The efficacy and acceptability of exposure therapy for the treatment of post-traumatic stress disorder in children and adolescents: a systematic review and meta-analysis

BACKGROUND: Posttraumatic stress disorder (PTSD) is common among children and adolescents who have experienced traumatic events. Exposure therapy (ET) has been shown to be effective in treating PTSD in adults. However, its efficacy remains uncertain in children and adolescents. AIMS: To evaluate the efficacy and acceptability of ET in children and adolescents with PTSD. METHOD: We searched PubMed, EMBASE, Cochrane, Web of Science, PsycINFO, CINAHL, ProQuest, LILACS, and international trial registries for randomized controlled trials (RCTs) assessed ET in children and adolescents (aged ≤18 years) with PTSD up to August 31, 2020. The primary outcomes were efficacy (the endpoint score from PTSD symptom severity rating scales) and acceptability (all-cause discontinuation), secondary outcomes included efficacy at follow-up (score from PTSD scales at the longest point of follow-up), depressive symptoms (end-point score on depressive symptom severity rating scales) and quality of life/social functioning (end-point score on quality of life/social functioning rating scales). This study was registered with PROSPERO (CRD42020150859). RESULT: A total of 6 RCTs (278 patients) were included. The results showed that ET was statistically more efficacious than control groups (standardized mean differences [SMD]: − 0.47, 95% confidence interval [CI]: − 0.91 to − 0.03). In subgroup analysis, exposure therapy was more efficacious for patients with single type of trauma (SMD: − 1.04, 95%CI: − 1.43 to − 0.65). Patients with an average age of 14 years and older, ET was more effective than the control groups (SMD: − 1.04, 95%CI: − 1.43 to − 0.65), and the intervention using prolonged exposure therapy (PE) (SMD: − 1.04, 95%CI: − 1.43 to − 0.65) was superior than control groups. Results for secondary outcomes of efficacy at follow-up (SMD: − 0.64, 95%CI: − 1.17 to − 0.10) and depressive symptoms (SMD: − 0.58, 95%CI: − 0.93 to − 0.22) were similar to the previous findings for efficacy outcome. No statistically significant effects for acceptability and quality of life/social functioning were found. CONCLUSION: ET showed superiority in efficacy at post-treatment/follow-up and depressive symptoms improvement in children and adolescents with PTSD. Patients with single type of trauma may benefit more from ET. And ET is more effective in patients 14 years or older. Moreover, PE could be a better choice.