In the long aftermath of atrocities such as the Newtown school massacre, families and healthcare professionals are left trying to comprehend the incomprehensible. Thoughts duly turn to the future, and to prevention of such incidents, but what happens to the children left behind? How best to help them cope? The sobering answer, according to a systematic review published in Pediatrics recently,1 is that we do not know.
Valerie Forman-Hoffman and colleagues had searched for high-quality studies that assessed interventions in children or adolescents exposed to non-relational traumatic events – including war, terrorist attacks, community violence, and natural disasters. Having boiled the available evidence down to just 22 short-term studies that tested 20 different treatments, they were left with worryingly vague conclusions.
Drugs, it seems, probably don’t work. Only three were assessed – imipramine, fluoxetine and sertraline – and none showed efficacy. Psychological treatments fared little better. Few showed clinical benefit (mainly school-based treatments that incorporated cognitive behavioural therapy), with the authors concluding, as strongly as available evidence would allow, that psychotherapeutic treatment might be more effective than no treatment at all.
The authors call for more research into the comparative effectiveness of different interventions for this age group.
But a focus on observational analysis of the long-term wellbeing of children and adolescents following a traumatic event would also be desirable. People cope with trauma in different ways. It is normal that extreme circumstances elicit extreme responses, but what is a normal reaction to a traumatic event? Without knowledge of the natural history of reaction to trauma, how do we know when to intervene, and when such intervention might be harmful?
The answers will vary from child to child, although research might yet reveal general patterns that will be of use to clinicians. In the meantime, it is important that evidence-based support is available when necessary – which might be some time after the original traumatic event.
- Forman-Hoffman V, Zolotor AH, McKeeman JL et al. Comparative effectiveness of interventions for children exposed to nonrelational traumatic events. Paediatrics 2013 [Epub 2013]