A Systematic Review of Interventions for Adolescents with Child Maltreatment-Related Trauma

Background and Purpose: Child maltreatment is a serious public health problem affecting approximately 1 in 5 children in the United States and costing an estimated $134 billion dollars a year (Finkelhor, Ormrod, Turner, & Holt, 2009; Wang, Holton, & America, 2007). Eighty percent of individuals with a history of child maltreatment will have at least one psychiatric diagnosis by the age of 18 (U.S. Department of Health and Human Services, 2012). Research indicates child maltreatment exposure can alter brain development and produce symptoms beyond the traditional posttraumatic stress diagnosis, including poor self-regulation, impaired attachment, inattention, and learning disability (De Bellis, Woolley, & Hooper, 2013; Stronach et al., 2011). Adolescence is a critical developmental period when child maltreatment related trauma symptoms are apparent and neurodevelopmental and psychosocial risk processes are established which, if untreated, may lead to functional impairment across the lifespan. While a number of interventions exist for children and adults with child-maltreatment related trauma, interventions targeting the developmental needs of adolescents have not been evaluated. Our primary aim is to examine the trauma literature to determine the types, rigor, and efficacy of interventions available for adolescents with child-maltreatment-related trauma.

Methods: A systematic review protocol adapted from Cochrane Collaboration guidelines was utilized to review the child maltreatment and trauma literature. Customized search strings were developed and two independent investigators completed data extraction using a standardized data extraction form. Interventions targeting outcomes of child-maltreatment related trauma meeting the following criteria were included: (a) adolescent participants aged 13 to 21, (b) experimental or quasi experimental design, and (c) participant history of child maltreatment.  Child-maltreatment was operationally defined as physical, sexual, and psychological abuse and neglect, and excluded community violence exposure only, single incident trauma (i.e. car accident, natural disaster) and war trauma. Studies were assessed using a rigor and bias rating system. Data from included studies were tabled, organized, and quantitative analyses were conducted where appropriate.

Results: Results indicate no randomized controlled trials currently exist for child maltreatment-related trauma intervention for adolescents. Within the pilot and quasi-experimental studies, the interventions evaluated were targeted to specific trauma groups, such as sexually abused adolescents and poly-victimized juvenile offenders, and focused primarily on aggressive behaviors or PTSD symptoms only. Interventions were often found to be effective, but had poor trauma conceptualization, small sample size, flawed methodology, and unreliable measurement.

Conclusions and Implications: No strong evidence exists to suggest that traditional PTSD treatment is equally effective with the range of problems experienced by poly-traumatized and chronically maltreated adolescents. Overall, developmentally appropriate trauma interventions for maltreated adolescents were limited. Existing intervention studies lacked rigor and addressed only a narrow range of symptoms. Practitioners should consider developmental adaptations when treating adolescent child maltreatment survivors. Comprehensive interventions need to be developed and tested for this population to treat existing symptoms and prevent the future development of more intractable functional impairments across the lifespan.