Feasibility and potential effectiveness of an intensive trauma-focused treatment programme for families with PTSD and mild intellectual disability

Liesbeth Mevissen; Marjolein Ooms-Evers; Marike Serra; Ad de Jongh; Robert Didden

doi:10.1080/20008198.2020.1777809

Feasibility and potential effectiveness of an intensive trauma-focused treatment programme for families with PTSD and mild intellectual disability

Eur J Psychotraumatol. 2020 Jul 14;11(1):1777809. doi: 10.1080/20008198.2020.1777809.

Authors

Liesbeth Mevissen¹, Marjolein Ooms-Evers², Marike Serra³, Ad de Jongh^{4

5

6

7

8}, Robert Didden^{1

9}

Affiliations

¹ Trajectum, Zwolle, The Netherlands.
² Ambiq, Hoogeveen, The Netherlands.
³ Accare, Assen, The Netherlands.
⁴ Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
⁵ Research Department, PSYTREC, Bilthoven, The Netherlands.
⁶ School of Health Sciences, Salford University, Manchester, UK.
⁷ Institute of Health and Society, University of Worcester, Worcester, UK.
⁸ School of Psychology, Queen's University, Belfast, Northern Ireland.
⁹ Behavioural Science Institute (BSI), Radboud University, Nijmegen, The Netherlands.

Abstract
in English, Spanish, Chinese

Background: Persons with mild intellectual disabilities or borderline intellectual functioning (MID-BIF; IQ 50-85) have a higher risk of being exposed to traumatic events and developing posttraumatic stress disorder (PTSD). EMDR therapy has shown to be applicable, safe and potentially effective for the treatment of PTSD in individuals with MID-BIF. However, in traumatized multi-problem families with MID-BIF and (impending) out of home placement of children, standard PTSD treatment in an outpatient setting may not be appropriate.

Objective: To evaluate the feasibility and potential effectiveness of KINGS-ID, a six-week clinical trauma-focused treatment programme consisting of intensive EMDR therapy with parents and children, and parental skills training followed by two weeks of parent support at home.

Method: Six families (nine parents of whom six had MID-BIF) and 10 children (all having MID-BIF) participated in the KINGS-ID programme. Seven parents and seven children had PTSD. Data were collected within a single case study design. For each family member data were collected during baseline (three measurements), treatment (seven weekly measurements), posttreatment (three measurements) and at follow-up (three measurements).

Results: None of the family members dropped out. Within the first two treatment weeks all but one child and one parent no longer met PTSD symptom criteria. In both children and parents, trauma-related symptoms and daily life impairment significantly decreased following treatment and in parents a significant decrease in symptoms of general psychopathology and parental stress was found. Results were maintained at six-month follow-up.

Conclusions: The findings of the current study are promising given that the treatment programme seems to offer new perspectives for traumatized multi-problem families with MID-BIF.

Antecedentes: Las personas con discapacidades intelectuales moderadas o funcionamiento intelectual límite (MID-BIF; IQ 50-85) tienen un mayor riesgo de estar expuestas a eventos traumáticos y desarrollar trastorno de estrés postraumático (TEPT). La terapia EMDR o DRMO ha demostrado ser aplicable, segura y potencialmente efectiva para el tratamiento de TEPT en individuos con MID-BIF. Sin embargo, en familias traumatizadas con múltiples problemas y MID-BIF e inminente relocalización de niños fuera del hogar, el tratamiento con EMDR estándar en modalidad ambulatoria puede ser inapropiado.Objetivo: Evaluar la factibilidad y potencial efectividad de KINGS-ID, un programa clínico de seis semanas de tratamiento centrado en el trauma, consistente en tratamiento EMDR intensivo con padres y niños, y un entrenamiento de habilidades parentales seguido por dos semanas de apoyo parental en el hogar.Método: Seis familias (nueve padres, de los cuales seis tenían MID-BIF) y 10 niños (todos con MID-BIF) participaron en el programa KINGS-ID. Siete padres y siete niños tenían TEPT. Los datos fueron recopilados en un diseño de estudio de caso único. Para cada miembro de la familia los datos fueron obtenidos durante el inicio (tres mediciones), el tratamiento (siete mediciones semanales), post-tratamiento (tres mediciones) y seguimiento (tres mediciones).Resultados: Ningún miembro de las familias desertó. Durante las dos primeras semanas de tratamiento, todos excepto un niño y un padre no cumplían criterios sintomáticos para TEPT. Tanto en niños como en los padres, los síntomas relacionados con el trauma y el deterioro en la vida diaria disminuyeron significativamente siguiendo el tratamiento y en los padres se encontró una disminución significativa en síntomas de psicopatología general y de estrés parental. Los resultados se mantuvieron a los seis meses de seguimiento.Conclusiones: Los hallazgos de este estudio son promisorios, dado que el programa de tratamiento parece ofrecer nuevas perspectivas para familias traumatizadas con múltiples problemas y MID-BIF.

背景: 患有轻度智力障碍或具有边缘智力功能 (MID-BIF; IQ 50-85) 的人暴露于创伤事件并发展为创伤后应激障碍 (PTSD) 的风险更高。 EMDR治疗已被证明对于MID-BIF患者的PTSD治疗是适用, 安全并且可能有效的。但是, 在患有MID-BIF和 (即将) 离家安置的儿童的多问题创伤家庭中, 门诊环境中的标准PTSD治疗可能不合适。目的: 评估KINGS-ID这项为期六周的聚焦创伤临床治疗方案的可行性和潜在有效性, 该方案包括与父母和孩子的强化EMDR治疗, 父母技能培训以及在家中接受父母两周的支持。方法: 六个家庭 (9个父母中有6个患有MID-BIF) 和十个孩子 (都具有MID-BIF) 参加了KINGS-ID计划。七个父母和七个孩子患有PTSD。在单个案例研究设计中收集数据。对于每个家庭成员, 在基线 (3次测量), 治疗时 (每周7次测量), 治疗后 (3次测量) 和随访 (3次测量) 期间收集数据。结果: 无家庭成员流失。在前两个治疗周内, 除一个孩子和一个父母之外, 其他参与者均不再符合PTSD症状标准。在儿童和父母中, 创伤相关症状和日常生活障碍在治疗后均显著降低, 在父母中发现了总体精神病态状态和父母压力的显著下降。结果在六个月的随访中维持。结论: 鉴于该治疗方案似乎为遭受创伤的MID-BIF多问题家庭提供了新视角, 本研究结果很有前景。.

Keywords: ACEs; PTSD; autism; family trauma treatment; intensive EMDR; intergenerational transmission; mild intellectual disabilities; parental trauma; • Multi problem families with mild intellectual disabilities or borderline intellectual functioning are at high risk for traumatisation and out of home placement of children.• KINGS-ID, a clinical trauma-focused family treatment programme, was found to be feasible and potentially effective..

Abstract in English, Spanish, Chinese

Abstract
in English, Spanish, Chinese