Posttraumatic stress disorder interventions for children aged zero to six years: a scoping review

Background: If left untreated, posttraumatic stress disorder (PTSD) has the potential to cause life-long risks to the health and wellbeing of young, traumatized children. Although DSM-5 diagnostic criteria recognize unique PTSD manifestations in children aged zero to six years, few well-established treatments exist.Objective: This review seeks to explore and synthesize the current literature on PTSD interventions for children aged zero to six years to inform the treatment and future research on effective, age-appropriate treatments.Method: A scoping review methodology was used to undertake this review. Following the creation of a comprehensive search strategy, a literature search utilizing the databases PubMed, CINAHL, and PsycINFO was conducted. A grey literature search was conducted in three different steps: (1) grey database search, (2) custom Google search, and (3) contacting relevant stakeholders/associations. All eligible studies were uploaded to Covidence (2024), a scoping review management service, to efficiently review and remove duplicate studies by two independent reviewers via a two-phase screening process.Results: We identified 37 original research articles that described the treatment of PTSD in children aged six years and under. Trauma-focused cognitive behavioural therapy (TF-CBT) was the most rigorously studied type of intervention with two published randomized controlled trials (RCTs). Child-parent psychotherapy (CPP), a skills-based form of dyadic psychotherapy, was established, with one published RCT and two large uncontrolled group studies. Most studies involved caregivers in the therapeutic process.Conclusions: It is recommended that methodologically rigorous studies further explore and compare treatment options in PTSD interventions for children aged zero to six years. No treatment recommendations are currently given for children aged zero to two years. TF-CBT is recommended to be the first-line therapy for children aged three to six years with PTSD.