Posttraumatic Stress Disorder due to Child Abuse and Neglect Treatment & Management

  • Author: Angelo P Giardino, MD, PhD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Aug 23, 2011
 

Medical Care

The first step of treatment in posttraumatic stress disorder (PTSD) is to provide a safe environment and to attend to urgent medical needs.

Immediately after a traumatic event, children are likely to be frightened and distressed. A sense of security can be achieved with a combination of respect, compassion, containment, assistance with helping the child experience consistency in their daily routines, and provision of opportunities for relaxation and positive experiences.

The role of formal debriefing sessions after a traumatic event is not entirely clear, but the discussion of trauma in asymptomatic individuals may increase the long-term risk of PTSD symptoms, possibly because the child becomes sensitized through exposure without having adequate treatment to process this stress.

Interventions with children

Cognitive behavioral therapy

  • Of all treatments, cognitive behavioral therapy (CBT), especially CBT with a trauma focus (TF-CBT), is most efficacious based on empirical evidence. It seems to help children with both acute and chronic PTSD with PTSD symptoms, as well as those with depression, shame, social skills, and behavioral disturbances. The improvements have been shown to persist for at least 2 years after treatment.
  • TF-CBT is a highly structured therapy that consists of manual-based sessions (eg, 10-18 sessions, each 1 h). The intervention focuses on stress management, education about symptoms, creating a narrative of the trauma (as a means of exposure), and cognitive reprocessing of the trauma and resultant symptoms.
  • Preliminary findings suggest that, after a disaster involving many children, a school-based cognitive-behavioral 10-session intervention by trained school-based mental health counselors significantly decreases future PTSD symptoms.
  • Other relaxation techniques, such as biofeedback, yoga, deep relaxation, self-hypnosis, or meditation, may be suitable in some children, but clinical evidence concerning their efficacy or use is unavailable.

Interventions with caregivers

Involving caregivers in treatment has been effective, particularly in reducing the child's comorbid depressive symptoms and improving the caregiver's own depressed mood, abuse-related distress, and ability to support the child. Caregivers and parents must be aware of the symptoms of PTSD, such as triggered memories, re-enactment, and hyperarousal symptoms (eg, sleep and appetite disruption, mood dysregulation, startle response). Caregivers should be instructed about the significance of these symptoms, which may warrant medical and psychological treatment.

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Consultations

Consider consultation with a therapist to establish cognitive behavior treatments.

A child psychiatrist may also be helpful and can provide assessment and pharmacologic management for PTSD, as well as comorbid psychiatric conditions.

Physical complications may require the attention of physicians who specialize in orthopedic injuries or burns, depending on the nature of the concern (see Burns, Thermal). These issues are described in corresponding sections of this pediatric journal.

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Diet

No restrictions are necessary in children with PTSD, unless clinically indicated.

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Activity

No restrictions are necessary in children with PTSD, unless clinically indicated.

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Contributor Information and Disclosures
Author

Angelo P Giardino, MD, PhD  Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc

Angelo P Giardino, MD, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect

Disclosure: Bayer Honoraria Review panel membership; Pfizer Grant/research funds Independent contractor; MedImmune Honoraria Review panel membership; Teva Pharmacutical travel & honoraria Managed Care Advisory Panel; CIGNA Honoraria Physician Advisory Council

Coauthor(s)

Toi Blakley Harris, MD  Assistant Professor and Director of Diversity and Education, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; Founder and Director, Texas Regional Psychiatry Minority Mentor Network

Toi Blakley Harris, MD, is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Eileen R Giardino, RN, MSN, PhD, FNP-BC, ANP-BC  Associate Professor of Nursing, Department of Acute and Continuing Care, University of Texas Health Sciences Center Houston School of Nursing

Eileen R Giardino, RN, MSN, PhD, FNP-BC, ANP-BC is a member of the following medical societies: American Academy of Nurse Practitioners, American College Health Association, American Nurses Association, American Professional Society on the Abuse of Children, and International Society for Prevention of Child Abuse and Neglect

Disclosure: Nothing to disclose.

Specialty Editor Board

Carol Diane Berkowitz, MD  Executive Vice Chair, Department of Pediatrics, Professor, Harbor-University of California at Los Angeles Medical Center

Carol Diane Berkowitz, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, American Pediatric Society, and North American Society for Pediatric and Adolescent Gynecology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH  Senior Child and Adolescent Psychiatrist, Sound Mental Health

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgments

The authors acknowledge the encouragement and support of Dr. John Sargent, who has taught us much and who has set a standard for us in terms of his being an excellent mentor and modeling for us the highest degree of professionalism as a colleague who works tirelessly to ameliorate the effects of child abuse and neglect among the children and families we serve.

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