Catani, C., Kohiladevy, M., Ruf, M., Schauer, E., Elbert, T., & Neuner, F. (2009). Treating children traumatized by war and tsunami: A comparison between exposure therapy and meditation-relaxation in North-East Sri Lanka. BMC Psychiatry, 9, Article 22. https://doi.org/10.1186/1471-244X-9-22

Type of Study: Randomized controlled trial
Number of Participants: 31

Population:

• Age — 8–14 years
• Race/Ethnicity — 100% Sri Lankan
• Gender — 16 Male and 14 Female
• Status — Participants were children who presented with a preliminary diagnosis of PTSD after a civil war and the 2004 tsunami.

Location/Institution: Manadkadu in the Vadamarachchi region in Northern Sri Lanka

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the efficacy of two short-term interventions when applied by trained local counselors. Participants were randomly assigned to either six sessions of narrative exposure therapy for children (KIDNET) or six sessions of meditation-relaxation (MED-RELAX). Measures utilized include the UCLA PTSD Index for DSM-IV and Mini International Neuropsychiatric Interview for Children and Adolescents. Results indicate that in both treatment conditions, PTSD symptoms and impairment in functioning were significantly reduced at one month post-test and remained stable over time. At 6 months follow-up, recovery rates were 81% for the children in the KIDNET group and 71% for those in the MED-RELAX group. There was no significant difference between the two therapy groups in any outcome measure. Limitations include the study needs to be replicated in other cultural settings, the small sample size, and lack of an untreated control group.

Length of controlled postintervention follow-up: 6 months.

Ruf, M., Schauer, M., Neuner, F., Catani, C., Schauer, E., & Elbert, T. (2010). Narrative exposure therapy for 7- to 16-year-olds: A randomized controlled trial with traumatized refugee children. Journal of Traumatic Stress, 23(4), 437–445. https://doi.org/10.1002/jts.20548

Type of Study: Randomized controlled trial
Number of Participants: 26

Population:

• Age — 7–16 years
• Race/Ethnicity — 8 Kurdish, 6 Balkan, 5 Syrian, 3 Chechen, 2 Russian, 1 Georgian, and 1 German
• Gender — 14 Male and 12 Female
• Status — Participants were recruited subjects that were going through the asylum process.

Location/Institution: The Research-Outpatient Clinic for Refugees at the University of Konstanz, Germany

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of the child adapted version of narrative exposure therapy, KIDNET in the treatment of refugee children suffering from PTSD and living in German exile. Participants were randomly assigned to either the KIDNET therapy or to the wait-list condition. Measures utilized include the UCLA PTSD Index for DSM-IV and the Mini International Neuropsychiatric Interview for Children and Adolescents. Results indicate that at both the 4-week post-test and the 6-month follow-up, significant reductions in PTSD symptoms were found for the KIDNET therapy group. Significant reductions were found for each of the individual symptom levels including intrusion, avoidance (all types), active avoidance, passive avoidance, hyperarousal, and functional impairment. At the 12-month follow-up, it was found that these improvements were sustained. Significant improvements in nonverbal cognitive functioning were also found between the 6- and 12-month follow-ups. Limitations include the 10-month follow-up was only for the intervention group, lack of an active control group, and the small sample size.

Length of controlled postintervention follow-up: 4 months.

Ertl, V., Pfeiffer, A., Schauer, A., Elbert, T., & Neuner, F. (2011). Community-implemented trauma therapy for former child soldiers in Northern Uganda: A randomized controlled trial. JAMA: Journal of the American Medical Association, 306(5), 503–512. https://doi.org/10.1001/jama.2011.1060

Type of Study: Randomized controlled trial
Number of Participants: 85

Population:

• Age — 12–25 years
• Race/Ethnicity — 100% Ugandan
• Gender — 47 Female
• Status — Participants were former child soldiers.

Location/Institution: Anaka, Awer, and Padibe, Uganda

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the efficacy of a community-based intervention targeting symptoms of posttraumatic stress disorder (PTSD) in formerly abducted individuals. Participants were randomized into 1 of 3 groups: 1) KIDNET, 2) an academic catch-up program with elements of supportive counseling, or 3) a waiting list. Measures utilized include the Posttraumatic Stress Diagnostic Scale, the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV), the Clinician-Administered PTSD Scale (CAPS), the Violence, War and Abduction Exposure Scale, the Mini International Neuropsychiatric Interview (MINI, English Version 5.0.0), the Perceived Stigmatization Questionnaire, and the Mini International Neuropsychiatric Interview for Children and Adolescents. Results indicate that PTSD symptom severity was significantly more improved in the KIDNET group than in the academic catch-up and waiting-list groups. Contrast analyses of the time X treatment interaction of the mixed-effects model on PTSD symptom change over time revealed a superiority of KIDNET compared with academic catch-up and wait-listing. KIDNET produced a larger within-treatment effect size than academic catch-up and wait-listing. Limitations include the small sample size, the reliance on self-reported measures, and follow-up time points beyond a 1-year period would have been helpful to investigate whether improvements in the waiting-list condition would have remained stable.

Length of controlled postintervention follow-up: 3, 6, and 12 months.

Peltonen, K., & Kangaslampi, S. (2019). Treating children and adolescents with multiple traumas: A randomized clinical trial of narrative exposure therapy. European Journal of Psychotraumatology, 10(1), Article 1558708. https://doi.org/10.1080/20008198.2018.1558708

Type of Study: Randomized controlled trial
Number of Participants: 50

Population:

• Age — 9–14 years (Mean=13.2 years)
• Race/Ethnicity — 13 Finnish, 14 Afghan, 14 Iraqi, and 9 Other Middle Eastern/African countries
• Gender — 16 Male and 14 Female
• Status — Participants were children who experienced prolonged traumatic conditions in the form of refugeedom or family violence and suffered from PTSD symptoms.

Location/Institution: Finland

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the effectiveness of narrative exposure therapy (NET) for children [now called, KIDNET], in traumatized children and adolescents. Participants were randomly assigned either to six sessions of NET or treatment as usual. Measures utilized include the Children’s Revised Impact of Event Scale (CRIES), the Event Checklist for War, Detention, and Torture Experiences, the Child and Adolescent Intake Form of the Center for Victims of Torture, the Depression Self-Rating Scale for Children (DSRS), the Child and Youth Resilience Measure (CYRM), and the Strengths and Difficulties Questionnaire (SDQ). Results indicate that PTSD and psychological distress, but not depression symptoms, decreased regardless of treatment group. Resilience increased in both groups. Within-group analyses showed that the decrease in PTSD symptoms was significant in the NET group only. The effect sizes were large in NET but small in TAU. Concerning PTSD symptom cut-off scores, the reduction in the share of participants with clinical-level PTSD was significant in the NET group only. Limitations include the high number of dropouts and missing data restrict the conclusions that can be drawn from this study, the reliance on mostly child-evaluated measures, and the participants could not be blinded to the intervention, as the differences between TAU and NET made it obvious to them which group they belonged to.

Length of controlled postintervention follow-up: 3 months.

The following studies were not included in rating KIDNET on the Scientific Rating Scale...

Onyut, L. P., Neuner, F., Schauer, E., Ertl, V., Odenwald, M., Schauer, M., & Elbert, T. (2005). Narrative exposure therapy as a treatment for child war survivors with posttraumatic stress disorder: Two case reports and a pilot study in an African refugee settlement. BMC Psychiatry, 5, Article 7. https://doi.org/10.1186/1471-244X-5-7

The purpose of the study was to present and illustrate the procedure of KIDNET, a child-friendly version of narrative exposure therapy (NET) as a treatment approach for traumatized children in post-conflict populations and to examine the feasibility and potential efficacy of the method in a field context. Measures utilized include the Posttraumatic Diagnostic Scale (PDS), the Hopkins Symptom Checklist-25 (HSCL) and the Composite International Diagnostic Interview (CIDI) version 2.1. Results indicate that there were reductions in posttraumatic symptoms as early as the post test. At follow-up, 2 of the 6 patients still fulfilled PTSD criteria, but at borderline levels and with less functional impairment. Clinically significant depression remitted to non-clinical levels in all four adolescents who had presented with depression in the pre-test. Limitations include lack of a comparison group, non-randomization of subjects, small sample size, and attrition rate. Note: This article was not used in the rating process due to the lack of a control group.