Diagnostic Criteria for PTSD in Children

DSM-5 Guidelines

Army veteran Brad Schwarz hangs out with his three-year-old daughter Arabella
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The 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) did not have specific criteria for diagnosing post-traumatic stress disorder (PTSD) in children, and many of the DSM-IV PTSD criteria were not age appropriate for children. As a result, it was difficult, if not impossible, to accurately diagnose PTSD in children.

Criteria in DSM-5 for Diagnosing PTSD in Children

The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) now includes specific guidelines for diagnosing PTSD in children under the age of 6.

Listed below are the criteria for PTSD in children.

A. Children under the age 6 have been exposed to an event involving real or threatened death, serious injury, or sexual violence in at least one of the following ways:

  1. The child directly experienced the event.
  2. The child witnessed the event, but this does not include events that were seen on television, in movies or some other form of media.
  3. The child learned about a traumatic event that happened to a caregiver.

B. The presence of at least one of the following intrusive symptoms that are associated with the traumatic event and began after the event occurred:

  1. Recurring, spontaneous, and intrusive upsetting memories of the traumatic event.
  2. Recurring and upsetting dreams about the event.
  3. Flashbacks or some other dissociative response where the child feels or acts as if the event were happening again.
  4. Strong and long-lasting emotional distress after being reminded of the event or after encountering trauma-related cues.
  1. Strong physical reactions, like increased heart rate or sweating, to trauma-related reminders.

C. The child exhibits at least one of the following avoidance symptoms or changes in his or her thoughts and mood. These symptoms must begin or worsen after the experience of the traumatic event.

  1. Avoidance of or the attempted avoidance of activities, places, or reminders that bring up thoughts about the traumatic event.
  1. Avoidance of or the attempted avoidance of people, conversations, or interpersonal situations that serve as reminders of the traumatic event.
  2. More frequent negative emotional states, such as fear, shame, or sadness.
  3. Increased lack of interest in activities that used to be meaningful or pleasurable.
  4. Social withdrawal.
  5. Long-standing reduction in the expression of positive emotions.

D. The child experiences at least one of the below changes in his or her arousal or reactivity, and these changes began or worsened after the traumatic event:

  1. Increased irritable behavior or angry outbursts. This may include extreme temper tantrums.
  2. Hypervigilance, which consists of being on guard all the time and unable to relax.
  3. Exaggerated startle response.
  4. Difficulties concentrating.
  5. Problems with sleeping.

In addition to the above criteria, these symptoms need to have lasted at least one month and result in considerable distress or difficulties in relationships or with school behavior. The symptoms also cannot be better attributed to ingestion of a substance or to some other medical condition.

Why the New DSM-5 Criteria are Important

The new PTSD criteria for young children can help improve our understanding of post-traumatic responses in children, potentially paving the way for new treatments for young children who have been exposed to a traumatic event. To learn more about these criteria, visit DSM5.org, hosted by the American Psychiatric Association.


American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Washington, DC: Author.

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