Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: a randomized controlled trial.

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. DESIGN Randomized controlled trial conducted using blinded evaluators. SETTING Recruitment, screening, and treatment were conducted at a community IPV center between September 1, 2004, and June 30, 2009. PARTICIPANTS Of 140 consecutively referred 7- to 14-year-old children, 124 participated. INTERVENTIONS Children and mothers were randomly assigned to receive 8 sessions of TF-CBT or usual care (child-centered therapy). MAIN OUTCOME MEASURES 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. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00183326.