Open Access

Regina Steil, Anne Fischer, Rita Rosner

• Über die Hälfte aller Kinder und Jugendlichen erleben vor ihrem 18. Geburtstag ein potentiell traumatisierendes Ereignis. Entwickeln die Betroffenen in der Folge eine posttraumatische Belastungsstörung (PTBS), wirken sich die damit verbundenen Konsequenzen häufig bis ins Erwachsenenalter aus. Klinische Leitlinien unterstützen die Behandlerinnen und Behandler bei der Auswahl geeigneter Therapien, sind aufgrund variierender Methodik und unterschiedlicher Evidenzgrundlage aber mit Interpretationsschwierigkeiten verbunden. Dieser Beitrag gibt einen Überblick über aktuelle nationale und internationale Leitlinienempfehlungen. Als Methode erster Wahl zur Behandlung der PTBS bei Kindern und Jugendlichen wird übereinstimmend Psychotherapie in Form von Traumafokussierter Kognitiver Verhaltenstherapie (Tf-KVT) und teilweise auch Eye Movement Desensitization and Reprocessing (EMDR) empfohlen. Bezugspersonen sollen, wenn möglich, in die Behandlung einbezogen werden. Eine Pharmakotherapie wird nicht empfohlen. Forschungsbedarf besteht in den Bereichen der Dissemination empirisch gestützter Behandlungen, EMDR, und der Behandlung komplexer PTBS.
• More than half of all children and adolescents experience a potentially traumatizing event before their 18th birthday. If they subsequently develop a posttraumatic stress disorder (PTSD), the associated consequences may often continue into adulthood. Clinical treatment guidelines assist treatment providers in selecting appropriate therapies but are also linked with interpretive difficulties because of varying methodology and evidence base. This article provides an overview of current recommendations from international and German treatment guidelines. Psychotherapy based on trauma-focused cognitive behavioral therapy (Tf-CBT) is consistently recommended as the treatment of choice for PTSD in children and adolescents. Eye movement desensitization and reprocessing (EMDR) is also sometimes mentioned, but recommendations on this intervention are inconsistent. Only one guideline sees sufficient evidence to recommend EMDR as a first-line approach; the remaining guidelines advise that it should be considered only if Tf-CBT is unavailable or inapplicable. Additionally, there is a call for further research regarding this approach to improve the evaluation of its effectiveness. Psychopharmacology is consistently not recommended for children and adolescents, either as a stand-alone intervention or as an additional treatment option. For the treatment of complex PTSD, the considered guidelines emphasize the need for further research and consequently do not currently commit to a recommendation for a specific intervention. Existing trauma-focused treatments, however, are considered to be promising for not only successfully reducing PTSD symptom severity but also for use with cases of complex PTSD. However, before every treatment, it is imperative to conduct an age-appropriate collection of a differentiated trauma history in the form of a self-report and an external report using validated PTSD survey instruments. Moreover, the guidelines recommend that caregivers be closely involved in the therapy process. Although the number of controlled studies on the treatment of PTSD for children and adolescents has increased considerably in recent years – and the early and effective treatment of PTSD in children and adolescents can prevent the development of secondary disorders and clinically relevant suffering – guidelines in the adult field are still much more comprehensive and differentiated. Efforts should be made to increase the dissemination of empirically supported treatments by training key providers of children and adolescents such as licensed psychotherapists, psychotherapists in training, child and youth welfare agencies, and pediatricians. Future research should furthermore concentrate on evaluating EMDR for PTSD in children and adolescents and the treatment of complex PTSD in this age group.