Intervention versus intervention

Characteristics Table for the ReferenceIDs included in the clinical question: Psychological intervention vs other psychological intervention (children)

Characteristics of Included Studies
MethodsParticipantsOutcomesInterventionsNotes
CELANO1996
Study Type: RCT

Blindness:
Duration (days): Mean 56

Setting: Pediatric emergency clinic of public hospital, local statutory child protection agencies and victims' assistance programs of the court system.

Info on Screening Process: 56 families screened, 7 did not meet eligibility criteria & 17 dropped out of the study
N= 32
Age: Mean 10 Range 8–13
Sex: all females
Diagnosis:

Exclusions: Mentally retarded, psychotic, or drug-addicted Ps.
Notes: Eligability consisted of experiencing sexual abuse within past 3 years.
Data Used
 Children's Global Assessment Scale
 Children's Impact of Traumatic Events Scales Revis
 Child Behavior Checklist (for parent)
Group 1 N= 15
 Recovering From Abuse Program - Eight 1-hour sessions, half with child, half with mother. Structured on Finkelhor's four- factor model. Therapy delivered by female psychiatrists, psychologists, social workers, nurses and trainees in psychiatry or psychology with prior experience.
Group 2 N= 17
 Treatment as Usual - Eight 1-hour sessions, half with child, half with mother. Therapy delivered by female psychiatrists, psychologists, social workers, nurses and trainees in psychiatry or psychology with prior experience.
COHEN1996
Study Type: RCT

Blindness: Single blind
Duration (days): Mean 84
Followup: 6 and 12 months
Setting: Outpatient

Info on Screening Process: 86 Ps recruited from referrals (e.g.rape crisis, child Protection/healthcare/police/judicial systems). 6 d/o after 1/2 sessions. 7d/o after 3–8 sessions. 6ps removed mid-study (persistent sexualised behaviour). 67 completed post-test.
N= 67
Age: Range 3–6
Sex: no information
Diagnosis:
 100% PTSD Symptoms by Weekly Behavr
 Report/Child Sexual Behav. Inventory
Exclusions: Did not meet min symptomatology. WBR Total Behavior score >7 or any sexually inappropriate behavior on CSBI. Mental retardation or pervasive developmental disorder, psychotic symptoms, a serious medical illness, psychotic disorder or active substance abuse in the parent participating in treatment, no long-term caretaker (<12 months). Ps could be removed from study for persistent inappropriate sexualised behaviour in therapy.
Notes: Sexual abuse was defined as sexual exploitation involving physical contact between a child and another person >5 yrs older. Abuse substantiated by Child Protection Services.
Data Used
 Child Sexual Behaviour Inventory
 Weekly Behaviour Report
 Child Behavior Checklist (for parent)
 Preschool Symptom Self-Report (PRESS)
Group 1 N= 39
 CBT for sexually abused preschoolers - 12 individual sessions approx 90 mins (50 mins with parent, 30–40 mins with child).
Group 2 N= 28
 nondirective supportive therapy - 12 individual sessions approx 90 mins (50 mins with parent, 30–40 mins with child).
COHEN1997
Study Type: RCT

Blindness: Single blind
Duration (days): Mean 84
Followup: 6 and 12 months.
Setting: Outpatient.
Notes: SAME AS COHEN1996
Info on Screening Process: 86 Ps recruited from referrals (e.g.rape crisis, child Protection/healthcare/police/judicial systems). 13 d/o during treatment; 6ps removed during treatment. 67 completed treatment and post- test. 43 completed follow-up assesments.
N= 43
Age: Mean 6 Range 4–8
Sex: 19 males 24 females
Diagnosis:
 100% PTSD Symptoms by Weekly Behavr
 Report/Child Sexual Behav. Inventory
Exclusions: SAME AS COHEN1996: Did not meet min symptomatology. WBR Total Behavior score >7 or any sexually inappropriate behavior on CSBI. Mental retardation or pervasive developmental disorder, psychotic symptoms, a serious medical illness, psychotic disorder or active substance abuse in the parent participating in treatment, no long-term caretaker (<12 months). Ps could be removed from study for persistent inappropriate sexualised behaviour in therapy.
Notes: SAME AS COHEN1996: Sexual abuse was defined as sexual exploitation involving physical contact between a child and another person >5 yrs older. Abuse substantiated by Child Protection Services.
Data Used
 Weekly Behaviour Report
 Child Sexual Behaviour Inventory
 Child Behavior Checklist (for parent)
Group 1 N= 0
 CBT for sexually abused preschoolers - SAME AS COHEN1996: 12 individual sessions approx 90 mins (50 mins with parent, 30–40 mins with child).
Group 2 N= 28
 nondirective supportive therapy - SAME AS COHEN1996: 12 individual sessions approx 90 mins (50 mins with parent, 30–40 mins with child).
SAME AS COHEN1996. 9Ps received further treatement during follow-up period, 3 of whom changed treatment groups and so were exlcluded from analysis.
COHEN1998
Study Type: RCT

Blindness: Single blind
Duration (days):

Setting: Outpatient. Ps referred from victim advocacy programs, child protective services, police, juvenile and family court, private practitioners.

Info on Screening Process: 82 ps completed initial assessment; 4 d/o pre-treatment. 10 d/o after 3 sessions or less; 10 d/o after 4–8 sessions; 9 ps removed due to sexualised behaviours in therapy; 49 ps (30 CBT 19 NST) completed treatment and post-tests.
N= 49
Age: Mean 11 Range 7–15
Sex: 15 males 34 females
Diagnosis:
 PTSD Symptoms by Child Behaviour Checklist
 Parent Form
Exclusions: Sexual abuse experienced > 6 months ago; mental retardation, pervasive developmental disorder, active psychosis or substance abuse, serious medical illness, lack of long-term caretaker (<12 months) active psychosis or substance abuse in primary caretaker; Ps could be removed from study for persistent inappropriate sexualised behaviour in therapy.
Data Used
 Child Sexual Behaviour Checklist
 Children's Depression Inventory
 State Anxiety Inventory for Children
 Child Behavior Checklist (for parent)
Group 1 N= 30
 CBT (Sexual Abuse Specific) - 12 sessions over a 12 week period. Each session 45 mins with child, 45 mins with parent: 18 total hours. Treatment aimed to address depression, anxiety and related behavioural difficulties.
Group 2 N= 19
 nondirective supportive therapy - 12 sessions over a 12 week period. Each session 45 mins with child, 45 mins with parent: 18 total hours.
COHEN2004
Study Type: RCT

Blindness: Single blind
Duration (days): Mean 74

Setting: Participants recruited from metropolitan/ suburban outpatient clinical treatment progs for abused/traumatised children.
Notes: Study required parent/caretaker to participate in the parental treatment component.
Info on Screening Process: Of 237 screened, 8 did not meet study criteria.
N= 229
Age: Mean 11 Range 8–14
Sex: 43 males 160 females
Diagnosis:
 100% PTSD Symptoms by DSM-IV
Exclusions: Active psychotic disorder/active substance use disorder; not fluent in English; documented developmental disorder; children without a participating parent/caretaker excluded; if child taking psychotropic medication, exclusion if less than 2 months stable medication regimen completed.
Notes: At least five criteria for sexual abuse-related DSM- IV-defined PTSD, including at least one symptom in each of the three PTSD clusters. More than 90% of children had been traumatised by events additional to sexual abuse.
Data Used
 Child Behavior Checklist (for parent)
 CAPS
 Spielberger State-Trait Anxiety Inventory (Child)
 Child Sexual Behaviour Inventory
 Child Depression Inventory
 K-SADS-PL-PTSD
Group 1 N= 114
 Trauma-focused CBT - Manualised treatment including psychoeducation about CSA and body safety; parent management skills. 12 weekly 90 minute sessions with time divided equally between individual sessions with parent and child plus occasional 30 min joint sessions.
Group 2 N= 115
 Child Centred Therapy - 12 weekly 90 minute sessions with time divided equally between individual sessions with parent and child plus occasional 30 min joint sessions.
Study also assessed children with: semi- structured interview for DSM-IV PTSD, Psychosis and Substance abuse; CDI; STAIC; CAPS.
Parents were assessed using: CBCL; CSBI; BDI; PERQ; PSQ; and a modified PPQ.
DEBLINGER1999
Study Type: RCT

Blindness:
Duration (days): Mean 84

Followup: 3 & 6 months, 1 & 2 years
N= 100
Age: Mean 10 Range 7–13
Sex: 17 males 83 females
Diagnosis:

Notes: Sexually abused children exhibiting a minimum of 3 PTSD symptoms
Data Used
 Parenting Practices Questionnaire
 Child Behavior Checklist (for parent)
 Child Depression Inventory
 K-SADS-E
 Structured Background Interview
Group 1 N= 25
 CBT for child - 12 weekly 45-minute treatment sessions
Group 2 N= 25
 CBT for mother - 12 weekly 45-minute treatment sessions
Group 3 N= 25
 CBT for mother & child - 12 weekly 90- minute treatment sessions
Group 4 N= 25
 Community Comparison - Children & parents referred to therapists in their own communities.
JABERGHADERI
Study Type: RCT

Blindness: Single blind
Duration (days): Mean 62 Range 28–84
Followup: 2 weeks after final session.
Setting: Oupatient, school setting.

Info on Screening Process: Parents of 125 girls contacted.123 girls completed CROPS; 62 scoring highly on PTSD did further tests, identifiying 24 as S.A.. 18 qualified & consented = randomised to promote equivalence of SA. 2 d/o pre-treat.2 d/o during treatmt. 14 completers.
N= 14
Age: Range 12–13
Sex: all females
Diagnosis:
 100% PTSD by DSM-IV
 0% Acute stress disorder by Acute Stress
 Disorder Interview
Exclusions: Non 6th grade. No initial parental consent given; <19 initial score on CROPS; non sexual abuse trauma on LITE measure; sexual abuse ongoing or more recent that 6 months prior to study.
Notes: 6th grade schoolgirls in urban Iran. Qualifying sexual abuse criteria: unwanted oral, anal, genital or breast contact with another person, 6 months+ prior to the study.
Data Used
 Subjective Units of Distress Scale (SUDS)
 Rutter Teacher Scacle (mental disturbance)
 Parent Report of Post-traumatic Symptoms (CROPS)
 Child Report of Post-traumatic Symptoms (CROPS)
Group 1 N= 7
 CBT - Up to 12 sessions of 45 minutes, plus homework estimated to be 10–15 hours total. Manualised, based on Deblinger & Heflin (1996) plus Camino (2000). Focus on symptom management and exposure to identified sex abuse memory.
Group 2 N= 7
 EMDR - Up to 12 sessions of 30–45 minutes. Minimal homework. Based on Shapiro (1995) modified for age. Limited skill development, less strict focus on trauma memory.
KING2000
Study Type: RCT

Blindness:
Duration (days): Mean 140
Followup: 12 weeks
Setting: Referrals from sexual assault centres, the Dept of Health and Community Services, mental health professionals, medical practitioners.

Info on Screening Process: 46 screened.
N= 36
Age: Mean 11
Range 5–17
Sex: 11 males
25 females
Diagnosis:
 100% PTSD by DSM-IV
Exclusions: Ongoing, unsupervised contact with the alleged perpetrstor, severe intellectual disability, psychosis or suicidal behavior, on antidepressants or antianxiety medication, child and/or parents unwilling to participate.
Notes: Sexually abused children
Data Used
 Child Behavior Checklist (for parent)
 Children's Depression Inventory
 Revised Children's Manifest Anxiety Scale
 Coping Questionnaire for Sexually Abused Children
 Fear Thermometer for Sexually Abused Children
 ADIS - child version
Group 1 N= 12
 Wait List
Group 2 N= 12
 Child only CBT - 20 weekly 50-minute individual therapy sessions
Group 3 N= 12
 Family CBT - 20 weekly 50-minute therapy sessions with child and nonoffending mothers
STEIN2003
Study Type: RCT

Blindness:
Duration (days):
Followup: 3 & 6 months after intervention
Setting: 2 large middle schools in LA.

Info on Screening Process: 769 screened, 643 didn't meet inclusion criteria/didn't consent, 126 randomized
N= 126
Age: Mean 11
Sex: 55 males 71 females
Diagnosis:

Notes: Included if reported exposure to violence and had clinical levels of PTSD symptoms.
Data Used
 Teacher-Child Rating Scale
 Pediatric Symptom Checklist
 Child Depression Inventory
 Child PTSD symptom scale
Group 1 N= 61
 Immediate CBT - 'Cognitive Behavioural Intervention for Trauma in Schools' (CBITS) 10 sessions delivered in groups of 5–8
Group 2 N= 65
 Delayed CBT - 'Cognitive Behavioural Intervention for Trauma in Schools' (CBITS) 10 sessions delivered in groups of 5–8. Delivered > 3 months after trauma
TROWELL2002
Study Type: RCT

Study Description: Comparison study.
Blindness: Single blind
Duration (days):
Followup: 1 year
Setting: Ps recruited from clinics and professional agencie in community in north and south london. Therapy took place in

Info on Screening Process: 94 screened (13 unwilling or ineligible); 81 interviewed (10 unsuitable due to various reasons, including reluctance to partake in individual therapy); 75 randomised (4 never attended).
N= 71
Age: Mean 10 Range 6–14
Sex: all females
Diagnosis:
 73% PTSD by Orvaschel's PTSD Scales
Exclusions: Outside 6–14 age bracket; severe developmental delay, psychosis, lack of reasonable confidence that further abuse would not occur, necessity for hospitalisation at the time of initial evaluation.
Notes: Victims of sexual abuse. No PTSD diagnosis required
Data Used
 Kiddie Global Assessment Scale
 Orvaschel's PTSD Scales
 Kiddie-SADS
Group 1 N= 35
 Focused Individual Psychotherapy - Up to 30 sessions of 50 mins,.
Group 2 N= 36
 Psychoeducational Group Therapy - Up to 18 sessions

From: Appendix 14, Evidence tables for clinical studies

Cover of Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care.
NICE Clinical Guidelines, No. 26.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): Gaskell; 2005.
Copyright © 2005, The Royal College of Psychiatrists & The British Psychological Society.

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