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Terapeutiske behandlingsmetoder til traumatiserede børn. Version 1.0

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Terapeutiske behandlingsmetoder til traumatiserede børn. Version 1.0

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Formålet med rapporten var at kortlægge den eksisterende evidens for en række behandlingsmetoder til traumatiserede børn. Dette ud fra et identificeret behov i forskningsmæssige- og praktiske sammenhænge, hvor der er en mangel på viden om og belysning af tilgængelige evidensbaserede behandlingsmetoder, særligt blandt førskolebørn og yngre skolebørn. I kølvandet af en national konference om Traumefokuserede indsatser og behandling til børn, som Videnscenter for Psykotraumatologi afholdt i 2020, nedsattes derfor en arbejdsgruppe for at imødekomme behovet for mere viden om traumefokuseret behandling til yngre børn i en dansk kontekst. Denne arbejdsgruppe bestod af behandlere, praktikere og forskere fra Videnscenteret. I arbejdsgruppen har vi kortlagt en række anvendte traumefokuserede behandlingsmetoder med henblik på at undersøge deres evidens og med henblik på at kvalificere disse behandlingsmetoder i en dansk kontekst. De kortlagte behandlingsmetoder inkluderer: Compassion Focused Therapy, Eye Movement Desensitization and Reprocessing, legeterapi, narrativ eksponeringsterapi til traumatiserede børn og unge, sandplay, Somatic Experience®, Theraplay ® og traumefokuseret kognitiv adfærdsterapi. Med henblik på at kortlægge evidensen af hver enkelt behandlingsmetode udførte vi, på tværs af seks databaser, otte systematiske litteratursøgninger. Vi søgte i de elektroniske databaser EMBASE, Eric, Medline, PILOTS, PsycINFO og PubMed. Søgningerne havde til formål at identificere empiriske studier foretaget blandt børn under 12 år med traumerelateret symptomatologi og vanskeligheder, som er publiceret på engelsk eller skandinaviske sprog i peer-reviewede tidsskrifter. Det var et kriterie, at studierne undersøgte behandlingernes effekt, at barnets traumehistorik er beskrevet, og at de i deres assessment anvendte standardiserede mål for traumesymptomer og traumerelaterede vanskeligheder. På tværs af litteratursøgningerne og databaserne blev 7849 studier identificeret, hvoraf 46 opfyldte kriterierne for inklusion. Vi identificerede ni empiriske studier om Eye Movement Desensitization and Reprocessing, to om legeterapi, tre om narrativ eksponeringsterapi til traumatiserede børn og unge og 32 om traumefokuseret kognitiv adfærdsterapi. Søgningen identificerede ingen studier, der har undersøgt de resterende behandlingsmetoder. Dette betyder, at der for disse behandlingsmetoder på nuværende tidspunkt hverken foreligger evidens for eller imod deres effekt. Karakteriserende for de behandlingsmetoder, hvor det var muligt at identificere empiriske studier, var varierende studiedesigns, relativt kulturelt homogene samples og få længerevarende opfølgningsmålinger (maksimalt 12 mdr.). Sammenfattende indikerer studierne, at hver af de fire behandlingsmetoder har en gavnlig effekt på deltagernes symptomer og vanskeligheder. På nuværende tidspunkt er traumefokuseret kognitiv adfærdsterapi mest undersøgt, hvorfor evidensen for denne er mest solid. Hernæst følger evidensen for Eye Movement Desensitization and Reprocessing og sluttelig narrativ eksponeringsterapi til traumatiserede børn og unge, og legeterapi, hvor der foreligger præliminær evidens. Som led på vejen mod at sikre, at traumatiserede børn og deres familier tilbydes den evidensbaserede behandling, der egner sig bedst til netop deres udfordringer, er der derfor fortsat et stort behov for flere undersøgelser af hver enkelt behandlingsmetodes effekt. Der er behov for studier med randomiserede kontrollerede designs, multiple opfølgningsmålinger og validerede, standardiserede mål for traumerelaterede symptomer og vanskeligheder. Dette gør sig gældende generelt for alle behandlingsmetoder, men særlig for de behandlingsmetoder, som anvendes i praksis, men som endnu ikke har forskningsmæssigt belæg for eller imod deres virkning til denne målgruppe (Compassion Focused Therapy, Sandplay, Somatic Experience®, Theraplay®) eller som har begrænset evidens for en gavnlig effekt (narrativ eksponeringsterapi til traumatiserede børn og unge samt legeterapi).
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