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Intervention for Posttraumatic Stress Disorder (ptsd) for Young Children

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The purpose of this study is to examine the effectiveness of group play therapy as an intervention for posttraumatic stress disorder (PTSD) for young children between the ages of 2 and 5.

Each year, Child Protective Services receives child maltreatment referrals for about 5.5 million children, and an estimated 30% of these cases are substantiated (Barnett, & Hamblen, 2009). Such a large number of instances still does not even account for other types of trauma or trauma that goes unreported. Children may suffer from a number of traumatic events. These events may include, but are not limited to: neglect, physical abuse, sexual abuse, psychological abuse, divorce, spousal abuse, war, or natural disaster. Even though so many children can experience so many types of trauma, according to U.S. Surgeon General's report on mental health at least 1 out of every 10 children suffer from emotional and behavioral health problems severe enough to cause impaired functioning, yet less than half of these children receive treatment (Bratton, Ray, Rhine, & Jones, 2005). And even when children under the age of 5 receive treatment after exposure to trauma, they are less likely to complete group therapy than older children (Huth-Bocks, Schettini, & Shebroe, 2001).

Some attribute this lack of engagement in therapy on the false assumption made by both parents and clinicians that young children are unable to cognitively process traumatic experiences and are therefore unaffected by them (Huth-Bocks, Schettini, & Shebroe, 2001). It is known that experiencing trauma can put older children, teens, and adults at risk for PTSD. But only recently has research suggested that PTSD symptoms can be expressed in a young child's behavior, even as early as 28 months of age (Terr, 1988). While there is a plethora of research available for interventions used to treat PTSD in older children and adults, little has been investigated for interventions geared towards the younger population.

The prevalence of trauma witnessed or experienced by young children, and the risk this places them at for PTSD, demands effective evidence based interventions. This study attempts to explore an appropriate intervention, by using an intervention known to benefit behavior and emotional problems in children to address this issue of childhood PTSD. The implications of this study will influence the way mental health professionals will both assess and treat young children who have experienced trauma.

A number of therapeutic treatment options are available for children who are experiencing PTSD symptoms. These include individual and group play therapy, family therapy, behavioral therapy, and pharmacological therapy. And while no one therapy stands alone as the most effective treatment for PTSD, played therapy is regarded as the most researched intervention. Research has shown that even when verbally unable to, children can communicate through play(Terr, 1988). Children provided with play therapy generally perform ¾ of a standard deviation better on given outcome measures compared to children who did not receive play therapy (Bratton, Ray, Rhine, & Jones, 2005), and studies have shown that children who have experienced trauma benefit from play therapy with reduced maladaptive behaviors (Jackson, Spreier Rump, Ferguson, & Brown, 1999).

Using play as primary means of communication, a study conducted in 1999 found that play therapy can be used as an assessment tool with young children. The participant sample was composed of 18 children; 8 children were 2 years old and 8 were 3 years old. The purpose of the study was to determine play therapy's efficacy in assessment of the childrens' cognitive and functional development. The results showed that both groups of children communicated their level of cognitive function through play. The older children tended to engage in more complex play than the younger children, and for each group, the complexity of play grew over the duration of each session. Such results suggest that children even as young as 2 express themselves through play,



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