Research Article

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Pre-Post Study to Assess EMDR-Based Group Therapy for Traumatized Refugee Preschoolers

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Abstract

Cross-culturally effective, low-threshold therapies for refugees that can be carried out quickly are urgently required. Worldwide, therapies are lacking, particularly for preschool refugee children, which support coping and prevent chronification of posttraumatic stress. This pilot study examined eye movement desensitization and reprocessing (EMDR)-based group treatment for preschool refugee children in German daycare centers. Ten refugee preschool children aged 4–6 years (n = 5 female) with posttraumatic stress disorder (PTSD) symptoms took part in an EMDR-based group treatment (with 2–4 children per group). PTSD symptoms were rated by parents and preschool teachers using items from the Child Behavior Checklist (CBCL 1½–5), pre- and posttreatment, and at 3-month follow-up. After treatment children tended to display less fear of animals or situations than before treatment. According to preschool teachers' perspective, the total number of PTSD symptoms dropped significantly at posttreatment (d = .93) and at follow-up (d = .81). Before the intervention, preschool teachers rated the children as being more defiant than their parents did (p = .020). After the intervention, the PTSD symptoms of boys were significantly higher than those of girls (p = .036) according to preschool teachers. The results indicate that timely psychotherapeutic interventions can be conducted with refugee children displaying PTSD symptoms in daycare centers. The efficacy of this intervention needs to be studied in a larger sample under controlled randomized conditions.

Figures

FIGURE 1.

Study design and flow of participants through the trial.

sgremdr_14_1_35View in Context
FIGURE 2.

Ben the Bear showing facial expresssion and posture.

sgremdr_14_1_37View in Context

Tables

TABLE 1.
Sociodemographics of Sample (N = 10)
Md (Range)n (%)n.a. in n (%)
Gender
 Male5 (50)
Age (years)5.0 [4 – 6]
Country of birth
 Afghanistan4 (40)
 Syria6 (60)
Duration of stay at time t0 (days)451.5 [223 – 832]2 (20)
Duration of flight (months)1.6 [0.5 – 4.0]2 (20)
Age on arrival (years)3.5 [3 – 4]2 (20)
Existing illness, disability or developmental disorders1 (10)2 (20)

Note. Md = Median; median and range rounded to one decimal place; n.a. = not available. All percentages calculated based on overall sample.

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TABLE 2.
Frequency of PTSD Symptoms as Reported by Parents and Preschool Teachers
t0t1t2
Parentsa

(n = 10)
Preschool teachersa

(n = 10)
*

**

***
Parentsa

(n = 8)
Preschool teachersa

(n = 9)
*

**

***
Parentsa (n = 6)Preschool teachersa

(n = 8)
*

**

***
Items from CBCL 1 ½–5 [item number]n%n%pn%n%pn%n%p
Unable to concentrate / pay attention for long [5]660770n.s.675667n.s.467786n.s.
Clings to grown-ups / is too dependent [10]770440n.s.338222n.s.350113n.s.
Is defiant [15]330990.02225556n.s.350450n.s.
Is afraid of certain animals / situations / places [32]990440n.s.450222n.s.233113n.s.
Nausea (without known physical causes) [45]110n.s.n.c.117n.s.
Is nervous / tense [47]550660n.s.225333n.s.350225n.s.
Has nightmares [48]330220n.s.225n.s.233n.s.
Stomachaches / stomach cramps (without physical cause) [78]330110n.s.225n.s.117113n.s.
Is stubborn, sullen, or irritable [81]440770n.s.563444n.s.233450n.s.
Displays sudden changes in mood /feelings [82]660660n.s.225333n.s.467450n.s.
Is too afraid, is anxious [87]550550n.s.563333n.s.350225n.s.
Is unhappy / sad / depressed [90]220440n.s.225556n.s.117450n.s.
Vomiting (without known physical cause) [93]n.c.n.c.117n.s.
Wakes up frequently at night [94]330110n.s.225n.s.350n.s.
Is withdrawn / does not make contact with others [98]440660n.s.563556n.s.117113n.s.
Sum score >8440660225222233225
Other [-]440110111113

Note. CBCL = Child Behavior Checklist.

a Items were dichotomized for analysis: responses of (1) applies somewhat/sometimes and (2) applies exactly/often were counted as “symptom is present”; n.s. = not significant; n.c. = not able to be calculated; the χ2 test was used (or Fisher's exact test in cases with low cell frequencies).

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TABLE 3.
Total Score of PTBS Symptoms
t0t1t2Friedman Test
As seen by …Md [Range]MRMd [Range]MRMd [Range]MRnχ2dfp
n = 10n = 8n = 6
Parents5.5 [2–16]2.756.5 [1–12]1.756.5 [2–10]1.5065.7272.057
n = 10n = 9n = 8
Preschool teachers9.5 [2–17]2.757.0 [0–13]1.563.5 [0–17]1.6987.0322.030

Note. df = degrees of freedom; Md = Median; MR = mean rank.

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TABLE 4.
Number of Children (and Percent of Sample) Above Cut-Off Over Time, Comparing t0, t1, and t2
As seen by …t0t1t2Chi-Squared Test
n = 10n = 8n = 6χ2dfp
Parents4 (40%)2 (25%)2 (33%).4502.799
n = 10n = 9n = 8
Preschool teachers6 (60%)2 (22%)2 (25%)3.6052.165

Note. df = degrees of freedom; Md = Median; MR = mean rank.

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