PTSD in children and adolescents¶
TL;DR — Development changes symptom expression, informant agreement, dependence on caregivers and treatment delivery. A 2025 network meta-analysis included 70 RCTs (n=5,528): TF-CBT g=1.06 (95% CI .86–1.26), EMDR g=.86 (.54–1.18), multidisciplinary treatment g=.88 (.53–1.23), and non-trauma-focused treatment g=.95 (.62–1.28), each versus passive control (Hoppen 2025, PMID 39630422). TF-CBT had the strongest and most durable evidence, but 74% of trials tested TF-CBT, creating an evidence-volume imbalance. Trauma-exposed youth meta-analysis estimated PTSD incidence 15.9% (11.5–21.5) (Alisic 2014, PMID 24785767).
Developmental assessment¶
Young children may express reenactment, separation fears, regression, irritability or somatic distress; caregiver and child reports may diverge. Instruments and thresholds must be age-validated (Maercker 2022, PMID 35780794) (Alisic 2014, PMID 24785767).
Treatment¶
TF-CBT combines skills, gradual exposure/trauma narrative, cognitive processing, caregiver work and safety enhancement. The NMA supports short-, mid- and long-term benefit (Hoppen 2025, PMID 39630422).
Caregiver role¶
Caregiver involvement can support practice and safety but may be complicated when the caregiver is unavailable, traumatised or implicated. Trials should report who participated.
EMDR and alternatives¶
EMDR and other interventions showed benefit versus passive control, but longer-term evidence was less developed than TF-CBT (Hoppen 2025, PMID 39630422). Network estimates should not be read as decisive head-to-head superiority.
Safeguarding¶
Ongoing abuse, exploitation, unsafe housing and suicidality change priorities. Treatment cannot substitute for protection.
Acceptability¶
Pediatric dropout is markedly lower than the adult figures reported on dropout-and-nonresponse. Across 40 RCTs, dropout from any treatment or active control arm was 11.7% (95% CI 9.0–14.6), 11.2% (95% CI 8.2–14.6) from evidence-based treatment (TF-CBTs and EMDR) and 12.8% (95% CI 7.6–19.1) from non-trauma-focused treatments or controls, with no significant difference in odds of dropout between modalities; group rather than individual delivery, and lay rather than professional delivery, were associated with less dropout (Simmons 2021, PMID 34377359). The common claim that trauma-focused work drives children out of treatment is not supported by the trial data.
Medication¶
Adult SSRI approvals do not automatically apply to children, and the guideline evidence base treats them as separate questions: NICE commissioned a dedicated evidence review of pharmacological interventions for the prevention and treatment of PTSD in children, distinct from its adult drug reviews (National Guideline Alliance 2018, PMID 32757557). The pediatric drug trials that exist are small and informant-discordant — a 26-child randomized trial of sertraline after burns found benefit on parent-reported but not child-reported symptoms (Stoddard 2011, PMID 22040192) — against 70 RCTs and 5,528 patients on the psychological side (Hoppen 2025, PMID 39630422). Pediatric medication decisions require age-specific efficacy and harm evidence that largely does not exist.
Pooling warning¶
A trial of general anxiety symptoms after adversity is not a pediatric PTSD trial. Full and subthreshold PTSD should be reported separately.
Quantitative anchors¶
| Measure | Estimate | Population/method | Source |
|---|---|---|---|
| Post-trauma incidence | 15.9% (95% CI 11.5–21.5) | 43 samples; n=3,563 | (Alisic 2014, PMID 24785767) |
| Pediatric NMA | 70 RCTs; n=5,528 | Full/subthreshold PTSD ≤19 | (Hoppen 2025, PMID 39630422) |
| TF-CBT vs passive | g=1.06 (95% CI .86–1.26) | Treatment endpoint | (Hoppen 2025, PMID 39630422) |
| EMDR vs passive | g=.86 (.54–1.18) | Treatment endpoint | (Hoppen 2025, PMID 39630422) |
| Parent-involved TF-CBT vs non-TF | g=.35 (.04–.66) | Sensitivity analysis | (Hoppen 2025, PMID 39630422) |
| Pediatric dropout, all arms | 11.7% (95% CI 9.0–14.6) | 40 RCTs | (Simmons 2021, PMID 34377359) |
| Pediatric dropout, TF-CBT/EMDR | 11.2% (95% CI 8.2–14.6) | Same review; no significant difference by modality | (Simmons 2021, PMID 34377359) |
| Pediatric sertraline after burns | benefit on parent- but not child-reported symptoms | n=26 | (Stoddard 2011, PMID 22040192) |
Evidence ledger¶
The ledger lists the live-retrieved records used to bound this page. Inclusion does not make every record equally probative; design, population and comparator remain decisive.
| PMID | Year | Evidence contribution | Scope caution |
|---|---|---|---|
| 39630422 | 2025 | Psychological Interventions for Pediatric Posttraumatic Stress Disorder: A Systematic Review and Network Meta-Analysis. | Synthesis: preserve included-population and certainty limits |
| 24785767 | 2014 | Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. | Synthesis: preserve included-population and certainty limits |
| 7492257 | 1995 | Posttraumatic stress disorder in the National Comorbidity Survey. | PTSD-specific record; inspect design and population |
| 24990362 | 2015 | An Update on Posttraumatic Stress Disorder in Children and Adolescents. | PTSD-specific record; inspect design and population |
| 19635237 | 2009 | Epidemiology of child traumatic stress. | PTSD-specific record; inspect design and population |
| 10795604 | 2000 | Posttraumatic stress disorder: epidemiology and health-related considerations. | PTSD-specific record; inspect design and population |
| 38225917 | 2024 | [PTSD and Complex PTSD - Assessment, management and treatment]. | PTSD-specific record; inspect design and population |
| 10439203 | 1999 | Posttraumatic stress disorders in children and adolescents. | PTSD-specific record; inspect design and population |
| 40783299 | 2025 | Prevalence of Post-Traumatic Stress Disorder (PTSD) in autistic children or young people (CYP) and adults: A systematic review and meta-analysis. | Synthesis: preserve included-population and certainty limits |
| 11909008 | 2002 | Post-traumatic stress disorder in children and adolescents: epidemiology, diagnosis and treatment options. | PTSD-specific record; inspect design and population |
| 18474199 | 2008 | Post-traumatic stress disorder and its treatment in children and adolescents. | PTSD-specific record; inspect design and population |
| 39540207 | 2024 | Trauma exposure and ICD-11 PTSD and CPTSD in a Greenlandic adolescent population. | PTSD-specific record; inspect design and population |
| 34242737 | 2022 | Systematic Review and Meta-analysis: Prevalence of Posttraumatic Stress Disorder in Trauma-Exposed Preschool-Aged Children. | Synthesis: preserve included-population and certainty limits |
| 12108814 | 2002 | Posttraumatic stress disorder among adolescent earthquake victims in Taiwan. | PTSD-specific record; inspect design and population |
| 26028651 | 2016 | Systematic Review on Post-Traumatic Stress Disorder Among Survivors of the Wenchuan Earthquake. | Synthesis: preserve included-population and certainty limits |
| 15513767 | 2004 | Interventions for post-traumatic stress disorder in children and adolescents. | PTSD-specific record; inspect design and population |
| 20940670 | 2010 | Suicidal behavior in adolescents with post-traumatic stress disorder. | PTSD-specific record; inspect design and population |
| 34479132 | 2021 | Child-reported posttraumatic stress symptoms and attrition from therapy. | PTSD-specific record; inspect design and population |
| 33111174 | 2021 | Prevalence of post-traumatic stress disorder in caregivers of pediatric neurosurgical patients. | PTSD-specific record; inspect design and population |
| 20441729 | 2010 | Psychopharmacologic treatment of posttraumatic stress disorder in children and adolescents: a review. | Synthesis: preserve included-population and certainty limits |
| 27359192 | 2017 | Posttraumatic Stress Disorder Diagnosis in Young Children With Burns. | PTSD-specific record; inspect design and population |
| 32063234 | 2020 | Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis. | Synthesis: preserve included-population and certainty limits |
| 32284821 | 2020 | Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. | Synthesis: preserve included-population and certainty limits |
| 26574151 | 2016 | Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. | Synthesis: preserve included-population and certainty limits |
| 21352105 | 2007 | Early intervention for post-traumatic stress disorder. | PTSD-specific record; inspect design and population |
| 34377359 | 2021 | A meta-analysis of dropout from evidence-based psychological treatment for post-traumatic stress disorder (PTSD) in children and young people. | Trial dropout, not routine-care dropout |
| 22040192 | 2011 | A randomized controlled trial of sertraline to prevent posttraumatic stress disorder in burned children. | n=26; informant discordance |
| 32757557 | 2018 | Evidence reviews for pharmacological interventions for the prevention and treatment of PTSD in children: Post-traumatic stress disorder: Evidence review E. | Guideline evidence review, not a primary study |
| 35780794 | 2022 | Complex post-traumatic stress disorder. | Review; includes assessment and treatment in children and adolescents |
Interpretation guardrails¶
- Trauma exposure, post-traumatic symptoms, acute stress disorder, DSM-5 PTSD, ICD-11 PTSD and ICD-11 complex PTSD are not interchangeable populations.
- A mixed-anxiety or transdiagnostic estimate is labelled as such; only a source’s PTSD stratum can be treated as a PTSD effect.
- Comorbid depression is measured separately and cross-linked to the depression condition; it is not absorbed into PTSD.
- Waitlist, treatment-as-usual, attention control and active treatment answer different causal questions.
- Registration, statistical significance and diagnostic loss do not respectively prove completion, clinical importance or functional recovery.
- This page synthesizes research and does not provide individual medical advice.
Minimum extraction frame for studies on this topic¶
| Field | What must be retained | Why it changes interpretation |
|---|---|---|
| Diagnostic system | DSM version, ICD version, full/subthreshold | Case mix is not interchangeable |
| Diagnostic method | Structured interview, clinician judgment, self-report cutoff | Screening is not diagnosis |
| Index trauma | Type, timing, repetition, direct/indirect/occupational | Conditional risk and phenotype differ |
| Population | Civilian, veteran, refugee, child/adolescent, mixed | Transportability is empirical |
| Baseline severity | Mean, SD, range and exclusion threshold | Ceiling and floor effects alter change |
| CPTSD status | ITQ/ICD-11 definition and DSO score | Complexity cannot be inferred from trauma count |
| Comorbidity | Depression, GAD, SUD, pain, TBI measured separately | Shared symptoms can distort effects |
| Comparator | Waitlist, usual care, attention, active treatment | The estimand changes with comparator |
| Treatment dose | Sessions offered/attended, duration, homework | Assignment is not exposure |
| Outcome | Symptoms, diagnosis, response, function, sleep | Outcomes are not interchangeable |
| Time point | End point and prespecified follow-up windows | Acute benefit may not persist |
| Missing data | Denominator, reasons, imputation and estimand | Attrition can bias rank and magnitude |
| Adverse events | Definitions, ascertainment and arm-level counts | Absence of reporting is not absence of harm |
| Therapist/context | Training, fidelity, allegiance, setting | Delivery is part of the intervention |
| Funding/conflicts | Sponsor role and analytic independence | Especially material for proprietary packages |
Claims this page does not make¶
- It does not infer PTSD from trauma exposure alone.
- It does not treat a self-report cutoff as equivalent to a structured diagnosis.
- It does not convert a pooled anxiety-disorder effect into a PTSD effect.
- It does not convert a depression outcome in a comorbid sample into a PTSD outcome.
- It does not infer superiority from a statistically significant within-group change.
- It does not infer equivalence from a non-significant between-group test.
- It does not infer effectiveness from trial registration or mechanistic plausibility.
- It does not assume military, civilian, refugee and pediatric estimates transport unchanged.
- It does not average conflicting estimates that use different definitions.
- It does not treat lack of adverse-event reporting as evidence of safety.
Evidence-updating triggers¶
| Trigger | Required response |
|---|---|
| New diagnostic revision | Recalculate which populations prior estimates represent |
| New head-to-head RCT | Compare against active treatment, not only waitlist |
| New individual-participant synthesis | Revisit effect modifiers and transportability |
| Registry status change | Verify results and linked publication before changing conclusions |
| Guideline update | Separate evidence review from panel recommendation |
| Regulatory decision | Record decision date and source; do not infer from efficacy papers |
| Safety signal | Re-extract denominator, ascertainment and exposure time by arm |
| Contradictory replication | Display estimates side by side; do not average definitions |
Evidence updates should preserve the prior estimate and explain why the new study changes—or does not change—the inference.
Open questions¶
- Which TF-CBT components and caregiver configurations drive durable benefit? (Hoppen 2025, PMID 39630422)
- How should trials measure developmental harms, school functioning and family outcomes? (Hoppen 2025, PMID 39630422)
- Which early interventions prevent chronic PTSD without over-treating natural recovery? (Alisic 2014, PMID 24785767)
Related pages¶
- early-intervention-and-prevention — post-trauma timing.
- diagnosis-and-classification — age-sensitive assessment.
- red-flags-and-safety-concerns — safeguarding.
- patient-experience-and-advocacy — youth and family priorities.
References¶
- Hoppen TH, et al. Psychological Interventions for Pediatric Posttraumatic Stress Disorder: A Systematic Review and Network Meta-Analysis. JAMA Psychiatry. 2025;82(2):130-141. PMID 39630422
- Alisic E, et al. Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Br J Psychiatry. 2014;204:335-40. PMID 24785767
- Kessler RC, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048-60. PMID 7492257
- Connor DF, et al. An Update on Posttraumatic Stress Disorder in Children and Adolescents. Clin Pediatr (Phila). 2015;54(6):517-28. PMID 24990362
- Fairbank JA, et al. Epidemiology of child traumatic stress. Curr Psychiatry Rep. 2009;11(4):289-95. PMID 19635237
- Hidalgo RB, et al. Posttraumatic stress disorder: epidemiology and health-related considerations. J Clin Psychiatry. 2000;61 Suppl 7:5-13. PMID 10795604
- Mijaljica G, et al. [PTSD and Complex PTSD - Assessment, management and treatment]. Lakartidningen. 2024;121:23091. PMID 38225917
- Perry BD, et al. Posttraumatic stress disorders in children and adolescents. Curr Opin Pediatr. 1999;11(4):310-6. PMID 10439203
- Mansour H, et al. Prevalence of Post-Traumatic Stress Disorder (PTSD) in autistic children or young people (CYP) and adults: A systematic review and meta-analysis. Clin Psychol Rev. 2025;120:102621. PMID 40783299
- Donnelly CL, et al. Post-traumatic stress disorder in children and adolescents: epidemiology, diagnosis and treatment options. Paediatr Drugs. 2002;4(3):159-70. PMID 11909008
- Najjar F, et al. Post-traumatic stress disorder and its treatment in children and adolescents. Curr Psychiatry Rep. 2008;10(2):104-8. PMID 18474199
- Banzon T, et al. Trauma exposure and ICD-11 PTSD and CPTSD in a Greenlandic adolescent population. Eur J Psychotraumatol. 2024;15(1):2425242. PMID 39540207
- Woolgar F, et al. Systematic Review and Meta-analysis: Prevalence of Posttraumatic Stress Disorder in Trauma-Exposed Preschool-Aged Children. J Am Acad Child Adolesc Psychiatry. 2022;61(3):366-377. PMID 34242737
- Hsu CC, et al. Posttraumatic stress disorder among adolescent earthquake victims in Taiwan. J Am Acad Child Adolesc Psychiatry. 2002;41(7):875-81. PMID 12108814
- Hong C, et al. Systematic Review on Post-Traumatic Stress Disorder Among Survivors of the Wenchuan Earthquake. Trauma Violence Abuse. 2016;17(5):542-561. PMID 26028651
- Carr A Interventions for post-traumatic stress disorder in children and adolescents. Pediatr Rehabil. 2004;7(4):231-44. PMID 15513767
- Ganz D, et al. Suicidal behavior in adolescents with post-traumatic stress disorder. Minerva Pediatr. 2010;62(4):363-70. PMID 20940670
- Wamser-Nanney R Child-reported posttraumatic stress symptoms and attrition from therapy. Child Abuse Negl. 2021;121:105266. PMID 34479132
- Beaudoin W, et al. Prevalence of post-traumatic stress disorder in caregivers of pediatric neurosurgical patients. Childs Nerv Syst. 2021;37(3):959-967. PMID 33111174
- Strawn JR, et al. Psychopharmacologic treatment of posttraumatic stress disorder in children and adolescents: a review. J Clin Psychiatry. 2010;71(7):932-41. PMID 20441729
- Stoddard FJ, et al. Posttraumatic Stress Disorder Diagnosis in Young Children With Burns. J Burn Care Res. 2017;38(1):e343-e351. PMID 27359192
- Mavranezouli I, et al. Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychol Med. 2020;50(4):542-555. PMID 32063234
- Lewis C, et al. Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. Eur J Psychotraumatol. 2020;11(1):1729633. PMID 32284821
- Cusack K, et al. Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clin Psychol Rev. 2016;43:128-41. PMID 26574151
- Bryant RA Early intervention for post-traumatic stress disorder. Early Interv Psychiatry. 2007;1(1):19-26. PMID 21352105
- Maercker A, et al. Complex post-traumatic stress disorder. Lancet. 2022;400(10345):60-72. PMID 35780794
- Simmons C, et al. A meta-analysis of dropout from evidence-based psychological treatment for post-traumatic stress disorder (PTSD) in children and young people. Eur J Psychotraumatol. 2021;12(1):1947570. PMID 34377359
- Stoddard FJ Jr, et al. A randomized controlled trial of sertraline to prevent posttraumatic stress disorder in burned children. J Child Adolesc Psychopharmacol. 2011;21(5):469-77. PMID 22040192
- National Guideline Alliance (UK). Evidence reviews for pharmacological interventions for the prevention and treatment of PTSD in children: Post-traumatic stress disorder: Evidence review E. London: NICE; 2018. PMID 32757557