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Approach to treating posttraumatic stress disorder in children and adolescents

Authors
David Brent, MD
Judith A Cohen, MD
Jeffrey Strawn, MD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD

INTRODUCTION

Posttraumatic stress disorder (PTSD) in children and adolescents is a severe, often chronic, and impairing mental disorder. PTSD is seen in some children (and not others) after exposure to traumatic experiences involving actual or threatened injury to themselves or others. Traumatic experiences leading to PTSD can include interpersonal violence, accidents, natural disasters, and injuries.

PTSD is characterized by intrusive thoughts and reminders of the traumatic experience(s), avoidance of trauma reminders, negative mood and cognitions related to the traumatic experience(s), and physiological hyperarousal that lead to significant social, school, and interpersonal problems. PTSD can occur even in toddlers (one to two years old) [1,2]. The consequences of PTSD include elevated risk for other mental disorders and suicide, substantial impairment in role functioning, reduced social and economic opportunity, and earlier onset of chronic diseases, particularly cardiovascular disease.

This topic describes our approach to selecting treatment, including psychosocial interventions and pharmacotherapy, for PTSD in children and adolescents. Psychosocial interventions for PTSD in children and pharmacotherapy for PTSD in children are reviewed separately. The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of PTSD in children are also reviewed separately. PTSD in adults is also reviewed separately. (See "Psychosocial interventions for posttraumatic stress disorder in children and adolescents" and "Pharmacotherapy for posttraumatic stress disorder in children and adolescents" and "Posttraumatic stress disorder in children and adolescents: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, assessment, and diagnosis" and "Psychotherapy for posttraumatic stress disorder in adults" and "Pharmacotherapy for posttraumatic stress disorder in adults".)

NEWLY DIAGNOSED PATIENTS

For most children and adolescents with posttraumatic stress disorder (PTSD) or prominent PTSD symptoms, including those with complex PTSD, we suggest first-line treatment with an evidence-based, trauma-focused psychotherapy rather than other psychosocial or medication treatments.

Multiple clinical trials have found trauma-focused psychotherapies to be efficacious in reducing PTSD symptoms in children and adolescents with the disorder [3-11]; in comparison, no medications for PTSD in this population are reliably supported by randomized clinical trial results. No medications have been approved by the US Food and Drug Administration for the treatment of PTSD in children. Serotonin reuptake inhibitors (SRIs), which are an efficacious, first-line pharmacologic treatment for adults with PTSD, have not been found to be efficacious in multiple small randomized trials in children. (See "Psychosocial interventions for posttraumatic stress disorder in children and adolescents", section on 'Trauma-focused psychotherapies' and "Pharmacotherapy for posttraumatic stress disorder in children and adolescents" and "Pharmacotherapy for posttraumatic stress disorder in adults".)

                   

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Literature review current through: Jul 2017. | This topic last updated: Apr 25, 2017.
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