Efficacy of EMDR Therapy for Children With PTSD: A Review of the Literature

Renée Beer

doi:10.1891/1933-3196.12.4.177

Focus

Abstract

The rationale is synthesized for the urgency of empirical studies demonstrating the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for children and adolescents with posttraumatic stress disorder (PTSD), symptoms of PTSD, or other trauma-related symptoms. This literature review examined 15 studies (including nine randomized clinical trials) that tested the efficacy of EMDR therapy for the treatment of children and adolescents with these symptoms. All studies found that EMDR therapy produced significant reductions in PTSD symptoms at posttreatment and also in other trauma-related symptoms, when measured. A methodological analysis identified limitations in most studies, reducing the value of these findings. Despite these shortcomings, the methodological strength of the identified studies has increased over time. The review also summarized three meta-analyses. The need for additional rigorous research is apparent, and in order to profit from experiences of the past, the article provides some guidelines for clinicians seeking to conduct future research in their agencies.

Tables

Table 1.

Criteria for the Evaluation of Empirical Studies

1. Clearly defined target symptoms

2. Reliable and valid measures

3. Blind, independent assessors of treatment effect

4. Assessor’s training

5. Manual-based replicable treatment

6. Randomized allocation to treatment condition

7. Reliable application of protocol (treatment fidelity)

i. No confounded conditions

ii. Multi-modal measures

iii. Length of treatment

iv. Reported level of therapist(s) training

v. Control or comparison group

vi. Report of effect size

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Table 2.

Studies on Efficacy of EMDR With Children

Author(s)	N	Age	Treatment (Number of sessions)	Events	Target-Symptoms	Measure(s)^a	Significant Results
Level 1. Studies without control group
Hensel, 2009	32	1, 9–18	EMDR (average 3)	Single: Varied	PTSD and other trauma-related symptoms	PROPS	Reduction of PTSD and other presenting symptoms (e.g., separation anxiety)
Ribchester et al., 2010	11	8–16	EMDR (Between 1–4, Average 2. 4 per child)	Single: Road traffic accident	PTSD, anxiety, depression, and attentional deficits	ADIS for DSM-IV, CASQ-R, CRIES, DSRS, RCMAS, emotional STROOP test, and more	Reduction in symptoms of PTSD, anxiety, and depression. If reduction in PTSD, then significant improvement in attention tasks
Level 2. Studies with control group, no randomized allocation
Puffer et al., 2000	20	8–17	EMDR (1) versus Waiting list (WL)	Single: Varied	PTSD symptoms	IES	EMDR > WL Reduction of PTSD symptoms.
Kemp et al., 2010	27	6–12	EMDR (4) versusWl	Single: Motor vehicle accident	PTSD symptoms, anxiety, depression	PTS-RI, CBCL, CDS, GFS, GHQ-12, IES, STAIC,	EMDR >WL For two or more PTSD symptoms: decrease in EMDR group from 100% to 25%; no decrease in WL group. For anxiety and depression: no significant difference pre- to posttreatment in both groups.
Wadaa et al., 2010	37	7–12	EMDR (12) versusNo treatment (NT)	Chronic: War and violence	PTSD	UCLAPTSD Index	EMDR >NTReduction of PTSD symptoms.
Tang et al., 2015	83	12–15	EMDR (4) versusTreatment as usual (TAU)	Single: Typhoon	Symptoms of anxiety(disaster-related or general), and depression	CES-D, IES, MASC	EMDR >TAU Alleviation of symptoms of disaster-related anxiety, general anxiety, and depression.
Level 3. RCTs, targeting trauma-related symptoms, including behavior problems
Scheck et al., 1998	60	16–25	EMDR (2) versus Active listening (AL) (2)	Chronic: Sexual abuse/molestation in childhood	Anxiety, depression, self-image	Various adult measures	EMDR >AL In EMDR group more reduction of PTSD symptoms, anxiety, depression. Participants showed also severe behavioral problems; effect on these unclear.
Chemtob et al., 2002	32	6–12	EMDR (3) versus Wl	Single: Hurricane	PTSD, Anxiety and Depression	CDI, CRI, RCMAS, and count of visits to health nurse	EMDR >Wl. Reduction of PTSD, symptoms of fear and depression.
Soberman et al., 2002	29	10–16	EMDR +CAU (3) versus Care As Usual (CAU)	Chronic: Varied	PTSD symptoms, severe behavioral problems	CROPS, PROPS, IES	EMDR >CAU Decrease of problem behavior and of reactivity on targeted memory; not all measures significant.
Jaberghaderi et al., 2004	14	12–13	EMDR (as needed) versus CBT (12)	Single + chronic: Sexual abuse	PTSD symptoms	CROPS, PROPS, Rutter Teacher Scale	EMDR = CBT Both effective Less sessions for EMDR (average 6.1 versus 11.6).
Ahmad et al., 2007	33	6–16	EMDR (8) versus Wl	Single + chronic: varied	PTSD	PTSS C	EMDR >Wl Reduction of PTSD, especially on symptoms of reliving and avoidance.
Wanders et al., 2008	26	10–14	EMDR (4) versus CBT (4)	Single + chronic: Children were not screened on this variable	Self-esteem, behavioral, emotional problems	CBCL, DQ-C, NASSQ-A, PSI, PNG-C, SPCC.	EMDR >CBT on improvement of target behaviors.
de Roos et al., 2011	52	4–18	EMDR (4) versus CBT (4)	Disaster: Explosion of a fireworks factory	PTSD, anxiety, depression, behavioral problems	CBCL, CROPS, DSRS, MASC, PROPS, PTSD-RI for DSM-IV	EMDR = CBT Both effective: reduction on all measures. EMDR needed less sessions (average 3.2 versus 4).
Diehle et al., 2015	48	8–18	EMDR (8) versus TF-CBT (8)	Single & chronic: Varied	PTSD, anxiety, depression, behavioral problems	ADIS C/; CRIES; CAPS-CA; RCADS; SDQ	EMDR = TF-CBT Both effective for reduction of PTSD. For reduction of comorbid (depressive and hyperactive) symptoms, TF-CBT >EMDR according to parent-report in TF-CBT group.
de Roos et al., 2017	103	8–18	EMDR (6) versus CBWT (6) versus WL	Single: Varied	PTSD, anxiety, depression, behavioral problems, negative trauma-related appraisals	ADIS-C/P, CSI-C/P, C-PTCI, IPG, KIDSCREEN-27, RCADS-C/P, CRTI-C/P, SDQ-A/P,	EMDR = CBWT Both effective for reduction of PTSD symptoms + comorbid problems. EMDR needed less sessions (average 4.1 versus 5.4).

a For full names of the measures and the authors, see Table 3.

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Table 3.

Measures Used in the EMDR Studies With Children and Adolescents

1. Anxiety and Related Disorders Interview Schedule (ADIS for DSM-IV; Albano & Silverman, 1996)

2. Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977)

3. Child Behavior Checklist (CBCL; Achenbach, 1991)

4. Children’s Depression Inventory (CDI; Kovacs, 1992)

5. Child Post Traumatic Stress Reaction Index (Frederick, Pynoos, & Nader, 1992)

6. Child Post Traumatic Stress Reaction Index: Parent Questionnaire (Parent PTS-RI; Nader, 1994)

7. Child Report of Post-Traumatic Symptoms (CROPS; Greenwald & Rubin, 1999)

8. Child Reaction Index (CRI; Pynoos et al., 1987)

9. Child Somatization Inventory, Child and Parent Version (CSI-C/P; Meesters, Muris, Ghys, Reumerman, & Rooijmans, 2003)

10. Children’s Attributional Style Questionnaire-Revised (CASQ-R; Thompson, Kaslow, Weiss, & Nolen-Hoeksema, 1998)

11. Children’s Depression Scale (CDS; Lang & Tisher, 1983)

12. Children’s Post Traumatic Cognitions Inventory (C-PTCI; Meiser-Stedman et al., 2009)

13. Children’s Revised Impact of Event Scale (CRIES; Dyregov & Yule, 1995)

14. Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA; Nader, Kriegler, Blake, Pynoos, & E.,, 1996)

15. Depression Questionnaire for Children (DQ-C; de Wit, 1987)

16. Depression Self Rating Scale (DSRS; Birleson, 1981)

17. General Functioning Scale (GFS derived from Family Assessment Device; Epstein, Baldwin, & Bishop, 1983)

18. General Health Questionnaire-12 (GHQ-12; Goldberg, 1978)

19. Impact of Event Scale (IES; Horowitz, Wilner, & Alvarez, 1979)

20. Inventory of Prolonged Grief for Children and Adolescents (IPG; Spuij et al., 2012)

21. Kidscreen-27, Child and Parent Version (Ravens-Sieberer et al., 2007)

22. Multidimensional Anxiety Scale for Children (MASC; March, Parker, Sullivan, Stallings, & Conners, 1997)

23. Negative Affect Self-Statement Questionnaire (NASSQ-A; Ronan, Kendall, Rowe, & Rowe, 1994)

24. Parent Report of Post-Traumatic Symptoms (PROPS; Greenwald & Rubin, 1999)

25. Parenting Stress Index (PSI; Abidin, 1983)

26. Positive and Negative Affect Self-Statement Questionnaire for Children (PNG-C; Bracke & Braet, 2000)

27. Post-Traumatic Stress Symptom Scale for Children (PTSS C; Ahmad, Sundelin-Wahlsten, Sofi, Qahar, & von Knorring, 2000)

28. Revised Child Anxiety and Depression Scale (RCADS; Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000)

29. Revised Children’s Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1978)

30. Revised Children’s Responses to Trauma Inventory (CRTI; Alisic & Kleber, 2010)

31. Rutter Teacher Scale (Kresanov, Tuominen, Piha, & Almqvist, 1998)

32. Self-Perception Profile for Children (SPCC; Harter, 1985)

33. State Trait Anxiety Inventory for Children (STAIC; Spielberger, 1979)

34. Strength and Difficulties Questionnaire (SDQ; Goodman, 2001)

35. UCLA PTSD Index (Rodriguez, Steinberg, & Pynoos, 1998); UCLA PTSD Reaction Index (PTSD-RI) for DSM-IV (Steinberg, Brymer, Decker, & Pynoos, 2004)

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Table A1.

Practical Recommendations

Prerequisites	1. Institution	Support of management Culture and infrastructure
	2. Therapists	Involvement Clear goals and tasks Pilot study
	3. Instruments	Reliable and valid
	4. Information flow	Rationale Monitoring progress
	5. Research team	Clinical and statistical expertise Consultation and coordination
Exploitable benefits	1. Therapists	Relevance of research data Prevention from “overprotection”
	2. Patients	Participation reassuring and rewarding

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