Child Trauma & Behavioral Problems

Clinical note: Marcus's aggression, nightmares, and bedwetting are classic child trauma responses — but effective treatment requires his grandmother's active involvement, because gains won't hold without a stable caregiving environment. TF-CBT (Cohen, Mannarino & Deblinger, 2006) has the strongest evidence for child PTSD, with multiple RCTs showing large effects (d = 0.70-1.0) and is recommended by NICE (NG116), APA, and the VA/DoD. Child-Centered Play Therapy has a solid meta-analytic base (Ray et al., 2015: d = 0.80) primarily for behavioral and emotional problems. PCIT (Eyberg, 1988) has excellent evidence for externalizing behaviors in children ages 2-7, with effects persisting at long-term follow-up. CPP (Lieberman et al., 2005) is the gold standard for young children exposed to violence. At 8, Marcus sits at the intersection of several approaches — a real-world plan might phase them: stabilize the grandmother-Marcus relationship with PCIT, then process trauma with TF-CBT. School coordination is essential — Marcus's teachers are managing his behavior daily, and the therapist who ignores that context is treating half the problem.