Js. March et al., COGNITIVE-BEHAVIORAL PSYCHOTHERAPY FOR CHILDREN AND ADOLESCENTS WITH POSTTRAUMATIC-STRESS-DISORDER AFTER A SINGLE-INCIDENT STRESSOR, Journal of the American Academy of Child and Adolescent Psychiatry, 37(6), 1998, pp. 585-593
Objective: To test the efficacy of a group-administered cognitive-beha
vioral psychotherapy (CBT) protocol for pediatric posttraumatic stress
disorder (PTSD) after a single-incident stressor. Method: After a sch
ool-wide selection-to-treatment procedure conducted in two elementary
and two junior high schools, children and adolescents with DSM-IV PTSD
by structured interview were entered into an 18-week, group-administe
red CBT protocol using a single case across time and setting experimen
tal design. Assessments of PTSD, anxiety, depression, trait anger, loc
us of control, and disruptive behavior were conducted at baseline, pos
ttreatment, and at 6-month follow-up. Results: Experimental control ac
ross time (staggered start date) and setting (school and age) was demo
nstrated. Fourteen of 17 subjects completed treatment. Of these, 8 (57
%) no longer met DSM-IV criteria for PTSD immediately after treatment;
12 (86%) of 14 were free of PTSD at 6-month follow-up. On intent-to-t
reat analyses, treatment produced a robust beneficial effect posttreat
ment on the Clinician-Administered PTSD Scale-Child and Adolescent Ver
sion, with additional improvement accruing at followup (p <.001). Impr
ovements of a similar magnitude were seen for depression (p <.001), an
xiety (p <.001), and anger (p <.005). Locus of control remained extern
al from pre-to posttreatment but became strongly internal at follow-up
(p < .001). Conclusion: More clinical trials are required to confirm
that CBT is a safe, acceptable, and effective treatment for PTSD in ch
ildren and adolescents.