Practice Profile: Trauma-Focused Treatment for Juveniles and Young Adults With Trauma Symptoms and Externalizing Behaviors

This practice consists of trauma-focused interventions to treat trauma symptoms and externalizing behaviors in juveniles and young adults. The practice is rated Effective for reducing trauma symptoms and for externalizing behaviors in juveniles and young adults, compared with juveniles and young adults in the control group who did not receive treatment.

Practice Goals/Target Population

Trauma-focused interventions are treatments targeted specifically at juveniles and young adults who have been exposed to traumatic events, such as physical or sexual violence or severe accidents (Hoogsteder et al. 2021). Research shows a connection between traumatic events and externalizing behaviors; up to 90 percent of justice-involved youths ages 12 to 18 have experienced at least one traumatic event, and adolescents diagnosed with posttraumatic stress disorder (PTSD) are more likely to recidivate within 3 years, compared with adolescents without a PTSD diagnosis (Becker and Kerig 2011; Becker et al. 2012). The goal of trauma-focused treatment is to address trauma symptoms and reduce externalizing behaviors (such as aggression, criminal behavior) to ultimately avoid future justice involvement.

Practice Components

In general, trauma-focused interventions to reduce PTSD symptoms in children, adolescents, and young adults can be grouped into two types of programs. The first is trauma-focused cognitive behavior therapy (TF–CBT). This type of CBT allows the individual experiencing trauma to talk directly about their traumatic experience in a supportive environment. Typically, this intervention is brief and takes place over the course of 12 to 18 weeks. The goals of TF–CBT are to provide the  skills to manage distressing thoughts related to their trauma and to process the events productively. Cognitive reframing and caregiver participation are often important aspects of this therapy. Additionally, gradual exposure and writing exercises that encourage discussion of the details of the traumatic event can be used to assist in discussing thoughts and feelings associated with the trauma (Cary and McMillen 2012; Cohen et al. 2004).

The second form of trauma-focused treatment is eye movement desensitization and reprocessing (EMDR). The goal of EDMR is to alleviate distress associated with traumatic memories through accessing and processing these memories in brief doses while focusing on an external stimulus (usually therapist-directed eye moments). EMDR is a brief intervention and takes place over the course of eight phases. The phases are history taking, treatment planning, preparation, reprocessing, installation of a positive cognition, checking for and processing any residual disturbing body sensations, positive closure, and evaluation (de Roos et al. 2017).

Hoogsteder and colleagues (2021) conducted moderator analyses to examine the impact of adolescent characteristics as moderators for the overall treatment effects on trauma symptoms and externalizing behaviors. The authors found that gender did not significantly moderate treatment effects. However, age was a moderator for overall treatment effects. The treatment effect of trauma-focused treatment on trauma symptoms and externalizing behaviors was larger for older adolescents, compared with younger adolescents. This difference was statistically significant.

These sources were used in the development of the practice profile:

These sources were used in the development of the practice profile:

Becker, Stephen P, and Patricia K. Kerig. 2011. “Posttraumatic Stress Symptoms Are Associated With the Frequency and Severity of Delinquency Among Detained Boys.” Journal of Clinical Child & Adolescent Psychology 40(5):765–71.

Becker, Stephen P., Patricia K. Kerig, Ji–Young Lim, and Rebecca N. Ezechukwu. 2012. “Predictors of Recidivism Among Delinquent Youth: Interrelations Among Ethnicity, Gender, Age, Mental Health Problems, and Posttraumatic Stress.” Journal of Child & Adolescent Trauma 5(2):145–60.

Cary, Colleen E., and J. Curtis McMillen. 2012. “The Data Behind the Dissemination: A Systematic Review of Trauma-Focused Cognitive Behavioral Therapy for Use With Children and Youth.” Children and Youth Services Review 34(4):748–57.

Cohen, Judith A., Esther Deblinger, Anthony P. Mannarino, and Robert A. Steer. 2004. “A Multisite Randomized Trial for Children With Sexual Abuse–Related PTSD Symptoms.” Journal of the American Academy of Child and Adolescent Psychiatry 43:393–402.

de Roos, Carlijin, Saskia van der Oord, Bonne Zijlstra, Sacha Lucassen, Sean Perrin, Paul Emmelkamp, and Ad de Jongh. 2017. “Comparison of Eye Movement Desensitization and Reprocessing Therapy, Cognitive Behavioral Writing Therapy, and Wait-List in Pediatric Posttraumatic Stress Disorder Following Single-Incident Trauma: A Multicenter Randomized Clinical Trial.” Journal of Child Psychology and Psychiatry 58(11):1219–28.

Following are CrimeSolutions-rated programs that are related to this practice:

Eye Movement Desensitization and Reprocessing (EMDR) for Traumatized Young Women

Cognitive Behavioral Intervention for Trauma in Schools (CBITS)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Bounce Back

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?