Preschool PTSD Treatment (PPT)

About This Program

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

Program Overview

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

Logic Model

The program representative did not provide information about a Logic Model for Preschool PTSD Treatment (PPT).

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

Program Delivery

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.

Recommended Intensity:

One 60-minute session per week

Recommended Duration:

12 sessions

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.

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.

Manuals and Training

Prerequisite/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.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

  • Scheeringa, M. S. (2016). Treating PTSD in preschoolers: A clinical guide. Guilford Press.

The manual can be purchased in paperback or e-book from https://www.guilford.com/books/Treating-PTSD-in-Preschoolers/Michael-Scheeringa/9781462522330

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Onsite

Number of days/hours:

Two days

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 formal support available for implementation of Preschool PTSD Treatment (PPT) as listed below:

Formal support is optional. It is provided as a one-day training and then individual weekly supervision on a case to completion, which usually takes 3-6 months.

Fidelity Measures

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

Fidelity measures are available as free paper checklists from the program contact (see bottom of page) or as a paid mobile app called Therapy Fidelity at www.therapyfidelity.com. Training is not required to use them.

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

Child Welfare Outcome: Child/Family Well-Being

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. https://doi.org/10.1111/j.1469-7610.2010.02354.x

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: 60% Black/African American, 35% White, and 5% Other Race; Caregivers: Not specified
  • Gender — Children: 66% Male; Caregivers: 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 basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy and feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) for treating posttraumatic stress disorder (PTSD) in three- through six-year-old children exposed to heterogeneous types of traumas. Participants were randomly assigned in Phase 2 to either 12-session manualized TF-CBT [now called Preschool PTSD Treatment (PPT)] or 12-weeks waitlist. Measures utilized include the Treatment Fidelity Checklist (TFC), the Preschool Age Psychiatric Assessment (PAPA), the Adverse Events Checklist (AEC), and the Adaptability Checklist–Child (ACC). Results indicate that the TF-CBT 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 techniques documented the feasibility of TF-CBT across this age span. Limitations include that the study was conducted in a very young population that was mostly minority and single parent, the small size of the samples, and the 6-month follow-up was for the intervention group only.

Length of controlled postintervention follow-up: None.

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. https://doi.org/10.1016/j.janxdis.2012.11.003

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

Population:

  • Age — Children: Mean=5.3 years; Caregivers: Mean=34.8 years
  • Race/Ethnicity — Children: 60% Black/African American, 35% White, and 5% Other Race; Caregivers: Not specified
  • Gender — Children: 66% Male; Caregivers: 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 basic study design, measures, results, and notable limitations)
The study used the same sample as Scheeringa et al. (2011). The purpose of the study was to examine maternal and child characteristics as moderators of posttraumatic stress (PTS) treatment outcomes in preschool children. Participants were randomly assigned in Phase 2 to either 12-session manualized TF-CBT [now called Preschool PTSD Treatment (PPT)] or 12-weeks waitlist. Measures utilized include the Treatment Fidelity Checklist (TFC), the Preschool Age Psychiatric Assessment (PAPA), the Adverse Events Checklist (AEC), and the Adaptability Checklist–Child (ACC). Results indicate that maternal depression was associated with higher initial child posttraumatic stress disorder (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, the 6-month follow-up was for the intervention group only, and the small sample size.

Length of controlled postintervention follow-up: None.

Additional 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

Michael Scheeringa, MD
Agency/Affiliation: Tulane University
Department: Department of Psychiatry and Behavioral Sciences
Website: www.michaelscheeringa.com/tools.html
Email:
Phone: (504) 669-2322
Fax: (504) 301-1026

Date Research Evidence Last Reviewed by CEBC: November 2023

Date Program Content Last Reviewed by Program Staff: April 2019

Date Program Originally Loaded onto CEBC: December 2013