This resource is part of our Treatment Navigator, a comprehensive guide to common behavioral/mental health diagnoses and the evidence based practices (EBPs) that help these conditions.

Overview

Posttraumatic Stress Disorder (PTSD) in children and adolescents arises following exposure to one or more traumatic events such as abuse, violence, natural disaster, or loss. Symptoms may include intrusive memories or play reenactment, avoidance of reminders, negative changes in mood or behavior, and heightened arousal or irritability. Unlike adults, children may express distress through play, regression, or behavioral changes rather than verbal description of fear or trauma. The primary goals of treatment are to help the child regain a sense of safety, reduce trauma-related distress, and support caregivers in fostering stability and emotional connection.

Indicated Evidence-Based Practices (EBPs)

• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) – first-line, structured approach integrating exposure, cognitive processing, and caregiver involvement
• Child and Family Traumatic Stress Intervention (CFTSI) – brief early intervention designed to reduce posttraumatic symptoms soon after exposure
• Prolonged Exposure for Adolescents (PE-A) – adaptation of adult PE emphasizing developmentally appropriate exposure and coping skills
• Cognitive Behavioral Intervention for Trauma in Schools (CBITS) – group-based CBT protocol delivered in school settings
• Trauma Systems Therapy (TST) – integrates individual treatment with systemic and environmental stabilization
• Eye Movement Desensitization and Reprocessing (EMDR) for children – incorporates play and parent participation for trauma memory reprocessing

When to Choose What

TF-CBT is the most extensively researched and broadly applicable EBP for children and adolescents with trauma exposure, effective across trauma types and settings.

CFTSI is ideal for early intervention—typically within weeks of trauma exposure—when full PTSD symptoms may not yet have developed.

PE-A is suited for older adolescents who can tolerate detailed exposure and wish to directly process traumatic memories.

CBITS is effective for school-based populations where access to individual therapy is limited.

EMDR and TST are appropriate for children with complex trauma histories or limited verbal expression.

For cases involving ongoing safety issues (e.g., current abuse or unstable home), prioritize stabilization and caregiver involvement before trauma exposure work.

Core Components of Treatment

• Psychoeducation for the child and caregivers on trauma responses and recovery
• Emotional regulation and relaxation skills for self-soothing and distress tolerance
• Gradual exposure or trauma narrative development (verbal, written, or play-based)
• Cognitive processing to address guilt, shame, and distorted self-blame
• Parental involvement to reinforce coping skills and reduce avoidance
• Safety planning and restoration of routines, social engagement, and developmental activities
• Termination phase focused on resilience building and relapse prevention

Measures and Monitoring

Screening and diagnostic tools

• UCLA PTSD Reaction Index for DSM-5: clinician- or self-report for children and adolescents; gold standard for trauma symptom assessment
• Child and Adolescent Trauma Screen (CATS): 20-item self-report and caregiver versions for DSM-5 PTSD symptoms
• CPSS-5 (Child PTSD Symptom Scale for DSM-5): brief self-report measure of PTSD symptom severity
• Trauma History Questionnaire – Child or Adolescent version (THQ): identifies exposure types
• K-SADS (Schedule for Affective Disorders and Schizophrenia for School-Age Children) PTSD module for diagnostic evaluation
• CATS-2 or CATS Caregiver Report when collateral input is needed for younger children

Monitoring and outcome tools

• CPSS-5 or CATS every 3–4 sessions to track symptom reduction
• SCARED (Screen for Child Anxiety Related Emotional Disorders) for comorbid anxiety
• PHQ-A (Adolescent Patient Health Questionnaire) when depressive symptoms are present
• SRS (Session Rating Scale) or CORS (Child Outcome Rating Scale) to assess therapeutic alliance and engagement
• Functional metrics such as school attendance, peer interaction, and caregiver stress to evaluate recovery progress

Adaptations and Special Considerations

Developmental stage: Use play, art, and storytelling for younger children; structured cognitive interventions for adolescents. Adjust language to be concrete and emotionally accessible.

Caregiver role: Active caregiver participation is essential in TF-CBT and other trauma models. Include caregiver sessions to address guilt, stress, and support for co-regulation.

Culture and context: Explore cultural meanings of trauma, expressions of distress, and family beliefs about help-seeking and disclosure.

Complex trauma: When multiple or chronic traumas are present, begin with a stabilization phase emphasizing safety, emotion regulation, and predictable routines before trauma processing.

Telehealth: Use creative adaptations such as digital storyboards, interactive grounding tools, and caregiver-assisted exercises to maintain engagement remotely.

School collaboration: Coordinate with school counselors or trauma-informed teams when academic or social functioning is affected.

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).

Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents: Treatment Applications. Guilford Press.

Berkowitz, S. J., Stover, C. S., & Marans, S. R. (2011). The Child and Family Traumatic Stress Intervention: Secondary prevention for youth at risk of developing PTSD. Journal of Child Psychology and Psychiatry, 52(6), 676–685.

Stein, B. D., Jaycox, L. H., Kataoka, S. H., et al. (2003). A mental health intervention for schoolchildren exposed to violence: A randomized controlled trial. JAMA, 290(5), 603–611.

Foa, E. B., McLean, C. P., Capaldi, S., & Rosenfield, D. (2013). Prolonged Exposure Therapy for Adolescents with PTSD: Emotional Processing of Traumatic Experiences. Journal of Consulting and Clinical Psychology, 81(5), 829–841.

Cloitre, M., Cohen, L. R., & Koenen, K. C. (2006). Treating Survivors of Childhood Abuse: Psychotherapy for the Interrupted Life. Guilford Press.

Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.