Children’s refractory posttraumatic stress disorder: An ecological, evidence-based perspective.
Brown, E. J., & Campbell, C. L. (2009). In D. McKay & E. Storch (Eds.), Cognitive behavior therapy for refractory cases in children and adolescents (pp. 201-229). New York, NY: Springer.
What was our goal? In addition to PTSD symptoms, traumatized youth often present with co-occurring symptoms of depression, aggression, risky sexual behavior, substance use, and self-injury (e.g., cutting). Trauma-specific therapies are designed to address such trauma symptoms by teaching children and caregivers coping skills that focus on how to manage “upset” feelings, thoughts and behaviors, improve parenting skills and process the child’s trauma experiences. Here we gather compelling research evidence in support of the treatment model and detail treatment components as they apply to children across different age groups, and present a case study.
How did we gather our data? JL was a 13-year old male with a history of child sexual and physical abuse, and was referred to treatment by child protective services. Per the intake evaluation, JL presented with symptoms of PTSD, depression, and anger; he also had a history of risky behaviors including aggression (resulting in suspensions), substance use and running away. The case example describes how we applied the aforementioned treatment model while working with JL and multiple caregivers (foster parents, biological parents, step-parent) who reported multiple stressors. The treatment also incorporated other evidence-based techniques to address the complexity of the case: 1) engagement with the caregiver who also took part in the physical abuse, 2) use of strategies to increase motivation to change problematic behaviors (e.g., substance use for teen and parenting strategies for caregivers) and 3) promote relationships between caregivers and other systems in the community (e.g., school).
What did we learn? At the end of treatment, JL no longer met criteria for PTSD and his scores for depression and anxiety were in the normal range. He also no longer presented with significant oppositional problems, with improvements in peer relations and academics.
How does this study impact our work? Based on the review of literature and the case presentation, we reached several important insights. Given that youth often have histories of multiple traumas, in addition to PTSD, their diagnostic picture often is complex, including clinical problems that may either maintain or worsen PTSD symptoms. Therefore, it is important to assess and treat the range of trauma-related mental health problems. Secondly, when presenting with complex PTSD, it is important to identify and incorporate other appropriate intervention strategies. And, finally, incorporating multiple caregivers is critical as is educating and collaborating with other professionals involved in the situation (e.g., law guardians, case workers, judges).
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