Understanding PTSD in Children and Adolescents
Steering Committee
June 12, 2025
Every June, PTSD Awareness Month shines a spotlight on the challenges faced by those living with post-traumatic stress disorder, including millions of children and adolescents. While PTSD is often associated with adults and veterans, young people are also vulnerable - especially after experiencing or witnessing traumatic events such as violence, accidents, or disasters. The symptoms of PTSD can disrupt daily life, relationships, and school performance, and may look different in children and teens compared to adults.
1 Raising awareness this month is crucial to reduce stigma, promote understanding, and foster supportive environments that promote healing and resilience for all children.
PTSD is a mental health condition triggered by experiencing or witnessing a traumatic event. Typically, a traumatic event is one that is dangerous, frightening, and/or upsetting, often times causing fear for life or safety. Not every child or adolescent that experiences or witnesses a traumatic event will develop PTSD, but they will feel its effects.
Children and adolescents can develop PTSD after exposure to a wide range of traumatic events, including, but not limited to:
- Physical, sexual, or emotional maltreatment
- Serious illness or sudden death of a parent, caregiver, or friend
- Severe accidents (car crashes, invasive medical procedures)
- Domestic or community violence
- Natural disasters (hurricanes, floods, earthquakes)
- Witnessing or learning about, violence against loved ones
- Neglect or bullying
- War or displacement
The risk of developing PTSD increases with the severity, proximity, and duration of the trauma. For example, children who directly witness violence are more likely to develop PTSD than those who hear about it secondhand.
2 National surveys indicate that about 5% of adolescents have met the criteria for PTSD in their lifetime, with higher rates among girls (8%) than boys (2.3%).
3 The prevalence in younger chilis less well-documented, partly due to the challenges in diagnosis. Risk factors that influence the likelihood of developing PTSD after trauma re multifaceted. The type and intensity of trauma play a significant role, as more severe or repeated traumatic experiences increase the risk of developing the disorder. Proximity to the event is also important, with direct exposure leading to higher rates of PTSD compared to indirect exposure. Additionally, a history of previous trauma or existing psychiatric disorders can compound a child's vulnerability. Parental and social support serve as protective factors; children with strong family and community support are less likely to develop PTSD, while those who have familial discord or parents who suffer from mental illness face a higher risk. Finally, resilience and coping skills are crucial, as children who possess effective coping mechanisms are less likely to experience persistent symptoms of PTSD.
4
While it is normal to react to a deeply stressful event, the length and severity of the reaction and how this affects the daily functioning of the individual determines whether they are diagnosed with PTSD. The disorder does not manifest the same in everyone who develops it - children and adolescents, in particular, may show symptoms in ways specific to their age, making recognition and intervention more challenging.
PTSD in children and adolescents includes three main symptom clusters:
- Re-experiencing
- Intrusive thoughts and memories
- Children might have intrusive thoughts or memories of the traumatic event, or they might experience flashbacks or feel like they are reliving the event.
- Nightmares
- Recurring nightmares related to the trauma are common.
- Play re-enactment
- Younger children may re-enact the trauma through play, using toys or engaging in play with trauma-related themes.
- Avoidance and Numbing
- Avoiding reminders
- Children may actively avoid anything that reminds them of the trauma, including places, people, conversations, or activities.
- Numbing
- They may experience emotional numbing, feeling detached or less responsive to emotions.
- Loss of interest
- Children might lose interest in activities they previously enjoyed.
- Hyperarousal
- Irritability and anger
- Children may become easily irritable or experience outbursts of anger.
- Difficulty sleeping
- Sleep disturbances, including trouble falling asleep or staying asleep, are common.
- Exaggerated startle response
- Children may be easily startled by loud noises or sudden movements.
- Difficulty concentrating
- They may have difficulty focusing or concentrating on tasks.5
The manifestation of symptoms of PTSD in children and adolescents can differ significantly depending on their developmental stage. Preschool and young children (ages six and under) often lack the ability to clearly verbalize their experiences, so their symptoms typically manifest as behavioral changes. These may include increased clinginess, regression to earlier behaviors such as bedwetting or thumb-sucking, and the reenactment of traumatic events during play. It is also common for young children to exhibit "time skew," where they mis-sequence events, and "omen foundation," where they believe they can prevent future trauma by being especially vigilant. Elementary school-aged children may engage in posttraumatc play, compulsively reenacting aspects of the trauma in literal ways. They might also experience difficulties with memory or concentration, which can lead to academic struggles. Other symptoms in this age group include increased irritability or aggression, social withdrawal, and physical complaints such as headaches or stomaches. In adolescents, PTSD symptoms being to resemble those seen in adults. Teenagers may display risk-taking, impulsive, or aggressive behaviors, and traumatic reenactment may occur through their actions or lifestyle choices. Additionally, depression, substance use, and academic decline are common co-occuring issues among adolescents with PTSD.
6
PTSD can significantly disrupt a child's ability to learn and function in school. Children and adolescents can experience:
- Difficulty concentrating or remembering information
- Trouble completing assignments or participating in class
- Increased absenteeism
- Social withdrawal or conflicts with peers and teachers
- Behavioral outbursts or sudden changes in mood 7
This may lead to a decline in academic performance and attendance at school, as well as behavioral changes that may be concerning. This makes it crucial for caregivers, educators, and all those who work with children and adolescents to ensure they
Recognize the Signs
- Be alert to behavioral changes, academic decline, or social withdrawal
- Understand that trauma may manifest as aggression, defiance, or regression, not just sadness or fear
Create a Supportive Environment
- Maintain predictable routines to foster a sense of safety
- Offer choices and a sense of control where possible
- Be patient and avoid punitive responses to trauma-related behaviors
Communicate and Collaborate
- Work closely with families, mental health professionals, and school staff
- Provide psychoeducation for families to demystify symptoms and reduce stigma, fostering a more supportive home environment
- Respect confidentiality but share concerns when a child's safety or well-being is at risk
Promote Resilience
- Encourage participation in activities the child enjoys and excels at
- Teach and model coping skills, such as deep breathing or positive self-talk
- Reinforce the child's strengths and progress, no matter how small
PTSD in children and adolescents is a serious but treatable condition. Addressing PTSD early and comprehensively in children and adolescents is critical to mitigate long-term psychological and functional impairments and promote healthier developmental trajectories. By fostering understanding, compassion, and collaboration, adults can help traumatized youth reclaim a sense of safety, hope, and possibility for the future. Understanding PTSD in young people is not just a clinical concern, it is a community responsibility. With awareness and action, educators and caregivers can be powerful allies in the journey toward healing.
References:
- Cisler JM, Herringa RJ. Posttraumatic Stress Disorder and the Developing Adolescent Brain. Biol Psychiatry. 2021 Jan 15;89(2):144-151. doi: 10.1016/j.biopsych.2020.06.001. Epub 2020 Jun 10. PMID: 32709416; PMCID: PMC7725977.
- U.S. Department of Veterans Affairs, PTSD: National Center for PTSD - PTSD in Children and Adolescents - link to website
- U.S. Department of Veterans Affairs, PTSD: National Center for PTSD - PTSD in Children and Adolescents
- Christoffersen MN, Thorup AAE. Post-traumatic Stress Disorder in School-age Children: A Nationwide Prospective Birth Cohort Study. J Child Adolesc Trauma. 2024 Feb 22;17(2):139-157. doi: 10.1007/s40653-024-00611-y. PMID: 38938938; PMCID: PMC11199452.
- Kaminer D, Seedat S, Stein DJ. Post-traumatic stress disorder in children. World Psychiatry. 2005 Jun;4(2):121-5. PMID: 16633528; PMCID: PMC1414752.
- Nemours KidsHealth Posttraumatic Stress Disorder Factsheet (for schools) - link to website
- Nemours Kidshealth Posttraumatic Stress Disroder Factsheet (for schools) - link to website
|
back to top |
Resources: