Cohen 1996.

Methods	Randomised trial of CBT vs supportive therapy
Participants	Included (n = 86) Preschool children who had been sexually abused, with the most recent episode of sexual abuse reported within the previous 6 months with minimal symptoms defined as a Weekly Behavior Report score > 7 or any sexually inappropriate behavior reported on the Child Sexual Behavior Inventory. Mean age: 4.7 years. Female: 58%. Caucasian 54%, African  American 42%, other 4%. Trauma: 25% abused once, 26% abused 2 to 5 times Excluded Children with mental retardation, pervasive developmental disorder, psychotic symptoms or serious mental illness or in short‐term care (< 12 months), or parents with a psychotic disorder or current substance abuse Setting Children were referred to the Center for Traumatic Stress in Children and Adolescents, Pittsburgh, USA
Interventions	Cognitive‐behavioural therapy for sexually abused preschool children (CBT‐SAP) (n = 39 completing treatment) A short‐term treatment model for sexually abused preschool children and their parents over 12 weekly sessions of 40 to 50 minutes with the child and 50 minutes with the parent. Specific issues addressed with the child were safety and assertiveness, ambivalence towards the perpetrator, behaviours, fears and anxiety. Interventions included cognitive reframing, thought stopping, positive imagery and contingency programmes. Issues addressed with parents included ambivalence to the perpetrator and their belief in the abuse, attributions, management of their fear and anxiety, their own history of abuse, feelings towards the child, legal issues and emotional support and behavioural management for the child Non‐directive supportive therapy (NST) (n = 28 completing treatment) Support from an understanding and concerned professional over 12 weekly sessions of 40 to 50 minutes with the child and 50 minutes with the parent designed to reduce isolation, loneliness, hopelessness and anxiety; improve understanding of their feelings; and validate these feelings. The therapist did not make interpretations or offer directive advice but could help identify alternatives through non‐directive suggestions Therapists Both therapists were master’s level clinicians who had worked with sexually abused children for several years. Two therapists were trained in both treatments before the study began. Detailed treatment manuals were provided for both therapies. Weekly individual supervision was provided. All treatment sessions were audiotaped, and scores for compliance with the treatment model were rated as greater than 90%
Outcomes	Behaviour Scale: Child Behavior Checklist Rater: parent When Post therapy and at 6‐ and 12‐month follow‐up
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Children and their parents were randomised by Efron's biased coin toss to ensure the 2 groups were balanced in terms of perpetrator, type of abuse, gender and age
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding of participants (performance bias	Unclear risk	Participants could not be blinded, but both groups received a psychological therapy
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Outcome assessment could not be blinded, as all measures were self reported or parent reported
Incomplete outcome data (attrition bias) All outcomes	High risk	Overall loss to follow‐up at the end of treatment was 22% and 50% at 6 and 12 months and was > 50% for the supportive therapy group at 6 and 12 months
Selective reporting (reporting bias)	Low risk	All outcomes appear to have been reported
Other bias	Low risk	No other bias was apparent