The Efficacy of Psychological Interventions for Child and Adolescent PTSD: A Network Meta-Analysis

Importance Pediatric post-traumatic stress disorder (PTSD) is a common and debilitating mental disorder. Yet, a comprehensive network meta-analysis examining the efficacy of psychological interventions is lacking. Objective To synthesize all available evidence on psychological interventions for pediatric PTSD in a comprehensive network meta-analysis. Data Sources PsycINFO, MEDLINE, Web of Science, and PTSDpubs were searched from inception to January 2 nd 2024 and 74 related systematic reviews were screened. Study Selection Two independent raters screened publications for eligibility. Inclusion criteria were: Randomized controlled trial (RCT) with ten or more patients per arm examining a psychological intervention for pediatric PTSD compared to a control group in children and adolescents (< 19 years) with full or subthreshold PTSD. Data Extraction and Synthesis PRISMA guidelines were followed to synthesize and present evidence. Two independent raters extracted data and assessed risk of bias with Cochrane criteria. Random effects network meta-analyses were run. Main Outcome and Measures S tandardized mean differences (Hedges’ g ) in PTSD severity. Results In total, 70 RCTs (N = 5,528 patients) were included. Most RCTs (74%) examined trauma-focused cognitive behavior therapy interventions (TF-CBTs). At treatment endpoint, TF-CBTs, EMDR, multi-disciplinary treatments (MDTs), and non-trauma-focused interventions (non-trauma-focused interventions) were all efficacious in reducing PTSD when compared to passive control conditions, with large pooled effects ( gs ≥ 0.86, all ps < .001) in the random effects network meta-analysis. TF-CBTs produced the strongest short-term effects relative to both passive and active control conditions and across all sensitivity analyses. In a sensitivity analysis including only trials with parent involvement, TF-CBTs were significantly more efficacious in reducing PTSD than non-trauma-focused interventions ( g = 0.35, p = .026). Results for mid-term (up to 5 months posttreatment) and long-term data (6-24 months posttreatment) were very similar. Conclusions and Relevance The present network meta-analysis is the most comprehensive summary of psychological treatments for pediatric PTSD to this date. Results confirm that TF-CBTs can efficaciously reduce PTSD symptom severity in children and adolescents in the short-, mid-, and long-term. More long-term data are needed for EMDR, MDTs, and non-trauma-focused interventions. Results of TF-CBTs are encouraging and disseminating these results may help reduce common treatment barriers. Key Points Question How efficacious are psychological treatments for pediatric PTSD? Findings Trauma-focused cognitive behavior therapies (TF-CBTs) are currently the most evaluated treatment for pediatric PTSD (74% of included studies). Data for other interventions are emerging. At short-term, TF-CBTs, Eye Movement Desensitization and Reprocessing (EMDR), non-trauma-focused interventions, and multi-disciplinary treatments (MDTs) all significantly reduced pediatric PTSD relative to no treatment. TF-CBTs produced the strongest short- and long-term treatment effects. EMDR and MDTs had insufficient long-term data. Meaning TF-CBTs should be the first-line treatment recommendation for pediatric PTSD. While data for other treatment approaches emerged with some promising findings, more data (including long-term data) are needed to draw firmer conclusions.