Preschool PTSD Treatment (PPT)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Preschool PTSD Treatment (PPT) has been rated by the CEBC in the area of: Trauma Treatment - Client-Level Interventions (Child & Adolescent).

Target Population: 3-6 year old children with posttraumatic stress disorder (PTSD) symptoms

For children/adolescents ages: 3 – 6

Brief Description

PPT is a manualized, 12-session cognitive-behavioral therapy protocol to treat very young children with posttraumatic stress disorder (PTSD) and trauma-related symptoms. The sessions are either with the therapist working individually with the child (with the parent observing via a video feed) or with the parent and child together.

Program Goals:

The primary goal of Preschool PTSD Treatment (PPT) is:

  • The reduction of PTSD symptoms in children

Essential Components

The essential components of Preschool PTSD Treatment (PPT) include:

  • Psychoeducation about posttraumatic stress disorder (PTSD) with pictorial aids for young children
  • A focus on defiant behavior and discipline plans following trauma
  • Identification of feelings and gradations of feelings in young children
  • Relaxation exercises as new coping skills
  • Narrative techniques for recall of traumatic events
  • In-office and homework exposure exercises
  • Development of developmentally appropriate safety plans
  • Relapse prevention session
  • Attunement of parents to children’s internalized phenomena through observation of sessions and reflection with therapist
  • Involvement of caregivers in every aspect of treatment
  • Direct discussion of reluctance to attend therapy
  • Time for caregivers to discuss their personal issues if appropriate

Child/Adolescent Services

Preschool PTSD Treatment (PPT) directly provides services to children/adolescents and addresses the following:

  • Posttraumatic stress disorder (PTSD) symptoms
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: At least one primary caregiver is involved in every therapy session, either in the room with the therapist and the child, or observing the child’s sessions on TV, or talking alone with the therapist. Caregivers are also essential for conducting in vivo (outside the office) exposure exercises as homework with the children.

Delivery Setting

This program is typically conducted in a(n):

  • Outpatient Clinic

Homework

Preschool PTSD Treatment (PPT) includes a homework component:

Parents are encouraged to conduct exposure exercises with their children between sessions.

Languages

Preschool PTSD Treatment (PPT) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

It is recommended that the caregiver watch the child’s sessions on TV (via a video feed) in real time. This requires a camera and a monitor and a second room for the parent. There are other technical ways to achieve this (baby monitor, laptop webcam, etc.). It is also helpful to have an additional staff person to supervise the children while the caregivers speak separately with the therapists.

Minimum Provider Qualifications

Licensed mental health clinician. The manual is designed to be delivered by beginners, but experience with cognitive-behavioral therapy and experience with young children are helpful.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Onsite

Number of days/hours:

Two days

Implementation Information

Since Preschool PTSD Treatment (PPT) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Preschool PTSD Treatment (PPT).

Formal Support for Implementation

There is no formal support available for implementation of Preschool PTSD Treatment (PPT).

Fidelity Measures

There are fidelity measures for Preschool PTSD Treatment (PPT) as listed below:

The fidelity measure is called the The Fidelity and Achievement Checklist. It is available in the published manual Treating PTSD in Preschoolers: A Clinical Guide (Guilford Press, 2016).

Implementation Guides or Manuals

There are implementation guides or manuals for Preschool PTSD Treatment (PPT) as listed below:

The PPT manual includes extensive guidance on implementation with tips and vignettes from real cases. It is available in the book Treating PTSD in Preschoolers: A Clinical Guide (Guilford Press, 2016).

Research on How to Implement the Program

Research has not been conducted on how to implement Preschool PTSD Treatment (PPT).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya-Jackson, L., & Guthrie, D. (2011). Trauma-Focused Cognitive-Behavioral Therapy for posttraumatic stress disorder in three through six year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52(8), 853-860.

Type of Study: Randomized controlled trial
Number of Participants: 64

Population:

  • Age — Children: Mean=5.3 years, Caregiver: Mean=34.8 years
  • Race/Ethnicity — Children: 59.5% Black/African American, 35.1% White, and 5.4% Other; Caregiver: Not specified
  • Gender — Children: 66.2% Male; Caregiver: Not specified
  • Status — Participants were children who suffered acute single blow trauma, suffered chronic repeated traumatic events, or were victims of the Hurricane Katrina disaster and their caregivers.

Location/Institution: Location/Institution: New Orleans metropolitan area

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the efficacy and feasibility of Preschool PTSD Treatment (PPT) for treating posttraumatic stress disorder (PTSD) in children 3-6 years of age exposed to heterogeneous types of traumas. Note that the model utilized in this study used specific Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) techniques with young children [now called PPT]. Children were assigned to either a 12-session treatment group or 12-week waitlist group. Measures utilized include Treatment Fidelity Checklist (TFC), the Preschool Age Psychiatric Assessment (PAPA), the Adverse Events Checklist (AEC), and the Adaptability Checklist–Child (ACC). Results indicated the treatment group improved significantly more on symptoms of PTSD, but not on depression, separation anxiety, oppositional defiant, or attention deficit/hyperactivity disorders. After the waiting period, all participants were offered treatment. Effect sizes were large for PTSD, depression, separation anxiety, and oppositional defiant disorders, but not attention-deficit/hyperactivity disorder. At follow-up, the effect size increased for PTSD, while remaining fairly constant for the comorbid disorders. The frequencies with which children were able to understand and complete specific TF-CBT techniques documented the feasibility this treatment across this age span [now called PPT]. Limitations include high attrition rates and small sample size.

Length of postintervention follow-up: 6 months (intervention group only).

Weems C. F., & Scheeringa, M. S. (2013). Maternal depression and treatment gains following a cognitive behavioral intervention for posttraumatic stress in preschool children. Journal of Anxiety Disorders, 27(1), 140-146.

Type of Study: Randomized controlled trial
Number of Participants: 64

Population:

  • Age — Children: Mean=5.3 years; Caregiver: Mean=34.8 years
  • Race/Ethnicity — Children: 59.5% Black/African American, 35.1% White, and 5.4% Other; Caregiver: Not specified
  • Gender — Children: 66.2% Male, Caregiver: Not specified
  • Status — Participants were children who suffered acute single blow trauma, suffered chronic repeated traumatic events, or were victims of the Hurricane Katrina disaster and their caregivers.

Location/Institution: New Orleans metropolitan area

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study uses the same sample as Scheeringa, et al. (2011). This paper examines maternal and child characteristics as moderators of the cognitive-behavioral intervention’s [now called Preschool PTSD Treatment (PPT)] outcomes in preschool children. Children were randomly assigned to either a 12-session treatment group or a 12-week waitlist group. Measures utilized include the Preschool Age Psychiatric Assessment (PAPA) and the NIMH-Diagnostic Interview Schedule (DIS) modules for major depression and posttraumatic stress disorder (PTSD). Results indicated maternal depression was associated with higher initial child PTSD symptoms, and was associated with increasing PTSD symptom trends at follow-up suggesting potential child PTSD symptom relapse. Maternal PTSD symptoms similarly predicted differential child separation anxiety symptom change, but not child PTSD symptom change. Limitations include high attrition rates and small sample size.

Length of postintervention follow-up: 6 months (intervention group only).

References

Scheeringa, M. S., Salloum, A., Arnberger, R. A., Weems, C. F., Amaya-Jackson, L., & Cohen, J. A. (2007). Feasibility and effectiveness of cognitive-behavioral therapy for posttraumatic stress disorder in preschool children: Two case reports. Journal of Traumatic Stress, 20(4), 631-636.

Contact Information

Name: Michael Scheeringa, MD
Agency/Affiliation: Tulane University
Department: Department of Psychiatry and Behavioral Sciences
Website: www2.tulane.edu/som/departments/psychiatry/ScheeringaLab/manuals-training.cfm
Email:
Phone: (504) 988-2167
Fax: (504) 988-6531

Date Research Evidence Last Reviewed by CEBC: July 2017

Date Program Content Last Reviewed by Program Staff: May 2017

Date Program Originally Loaded onto CEBC: December 2013