The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds

Caitlin Hitchcock; Benjamin Goodall; Isobel M. Wright; Adrian Boyle; David Johnston; Darren Dunning; Julia Gillard; Kirsty Griffiths; Ayla Humphrey; Anna McKinnon; Inderpal K. Panesar; Aliza Werner-Seidler; Peter Watson; Patrick Smith; Richard Meiser-Stedman; Tim Dalgleish

doi:10.1111/jcpp.13460

The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds

Caitlin Hitchcock, Benjamin Goodall, Isobel M. Wright, Adrian Boyle, David Johnston, Darren Dunning, Julia Gillard, Kirsty Griffiths, Ayla Humphrey, Anna McKinnon, Inderpal K. Panesar, Aliza Werner-Seidler, Peter Watson, Patrick Smith, Richard Meiser-Stedman, Tim Dalgleish^*

^*Corresponding author for this work

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Abstract

Background: The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC. Method: Study 1 (N = 105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC. Results: In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures. Conclusions: The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted.

Original language	English
Pages (from-to)	58-67
Number of pages	10
Journal	Journal of Child Psychology and Psychiatry and Allied Disciplines
Volume	63
Issue number	1
DOIs	https://doi.org/10.1111/jcpp.13460
Publication status	Published - Jan 2022

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Hitchcock, C., Goodall, B., Wright, I. M., Boyle, A., Johnston, D., Dunning, D., Gillard, J., Griffiths, K., Humphrey, A., McKinnon, A., Panesar, I. K., Werner-Seidler, A., Watson, P., Smith, P., Meiser-Stedman, R., & Dalgleish, T. (2022). The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds. Journal of Child Psychology and Psychiatry and Allied Disciplines, 63(1), 58-67. https://doi.org/10.1111/jcpp.13460

Hitchcock, Caitlin ; Goodall, Benjamin ; Wright, Isobel M. et al. / The early course and treatment of posttraumatic stress disorder in very young children : diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds. In: Journal of Child Psychology and Psychiatry and Allied Disciplines. 2022 ; Vol. 63, No. 1. pp. 58-67.

@article{e07c7c91d3e148ccb0a9ce806bbba128,

title = "The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds",

abstract = "Background: The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC. Method: Study 1 (N = 105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC. Results: In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6\% in the first month post-trauma and 10.1\% at 3 months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50\% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6\%) relative to TAU (6.7\%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures. Conclusions: The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted.",

author = "Caitlin Hitchcock and Benjamin Goodall and Wright, \{Isobel M.\} and Adrian Boyle and David Johnston and Darren Dunning and Julia Gillard and Kirsty Griffiths and Ayla Humphrey and Anna McKinnon and Panesar, \{Inderpal K.\} and Aliza Werner-Seidler and Peter Watson and Patrick Smith and Richard Meiser-Stedman and Tim Dalgleish",

note = "Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2022",

month = jan,

doi = "10.1111/jcpp.13460",

language = "English",

volume = "63",

pages = "58--67",

journal = "Journal of Child Psychology and Psychiatry and Allied Disciplines",

issn = "0021-9630",

publisher = "Wiley-Blackwell, Wiley",

number = "1",

}

Hitchcock, C, Goodall, B, Wright, IM, Boyle, A, Johnston, D, Dunning, D, Gillard, J, Griffiths, K, Humphrey, A, McKinnon, A, Panesar, IK, Werner-Seidler, A, Watson, P, Smith, P, Meiser-Stedman, R & Dalgleish, T 2022, 'The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds', Journal of Child Psychology and Psychiatry and Allied Disciplines, vol. 63, no. 1, pp. 58-67. https://doi.org/10.1111/jcpp.13460

The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds. / Hitchcock, Caitlin; Goodall, Benjamin; Wright, Isobel M. et al.
In: Journal of Child Psychology and Psychiatry and Allied Disciplines, Vol. 63, No. 1, 01.2022, p. 58-67.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The early course and treatment of posttraumatic stress disorder in very young children

T2 - diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds

AU - Hitchcock, Caitlin

AU - Goodall, Benjamin

AU - Wright, Isobel M.

AU - Boyle, Adrian

AU - Johnston, David

AU - Dunning, Darren

AU - Gillard, Julia

AU - Griffiths, Kirsty

AU - Humphrey, Ayla

AU - McKinnon, Anna

AU - Panesar, Inderpal K.

AU - Werner-Seidler, Aliza

AU - Watson, Peter

AU - Smith, Patrick

AU - Meiser-Stedman, Richard

AU - Dalgleish, Tim

N1 - Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2022/1

Y1 - 2022/1

N2 - Background: The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC. Method: Study 1 (N = 105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC. Results: In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures. Conclusions: The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted.

AB - Background: The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC. Method: Study 1 (N = 105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC. Results: In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures. Conclusions: The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted.

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Hitchcock C, Goodall B, Wright IM, Boyle A, Johnston D, Dunning D et al. The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds. Journal of Child Psychology and Psychiatry and Allied Disciplines. 2022 Jan;63(1):58-67. doi: 10.1111/jcpp.13460

The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds

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