Tulane Pioneers Treatment of Preschoolers After Trauma

May 20, 2005

Fran Simon
Phone: 504-247-1425

The Tulane University Young Child Trauma Project recently received a three-year grant of more than $600,000 to evaluate the effectiveness of a systematic approach to treating posttraumatic stress disorder (PTSD) in preschool children. The Tulane team developed the first treatment manual for very young children who survive a trauma they perceive is life-threatening. Tulane has provided the manual free to mental health professionals at 64 sites in the U.S., New Zealand and England.

"A treatment manual for young children previously only existed for sexual trauma, so we developed a cognitive-behavioral therapy program for children aged three to six years of age who have suffered a wide variety of trauma situations," says Tulane child psychiatrist Michael Scheeringa. "Cognitive-behavioral therapy has been shown effective in treating older patients for the symptoms of PTSD. Now, we're going to determine its effectiveness in treating young children who suffer from PTSD."

The manual is based upon the team's two-year study of a group of 62 preschool children who had experienced life-threatening traumatic experiences, including witnessing domestic violence, automobile accidents and receiving invasive cancer treatment. A subset of 19 children received standard treatment from a variety of community clinics.

"We were surprised to find that standard community therapy, does not improve the child's symptoms of posttraumatic stress disorder," Scheeringa says. The traditional treatment involved non-directive play therapy with the child, without intensive involvement of a parent. "We believe it's important to involve heavily a parent in therapy of a child who has PTSD," Scheeringa says. "The child needs to address feelings toward the parent, such as anger at not being protected, and the parent needs to address their own feelings."

The manual details two steps of cognitive-behavioral therapy that the team recommends:

- Training the child in relaxation therapy to handle anxiety, including breathing exercises, muscle relaxation techniques and imagining positive images
- Systematically re-exposing the child to memories of the traumatic event, using the new relaxation tools to desensitize the child to the traumatic stimulus Scheeringa says the program worked well in one pilot case of a girl who had witnessed severe domestic violence.

The child and her mother moved away from the home where the violence occurred, and the girl was irritable and had angry outbursts. After learning the relaxation exercises, the mother started walking with her daughter closer to the house, coaching the child along the way in the relaxation methods. At first, the girl ranked a 10 out of 10 on a stress scale when she was two blocks away from the old house.

"The mother was amazed to see weekly improvement," Scheeringa says. "Overall, the child was calmer and less irritable."

Often, parents say the main problems with children who have PTSD are defiant behavior, opposition and new aggression, although these signs are not among the 17 symptoms used to diagnose PTSD, Scheeringa says. Other signs of PTSD in young children include nightmares or other sleep problems, and feeling scared by reminders of the trauma.

For more information about volunteering for the study, which is for New Orleans-area children three to six years of age, call 504.988.1438.

Tulane University, New Orleans, LA 70118 504-865-5000