Predictors and moderators of treatment outcome for single incident paediatric PTSD: a multi-centre randomized clinical trial

Oct 8, 2021European journal of psychotraumatology

Factors that influence treatment results for children with PTSD after a single traumatic event in a multi-center clinical trial

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Abstract

Youth with an index trauma of sexual abuse and severe symptoms showed poorer outcomes in both and Cognitive Behavioural Writing Therapy.

Youth with severe PTSD symptoms, anxiety, and negative posttraumatic beliefs had worse treatment outcomes.
Parental psychopathology was associated with poorer outcomes for youth in both treatment groups.
Children with more severe self-reported PTSD symptoms improved more with EMDR than with Cognitive Behavioural Writing Therapy.
The opposite trend was observed for children and parents with a less severe clinical profile.
The effects of these variables were time-limited, suggesting a focus on broad implementation of treatments.

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BACKGROUND: With few RCTs having compared active treatments for paediatric , little is known about whether or which baseline (i.e. pre-randomization) variables predict or moderate outcomes in the evaluated treatments.

OBJECTIVE: To identify predictors and moderators of paediatric PTSD outcomes for Eye Movement Desensitization and Reprocessing Therapy () and Cognitive Behavioural Writing Therapy ().

METHOD: Data were obtained as part of a multi-centre, randomized controlled trial of up to six sessions (up to 45 minutes each) of either EMDR therapy, CBWT, or wait-list, involving 101 youth (aged 8-18 years) with a PTSD diagnosis (full/subthreshold) tied to a single event. The predictive and moderating effects of the child's baseline sociodemographic and clinical characteristics, and parent's psychopathology were evaluated using linear mixed models (LMM) from pre- to post-treatment and from pre- to 3- and 12-month follow-ups.

RESULTS: At post-treatment and 3-month follow-up, youth with an index trauma of sexual abuse, severe symptoms of PTSD, anxiety, depression, more comorbid disorders, negative posttraumatic beliefs, and with a parent with more severe psychopathology fared worse in both treatments. For children with more severe self-reported PTSD symptoms at baseline, the (exploratory) moderator analysis showed that the EMDR group improved more than the CBWT group, with the opposite being true for children and parents with a less severe clinical profile.

CONCLUSIONS: The most consistent finding from the predictor analyses was that parental symptomatology predicted poorer outcomes, suggesting that parents should be assessed, supported and referred for their own treatment where indicated. The effect of the significant moderator variables was time-limited, and given the large response rate (>90%) and brevity (<4 hours) of both treatments, the present findings suggest a focus on implementation and dissemination, rather than tailoring, of evidence-based trauma-focused treatments for paediatric PTSD tied to a single event.

Key numbers

>90%

Improvement Rate

Percentage of youth achieving remission post-treatment in both therapies.

13.6 years

Participant Age

Mean age of youth participants in the study.

28% physical abuse, 26% sexual abuse

Trauma Type Distribution

Distribution of trauma types among participants.

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Abstract

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