Paeds · mental-behavioural-and-psychosomatic
Post-traumatic stress disorder and trauma responses
Also known as Paediatric PTSD · Childhood post-traumatic stress disorder · Acute stress disorder in children · Complex trauma and developmental trauma · Trauma-focused care
Fellowship guide to post-traumatic stress disorder and the wider trauma-response spectrum in children and adolescents: the reaction-to-disorder continuum, DSM-5-TR and ICD-11 structure, preschool subtype, trauma-informed assessment, risk factors that predict persistence, stepped care with trauma-focused CBT first-line, watchful waiting, no single-session debriefing, and a closed safeguarding and disposition plan across ANZ, UK, US and Canada.
On this page
Study tools
Your progress
Saved on this device.
Practise this topic
Target exams
Red flags
- Active suicidal ideation or self-harm disclosed during a trauma assessment
- Ongoing abuse, domestic violence or an unsafe placement as the source of trauma
- Acute dissociation, frank psychosis, or medical mimics such as post-concussion syndrome or seizures mislabelled as behaviour
- Disclosure of sexual abuse or non-accidental injury requiring mandatory reporting today
- Starting an SSRI as first-line treatment for prepubertal PTSD
- Delivering single-session psychological debriefing as routine 'prevention'
- Beginning exposure-based trauma work before the child is safe and stabilised
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Behavioural and mental health
- Child protection and advocacy
- Learning goal 15 essential general paediatrics
- Adolescent medicine and mental health
- Clinical Applications
- Long Cases
- Short Cases
- Communication
- Mental health and emotional wellbeing
- Safeguarding
- Patient management
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- History
- Clinical
- General Pediatrics Content Outline — Domain 11: Mental and Behavioral Health
- General Pediatrics Content Outline — Domain 7: Child Abuse and Neglect
- General Pediatrics EPA: Assess and manage common behavioral and mental health concerns
- Patient Care 1: History
- Patient Care 4: Clinical Reasoning
- Patient Care 5: Patient Management
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Systems-Based Practice 3: System Navigation for Patient Centered Care – Coordination of Care
- Medical Expert
- Communicator
- Collaborator
- Health Advocate
- Pediatrics: Foundations EPA — Assessing and managing mental health and trauma presentations
Overview & Definition
A parent brings a seven-year-old who, three weeks after a serious car crash, will not get into a car, wakes screaming, and has stopped concentrating at school. The question is not "does he have PTSD?" but "is this an expected reaction still within the recovery window, or a disorder that has taken hold?" Most frightened children settle with time and support; the minority who do not are the ones your assessment must find. [7] [8]
A trauma response is the full spectrum of psychological reactions to an event involving actual or threatened death, serious injury, or sexual violence — whether experienced directly, witnessed, learned about, or encountered repeatedly through aversive details. It runs from a brief, expected acute stress reaction in the first hours and days, through Acute Stress Disorder (three days to one month), to post-traumatic stress disorder (PTSD) when symptoms persist beyond one month and cause functional impairment. [12]
In children the picture is developmental. A preschooler does not narrate a "flashback"; they re-enact the event in repetitive play, develop new fears, regress, or cling. An adolescent may look sullen and irritable and self-medicate with alcohol rather than report intrusion. Because children express trauma through behaviour and the body far more than through verbal report, PTSD is easily missed — or wrongly labelled as ADHD, oppositional behaviour, or "just naughty". [2] [12]
Deep technique for suicide risk lives on the linked self-harm leaf, attachment-specific disorders on the attachment leaf, and acute crisis disposition on the emergency mental-health leaf. This page owns the trauma-response spine from recognition to closed-loop care. [1] [11]
References13ShowHide
- [1]Cohen JA, Deblinger E, Mannarino AP, Steer RA A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. J Am Acad Child Adolesc Psychiatry, 2004.PMID 15187799
- [2]Scheeringa MS, Weems CF, Cohen JA, Amaya-Jackson L, Guthrie D Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: a randomized clinical trial. J Child Psychol Psychiatry, 2011.PMID 21155776
- [3]Salloum A, Wang W, Robst J, et al Stepped care versus standard trauma-focused cognitive behavioral therapy for young children. J Child Psychol Psychiatry, 2016.PMID 26443493
- [4]Ngo V, Langley A, Kataoka SH, Nadeem E, Escudero P, Stein BD Providing evidence-based practice to ethnically diverse youths: examples from the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program. J Am Acad Child Adolesc Psychiatry, 2008.PMID 18645419
- [5]Steinberg AM, Brymer MJ, Kim S, et al Psychometric properties of the UCLA PTSD reaction index: part I. J Trauma Stress, 2013.PMID 23417873
- [6]Foa EB, Asnaani A, Zang Y, et al. Psychometrics of the Child PTSD Symptom Scale for DSM-5 for Trauma-Exposed Children and Adolescents. J Clin Child Adolesc Psychol, 2018.PMID 28820616
- [7]Alisic E, Zalta AK, van Wesel F, et al Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Br J Psychiatry, 2014.PMID 24785767
- [8]Trickey D, Siddaway AP, Meiser-Stedman R, Serpell L, Field AP A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clin Psychol Rev, 2012.PMID 22245560
- [9]Catani C, Schauer E, Neuner F Beyond individual war trauma: domestic violence against children in Afghanistan and Sri Lanka. J Marital Fam Ther, 2008.PMID 18412824
- [10]Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev, 2013.PMID 24338345
- [11]Mavranezouli I, Megnin-Viggars O, Trickey D, et al Cost-effectiveness of psychological interventions for children and young people with post-traumatic stress disorder. J Child Psychol Psychiatry, 2020.PMID 31654414
- [12]Cohen JA, Deblinger E, Mannarino AP Trauma-Focused Cognitive Behavioral Therapy for Children and Parents. Child Adolesc Psychiatr Clin N Am, 2026.PMID 41934973
- [13]Melhem NM, Porta G, Walker Payne M, Brent DA Identifying prolonged grief reactions in children: dimensional and diagnostic approaches. J Am Acad Child Adolesc Psychiatry, 2013.PMID 23702449