examining cognitive and emotional processes and developmental considerations. Dissertation Abstracts International: Section B: The Sciences and Engineering 2013; Vol. 74.
Lyshak‐Stelzer 2007 {published data only}
    1. Lyshak‐Stelzer F, Singer P, John P, Chemtob CM. Art therapy for adolescents with posttraumatic stress disorder symptoms: a pilot study. Art Therapy 2007;24(4):163‐9.
McWhirter 2011 {published data only}
    1. McWhirter PT. Differential therapeutic outcomes of community‐based group interventions for women and children exposed to intimate partner violence. Journal of Interpersonal Violence 2011;26(12):2457‐82. - PubMed
Murray 2015 {published data only}
    1. Murray LK, Skavenski S, Kane JC, Mayeya J, Dorsey S, Cohen JA, et al. Effectiveness of trauma‐focused cognitive behavioral therapy among trauma‐affected children in Lusaka, Zambia: a randomized clinical trial. JAMA Pediatriatics 2015;169(8):761‐9. - PMC - PubMed
Pfeffer 2002 {published data only}
    1. Pfeffer CR, Jiang H, Kakuma T, Hwang J, Metsch M. Group intervention for children bereaved by the suicide of a relative. Journal of the American Academy of Child and Adolescent Psychiatry 2002;41(5):505‐13. - PubMed
Phipps 2012 {published data only}
    1. Phipps S, Peasant C, Barrera M, Alderfer MA, Huang Q, Vannatta K. Resilience in children undergoing stem cell transplantation: results of a complementary intervention trial. Pediatrics 2012;129(3):e762‐70. - PMC - PubMed
Rosner 2014 {published data only}
    1. Rimane E, Rosner R. Developmentally Adapted Cognitive Processing Therapy for Adolescents and Young Adults With PTSD Symptoms After Physical and Sexual Abuse ‐ D‐CPT. http://wwwdrksde/DRKS00004787 2013. - PMC - PubMed
    1. Rosner R, Konig HH, Neuner F, Schmidt U, Steil R. Developmentally adapted cognitive processing therapy for adolescents and young adults with PTSD symptoms after physical and sexual abuse: study protocol for a randomized controlled trial. Trials 2014;15:195. - PMC - PubMed
Rubin 2001 {published data only}
    1. Rubin A, Bischofshausen S, Conroy‐Moore K, Dennis B, Hastie M, Melnick L, et al. The effectiveness of EMDR in a child guidance center. Research on Social Work Practice 2001;11(4):435‐57.
Ruf 2010 {published data only}
    1. Ruf M, Schauer M, Neuner F, Catani C, Elbert T. World Psychiatric Association, International Congress; 2006 July 12 ‐ 16; Istanbul, Turkey. 2006:146.
    1. Ruf M, Schauer M, Neuner F, Catani C, Schauer E, Elbert T. Narrative exposure therapy for 7‐ to 16‐year‐olds: a randomized controlled trial with traumatized refugee children. Journal of Traumatic Stress 2010;23(4):437‐45. - PubMed
Ruf 2012 {unpublished data only}
    1. Ruf M. Lifeline‐NET (Narrative Exposure Therapy): a short‐term treatment for traumatized refugees and asylum seekers. https://clinicaltrials.gov/show/NCT01720732 2012.
Saxe 2012 {published data only}
    1. Saxe GN, Heidi EB, Fogler J, Navalta CP. Innovations in practice: preliminary evidence for effective family engagement in treatment for child traumatic stress‐trauma systems therapy approach to preventing dropout. Child and Adolescent Mental Health 2012;17(1):58‐61. - PubMed
Schaal 2009 {published data only}
    1. Schaal S, Elbert T, Neuner F. Narrative exposure therapy versus interpersonal psychotherapy: a pilot randomized controlled trial with Rwandan genocide orphans. Psychotherapy and Psychosomatics 2009;78(5):298‐306. - PubMed
Schauer 2008 {unpublished data only}
    1. Schauer E. Trauma treatment for children in war: build‐up of an evidence‐based large‐scale mental health intervention in north‐eastern Sri Lanka. PhD thesis submitted to Konstanz University, 2008.
Scheeringa 2011 {published data only}
    1. 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. Journal of Child Psychology & Psychiatry and Allied Disciplines 2011;52(8):853‐60. - PMC - PubMed
Shelby 1995 {published data only}
    1. Shelby JS. Crisis intervention with children following Hurricane Andrew: a comparison of two treatment approaches. Dissertation Abstracts International 1995:1121.
Shooshtary 2008 {published data only}
    1. Shooshtary MH, Panaghi L, Moghadam JA. Outcome of cognitive behavioral therapy in adolescents after natural disaster. Journal of Adolescent Health 2008;42(5):466‐72. - PubMed
Soltanifar 2012 {unpublished data only}
    1. Soltanifar A. The Efficacy of Developmental Attachment‐Based Play Therapy on Developmental Trauma Disorder Symptoms in Children From 3 to 9 Years Old. Iranian Registry of Clinical Trials, http://www.irct.ir/searchresult.php?id=5280&number=8.
    1. Soltanifar A, Rezaei Ardani A, Soltanifar A, Jafarzadeh Fadaki M, Modarres Gharavi M, Mokhber N. Attachment‐based play therapy for Iranian children and parenting stress of their mothers. Middle‐East Journal of Scientific Research 2013;18(4):432‐37.
Stronach 2012 {published data only}
    1. Stronach EP. Preventive interventions and sustained attachment security in maltreated children: a 12‐month follow‐up of a randomized controlled trial dissertation. Dissertation Abstracts International 2013; Vol. 74, issue 3‐B(E). - PMC - PubMed
    1. Stronach EP, Toth SL, Rogosch F, Cicchetti D. Preventive interventions and sustained attachment security in maltreated children. Development and Psychopathology 2013;25(4):919‐30. - PMC - PubMed
Thabet 2005 {published data only}
    1. Thabet AA, Vostanis P, Karim K. Group crisis intervention for children during ongoing war conflict. European Child and Adolescent Psychiatry 2005;14(5):262‐9. - PubMed
Wang 2011 {published data only}
    1. Wang Z‐Y, Yang F, Wang Y‐Y, Gao J, Qian M‐Y. Effects of group intervention on depression and post‐traumatic stress symptoms among junior middle school students in earthquake area. Chinese Mental Health Journal 2011;25(4):284‐8.
Wolmer 2011a {published data only}
    1. Wolmer L, Hamiel D, Laor N. Preventing children's posttraumatic stress after disaster with teacher‐based intervention: a controlled study. Journal of the American Academy of Child and Adolescent Psychiatry 2011;50(4):340‐8. - PubMed
Wolmer 2011b {published data only}
    1. Wolmer L, Hamiel D, Barchas JD, Slone M, Laor N. Teacher‐delivered resilience‐focused intervention in schools with traumatized children following the second Lebanon War. Journal of Traumatic Stress 2011;24(3):309‐16. - PubMed

References to studies awaiting assessment

Crombach 2012 {unpublished data only}
    1. Crombach A. Treatment of Aggressive Behavior and Post‐Traumatic Stress Disorder. http://www.clinicaltrials.gov/ct2/show/NCT01519193.
Elbert 2009 {unpublished data only}
    1. Elbert T. Trauma and Truth Interventions (NET) Versus Conflict Resolution and Social Skills Trainings for Vulnerable Youths in Northern Uganda. http://clinicaltrials.gov/ct2/show/NCT00893750.
Elbert 2013 {unpublished data only}
    1. Elbert T. MemoTV: Epigenetic, Neural and Cognitive Memories of Traumatic Stress and Violence in Former Offenders of the Townships of South Africa. http://clinicaltrialsgov/show/NCT02012738 2013.
Hultmann 2012 {unpublished data only}
    1. Hultmann O. Identification and Treatment of Children Exposed or Subjected to Intimate Partner Violence or Child Abuse in Sweden. http://www.controlled‐trials.com/ISRCTN58027256.
Jessiman 2013 {unpublished data only}
    1. Jessiman P. Letting the Future In: Therapeutic Intervention for Child Sexual Abuse – Randomised Trial. http://www.controlled‐trials.com/ISRCTN65340805.
Kassam‐Adams 2016 {published and unpublished data}
    1. Kassam‐Adams N, Marsac ML, Kohser KL, Kenardy J, March S, Winston FK. Pilot Randomized Controlled Trial of a Novel Web‐Based Intervention to Prevent Posttraumatic Stress in Children Following Medical Events. Journal of Pediatric Psychology 2015;41(1):138‐48. - PMC - PubMed
    1. Marsac ML, Kohser KL, Winston FK, Kenardy J, March S, Kassam‐Adams N. Using a web‐based game to prevent posttraumatic stress in children following medical events: design of a randomized controlled trial. European Journal of Psychotraumatology 2013;4:21311. - PMC - PubMed
Kramer 2014 {unpublished data only}
    1. Landolt M. Psychological Interventions in Children After Road Traffic Accidents or Burns: A Randomized Controlled Study. http://clinicaltrials.gov/show/NCT01085370.
Mahmoudi‐Gharaei 2006 {published data only}
    1. Mahmoudi‐Gharaei J, Mohammadi M, Bina M, Yasami M, Fakour Y. Supportive and cognitive behavioral group interventions on Bam earthquake related PTSD symptoms in adolescents. Tehran University Medical Journal 2006;64(8):57‐67.
Narimani 2013 {published data only}
    1. Narimani M, Basharpoor S, Gamarigive H, Abolgasemi A. Impact of cognitive processing and holographic reprocessing on posttraumatic symptoms improvement amongst Iranian students. Advances in Cognitive Science 2013;15:50‐62.
Ooi 2010 {unpublished data only}
    1. Ooi C. A Pretest Posttest 3‐Month Follow‐up Randomised Controlled Trial of a Group Intervention "Teaching Recovery Techniques" to Prevent Worsening of Early Posttraumatic Stress Symptoms in Young Migrants. http://www.anzctr.org.au/ACTRN12611000948998.aspx.
Rowe 2013 {published data only}
    1. Rowe C. Family‐Based Drug Services for Young Disaster Victims (Katrina). ClinicalTrials.gov 2013; Vol. https://clinicaltrials.gov/ct2/show/NCT01859000.
    1. Rowe CL, Greca AM, Alexandersson A. Family and individual factors associated with substance involvement and PTS symptoms among adolescents in greater New Orleans after Hurricane Katrina. Journal of Consulting and Clinical Psychology 2010;78(6):806‐17. - PubMed
Ruggiero 2015 {published data only}
    1. Ruggiero KJ. Web‐based Intervention for Disaster‐Affected Youth and Families. http://clinicaltrials.gov/show/NCT01606514.
    1. Ruggiero KJ, Davidson TM, McCauley J, Gros KS, Welsh K, Price M, et al. Bounce Back Now! Protocol of a population‐based randomized controlled trial to examine the efficacy of a web‐based intervention with disaster‐affected families. Contemporary Clinical Trials 2015;40:138‐49. - PMC - PubMed
    1. Ruggiero KJ, Price M, Adams Z, Stauffacher K, McCauley J, Danielson CK, Knapp R, Hanson RF, Davidson TM, Amstadter AB, Carpenter MJ, Saunders BE, Kilpatrick DG, Resnick HS. Web intervention for adolescents affected by disaster: population‐based randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry 2015;54(9):709‐17. - PMC - PubMed
Shen 2012 {published data only}
    1. Shen P‐Y, Zhu X‐Y, Xin Y. Effects of expressive group counseling on psychological well‐being in children after earthquake. Chinese Mental Health Journal 2012;26:466‐70.
Zang 2013 {published and unpublished data}
    1. Zang Y. Resilience and Implications From Writings of Children Traumatised by the Earthquake: A Study of Guided Narrative Technique. Chinese Clinical Trial Registry (ChiCTR), http://www.chictr.org/en/proj/show.aspx?proj=4143.
    1. Zang Y. The Effect of a Guided Narrative Technique Among Children Traumatised by the Earthquake: Pilot Study. Chinese Clinical Trial Registry (ChiCTR), http://www.chictr.org/en/proj/show.aspx?proj=4142.
    1. Zang Y, Hunt N, Cox T. The effect of guided narrative technique among children traumatised by the earthquake. In: Barrette C, Haylock B, Mortimer D editor(s). Trauma Imprints: Performance, Art, Literature and Theoretical Practice. 1st Edition. Oxford, UK: Inter‐disciplinary Press, 2011:173‐282. [ISBN: 978‐1‐84888‐085‐6]

References to ongoing studies

Belcher 2009 {unpublished data only}
    1. Belcher HME. FamilyLive Feasibility and Effectiveness Study. http://www.clinicaltrials.gov/ct2/show/NCT01524185 issue accessed 1‐10‐13.
Dorsey 2012 {unpublished data only}
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Roos 2013 {unpublished data only}
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References to other published versions of this review

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