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Background Practice guidelines for childhood posttraumatic stress disorder ( PTSD) recommend trauma-focused psychotherapies, mainly cognitive behavioral therapy ( CBT). Eye movement desensitization and reprocessing ( EMDR) therapy is a brief trauma-focused, evidence-based treatment for PTSD in adults, but with few well-designed trials involving children and adolescents. Methods We conducted a single-blind, randomized trial with three arms ( n = 103): EMDR ( n = 43), Cognitive Behavior Writing Therapy ( CBWT; n = 42), and wait-list ( WL; n = 18). WL participants were randomly reallocated to CBWT or EMDR after 6 weeks; follow-ups were conducted at 3 and 12 months posttreatment. Participants were treatment-seeking youth (aged 8-18 years) with a DSM- IV diagnosis of PTSD (or subthreshold PTSD) tied to a single trauma, who received up to six sessions of EMDR or CBWT lasting maximally 45 min each. Results Both treatments were well-tolerated and relative to WL yielded large, intent-to-treat effect sizes for the primary outcomes at posttreatment: PTSD symptoms ( EMDR: d = 1.27; CBWT: d = 1.24). At posttreatment 92.5% of EMDR, and 90.2% of CBWT no longer met the diagnostic criteria for PTSD. All gains were maintained at follow-up. Compared to WL, small to large (range d = 0.39-1.03) intent-to-treat effect sizes were obtained at posttreatment for negative trauma-related appraisals, anxiety, depression, and behavior problems with these gains being maintained at follow-up. Gains were attained with significantly less therapist contact time for EMDR than CBWT (mean = 4.1 sessions/140 min vs. 5.4 sessions/227 min). Conclusions EMDR and CBWT are brief, trauma-focused treatments that yielded equally large remission rates for PTSD and reductions in the severity of PTSD and comorbid difficulties in children and adolescents seeking treatment for PTSD tied to a single event. Further trials of both treatments with PTSD tied to multiple traumas are warranted. [ABSTRACT FROM AUTHOR]

Background: Reviews and practice guidelines for paediatric obsessive-compulsive disorder (OCD) recommend cognitive-behaviour therapy (CBT) as the psychological treatment of choice, but note that it has not been sufficiently evaluated for children and adolescents and that more randomized controlled trials are needed. The aim of this trial was to evaluate effectiveness and optimal delivery of CBT, emphasizing cognitive interventions. Methods: A total of 96 children and adolescents with OCD were randomly allocated to the three conditions each of approximately 12 weeks duration: full CBT (average therapist contact: 12 sessions) and brief CBT (average contact: 5 sessions, with use of therapist-guided workbooks), and wait-list/delayed treatment. The primary outcome measure was the child version of the semi-structured interviewer-based Yale-Brown Obsessive Compulsive Scale. Clinical Trial registration: ; unique identifier: ISRCTN29092580. Results: There was statistically significant symptomatic improvement in both treatment groups compared with the wait-list group, with no significant differences in outcomes between the two treatment groups. Controlled treatment effect sizes in intention-to-treat analyses were 2.2 for full CBT and 1.6 for brief CBT. Improvements were maintained at follow-up an average of 14 weeks later. Conclusions: The findings demonstrate the benefits of CBT emphasizing cognitive interventions for children and adolescents with OCD and suggest that relatively lower therapist intensity delivery with use of therapist-guided workbooks is an efficient mode of delivery. [ABSTRACT FROM AUTHOR]

Background: To investigate the association between normative repetitive routines of childhood and paediatric obsessive compulsive symptom syndrome (OCSS) and the extent to which it is genetically mediated. Methods: In a two-phase design a community sample of 4,662 6-year-old twin-pairs were sampled and 854 pairs were assessed in the second phase for normative repetitive routines using the Childhood Routines Inventory (CRI) and for OCSS by maternal-informant diagnostic interview. The OCSS phenotype was defined using standard diagnostic criteria for obsessive compulsive disorder, though regardless of impairment. Results: In the bivariate model, correlation between the CRI defined phenotype and the OCSS phenotype was estimated to be .40 (95% CI .27–.50), and this correlation was attributable wholly to additive genetic effects. The bivariate model also provided estimates of heritability of the two phenotypes separately: 55% (95% CI 80–89%) for the OCSS phenotype, with the remaining variance attributable mainly to non-shared environment, and 50% (95% CI 39–62%) for CRI assessed normative repetitive routines of childhood, with 36% of the remaining variance attributable to shared environment and 14% to non-shared. Conclusions: The moderate correlation between normative childhood repetitive routines and obsessive compulsive symptomatology, attributable to genetic factors, is consistent with the hypothesis that high levels of this trait in young children constitute a risk factor for the development of obsessive compulsive symptoms. [ABSTRACT FROM AUTHOR]

Background: From middle childhood onwards, substantial evidence points to phenotypic differentiation between anxiety diagnostic categories such as generalised anxiety, separation anxiety, specific phobia, and obsessive-compulsive disorders. However, little is known about the genetics of these categories and especially about the phenotypic and genetic structure of related behaviours in pre-school children. Methods: We examined the phenotypic differentiation and genetics of mother-reported anxiety-related behaviours in 4,564 four-year-old twin pairs, from a population-based sample. Results: Confirmatory factor analyses provided support for five correlated factors: General Distress, Separation Anxiety, Fears, Obsessive-Compulsive Behaviours, and Shyness/Inhibition. Genetic influences were found on all five factors, but the pattern of influences differed considerably across them, with particularly high heritability estimates for Obsessive-Compulsive Behaviours and Shyness/Inhibition, and substantial shared environmental influence on Separation Anxiety. Multivariate genetic analyses revealed moderate genetic correlations between the five factors. Genetic overlap was particularly pronounced between General Distress and the other anxiety-related behaviours, accounting for about half of their covariance. Genetic variance on Obsessive-Compulsive Behaviours was the least correlated with the other scales. The shared environmental influences correlated highly across the factors, accounting for the greatest proportion of covariation between Separation Anxiety, Fears and Obsessive-Compulsive Behaviours. The non-shared environment influences were largely variable specific. Conclusions: These data provide evidence for phenotypic and genetic overlap as well as differentiation between aspects of anxiety-related behaviours in young children. We conclude that research with young children will benefit from more specific assessments of anxiety-related behaviours in addition to less differentiated assessments of 'internalising' symptoms. [ABSTRACT FROM AUTHOR]

As part of a UNICEF-sponsored Psychosocial Programme in Bosnia, data were collected from a representative sample of 339 children aged 9-14 years, their mothers, and their teachers in order to investigate risk and moderating factors in children's psychological reactions to war. Self-report data from children revealed high levels of post-traumatic stress symptoms and grief reactions, but normal levels of depression and anxiety. Mothers' self-reports also indicated high levels of post-traumatic stress reactions, but normal levels of depression and anxiety. Child distress was related to both their level of exposure and to maternal reactions. Structural equation modeling was used to quantify the relationships between these risk factors and child distress, and to examine putative pathways to account for the association between child and maternal health. Children's adjustment was associated significantly with both exposure ( φ= .37) and maternal mental health ( φ= .37). Modeling also revealed a significant distorting effect of mother's own mental health on behavioural ratings of her child ( ψ= .59). Although evidence exists for an association between maternal mental health and mother rating errors, there is also a substantive association between maternal mental health and children's adjustment following war. [ABSTRACT FROM AUTHOR]

Post-traumatic Stress Disorder (PTSD) is a syndrome defined by the intrusive re- experiencing of a trauma, avoidance of traumatic reminders, and persistent physiological arousal. PTSD is associated with high levels of comorbidity and may increase the risk for additional disorders over time. While controversies remain regarding the applicability of the PTSD criteria to very young children, it has proved to be a useful framework for guiding assessment and treatment research with older children and adolescents. This article presents an overview of the literature on the clinical characteristics, assessment, and treatment of PTSD in children and adolescents. [ABSTRACT FROM AUTHOR]