Table APopulation, intervention, comparator, outcome, timing, and setting

DomainDescription
Population
  • Children ages 0–17 years who have been exposed to a trauma other than maltreatment, neglect, or family violence. Specific types of trauma include terrorism, community violence, war, school violence, natural disasters, medical trauma, and death of loved onesa
  • Children ages 0–17 years who have been exposed to a trauma other than maltreatment, neglect, or family violence who already are experiencing symptomsa
InterventionInterventions for children exposed to trauma
  • Psychotherapy (e.g., cognitive behavioral therapy, hypnotherapy, psychodynamic therapy, community- or classroom-based interventions)
  • Pharmacotherapy (e.g., SSRIs, TCAs, benzodiazepines, beta blockers, alpha blockers, mood stabilizers, antipsychotics, combined therapy, other therapy)
Interventions for children exposed to trauma who already have symptoms
  • Psychotherapy, including trauma-focused vs. nontrauma-focused groupings (e.g., cognitive behavioral therapy, parent-child interaction therapy, child-parent psychotherapy, eye movement desensitization and reprocessing, dialectical behavior therapy, complementary and alternative therapies [e.g., equine-assisted therapy], and community- or classroom-based interventions)
  • Pharmacotherapy (e.g., SSRIs, TCAs, benzodiazepines, beta blockers, alpha blockers, mood stabilizers, antipsychotics, combined therapy, other therapy)
ComparatorThe comparison condition as defined in the respective studies, including active controls (such as usual care) and inactive controls (such as wait-list groups)
OutcomeOutcomes for studies targeting children exposed to traumab
  • Prevention of or reduction in traumatic stress symptoms or syndromes (e.g., PTSD, acute stress disorder, developmental trauma disorder)
  • Prevention of or reduction in mental health conditions or symptoms (e.g., depression, anxiety)
  • Prevention of or reduction in physical health conditions or symptoms (e.g., sleep disorders, eating disorders, pain, overweight or obesity, asthma, cardiovascular problems, gastrointestinal problems, headaches)
  • Reduction in risk-taking behaviors (including substance use), behavioral problems (including conduct disorder and ADHD), or criminal activities
  • Healthy development (including improvements in interpersonal and social functioning), or reductions in the signs of developmental regression
  • School-based functioning
  • Improvements in quality of life
  • Decreased suicidality
  • Low adherence/dropouts
  • Side effects
  • Retraumatization
Outcomes for studies targeting children exposed to trauma who already have symptomsb
  • Remission of PTSD
  • Reduction in severity or number of traumatic stress syndromes or symptoms
  • Prevention of or reduction in co-occurring mental health conditions or symptoms (e.g., depression, anxiety)
  • Prevention of or reduction in co-occurring physical health conditions or symptoms (e.g., sleep disorders, eating disorders, pain, overweight or obesity, asthma, cardiovascular problems, gastrointestinal problems, headaches)
  • Reduction in risk-taking behaviors (including substance use), behavioral problems (including conduct disorder and ADHD), or criminal activities
  • Healthy development (including improvements in interpersonal/social functioning), or signs of developmental regression
  • School-based functioning
  • Improvements in quality of life
  • Decreased suicidality
  • Low adherence/dropouts
  • Side effects
  • Retraumatization
Timing
  • All outcomes included, regardless of timing of measurement
Setting
  • Studies conducted in the United States or internationally
  • Specialty (e.g., outpatient and inpatient primary care or mental health care settings)
  • Nonspecialty (e.g., schools, community-based providers, shelters)
  • Home-based settings and out-of-home care (e.g., residential treatment)
Publication type
  • Not editorials, letters to the editor
Study design
  • Included designs: systematic reviews, randomized controlled trials, nonrandomized controlled trials, prospective cohort studies, and nested case-control studies
  • Excluded designs: case reports, case series, cross-sectional studies, nonsystematic reviews, retrospective cohort studies, non-nested case-control studies
Sample size
  • N ≥10
Time of publication
  • 1990 to present
Language of publication
  • English
Risk of bias
  • Low or medium. We excluded studies with a high risk of bias, as determined by one or more significant flaws that invalidated the findings (e.g., attrition bias of overall attrition ≥20% or differential attrition ≥15% without appropriate handing of missing data, such as the use of intention-to-treat analyses), detection bias, selection bias, performance bias, and/or reporting bias

ADHD = attention deficit hyperactivity disorder; N = number; PTSD = post-traumatic stress disorder; SSRI = selective serotonin reuptake inhibitors; TCA = tricyclic antidepressants

a

At least 95% of the sample was required to be between 0 and 17 years of age.

b

At least one outcome had to relate to the assessment of trauma for the study to be included. For each study, we also included findings that showed nonbeneficial outcomes associated with the intervention (e.g., no significant changes in outcomes between groups or significantly worse outcomes in the intervention group).

From: Executive Summary

Cover of Child and Adolescent Exposure to Trauma
Child and Adolescent Exposure to Trauma: Comparative Effectiveness of Interventions Addressing Trauma Other Than Maltreatment or Family Violence [Internet].
Comparative Effectiveness Reviews, No. 107.
Forman-Hoffman V, Knauer S, McKeeman J, et al.

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