Post-traumatic stress disorder in a national sample of preadolescent children 9 to 10 years old: Prevalence, correlates, clinical sequelae, and treatment utilization

The study addresses the limited epidemiological understanding of PTSD in preadolescent children (ages 9–10) in the United States. Prior national studies reported lifetime PTSD prevalence of approximately 7–8% in adults and 4.7% in adolescents, but data for preadolescents have been sparse, often based on small, regionally bound samples that limit generalizability and preclude detailed analyses of correlates and treatment. The purpose of this study is to provide a comprehensive, population-based estimate of lifetime and current PTSD prevalence in preadolescents; identify sociodemographic and psychiatric correlates; evaluate whether past PTSD predicts subsequent onset of other psychiatric disorders; quantify lifetime psychiatric treatment utilization among children with PTSD; and examine the association between PTSD and service use. Understanding PTSD at this developmental stage is critical for informing prevention and early intervention strategies and clarifying developmental trajectories of risk.

Existing literature shows lifetime PTSD prevalence estimates in U.S. adults around 7.3–7.8% and 4.7% in adolescents. In preadolescents, prior work has often involved small samples, yielding unstable estimates and limited generalizability; a notable larger regional study reported a very low lifetime prevalence (0.1%) but lacked national representativeness and had too few cases to examine correlates, comorbidity, or treatment. Research in adolescents and young adults indicates that PTSD is associated with subsequent comorbid psychopathology, but clinical sequelae among preadolescents remain unclear. Sociodemographic factors such as minority sexual orientation and lower socioeconomic status have been associated with elevated PTSD risk in older populations, and sex differences (higher prevalence among females) typically emerge in adolescence and adulthood, suggesting potential developmental shifts in risk. These gaps motivated a national, population-based investigation in preadolescents.

Design and data source: Cross-sectional analyses using the Adolescent Brain and Cognitive Development (ABCD) Study, release 5.0, a population-based U.S. cohort. Participants: Unweighted n = 11,875 children recruited from 21 U.S. catchment sites. Recruitment and sampling procedures were designed to approximate national sociodemographics, with certain groups oversampled; propensity (inverse probability) weights were applied to generate population-representative estimates. Children were assessed at ages 9–10 years (M = 9.50, SE = 0.021). Measures: Sociodemographics (parent-reported): child sex; ethnicity (Hispanic vs non-Hispanic); race (Black, White, Multiracial, Other [American Indian/Alaska Native, Asian, and other combined]); parental education (<HS, HS/GED, some college, college graduate); parental marital status (married vs other). Child-reported sexual orientation (gay/lesbian/bisexual or questioning vs heterosexual/did not understand); responses of “yes” and “maybe” classified as sexual minority/questioning. Family economic insecurity operationalized as indicators of low SES, including perceived financial strain and receipt of financial/food assistance. Psychiatric diagnoses: Lifetime and current (past 2 weeks) diagnoses using the youth K-SADS-PL for DSM-5, with separate child and parent reports; diagnoses required concordant endorsement from both informants. Disorders assessed included PTSD, mood disorders (including major depressive disorder), generalized anxiety disorder, social anxiety disorder, specific phobia, separation anxiety, conduct disorder, oppositional defiant disorder, obsessive–compulsive disorder, eating disorders, and psychosis. Trauma exposure: Parents endorsed standardized traumatic events; a trauma count (“trauma prompt”) variable was computed. Treatment utilization: Parents reported any lifetime mental health treatment (e.g., psychotherapy, medication) across modalities/settings. Statistical analysis: Conducted in SPSS v25 with propensity weights. Prevalence: Cross-tabulations estimated current (2-week) and lifetime PTSD prevalence overall and within sociodemographic/diagnostic strata. Correlates of PTSD: Univariate logistic regressions examined associations of individual sociodemographic factors with lifetime PTSD, followed by a multivariate model including all sociodemographics and trauma count. Psychiatric diagnostic correlates: Univariate logistic regressions with each lifetime diagnosis predicting lifetime PTSD; then a multivariate model including all diagnoses simultaneously, covarying for child sex, sexual orientation, ethnicity, race, family economic insecurity, and trauma count. A separate model evaluated number of lifetime psychiatric disorders (excluding PTSD) predicting lifetime PTSD, with and without the same covariates. Clinical sequelae: Bivariate logistic regression tested whether past (lifetime, excluding current) PTSD predicted current (past 2 weeks) first-onset of any non-PTSD psychiatric diagnosis; a multivariate model included all past diagnoses as covariates and static demographics (sex, race, ethnicity) to ensure temporal separation; children with current PTSD were excluded. Treatment utilization: Logistic regressions evaluated whether lifetime PTSD predicted any lifetime mental health service use, unadjusted and adjusted for comorbid diagnoses and covariates (sex, sexual orientation, race, ethnicity, family economic insecurity, trauma count).

- Prevalence: Weighted lifetime PTSD prevalence was 2.17% (SE = 0.16) among U.S. children aged 9–10; 2-week (current) prevalence was 0.12% (SE = 0.04). - Sociodemographic correlates: In multivariate analyses adjusting for other sociodemographics and trauma count, significant predictors of lifetime PTSD included sexual minority/questioning status, unmarried parent status, and family economic insecurity (small to medium-to-large effects). Race effects from bivariate analyses (higher odds in Black and Multiracial children) attenuated variably after adjustment; Multiracial status remained notable. - Psychiatric comorbidity: PTSD showed broad comorbidity. Unadjusted odds for PTSD were elevated across disorders (e.g., separation anxiety OR = 12.13, 95% CI 9.00–16.35; generalized anxiety disorder OR = 10.92, 95% CI 7.94–15.61; oppositional defiant disorder OR = 8.40, 95% CI 6.25–11.30; psychosis OR = 8.18, 95% CI 4.79–13.96; specific phobia OR = 4.21, 95% CI 3.13–5.66). In the fully adjusted multivariate model, significant associations persisted for separation anxiety (OR = 3.60, 95% CI 2.37–5.46), generalized anxiety disorder (OR = 2.71, 95% CI 1.68–4.38), oppositional defiant disorder (OR = 3.02, 95% CI 2.03–4.49), obsessive–compulsive disorder (OR = 1.97, 95% CI 1.31–2.95), and specific phobia (OR = 1.66, 95% CI 1.14–2.42). Associations with psychosis (OR = 1.81, p = 0.13), major depressive disorder (OR = 1.56, p = 0.06), social anxiety (OR = 1.05, p = 0.86), eating disorders (OR = 0.97, p = 0.94), and conduct disorder (OR = 1.24, p = 0.48) were not statistically significant after adjustment. Each additional lifetime psychiatric disorder (excluding PTSD) was associated with higher odds of PTSD (univariate OR = 2.30, 95% CI 2.14–2.48; adjusted OR = 2.07, 95% CI 1.90–2.66; both p < 0.001). - Clinical sequelae: Past PTSD predicted increased odds of current first-onset of a new psychiatric disorder (excluding PTSD). Bivariate OR = 4.98 (95% CI 3.66–6.73, p < 0.001); adjusted OR = 2.05 (95% CI 1.43–2.93, p < 0.001) controlling for past diagnoses and static demographics; participants with current PTSD were excluded. - Treatment utilization: Among children with lifetime PTSD, 63.0% (SE = 3.5) received at least one form of mental health treatment; thus, 37.0% had not received treatment. Lifetime PTSD strongly predicted service use (bivariate OR = 9.36, 95% CI 6.91–12.68, p < 0.001), and remained significant after adjusting for comorbidity and covariates (adjusted OR = 2.16, 95% CI 1.43–3.24, p < 0.001). - Course: The low current prevalence relative to lifetime suggests PTSD may be less chronic in preadolescence compared with adolescence/adulthood, despite persistent risk for subsequent psychopathology after remission.

The findings address the research aims by establishing a national, population-based estimate of PTSD in preadolescents (2.17% lifetime) and demonstrating a developmental pattern where prevalence increases from preadolescence to adolescence and adulthood. Sexual minority/questioning status, unmarried parental status, and family economic insecurity emerged as salient sociodemographic correlates, highlighting early-appearing disparities and the need for targeted prevention and support for vulnerable groups. PTSD showed broad psychiatric comorbidity, with separation anxiety most strongly associated even after accounting for trauma exposure and demographics, consistent with transdiagnostic vulnerability. Despite the low current (2-week) prevalence indicating less chronicity at this age, a history of PTSD independently predicted new-onset psychiatric conditions, underscoring that remission does not eliminate risk and that PTSD in preadolescence signals enduring vulnerability. Treatment utilization was higher among those with PTSD, yet over one-third had not engaged in care, revealing substantial unmet need with implications for educational attainment, functioning, and long-term health. Collectively, the results emphasize early detection, the importance of addressing socioeconomic and minority stress-related risks, and the necessity of sustained monitoring and intervention even after symptomatic remission.

This study provides the first national, population-based characterization of PTSD among U.S. preadolescents, documenting a 2.17% lifetime prevalence, identifying key sociodemographic (sexual minority status, unmarried parents, economic insecurity) and psychiatric correlates (notably separation anxiety), and demonstrating that past PTSD elevates risk for subsequent psychiatric disorders even after remission. Despite increased odds of treatment engagement among those with PTSD, a substantial proportion remains untreated. Future research should employ prospective longitudinal designs to clarify temporal risk pathways, mechanisms driving elevated risk among sexual minority youth (e.g., minority stress), and strategies to reduce socioeconomic barriers to care. Clinically, screening and prevention efforts should target both boys and girls in preadolescence and prioritize linkage to evidence-based treatments and follow-up care post-remission.

Key limitations include: (1) very low current (2-week) PTSD prevalence precluded analysis of correlates and comorbidity for current PTSD, limiting inference about active cases; (2) cross-sectional and retrospective temporal analyses constrain causal inference despite efforts to ensure temporal separation; (3) reliance on concordant parent–child report may underdetect some diagnoses; (4) inability to fully generalize correlates of lifetime PTSD to current PTSD; and (5) novel findings regarding sexual orientation in preadolescents warrant replication and deeper mechanistic investigation. Prospective longitudinal studies are needed to examine incident PTSD and antecedent risk factors over time.