title: Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate community-provided trauma-focused cognitive behavior therapy (TF-CBT) compared with usual community treatment for children with intimate partner violence (IPV)-related posttraumatic stress disorder (PTSD) symptoms.
  
  
  METHODS
  Randomized controlled trial conducted using blinded evaluators.
  
  
  METHODS
  Recruitment, screening, and treatment were conducted at a community IPV center between September 1, 2004, and June 30, 2009.
  
  
  METHODS
  Of 140 consecutively referred 7- to 14-year-old children, 124 participated.
  
  
  METHODS
  Children and mothers were randomly assigned to receive 8 sessions of TF-CBT or usual care (child-centered therapy).
  
  
  METHODS
  Total child PTSD symptoms assessed using child and parent structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version [K-SADS-PL]) and self-report (University of California at Los Angeles PTSD Reaction Index [RI]). Secondary child outcomes were scores on the K-SADS-PL (PTSD symptom clusters), Screen for Child Anxiety Related Emotional Disorders (SCARED) (anxiety), Children's Depression Inventory (depression), Kaufman Brief Intelligence Test (cognitive functioning), and Child Behavior Checklist (total behavior problems).
  
  
  RESULTS
  Intent-to-treat analysis using last observation carried forward showed superior outcomes for TF-CBT on the total K-SADS-PL (mean difference, 1.63; 95% confidence interval [CI], 0.44-2.82), RI (mean difference, 5.5; 95% CI, 1.37-9.63), K-SADS-PL hyperarousal (mean difference, 0.71; 95% CI, 0.22-1.20), K-SADS-PL avoidance (0.55; 0.07-1.03), and SCARED (mean difference, 5.13; 95% CI, 1.31-8.96). Multiple imputation analyses confirmed most of these findings. The TF-CBT completers experienced significantly greater PTSD diagnostic remission (χ(2) = 4.67, P = .03) and had significantly fewer serious adverse events.
  
  
  CONCLUSIONS
  Community TF-CBT effectively improves children's IPV-related PTSD and anxiety.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00183326.
authors.affiliation: Department of Psychiatry, Allegheny General Hospital, Pittsburgh, PA 15212, USA. jcohen1@wpahs.org
authors.forename: Judith A
authors.initials: JA
authors.lastname: Cohen
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Mannarino
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001008:Anxiety Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000706:statistics & numerical data; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003863:Depression / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D017579:Domestic Violence / Q000706:statistics & numerical data; D004781:Environmental Exposure / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018802:Patient-Centered Care / Q000379:methods* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment; D012737:Sex Factors; D012742:Sex Offenses / Q000523:psychology / Q000706:statistics & numerical data*; D016037:Single-Blind Method; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome