PTSD Post-Traumatic Stress Disorder Guide Post-Traumatic Stress Disorder Guide Symptoms & Diagnosis Causes & Risk Factors Treatment Living With In Children Understanding PTSD in Children By Matthew Tull, PhD Matthew Tull, PhD Twitter Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. Learn about our editorial process Updated on October 02, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Akeem Marsh, MD Medically reviewed by Akeem Marsh, MD LinkedIn Twitter Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities. Learn about our Medical Review Board Print Table of Contents View All Table of Contents Diagnosing PTSD in Young Children Signs and Symptoms Risk Factors Tips for Parents and Caregivers Next in Post-Traumatic Stress Disorder Guide PTSD: Symptoms and Diagnosis Adults are certainly not the only ones who can experience PTSD after going through a traumatic event. Children and adolescents can experience the same emotional challenges and behavioral symptoms of post-traumatic stress disorder as adults. More than two-thirds of children in the United States report having experienced at least one traumatic event by the age of 16 years old. Of children who experience trauma, it is estimated that about 16 percent will end up struggling with PTSD. Common examples of trauma that children and adolescents can experience include things like: Sexual abuse/rape School violence Natural disasters Military-family related stressors Sudden or violent loss of a loved one Neglect Serious accidents Life-threatening illnesses Illustration by JR Bee, Verywell Updates to PTSD Diagnosis The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), is the most up-to-date version of the manual that clinical professionals use to diagnose mental health concerns. Not until this most recent revision were there specific criteria listed for diagnosing PTSD in children, specifically for children six years old or younger. As children continue to be exposed to traumatic events, it is important to recognize that they, too, can experience debilitating emotional challenges after going through trauma. Diagnosing PTSD in Young Children The general criteria for diagnosing PTSD applies to adults and any person over the age of six years old. The following are the new specific criteria outlined in the DSM-5 for the preschool specifier, or for those six years or younger. Criterion A Children under the age 6 have been exposed to an event involving real or threatened death, serious injury, or sexual violence in at least one of the following ways: The child directly experienced the event.The child witnessed the event, but this does not include events that were seen on television, in movies, or some other form of media.The child learned about a traumatic event that happened to a caregiver. Criterion B The presence of at least one of the following intrusive symptoms that are associated with the traumatic event and began after the event occurred: Recurring, spontaneous, and intrusive upsetting memories of the traumatic event, which can be expressed through play Recurring and upsetting dreams about the event Flashbacks or some other dissociative response where the child feels or acts as if the event were happening again, which can be expressed through play Strong and long-lasting emotional distress after being reminded of the event or after encountering trauma-related cues Strong physical reactions, like increased heart rate or sweating, to trauma-related reminders Criterion C The child exhibits at least one of the following avoidance symptoms or changes in his or her thoughts and mood. These symptoms must begin or worsen after the experience of the traumatic event. Avoidance of or the attempted avoidance of activities, places, or reminders that bring up thoughts about the traumatic event. Avoidance of or the attempted avoidance of people, conversations, or interpersonal situations that serve as reminders of the traumatic event. More frequent negative emotional states, such as fear, shame, or sadness Increased lack of interest in activities that used to be meaningful or fun. Social withdrawal Reduced expression of positive emotions Criterion D The child experiences at least one of the below changes in his or her arousal or reactivity, and these changes began or worsened after the traumatic event: Increased irritable behavior or angry outbursts. This may include extreme temper tantrums. Hypervigilance, which consists of being on guard all the time and unable to relax Exaggerated startle response Difficulties concentrating Problems with sleeping In addition to the above criteria, these symptoms need to have lasted at least one month and result in considerable distress or difficulties in relationships or with school behavior. The symptoms also cannot be better attributed to ingestion of a substance or to some other medical condition. Signs and Symptoms It is important to keep in mind that not all children who experience trauma will go on to develop PTSD. Although there are specific clinical criteria that need to be met in order for a child to be accurately diagnosed with PTSD, there are a variety of things that parents, caregivers, and other adults can look for in children if they suspect that a child might be struggling. Note that PTSD in children may manifest in a way that relates to the trauma experienced. For example, youth that are physically abused may exhibit aggression as a post-traumatic reaction, while those that are sexually abused may appear to act out sexually. If you see any of the following, or additional behaviors or symptoms that seem out of the norm for your child and are not listed here, it can be worth checking in with them to see if talking with a trained professional could be helpful. Exhibiting unusual behaviors doesn't mean your child has PTSD, but it's important to be aware of possible warning signs, especially if your child has recently faced trauma of some kind. Preschool Cry or scream a lotEat poorly or lose weight due to loss of appetiteExperience nightmares or night terrorsExtraordinary fear of being separated from their parent or caregiver School Age Have a hard time concentrating at schoolDifficulty sleeping—insomnia or nightmaresFeelings of guilt or shameAnxious or fearful in a variety of situations Teens Eating disorder behaviors Self-harm Feeling depressed or alone Begin abusing alcohol or drugs Engage in risky sexual behavior Make impulsive dangerous decisions Isolating behaviors College Students Inability to concentrate Missing classes Poor grades Dissociative tendencies Withdraw from relationships Trouble sleeping Hyper aware of location and surroundings On edge much of the time Negative thoughts and emotions Avoiding things they used to enjoy Risk Factors Traumatic events that were life-threatening or caused physical harm can be a risk factor that influences the development of PTSD. Events that involve interpersonal violence, such as a physical attack, sexual abuse, or rape, are more likely to influence someone experiencing PTSD after their trauma. Research has shown that between 30 percent and 40 percent of children who experience physical or sexual abuse will end up developing PTSD. Characteristics of the Child As with adults, it is more common for someone to develop PTSD after a traumatic event when they have already been through a previous traumatic event. The emotional impact of trauma can have a cumulative effect, so even if a child didn't demonstrate PTSD symptoms after a previous traumatic experience, it is more likely that they will experience PTSD with each subsequent trauma. Girls are two to three times more likely than boys to develop PTSD after trauma. Some researchers suggest that this difference is due to the likelihood of girls being exposed to a traumatic event—such as sexual abuse—earlier and more often than boys. Other elements to explain this difference in the rate of PTSD between girls and boys is still being researched. Children and teens who have a previous diagnosis of a mood or anxiety related disorder are more likely to develop PTSD after a traumatic event than those with no prior mental health diagnosis. Family Dynamics There are some characteristics within the family that can be influential factors in a child or teen developing PTSD. For example, parent reactions to trauma can be a risk factor for children. There are times when the entire family has experienced the traumatic event together and the children witness their parents demonstrating symptoms of PTSD. Alternatively, there are times when only the child has experienced the traumatic event but the parent still develops symptoms of PTSD. Children and teens with greater social support have been shown to be less likely to develop PTSD after a traumatic event. Although social support primarily involves parents and caregivers, the benefits of social support can include teachers and peers as well. Since many people who struggle with PTSD tend to do so in isolation, the secure and safe connections with others can help minimize the lonely feelings and the opportunities to isolate. Responses to the Event The following cognitive and emotional responses to the traumatic event have been shown to influence the development of PTSD in children and teens: Anger about the event Repetitive thinking about the event (ruminating) Avoidance and suppression of the trauma related thoughts Dissociation during or after the event Higher heart rate at time of hospitalization if required due to injury during the event Tips for Parents and Caregivers Although we cannot always prevent our children from traumatic experiences, there are certain things that parents and caregivers can do to help their child find the support and resources they need to experience healing. Education Educating yourself on the signs and symptoms that can show up at various stages of development can be helpful. Often children do not want to open up about their experience due to feelings of guilt and shame. By noticing behaviors or symptoms that seem different or out of the norm for your child, you can create opportunities for children to open up about their experience. The safer a child feels to be free of judgment or criticism, the likelier they are to become more open about their experience and the struggles they are having. Finding Resources Take time to find resources. Many schools, from preschool programs to college campuses, can offer resources for students struggling with PTSD. If they don't offer the resources themselves, they can certainly help to connect you with appropriate programs in your area. Children sometimes don't understand what they need and are looking to adults to help guide the way. If you are uncertain where to begin, you can start with contacting the school or even speaking with your pediatrician or other healthcare provider. Treatment Keep an open mind about treatment. It is highly likely that your child will be encouraged to participate in counseling services as part of their treatment for PTSD. This can feel uncomfortable for parents and caregivers, especially if the child has not been in counseling before. Share concerns with the therapist and make sure to ask questions about what your child can expect in treatment and any ways that you can be of help. You may be asked to sit in and participate in sessions as well. The 7 Best Online Therapy Programs for Kids Medication Depending on the situation and the age of your child, medication may also be discussed as part of treatment. It is important that medications be monitored closely by the prescribing professional. Making sure that your child is taking their medication as scheduled, and sharing with you any adverse reactions or experiences as a result of taking the medication, is critical. If your child is struggling with PTSD, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. 13 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Substance Abuse and Mental Health Services Administration (SAMHSA). Understanding Child Trauma. Hiller RM, Meiser-Stedman R, Fearon P, et al. 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Child Adolesc Psychiatr Clin N Am. 2012;21(1):119–x. doi:10.1016/j.chc.2011.08.009 Donnelly CL. Pharmacologic treatment approaches for children and adolescents with posttraumatic stress disorder. Child Adolesc Psychiatr Clin N Am. 2003;12(2):251-69. doi:10.1016/S1056-4993(02)00102-5 Additional Reading American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. By Matthew Tull, PhD Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for PTSD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.