PTSD in Children and Teens: What Parents Can Notice and Do

A child may show the effects of trauma through play, sleep, anger, or school problems before they can explain what is wrong. PTSD is one possible cause. Those changes can also have other causes, so the next step is an age-appropriate assessment, not a home diagnosis.

Help can start now. A child does not have to meet every PTSD requirement, describe the event in detail, or wait a month before getting support. If abuse or another danger is continuing, safety needs belong in the first conversation. Treatment and protection may need to move forward together.1

What matters most

• Children often show trauma through play, sleep, anger, or school problems before they can explain it. The next step is an age-appropriate assessment, not a home diagnosis.
• Help can start now. A child does not need to meet every PTSD requirement or wait a month. If danger is continuing, safety belongs in the first conversation.
• Listen without interviewing. Do not promise secrecy; in California, clinicians are mandated reporters when they reasonably suspect abuse or neglect.
• Ask which named therapy is offered. Trauma-focused cognitive behavioral therapies have the strongest evidence, and TF-CBT, CPP, CBITS, PE-A, and EMDR each have specific trials.
• No medication is FDA approved for pediatric PTSD, and NICE recommends against drug treatment for PTSD under 18. Medicine may still be considered for a separate condition.

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Look for a change in the child’s life

A young child might cling at bedtime or repeat a frightening theme in play. An older child may avoid a room, complain of stomach pain, or seem unable to focus. A teen may withdraw, become more irritable, or use alcohol to cope. None of these signs proves PTSD. What matters is the pattern, when it began, what it disrupts, and what else could explain it.23

This is an observation guide, not a checklist to score. A child who seems quiet may still be struggling. A child who has a hard week may also recover with ordinary support. Neither a calm appearance nor an intense reaction settles the diagnosis.

PTSD requires a qualifying traumatic exposure and a particular pattern of symptoms and impairment. For a PTSD diagnosis, symptoms must last longer than one month. The DSM framework has a developmentally adapted approach for children age 6 and younger. It allows clinicians to recognize distress that a small child cannot describe like an adult. It does not mean all difficult childhood experiences count as PTSD.24

Listen without turning home into an interview

If a child starts talking, listen. Let them use their own words. You can say, as an example, “I’m glad you told me. I want to help you be safe.” Avoid repeated questioning, guesses about what happened, or pressure to agree with an adult’s version. Do not promise to keep information secret when someone may need to act to protect them.

Explain that some information may need to be shared with people who can help. In California, mandated reporters have duties when they know or reasonably suspect child abuse or neglect. That process differs from routine treatment privacy. A clinician can explain the limits before asking sensitive questions.5

A teen may need private time with a clinician as part of care. Ask how the clinician handles privacy, caregiver involvement, and urgent safety information. Do not assume every part of the visit will be shared, or that everything can stay private in every circumstance.

A safe caregiver can help with predictable meals, bedtime, school contact, and getting to appointments. These are supports, not a guarantee against PTSD. Children should not have to reassure adults that the family is fine. They did not cause an adult’s symptoms and are not responsible for keeping that adult stable.

Caregivers can need support too. Ask the therapist which changes protect your child and which may keep avoidance going; make any changes together, with attention to real safety.

What a good assessment includes

An assessment should consider the child’s development, symptoms, health, family circumstances, and current safety. The clinician may speak with the child and a safe caregiver separately, then bring information together. School observations can help when sharing them is appropriate and authorized. Different accounts need exploration; they do not automatically mean someone is lying.

Trauma and ADHD can both involve poor concentration, restlessness, or impulsive behavior. They can also occur together.3 Timing helps: did the attention problem predate the event, or did it start afterward? Does it appear across settings, or mainly around reminders? Those clues guide assessment but do not decide it. Sleep problems, learning needs, depression, anxiety, and medical issues also deserve attention.

Questionnaires can organize symptoms and help track progress. They cannot replace the interview. Different tools have different ages and versions:

• The original Child and Adolescent Trauma Screen has caregiver versions for younger children and self-report options for older children. The CATS-2 validation study involved ages 7 to 17; its findings should not be assigned to preschool children.
• The UCLA PTSD Reaction Index has age-specific child and caregiver formats, including a caregiver interview for young children.
• The Child PTSD Symptom Scale for DSM-5 was designed for ages 8 to 18.

Access rules differ. CATS and CATS-2 are freely available, the UCLA measure requires a license, and CPSS-5 has version-specific access terms.6 Ask which version is being used, why it fits the child’s age, and how the result will inform care.789

Which therapy is being offered?

The name matters. “We work with trauma” does not tell you whether a clinician offers a treatment studied for children with PTSD.

A large review published in 2025 combined 70 randomized trials involving young people with full or partial PTSD. Trauma-focused cognitive behavioral therapies had the strongest overall evidence across follow-up periods. EMDR also improved symptoms compared with waiting or similar passive controls. The evidence was less complete for its longer-term results. These are findings across groups, not a ranking that can choose one child’s therapist.10

Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT, is a named treatment that often involves both a child and a safe caregiver. It teaches ways to handle distress, works on trauma-related thoughts, and helps the child process memories with support. Caregiver work can help adults respond without blame or pressure. In a trial of children ages 8 to 14 with sexual abuse-related symptoms, TF-CBT improved several child and caregiver outcomes more than child-centered therapy. That study does not represent every trauma type or family situation.11

Child-Parent Psychotherapy, or CPP, works through the relationship between a young child and a safe caregiver. A trial involving preschool children exposed to partner violence found benefits over case management and community referrals. Treatment lasted about a year. The study’s safety and family eligibility rules matter: it does not show that joint sessions with an abusive caregiver are safe.12

CBITS, a school-based cognitive behavioral program, was tested with sixth graders exposed to violence in two Los Angeles schools. It reduced PTSD symptoms compared with delayed treatment. A school offering ordinary counseling is not necessarily offering CBITS, and this one trial does not establish the same result for every age or school.13

Prolonged Exposure for Adolescents, or PE-A, helps a teen work with trauma memories and safe situations they avoid. A trial of adolescent girls with sexual abuse-related PTSD favored PE-A over supportive counseling. It was clinician-delivered treatment, not advice for parents to create exposure exercises at home.14

EMDR uses a structured therapy process in which the young person focuses on the memory in short sets while following guided eye movements or another form of alternating stimulation. A trial in young people after a single event found benefit compared with waiting. It did not prove EMDR superior to the active writing-based treatment tested alongside it.15

Ask how the clinician chooses among these approaches. The answer should account for age, safety, the young person’s wishes, caregiver involvement, and the clinician’s training.

Medicine has a different role

No medication was identified as FDA approved specifically for pediatric PTSD through September 5, 2026. That does not mean no medicine is approved for children. For example, sertraline has a pediatric OCD indication, which is different from PTSD. The adult PTSD approval for paroxetine also does not extend to pediatric PTSD.1617

A placebo-controlled sertraline trial in children and adolescents did not show a PTSD symptom advantage. A much smaller study of 24 girls ages 10 to 17 that added sertraline to TF-CBT also found little evidence of added PTSD benefit. These results support caution, not the claim that medication can never help a young person who also has depression, anxiety, or another condition.1819

Clinicians sometimes consider medicines such as prazosin, clonidine, or guanfacine off-label for trauma-related nightmares. Pediatric evidence includes small, uncontrolled or retrospective studies. One chart review reported that most children improved on either type of medicine, but its design, with no untreated comparison group and no standard nightmare scale, could not establish that either medicine caused the improvement or that they were equally effective. These medicines also lower blood pressure, so low blood pressure and other adverse effects matter.20

NICE recommends against medication to prevent or treat PTSD in people under 18. This is a guideline recommendation, distinct from FDA approval and from treating a separate diagnosis. If a medicine is proposed, ask what problem it targets, what evidence supports that use at this age, and how benefit and harm will be checked. Do not change a child’s prescription without the prescriber.1

Getting help in California

Start with the child’s clinician and, when school is affected, the school counselor or psychologist. Ask about an evaluation and the supports the school can provide. Ask how the school evaluates needs and decides which supports to offer. School counseling may need to be paired with outside treatment. If school itself is unsafe, make that part of any support or return plan.21

Medi-Cal for Kids & Teens covers screening and treatment for physical and mental health needs for enrolled people under 21. This is California’s name for the federal EPSDT benefit.22 The age boundary is a coverage rule, not a finding that all therapies studied in teenagers work identically through age 20. Ask the plan about care, language support, and transport. Coverage does not guarantee an immediate appointment; a share-of-cost arrangement can also affect what a member pays.23

Describe urgent safety concerns when asking for help. If a child is in immediate danger or has a medical emergency, call 911. In the United States, call or text 988 for a suicide or mental health crisis, or use the Lifeline’s online chat. These services do not replace needed child protection or ongoing treatment.24

Frequently asked questions

How do I know if it is PTSD or just a hard week?

A calm appearance does not settle it, and neither does an intense reaction. What matters is the pattern, when it began, what it disrupts, and what else could explain it. An assessment sorts this out.23

Should I ask my child to tell me everything?

No. Listen if they talk, use their words, and avoid repeated questioning or guesses. A professional can guide what information is needed.5

Could it be ADHD instead?

Both can involve poor concentration and restlessness, and they can occur together. Timing and settings help the clinician sort it out, but do not decide it.3

Is there a medicine for PTSD in children?

None is FDA approved specifically for pediatric PTSD, and a placebo-controlled sertraline trial did not show a PTSD advantage. Medicine may be considered for depression, anxiety, or another condition.17181

Bring observations, not a score

Before an appointment, choose a few details to share:

1. What changed, and about when did it start?
2. What is happening with sleep, school, friendships, and ordinary activities?
3. What does the child say is hardest?
4. Is there ongoing danger or a new medical concern?
5. Which named treatment might fit, and how will we know it is helping?

You do not need a complete history to make the first call. Avoid collecting graphic details or asking the child to rehearse a story. The professional can guide what information is needed.

This week, choose one person to contact: the child’s clinician, the school support team, or the health plan. Bring one specific change you have noticed and ask for the next assessment step.

This article is for education. It does not replace an individual assessment or treatment plan. Talk with your clinician before changing medication or treatment. Evidence, contact numbers, and U.S. guidance were checked through September 6, 2026.

Related reading on NP FADY

• Your ACE Score: What It Predicts, and What It Cannot
• Abusive Relationships and PTSD: Safety and Treatment
• The Many Faces of PTSD: Why It Almost Never Looks Like the Movies
• Parenting essays
• ADHD essays

References

1. NICE. Post-traumatic stress disorder. NG116. 2018. Sections 1.6.6–1.6.14. https://www.ncbi.nlm.nih.gov/books/NBK542453/

2. VA National Center for PTSD. PTSD for children 6 years and younger. https://www.ptsd.va.gov/professional/treat/specific/ptsd_child_under6.asp

3. VA National Center for PTSD. PTSD in children and adolescents. https://www.ptsd.va.gov/professional/treat/specific/ptsd_child_teens.asp

4. VA National Center for PTSD. PTSD and DSM-5. https://www.ptsd.va.gov/professional/treat/essentials/dsm5_ptsd.asp

5. California Legislature. Penal Code §11166. Effective July 2, 2024 amendment; accessed September 5, 2026. https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=11166.&lawCode=PEN

6. ISTSS. Child and Adolescent Trauma Screen: original versions and access terms. https://istss.org/clinical-resources/child-adolescent-trauma-assessments/child-and-adolescent-trauma-screen/

7. Sachser C, Berliner L, Risch E, et al. The Child and Adolescent Trauma Screen 2 (CATS-2): Validation of an instrument to measure DSM-5 and ICD-11 PTSD and complex PTSD in children and adolescents. Eur J Psychotraumatol. 2022;13(2):2105580. doi:10.1080/20008066.2022.2105580. https://www.uni-ulm.de/fileadmin/website_uni_ulm/med.cibits/Validierungsstudie_zum_CATS-2_Sachser_et_al._2022.pdf

8. UCLA PTSD Reaction Index. Frequently asked questions. https://www.reactionindex.com/faq/

9. ISTSS. Child PTSD Symptom Scale for DSM-5. https://istss.org/clinical-resources/child-adolescent-trauma-assessments/child-and-adolescent-trauma-screen/child-ptsd-symptom-scale-for-dsm-5/

10. Hoppen TH, Wessarges L, Jehn M, et al. Psychological interventions for pediatric posttraumatic stress disorder: A systematic review and network meta-analysis. JAMA Psychiatry. 2025;82:130–141. doi:10.1001/jamapsychiatry.2024.3908. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2827463

11. 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;43:393–402. doi:10.1097/00004583-200404000-00005. https://www.researchwithrowan.com/en/publications/a-multisite-randomized-controlled-trial-for-children-with-sexual-/

12. Lieberman AF, Van Horn P, Ghosh Ippen C. Toward evidence-based treatment: Child-parent psychotherapy with preschoolers exposed to marital violence. J Am Acad Child Adolesc Psychiatry. 2005;44:1241–1248. doi:10.1097/01.chi.0000181047.59702.58. https://childparentpsychotherapy.com/wp-content/uploads/2016/11/lieberman-vanhorn-ghosh-2005.pdf

13. Stein BD, Jaycox LH, Kataoka SH, et al. A mental health intervention for schoolchildren exposed to violence: A randomized controlled trial. JAMA. 2003;290:603–611. doi:10.1001/jama.290.5.603. https://jamanetwork.com/journals/jama/fullarticle/197033

14. Foa EB, McLean CP, Capaldi S, Rosenfield D. Prolonged exposure vs supportive counseling for sexual abuse-related PTSD in adolescent girls: A randomized clinical trial. JAMA. 2013;310:2650–2657. doi:10.1001/jama.2013.282829. https://jamanetwork.com/journals/jama/fullarticle/1793800

15. de Roos C, van der Oord S, Zijlstra B, et al. Comparison of eye movement desensitization and reprocessing therapy, cognitive behavioral writing therapy, and wait-list in pediatric posttraumatic stress disorder following single-incident trauma: A multicenter randomized clinical trial. J Child Psychol Psychiatry. 2017;58:1219–1228. doi:10.1111/jcpp.12768. https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12768

16. DailyMed. PAXIL (paroxetine) prescribing information, indications and pediatric use. Revised November 2024. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=ef3b5cbe-f9e1-c1ac-79da-cfe14e3a7e7e&type=display

17. DailyMed. Sertraline prescribing information, pediatric use and indications. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=fda754f6-d0f3-4dce-a17a-927d64f912f7

18. Robb AS, Cueva JE, Sporn J, Yang R, Vanderburg DG. Sertraline treatment of children and adolescents with posttraumatic stress disorder: A double-blind, placebo-controlled trial. J Child Adolesc Psychopharmacol. 2010;20(6):463–471. doi:10.1089/cap.2009.0115. PMID:21186964. https://journals.sagepub.com/doi/abs/10.1089/cap.2009.0115

19. Cohen JA, Mannarino AP, Perel JM, Staron V. A pilot randomized controlled trial of combined trauma-focused CBT and sertraline for childhood PTSD symptoms. J Am Acad Child Adolesc Psychiatry. 2007;46:811–819. doi:10.1097/chi.0b013e3180547105. https://pubmed.ncbi.nlm.nih.gov/17581445/

20. Khalid S, Mitchell S, Al-Mateen C. Comparison of alpha-2 agonist versus alpha-1 antagonist for post-traumatic stress disorder-associated nightmares in pediatric patients. Ment Health Clin. 2024;14(3):199–203. doi:10.9740/mhc.2024.06.199. https://pmc.ncbi.nlm.nih.gov/articles/PMC11147653/

21. California Department of Education. Mental Health Services Program Overview. Reviewed July 17, 2026. https://www.cde.ca.gov/ls/mh/mentalhealth.asp

22. DHCS. Medi-Cal for Kids & Teens: Provider information. https://www.dhcs.ca.gov/services/medi-cal-resources/medi-cal-for-kids-teens/provider-information/

23. DHCS. Medi-Cal for Kids & Teens: Member information. https://www.dhcs.ca.gov/services/medi-cal-resources/medi-cal-for-kids-teens/member-information/

24. 988 Suicide & Crisis Lifeline. https://988lifeline.org/

If you or someone you know is in crisis

• Call 911 or go to your nearest emergency room for any life-threatening emergency.
• 988 Suicide & Crisis Lifeline — call or text 988, available 24/7. En español: marque 988 y oprima 2. Veterans: 988 and press 1, or text 838255.
• Crisis Text Line — text HOME to 741741.
• The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
• National Sexual Assault Hotline (RAINN) — call 1-800-656-HOPE (4673) or text HOPE to 64673; free, confidential, 24/7. Online chat at RAINN.org/hotline.
• National Domestic Violence Hotline — call 1-800-799-SAFE (7233) or text START to 88788; 24/7, help in 200+ languages. Online chat at TheHotline.org. If your phone or computer may be monitored, calling from a safer device is an option.
• Riverside County — Inland SoCal Crisis Helpline 951-686-HELP (4357), 24/7 (Inland SoCal United Way / 211+, in partnership with RUHS-BH); Community Access, Referral, Evaluation and Support (CARES) Line 800-499-3008, 24/7.
• San Bernardino County — Access Unit (Behavioral Health Helpline) 888-743-1478, 24/7; Mobile Crisis/CCRT 800-398-0018 (24/7, all ages) or text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated walk-in adolescent psychiatric ER (ages 13–17).
• Children under 13 — call 911 for immediate danger, contact your county's mobile crisis team (they respond to all ages), or go to the nearest pediatric emergency room.
• California Peer-Run Warm Line (non-crisis — someone to talk to) — call or text 1-855-600-WARM (9276); daytime and evening hours, not a 24/7 line.
• NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.