Trauma Intervention Bibliography (under construction)

Winter 2005 Graduate Seminar
Jennifer J. Freyd & Pamela Birrell
University of Oregon

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Weekly Topics

Focus books for the course:

Bloom, Sandra. (1997) Creating Sanctuary: toward the evolution of sane societies. Routledge.

Brewin, Chris (2003) Post-traumatic stress disorder: malady or myth? Yale University Press.

Recommended books for this course and your personal library:

Herman, J.L. (1997). Trauma and recovery. Basic Books.

Wison, J.P. & Keane, T.M. (Eds) (2004) Assessing Psychological Trauma and PTSD, Second Edition. Guilford.

Some other books and readings include:

Birrell, P.J. & Freyd, J.J. (in press) Betrayal Trauma: Relational Models of Harm and Healing. Journal of Trauma Practice.

Burstow, B. (2003) Toward a radical understanding of trauma and trauma work. Violence Against Women, 9, 1293-1317.

Cohen JA, Deblinger E, Mannarino AP, Steer R (2004), A multi-site randomized controlled trial for multiply traumatized children with sexual abuse-related PTSD. J Am Acad Child Adolesc Psychiatry 43(4):393-402.

Cohen J, Mannarino AP (1996a), A treatment outcome study for sexually abused preschool children: initial findings. J Am Acad Child Adolesc Psychiatry 35(1):42-50.

Cohen JA, Mannarino AP (1996b), Factors that mediate treatment outcome of sexually abused preschool children. J Am Acad Child Adolesc Psychiatry 35(10):1402-1410.

Cohen JA, Mannarino AP (1997), A treatment study for sexually abused preschool children: outcome during a one-year follow-up. J Am Acad Child Adolesc Psychiatry 36(9):1228-1235.

Cohen JA, Mannarino AP (1998a), Factors that mediate treatment outcome of sexually abused preschool children: six- and 12-month follow-up. J Am Acad Child Adolesc Psychiatry 37(1):44-51.

Cohen JA, Mannarino AP (1998b), Interventions for sexually abused children: initial treatment findings. Child Maltreat 3(1):17-26.

Cohen JA, Mannarino AP (2000), Predictors of treatment outcome in sexually abused children. Child Abuse Negl 24(7):983-994.

Cohen JA, Mannarino AP, Deblinger E (2001), Child and Parent Trauma-Focused Cognitive Behavioral Therapy Treatment Manual. Philadelphia: Drexel University College of Medicine (available from authors).

Cohen JA, Mannarino AP, Knudsen K (in press b), Treating sexually abused children: One year follow-up of a randomized controlled trial. Child Abuse Negl.

Deblinger E, Heflin AH (1996), Treating Sexually Abused Children and Their Nonoffending Parents: A Cognitive Behavioral Approach. Thousand Oaks, Calif.: Sage Publications.

Deblinger E, Lippmann J, Steer R (1996), Sexually abused children suffering posttraumatic stress symptoms: initial treatment outcome findings. Child Maltreat 1:310-321.

Deblinger E, Stauffer LB, Steer RA (2001), Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreat 6(4):332-343.

Deblinger E, Steer R, Lippman J (1999), Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms. Child Abuse Negl 23(12):1371-1378.

Downing J, Jenkins SJ, Fisher GL (1988), A comparison of psychodynamic and reinforcement treatment with sexually abused children. Elementary School Guidance and Counseling 22:291-298.

King NJ, Tonge BJ, Mullen P et al. (2000), Treating sexually abused children with posttraumatic stress symptoms: a randomized clinical trial. J Am Acad Child Adolesc Psychiatry 39(11):1347-1355 [see comment].

Trowell J, Kolvin I, Weeramanthri T et al. (2002), Psychotherapy for sexually abused girls: psychopathological outcome findings and patterns of change. [Published erratum Br J Psychiatry 180:553.] Br J Psychiatry 180:234-247.

From Rose:

V. Sinason (2002) (Ed.), Attachment, Trauma, and Multiplicity: Working with Dissociative Identity Disorder. New York: Taylor & Francis.

Maldonado, J. R., Butler, L. D., & Spiegel, D. (1998). Treatments for dissociative disorders. In P. E. Nathan & J. M. Gordon (Eds.), A Guide to treatments that work (pp. 423-446). New York: Oxford University Press.

Trauma and Sexuality: The Effects of Childhood Sexual, Physical, and Emotional Abuse on Sexual Identity and Behavior by James A., MD Chu, Elizabeth S., Md. Bowman (http://tinyurl.com/3u8fk)

Rebuilding Shattered Lives : The Responsible Treatment of Complex Post-Traumatic and Dissociative Disorders by James A. Chu (http://tinyurl.com/3se9m)

Subversive Dialogues: Theory In Feminist Therapy by Laura Brown

Child Abuse Trauma: Theory and Treatment of the Lasting Effects (Interpersonal Violence:The Practice Series) by John Briere

Miller, D. (1996) Challenging self-harm through transformation of the trauma story. Sexual Addiction & Compulsivity. Vol 3(3) 1996, 213-227.

• Abstract (from the journal abstract) Self-injuring behavior in teenagers and adults is highly correlated with histories of childhood trauma. These symptoms, including self-mutilation, eating disorders, substance abuse, excessive cosmetic surgeries, and compulsive exposure to danger, can be understood as physical and psychological reenactments of trauma-based relationships with the abuser(s) and the nonprotecting bystanders. Using an integrated three-stage treatment model, Trauma Reenactment Syndrome (TRS) can be approached through a narrative focus on the logic and relational functions of the self-harming behavior. Assessment and treatment guidelines are described.

Peters, L.G. (1994). Rites of passage and the borderline syndrome: Perspectives in transpersonal anthropology. Anthropology of Consciousness, 5(1), 1-15.

From Lisa:

Treating Sexually Abused Children and Their Nonoffending Parents : A Cognitive Behavioral Approach (Interpersonal Violence: The Practice Series) by Esther Deblinger, Anne Hope Heflin

Friedrich, W. N. (2002). Psychological assessment of sexually abused children and their families. Thousand Oaks, CA: Sage Publications.

Bisson, J. I. (2003). Single-session early psychological interventions following traumatic events. Clinical Psychology Review, 23(3), 481-499.

Bisson, J.I., McFarlane, A.C., & Rose, S. (2000). Psychological debriefing. In E.B. Foa, T.M. Keane, & M.J. Friedman (Eds.), Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. (pp. 317-320). New York: Guilford Press.

Abney, V.D. (2002). Cultural competency in the field of child maltreatment. In J.E.B. Myers, L. Berliner, J. Briere, C.T. Hendrix, C. Jenny, & T. A. Reid (Eds.), The American Professional Society on the Abuse of Children handbook on child maltreatment (2nd ed.), (pp. 477-486). Thousand Oaks, CA: Sage Publications.

Kolko's stuff might round out the Cohen readings a bit. I haven't read this book since prelims. From what I recall, it was useful and easy to read...nothing incredibly new for me, but perhaps helpful for other clinical folks. This from my prelim list:

Kolko, D.J., & Swenson, C.C. (2002). A comprehensive individual and family cognitive-behavioral therapy model. In D.J. Kolko & C.C. Swenson, Assessing and treating physically abused children and their families (pp. 76-91). Thousand Oaks, CA: Sage Publications, Inc.

Kolko, D.J., & Swenson, C.C. (2002). Initial treatment considerations. In D.J. Kolko & C.C. Swenson, Assessing and treating physically abused children and their families (pp. 92-119). Thousand Oaks,
CA: Sage Publications, Inc.

Kolko, D.J., & Swenson, C.C. (2002). Promoting children's effective coping and social competence. In D.J. Kolko & C.C. Swenson, Assessing and treating physically abused children and their families (pp. 172-196). Thousand Oaks, CA: Sage Publications, Inc.

Kolko, D.J., & Swenson, C.C. (2002). Treatment outcome studies:Clinical and research implications. In D.J. Kolko & C.C. Swenson, Assessing and treating physically abused children and their families (pp. 34-52). Thousand Oaks, CA: Sage Publications, Inc.

From Carolyn:

Bolen, R. M. (2003). "Child sexual abuse: Prevention or promotion?" Social Work, 48(2), 174-185.

• Current child sexual abuse prevention programs assume that, by targeting potential victims, they can reduce the prevalence of child sexual abuse. This article presents findings, however, that suggest this assumption is flawed. First, recent studies indicate that the prevalence of abuse has not decreased over the history of prevention programs. Second, because of the pervasiveness of the threat of child sexual abuse, it is doubtful that prevention programs can adequately prepare children for the diversity of approaches by potential offenders. It is suggested instead that potential offenders are more appropriate targets of prevention programs. Because a large portion of abuse appears to be related to socialized relational patterns gone awry, it is suggested that a more efficacious method of prevention is a school-based program that promotes healthy relationship patterns. The article compares the existing victim-based paradigm with the proposed potential healthy relationships paradigms along four domains: underlying assumptions, orientation, method, and goals.

Bryant, R. A. (2000). Cognitive behavioral therapy of violence-related posttraumatic stress disorder. Aggression & Violent Behavior, 5(1), 79-97.

• Posttraumatic stress disorder (PTSD) represents the most common psychiatric condition following exposure to violence. Although an increasing number of cognitive behavioral therapy (CBT) studies point to efficacy of this approach in ameliorating PTSD following violence, the methodological rigor of many studies has not been optimal. Further, a significant proportion of traumatized individuals does not benefit from CBT. This article reviews CBT outcome studies, discusses the methodological limitations of CBT studies for PTSD, and offers suggestions for future research. This review highlights the need for more systematic studies of components of CBT with a range of trauma populations to delineate the parameters of effective CBT for individuals with PTSD.

Bryant, R. A., Moulds, M. L., & Nixon, R. V. D. (2003). Cognitive behaviour therapy of acute stress disorder: a four year follow-up. Behaviour Research and Therapy, 41, 489-494.

• The aim of this study was to index the long-term benefits of early provision of cognitive behavior therapy to trauma survivors with acute stress disorder. Civilian trauma survivors (n = ?80) with acute stress disorder were randomly allocated to either cognitive behavior therapy (CBT) or supportive counseling (SC) - 69 completed treatment, and 41 were assessed four years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician Administered PTSD Scale. Two CBT patients (8%) and four SC patients (25%) met PTSD criteria at four-year follow-up. Patients who received CBT reported less intense PTSD symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. These findings suggest that early provision of CBT in the initial month after trauma has long-term benefits for people who are at risk of developing PTSD.

Ehlers, A., Clark, D. M. (2003). Early psychological interventions for adult survivors of trauma: A review. Biological Psychiatry, 53(9), 817-826.

• Psychological interventions after traumatic events have only recently been evaluated in randomized, controlled trials. Recent systematic reviews concluded that single sessions of individual psychological debriefing are not effective in reducing distress or subsequent posttraumatic stress disorder (PTSD) symptoms. The present article reviews trials of early cognitive behavior therapy (CBT) after trauma. Cognitive behavioral therapy was more effective than supportive counseling in preventing chronicity of PTSD symptoms; however, in most available studies it remained unclear whether supportive counseling facilitated or retarded recovery, compared with no intervention. A brief CBT program given in the first month of trauma was not superior to repeated assessment; however, a course of CBT of up to 16 sessions given at 1-4 months after trauma was superior to self-help, repeated assessment, and no intervention. Possible reasons for the difference in efficacy between CBT and debriefing or self-help are discussed. These include the way of working through traumatic memories and the impact of the interventions on patients' interpretations of their PTSD symptoms.

Foa, E. B. (2000). Psychosocial treatment of posttraumatic stress disorder. Journal of Clinical Psychiatry, 61(Suppl 5), 43-51.

• Reviews empirically validated psychosocial treatments for posttraumatic stress disorder (PTSD) and considers factors associated with successful therapy outcome. Most of the treatments whose efficacy was studied empirically fall within the broad category of cognitive-behavioral therapy. These include exposure therapy, anxiety management programs, and cognitive therapy. These therapy modalities have been developed to modify conditioned fear and erroneous cognitions that are thought to underlie PTSD. Exposure therapy has the most empirical support because it was found to be effective across different populations of trauma victims with PTSD. Combinations of therapies have also been used, and the value of these is discussed. In addition, this article presents recent evidence about the efficacy of eye movement and desensitization reprocessing. A growing body of evidence supports the use of psychosocial treatments for PTSD, but not all patients benefit. Future research should develop programs that increase the motivation of patients to take advantage of these efficacious treatments. A roundtable discussion follows.

Foa, E. B., Davidson, J. R. T., Frances, A., Culpepper, L., Ross, R., Ross, D. (Eds.). The expert consensus guideline series: Treatment of posttraumatic stress disorder. Journal of Clinical Psychiatry, 60(Suppl 16), 4-76.

• Presents expert consensus guideline recommendations for the treatment of posttraumatic stress disorder (PTSD) based on the survey responses of 52 experts on the psychotherapy treatment and 57 experts in the medication treatment of PTSD. The guidelines are organized so that clinicians can quickly locate the experts' treatment recommendations. The recommendations are presented in 11 easy-to-use tabular guidelines that are organized into four sections: (1) diagnosis, (2) selecting initial treatment strategies, (3) what to do after the initial trials, and (4) other treatment issues. A primary care treatment guide summarizing the key recommendations in an easy-to-use format for primary care practitioners is also included. Finally, a patient-family educational handout that can be reproduced for distribution to families and patients is provided.

Foa, E. B., Hearst-Ikeda, D., Perry, K. J. (1995). Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. Journal of Consulting & Clinical Psychology, 63(6), 948-955.

• The efficacy of a brief prevention program (BP) aimed at arresting the development of chronic posttraumatic stress disorder (PTSD) was examined with 10 recent female victims of sexual and nonsexual assault who received 4 sessions of a cognitive-behavioral program shortly after the assault. Their PTSD and depression severity was compared with that of 10 matched recent female assault victims who received repeated assessments of their trauma-related psychopathology (assessment control; AC). The BP program consisted of education about common reactions to assault and cognitive-behavioral procedures. Two months postassault, victims who received the BP program had significantly less severe PTSD symptoms than victims in the control condition; 10% of the former group met criteria for PTSD versus 70% of the latter group. Five and a half months postassault, victims in the BP group were significantly less depressed than victims in the AC group and had significantly less severe reexperiencing symptoms.

Geeraert, L., Van den Noortgate, W., Grietens, H., & Onghena, P. (2004). The Effects of Early Prevention Programs for Families With Young Children At Risk for Physical Child Abuse and Neglect: A Meta-Analysis. Child Maltreatment, 9(3), 277-291.

• In this article, a meta-analysis is presented on 40 evaluation studies of early prevention programs for families with young children at risk for physical child abuse and neglect with mostly nonrandomized designs. The main aim of all programs was to prevent physical child abuse and neglect by providing early family support. For the meta-analysis, a multilevel approach was used. A significant overall positive effect was found, pointing to the potential usefulness of these programs. The study demonstrated a significant decrease in the manifestation of abusive and neglectful acts and a significant risk reduction in factors such as child functioning, parent-child interaction, parent functioning, family functioning, and context characteristics.

Gershater-Molko, R. M., J. R. Lutzker, et al. (2003). Project SafeCare: Improving health, safety, and parenting skills in families reported for, and at-risk for child maltreatment. Journal of Family Violence, 18(6), 377-386.

• Project SafeCare was a 4-year, in-home, research and intervention program that provided parent training to families of children at-risk for maltreatment, and families of children who were victims of maltreatment. Parents were trained in treating children's illnesses and maximizing their own healthcare skills (Health), positive and effective parent-child interaction skills (Parenting), and maintaining low hazard homes (Safety). The effectiveness of these training components was evaluated as the change in the parents' scores on roleplay situations for child health problems, hazards present in the home, and the frequency and quality of parent-child interactions during activities of daily living. Statistically significant improvements were seen in child health care, home safety, and parent-child interactions.

Guterman, N. B.(1999). Enrollment strategies in early home visitation to prevent physical child abuse and neglect and the "Universal versus targeted" debate: A meta-analysis of population-based and screening-based programs. Child Abuse & Neglect, 23(9), 863-890.

• Conducted a meta-analysis to examine enrollment approaches in early home visitation studies and their reported outcomes. Quantitative meta-analytic techniques were used to compare effect sizes from 19 controlled outcome studies across screening-based (SB) and population-based (PB) enrollment strategies. Effect sizes were calculated on protective services data and on child maltreatment related measures of parenting. On protective services report data, PB studies reported a weighted mean effect size attributable to early home visitation of +3.72%, in comparison to -0.07% for SB studies. On child maltreatment related measures of parenting, PB studies reported a weighted mean effect size (r) attributable to early home visitation of +0.092 vs +0.020 for SB studies. PB enrollment strategies appear favorable to SB ones in early home visitation programs seeking to prevent physical child abuse and neglect.

Hembree, E. A., Street, G. P., Riggs, D. S., & Foa, E. B. (2004). Do Assault-Related Variables Predict Response to Cognitive Behavioral Treatment for PTSD? Journal of Consulting and Clinical Psychology, 72(3), 531-534.

• This study examined the hypothesis that variables such as history of prior trauma, assault severity, and type of assault, previously found to be associated with natural recovery, would also predict treatment outcome. Trauma-related variables were examined as predictors of posttreatment posttraumatic stress disorder (PTSD) severity in a sample of 73 female assault victims with chronic PTSD who completed treatment in a comparative outcome study (E. B. Foa et al., 1999). Results indicated that after controlling for initial severity of PTSD symptoms, the experience of trauma in childhood and sustaining physical injury during the adult assault were predictive of greater PTSD severity following treatment.

Litz, B. T., Gray, M. J., Bryant, R. A., Adler, A. B. (2002). Early intervention for trauma: Current status and future directions. Clinical Psychology: Science & Practice, 9(2), 112-134.

• Notes that although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, it is proposed that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.

Renk, K., Liljequist, L., Steinberg, A., Bosco, G., Phares, V. (2002). Prevention of child sexual abuse: Are we doing enough? Trauma Violence & Abuse, 3(1), 68-84.

• In response to an increase in public awareness and interest in the problem of child sexual abuse, programs have been developed to promote the awareness, prevention, and treatment of sexual abuse. These programs have been varied in scope, focus, and effectiveness. This article reviews the child sexual abuse literature, with particular emphasis on efforts aimed at the prevention of child sexual abuse. Prevention efforts targeting potential victims as well as parents, teachers, and offenders, are reviewed and evaluated. Overall, there is not enough adequate work being done to prevent child sexual abuse. More efforts need to address child sexual abuse prevention by targeting adults who can help children avoid such an experience and adults who may perpetrate against children. Suggestions about future preventive endeavors, based on this review, are offered.

Resick, P. A., Nishith, P., & Griffin, M. G. (2003). How well does cognitive-behavioral therapy treat symptoms of complex PTSD? An examination of child sexual abuse survivors within a clinical trial. CNS Spectrums, 8(5), 342-351.

• Are brief cognitive-behavioral treatments for posttraumatic stress disorder (PTSD) also effective for the wider range of symptoms conceptualized as complex PTSD? Female rape victims, most of whom had extensive histories of trauma, were randomly assigned to cognitive-processing therapy, prolonged exposure, or a delayed-treatment waiting- list condition. After determining that both types of treatment were equally effective for treating complex PTSD symptoms, we divided the sample of 121 participants into two groups depending upon whether they had a history of child sexual abuse. Both groups improved significantly over the course of treatment with regard to PTSD, depression, and the symptoms of complex PTSD as measured by the Trauma Symptom Inventory. Improvements were maintained for at least 9 months. Although there were group main effects on the Self and Trauma factors, there were no differences between the two groups at posttreatment once pretreatment scores were covaried. These findings indicate that cognitive-behavioral therapies are effective for patients with complex trauma histories and symptoms patterns.

Ross, G., & O'Carroll, P. (2004). Cognitive behavioural psychotherapy intervention in childhood sexual Abuse: Identifying new directions from the literature. Child Abuse Review, 13(1), 51-64.

• The short- and long-term consequences of childhood sexual abuse have been extensively reported. However, for many years there has been an absence of psychological conceptual frameworks for understanding and treating abuse trauma symptoms. This paper reviews a number of outcome studies for the treatment of child sexual abuse where a post-traumatic stress disorder (PTSD) conceptualization was used to plan treatment interventions. The paper concludes that, contrary to some concerns expressed by clinicians, sexually abused children and their non-abusing carers can significantly benefit from cognitive behavioral interventions which use reliving and confrontation of the abusive experience. Notwithstanding this, there is a need for further controlled outcome research of cognitive behavioral interventions using reliving techniques to explore how and why these interventions help in reducing abuse-related PTSD symptoms.

Sabol, W. J., C. J. Coulton, et al. (2004). Building community capacity for violence prevention. Journal of Interpersonal Violence, 19(3), 322-340.

• The capacity of communities to prevent violence is examined from three perspectives: youth violence, child maltreatment, and intimate partner violence. The analysis suggests that community social control and collective efficacy are significant protective factors for all three types of violence, but these need to be further distinguished for their relationships to private, parochial, and state controls. It is argued that strong interpersonal ties are not the only contributor to collective efficacy and violence prevention. Weak ties, including those outside the community, and organizational ties are also seen as necessary. Violence prevention programs should be structured in ways that contribute to the communities' own capacity to prevent violence.

Saunders, B. E., Berliner, L., & Hanson, R.F. (Eds.). (2004). Child Physical and Sexual Abuse: Guidelines for Treatment (Revised Report: April 26, 2004). Charleston, SC:, National Crime Victims Research and Treatment Center. (see http://www.musc.edu/cvc/guidelinesfinal.pdf)

• Solomon, S. D. and D. M. Johnson (2002). Psychosocial treatment of posttraumatic stress disorder: A practice-friendly review of outcome research. Journal of Clinical Psychology, 58(8), 947-959.
  A review of the treatment research indicates that several forms of therapy appear to be useful in reducing the symptoms of posttraumatic stress disorder (PTSD). Strongest support is found for the treatments that combine cognitive and behavioral techniques. Hypnosis, psychodynamic, anxiety management, and group therapies also may produce short-term symptom reduction. Still unknown is whether any approach produces lasting effects. Imaginal exposure to trauma memories and hypnosis are techniques most likely to affect the intrusive symptoms of PTSD, while cognitive and psychodynamic approaches may address better the numbing and avoidance symptoms. Treatment should be tailored to the severity and type of presenting PTSD symptoms, to the type of trauma experience, and to the many likely comorbid diagnoses and adjustment problems.

Stauffer, L. B., Deblinger, E. (1996). Cognitive behavioral groups for nonoffending mothers and their young sexually abused children: A preliminary treatment outcome study. Child Maltreatment, 1(1), 65-76.

• The purpose of the current study was to evaluate the effectiveness of concurrent 11 wk cognitive behavioral groups for 19 nonoffending mothers (aged 23-65 yrs) and their young sexually abused children (aged 2-6 yrs). Evaluation included standardized assessment of maternal distress levels and maternal reports of children's behavioral functioning at initial contact, pretreatment, posttreatment, and 3 mo follow-up. Results of this preliminary treatment outcome study suggest that these cognitive behavioral group interventions may be effective in decreasing symptomatology exhibited by young sexually abused children and their nonoffending mothers. In addition, the parent intervention appeared to be effective in assisting nonoffending mothers to improve their self-reported parenting practices. The improvements achieved during treatment were maintained at 3 mo follow-up, and were a function of group participation.

Taylor, T. L., Chemtob, C. M. (2004). Efficacy of treatment for child and adolescent traumatic stress. Archives of Pediatrics and Adolescent Medicine, 158, 786-791

• Background: Despite the expenditure of large sums of public monies to ameliorate the consequences of childhood trauma, little is known about the efficacy of treatment for traumatized children and their families. Objective: To review the efficacy of treatment for child and adolescent traumatic stress. Data Sources: An extensive literature search identified 102 studies addressing child and adolescent trauma treatment. Study Selection: Only 8 studies met the minimal inclusion criteria of (1) using a comparison group and (2) including symptoms of traumatic stress as a treatment outcome. Data Extraction: These studies are critically evaluated for adherence to standards of good efficacy research using formal criteria of treatment research quality. Data Synthesis: Treatment for traumatic stress appears to lead to greater improvement than either no treatment or routine community care. Conclusions: Child and adolescent posttraumatic stress disorder treatment research lags behind both adult posttraumatic stress disorder treatment research and other child treatment research. There is considerable need to establish a programmatic approach to developing evidence- based child trauma treatment. Barriers to conducting child trauma treatment research include sensitivity to the rights of victims and child service models that perceive research as intruding on vulnerable children at critically sensitive points in their development.

Wheatley, M., J. Plant, et al. (2004). Clozapine treatment of adolescents with posttraumatic stress disorder and psychotic symptoms. Journal of Clinical Psychopharmacology, 24(2), 167-173.

• This study investigates the efficacy of clozapine in treatment-resistant abused adolescents detained in a secure environment who present with chronic posttraumatic stress disorder and psychotic symptoms. All participants had received at least 2 trials of conventional neuroleptic medication prior to starting clozapine. Efficacy was assessed by using single case methodology across 6 participants employing predependent and postdependent measures of psychiatric symptoms and behavioral observations. Subjective self-reports were also sought after treatment had been established. Evaluation of the data suggests that 4 of the participants demonstrated substantial improvements in psychiatric symptoms and behavioral presentation once a therapeutic dose of clozapine had been achieved. Questionnaire responses from 5 participants indicated that clozapine treatment was associated with a reduction in hallucinatory experiences. The most troubling side effects were those of excessive salivation, dizziness, and weight gain. These findings indicate that clozapine may be effective in decreasing psychiatric symptoms and risk behaviors in traumatized adolescents presenting with psychotic symptoms.

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