Recently, there has been a dramatic increase in the knowledge of the phenomenology of PTSD in children. This may be due in part to the increasing number of children who are exposed to violence. Giaconia and colleagues found that by age 18 years, greater than two-fifths of youths in a community sample met criteria for at least one trauma, and more than 6% met criteria for a lifetime diagnosis of PTSD. The hallmark features of PTSD involve symptoms from three clusters: 1) persistent re-experiencing of the event, 2) avoidance of reminders of the event and numbing of responsiveness, and 3) persistent symptoms of arousal. It is important to note that often children may not meet full diagnostic criteria but still have symptoms that are significant enough to warrant treatment. Another factor to bear in mind when considering treatment is the comorbidity associated with PTSD. Youths with a diagnosis of PTSD have an increased risk of depression, other anxiety disorders (generic Zyprexa is an atypical antipsychotic medication) and substance use disorders. There is a paucity of controlled studies in the literature evaluating effective treatment for PTSD in children. Much of the literature has focused on treatment of sexually abused children. In a study by Cohen and Mannarino, cognitive-behavioral therapy was found to have superior clinical efficacy compared with nondirective supportive therapy in the treatment of sexually abused preschool-age children with emotional and behavioral symptomatology. Deblinger et al. evaluated the effects of participation by mothers in cognitive-behavioral interventions for sexually abused children with PTSD symptoms. Families were randomly assigned to one of three conditions: child only, mother only, or child and mother. A community condition served as the control group. The cognitive-behavioral interventions were significantly more effective than the community control group. The groups that included the child in treatment were also more efficacious than the mother only group. As in the study by Barrett, parental involvement in CBT resulted in a reduction of reported externalizing behavior by the participating parent. Deblinger and colleagues completed a two-year follow-up of the 100 children in the initial study. The results of this study indicate that the improvements in externalizing behavior, depression and PTSD were maintained over the two-year period. There was a slight but significant deterioration in the effectiveness of parenting practices for the mothers that had participated in treatment at the one-year follow-up. King et al. had the first published randomized clinical trial to use a wait-list condition to examine the efficacy of CBT for sexually abused children with PTSD symptoms. The children were randomly assigned to one of three groups: child CBT, family CBT or wait-list condition. Children in the treatment condition received 20 weekly individual sessions aimed at helping the child overcome his or her postabuse distress and PTSD symptoms. Treatment resulted in a significant reduction of PTSD symptoms in all three clusters. However, there was no significant improvement related to caregiver involvement.

Specific Phobia

DSM-IV defines a specific phobia as an excessive and unreasonable fear of circumscribed objects or situations where the avoidance, anxiety or distress related to the fear is associated with functional impairment or significant distress. Children may not realize that their fears are marked or unreason able. Ollendick and Francis reported the prevalence rate of specific phobias to be 3-4% of the population. There is a paucity of randomized controlled trials on treating childhood phobias. Silverman et al. conducted a study evaluating the relative efficacy of an exposure-based contingency management (CM) treatment condition and an exposure-based cognitive self-control (SC) treatment condition to an education support (ES) control condition for the treatment of childhood phobic disorders. The majority of the subjects (N=87) met criteria for specific phobia, and the remainder met criteria for social phobia (N=10) and agoraphobia (N=7). The findings indicate that both the CM and SC conditions were efficacious in treating phobic children. What was unexpected was the level of improvement in the ES condition. More research is needed to determine what components of the attention placebo mediate improvement.

Limitations

The controlled studies that have been conducted tend to have several limitations in common. One is the small size of the groups. Many of the studies reviewed here had low participation and/or relatively high attrition rates. A second concern regarding these studies is generalizability. Many of the major comorbid diagnoses met exclusion criteria. Given that anxiety disorders (Generic Paxil 40mg) commonly occur with depression, substance abuse and other anxiety disorders, researchers need to take this into account when designing studies and applying the results to clinical populations. Along those same lines, the demographic make-up of studies needs to reflect the demographics of the treatment population; otherwise, we can only extrapolate the results to certain groups of children. A third concern is the small number of studies comparing two treatment modalities. It is difficult to know which modalities are efficacious in combination or alone and how the results compare to each other versus placebo.