Each year an estimated 3-10 million children in America are exposed to domestic violence (DV) directed at their mothers by intimate partners. DV exposure places these children at heightened risk for externalizing behavior problems as well as depression and anxiety symptoms. Recent research has also documented that more than half of these children develop significant symptoms of Posttraumatic Stress Disorder (PTSD), with a substantial proportion meeting full DSM-IV diagnostic criteria for this disorder. Childhood PTSD is associated with potentially serious and long-lasting problems, including neurobiological changes (smaller intracranial volume, lower IQs., dysfunction of immune and hypothalamic-pituitary-adrenal stress response systems) and increased risk of substance abuse and suicidality in adolescence and adulthood. Relatively few randomized controlled treatment trials (RCT) have been conducted with DV-exposed children, and none of these have specifically targeted or evaluated improvement in PTSD symptoms. However, there is evidence from several RCTs for sexually abused children and children traumatized by disasters that Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is efficacious in improving PTSD, as well as depressive, anxiety, and behavioral symptoms. The largest such RCT included over 200 children, of whom 58% had experienced DV in addition to sexual abuse. The current study proposes to conduct a RCT for 7- 12-year-old children who have DV-related PTSD symptoms. Children will be recruited by, and the study will be conducted at the Women's Center and Shelter of Greater Pittsburgh (WCS), a community DV agency. Children and their mothers will be randomly assigned to 12 weeks of individual child-focused TF-CBT or Child Centered Supportive Therapy (CCT), a supportive empowerment treatment that is commonly provided to DV-exposed and other traumatized children, and is currently the predominant treatment model used at WCS. Both treatments have been manualized and were used in the Investigators' previous RCTs for traumatized children. Children and mothers will be assessed at pretreatment, post treatment, and at 6- and 12-month follow-ups. Children's PTSD, depression, anxiety, and behavior problems will be evaluated as outcome measures. Additionally, the study will evaluate the impact of hypothesized moderators (age, gender, ethnicity and DV severity) and mediators (children's DV-related attributions and perceptions, and mother's PTSD, depression, parenting practices and emotional distress about the child's DV exposure) on treatment outcome, using standardized instruments which have documented main treatment and moderator/mediator effects in previous studies of traumatized children.
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