Treating Children and Adolescents with Posttraumatic Stress Disorder: Moderators of Treatment Response

Youth exposed to a wide range of potentially traumatic events, such as natural disasters, acts of violence, terrorism, motor vehicle accidents, and life-threatening illnesses, are at risk for developing posttraumatic stress disorder (PTSD) or significant posttraumatic stress symptoms (PTSS). Recent reviews of the existing evidence-base for the treatment of PTSD in children and adolescents identified trauma-focused cognitive behavioral therapy (TF-CBT) and cognitive behavioral therapy (CBT) as well-established treatments. However, studies that evaluated treatment moderators have been scant. Research on treatment moderators is important for guiding clinical decision-making around selecting treatments that might be most effective given the characteristics and circumstances of a particular child or adolescent. Thus, this article provides an updated review of potential moderators evaluated in recent (i.e., past 5 years) meta-analyses and systematic reviews of psychological treatments for PTSD in youth. The moderators examined were in the areas of youth characteristics (age, gender, ethnicity, domicile), parent/caregiver factors (involvement, functioning), trauma type, and treatment factors (dose, individual/group, provider, exposure elements, sudden gains). Some support was identified for age, gender, domicile, parent/caregiver involvement, maternal depressive symptoms, treatment dose, individual/group, and sudden gains as possible treatment moderators, although the strength of the evidence varied and more research is needed to clarify findings. Further study of moderators will be essential to advance the knowledge base in the treatment of PTSD in youth.