It's become a standard line in the sad stories about a violent attack in a school, the suicide of a teenager, or a big natural disaster: Counselors are being provided to help the children with their grief. Professionals speak confidently about the need to help children and the many different approaches they have available.
But, in fact, there’s no hard evidence that any of them work. Grief counselors, therapists and social workers have no body of scientific data to draw from when they seek to help traumatized kids, a team of experts reports in Monday’s issue of the journal Pediatrics.
“People come to me and say ‘What works?’ and I answer, ‘We don’t really know,’” says Valerie Forman-Hoffman of RTI International in Research Triangle Park, N.C., who led the study.
“I don’t think that what this study is saying is that no treatment works,” Forman-Hoffman said in a telephone interview. ”I think that what our review shows is that we don’t have a good evidence base to make good recommendations.”
The need is clear, Forman-Hoffman and her colleagues say.
“Approximately two-thirds of children and adolescents younger than age 18 years will experience at least one traumatic event, creating a critical need to identify effective child trauma interventions,” they wrote. Traumatic events in this study included the death of a parent, a violent incident at school, wars, or natural disasters. They did not include personal events such as abuse by a parent or sexual abuse.
“Although some children exposed to trauma do not experience long-term negative consequences in terms of psychological and social functioning, many later develop traumatic stress syndromes, including posttraumatic stress disorder (PTSD),” they added. PTSD in turn can cause depression, and lead to substance abuse, suicide and behavior disorders.
The researchers -- who included a clinical psychologist, a child psychiatrist, a family physician specializing in child trauma, a psychiatric epidemiologist and a a developmental psychologist -- reviewed 25 articles based on 23 studies testing 20 different interventions.One thing was clear. Using drugs, including antidepressants, antispychotics and amphetamines, did not help in the short term. After that, results were fuzzy at best.“We found some evidence that some types of psychotherapies might be helpful,” Forman-Hoffman said. “Far more research is needed.”
The trouble is, it’s hard to conduct a neutral, balanced, unbiased study on something like therapy for trauma.
“Humans are so variable,” says Katey Smith, a counselor at Family Centers, a nonprofit organization in Fairfield, Conn.
“What works with some kids doesn’t work with others,” added Smith, who was not involved in the study. And a lot of it comes down to the observer, she says.
“Was it the treatment that made the child better or was it time? Who knows? It’s so hard to read the different pieces. There are so many different variables.”
Smith says it’s clear it takes a full court press to help a traumatized child. In her experience, the child needs help from a therapist with family, caregivers and teachers all helping, too.
“The child isn’t an island,” she says. Smith often uses an approach called trauma-focused cognitive behavioral therapy, or TF-CBT for short. She says it worked with a child who had suffered several traumas, but it took a lot of time and a lot of outside help.
“We teach the child the link between thoughts, feelings and actions,” says Smith. “We teach them how you can change your thoughts, which then changes your feelings and changes your behavior. We teach coping techniques like deep breathing and relaxation, so they have a little toolkit to use.”
Children need help remembering this, and they need parents and educators to understand so they can help.
“The parent has to be pretty invested in supporting the child through the process,” says Smith. “This particular mother was very involved. She didn’t just work in the session -- she took it home. She would prompt him: ‘Remember, this is what we do when we feel this way. We are going to do this deep breathing’,” said Smith.
”The mother was also good at modifying tools to make them fun,” Smith added. “For instance, she taught the child to treat intrusive thoughts like a radio station he could just change. “She’d say, ‘Let’s tune it to a song.’”
But assessing this? It would be difficult. “It’s individual to each kid,” Smith says. “You really have to be creative and find what works for the child you are working with.”