New Parameters for Assessing and Treating PTSD

Early identification of post traumatic stress disorder (PTSD) and use of trauma-focused psychotherapy in children and adolescents are among the key topics addressed in the updated Practice Parameter for the Assessment and Treatment of Children and Adolescents with Posttraumatic Stress Disorder, which was recently released by the AACAP.

Originally published in 1998 in the Journal of the American Academy of Child and Adolescent Psychiatry, the AACAP Practice Parameters are designed to assist clinicians in providing high quality assessment and treatment for children and adolescents that is consistent with the best available scientific evidence and clinical consensus.

The 2010 version highlights the importance of early identification of PTSD, the importance of gathering information from parents and children, and the assessment and treatment of comorbid disorders. It presents evidence to support trauma-focused psychotherapy, medications, and a combination of interventions in a multimodal approach.

According to the AACAP, more than one of four children experiences a significant traumatic event before reaching adulthood. These traumas may include events such as child abuse; domestic, community, or school violence; disasters, vehicular or other accidents, medical traumas, war, terrorism, refugee trauma, the traumatic death of significant others; or other shocking, unexpected or terrifying experiences. And although most children are resilient after trauma exposure, some develop significant and potentially long-lasting mental health problems.

The Practice Parameter was developed to help child and adolescent psychiatrists and other medical and mental health professionals assess and treat the condition more effectively.

Recommendations from AACAP are as follows:Screening

1. The psychiatric assessment of children and adolescents should routinely include questions about traumatic experiences and PTSD symptom.

Evaluation

2. If screening indicates significant PTSD symptoms, the clinician should conduct a formal evaluation to determine whether PTSD is present, the severity of those symptoms, and the degree of functional impairment. Parents or other caregivers should be included in this evaluation wherever possible.

3. The psychiatric assessment should consider differential diagnoses of other psychiatric disorders and physical conditions that may mimic PTSD.

4. Treatment planning should consider a comprehensive treatment approach which includes consideration of the severity and degree of impairment of the child’s PTSD symptoms.

5. Treatment planning should incorporate appropriate interventions for comorbid psychiatric disorders.

6. Trauma-focused psychotherapies should be considered first-line treatments for children and adolescents with PTSD.

7. SSRIs can be considered for the treatment of children and adolescents with PTSD.

8. Medications other than SSRIs may be considered for children and adolescents with PTSD.

9. Treatment planning may consider school-based accommodations.

10. Use of restrictive “rebirthing” therapies and other techniques that bind, restrict, withhold food or water, or are otherwise coercive are not endorsed.

Prevention and Early Screening

11. School- or other community-based screening for PTSD symptoms and risk factors should be conducted after traumatic events that affect significant numbers of children.

To access the Practice Parameters, click here.