Copyright @ 2007 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited. Cognitive-Behavioral Therapy for PTSD in Children and Adolescents: A Preliminary Randomized Controlled Trial PATRICK SMITH, PH.D., WILLIAM YULE, PH.D., SEAN PERRIN, PH.D., TROY TRANAH, PH.D., TIM DALGLEISH, PH.D., AND DAVID M. CLARK, D.PHIL. ABSTRACT Objective: To evaluate the efficacy of individual trauma-focused cognitive-behavioral therapy (CBT) for treating posttraumatic stress disorder (PTSD) in children and young people. Method: Following a 4-week symptom-monitoring baseline period, 24 children and young people (8Y18 years old) who met full DSM-IV PTSD diagnostic criteria after experiencing single-incident traumatic events (motor vehicle accidents, interpersonal violence, or witnessing violence) were randomly allocated to a 10-week course of individual CBT or to placement on a waitlist (WL) for 10 weeks. Results: Compared to the WL group, participants who received CBT showed significantly greater improvement in symptoms of PTSD, depression, and anxiety, with significantly better functioning. After CBT, 92% of participants no longer met criteria for PTSD; after WL, 42% of participants no longer met criteria. CBT gains were maintained at 6-month follow-up. Effects of CBT were partially mediated by changes in maladaptive cognitions, as predicted by cognitive models of PTSD. Conclusions: Individual trauma-focused CBT is an effective treatment for PTSD in children and young people. J. Am. Acad. Child Adolesc. Psychiatry, 2007;46(8):1051Y1061. Key Words: posttraumatic stress disorder, cognitive-behavioral therapy. Children and adolescents can develop posttraumatic stress disorder (PTSD) after exposure to a variety of traumatic events, including sexual abuse, interpersonal violence, and motor vehicle accidents. PTSD is associated with substantial impairments in social and academic functioning, even at subclinical levels (Giaconia et al., 1995) and, if left untreated, may run a chronic course for at least 5 years in more than one third of children who develop the disorder (Yule et al., 2000). Effective treatment for pediatric PTSD is needed (see Feeny et al., 2004; Stallard, 2006). A substantial body of work provides support for the efficacy of cognitive-behavioral therapy (CBT) for children with PTSD and other symptoms following sexual abuse. For example, a series of studies by Deblinger and colleagues (e.g., Cohen et al., 2004; Deblinger et al., 1990, 1999) has demonstrated that trauma-focused CBT (which included anxiety manage- ment components such as coping skills training and joint work with parents) with children 3Y16 years old is effective in reducing symptoms of PTSD and exter- nalizing symptoms relative to waitlist (i.e., delayed treatment; WL), to child-centered therapy, to parent- only intervention, and to community-care referrals. However, not all of the participants in these studies met criteria for a diagnosis of PTSD, and many presented with additional difficulties (including behavior prob- lems and other anxiety disorders). Indeed, Feeny et al. (2004) note in their recent review that child survivors of sexual abuse may present a different symptom picture from that of children exposed to single-incident Accepted March 12, 2007. Drs. Smith, Perrin, Tranah, Yule, and Clark are with Kings College London, Institute of Psychiatry; and Dr. Dalgleish is with the Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK. This trial was funded by the Psychiatry Research Trust by a Kraupl Taylor Fellowship awarded to the first author. The authors thank Drs. Ed Glucksman, Peter Thompson, Patricia Kenny, and the staff of the Accident and Emergency Departments at Kings College and Lewisham University Hospitals and the young people who participated in the study. Correspondence to Dr. Patrick Smith, Department of Psychology PO77, Institute of Psychiatry, de Crespigny Park, London SE5 8AF, UK; e-mail: patrick.smith@iop.kcl.ac.uk. 0890-8567/07/4608-1051Ó2007 by the American Academy of Child and Adolescent Psychiatry. DOI: 10.1097/CHI.0b013e318067e288 1051 J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 46:8, AUGUST 2007