Attrition from pediatric trauma‐focused cognitive behavioral therapy: A meta‐analysis.

Trauma‐focused cognitive behavioral therapy (TF‐CBT) is one of the leading interventions for trauma‐exposed children and adolescents and is associated with significant improvements in a variety of trauma‐related symptoms. Nonetheless, attrition from TF‐CBT is quite common, and children who do not receive the full intervention may continue to suffer from trauma‐related symptoms. Rates of premature termination have varied across studies, and to date, no meta‐analyses have been conducted regarding dropout from TF‐CBT. The objective of the present study was to conduct a meta‐analysis of the rates of attrition from TF‐CBT, as well as review factors related to premature termination from this intervention. A total of 22 studies were available for inclusion in this meta‐analysis. The prevalence of attrition was 33.9% (95% CI [26.2%, 42.5%]) from 2,059 children receiving TF‐CBT. Clinician‐rated attrition was 38.5%, and 17.5% did not receive an adequate dose of TF‐CBT (e.g., 12+ sessions). Further, the study type was related to differing rates of dropout, with randomized controlled trials having a much lower attrition rate. Regarding risk factors for premature termination, the emerging literature suggests that a child's age, racial‐ethnic minority status, and symptom levels may evince some ties to attrition. Caregiver, family, therapist, and treatment factors remain underexplored in relation to premature termination; however, preliminary work suggests that lack of caregiver attendance and difficulty in the child‐therapist relationship may be related to attrition. A substantial number of children prematurely terminate from TF‐CBT, underscoring the need to better prevent dropout. [ABSTRACT FROM AUTHOR]