Academic journal article New Zealand Journal of Psychology

Trauma-Focused Cognitive Behavioural Therapy for Abused Children with Posttraumatic Stress Disorder: A Pilot Study

Academic journal article New Zealand Journal of Psychology

Trauma-Focused Cognitive Behavioural Therapy for Abused Children with Posttraumatic Stress Disorder: A Pilot Study

Article excerpt

A manualised trauma-focused cognitive behavioural therapy (TF-CBT) programme was developed for multiply-abused children diagnosed with posttraumatic stress disorder (PTSD; Feather & Ronan, 2004). It was piloted with 4 children (aged 9-14 years) referred to a specialist clinic of the statutory child protection agency. The locally developed programme built on efficacious treatments for childhood anxiety and PTSD as a result of sexual abuse. It comprises psychosocial strengthening, coping skills training, gradual exposure using creative media, and special issues relevant to trauma and abuse. A multiple baseline design was used to demonstrate the controlling effects of the treatment. The results indicate a good deal of promise. PTSD symptoms generally decreased and child coping increased. Gains improved over 3, 6, and 12 month follow-ups. Results are discussed in terms of the value of clinicians engaging in local research aimed at increasing outcomes for their clients.

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Child abuse (CA) statistics in New Zealand are alarmingly high. Violence against children leading to death is an indicator for non-fatal forms of CA. Of 27 wealthy nations, New Zealand had the third highest CA death rate (1.2 per 100,000) in the 1990's (UNICEF, 2003). Life time estimates of CA suggest that 4% to 10% of New Zealand children experience harsh or severe physical punishment and approximately 18% experience sexual abuse (Ministry of Health, 2001). It is commonly agreed by service providers in New Zealand that one in seven families experience family violence (Snively, 1994). Family violence encompasses child physical, sexual, and psychological/emotional abuse including threats and witnessing violence (The Risk Management Project, 1997). Notifications of suspected CA reported to the Child, Youth and Family Service of the Ministry of Social Development (CYF) continue to rise. CYF statistics show that intakes to the end of June 2005 stood at 53,097, up from 43,314 the year before (to end of June 2004) and 31,781 the year before that (year to end of June 2003). CA requiring further action was established in approximately 85% of these cases each year (Department of Child Youth and Family Services, 2005).

Clinical and population studies have found that CA is responsible for longterm psychiatric disabilities, medical problems, substance abuse, learning problems, interpersonal violence and other serious social and health problems (Mullen, Martin, Anderson, Romans, & Herbison, 1996; Streeck-Fischer & van der Kolk, 2000). While recent researchers have emphasised the potential for growth rather than pathology (Christopher, 2004), reviewers have identified that many children who have been abused demonstrate adverse reactions in their affective, cognitive, behavioural, and neurobiological development both in the short- and long- term (Berliner & Elliott, 2002; Glasser, 2000; Kaplan, Pelcovitz, & Labruna, 1999; Kendall-Tackett, Williams, & Finkelhor, 1993; Kitzmann, Gaylord, Holt, & Kenny, 2003; Kolko, 2002; Putnam, 2003). There is growing evidence that early comprehensive intervention may effectively reverse some of these changes and considerably lessen the long-term risk abused children pose to themselves and to society at large (Streeck-Fischer & van der Kolk, 2000).

It has been recognised that CA can lead to a pattern of psychological distress similar to that derived from other traumatic events (van der Kolk, Weisaeth, & van der Hart, 1996; Weaver & Clum, 1995). In 1980, the psychological effects of trauma exposure became subsumed under the diagnosis of Posttraumatic Stress Disorder (PTSD) (American Psychiatric Association, 1980). In 1987, it was acknowledged that PTSD can also occur in children (American Psychiatric Association, 1987). In fact, children appear to be the demographic group at highest risk for PTSD (e.g., Norris et al., 2002). Like adults, children show the cardinal tripartite grouping of symptoms: re-experiencing, avoidance and increased arousal (American Psychiatric Association, 1994). …

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