Summary: Pine DS and Cohen JA. "Trauma in children and adolescents: Risk and treatment of psychiatric sequelae," Biological Psychiatry vol 51(7): 519-531. 2002.

This article is a literature review, examining research on risk factors for traumatic stress in children. It also discusses treatment. The review focuses on longitudinal studies with a large number of subjects. These studies follow a group of children over a period of time. Rather than giving a snapshot of children's symptoms, longitudinal studies are more like a motion picture, examining changes over time.

The experience of trauma is linked to many negative psychiatric outcomes. Research most clearly shows links between trauma and depressive disorders and anxiety disorders. Posttraumatic stress disorder (PTSD), acute stress disorder, separation anxiety, and generalized anxiety disorder are the most common types of anxiety disorders that children develop following trauma. There is a link as well between trauma and behavior disorders such as attention deficit/hyperactivity disorder. The link exists in both directions, with some behavior disorders representing risk factors for trauma.

There are three sets of factors that may influence psychological outcomes following trauma exposure: the event itself, the social world in which the event is embedded, and the characteristics of the individual. Studies have shown fairly consistently that the level of trauma exposure is linked to negative outcomes. On the other hand, strong social support moderates negative outcomes. In terms of personal characteristics, previous trauma or previous psychological problems is associated with poorer outcomes. Gender also plays a role, with girls more at risk for anxiety and mood disorders; boys show more behavioral problems.

Turning to treatment, good evidence exists for the value of cognitive-behavioral therapy (CBT). Randomized controlled trials-where one group of subjects is randomly chosen to receive the treatment being evaluated, while another group gets a different treatment, or is placed on a waiting list-support the use of CBT for children who've been traumatized by sexual abuse. The effectiveness of CBT has also been demonstrated in uncontrolled studies, where random assignment did not take place. Such studies are less rigorous, but are valuable nonetheless.

Based on studies in adults, there is evidence that drugs known as selective serotonin reuptake inhibitors (SSRIs) can be effective in treating anxiety and depression in traumatized people. Evidence that supports the use of other types of drugs-especially in children-is minimal.

The authors close this article by offering directions for future research. Suggestions include conducting trials on CBT in children who have suffered nonsexual traumas and pursing brain imaging studies of trauma exposed children and adolescents.