Systematic review finds TF-CBT most supported for trauma in children under 12

INTRODUCTION: Treatment effects among trauma-exposed child populations (≤12 years) are understudied. Practicians must therefore rely on their own clinical experience and evidence from older children when deciding on interventions for young, traumatized children. The present study aimed to review the evidence for 12 psychological treatments employed with trauma-exposed child populations. METHODS: Systematic literature searches for quantitative studies with pre-post designs were conducted separately for each method across six databases. Results were narratively synthesized and assessed on strength of evidence and methodological quality. For TF-CBT, EMDR, play therapy, CPP, and Sandplay, supplementary three-level meta-analyses of controlled studies were conducted. RESULTS: A total of 127 studies involving N = 5689 children were included in the narrative synthesis with most studies concerning TF-CBT. Study methodological quality varied considerably. For five of the assessed treatments (KIDNET, the Neuro-Affective Relational Model, Somatic Experiencing®, the Sleeping Dogs Method, and Compassion-Focused Therapy), no evidence was available. The partial meta-analyses revealed a large effect size for Sandplay (k = 3), moderate-to-large effect for TF-CBT (k = 24) and small-to-moderate effects for EMDR (k = 6), play therapy (k = 10), and CPP (k = 5). DISCUSSION AND CONCLUSIONS: TF-CBT is currently the most empirically supported intervention for treating trauma-related symptoms among children ≤12 years. Findings are discussed in light of methodological limitations embedded in the literature reviewed and in relation to current international treatment guidelines for PTSD in children and youth. Future research should focus on studying treatments with meager or no evidence, developmentally sensitive method refinements and more diverse samples e.g., younger ages, cultural background, trauma type(s), and associated symptomatology.