Comportement des enfants et des adolescents

Abstrait

A Complex Multimodal 4-Week Residential Treatment Program Significantly Reduces PTSD Symptoms in Child Sexual Abuse Victims: The Be Brave Ranch

Peter H Silverstone, Farrel Greenspan, Millie Silverstone, Hanelle Sawa, Jacqui Linder

Childhood sexual abuse (CSA) occurs frequently and often has serious long-term sequelae including posttraumatic stress disorder (PTSD), which often leads to significantly worse outcomes among CSA survivors. However, the most effective treatment, particularly for younger children, remains uncertain. Research supports trauma-focused cognitive behavioural therapy (TF-CBT) in different age groups, and we designed a 4-week residential treatment program for CSA victims aged 8-12. Here we report the outcome from the first 35 children to take part in a complex multimodal program (mean age 10 years old), located at a dedicated facility (the “Be Brave Ranch”), with the primary therapeutic focus being TF-CBT, although several other treatment modalities were also utilized. Of the 35 children, 23 were female and 12 were male. The results show a highly significant (p<0.001) reduction in Child Post-Traumatic Stress Disorder Symptom Scale (CPSS) scores from baseline (20.5 ± 1.56) to follow-up (14.6 ± 1.55). Also, the number of children who were above the threshold for PTSD using this scale (a score of 16 or more) fell from 26 at baseline to 14 at the end of the 4-week intervention, suggesting that these improvements are also highly clinically relevant. There was also a significant (p<0.02) decrease in depression and anxiety, as measured by the Revised Child Anxiety and Depression Scale-Short Version scale, with scores decreasing from baseline (23.8 ± 1.77) to follow-up (20.6 ± 1.68). These results support the use of this short, but intense, residential intervention for CSA victims. They are also consistent with recent PTSD studies in adults demonstrating better efficacy for brief intensive interventions. Since reducing the number of CSA survivors who develop PTSD can have profound longer-term benefits, this suggests that such an approach might be more widely utilized. Further research should examine longer-term outcomes and effects of additional interventions, as well as comparisons to other therapies and determining if similar programs are useful in older age groups.