Management

Treatment strategies for PTSD have included critical-incident stress debriefing soon after the event, which can greatly reduce distress in girls. ty1.,46 This technique involves discussing the nature and impact of the trauma event in a group format, in which individuals can describe and compare their perceptions and appraisals of the experience with each other. Where natural groupings have occurred in communities and schools, such treatments have been found to be useful for sharing feelings—boosting a sense of mastery and coping, sharing and solving common problems past the trauma. These techniques appear likely to reduce the 'contagion effect' of spreading emotional, particularly somatic, symptoms from severely impaired to mild or even non-impaired members of adolescent groups. In this regard they are potentially cost-effective by having a preventive impact as well as direct effects on existing cases.

Cognitive-behavioural and play therapy techniques have been used with individual children, but there have been few systematic reports of these more individual-based treatments. It is generally considered that asking children to draw on their experience often assists recall of both the event and the associated emotion. The therapeutic issue is to ensure that re-experiencing the event results in mastery of the associated distress in the here and now and diminishes personal impairment, rather than magnifying the impact of the original trauma and risking an increase in personal impairment.

To date, there are insufficient controlled studies of treatments to establish a clear set of guidelines for routine practice. However, whatever child-focused treatments are chosen it is important to involve parents, and perhaps siblings, in a general treatment plan, since parental reactions are known to influence children's compliance and the effectiveness of any individual or child group treatment employed.

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