Australian guidelines on treating trauma

This week, the Australian Centre for Posttraumatic Mental Health (ACPMH) released their latest Guidelines on the treatment of Posttraumatic Stresss Disorder (PTSD) and Acute Stress Disorder (ASD). The ACPMH are to be congratulated on the development of such a comprehensive resource. 

Of course, we were particularly interested to read what they had to say about the treatment of trauma in kids. The guidelines highlight that around two third of kids in the US will experience a traumatic event by the time that they are 16 years old, and we can say that similar statistics have been found in Australia as well. Whilst most of these events will be potentially traumatic events (ie most kids will be resilient but some will experience negative outcomes as a result of the trauma), it really show us the need to pay more attention to kids and trauma. 

The guidelines provide great guidance for clinicians on the important considerations around family: such as the impact that the family functioning will have on the child's response to the traumatic event; the importance and need to engage with the family, especially in the treatment of younger children; and the differences that can sometimes be present in the child and parents understanding of the impact of the traumatic event. 

The ACPMH has included a good summary of the literature around the pre and post trauma risk factors for the development of trauma in children. The identification of these risk factors being so important in the prevention and early intervention of trauma. 

These guidelines provide us with some interesting insights around the treatment of PTSD in children and adolescents. First of all, it is worth noting that the guidelines remind us that when a child is exposed to trauma, it is not only PTSD that they may develop. Children and young people exposed to trauma often present for treatment for depression or anxiety and increasingly difficulties with behaviour and education. Trauma focussed cognitive behavioural therapy (TF CBT) is featured as the treatment with the greatest evidence base for children. The guidelines also feature information on the success of TF CBT in school environments, especially post disaster, with these interventions reaching greater numbers of kids who stay engaged with the intervention for longer periods of time. The role that school professionals play in these interventions needs to be recognised and supported. 

What we can also gain from reading these guidelines is that there remains so much important work to be done in the area of childhood trauma. There needs to a lot more work done in the area of complex trauma, which we know has the potential to be so damaging for children and young people. We also need to be looking more closely at the needs of infants who experience trauma. After a disaster, or other mass trauma, infants are often overlooked when providing assistance and interventions and they often miss out on the benefits of school based interventions. And, of course, we need to keep finding out more about what works to help kids who are traumatised.