Treating child and adolescent PTSD – from research to the clinic

Almost one in four children or adolescents exposed to one or more traumatic events will develop PTSD. PTSD is a serious mental health disorder which can lead to the person repeatedly re-living the traumatic event through flashbacks and nightmares, as well as anxiety, isolation and distress.

It is especially common in those exposed to repeated interpersonal trauma, such as chronic physical, sexual and emotional abuse, and the millions of children and adolescents who have been traumatised by armed conflict or natural disasters. If left untreated, PTSD often becomes chronic, hindering normal development in those affected. The effective treatment of PTSD in children and adolescents is therefore crucial.

Several psychological interventions for childhood PTSD have been developed over the past four decades, and their efficacy has been tested in dozens of clinical trials. However, an up-to-date synthesis of all the available evidence was lacking. To address this, we performed a network meta-analysis – a statistical analysis that summarises data from clinical trials and provides an overview of how effective different interventions are.

Network meta-analyses play an important role in developing and updating treatment guidelines and informing clinical practice. They can provide evidence-based treatment recommendations for clinicians, patients and their caregivers.

Finding the best treatment for childhood PTSD

In our network meta-analysis, published in JAMA Psychiatry this month, we found that most studies (75 per cent) examined trauma-focused CBT as a treatment for child and adolescent PTSD. This was followed by Eye Movement Desensitisation and Reprocessing (EMDR), a treatment that involves guided eye movements to help process and reduce distress associated with trauma, non-trauma-focused psychological interventions and multi-disciplinary treatments (such as mind-body skills groups or intensive programmes that incorporate therapy, physical exercise, art therapy and educational workshops).

With the meta-analysis we could estimate the short-term efficacy (i.e., at the end of treatment) for all interventions. We found that trauma-focused CBT is highly effective for children and adolescents. Compared to other treatments, it performed best across our main analyses and various sensitivity analyses (e.g., analyses in different age groups or those including only data of a certain quality).

Trauma-focused CBT was also the most effective intervention when examining longer-term outcomes (up to 24 months post-treatment), but there was not enough long-term data for EMDR and multi-disciplinary treatments. 

We are now completing another network meta-analysis to investigate the effectiveness of trauma-focused CBT for people who developed childhood or adolescent PTSD in response to multiple trauma exposures. Multiple-event-related PTSD is clinically important for two reasons: First, many children and adolescents who suffer from PTSD have experienced multiple traumatic events. Second, there are greater treatment barriers for children and adolescents with multiple-event-related PTSD.

Affected individuals and their carers may fear that talking about traumatic experiences in trauma-focused therapies could make things worse. Even clinicians without expertise or training in the treatment of childhood PTSD sometimes perceive children and adolescents with multiple-event-related PTSD as particularly vulnerable and fear destabilisation or worsening through trauma-focused work. Existing evidence suggests that this is not the case, and our meta-analysis will be the first to collate and analyse this evidence.

What happens in the clinic?

In the Trauma, Anxiety and Depression Clinic at South London and Maudsley NHS Foundation Trust National and Specialist CAMHS (which will be based in the Pears Maudsley Centre from May 2025), we support many children and adolescents who are experiencing severe and/or treatment-resistant PTSD. We are a team of academic and clinical experts who work with young people with PTSD, lead research trials, and train clinicians around the country in a trauma-focused CBT approach.

At the clinic, we specialise in delivering trauma-focused CBT for PTSD. We teach young people about their trauma responses, help them develop timelines to identify which memories to work on, support them to process their memory of the identified trauma(s), help them reframe specific thoughts and feelings about the event, and teach positive coping strategies. Therapy is delivered in collaboration with the young person’s support network.

Young people often come to us feeling scared about confronting their difficult experiences. However, this usually changes once they understand that avoiding the trauma keeps PTSD symptoms active, while processing the memory, identifying their emotions, and reframing the event’s meaning helps stop the memory from repeatedly resurfacing.

Informing clinical practice with research

The King’s Maudsley Partnership, which is a unique collaboration between researchers at King’s College London and clinicians at the South London and Maudsley NHS Foundation Trust, allows our CAMHS clinicians to better support young people in their recovery from PTSD.

This latest network meta-analysis provides encouragement and guidance for patients, their families and clinicians, which can be applied in mental healthcare settings around the world. The findings highlight why trauma-focused CBT is the first line treatment recommendation in the Trauma, Anxiety and Depression Clinic.

With researchers and clinicians working more closely, we can rapidly inform the development and implementation of evidence-based treatments for PTSD in children and adolescents, as well as making direct adjustments to clinical teaching programmes at King’s.

This blog was co-authored by Dr Julian Mutz (King's College London), Dr Jessica Richardson (King's College London and South London and Maudsley NHS Foundation Trust), Dr Thole Hoppen (University of Münster) and Professor Nexhmedin Morina (University of Münster).