Behavior Management in Young Children Exposed to Trauma: A Case Study of Three Evidence-Based Treatments.

Young children are particularly vulnerable to traumatic events and the development of posttraumatic stress symptoms, including comorbid disruptive behaviors. Fortunately, several evidence-based interventions have been shown to be effective at decreasing both posttraumatic stress symptoms and disruptive behaviors in young children. This paper provides an overview of three such interventions-Child-Parent Psychotherapy (CPP), Parent-Child Interaction Therapy (PCIT), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). An illustrative case study is used to compare how each intervention addresses disruptive behaviors, with a focus on theoretical underpinnings, model similarities, and model differences. The models each have empirical evidence for the treatment of disruptive behavior in young children, and therefore, may be appropriate for treating children with a history of trauma exposure and comorbid disruptive behaviors. Child, caregiver, and environmental factors are essential to consider when identifying an evidence-based intervention for this population.

Sleep as a Moderator of Young Children's Traumatic Stress and Behavior Problems: a Treatment-Referred Sample.

Empirical evidence suggests young children who have experienced trauma are at risk of developing sleep problems and behavior difficulties, but it is unclear of the specific relation between these behavioral health concerns. The primary purpose of the study is to determine whether sleep problems moderate the relation between traumatic stress and behavior problems in a sample of young children referred for treatment. A secondary purpose is to explore if sleep problems also moderate the relation between specific domains of traumatic stress (i.e., intrusion, avoidance, arousal) and behavior problems. Data from 170 preschoolers ages 3 through 5 referred for treatment were gathered at intake and utilized in this study. Results indicate sleep problems moderate the effect of overall traumatic stress on behavior problems. This statistical finding also was found with intrusive symptoms, and the moderation analyses approached significance with avoidance and arousal. Our findings highlight the importance for clinicians to assess for sleep problems when young children who have experienced trauma are referred to them for treatment, particularly if a low level of overall traumatic stress is present.

Treatments for Early Childhood Trauma: Decision Considerations for Clinicians.

The period from birth to age six represents a time of significant risk for exposure to trauma. Following trauma exposure, children may experience significant negative and lasting psychological, cognitive, and physical effects. Over the last two decades, the demand for and availability of evidence-based treatments (EBTs) for children under the age of six who have experienced trauma has dramatically increased. Three of the most well-supported and widely disseminated EBTs for early childhood trauma are Trauma-Focused Cognitive Behavioral Therapy, Parent-Child Interaction Therapy, and Child-Parent Psychotherapy. Increasingly, clinicians are receiving training in more than one EBT. This paper provides an overview of each intervention; presents clinicians with various child, caregiver, and environmental factors to consider when deciding amongst these three EBTs; and applies these considerations to three composite cases.

A PRELIMINARY EVALUATION OF THE MANAGING YOUTH TRAUMA EFFECTIVELY PROGRAM FOR SUBSTANCE-ABUSING WOMEN AND THEIR CHILDREN.

This article provides a description of the development, implementation, and preliminary evaluation of feasibility and acceptability of the Managing Youth Trauma Effectively (MYTE) program and highlights perceptions of changes in mothers' trauma-informed parenting practices. The program consists of a training and consultation program for staff of the U.S. State of Arkansas' Specialized Women's Programs (SWS), and an 8-week, group psychoeducational program designed to help mothers with substance-abuse problems learn how traumatic experiences may affect their children and how they may help support their children by creating a safe and nurturing environment. A posttraining evaluation with leadership and staff at SWS centers, feedback provided on consultation calls with MYTE facilitators, and a retrospective pre/post survey were used to examine feasibility, acceptability, and perceptions of changes in mothers' trauma-informed parenting practices. Preliminary results suggest that the MYTE program is feasible to implement and is acceptable to training participants, facilitators, and mothers participating in the program. Mothers reported significant growth in their perceptions of use of trauma-informed parenting practices. Future research is necessary to confirm these results and examine the effectiveness of the program using a randomized clinical trial.

Implementing trauma-focused CBT with fidelity and flexibility: a family case study.

Effective approaches for the treatment of childhood posttraumatic stress disorder and traumatic grief are needed given the prevalence of trauma and its impact on children's lives. To effectively treat posttraumatic stress disorder in children, evidence-based practices should be implemented with flexibility and responsiveness to culture, developmental level, and the specific needs of the family. This case study illustrates flexibility with fidelity in the use of a manualized treatment, describing the implementation of Trauma Focused-Cognitive Behavior Therapy with three traumatized family members-a caregiver and two children. Particular attention is paid to the use of creative strategies to tailor interventions to the individual clients while maintaining fidelity to the principles and components of this evidence-based treatment.

Posttraumatic stress as a mediator of the relationship between trauma and mental health problems among juvenile delinquents.

This study investigated the interrelationships among trauma exposure, PTSD, and mental health problems in a sample of 289 adolescents (199 male, 90 female) detained in a juvenile correctional facility. Mean differences were found in that females scored higher than males on measures of interpersonal trauma exposure and symptoms of both simple and complex PTSD. Females also endorsed more mental health problems in the areas of depression/anxiety, somatic complaints, and suicidal ideation. For all youth, trauma exposure, PTSD, and mental health problems were correlated. Results of structural equation modeling were consistent with the hypothesis that PTSD mediates the relationship between interpersonal trauma and mental health problems for all youth, although the results were stronger for females.