Child sexual abuse is a serious public health problem that is both widespread and potentially very deleterious in its psychosocial impact. Children who have experienced sexual abuse are at high risk for suffering posttraumatic stress disorder (PTSD), depression, conduct problems, substance abuse, sexually inappropriate behavior, and further violent victimization. It is critical that we identify empirically validated interventions that can prevent and/or ameliorate the difficulties experienced by young survivors of sexual abuse. Recent research has documented the efficacy of cognitive behavioral interventions in addressing abuse-related symptomatology in sexually abused children (SAC) and their nonoffending parents. However, there continues to be resistance by therapists and parents to the use of gradual exposure/processing (GE), a core feature of cognitive behavioral treatment (CBT), because of concerns about increasing the discomfort level of children. Additionally, there are no empirical data with regard to the amount (i.e., dose) of therapy required to achieve optimal treatment outcomes. The current collaborative multi-site investigation will examine the necessity and developmental appropriateness of including exposure interventions in individual CBT for SAC, while also examining the optimal length of treatment for this population as a function &age group (4-7 vs. 8-11 year aids). The findings of this study will establish developmental and clinical markers for the early identification of families who may require more focused (i.e., including gradual exposure) and/or longer treatment to achieve optimal outcomes. This information will assist us in more effectively allocating the limited mental health resources available to address the needs of this high risk pouplation. Subjects in this study will be sexually abused children (4 to 11 years old) and their nonoffending parents. Standardized evaluations will be conducted to assess parents' distress and support levels, parent reports of children's behavior patterns, sexualized behaviors and PTSD symptoms, and children's self-reports of PTSD, depression and anxiety symptoms, body safety skills and victimization experiences. After the initial assessment, children and their parents will be randomly assigned to one of four treatment conditions: 1) briefCBT with gardual exposure (GE); 2) briefCBT without GE; 3) extended CBT with GE; and 4) extended CBT without GE. Assessments will be conducted at pre- and post-treatment, 6- and 12-month follow-ups.
|Mannarino, Anthony P; Cohen, Judith A; Deblinger, Esther et al. (2012) Trauma-focused cognitive-behavioral therapy for children: sustained impact of treatment 6 and 12 months later. Child Maltreat 17:231-41|
|Deblinger, Esther; Mannarino, Anthony P; Cohen, Judith A et al. (2011) Trauma-focused cognitive behavioral therapy for children: impact of the trauma narrative and treatment length. Depress Anxiety 28:67-75|