Nyt om behandling af børn og unge med traumer

Der er gode nyheder, og ikke overraskende, der er dårlige nyheder for børn og unge som kæmper med de psykologiske eftervirkninger af traumer. På den god side, forskning viser, at kognitiv-adfærdsmæssig terapi letter posttraumatisk stress disorder og andre traume-relaterede problemer hos de unge. På den negative side, de fleste behandlere, psykologer og psykiatere, anvender behandlingsformer til børn og teenagere, der mangler videnskabelig støtte.

Konklusionerne kommer fra et research review foretaget af Task Force on Community Preventive Services, en gruppe på 12 forskere delvist finansieret af den føderale regering. Resultaterne er publiceret i september udgaven af American Journal of Preventive Medicine.

Børn med traume-relaterede psykiske problemer har tendens til at klare sig dårligt i skolen, hvis de er ubehandlet eller behandlet forkert.

Det anslås at en ud af otte børn har oplevet fysisk eller seksuelt misbrug, vanrøgt, mobning og andre former for mishandling. Mere end én ud af tre har oplevet vold eller oplevet det indirekte. Børn der oplever traumer kan udvikle PTSD eller andre lidelser.

Der er evidens for at individuel og gruppe kognitiv-adfærdsterapeutisk behandling reducerer symptomerne på PTSD, depression, angst og relaterede adfærdsmæssige problemer i traumatiserede børn og unge, i følge Task Force rapporten. Kognitiv-adfærdsmæssige teknikker omfatter diskussion eller at skrive om traumatiske oplevelser, lære afslapningsteknikker og erstatte paralyserende frygt med mere realistiske vurderinger. Ugentlige møder kan strække sig over en til tre måneder.

Review rapporten finder ikke tilstrækkelige beviser for at anbefale nogen af de fem andre almindelige behandlingstilgange: play terapi, kunst terapi, medicinsk behandling, psykodynamisk terapi eller psykologisk debriefing.

Psykodynamisk terapi fokuserer på at ændre ubevidste reaktioner på traumatiske begivenheder. Debriefing består af gruppediskussioner og uddannelse en til tre dage efter en traumatisk begivenhed.

Mere end tre fjerdedele af U.S. mental health professionals, der behandler børn og teenagere med PTSD oplyser at de anvender behandlinger, der ikke er blevet videnskabeligt reviewed eller deres effektivitet kunne ikke bestemmes af Task Force gruppen.

The Effectiveness of Interventions to Reduce Psychological Harm from Traumatic Events Among Children and Adolescents: A Systematic Review.
Holly R. Wethington, Robert A. Hahn, Dawna S. Fuqua-Whitley, Theresa Ann Sipe, Alex E. Crosby, Robert L. Johnson, Akiva M. Liberman, Eve Moscicki, LeShawndra N. Price, Farris K. Tuma, Geetika Kalra, Sajal K. Chattopadhyay and Task Force on Community Preventive Services.

American Journal of Preventive Medicine, Volume 35, Issue 3, Pages 287-313 (September 2008)

Recommendations to Reduce Psychological Harm from Traumatic Events Among Children and Adolescents; Task Force on Community Preventive Services. American Journal of Preventive Medicine,
Volume 35, Issue 3, pages 314-316 (September 2008).

Tilføjelse 7. oktober 2008:
Artikel i JP: Børn i tusindvis bliver mishandlet i Danmark.

Læs abstrakt fra artikel i American Journal of Preventive Medicine:

Abstract:

Children and adolescents in the U.S. and worldwide are commonly exposed to traumatic events, yet practitioners treating these young people to reduce subsequent psychological harm may not be aware of—or use—interventions based on the best available evidence. This systematic review evaluated interventions commonly used to reduce psychological harm among children and adolescents exposed to traumatic events. Guide to Community Preventive Services (Community Guide) criteria were used to assess study design and execution. Meta-analyses were conducted, stratifying by traumatic exposures.
Evaluated interventions were conducted in high-income economies, published up to March 2007. Subjects in studies were =21 years of age, exposed to individual/mass, intentional/unintentional, or manmade/natural traumatic events.

The seven evaluated interventions were individual cognitive–behavioral therapy, group cognitive behavioral therapy, play therapy, art therapy, psychodynamic therapy, and pharmacologic therapy for symptomatic children and adolescents, and psychological debriefing, regardless of symptoms. The main outcome measures were indices of depressive disorders, anxiety and posttraumatic stress disorder, internalizing and externalizing disorders, and suicidal behavior.

Strong evidence (according to Community Guide rules) showed that individual and group cognitive–behavioral therapy can decrease psychological harm among symptomatic children and adolescents exposed to trauma. Evidence was insufficient to determine the effectiveness of play therapy, art therapy, pharmacologic therapy, psychodynamic therapy, or psychological debriefing in reducing psychological harm.

Personnel treating children and adolescents exposed to traumatic events should use interventions for which evidence of effectiveness is available, such as individual and group cognitive–behavior therapy. Interventions should be adapted for use in diverse populations and settings. Research should be pursued on the effectiveness of interventions for which evidence is currently insufficient.

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