PTSD is a mental health disorder that can affect kids who have experienced something very frightening, traumatic, or life-threatening, such as violence, abuse, natural disasters, or bad accidents. The child or teen does not even have to experience the upsetting event for him or herself, as PTSD can also arise after seeing something happening to someone they are close to or even just hearing about it.

Kids with PTSD have extreme anxiety that might result in multiple issues, such as being easily annoyed, having tantrums, having trouble concentrating, having trouble sleeping, nightmares, feeling guilty, or feeling detached from others around them. When a child has PTSD, they may avoid situations or places that remind them of the traumatic event, or they may have flashbacks.

Different kids may perceive and react to events in different ways, so not all children who go through an upsetting event experience it as trauma. PTSD can also look different depending on age: young children might not have the ability to communicate how they feel, while older kids may be more concerned with fairness, wondering why the trauma happened or feeling angry about it.

What are the symptoms of PTSD?

PTSD follows exposure to actual or threatened serious injury, physical or sexual violence, or threatened death, including the following:

  • Direct experience with a traumatic event
  • Witnessing a traumatic event occurring to another
  • Learning that a traumatic event has occurred to a close family member or close friend
  • Experiencing extreme or repeated exposure to aversive details of traumatic events (Ages 7 and up only)

Children and teens with PTSD can have a variety of symptoms. Some of these symptoms may be easier for caregivers and teachers to notice, while others may be more subtle. Specific symptoms of PTSD include:

Core Symptoms of PTSD (Ages 7 and up)

Core Symptoms of PTSD (Ages 6 and younger)

One or more of the following, beginning after the traumatic event:

  • Recurrent, involuntary, and intrusive memories of a traumatic event, including through repetitive play
  • Recurrent nightmares related to the traumatic event
  • Flashbacks giving the feeling that the traumatic event is recurring
  • Intense or prolonged distress after exposure to cues (even memories) related to the traumatic event
  • Intense physiological reactions (e.g. fast heart breathing, fast breathing, sweating, dry mouth etc) to cues (even memories) related to the traumatic event

Persistent avoidance of stimuli related to the traumatic event:

  • Avoidance or efforts to avoid memories, thoughts, or feelings related to the traumatic event
  • Avoidance or efforts to avoid reminders (e.g., people, places, objects, activities) related to the traumatic event

Negative alterations to thoughts or feelings about the traumatic event:

  • Inability to remember important aspects
  • Persistent, exaggerative negative beliefs about oneself
  • Persistent, distorted thoughts about the cause or consequences of the event, including self-blame
  • Persistent negative feelings (e.g., fear, horror, anger, guilt, shame)
  • Diminished interest or participation in activities
  • Detached or estranged feelings
  • Persistent inability to experience positive emotions (e.g., happiness, satisfaction, love)

Altered arousal and reactivity associated with the traumatic event:

  • Irritable behavior or angry outbursts
  • Reckless or self-destructive behavior
  • Hypervigilance
  • Exaggerated startle response
  • Problems with concentration
  • Sleep issues

One or more of the following, beginning after the traumatic event:

  • Recurrent, involuntary, and intrusive memories of a traumatic event, including through repetitive play
  • Recurrent nightmares related to the traumatic event
  • Flashbacks giving the feeling that the traumatic event is recurring
  • Intense or prolonged distress after exposure to cues (even memories) related to the traumatic event
  • Intense physiological reactions (e.g., fast heart breathing, fast breathing, sweating, dry mouth etc) to cues (even memories) related to the traumatic event

Persistent avoidance of stimuli related to the traumatic event or negative alterations to thoughts or feelings about the traumatic event:

  • Avoidance or efforts to avoid memories, thoughts, or feelings related to the traumatic event
  • Avoidance or efforts to avoid reminders (e.g., people, places, objects, activities) related to the traumatic event
  • Persistent negative feelings (e.g., fear, horror, anger, guilt, shame)
  • Diminished interest or participation in activities
  • Socially withdrawn behavior
  • Persistent reduction in expression of positive emotions (e.g., happiness, satisfaction, love)

Altered arousal and reactivity associated with the traumatic event:

  • Irritable behavior or angry outbursts
  • Seeming vigilant or on edge
  • Exaggerated responses to surprises
  • Problems with concentration
  • Sleep issues

How is PTSD diagnosed?

A child-adolescent psychiatrist may diagnose a child or teen with PTSD after determining that their thoughts or feelings are associated with a specific event; they have difficulty controlling their thoughts or feelings related to the event; their symptoms have been persistent, occurring for a period of at least one month; and their symptoms result in significant distress and impairment in other aspects of everyday functioning (e.g., social, familial, academic, etc.).

The child-adolescent psychiatrist may interview and/or assess both the child or teen and a caregiver in order to determine the specific nature of the child’s or teen’s distress, although many practitioners also use behavior and emotion rating form results to support the diagnosis. The practitioner will also seek to determine that the child’s or teen’s distress is not related to something unforeseen.

PTSD Facts

Worldwide frequency of the condition

Prevalence rates for PTSD vary widely, the disorder is estimated to be present in 3.9% of the world’s population. The frequency is higher, 5.6% in those who have experienced trauma, and 22.71% of refugees and asylum seekers. There is no recent, specific epidemiological data for Greece.

Burden of the condition in Greece

PTSD accounts for less than 0.03% for all disability adjusted life years (DALYs) lost to health conditions in Greece for 5- to 14-year-old children and adolescents.

Gender ratio

Gender comparative data for PTSD suggests that females are more likely to be diagnosed than males at a rate of 2:1.

Peak age of onset

The peak age of onset for PTSD is estimated to be 15.5 years.

Proportion of the condition that emerges before age 18

According to recent data, 27.6% of individuals with PTSD will have been diagnosed by the time they are 18 years old.

What are the associated factors for PTSD?

Some common factors associated with PTSD are:

  • Genetic and familial factors. Most likely a combination of multiple genes that interact in a complex way with multiple environmental factors.
  • Environmental factors. These include lower socioeconomic status (SES), lower familial education, exposure to previous trauma, family dysfunction, and parental separation or death.
  • Child temperament. These include chronic irritability and problems with oppositionality.
  • Factors during a traumatic event. These include the severity of the traumatic event, perceived life threat, personal injury.
  • Factors after a traumatic event. These include subsequent exposure to repeated upsetting reminders, additional negative life events, financial hardship, forced migration following the event, and racial or ethnic discrimination.

What other disorders co-occur with PTSD?

Even though each child and adolescent is different, individuals who meet the criteria for PTSD sometimes also struggle with depression, bipolar disorder, anxiety, or substance use disorders.

How is PTSD treated?

The main treatment for PTSD in children and adolescents is psychotherapy. The four most supported types of psychotherapy for kids with PTSD are cognitive-behavioral therapy (CBT), trauma-focused cognitive-behavioral therapy (TF-CBT), prolonged exposure therapy (PE), and cognitive processing therapy (CPT).

CBT teaches individuals to manage their fear. In CBT, the kid does not talk directly about the upsetting event but instead learns skills to deal with difficult feelings. Therapy for PTSD almost always includes a parent or other caregiver who takes care of the child.

TF-CBT is a more robust treatment that is now considered the gold standard treatment for children and adolescents with PTSD. TF-CBT has several components, the first being teaching a child and his or her caregiver(s) about what trauma looks like. Next, TF-CBT moves to helping kids learn how to deal with those symptoms. After building that skill base, treatment moves on to helping them talk about their trauma in as much detail as possible. Part of processing the event is creating what is known as a “trauma narrative.” These are often written stories that the child-adolescent psychiatrist can help the child create, but could also be cartoons, drawings or PowerPoint presentations. By thinking and talking about what happened in a calm, safe space, the child learns that the more he or she can face the traumatic memory and talk about it, the less scary that memory becomes. That helps the child be better able to manage his or her feelings when the memory comes up.

PE is more suitable for adolescents than younger children. The treatment is designed to help individuals stop avoiding thinking about their traumatic experience or reminders of it. Rather, a therapist helps the individual confront their trauma memory by purposefully retelling their experience, creating a list of the things associated with the experience that they have been avoiding, and gradually adjusting to these things.

CPT is another treatment for young adolescents that helps them talk about what happened to them, but with a focus on identifying how the trauma altered their beliefs. After a trauma, people often develop new ways of thinking—or they adapt their old ways of thinking—to try to make sense of what happened to them. They get caught on these points, which prevent them from recovering. In CPT, the therapist helps the individual examine how their beliefs have changed. They talk through what is true and what is not, with goals of developing a healthier view of what happened and moving past it.

While there is not much evidence pharmacotherapy leads to significant improvement in the PTSD symptoms in children and adolescents, some patients, especially when other anxious or depressive symptoms are associated with PTSD, might benefit from certain antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). Medications can have side effects, but they are safe for children to use with proper care from their doctor. A child or teen who is taking one of these medications should see their doctor regularly, especially if their dosage has recently changed.

Where to find more information

If you need more information on worries and reasons for concerns, you can also go to "Persistent Distress After Traumatic Experiences" on our website.

To learn more about the technical work conducted to develop this guide, please consult our reference list:

References

Clinical description, symptoms, and diagnostic information

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Child Mind Institute. (2021, September 7). Quick guide to Post-Traumatic Stress Disorder (PTSD) in kids. https://childmind.org/guide/quick-guide-to-post-traumatic-stress-disorder-ptsd/
  • Ehmke, R. (2021, October 12). What is PTSD? The disorder looks different in children as they develop. https://childmind.org/article/what-is-ptsd/
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6B40 Post Traumatic Stress Disorder. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/2070699808

Facts

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Blackmore, R., Gray, K. M., Boyle, J. A., Fazel, M., Ranasinha, S., Fitzgerald, G., Misso, M., & Gibson-Helm, M. (2020). Systematic Review and Meta-analysis: The Prevalence of Mental Illness in Child and Adolescent Refugees and Asylum Seekers. Journal of the American Academy of Child & Adolescent Psychiatry, 59(6), 705–714. https://doi.org/10.1016/j.jaac.2019.11.011
  • Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from http:// vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)
  • Koenen, K. C., Ratanatharathorn, A., Ng, L., McLaughlin, K. A., Bromet, E. J., Stein, D. J., Karam, E. G., Meron Ruscio, A., Benjet, C., Scott, K., Atwoli, L., Petukhova, M., Lim, C. C. W., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Bunting, B., Ciutan, M., de Girolamo, G., … Kessler, R. C. (2017). Posttraumatic stress disorder in the World Mental Health Surveys. Psychological Medicine, 47(13), 2260–2274. https://doi.org/10.1017/S0033291717000708
  • Santiago, P. N., Ursano, R. J., Gray, C. L., Pynoos, R. S., Spiegel, D., Lewis-Fernandez, R., Friedman, M. J., & Fullerton, C. S. (2013). A Systematic Review of PTSD Prevalence and Trajectories in DSM-5 Defined Trauma Exposed Populations: Intentional and Non-Intentional Traumatic Events. PLoS ONE, 8(4), e59236. https://doi.org/10.1371/journal.pone.0059236
  • Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7
  • Somers, J. M., Goldner, E. M., Waraich, P., & Hsu, L. (2006). Prevalence and Incidence Studies of Anxiety Disorders: A Systematic Review of the Literature. The Canadian Journal of Psychiatry, 51(2), 100–113. https://doi.org/10.1177/070674370605100206

Associated factors

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Arango, C., Dragioti, E., Solmi, M., Cortese, S., Domschke, K., Murray, R. M., Jones, P. B., Uher, R., Carvalho, A. F., Reichenberg, A., Shin, J. I., Andreassen, O. A., Correll, C. U., & Fusar‐Poli, P. (2021). Risk and protective factors for mental disorders beyond genetics: An evidence‐based atlas. World Psychiatry, 20(3), 417–436. https://doi.org/10.1002/wps.20894
  • Ayano, G., Betts, K., Maravilla, J. C., & Alati, R. (2021). The risk of anxiety disorders in children of parents with severe psychiatric disorders: A systematic review and meta-analysis. Journal of Affective Disorders, 282, 472–487. https://doi.org/10.1016/j.jad.2020.12.134
  • DiGangi, J. A., Gomez, D., Mendoza, L., Jason, L. A., Keys, C. B., & Koenen, K. C. (2013). Pretrauma risk factors for posttraumatic stress disorder: A systematic review of the literature. Clinical Psychology Review, 33(6), 728–744. https://doi.org/10.1016/j.cpr.2013.05.002
  • Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50
  • Smith, P., Dalgleish, T., & Meiser‐Stedman, R. (2019). Practitioner Review: Posttraumatic stress disorder and its treatment in children and adolescents. Journal of Child Psychology and Psychiatry, 60(5), 500–515. https://doi.org/10.1111/jcpp.12983
  • Tortella-Feliu, M., Fullana, M. A., Pérez-Vigil, A., Torres, X., Chamorro, J., Littarelli, S. A., Solanes, A., Ramella-Cravaro, V., Vilar, A., González-Parra, J. A., Andero, R., Reichenberg, A., Mataix-Cols, D., Vieta, E., Fusar-Poli, P., Ioannidis, J. P. A., Stein, M. B., Radua, J., & Fernández de la Cruz, L. (2019). Risk factors for posttraumatic stress disorder: An umbrella review of systematic reviews and meta-analyses. Neuroscience & Biobehavioral Reviews, 107, 154–165. https://doi.org/10.1016/j.neubiorev.2019.09.013

Co-occurring disorders

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Debell, F., Fear, N. T., Head, M., Batt-Rawden, S., Greenberg, N., Wessely, S., & Goodwin, L. (2014). A systematic review of the comorbidity between PTSD and alcohol misuse. Social Psychiatry and Psychiatric Epidemiology, 49(9), 1401–1425. https://doi.org/10.1007/s00127-014-0855-7
  • Saha, S., Lim, C. C. W., Cannon, D. L., Burton, L., Bremner, M., Cosgrove, P., Huo, Y., & McGrath, J. (2021). Co‐morbidity between mood and anxiety disorders: A systematic review and meta‐analysis. Depression and Anxiety, 38(3), 286–306. https://doi.org/10.1002/da.23113

Interventions

  • Correll, C. U., Cortese, S., Croatto, G., Monaco, F., Krinitski, D., Arrondo, G., Ostinelli, E. G., Zangani, C., Fornaro, M., Estradé, A., Fusar‐Poli, P., Carvalho, A. F., & Solmi, M. (2021). Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: An umbrella review. World Psychiatry, 20(2), 244–275. https://doi.org/10.1002/wps.20881Smith, P., Dalgleish, T., & Meiser‐Stedman, R. (2019). Practitioner Review: Posttraumatic stress disorder and its treatment in children and adolescents. Journal of Child Psychology and Psychiatry, 60(5), 500–515. https://doi.org/10.1111/jcpp.12983
  • Locher, C., Koechlin, H., Zion, S. R., Werner, C., Pine, D. S., Kirsch, I., Kessler, R. C., & Kossowsky, J. (2017). Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Psychiatry, 74(10), 1011. https://doi.org/10.1001/jamapsychiatry.2017.2432
  • McGuire, A., Steele, R. G., & Singh, M. N. (2021). Systematic Review on the Application of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Preschool-Aged Children. Clinical Child and Family Psychology Review, 24(1), 20–37. https://doi.org/10.1007/s10567-020-00334-0
  • Plaisted, H., Waite, P., Gordon, K., & Creswell, C. (2021). Optimising Exposure for Children and Adolescents with Anxiety, OCD and PTSD: A Systematic Review. Clinical Child and Family Psychology Review, 24(2), 348–369. https://doi.org/10.1007/s10567-020-00335-z
  • Smith, P., Dalgleish, T., & Meiser‐Stedman, R. (2019). Practitioner Review: Posttraumatic stress disorder and its treatment in children and adolescents. Journal of Child Psychology and Psychiatry, 60(5), 500–515. https://doi.org/10.1111/jcpp.12983
  • Thielemann, J. F. B., Kasparik, B., König, J., Unterhitzenberger, J., & Rosner, R. (2022). A systematic review and meta-analysis of trauma-focused cognitive behavioral therapy for children and adolescents. Child Abuse & Neglect, 134, 105899. https://doi.org/10.1016/j.chiabu.2022.105899
  • Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Frontiers in Behavioral Neuroscience, 12, 258. https://doi.org/10.3389/fnbeh.2018.00258
  • Xiang Y, Cipriani A, Teng T, et al. Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: a systematic review and network meta-analysis. Evid Based Mental Health. 2021;24(4):153-160. doi:10.1136/ebmental-2021-300346

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