We are the Association for Child and Adolescent Mental Health, or ACAMH for short. And this is ACAMH Learn. Hello, my name is Katherine Guyon-Harris. I'm an assistant professor at the University of Pittsburgh in the School of Medicine. I'm a clinical psychologist by training and specialise in infant and early childhood mental health. My colleague Kate Humphreys and I prepared this annual research review on interventions for young children exposed to trauma. And I'm excited to give an overview of our paper with you today. So first, just some learning objectives. So the objectives for today are to describe the developmental rationale for trauma focused interventions in early childhood to differentiate among evidence-based trauma interventions for young children by age group, and to identify critical gaps in the current evidence-based and prioritise future directions for research and implementation. So children experience reactions following trauma exposure and require intervention similar to adults. But this understanding has really only gained traction in the past few decades. For a long time, it was assumed that children don't really remember traumatic experiences or just aren't as affected as adults or older children. But we now know that they not only remember, but they're uniquely impacted given their young age and limited verbal abilities, along with rapid development and reliance on caregivers who can be a buffer for traumatic stress or an additional source of trauma and dysregulation. So the dramatic neurocognitive development during early childhood makes understanding trauma experiences in young children more complex than in older populations with more developed abilities. So for young children, trauma experiences can have particularly profound impacts due to rapidly developing brains and heightened vulnerability. And in the aftermath of trauma, young children are entirely dependent on adult caregivers for safety, protection, and access to intervention. And this is further complicated when caregivers are the perpetrators of trauma and not able to provide adequate safety and protection. Consequently, interventions for young children need to necessarily include healthy, reliable, and regulated caregivers in the therapeutic process. So because young children are unique in their reliance on caregivers, both physical and psychological safety, it's not surprising that all empirically validated interventions for trauma exposed young children do require caregiver involvement to varying degrees. So our review addresses a significant gap in the literature by examining interventions that are specifically designed for trauma exposed children ages 0 to 8 years old. There are lots of reviews that have examined trauma interventions broadly across childhood and adolescence, but there was a need for a review focused exclusively on evidence-based treatments for the earliest developmental period, with particular attention paid to caregiver involvement. So our review begins by defining trauma and early childhood, followed by theoretical frameworks that can guide intervention approaches. We then examine evidence-based interventions organised by developmental periods, highlighting exemplar treatments with demonstrated efficacy. And we wrap up with innovations, challenges, and future directions for the field. Our review covers four prominent perspectives that provide complementary understanding of trauma's effects on young children, and that can guide intervention strategies. So you'll find more detailed information in the paper. But briefly, just to summarise, learning and behaviour theory is based in fear conditioning and lends itself to exposure-based interventions and strategies. Cognitive models are rooted in maladaptive beliefs about the self, others, and the world and point to cognitive processing techniques. Developmental theory suggests that trauma develops-- disrupts normal development, and supports age-based strategies and developmental guidance to rebuild competencies. And finally, attachment theory posits that trauma impacts trust and relationships, and that building trust and fostering secure attachments is a central tenet to intervention for young children exposed to trauma. Several core therapeutic elements emerge from the theoretical frameworks as essential components of effective trauma interventions for young children. So while they're implemented differently across age groups intervention models, these components form the core foundation of evidence-based trauma treatment and address specific aspects of trauma impact. And they are safety and stabilisation, exposure, cognitive processing, skill building, and caregiver involvement. And in addition to these core elements, interventions are universally supported by education and preparation, which is sometimes termed psychoeducation, in which families are provided with information about trauma, its effects, prevalence, and expected treatment outcomes. This psychoeducation component builds engagement and rapport, normalises traumatic experiences, validates emotions, and reduces stigma. For young children, psychoeducation is delivered primarily through caregivers with simple, concrete explanations provided directly to the children-based on their developmental capacity. Following our review of core elements for trauma treatment, we dive into interventions. Despite clear evidence that young children experience trauma at high rates and develop PTSD, evidence-based interventions specifically designed for children under eight years, remain limited compared to treatments available for older populations. So in our review, we identified exemplar interventions by developmental period, and we focused on interventions that target trauma symptoms as primary outcomes were designed for children ages 0 to 8, include substantive caregiver involvement, and have empirical support from published randomised controlled trials or well-designed quasi experimental studies. We excluded interventions that were designed for broad age ranges, like 6 to 18 years, where the average participant age consistently fell outside of our zero to eight-year-old focus, indicating that young children were really not the primary target population for the study. We also excluded trauma-informed approaches that address general behaviour problems or psychopathology, rather than targeting trauma symptoms directly, as well as general psychotherapy approaches without specific trauma components. Parenting interventions with trauma-focused and school-based universal prevention programmes. Beyond these exemplars that we identified, child-parent psychotherapy, preschool PTSD treatment, and trauma-focused CBT. We also identified several emerging interventions with preliminary evidence that warrant attention. You can find more information in our paper, but these approaches represent innovative methods for addressing trauma in young children and highlight important directions for future research, and they are coping with accident reactions or care, neurofeedback training and eye movement integration. In our review, we also provide a decision-making framework for treatment selection in trauma-exposed children ages six to eight years old. The optimal intervention approach for children in this age range remains an important question. So these children are unique, and they sit at the intersection between interventions designed specifically for young children and those developed for older children and adolescents. Meta-analytic findings on interventions for children and adolescents with anxiety disorders, including PTSD, have reported smaller effects of CBT-based interventions for children under age 13 compared to adolescents. However, another meta-analysis found higher efficacy when interventions had a component of caregiver involvement. Most meta-analyses include very few studies with children under eight making definitive conclusions difficult for this age group. So we suggest that for this transitional age, several factors beyond just chronological age should guide intervention selection. And these include the caregivers resources and capacity, the child's developmental functioning, symptom presentation and comorbidities, barriers, and the child's own thoughts about what might be helpful for them. Our review concludes with key gaps in the field and innovations and future directions. The landscape of trauma-focused interventions for young children has evolved significantly, but there are substantial gaps, particularly for children under the age of three. Furthermore, interpersonal traumas, particularly childhood maltreatment, dominate the intervention literature for young children. Exposure to non-interpersonal events like accidents, natural disasters, and medical procedures has received far less attention despite potentially profound impacts. One of the more prominent challenges noted across the literature on trauma during early childhood is identifying the presence of PTSD in young children, which can be a barrier to identification and referral to intervention. There's also widespread misinformation about the impact of trauma on young children, and the fact that even very young infants can exhibit trauma symptoms. It's important to note that a formal PTSD diagnosis is not required to initiate trauma-focused treatment. Symptom-based, trauma-informed approach that treats distress and functional impairment following an identified trauma exposure aligns with trauma-informed care principles and reflects real-world clinical practise. Multimethod, multiformat assessment approaches yield the most comprehensive understanding of a child's trauma symptoms and should be considered best practise. Future research should focus on developing assessment approaches that can track trauma symptoms longitudinally across developmental transitions, while also accounting for normative developmental changes in symptom expression. Finally, our review also revealed that there is insufficient implementation research on disseminating interventions in community settings. Flowing from that, future research priorities should include expanding the evidence-based for existing promising interventions through well-powered trials and diverse samples, developing and testing preventive interventions delivered following potentially traumatic events. Adapting established interventions for broader, understudied trauma types, and implementation research to support widespread adoption in real-world settings. One really important innovation is the development of interventions for caregivers of trauma-exposed young children, particularly following medical traumas. These approaches delivered in the acute phases of trauma exposure, recognise that supporting caregivers while being enhances their ability to buffer children from the effects of trauma. In conclusion, developmental considerations fundamentally shape trauma intervention for young children. The rapid neurodevelopmental changes across early childhood necessitate interventions specifically designed for children's evolving capacities, rather than simply scaled down versions of adult treatments. For the youngest children, interventions operate primarily through a caregiver child relationship with the degree of direct child engagement increasing as children age. The stakes for advancing the field could not be higher. Early childhood trauma exposure occurs during sensitive periods of brain development with potential lifelong consequences. Yet, this same developmental plasticity creates unique opportunities for intervention to redirect trajectories toward positive outcomes. By continuing to refine effective trauma interventions for our youngest children, we can not only alleviate immediate suffering, but potentially prevent decades of associated difficulties across the lifespan. Thank you so much for listening today. [MUSIC PLAYING]