What is the recommended treatment approach for a Glass child at risk of developing complex post-traumatic stress disorder (PTSD)?

From the Guidelines

The recommended treatment approach for a Glass child at risk of developing complex PTSD involves early therapeutic intervention with evidence-based treatments (EBTs) that have demonstrated efficacy for children who have experienced trauma, as outlined in the most recent and highest quality study 1.

Key Considerations

• The most effective therapies are evidence-based treatments (EBTs) with demonstrated efficacy for children who have experienced trauma, such as trauma-focused cognitive behavioral therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR) 1.
• Having these services available on-site or through direct communication with colleagues in mental health (a “warm handoff”) has been revealed to be the most effective approach 1.
• It is essential for caregivers who have their own history of trauma to seek individual therapy, and the pediatric provider may find it useful to have a list of adult mental health providers who address trauma 1.

Treatment Approach

• Individual therapy sessions (typically 45-60 minutes weekly for at least 12-16 weeks) focused on processing their experiences, developing healthy coping mechanisms, and addressing feelings of neglect or invisibility.
• Family therapy is equally important to improve communication patterns and help parents balance attention among all children.
• Creating a supportive home environment where the Glass child's achievements and needs are acknowledged is crucial.

Medications

• No specific medications are indicated preventatively, though if symptoms develop, selective serotonin reuptake inhibitors (SSRIs) might be prescribed under psychiatric supervision.

Importance of Early Intervention

• Early intervention is justified because Glass children often internalize stress and develop maladaptive coping mechanisms when their emotional needs are consistently overlooked in favor of their siblings with higher visible needs, placing them at risk for complex trauma responses that can affect their development and relationships throughout life.
• The pediatric provider should be aware of the potential triggers that may cause an unanticipated, acute resurgence of grief or trauma symptoms, such as anniversaries of the disaster, severe weather, or persistent signs of destruction in the community, and help children anticipate and plan for how to address these feelings 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment Approach for Glass Child at Risk of Developing Complex PTSD

The treatment approach for a Glass child at risk of developing complex post-traumatic stress disorder (PTSD) should be tailored to their specific needs and circumstances.

• The recommended treatment approach typically involves trauma-focused psychotherapies, such as prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitization and reprocessing 2.
• For children and adolescents, trauma-focused cognitive behavioral therapy (TF-CBT) and cognitive behavioral therapy (CBT) are well-established treatments for PTSD 3.
• Multicomponent therapies that include a focus on safety, psychoeducation, and patient-provider collaboration, as well as self-regulatory strategies and trauma-focused interventions, may be effective for individuals with complex PTSD 4.

Considerations for Treatment

When treating a Glass child at risk of developing complex PTSD, it is essential to consider the following factors:

• The child's age, gender, ethnicity, and domicile may influence treatment outcomes 3.
• Parent/caregiver involvement and functioning can impact treatment effectiveness 3.
• The type of trauma experienced by the child and the presence of ongoing threat may require adaptations to the treatment approach 5.
• A comprehensive treatment plan should prioritize establishing a sense of safety and security for the child, while also addressing their specific needs and circumstances 4, 5.

Neurobiological and Translational Neuroscience Perspectives

From a neurobiological and translational neuroscience perspective, PTSD can be viewed as a disorder that involves dysregulation of normal fear processes 6.

• The neural circuitry underlying fear and threat-related behavior and learning in mammals, including the amygdala-hippocampus-medial prefrontal cortex circuit, is well-understood 6.
• Combining molecular-genetic approaches with a translational, mechanistic knowledge of fear circuitry may lead to advances in understanding mechanisms and identifying new treatments and interventions for PTSD 6.