AGH Center for Traumatic Stress in Children and Adolescents

This project is a follow-up study of a multisite randomized controlled trial to evaluate the durability of treatment effects for children with sexual abuse-related posttraumatic stress disorder (PTSD) symptoms. The original trial compared trauma-focused cognitive-behavioral therapy (TF-CBT) with child-centered therapy (CCT) for children ages 8 to 14 and their primary caregivers. The follow-up assessed outcomes at 6 and 12 months after posttreatment evaluations for 183 children and their caregivers, with the aim of determining whether the relative advantages of TF-CBT observed immediately after treatment would persist over time and to identify pretreatment predictors of outcome.

Methodologically, the study used mixed-model repeated analyses of covariance to examine longitudinal symptom trajectories and caregiver distress. The primary outcomes included the severity and number of PTSD symptoms in children, clinical indicators of shame, and abuse-specific parental distress reported by caregivers. The participant sample was drawn from multiple sites, enabling examination of treatment effects across varied clinical settings and enhancing the generalizability of findings. The study also explored whether factors such as multiple traumatic exposures and baseline levels of depressive symptoms predicted posttreatment PTSD symptom counts within each treatment arm.

Findings demonstrated that children who received TF-CBT continued to report significantly fewer PTSD symptoms and lower levels of shame at both the 6- and 12-month follow-ups compared with children who received CCT. Caregivers who participated in TF-CBT likewise reported persistently lower levels of abuse-specific distress during the follow-up period relative to caregivers in the CCT condition. These sustained differences indicate that TF-CBT produced more durable improvements in both child trauma symptoms and caregiver well-being than did the non-directive, child-centered approach evaluated in the trial. Importantly, the study identified that among children assigned to CCT, those with histories of multiple traumas and higher pretreatment depression had higher numbers of PTSD symptoms at posttreatment, suggesting that certain pretreatment clinical characteristics can negatively influence outcomes in non-trauma-focused interventions.

The study's conclusions support the long-term effectiveness of TF-CBT for treating sexual abuse-related PTSD symptoms in children and for reducing associated feelings of shame and parental distress. The multisite randomized design and follow-up assessments strengthen confidence that TF-CBT yields meaningful, persistent clinical benefits for both children and their caregivers. These results underscore the importance of implementing trauma-focused, evidence-based interventions in clinical settings serving sexually abused children, and they highlight the need to consider pretreatment trauma exposure and comorbid depression when selecting or tailoring interventions. Funded through NIMH grant mechanisms listed on the publication, the study contributes robust follow-up evidence to the field of child traumatic stress and informs clinical decision-making regarding treatment selection for sexually abused youth and their families.