Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Does Science Know How to Treat Traumatized Children? in the Wake of the Newtown Massacre, the Answer Is No

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Does Science Know How to Treat Traumatized Children? in the Wake of the Newtown Massacre, the Answer Is No

Article excerpt

Ever since the horrific shootings at Connecticut's Sandy Hook Elementary School in December, Mary Jo Barrett has been getting a steady stream of phone calls from therapists treating the schoolchildren who survived.

How should they proceed, they ask Ms. Barrett, an internationally renowned expert in child trauma. With parent-child interaction therapy? Cognitive behavioral therapy? Art therapy? Yoga therapy?

One child is going home to a mother "who is completely fragmented and derailed," noted Ms. Barrett, executive director of the Center for Contextual Change in Chicago, an integrative trauma center. "So in that case, I told the therapist that the focus has to be on doing some work with the mother."

There is, she notes, "no one-size-fits-all."

But in an article published in the journal Pediatrics earlier this month, some researchers said that's exactly the problem. Because of inadequate research, there is no consensus about what works and what doesn't.

"Based on the evidence, we can make very few recommendations about what the best treatment is for children," said Valerie Forman- Hoffman, a psychiatric epidemiologist at RTI International, a research institute in North Carolina and one of the authors of the study. It was commissioned by the federal Agency for Healthcare Research and Quality as part of a regular "comparative effectiveness review" of federally funded research.

However, trauma-focused cognitive behavior therapy -- developed in part by Judith Cohen and Anthony Mannarino at Allegheny General Hospital -- did get good marks in the Pediatrics study for its step- by-step approach of relaxing the child, teaching coping strategies and visualization to control disturbing thoughts and helping the child construct a personal story about what happened.

But Dr. Cohen isn't returning the favor. She noted that the Pediatrics study made an unnecessary distinction between "nonrelational" trauma -- one-time events such as shootings, accidents or natural disasters -- and the far more common "relational" traumas experienced by children in homes with domestic violence or sexual abuse.

"There is this presumption that there are critical differences between these different kinds of trauma, when in fact there is no evidence to back up that premise. Our current understanding of trauma is that there are many more commonalities than there are differences in how children respond to treatment for multiple types of traumas."

Indeed, the researchers in the journal article seemed to be aiming at a particular audience, perhaps on Capitol Hill, said David Kolko, professor of psychiatry, psychology and pediatrics at the University of Pittsburgh School of Medicine, "which perhaps is a prudent approach to stimulating financial support for additional research on trauma from a political viewpoint."

Dr. Kolko has been the lead developer of another widely used therapy for family conflict, called Alternative For Families: A Cognitive Behavioral Therapy, which involves skills training with caregivers and their children. Work focuses on helping children learn to self-regulate their emotional responses -- "to adjust the thermostat" -- when they have distressing or upsetting reactions to traumatic events.

The researchers in the Pediatrics study issued "a call to action" for more funding and research, an appeal perhaps aimed at those members of Congress who might hesitate to fund studies of children traumatized by frequent gun violence in Chicago or Philadelphia -- but jump at the opportunity to do something for victims of school shootings such as those in Newtown, Conn., where Adam Lanza killed 20 first-graders and six staff members before killing himself.

"With Sandy Hook, some of those kids will do just fine with a debriefing, while others may require completely different measures," said Ms. Barrett. "The model I use is organizational therapy -- which means, quite simply, to organize therapies and responses around the needs of the patient, whether it's art or play therapy, or cognitive therapy. …

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