Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: a randomized controlled trial

Abstract

Objective: To evaluate community-provided trauma-focused cognitive behavior therapy (TF-CBT) compared with usual community treatment for children with intimate partner violence (IPV)-related posttraumatic stress disorder (PTSD) symptoms.

Design: Randomized controlled trial conducted using blinded evaluators.

Setting: Recruitment, screening, and treatment were conducted at a community IPV center between September 1, 2004, and June 30, 2009.

Participants: Of 140 consecutively referred 7- to 14-year-old children, 124 participated.

Interventions: Children and mothers were randomly assigned to receive 8 sessions of TF-CBT or usual care (child-centered therapy).

Main outcome measures: Total child PTSD symptoms assessed using child and parent structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version [K-SADS-PL]) and self-report (University of California at Los Angeles PTSD Reaction Index [RI]). Secondary child outcomes were scores on the K-SADS-PL (PTSD symptom clusters), Screen for Child Anxiety Related Emotional Disorders (SCARED) (anxiety), Children's Depression Inventory (depression), Kaufman Brief Intelligence Test (cognitive functioning), and Child Behavior Checklist (total behavior problems).

Results: Intent-to-treat analysis using last observation carried forward showed superior outcomes for TF-CBT on the total K-SADS-PL (mean difference, 1.63; 95% confidence interval [CI], 0.44-2.82), RI (mean difference, 5.5; 95% CI, 1.37-9.63), K-SADS-PL hyperarousal (mean difference, 0.71; 95% CI, 0.22-1.20), K-SADS-PL avoidance (0.55; 0.07-1.03), and SCARED (mean difference, 5.13; 95% CI, 1.31-8.96). Multiple imputation analyses confirmed most of these findings. The TF-CBT completers experienced significantly greater PTSD diagnostic remission (χ(2) = 4.67, P = .03) and had significantly fewer serious adverse events.

Conclusions: Community TF-CBT effectively improves children's IPV-related PTSD and anxiety.

Trial registration: clinicaltrials.gov Identifier: NCT00183326.