(PS6-56) Randomized Clinical Trial of Attention Training for PTSD in Children

PTSD is a serious diagnosis marked by re-experiencing, avoidance, mood, cognitive, and hyperarousal symptoms. PTSD affects 5% of youth. Unfortunately, standard of care for PTSD - exposure therapy - is only partly effective and requires intense revisiting of traumatic events. New and less distressing interventions for PTSD are needed. Research has shown that attention training is an effective intervention for adults with combat or civilian PTSD; however, it has not been tested in children. Our study recruited children aged 7-15 with past trauma (N=89) specifically recruiting inner city youth. Participants were assessed using the Trauma History Profile, UCLA Child/Adolescent Reaction Index for PTSD, and Trauma Symptom Checklist for Children. Of those assessed, 41.6% (n=37) had probable PTSD based on UCLA Index scores ³35 and were suitable for study inclusion. Those children were randomly assigned to groups: attention training (n=24) and placebo (n=13) at a 2:1 ratio. Both the attention training and placebo consisted of 6 sessions (10 minutes each) of a computerized task that displayed two faces of the same actor on a screen, followed by a small right or left arrow appearing in the location vacated by one of the faces. Participants were required to respond as quickly as possible by pressing the right or left arrow key. In attention control training, the participant viewed the actor displaying a neutral and an angry expression. In the placebo both expressions were neutral. In both conditions the location of the arrow was random. Notably, this image-based version of attention training is well-suited for children because it is a nonverbal intervention.

13 (of 13) children completed placebo, and 22 (of 24) children completed attention training. The average age of participants (19 boys and 16 girls) was 9.66(2.29) years. 40.0% of participants identified as multiracial, 31.4% Black, 14.3% Hispanic, 8.6% Native American, and 5.7% White. The total sample improved significantly from pre to post test on both measures of PTSD (ps< 0.001). However, there was not a significant time by condition interaction on the UCLA scale (p=0.46) nor the TSCC PTSD scale (p=0.14). Reliable change for the UCLA measure is estimated at 8.28, and the total sample improved from a pre-test score of 49.09(11.17) to a post-test score of 36.03(14.10) for a 13.06 point improvement. Similarly, the TSCC PTSD scale scores improved by roughly a standard deviation from 17.20(5.42) to 11.71(6.17). Improvement over time with such a simple intervention is a positive outcome, especially given that the sample was predominantly low SES and mostly seen during their school day with minimal disruption to their schedule. Encouragingly, the children were young and not focused on their psychological symptoms, so the observed improvement is not likely biased. However, improvement could be due to time, positive adult attention, or doing either computer task as both required cognitive focus. This study was limited by significant attentional/behavioral issues in the sample. Future research with children should examine attention training for PTSD compared to standard interventions and exclude youth with other attentional/behavioral issues to better determine the mechanism behind improvement over time.