Background The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6‐year‐old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD‐YC), including the adult‐led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive‐focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD‐YC. Method Study 1 ( N = 105) assessed ASD and PTSD‐YC diagnosis in 3‐ to 8‐year‐old children within one month and at around three months following attendance at an emergency room. Study 2 ( N = 37) was a preregistered ( www.isrctn.com/ISRCTN35018680 ) randomized controlled early‐phase trial comparing CBT‐3M, a cognitive‐focused intervention, to treatment‐as‐usual (TAU) delivered within the UK NHS to 3‐ to 8‐year‐olds diagnosed with PTSD‐YC. Results In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD‐YC (minus the duration requirement) was 8.6% in the first month post‐trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma‐related characteristics, predicted development of later PTSD‐YC. Early (within one month) diagnosis of acute PTSD‐YC had a positive predictive value of 50% for later PTSD‐YC. In Study 2, most children lost their PTSD‐YC diagnosis following completion of CBT‐3M (84.6%) relative to TAU (6.7%) and CBT‐3M was acceptable to recipient families. Effect sizes were also in favor of CBT‐3M for secondary outcome measures. Conclusions The ASD diagnosis is not fit for purpose in this age‐group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive‐focused treatment for PTSD, and a larger trial of CBT‐3M is now warranted.

Impaired ability to recall specific autobiographical memories is characteristic of depression, which when reversed, may have therapeutic benefits. This cluster-randomized controlled pilot trial investigated efficacy and aspects of acceptability, and feasibility of MEmory Specificity Training (MEST) relative to Psychoeducation and Supportive Counselling (PSC) for Major Depressive Disorder (N = 62). A key aim of this study was to determine a range of effect size estimates to inform a later phase trial. Assessments were completed at baseline, posttreatment and 3-month follow-up. The cognitive process outcome was memory specificity. The primary clinical outcome was symptoms on the Beck Depression Inventory-II at 3-month follow-up. The MEST group demonstrated greater improvement in memory specificity relative to PSC at post-intervention (d = 0.88) and follow-up (d = 0.74), relative to PSC. Both groups experienced a reduction in depressive symptoms at 3-month follow-up (d = 0.67). However, there was no support for a greater improvement in depressive symptoms at 3 months following MEST relative to PSC (d = - 0.04). Although MEST generated changes on memory specificity and improved depressive symptoms, results provide no indication that MEST is superior to PSC in the resolution of self-reported depressive symptoms. Implications for later-phase definitive trials of MEST are discussed.

Background Following horrific or life-threatening events approximately 10 to 15% of young children develop post traumatic stress disorder (PTSD). The symptoms of this disorder are distressing - nightmares, flashbacks, anger outbursts and disturbed play. These symptoms cause major disruption to a child’s functioning and, if left untreated, can persist for many years. As yet, there are no established empirically-validated treatments for PTSD in young children. Trauma-focused cognitive behaviour therapy (TF-CBT) is a psychological intervention that is effective in treating the disorder in older children (8 to 12 years), adolescents and adults. This study examines TF-CBT adapted for children aged between 3 and 8 years. Methods/Design This protocol describes a two-arm exploratory randomised controlled trial comparing TF-CBT to treatment as usual (TAU) in children aged 3 to 8 years with a principal diagnosis of PTSD following a single-event discrete trauma. Using a half-crossover design, 44 participants will be randomly allocated to receive the intervention or to receive TAU. Those allocated to TAU will be offered TF-CBT at the end of the ‘treatment’ period (approximately 12 weeks) if still indicated. The primary outcome is PTSD diagnosis according to DSM-5 criteria for children 6 years and younger at post-treatment. Secondary outcomes include effects on co-morbid diagnoses and changes in emotion and trauma symptoms at each of the follow-up points (post-treatment, 3-months, 12-months). Additionally, broader efficacy will be considered with regard to treatment feasibility, acceptability and service utilisation. The key targets of the intervention are trauma memory, the interpretation of the meaning of the event, and the management of symptoms. Discussion This is the first European trial to examine the efficacy of TF-CBT in alleviating PTSD in very young children. As well as providing much-needed data on the utility of the intervention, this exploratory trial will also allow us to gather important information about the feasibility of delivering the treatment in UK National Health Service (NHS) settings, and its acceptability to the children and their families. This study will highlight aspects of the intervention that need improvement or modification in preparation for a full-scale evaluation in a larger sample. Trial registration ISRCTN35018680 , registered on 18 November 2013.

Major depressive disorder (MDD) is associated with chronic biases in the allocation of attention and recollection of personal memories. Impaired flexibility in attention and autobiographical memory retrieval is seen to both maintain current symptoms and predict future depression. Development of innovative interventions to reduce maladaptive cognitive patterns and improve cognitive flexibility in the domain of memory may therefore advance current treatment approaches for depression. Memory specificity training and cognitive bias modification techniques have both shown some promise in improving cognitive flexibility. Here we outline plans for a trial of an innovative memory flexibility training programme, MemFlex, which advances current training techniques with the aim of improving flexibility of autobiographical memory retrieval. This trial seeks to estimate the efficacy of MemFlex, provide data on feasibility, and begin to explore mechanisms of change.