Cognitive Therapy for PTSD in Children and Adolescents

Children and adolescents exposed to traumatic events are at high risk of developing post-traumatic stress disorder (PTSD). With the rare exception of young children, their PTSD presentations at the symptom level are similar to those of trauma-exposed adults, as are their patterns of psychiatric comorbidity, particularly for adolescents. Untreated, at least a significant proportion will carry on with symptoms at or above the diagnostic threshold or at sub-threshold levels that are still clinically impairing. The presence of untreated or poorly treated PTSD symptoms leaves the young person at significantly increased risk of developing other psychiatric disorders, a worsening of any pre-existing conditions, and with greater long-term impairments in education, family, and peer functioning. Fortunately, evidence-based treatments exist with the first-line recommendation being trauma-focused cognitive behavioural therapies, with a growing body of evidence for the efficacy of eye movement desensitization and reprocessing therapy (EMDR). This chapter provides an update on the state of the literature with respect to the evidence base for trauma-focused cognitive behavioral therapy (CBT), and in particular, for an explicitly cognitive approach, originally developed for use with adults and successfully adapted for use with children and adolescents across the age range. The chapter describes the theoretical underpinning for this approach, guidance on reliving (a form of exposure to update the trauma memory) and the modification of trauma-related beliefs (two primary targets in treatment), parental involvement in treatment, dealing with comorbidity, and a case example.