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Evidence lacking on how to help kids after trauma

By Genevra Pittman

NEW YORK (Reuters Health) - There's no good evidence to say what types of treatment might help ward off anxiety and stress disorders in kids and teens exposed to traumatic events, according to a new analysis.

Researchers said that a few psychological interventions, including talk therapy and school-based programs, "appear promising" for helping young people cope with the kind of trauma stemming from accidents, mass shootings and natural disasters. But so far, there are too many holes in the data to know what to recommend for children's long-term health and wellbeing, according to Meera Viswanathan from RTI International in Research Triangle Park, North Carolina, and her colleagues.

Nicole Nugent, who has studied stress disorders in kids at Warren Alpert Medical School of Brown University in Providence, Rhode Island, said one difficulty is that children get exposed to many different types of trauma, and as a result have many different treatment needs.

Nonetheless, "We can't just say, ‘Let's just not address it until we know more about the interventions that are effective,'" Nugent, who wasn't involved in the new review, told Reuters Health.

"One thing that we know doesn't work is nothing," she said.

"Something horrible happens, and (kids) think, ‘If I don't think about it, if I don't talk about it, it will go away.' And that absolutely doesn't happen."

So-called nonrelational trauma is different from interpersonal trauma, which stems from acts committed by a person the child knows, such as sexual abuse or maltreatment by a friend or family member.

The young victim in the recent Alabama hostage drama, a six-year-old known only as Ethan, who was held in an underground bunker for six days, could have suffered nonrelational trauma because he didn't have a prior relationship with his kidnapper, Viswanathan said.

In an interview today on the "Dr. Phil" television show, Ethan's mother talked about the boy's emotional state since being rescued, including his difficulty sleeping - a symptom common among both kids and adults following trauma.

Viswanathan's team analyzed 25 studies in which children who had been exposed to nonrelational trauma were assigned to a particular treatment intervention or a comparison group.

Depending on the trial, some of those children were already experiencing anxiety and other symptoms related to the trauma.

Treatment programs varied in their methods - from medication to talk therapy - as well as in their intensity and how long they lasted.

None of the studies testing medications such as antidepressants found they had a positive effect on children's mental health, according to the findings published Monday in Pediatrics.

On the other hand, youth who went through some type of talk therapy tended to do better than others who weren't treated at all - though Viswanathan called that pattern a "weak signal."

Researchers said some of what has been learned helping children who experience interpersonal trauma can be applied to young survivors of accidents and natural disasters as well.

"In the absence of other evidence," Viswanathan told Reuters Health, "certainly don't ignore the problem. Provide children with the support that can be available, and also tailor it for the needs of the children."

She urged for more research looking at how kids respond to nonrelational trauma, in particular.

"Sadly, the shootings in Newtown are unlikely to be the last that we see, and we don't want to be in a position that we wish we had better evidence" on how to help children move on.

SOURCE: http://bit.ly/XAOQ3Z Pediatrics, online February 11, 2013.

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