Cognitive therapy as an early treatment for post-traumatic stress disorder in children and adolescents: a randomized controlled trial addressing preliminary efficacy and mechanisms of action / Richard MEISER-STEDMAN in Journal of Child Psychology and Psychiatry, 58-5 (May 2017)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 58-5 (May 2017) . - p.623-633 Titre : Cognitive therapy as an early treatment for post-traumatic stress disorder in children and adolescents: a randomized controlled trial addressing preliminary efficacy and mechanisms of action Type de document : texte imprimé Auteurs : Richard MEISER-STEDMAN, Auteur ; Patrick SMITH, Auteur ; Anna MCKINNON, Auteur ; Clare DIXON, Auteur ; David TRICKEY, Auteur ; Anke EHLERS, Auteur ; David M. CLARK, Auteur ; Adrian BOYLE, Auteur ; Peter WATSON, Auteur ; Ian M. GOODYER, Auteur ; Tim DALGLEISH, Auteur Article en page(s) : p.623-633 Langues : Anglais (eng) Mots-clés : Post-traumatic stress disorder  cognitive therapy Index. décimale : PER Périodiques Résumé : Background Few efficacious early treatments for post-traumatic stress disorder (PTSD) in children and adolescents exist. Previous trials have intervened within the first month post-trauma and focused on secondary prevention of later post-traumatic stress; however, considerable natural recovery may still occur up to 6-months post-trauma. No trials have addressed the early treatment of established PTSD (i.e. 2- to 6-months post-trauma). Methods Twenty-nine youth (8–17 years) with PTSD (according to age-appropriate DSM-IV or ICD-10 diagnostic criteria) after a single-event trauma in the previous 2–6 months were randomly allocated to Cognitive Therapy for PTSD (CT-PTSD; n = 14) or waiting list (WL; n = 15) for 10 weeks. Results Significantly more participants were free of PTSD after CT-PTSD (71%) than WL (27%) at posttreatment (intent-to-treat, 95% CI for difference .04–.71). CT-PTSD yielded greater improvement on child-report questionnaire measures of PTSD, depression and anxiety; clinician-rated functioning; and parent-reported outcomes. Recovery after CT-PTSD was maintained at 6- and 12-month posttreatment. Beneficial effects of CT-PTSD were mediated through changes in appraisals and safety-seeking behaviours, as predicted by cognitive models of PTSD. CT-PTSD was considered acceptable on the basis of low dropout and high treatment credibility and therapist alliance ratings. Conclusions This trial provides preliminary support for the efficacy and acceptability of CT-PTSD as an early treatment for PTSD in youth. Moreover, the trial did not support the extension of ‘watchful waiting’ into the 2- to 6-month post-trauma window, as significant improvements in the WL arm (particularly in terms of functioning and depression) were not observed. Replication in larger samples is needed, but attention to recruitment issues will be required. En ligne : http://dx.doi.org/10.1111/jcpp.12673 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=306 [article] Cognitive therapy as an early treatment for post-traumatic stress disorder in children and adolescents: a randomized controlled trial addressing preliminary efficacy and mechanisms of action [texte imprimé] / Richard MEISER-STEDMAN, Auteur ; Patrick SMITH, Auteur ; Anna MCKINNON, Auteur ; Clare DIXON, Auteur ; David TRICKEY, Auteur ; Anke EHLERS, Auteur ; David M. CLARK, Auteur ; Adrian BOYLE, Auteur ; Peter WATSON, Auteur ; Ian M. GOODYER, Auteur ; Tim DALGLEISH, Auteur . - p.623-633. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 58-5 (May 2017) . - p.623-633 Mots-clés : Post-traumatic stress disorder  cognitive therapy Index. décimale : PER Périodiques Résumé : Background Few efficacious early treatments for post-traumatic stress disorder (PTSD) in children and adolescents exist. Previous trials have intervened within the first month post-trauma and focused on secondary prevention of later post-traumatic stress; however, considerable natural recovery may still occur up to 6-months post-trauma. No trials have addressed the early treatment of established PTSD (i.e. 2- to 6-months post-trauma). Methods Twenty-nine youth (8–17 years) with PTSD (according to age-appropriate DSM-IV or ICD-10 diagnostic criteria) after a single-event trauma in the previous 2–6 months were randomly allocated to Cognitive Therapy for PTSD (CT-PTSD; n = 14) or waiting list (WL; n = 15) for 10 weeks. Results Significantly more participants were free of PTSD after CT-PTSD (71%) than WL (27%) at posttreatment (intent-to-treat, 95% CI for difference .04–.71). CT-PTSD yielded greater improvement on child-report questionnaire measures of PTSD, depression and anxiety; clinician-rated functioning; and parent-reported outcomes. Recovery after CT-PTSD was maintained at 6- and 12-month posttreatment. Beneficial effects of CT-PTSD were mediated through changes in appraisals and safety-seeking behaviours, as predicted by cognitive models of PTSD. CT-PTSD was considered acceptable on the basis of low dropout and high treatment credibility and therapist alliance ratings. Conclusions This trial provides preliminary support for the efficacy and acceptability of CT-PTSD as an early treatment for PTSD in youth. Moreover, the trial did not support the extension of ‘watchful waiting’ into the 2- to 6-month post-trauma window, as significant improvements in the WL arm (particularly in terms of functioning and depression) were not observed. Replication in larger samples is needed, but attention to recruitment issues will be required. En ligne : http://dx.doi.org/10.1111/jcpp.12673 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=306

A core role for cognitive processes in the acute onset and maintenance of post-traumatic stress in children and adolescents / Richard MEISER-STEDMAN in Journal of Child Psychology and Psychiatry, 60-8 (August 2019)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 60-8 (August 2019) . - p.875-884 Titre : A core role for cognitive processes in the acute onset and maintenance of post-traumatic stress in children and adolescents Type de document : texte imprimé Auteurs : Richard MEISER-STEDMAN, Auteur ; Anna MCKINNON, Auteur ; Clare DIXON, Auteur ; Adrian BOYLE, Auteur ; Paula SMITH, Auteur ; Tim DALGLEISH, Auteur Article en page(s) : p.875-884 Langues : Anglais (eng) Mots-clés : Post-traumatic stress disorder  cognitive development  early intervention  longitudinal studies Index. décimale : PER Périodiques Résumé : BACKGROUND: Post-traumatic stress disorder (PTSD) is a common reaction to trauma in children and adolescents. While a significant minority of trauma-exposed youth go on to have persistent PTSD, many youths who initially have a severe traumatic stress response undergo natural recovery. The present study investigated the role of cognitive processes in shaping the early reactions of child and adolescents to traumatic stressors, and the transition to persistent clinically significant post-traumatic stress symptoms (PTSS). METHODS: A prospective longitudinal study of youth aged 8-17 years who had attended a hospital emergency department following single trauma was undertaken, with assessments performed at 2-4 weeks (N = 226) and 2 months (N = 208) post-trauma. Acute stress disorder and PTSD were assessed using a structured interview, while PTSS, depression severity and peritraumatic and post-traumatic cognitive processes were assessed using self-report questionnaires. On the basis of their PTSS scores at each assessment, participants were categorised as being on a resilient, recovery or persistent trajectory. RESULTS: PTSS decreased between the two assessments. Cognitive processes at the 2- to 4-week assessment accounted for the most variance in PTSS at both the initial and follow-up assessment. The onset of post-traumatic stress was associated particularly with peritraumatic subjective threat, data-driven processing and pain. Its maintenance was associated with greater peritraumatic dissociation and panic, and post-traumatic persistent dissociation, trauma memory quality, rumination and negative appraisals. Efforts to deliberately process the trauma were more common in youth who experienced the onset of clinically significant PTSS. Regression modelling indicated that the predictive effect of baseline negative appraisals remained when also accounting for baseline PTSS and depression. CONCLUSIONS: Cognitive processes play an important role in the onset and maintenance of PTSS in children and adolescents exposed to trauma. Trauma-related appraisals play a particular role when considering whether youth make the transition from clinically significant acute PTSS to persistent PTSS. En ligne : http://dx.doi.org/10.1111/jcpp.13054 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=404 [article] A core role for cognitive processes in the acute onset and maintenance of post-traumatic stress in children and adolescents [texte imprimé] / Richard MEISER-STEDMAN, Auteur ; Anna MCKINNON, Auteur ; Clare DIXON, Auteur ; Adrian BOYLE, Auteur ; Paula SMITH, Auteur ; Tim DALGLEISH, Auteur . - p.875-884. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 60-8 (August 2019) . - p.875-884 Mots-clés : Post-traumatic stress disorder  cognitive development  early intervention  longitudinal studies Index. décimale : PER Périodiques Résumé : BACKGROUND: Post-traumatic stress disorder (PTSD) is a common reaction to trauma in children and adolescents. While a significant minority of trauma-exposed youth go on to have persistent PTSD, many youths who initially have a severe traumatic stress response undergo natural recovery. The present study investigated the role of cognitive processes in shaping the early reactions of child and adolescents to traumatic stressors, and the transition to persistent clinically significant post-traumatic stress symptoms (PTSS). METHODS: A prospective longitudinal study of youth aged 8-17 years who had attended a hospital emergency department following single trauma was undertaken, with assessments performed at 2-4 weeks (N = 226) and 2 months (N = 208) post-trauma. Acute stress disorder and PTSD were assessed using a structured interview, while PTSS, depression severity and peritraumatic and post-traumatic cognitive processes were assessed using self-report questionnaires. On the basis of their PTSS scores at each assessment, participants were categorised as being on a resilient, recovery or persistent trajectory. RESULTS: PTSS decreased between the two assessments. Cognitive processes at the 2- to 4-week assessment accounted for the most variance in PTSS at both the initial and follow-up assessment. The onset of post-traumatic stress was associated particularly with peritraumatic subjective threat, data-driven processing and pain. Its maintenance was associated with greater peritraumatic dissociation and panic, and post-traumatic persistent dissociation, trauma memory quality, rumination and negative appraisals. Efforts to deliberately process the trauma were more common in youth who experienced the onset of clinically significant PTSS. Regression modelling indicated that the predictive effect of baseline negative appraisals remained when also accounting for baseline PTSS and depression. CONCLUSIONS: Cognitive processes play an important role in the onset and maintenance of PTSS in children and adolescents exposed to trauma. Trauma-related appraisals play a particular role when considering whether youth make the transition from clinically significant acute PTSS to persistent PTSS. En ligne : http://dx.doi.org/10.1111/jcpp.13054 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=404

Prevalence and predictive value of ICD-11 post-traumatic stress disorder and Complex PTSD diagnoses in children and adolescents exposed to a single-event trauma / Rachel ELLIOTT in Journal of Child Psychology and Psychiatry, 62-3 (March 2021)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 62-3 (March 2021) . - p.270-276 Titre : Prevalence and predictive value of ICD-11 post-traumatic stress disorder and Complex PTSD diagnoses in children and adolescents exposed to a single-event trauma Type de document : texte imprimé Auteurs : Rachel ELLIOTT, Auteur ; Anna MCKINNON, Auteur ; Clare DIXON, Auteur ; Adrian BOYLE, Auteur ; Fionnuala MURPHY, Auteur ; Theresa DAHM, Auteur ; Emma TRAVERS-HILL, Auteur ; Cari-Lène MUL, Auteur ; Sarah-Jane ARCHIBALD, Auteur ; Patrick SMITH, Auteur ; Tim DALGLEISH, Auteur ; Richard MEISER-STEDMAN, Auteur ; Caitlin HITCHCOCK, Auteur Article en page(s) : p.270-276 Langues : Anglais (eng) Mots-clés : Complex PTSD  International Classification of Diseases  Post-traumatic stress disorder  adolescent  child  trauma Index. décimale : PER Périodiques Résumé : BACKGROUND: The 11th edition of the International Classification of Diseases (ICD-11) made a number of significant changes to the diagnostic criteria for post-traumatic stress disorder (PTSD). We sought to determine the prevalence and 3-month predictive values of the new ICD-11 PTSD criteria relative to ICD-10 PTSD, in children and adolescents following a single traumatic event. ICD-11 also introduced a diagnosis of Complex PTSD (CPTSD), proposed to typically result from prolonged, chronic exposure to traumatic experiences, although the CPTSD diagnostic criteria do not require a repeated experience of trauma. We therefore explored whether children and adolescents demonstrate ICD-11 CPTSD features following exposure to a single-incident trauma. METHOD: Data were analysed from a prospective cohort study of youth aged 8-17 years who had attended an emergency department following a single trauma. Assessments of PTSD, CPTSD, depressive and anxiety symptoms were performed at two to four weeks (n = 226) and nine weeks (n = 208) post-trauma, allowing us to calculate and compare the prevalence and predictive value of ICD-10 and ICD-11 PTSD criteria, along with CPTSD. Predictive abilities of different diagnostic thresholds were undertaken using positive/negative predictive values, sensitivity/specificity statistics and logistic regressions. RESULTS: At Week 9, 15 participants (7%) were identified as experiencing ICD-11 PTSD, compared to 23 (11%) experiencing ICD-10 PTSD. There was no significant difference in comorbidity rates between ICD-10 and ICD-11 PTSD diagnoses. Ninety per cent of participants with ICD-11 PTSD also met criteria for at least one CPTSD feature. Five participants met full CPTSD criteria. CONCLUSIONS: Reduced prevalence of PTSD associated with the use of ICD-11 criteria is likely to reduce identification of PTSD relative to using ICD-10 criteria but not relative to DSM-4 and DSM-5 criteria. Diagnosis of CPTSD is likely to be infrequent following single-incident trauma. En ligne : http://dx.doi.org/10.1111/jcpp.13240 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=443 [article] Prevalence and predictive value of ICD-11 post-traumatic stress disorder and Complex PTSD diagnoses in children and adolescents exposed to a single-event trauma [texte imprimé] / Rachel ELLIOTT, Auteur ; Anna MCKINNON, Auteur ; Clare DIXON, Auteur ; Adrian BOYLE, Auteur ; Fionnuala MURPHY, Auteur ; Theresa DAHM, Auteur ; Emma TRAVERS-HILL, Auteur ; Cari-Lène MUL, Auteur ; Sarah-Jane ARCHIBALD, Auteur ; Patrick SMITH, Auteur ; Tim DALGLEISH, Auteur ; Richard MEISER-STEDMAN, Auteur ; Caitlin HITCHCOCK, Auteur . - p.270-276. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 62-3 (March 2021) . - p.270-276 Mots-clés : Complex PTSD  International Classification of Diseases  Post-traumatic stress disorder  adolescent  child  trauma Index. décimale : PER Périodiques Résumé : BACKGROUND: The 11th edition of the International Classification of Diseases (ICD-11) made a number of significant changes to the diagnostic criteria for post-traumatic stress disorder (PTSD). We sought to determine the prevalence and 3-month predictive values of the new ICD-11 PTSD criteria relative to ICD-10 PTSD, in children and adolescents following a single traumatic event. ICD-11 also introduced a diagnosis of Complex PTSD (CPTSD), proposed to typically result from prolonged, chronic exposure to traumatic experiences, although the CPTSD diagnostic criteria do not require a repeated experience of trauma. We therefore explored whether children and adolescents demonstrate ICD-11 CPTSD features following exposure to a single-incident trauma. METHOD: Data were analysed from a prospective cohort study of youth aged 8-17 years who had attended an emergency department following a single trauma. Assessments of PTSD, CPTSD, depressive and anxiety symptoms were performed at two to four weeks (n = 226) and nine weeks (n = 208) post-trauma, allowing us to calculate and compare the prevalence and predictive value of ICD-10 and ICD-11 PTSD criteria, along with CPTSD. Predictive abilities of different diagnostic thresholds were undertaken using positive/negative predictive values, sensitivity/specificity statistics and logistic regressions. RESULTS: At Week 9, 15 participants (7%) were identified as experiencing ICD-11 PTSD, compared to 23 (11%) experiencing ICD-10 PTSD. There was no significant difference in comorbidity rates between ICD-10 and ICD-11 PTSD diagnoses. Ninety per cent of participants with ICD-11 PTSD also met criteria for at least one CPTSD feature. Five participants met full CPTSD criteria. CONCLUSIONS: Reduced prevalence of PTSD associated with the use of ICD-11 criteria is likely to reduce identification of PTSD relative to using ICD-10 criteria but not relative to DSM-4 and DSM-5 criteria. Diagnosis of CPTSD is likely to be infrequent following single-incident trauma. En ligne : http://dx.doi.org/10.1111/jcpp.13240 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=443

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 in Journal of Child Psychology and Psychiatry, 63-1 (January 2022)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 63-1 (January 2022) . - p.58-67 Titre : 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 Type de document : texte imprimé Auteurs : Caitlin HITCHCOCK, Auteur ; Benjamin GOODALL, Auteur ; Isobel M. WRIGHT, Auteur ; Adrian BOYLE, Auteur ; David JOHNSTON, Auteur ; Darren L. DUNNING, Auteur ; Julia GILLARD, Auteur ; Kirsty GRIFFITHS, Auteur ; Ayla HUMPHREY, Auteur ; Anna MCKINNON, Auteur ; Inderpal K. PANESAR, Auteur ; Aliza WERNER-SEIDLER, Auteur ; Peter WATSON, Auteur ; Paula SMITH, Auteur ; Richard MEISER-STEDMAN, Auteur ; Tim DALGLEISH, Auteur Article en page(s) : p.58-67 Langues : Anglais (eng) Mots-clés : Adult  Child  Child, Preschool  Cognitive Behavioral Therapy  Hospitals  Humans  Prevalence  Psychotherapy  Stress Disorders, Post-Traumatic/diagnosis/epidemiology/therapy  Posttraumatic stress disorder  randomized control trial  young children Index. décimale : PER Périodiques Résumé : 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. En ligne : http://dx.doi.org/10.1111/jcpp.13460 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=456 [article] 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 [texte imprimé] / Caitlin HITCHCOCK, Auteur ; Benjamin GOODALL, Auteur ; Isobel M. WRIGHT, Auteur ; Adrian BOYLE, Auteur ; David JOHNSTON, Auteur ; Darren L. DUNNING, Auteur ; Julia GILLARD, Auteur ; Kirsty GRIFFITHS, Auteur ; Ayla HUMPHREY, Auteur ; Anna MCKINNON, Auteur ; Inderpal K. PANESAR, Auteur ; Aliza WERNER-SEIDLER, Auteur ; Peter WATSON, Auteur ; Paula SMITH, Auteur ; Richard MEISER-STEDMAN, Auteur ; Tim DALGLEISH, Auteur . - p.58-67. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 63-1 (January 2022) . - p.58-67 Mots-clés : Adult  Child  Child, Preschool  Cognitive Behavioral Therapy  Hospitals  Humans  Prevalence  Psychotherapy  Stress Disorders, Post-Traumatic/diagnosis/epidemiology/therapy  Posttraumatic stress disorder  randomized control trial  young children Index. décimale : PER Périodiques Résumé : 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. En ligne : http://dx.doi.org/10.1111/jcpp.13460 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=456

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