{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T08:30:51Z","timestamp":1786350651113,"version":"build-2736575974"},"reference-count":56,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acamh.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Child Psychology Psychiatry"],"abstract":"\n Background<\/jats:title>\n 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\u2010analysis is lacking.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a preregistered systematic review and meta\u2010analysis (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 \u226510 participants per arm. Two independent coders extracted data and assessed risk of bias.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Seventy\u2010two RCTs (\n N<\/jats:italic>\n \u2009=\u20095,677) met inclusion criteria. Of these, 69, 6, and 19 reported the incidence of all\u2010cause dropout, deterioration of PTSD, and adverse events, respectively. Most trials (74%) investigated trauma\u2010focused cognitive behavioral therapy (TF\u2010CBT). Random effects meta\u2010analysis showed that 7.87% of patients (95% CI, 4.07\u201312.55;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200982%) dropped out, with no significant difference relative to passive controls (RR\u2009=\u20091.04, 95% CI, 0.64\u20131.69;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200953%). Less than 0.01% (95% CI, 0.00\u20132.39;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090%) of patients reported deterioration after TF\u2010CBT, compared to 1.26% (95% CI, 0.00\u20138.13;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200940%) 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\u20132.67;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200934%) and similar to passive controls (1.14%, 95% CI, 0.00\u20138.02;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200984%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Psychological treatments for pediatric PTSD\u2014with most accumulated evidence for TF\u2010CBT\u2014appear 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jcpp.70216","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T08:08:00Z","timestamp":1786349280000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence and relative risk of negative outcomes of psychological interventions for pediatric posttraumatic stress disorder: a systematic review and meta\u2010analysis of randomized controlled trials"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6050-8696","authenticated-orcid":false,"given":"Thole H.","family":"Hoppen","sequence":"first","affiliation":[{"name":"Institute of Psychology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Schl\u00fcter","sequence":"additional","affiliation":[{"name":"Institute of Psychology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marielle","family":"Placzek","sequence":"additional","affiliation":[{"name":"Institute of Psychology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna S.","family":"Lindemann","sequence":"additional","affiliation":[{"name":"Institute of Psychology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6399-2516","authenticated-orcid":false,"given":"Ahlke","family":"Kip","sequence":"additional","affiliation":[{"name":"Institute of Psychology University of M\u00fcnster M\u00fcnster Germany"},{"name":"Medical Psychology and Medical Sociology, Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5916-3694","authenticated-orcid":false,"given":"Pascal","family":"Schlechter","sequence":"additional","affiliation":[{"name":"Institute of Psychology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0262-623X","authenticated-orcid":false,"given":"Richard","family":"Meiser\u2010Stedman","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology and Psychological Therapies, Norwich Medical School University of East Anglia Norwich UK"},{"name":"Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2331-9140","authenticated-orcid":false,"given":"Nexhmedin","family":"Morina","sequence":"additional","affiliation":[{"name":"Institute of Psychology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"119","article-title":"Approximate is better than \u201cexact\u201d for interval estimation of binomial proportions","volume":"52","author":"Agresti A.","year":"1998","journal-title":"The American Statistician"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1300\/J146v06n01_10","article-title":"Cognitive processing therapy for incarcerated adolescents with PTSD","volume":"6","author":"Ahrens J.","year":"2002","journal-title":"Journal of Aggression, Maltreatment & 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Doctoral thesis University of Konstanz."},{"key":"e_1_2_11_50_1","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-21416-0","volume-title":"Meta\u2010analysis with R","author":"Schwarzer G.","year":"2015"},{"key":"e_1_2_11_51_1","doi-asserted-by":"crossref","DOI":"10.1080\/20008198.2021.1947570","article-title":"A meta\u2010analysis of dropout from evidence\u2010based psychological treatment for post\u2010traumatic stress disorder (PTSD) in children and young people","volume":"12","author":"Simmons C.","year":"2021","journal-title":"European Journal of Psychotraumatology"},{"key":"e_1_2_11_52_1","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1111\/jcpp.14124","article-title":"Early\u2010stage randomised controlled trial of therapist\u2010supported online cognitive therapy for post\u2010traumatic stress disorder in young people","volume":"66","author":"Smith P.","year":"2025","journal-title":"Journal of Child Psychology and Psychiatry, and Allied Disciplines"},{"key":"e_1_2_11_53_1","first-page":"1051","article-title":"Cognitive\u2010behavioral therapy for PTSD in children and adolescents: A preliminary randomized controlled trial","volume":"46","author":"Smith P.","year":"2007","journal-title":"Journal of the American Academy of Child and Adolescent Psychiatry"},{"key":"e_1_2_11_54_1","doi-asserted-by":"crossref","first-page":"d4002","DOI":"10.1136\/bmj.d4002","article-title":"Recommendations for examining and interpreting funnel plot asymmetry in meta\u2010analyses of randomised controlled trials","volume":"343","author":"Sterne J.A.C.","year":"2011","journal-title":"British Medical Journal"},{"key":"e_1_2_11_55_1","volume-title":"Using multivariate statistics (6. ed., internat. ed.). 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