Predictors and moderators of treatment outcome for single incident paediatric PTSD: a multi-centre randomized clinical trial

Figures & data

Figure 1. CONSORT flow chart for the trial

Table 1. Descriptive statistics for the outcome and predictor/moderator variables at baseline by treatment group and between group comparisons (N = 101)

	Treatment group		Group comparison
Variable	EMDR (n = 54)	CBWT (n = 47)	F/X^2	p
Child
Age in months, M (SD)	153.11 (37.19)	161.94 (32.83)	1.58	.21
Female, no (%)	30 (56)	28 (60)	.17	.68
Trauma type, no (%)			10.37	.04
Physical abuse/assault	15 (28)	8 (17)
Sexual abuse	14 (26)	13 (27.7)
Accident/injury to loved one	5 (9)	15 (32)
Traumatic loss	13 (24)	5 (11)
PTSD-child report (CRTI – C), M (SD)	80.95 (21.04)	91.74 (23.20)	5.94	.02
PTSD-parent report (CRTI – P), M (SD)	83.84 (22.72)	87.39 (25.76)	.53	.47
Anx/dep-child report (RCADS-C), M (SD)	31.59 (19.58)	44.01 (19.65)	9.96	.002
Anx/dep-parent report (RCADS-P), M (SD)	35.04 (19.31)	38.63 (21.97)	.74	.39
No. comorbid disorders-child interview (ADIS-C), M (SD)	.92 (1.26)	1.13 (1.42)	.57	.45
No. comorbid disorders-parent interview (ADIS-P), M (SD)	.93 (1.28)	.85 (1.16)	.28	.60
Trauma-related beliefs (CPTCI), M (SD)	43.12 (12.81)	49.90 (14.59)	5.82	.02
Parent
PTSD (IES), M (SD)	19.29 (20.33)	18.68 (22.91)	.02	.89
Overall psychopathology (BSI) M (SD)	27.02 (29.95)	24.78 (38.45)	.10	.75
Depression subscale	3.25 (3.71)	2.93 (4.82)	.13	.72
Anxiety subscale	3.58 (4.59)	2.98 (5.12)	.37	.55

Abbreviations: EMDR: Eye Movement Desensitization and Reprocessing; CBWT: Cognitive Behavioural Writing Therapy; CRTI-C/P: Children’s Responses to Trauma Inventory – Child/Parent Versions; RCADS-C/P: Revised Child Anxiety and Depression Scale -Child/Parent Versions; ADIS-C/P: Anxiety Disorders Interview Schedule for DSM-IV- Child/Parent Versions; CPTCI: Children’s Post Traumatic Cognitions Inventory; IES: Impact of Event Scale; BSI: Brief Symptom Inventory.

Table 2. Results of linear mixed models testing predictor by time interaction on change per week in child-reported PTSD symptoms from pre-treatment to post-treatment and follow-up (N = 101)

	Pre- to post-treatment				Pre-treatment to 3 months				Pre-treatment to 12 months
Outcome/predictor variables	Change pw (SE)	Estimate (SE)	t	p	Change pw (SE)	Estimate (SE)	t	p	Change pw (SE)	Estimate (SE)	t	p
Child variables
Age in months	−2.227 (.170)	.008 (.005)	1.67	.097	−1.144 (.088)	.002 (.002)	.78	.438	−.395 (.037)	−.000 (.001)	−.25	.807
Gender (male = 0)	−2.172 (.237)	<.001 (.310)	−.002	.999	−1.097 (.119)	−.082 (.155)	−.53	.597	−.380 (.053)	−.026 (.067)	−.39	.699
Trauma type
Physical abuse/assault	−1.973 (.177)	−1.303 (.436)	−2.99	.003	−1.076 (.095)	−.332 (.199)	−1.67	.096	−.372 (.041)	−.122 (.085)	−1.43	.153
Sexual abuse	−2.409 (.190)	.982 (.347)	2.83	.005	−1.227 (.097)	.409 (.184)	2.23	.027	−.422 (.043)	.099 (.075)	1.33	.184
Accident/injury to loved one	−2.025 (.180)	−.765 (.402)	−1.91	.057	−1.065 (.097)	−.318 (.184)	−1.73	.085	−.381 (.041)	−.070 (.084)	−.84	.404
Traumatic loss	−2.045 (.177)	−.844 (.430)	−1.96	.051	−1.138 (.094)	−.011 (.204)	−.053	.958	−.411 (.040)	.087 (.086)	1.00	.318
PTSD-child report (CRTI-C)	−2.297 (.170)	.014 (.006)	2.24	.025	−1.159 (.086)	.000 (.003)	.056	.956	−.399 (.037)	−.001 (.001)	−.58	.565
PTSD-parent report (CRTI-P)	−2.375 (.177)	.022 (.006)	3.99	<.001	−1.159 (.090)	.007 (.003)	2.39	.017	−.393 (.038)	.001 (.001)	.79	.428
Anxiety/depression-child report (RCADS-C)	−2.279 (.172)	.024 (.008)	3.15	.002	−1.137 (.088)	.006 (.004)	1.62	.106	−.394 (.038)	−.000 (.002)	−.06	.952
Anxiety/depression-parent report (RCADS-P)	−2.447 (.178)	.031 (.006)	5.08	<.001	−1.154 (.090)	.011 (.003)	3.08	.002	−.390 (.038)	.002 (.002)	1.15	.250
No. comorbid disorders-child interv. (ADIS-C)	−2.362 (.192)	.219 (.103)	2.12	.035	−1.222 (.102)	.094 (.059)	1.60	.110	−.406 (.045)	.011 (.025)	.44	.659
No. comorbid disorders-parent interv. (ADIS-P)	−2.428 (.195)	.245 (.094)	2.61	.009	−1.261 (.103)	.119 (.054)	2.22	.027	−.426 (.044)	.034 (.025)	1.34	.180
Trauma-related beliefs (CPTCI)	−2.164 (.173)	.033 (.011)	2.94	.003	−1.111 (.090)	.012 (.006)	2.17	.031	−.398 (.039)	.002 (.002)	1.01	.314
Parent variables
PTSD (IES)	−2.376 (.180)	.020 (.005)	4.19	<.001	−1.152 (.089)	.009 (.003)	3.27	.001	−.387 (.037)	.002 (.001)	1.55	.122
Overall psychopathology (BSI)	−2.456 (.185)	.012 (.002)	5.12	<.001	−1.155 (.091)	.006 (.002)	3.74	<.001	−.386 (.038)	.001 (.001)	1.61	.108
Depression subscale	−2.427 (.183)	.108 (.021)	5.03	<.001	−1.135 (.090)	.047 (.014)	3.35	.001	−.385 (.038)	.013 (.007)	1.75	.082
Anxiety subscale	−2.379 (.183)	.089 (.020)	4.54	<.001	−1.131 (.090)	.041 (.013)	3.21	.001	−.384 (.038)	.010 (.007)	1.47	.142

Abbreviations: EMDR: Eye Movement Desensitization and Reprocessing; CBWT: Cognitive Behavioural Writing Therapy; CRTI-C/P: Children’s Responses to Trauma Inventory – Child/Parent Versions; RCADS-C/P: Revised Child Anxiety and Depression Scale – Child/Parent Versions; ADIS-C/P: Anxiety Disorders Interview Schedule for DSM-IV – Child/Parent Versions; CPTCI: Children’s Post Traumatic Cognitions Inventory; IES: Impact of Event Scale; BSI: Brief Symptom Inventory.

Table 3. Results of linear mixed models testing for effect between time, moderator and treatment condition, with estimates of change per week and the difference in change estimates between CBWT and EMDR for child-reported PTSD symptoms from pre-treatment to post-treatment and follow-up (N = 101)

	Pre- to post-treatment				Pre-treatment to 3 months				Pre-treatment to 12 months
Outcome/moderator variables	CBWT estimate (SE)	EMDR Δ estimate (SE)	t	p	CBWT Estimate (SE)	EMDR Δ Estimate (SE)	t	p	CBWT estimate (SE)	EMDR Δ estimate (SE)	t	p
Child variables
Age in months	0.016 (.007)	−.015 (.009)	−1.63	.104	.008 (.004)	−.011 (.005)	−2.26	.024	001 (.002)	−.003 (.002)	−1.26	.208
Gender (male = 0)	−.014 (.390)	.314 (.633)	.50	.620	.053 (.218)	−.268 (.308)	−.87	.385	.051 (.097)	−.147 (.134)	−1.09	.274
PTSD-child report (CRTI-C)	.018 (.008)	−.035 (.016)	−2.17	.031	.004 (.004)	−.007 (.007)	−.95	.342	.001 (.002)	−.004 (.003)	−1.30	.194
PTSD-parent report (CRTI-P)	.031 (.007)	−.031 (.012)	−2.48	.014	.012 (.004)	−.010 (.006)	−1.60	.109	.003 (.002)	−.004(.003)	−1.40	.162
Anx/dep-child report (RCADS-C)	.023 (.010)	−.011 (.018)	−.64	.524	.005 (.005)	.004 (.008)	.47	.639	.001 (.003)	−.002 (.004)	−.64	.523
Anx/dep-parent report (RCADS-P)	.039 (008)	−.029 (.014)	−1.99	.047	.016 (.004)	−.011 (.007)	−1.54	.125	.004 (.002)	−.004 (.003)	−1.35	.178
No. comorbid disorders-child interv. (ADIS-C)	.194 (.118)	.049 (.234)	.21	.836	.076 (.074)	.054 (.120)	.45	.655	.049 (.032)	−.092 (.050)	−1.82	.069
No. comorbid disorders-parent interv. (ADIS-P)	.263 (.110)	−.090 (.213)	−.42	.673	.132 (.076)	−.023 (.106)	−.22	.826	.064 (.034)	−.062 (.050)	−1.25	.214
Trauma-related beliefs (CPTCI)	.031 (.013)	−.014(.026)	−.55	.585	.013 (.008)	−.001 (.012)	−.05	.964	.005 (.003)	−.006 (.005)	−1.19	.236
Parent variables
PTSD symptoms (IES)	.028 (.005)	−.045 (.013)	−3.57	<.001	.013 (.003)	−.009 (.006)	−1.34	.182	.003 (.002)	−.003 (.003)	−.95	.343
Overall psychoapthology (BSI)	.015 (.003)	−.026 (.010)	−2.66	.008	.008 (.002)	−.007 (.004)	−1.65	.100	.002 (.001)	−.003 (.002)	−1.58	.115
Depression subscale	.138 (.023)	−.233 (.076)	−3.07	.002	.070 (.016)	−.084 (.035)	−2.38	.018	.022 (.009)	−.027 (.016)	−1.69	.092
Anxiety subscale	.123 (.021)	−.255 (.064)	−4.00	<.001	.064 (.014)	−.077 (.030)	−2.56	.011	.021 (.008)	−.027 (.013)	−2.02	.044

Abbreviations: EMDR: Eye Movement Desensitization and Reprocessing; CBWT: Cognitive Behavioural Writing Therapy; CRTI-C/P: Children’s Responses to Trauma Inventory – Child/Parent Versions; RCADS-C/P: Revised Child Anxiety and Depression Scale – Child/Parent Versions; ADIS-C/P: Anxiety Disorders Interview Schedule for DSM-IV – Child/Parent Versions; CPTCI: Children’s Post Traumatic Cognitions Inventory; IES: Impact of Event Scale; BSI: Brief Symptom Inventory.

Note: t and p values are for the difference in Δ estimates (change per week) between CBWT and EMDR groups.

Table 4. Estimated means for child-reported PTSD symptoms at pre- and post-treatment, and difference (Δ) between these means, separately for participants scoring at the high- and low-end of the significant moderator variables in EMDR and CBWT groups

	Severity of child-reported PTSD symptoms
	Low severity (< 40^th percentile)			High severity (> 60^th percentile)
Moderator/treatment condition	Pre-treatment	Post-treatment	Pre- to post-treatment Δ	Pre-treatment	Post-treatment	Pre- to post-treatment Δ
Child psychopathology
Child-reported PTSD (CRTI-C)
EMDR	66.92	47.60	19.32	94.03	66.93	27.10
CBWT	73.93	44.94	28.99	94.93	72.40	22.53
Parent-reported PTSD (CRTI-P)
EMDR	72.93	50.56	22.37	78.73	55.33	23.40
CBWT	87.44	54.72	32.72	89.14	65.41	23.73
Parent-reported anx/dep (RCADS-P)
EMDR	72.67	47.49	25.18	79.00	57.18	21.82
CBWT	85.80	52.95	32.85	89.42	66.47	22.95
Parental psychopathology
PTSD symptoms (IES)
EMDR	69.75	50.43	19.32	77.61	52.35	25.26
CBWT	86.97	58.24	28.73	88.48	63.90	24.58
Overall psychopathology (BSI-Total)
EMDR	72.08	53.15	18.93	77.28	52.52	24.76
CBWT	87.10	57.34	29.76	89.74	61.50	28.24
Depression (BSI-Depression)
EMDR	74.50	53.56	20.94	77.17	52.98	24.19
CBWT	88.82	57.69	31.13	85.69	60.40	25.29
Anxiety (BSI-Anxiety)
EMDR	76.92	58.80	18.12	75.81	51.19	24.62
CBWT	86.90	54.67	32.23	86.95	62.96	23.99

Abbreviations: EMDR: Eye Movement Desensitization and Reprocessing; CBWT: Cognitive Behavioural Writing Therapy; CRTI-C/P: Children’s Responses to Trauma Inventory Child/Parent Versions; RCADS-P: Revised Child Anxiety and Depression Scale – Parent Version; IES: Impact of Event Scale; BSI: Brief Symptom Inventory.

Supporting information

Additional Supporting Information may be found in the online version of this article:Appendix S1. Table with estimated means in child reported PTSD symptoms pre- and follow-ups for low- and high scoring groups (EMDR therapy and CBWT).

Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data are not available.