A meta-analysis of dropout from evidence-based psychological treatment for post-traumatic stress disorder (PTSD) in children and young people

Figures & data

Figure 1. PRISMA flowchart of study identification process

Table 1. Characteristics of included studies

Authors, year	Country	Trauma type	Single incident, multiple or mixed		Interventions	Number of participants	Format	Maximum duration weeks, sessions, (minutes)	Delivered by	Age range (mean)	Met PTSD diagnostic threshold at pre-treatment (%)	Male (%)/ Female (%)	Dropout (%)^a
Ahmad, Larsson, & Sundelin-Wahlsten, 2007	Sweden	Various	Mixed		EMDR vs WL	33	Individual	8, 8 (45)	Therapists (authors)	6–16(10)	100	41.2/58.8	9.1
Ahrens & Rexford, 2002	USA	Violence	Mixed		CPT vs WL	38	Group	8, 8 (60)	Experienced doctoral candidate and qualified psychologist	15–18(16.4)	100	100/0	0
Barron, Abdallah, & Heltne, 2016	Palestine	Mass Conflict	Mixed		TRT vs WL	154	Group	n.r., 5 (60)	School counsellors	11–18 (13.5)	100	36.4/63.6	16.9
Catani et al., 2009	Sri Lanka	Civil unrest, Tsunami	Mixed		KidNET vs MED-RELAX	31	Individual	2, 6 (60–90)	Teachers trained as ‘master counsellors’	8–14(11.9)	n.r.	54.8/45.2	0
Cohen et al., 2004	USA	Sexual abuse	Mixed		TFCBT vs CCT	229	Individual(with parent involvement)	12,12 (45)	Experienced therapist (social workers and psychologists)	8–14(10.7)	89	21.2/78.8	11.4
Cohen et al., 2011	USA	Intimate Partner Violence	Mixed		TFCBT vs CCT	124	Individual(with parent involvement)	8, 8 (45)	Social workers	7–14 (9.6)	25	49.2/50.8	39.5
Dawson et al., 2018	Indonesia	Civil conflict	Mixed		TFCBT vs PS	64	Individual(with care-giver involvement)	6, 6 (60)	Lay counsellors	7–14 (10.4)	75	51.5/48.5	0
de Roos et al., 2011	Netherlands	Firework Factory explosion	Single incident		TFCBT vs EMDR	52	Individual(with parent involvement)	8, 4 individual plus 4 parent (60)	Licenced therapists	4–18(10.1)	17.3	55.8/44.2	25.9
de Roos et al., 2017	Netherlands	Various	Single incident		CBWT vs EMDR vs WL	103	Individual	Up to 6, 6 (45)	Clinical psychologists	8–18 (13.1)	61.2	42.7/57.3	3.9
Deblinger et al., 2011	USA	Child sexual abuse	Mixed		TFCBT (with TN) vs TFCBT (without TN)	210	Individual(with caregiver involvement)	Either 8 or 16, 8 or 16, (90)	Graduates with 3+ years of clinical experience	4–11 (7.7)	n.r.	39/61	24.8
Diehle et al., 2015	Netherlands	Various	Mixed		TFCBT vs EMDR	48	Individual(with parent involvement)	8, 8 (60)	Experienced therapists	8–18 (13)	33	38/62	25
Ertl et al., 2011	Uganda	Former child soldiers	Multiple		KidNET vs Academic catchup with SC	85	Individual	3, 8 (90–120)	Lay counsellors	12–25 (18)	100	44.7/55.3	7.6
Foa, McLean, Capaldi, & Rosenfield, 2013	USA	Child sexual abuse	Mixed	PE vs SC		61	Individual	14,14 (60 − 90)	Masters-level counsellors	13 − 18 (15.3)	100	0/100	13.1
Ford et al., 2012	USA	Various	Mixed	TARGET vs ETAU		59	Individual	n.r., 12 (50)	Experienced therapists with professional qualifications	13–17 (14.7)	62.8	0/100	27.1
Gilboa-Schechtman et al., 2010	Israel	Various	Single Incident	PE-A vs TLDP		38	Individual	PE-A: 15,15 (90)TLDP: n.r., 18 (50)	‘MA level clinicians’	12–18 (14.1)	100	37/63	21.1
Goldbeck et al., 2016	Germany	Various	Mixed	TFCBT vs WL		159	Individual(with parent involvement)	12, 12 (90)	Therapist with advanced clinical training	7–17 (13.0)	75.5	28.3/71.7	1.9
Jaberghaderi et al., 2004	Iran	Sexual abuse	Mixed	TFCBT vs EMDR		18	Individual(with parent involvement)	12, 12 (45)	Clinical psychologist	12–13 (n.r.)	n.r.	0/100	21.1
Jaberghaderi et al., 2019	Iran	Domestic Violence	Multiple	TFCBT vs EMDR		40	Individual(with parent involvement)	12, 12 (60)	Experienced therapists (including author)	8–12 (n.r.)	100	50.4/49.6	23.8
Jensen et al., 2014	Norway	Various	Mixed	TFCBT vs TAU		156	Individual(with parent involvement)	n.r., 15 (45)	Experienced therapist from mix of professions	(15.1)	66.7	20.5/79.5	25
Kemp et al., 2010	Australia	Motor vehicle accidents	Single incident	EMDR vs WL		27	Individual	6, 4 (60)	Doctoral-level psychologist with advance training	6–12(8.9)	n.r.	55.6/44.4	11.1
King et al., 2000	Australia	Child sexual abuse	Multiple	Child CBT vs Family CBT vs WL		36	Individual (child only)/Individual parent & child)	20, 20 (50)	Registered psychologist	5–17 (11.5)	69.4	31/69	22.2
McMullen et al., 2013	DR Congo	War	Mixed	TFCBT vs WL		50	Group	n.r., 15 (45)	Authors and experienced Congolese counsellors	13–17 (15.8)	n.r.	100/0	4
Meiser-Stedman et al., 2017	UK	Various	Single incident	CT-PTSD vs WL		29	Individual	10, 10 (90)	Clinical psychologists (including authors)	8–17(13.3)	100	27.8/72.2	10.3
Murray et al., 2015	Zambia	Various	Mixed	TFCBT vs TAU		257	Individual	16, 16 (90)	Lay counsellors	5–18 (13.7)	n.r.	50.2/49.8	9.7
Nixon et al., 2012	Australia	Various	Single incident	TFCBT vs Cognitive Therapy (no exposure)		34	Individual(with parent involvement)	9, 9 (90)	Trainee clinical psychologists	7–17 (10.8)	100	63.3/36.7	38.2
O’Callaghan et al., 2013	DR Congo	War	Mixed	TFCBT vs WL		52	Group (plus x3 individual sessions & x3 caregiver sessions)	5, 15, (120)	Social workers	12–17 (16.1)	60	0/100	11.5
O’Callaghan et al., 2015	DR Congo	War	Mixed	TFCBT vs CFS		50	Group	3, 9 (90)	Lay facilitators	8–17 (14.8)	92	58/42	0
Peltonen & Kangaslampi, 2019	Finland	Various	Mixed	NET vs TAU		50	Individual	10, 10 (9)	Experienced MH professionals	9–17 (13.2)	n.r.	58/42	14
Pityaratstian et al., 2015	Thailand	Tsunami	Mixed	TRT (adapted) vs WL		36	Group	0.4, 3 (120)^b	Certified child psychiatrists (incl. author)	10–15 (12.3)	100	27.8/72.2	0
Robjant et al., 2019	DR Congo	Former Child Soldiers	Multiple	FORNET vs TAU		92	Individual(plus x1 group session per week)	6, 12 (120)	Lay people	16–25 (18)	100	0/100	0
Rosner et al., 2019	Germany	Various	Mixed	D-CPT vs WL/TA		88	Group	20, 30 (50)	Masters-level or postdoctoral therapists	14–21 (18.1)	100	15/85	21.6
Ruf et al., 2010	Germany	Refugees	Multiple	KidNET vs WL		26	Group	8, 8 (120)	Clinical psychologists	7–16 (11.5)	100	54/46	3.9
Salloum & Overstreet, 2012	USA	Various	Mixed	GTI-CN vs GTI-C		72	Group (plus x1 individual & x1 parent session)	10, 12 (60)	Social workers, social work interns, psychology doctoral student	6–12 (9.6)	n.r.	55.7/44.3	5.6
Santiago et al., 2014	USA	Community Violence	Mixed	CBITS vs CBITS + Family		64	Group (plus 1–3 individual & 1–2 group sessions for parents)	n.r., 12 (50)	Social workers	10–14 (11.7)	100	41/59	0
Scheeringa et al., 2011	USA	Various	Mixed	TFCBT vs WL		64	Individual(with parent involvement)	12, 12 (50)	Social workers	3–6 (5.3)	24	66.2/33.8	29.7
Schottelkorb et al., 2012	USA	Refugees	Mixed	TFCBT vs CCPT		31	Individual(with parent involvement)	TFCBT: 12, 20 (30)C0+: 12, 24 (30)	Masters-level student counsellors	6–13 (9.1)	58	54.8/45.2	16.1
Shein-Szydlo et al., 2016	Mexico	Various	Mixed	TFCBT vs WL		100	Individual	12, 12 (60)	Psychologists (Authors)	12–19 (14.9)	100	44/56	1
Smith et al., 2007	UK	Various	Single incident	TFCBT vs WL		24	Individual(with parent involvement)	10, 12 (n.r.)	Clinical psychologists	8–18 (13.8)	100	50/50	0
Stein et al., 2003	USA	Violence	Mixed	CBITS vs WL		126	Group	10, 10 (60)	School clinicians	n.r. (11)	n.r.	43.7/56.3	9.5
Tol et al., 2008	Indonesia	Civil conflict	Mixed	CBT-CBI vs WL		403	Group	5, 15 (n.r.)	Local lay people	(9.9)	n.r.	51.4/48.6	2.5

EMDR, eye movement desensitization and reprocessing; WL, waiting list; CPT , cognitive processing therapy; TRT, Teaching Recovery Techniques; KidNET, narrative exposure therapy for children; MED-RELAX, meditation and relaxation intervention; TFCBT, trauma-focused cognitive behaviour therapy; CCT, child-centred therapy; PS, problem solving intervention; CBWT, cognitive behavioural writing therapy; TN, trauma narrative; SC, supportive counselling; PE, prolonged exposure; TARGET, Trauma Affect Regulation: Guide for Education and Therapy; ETAU,enhanced treatment as usual (relationship supportive therapy); PE-A, prolonged exposure for adolescents; TLDP, time-limited psychodynamic therapy; TAU, treatment as usual; CBT,cognitive behavioural therapy; CT-PTSD, cognitive therapy for post-traumatic stress disorder; CFS,child friendly spaces; NET, narrative exposure therapy; FORNET, narrative exposure therapy adapted for offenders; WL/TA, waiting list with treatment advice; GTI-CN, grief and trauma intervention with coping skills and trauma narrative processing; GTI-C, grief and trauma intervention – coping skills only; CCPT, child centred play therapy; cbits=cognitive behavioural intervention for trauma in schools; CBT-CBI, cognitive behavioural therapy classroom-based Intervention; n.r. = not reported.

^aDropout from all arms including waiting list. ^bIntervention delivered over three consecutive days followed by homework over the following month.

Table 2. Studies with explicit definitions of dropout or completion

Study	Definition of completion
Ahmad et al., 2007	Three or more sessions of a possible eight
Cohen et al, 2004	Three or more sessions of a possible 12
Cohen et al, 2011	Completion of all eight sessions
Dawson et al, 2018	Completion of all five sessions
de Roos et al, 2011	Completion of four sessions unless asymptomatic
de Roos et al, 2017	Completion of six sessions or fewer if units of distress reduced to zero
Deblinger et al, 2011	Three or more sessions of a possible 8 or 16
Diehle et al, 2015	Eight sessions but treatment could be concluded earlier if cured
Ertl et al, 2011	Completion of all eight sessions
Foa et al., 2013	Eight or more sessions of a possible 14
Ford et al, 2012	Five or more sessions of a possible 12
Goldbeck et al, 2016	Eight or more sessions
Jaberghaderi et al, 2004	Ten or more sessions of TFCBT No minimum for EMDR
Jaberghaderi et al, 2019	Five or more sessions of a possible 12
Jensen et al, 2014	Six or more sessions
Peltonen & Kangaslampi, 2019	Seven or more sessions

Table 3. Results of proportion meta-analyses

				95% CI		Heterogeneity statistics
Analysis	k	N	Prevalence (%)	LI	UL	Q	df	p	I^2 (%)
Dropout from all treatment arms excluding WL	66	2658	11.7	9.0	14.6	326.5	65	<0.001	79.0
Lower quality removed	53	2383	11.6	8.8	14.8	286.7	52	<0.001	80.7
Defined dropout	32	1386	15.9	12.0	20.2	132.0	31	<0.001	76.1
Dropout from all TFCBT arms	41	1696	10.6	7.5	14.2	206.1	40	<0.001	79.3
Lower quality removed	31	1457	10.1	6.7	14.0	166.8	30	<0.001	80.1
Defined dropout	16	778	14.7	9.4	20.9	70.1	15	<0.001	78.7
Dropout from all TFCBT and EMDR arms	48	1869	11.2	8.2	14.6	226.5	47	<0.001	77.6
Lower quality removed	36	1608	10.8	7.6	14.5	186.7	35	<0.001	79.2
Defined dropout	22	891	15.2	10.6	20.4	85.3	21	<0.001	74.9
Dropout from all EMDR arms	7	173	15.5	7.8	25.3	15.7	6	0.015	59.0
Lower quality removed	5	151	16.2	6.9	28.5	14.7	4	0.005	70.1
Defined dropout	6	160	16.7	8.0	27.8	15.1	5	0.010	63.6
Dropout from all non-trauma focussed arms^a	18	789	12.8	7.6	19.1	90.1	17	<0.001	82.4
Lower quality removed	17	775	13.4	7.9	20.0	87.8	16	<0.001	83.1
Defined dropout	10	495	17.4	10.5	25.6	43.4	9	<0.001	79.2

WL, waiting list; TFCBT, trauma-focused cognitive behavioural therapies; EMDR, eye movement desensitization and reprocessing.

^aAll active control arms, non-NICE recommended psychotherapies and the arms from component studies with exposure or trauma narrative elements removed.

Table 4. Odds ratios of dropout from different types of intervention

				95% CI			Heterogeneity statistics
Analysis	k	N	Odds ratio	LL	UL	p	Q	df	p	I^2 (%)
TFCBT vs any active control	22	1848	0.89	0.68	1.17	0.398	12.2	21	0.935	0
Lower quality removed	20	1799	0.87	0.66	1.14	0.398	9.1	19	0.972	0
Defined dropout	15	1337	0.85	6.23	1.15	0.398	8.0	14	0.889	0
EMDR vs any active control	5	283	1.03	0.54	1.93	0.938	1.3	4	0.870	0
Lower qualityremoved	4	265	1.03	0.53	1.99	0.938	1.3	3	0.741	0
Defined dropout^a	-	-	-	-	-	-	-	-	-	-
TFCBT or EMDR vs WL	17	1417	1.01	0.50	2.04	0.975	25.9	16	0.055	42.3
Lower quality removed	12	1153	1.22	0.33	2.03	0.975	17.7	11	0.088	42.2
Defined dropout^b	-	-	-	-	-	-	-	-	-	-
TFCBT or EMDR vs active control^c	14	1299	0.88	0.63	1.21	0.424	7.7	13	0.863	0
Lower quality removed	13	1268	0.85	0.61	1.18	0.424	4.6	12	0.971	0
Defined dropout	8	800	0.83	0.57	1.21	0.424	4.5	7	0.720	0
Component studies^d	4	314	0.81	0.42	1.55	0.518	2.0	3	0.581	0
Lower dropout removed^a	-	-	-	-	-	-	-	-	-	-
Defined dropout^b	-	-	-	-	-	-	-	-	-	-

LL, lower limit; UL, upper limit; CBT, cognitive behavioural therapies; EMDR, eye movement desensitization and reprocessing; WL, waiting list.

^aAnalysis not conducted because there were too few eligible arms (k = 2). ^bSame as the analysis above. ^cExcludes component studies and EMDR vs TFCBT studies. ^dArms with exposure/trauma narrative component vs arms with those elements removed.

Table 5. Proportion dropout meta-analyses for each active arm: subgroup and moderator analyses

				95% CI		Heterogeneity statistics
Analysis	k	N	Dropout prevalence (%)	LL	UL	Q	df	p	I^2 (%)
Individual vs group
Individual arms^a	53	2067	14.2	11.0	17.6	218.3	52	<0.001	76.9
Group arms^a	13	591	4.0	1.8	7.1	34.9	12	<0.001	59.7
Test of moderation, p < .001; defined drop only, n/a^b; lower quality studies removed, p = .005
Multiple vs single trauma
Multiple/mixed trauma arms	55	2410	11.1	8.4	14.2	286.0	54	<0.001	79.9
Single trauma arms	11	248	15.1	7.6	24.7	38.9	10	<0.001	72.3
Test of moderation, p = .345; defined drop only, p = .322; lower quality studies removed, p = .269
Lay vs professional therapist
Lay delivered arms	13	628	4.1	1.8	7.4	40.0	12	<0.001	64.3
Professional delivered arms	53	2030	14.0	11.0	17.4	212.1	52	<0.001	76.2
Test of moderation, p = .003; defined drop only, p = .027; lower quality studies removed, p = .001
Number of sessions
Test of moderation, p = .461; defined drop only, p = .434; lower quality studies removed, p = .914
CBT vs other^c
Test of moderation, p = .317; defined drop only, p = .548; lower quality studies removed, p = .214
CBT or EMDR vs other^c
Test of moderation, p = .612; defined drop only, p = .624; lower quality studies removed, p = .446

^aExperimental or control arms. ^bNot applicable, as no eligible arms. ^cSubgroup data available in Table 2.

Ahmad, A., Larsson, B., & Sundelin-Wahlsten, V. (2007). EMDR treatment for children with PTSD: Results of a randomized controlled trial. Nordic Journal of Psychiatry, 61(5), 349–17. doi:10.1080/08039480701643464

 PubMed Web of Science ®Google Scholar

Ahrens, J., & Rexford, L. (2002). Cognitive processing therapy for incarcerated adolescents with PTSD. Journal of Aggression, Maltreatment & Trauma, 6(1), 201–216. doi:10.1300/J146v06n01_10

 Google Scholar

Barron, I., Abdallah, G., & Heltne, U. (2016). Randomized control trial of Teaching Recovery Techniques in rural occupied Palestine: Effect on adolescent dissociation. Journal of Aggression, Maltreatment & Trauma, 25(9), 955–973. doi:10.1080/10926771.2016.1231149

 Web of Science ®Google Scholar

Catani, C., Kohiladevy, M., Ruf, M., Schauer, E., Elbert, T., & Neuner, F. (2009). Treating children traumatized by war and tsunami: A comparison between exposure therapy and meditation-relaxation in North-East Sri Lanka. BMC Psychiatry, 9, 22. doi:10.1186/1471-244X–9–22

 Google Scholar

Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43(4), 393–402. doi:10.1097/01.chi.0000111364.94169.f9

 PubMed Web of Science ®Google Scholar

Cohen, J. A., Mannarino, A. P., & Iyengar, S. (2011). Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence a randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 165(1), 16–21. doi:10.1001/archpediatrics.2010.247

 PubMedGoogle Scholar

Dawson, K., Joscelyne, A., Meijer, C., Steel, Z., Silove, D., & Bryant, R. A. (2018). A controlled trial of trauma-focused therapy versus problem-solving in Islamic children affected by civil conflict and disaster in Aceh, Indonesia. Australian & New Zealand Journal of Psychiatry, 52(3), 253–261. doi:10.1177/0004867417714333

 PubMed Web of Science ®Google Scholar

de Roos, C., Greenwald, R., den Hollander-Gijsman, M., Noorthoorn, E., van Buuren, S., & de Jongh, A. (2011). A randomized comparison of cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) in disaster-exposed children. European Journal of Psychotraumatology, 2, 5694. doi:10.3402/ejpt.v2i0.5694.

 Google Scholar

de Roos, C., van der Oord, S., Zijlstra, B., Lucassen, S., Perrin, S., Emmelkamp, P., & de Jongh, A. (2017). Comparison of eye movement desensitization and reprocessing therapy, cognitive behavioral writing therapy, and wait-list in pediatric posttraumatic stress disorder following single-incident trauma: A multicenter randomized clinical trial. Journal of Child Psychology and Psychiatry, 58(11), 1219–1228. doi:10.1111/jcpp.12768

 Google Scholar

Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Steer, R. A. (2011). Trauma-focused cognitive behavioral therapy for children: Impact of the trauma narrative and treatment length. Depression and Anxiety, 28(1), 67–75. doi:10.1002/da.20744

 PubMed Web of Science ®Google Scholar

Diehle, J., Opmeer, B. C., Boer, F., Mannarino, A. P., & Lindauer, R. J. L. (2015). Trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing: What works in children with posttraumatic stress symptoms? A randomized controlled trial. European Child & Adolescent Psychiatry, 24(2), 227–236. doi:10.1007/s00787-014-0572-5

 PubMed Web of Science ®Google Scholar

Ertl, V., Pfeiffer, A., Schauer, E., Elbert, T., & Neuner, F. (2011). Community-implemented trauma therapy for former child soldiers in Northern Uganda: A randomized controlled trial. Journal of the American Medical Association, 306(5), 503–512. doi:10.1001/jama.2011.1060

 Web of Science ®Google Scholar

Foa, E. B., McLean, C. P., Capaldi, S., & Rosenfield, D. (2013). Prolonged exposure vs supportive counselling for sexual abuse-related PTSD in adolescent girls a randomized clinical trial. Journal of the American Medical Association, 310(24), 2650–2657. doi:10.1001/jama.2013.282829

 Web of Science ®Google Scholar

Ford, J. D., Steinberg, K. L., Hawke, J., Levine, J., & Zhang, W. (2012). Randomized trial comparison of emotion regulation and relational psychotherapies for PTSD with girls involved in delinquency. Journal of Clinical Child and Adolescent Psychology, 41(1), 27–37. doi:10.1080/15374416.2012.632343

 PubMed Web of Science ®Google Scholar

Gilboa-Schechtman, E., Foa, E. B., Shafran, N., Aderka, I. M., Powers, M. B., Rachamim, L., & Apter, A. (2010). Prolonged exposure versus dynamic therapy for adolescent PTSD: A pilot randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 1034–1042. doi:10.1016/j.jaac.2010.07.014

 PubMed Web of Science ®Google Scholar

Goldbeck, L., Muche, R., Sachser, C., Tutus, D., & Rosner, R. (2016). Effectiveness of trauma-focused cognitive behavioral therapy for children and adolescents: A randomized controlled trial in eight German mental health clinics. Psychotherapy and Psychosomatics, 85(3), 159–170. doi:10.1159/000442824

 PubMed Web of Science ®Google Scholar

Jaberghaderi, N., Greenwald, R., Rubin, A., Zand, S. O., & Dolatabadi. (2004). A comparison of CBT and EMDR for sexually-abused Iranian girls. Clinical Psychology and Psychotherapy, 11(5), 358–368.

 Google Scholar

Jaberghaderi, N., Rezaei, M., Kolivand, M., & Shokoohi, A. (2019). Effectiveness of ognitive behavioral therapy and eye movement desensitization and reprocessing in child victims of domestic violence. Iranian Journal of Psychiatry, 14(1), 67–75.

 Google Scholar

Jensen, T. K., Holt, T., Ormhaug, S. M., Egeland, K., Granly, L., Hoaas, L. C., & Wentzel-Larsen, T. (2014). A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual for youth. Journal of Clinical Child and Adolescent Psychology, 43(3), 356–369. doi:10.1080/15374416.2013.822307

 Google Scholar

Kemp, M., Drummond, P., & McDermott, B. (2010). A wait-list controlled pilot study of eye movement desensitization and reprocessing (EMDR) for children with posttraumatic stress disorder (PTSD) symptoms from motor vehicle accidents. Clinical Child Psychology and Psychiatry, 15(1), 5–25. doi:10.1177/1359104509339086

 PubMedGoogle Scholar

King, N., Tonge, B., Mullen, P., Myerson, N., Heyne, D., Rollings, S., & Ollendick, T. (2000). Treating sexually abused children with posttraumatic stress symptoms: A randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 39(11), 1347–1355. doi:10.1097/00004583-200011000-00008

 PubMed Web of Science ®Google Scholar

McMullen, J., O'Callaghan, P., Shannon, C., Black, A., & Eakin, J. (2013). Group trauma-focused cognitive-behavioral therapy with former child soldiers and other war-affected boys in the DR Congo: A randomized controlled trial. Journal of Child Psychology and Psychiatry, 54(11), 1231–1241. doi:10.1111/jcpp.12094

 Google Scholar

Meiser-Stedman. R., Smith, P., McKinnon, A., Dixon, C., Trickey, D., Ehlers, A., Clark, D. M., Boyle, A., Watson, P., Goodyer, I. & Dalgleish, T. (2017). Cognitive therapy as an early treatment for post-traumatic stress disorder in children and adolescents: A randomized controlled trial addressing preliminary efficacy and mechanisms of action. Journal of Child Psychology and Psychiatry, 58(5), 623–633. doi:10.1111/jcpp.12673

 PubMed Web of Science ®Google Scholar

Murray, L. K., Skavenski, S., Kane, J. C., Mayeya, J., Dorsey, S., Cohen, J. A., Michalopoulos, L. T. M., Imasiku, M., & Bolton, P. A. (2015). Effectiveness of trauma-focused cognitive behavioral therapy among trauma-affected children in Lusaka, Zambia: A randomized clinical trial. Journal of the American Medical Association Pediatrics, 169(8), 761–769. doi:10.1001/jamapediatrics.2015.0580

 Google Scholar

Nixon, R. D., Sterk, J., & Pearce, A. (2012). A randomized trial of cognitive behaviour therapy and cognitive therapy for children with Posttraumatic Stress Disorder following single-incident trauma. Journal of Abnormal Child Psychology, 40(3), 327–337. doi:10.1007/s10802-011-9566-7

 PubMed Web of Science ®Google Scholar

O'Callaghan, P., McMullen, J., Shannon, C., Rafferty, H., & Black, A. (2013). A randomized controlled trial of trauma-focused cognitive behavioral therapy for sexually exploited, war-affected Congolese girls. Journal of the American Academy of Child and Adolescent Psychiatry, 52(4), 359–369. doi:10.1016/j.jaac.2013.01.013

 Google Scholar

O'Callaghan, P., McMullen, J., Shannon, C., & Rafferty, H. (2015). Comparing a trauma focused and non trauma focused intervention with war affected Congolese youth: A preliminary randomized trial. Intervention, 13, 28–44.

 Google Scholar

Peltonen, K., & Kangaslampi, S. (2019). Treating children and adolescents with multiple traumas: A randomized clinical trial of narrative exposure therapy. European Journal of Psychotraumatology, 10(1), e1558780. doi:10.1080/20008198.2018

 Google Scholar

Pityaratstian, N., Piyasil, V., Ketumarn, P., Sitdhiraksa, N., Ularntinon, S., & Pariwatcharakul, P. (2015). Randomized controlled trial of group cognitive behavioral therapy for post-traumatic stress disorder in children and adolescents exposed to tsunami in Thailand. Behavioral and Cognitive Psychotherapy, 43(5), 549–561. doi:10.1017/S1352465813001197

 PubMed Web of Science ®Google Scholar

Robjant, K., Koebach, A., Schmitt, S., Chibashimba, A., Carleial, S., & Elbert, T. (2019). The treatment of posttraumatic stress symptoms and aggression in female former child soldiers using adapted Narrative Exposure therapy – A RCT in Eastern Democratic Republic of Congo. Behaviour Research and Therapy, 123. doi:10.1016/j.brat.2019.103482

 Google Scholar

Rosner, R., Rimane, E., Frick, U., Gutermann, J., Hagl, M., Renneberg, B., Schreiber, F., Vogel, A., & Steil, R. (2019). Effect of developmentally adapted cognitive processing therapy for youth with symptoms of posttraumatic stress disorder after childhood sexual and physical abuse: A randomized clinical trial. Journal of the American Medical Association Psychiatry, 76(5), 484–491. doi:10.1001/jamapsychiatry.2018.4349

 Google Scholar

Ruf, M., Schauer, M., Neuner, F., Catani, C., Schauer, E., & Elbert, T. (2010). Narrative exposure therapy for 7- to 16-year-olds: A randomized controlled trial with traumatized refugee children. Journal of Traumatic Stress, 23(4), 437–445. doi:10.1002/jts.20548

 PubMed Web of Science ®Google Scholar

Salloum, A., & Overstreet, S. (2012). Grief and trauma intervention for children after disaster: Exploring coping skills versus trauma narration. Behaviour Research and Therapy, 50(3), 169–179. doi:10.1016/j.brat.2021.01.001

 Google Scholar

Santiago, C. D., Lennon, J. M., Fuller, A. K., Brewer, S. K. & Kataoka, S. H. (2014). Examining the impact of a family treatment component for CBITS: When and for whom is it helpful? Journal of Family Psychology, 28(4), 560–570. doi:10.1037/a0037329

 Google Scholar

Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya-Jackson, L., & Guthrie, D. (2011). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52(8), 853–860. doi:10.1111/j.1469-7610.2010.02354.x

 Google Scholar

Schottelkorb, A. A., Doumas, D. M., & Garcia, R. (2012). Treatment for childhood refugee trauma: A randomized, controlled trial. International Journal of Play Therapy, 21(2), 57. doi:10.1037/a0027430

 Google Scholar

Shein-Szydlo, J., Sukhodolsky, D. G., Kon, D. S., Tejeda, M. M., Ramirez, E., & Ruchkin, V. (2016). A randomized controlled study of cognitive–behavioral therapy for Posttraumatic Stress in street children in Mexico City. Journal of Traumatic Stress, 29(5), 406–414. doi:10.1002/jts.22124

 Google Scholar

Smith, P., Yule, W., Perrin, S., Tranah, T., Dalgleish, T., & Clark, D. M. (2007). Cognitive-behavioral therapy for PTSD in children and adolescents: A preliminary randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 46(8), 1051–1061. doi:10.1097/CHI.0b013e318067e288

 PubMed Web of Science ®Google Scholar

Stein, B. D., Jaycox, L. H., Kataoka, S. H., Wong, M., Tu, W. L., Elliott, M. N., & Fink, A. (2003). A mental health intervention for schoolchildren exposed to violence — A randomized controlled trial. Journal of the American Medical Association, 290(5), 603–611. doi:10.1001/jama.290.5.603

 Web of Science ®Google Scholar

Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J., Macy, R. D., & De Jong, J. T. (2008). School-based mental health intervention for children affected by political violence in Indonesia: A cluster randomized trial. Journal of the American Medical Association, 300(6), 655–662. doi:10.1001/jama.300.6.655

 Google Scholar

Data availability statement

Data sharing is not applicable to this article as no new data were created or analysed in this study.