Experts unclear how to help children who experience trauma

Melissa Makris, the mother of a fourth grade student at the Connecticut elementary school where at least 27 people were killed in a shooting rampage, discusses her son's reaction to the event and describes what it was like trying to pick him up from the school. Shannon Hicks

Research suggests that two out of three children will experience one traumatic event by the time they reach 18 years old. What's also troubling is that experts are still searching for the best way to help these young people cope with what they have been through, according to the authors of a new study.

"The current body of evidence provides only a little insight into best practices in treating children exposed to trauma, some of whom already have symptoms," lead author Valerie Forman-Hoffman, a research epidemiologist at RTI International, said in a press release. "This is particularly discouraging given recent shootings at schools and other places where children have been victims. We simply don't have much of an evidence-base to be able to recommend best treatment practices."

A new study published in Pediatrics on Feb. 11 took a closer look at 22 earlier studies that examined different clinical interventions aimed at treating kids who experienced traumatic events, which can include an accident, natural disaster, community violence, war, or political instability. Therapies for abused or neglected children were not included in the study.

Around 20 methods in total were looked at, including medical trials for medications like imipramine (Tofranil) , fluoxetine (Prozac) and sertraline (Zoloft), various psychotherapies, group therapy and school-based counseling.

Pharmacological therapies were not found to be effective, according to researchers. In addition, it was unclear if any therapy worked in the long run, and researchers weren't able to determine if there were any negative consequences from the various forms of treatment. For example, not much research has been done looking at whether making a child relive the trauma could affect them negatively. Many of the studies did not have a comparison group, which could be important because many children may recover on their own, Scientific American pointed out.

"I thought we were going to find a lot of studies on different interventions and make clinical recommendations," Forman-Hoffman admitted to Scientific American."It's depressing. The evidence base is just lacking."

"That's not saying that no treatment works but based on the evidence, we don't know what works," she added.

However, the researchers discovered that some psychotherapeutic treatments might be able to help children. School-based counseling that involved cognitive behavior therapy (otherwise known as "talk therapy") was the most effective, and shown to reduce post-traumatic stress, anxiety, depression and anger.

About 13 percent of children who live through trauma will develop a post-traumatic stress disorder (PTSD) symptom, according to the study authors. PTSD can manifest itself in different ways including "reliving" the event so much that a person cannot complete their daily routine, avoidance of the trauma or being more agitated. This can lead to increased anxiety and other behavioral problems.

"These findings serve as a call to action: psychotherapeutic intervention can provide some benefit to children exposed to traumatic events, but far more research is needed to make definitive conclusions," co-author Dr. Adam Zolotor, a family physician at the University of North Carolina , said in a press release. "Because trauma is a common and costly source of childhood psychological distress, it is critical to understand effective forms of treatment."

The authors believe that funding agencies, public health authorities and policy makers need to pay more attention to childhood trauma. Medical professionals should also be aware of the difficulties and learn to treat kids at risk. They advocated for more research to learn about how different treatments can reduce risk-taking behaviors and suicidal thoughts in children while increase long-term goals of positive development and functioning.

"We just don't know much," Dr. Denise Dowd, who specializes in emergency care at Children's Mercy Hospitals and Clinics in Kansas City, Mo., told HealthDay. She wrote an accompanying editorial to the study.

Dowd added that there is some evidence on what works and that it is important to help a child who might have difficulty recovering from a traumatic event. Doctors also know that supportive parents can help a struggling child.

"Parents should recognize the power of their own nurturing. You don't need published research evidence to know that's important," Down said.

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