Incidence and relative risk of negative outcomes of psychological interventions for pediatric posttraumatic stress disorder: a systematic review and meta-analysis of randomized controlled trials
In brief
TF-CBT causes worsening in fewer than one in ten thousand children with PTSD
In a meta-analysis of 72 randomized trials (5,677 participants), less than 0.01% of children receiving trauma-focused CBT showed symptom deterioration, far below the 1.3% seen with passive controls. Dropout occurred in about 8% of all patients and adverse events were rare, supporting the overall safety of these therapies while highlighting the need for better reporting of negative outcomes.
- Journal
- Journal of child psychology and psychiatry, and allied disciplines (Q1)
- Published
- 10 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Thole H Hoppen, Sophie Schlüter, Marielle Placzek, Anna S Lindemann, Ahlke Kip, Pascal Schlechter, et al.
- PMID
- 42572827
- DOI
- 10.1111/jcpp.70216
Why clinicians should know about it
- Picked for Pediatrics and Child Health (top studies of the week, 16 August 2026): Negative outcomes of PTSD interventions meta‑analysis
Abstract
BACKGROUND: Negative outcomes of psychological treatments for pediatric posttraumatic stress disorder (PTSD) have been underresearched. Although reporting has increased over the years, a comprehensive systematic review and meta-analysis is lacking. METHODS: We conducted a preregistered systematic review and meta-analysis (PROSPERO ID: CRD42020206290) and followed PRISMA guidelines. MEDLINE, PsycInfo, Web of Science, and PTSDpubs were systematically searched from inception to May 13, 2025. Eligible studies were randomized controlled trials (RCTs) of psychotherapies for pediatric PTSD with ≥10 participants per arm. Two independent coders extracted data and assessed risk of bias. RESULTS: Seventy-two RCTs (N = 5,677) met inclusion criteria. Of these, 69, 6, and 19 reported the incidence of all-cause dropout, deterioration of PTSD, and adverse events, respectively. Most trials (74%) investigated trauma-focused cognitive behavioral therapy (TF-CBT). Random effects meta-analysis showed that 7.87% of patients (95% CI, 4.07-12.55; I2 = 82%) dropped out, with no significant difference relative to passive controls (RR = 1.04, 95% CI, 0.64-1.69; I2 = 53%). Less than 0.01% (95% CI, 0.00-2.39; I2 = 0%) of patients reported deterioration after TF-CBT, compared to 1.26% (95% CI, 0.00-8.13; I2 = 40%) of passive controls. Limited data prohibited isolated review of other treatments. The incidence of adverse events during psychological treatments was also uncommon (0.29%, 95% CI, 0.00-2.67; I2 = 34%) and similar to passive controls (1.14%, 95% CI, 0.00-8.02; I2 = 84%). CONCLUSIONS: Psychological treatments for pediatric PTSD-with most accumulated evidence for TF-CBT-appear safe and acceptable for the vast majority of children and adolescents with PTSD, which is encouraging for clinical practice. Reporting on deterioration and adverse events was scarce, limiting statistical power. Negative outcomes should be routinely assessed in clinical practice and future research, using validated measures and clearly defined constructs. Future work should distinguish serious adverse events and adverse events.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.