A cost effective way to help children after trauma

There is an increasing shift in community health to looking at more cost effective models to treat children and young people who have a range of mental health difficulties, including anxiety, depression and more recently post-traumatic stress. One of the models that is currently being trialled is a stepped care model. You can read more about the latest research on this here. 

Stepped care models provide treatments that are designed to minimise the use of therapist hours as well as costs, time and inconvenience to those participating in the therapy. Therapists provide treatment in steps according to the needs of the individual they are treating. Step 1 involves few therapist sessions, with clients working through material at home and accessing support as needed. Clients are monitored and assessed to determine if they then need more intensive treatment following Step 1, and if they do, they proceed to Step 2, involving an increase in one on one sessions with therapists. 

This is a particularly useful model to consider in the treatment of young children who have experienced trauma. There is often limited access to therapists who are well trained in treating symptoms of trauma in young children, and the services that they typically present to - community and public health systems - are often limited in terms of providing cost intensive treatments. Step 1 of the stepped care model for treating trauma, also puts the parent in the role of providing some of the treatment, an element which has been strongly supported in therapy with younger children. A potential barrier to treatment for parents of young children seeking or completing treatment is the parents desire to solve the problem related to the child on their own. With both parents and children both actively involved in therapy it is likely that it will be more successful. Some of the components of the intervention that has been trialled include: 

• 3 sessions with a therapist
• workbooks for both the parents and the child to work through at home that incorporates exposure tasks and relaxation exercises
• phone calls to therapist for support
• access to psychoeducation through online resources 

This is a promising development in the area of treating children affected by trauma, with the potential to allow greater access to children earlier in life. For more information on the latest research and news coming out in this area, subscribe to the Australian Child & Adolescent Trauma, Loss & Grief Network and visit our Journals section. 

A link between ADHD and trauma

A recent study by the American Academy of Pediatrics has found that children who have a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) are more likely to experience more adverse life events than those children without ADHD. The researchers involved in the study analysed data from the National Survey of Children's Health in the United States. They found: 

• 17% of children with ADHD experienced 4 or more adverse events compared to 6% of children without ADHD. 
• These children with 4 or more adverse events were more likely to be using medication to treat the ADHD. 
• The parents of these children with ADHD and 4 or more adverse events were more likely to rate their child's ADHD as moderate to severe. 

The adversities that were measured as part of the study included divorce; death of a parent or guardian; discrimination; domestic violence; mental health difficulties in the family; incarceration of a family member; neighbourhood violence; living in poverty; and substance abuse in the family. 

The results of this study are interesting for many reasons, especially given the ongoing public concern that there is an over diagnosis of ADHD in the community. 

Many of the symptoms that a child displays when they have been negatively impacted by an adverse or potentially traumatic event, are very similar to symptoms that children who are diagnosed with ADHD present with. These include symptoms such as difficulties in concentration and attention, difficulties in organisation, difficulties in relating to others and difficulties in behaviour. 

The study highlights the need that those working with children and young people need to be trauma aware and trauma informed. Unfortunately, there are some cases where children do get misdiagnosed and treating a child for ADHD when they are presenting with behaviours and symptoms of trauma is not meeting the needs of the child.