Post-traumatic stress disorder (PTSD) is well-understood in adults, with national studies reporting lifetime prevalence rates around 7%. However, its epidemiology in children, particularly preadolescents, remains unclear. Previous research on this age group has been limited by small sample sizes, resulting in unstable prevalence estimates and restricted generalizability. One of the largest studies to date reported a lifetime prevalence of only 0.1% in a regional population, with insufficient data to investigate correlates and treatment utilization. Understanding PTSD in preadolescents is crucial for developing effective prevention and intervention strategies. This study aimed to provide a comprehensive assessment of PTSD in a national sample of 9-10-year-olds, focusing on prevalence, sociodemographic and psychiatric correlates, prediction of subsequent psychopathology, treatment utilization, and the relationship between PTSD diagnosis and treatment.

Existing literature on PTSD in preadolescents is sparse and hampered by small, non-representative samples, limiting the reliability and generalizability of findings on prevalence rates and associated factors. Studies in adolescents and young adults demonstrate the emergence of comorbid psychological adversity following a PTSD diagnosis, but the clinical sequelae in preadolescents remain largely unknown. The scarcity of data necessitates a large-scale, population-based study to accurately characterize PTSD and its consequences in this age group and inform the development of appropriate interventions.

This study utilized data from the Adolescent Brain and Cognitive Development (ABCD) Study (release 5.0), a national study encompassing a sample of 11,875 preadolescents aged 9-10 from 21 sites across the United States. The sampling strategy aimed for representation of the US population's sociodemographics, with some oversampling of certain groups. Data collection involved standardized computerized assessments for both parents and children, including sociodemographic information (sex, ethnicity, race, parental education, marital status, sexual orientation, and family economic insecurity), psychiatric diagnoses (PTSD, mood disorders, anxiety disorders, etc.) using the K-SADS-PL, and information on trauma exposure and treatment utilization. Propensity weights were applied to ensure population representativeness. Statistical analyses involved cross-tabulations, univariate and multivariate logistic regression to assess associations between PTSD and sociodemographic factors, psychiatric diagnoses, and treatment utilization. Analyses considered both lifetime and current (past 2 weeks) PTSD. To evaluate clinical sequelae, analyses examined the association between past PTSD and current onset of new psychiatric disorders.

The lifetime prevalence of PTSD in the sample was 2.17% (SE = 0.16), while the 2-week prevalence was considerably lower at 0.12% (SE = 0.04). Several sociodemographic factors were significantly associated with higher odds of lifetime PTSD, including sexual minority status (strongest effect), being multiracial, having unmarried parents, and family economic insecurity. Multivariate analyses confirmed these associations even after accounting for the number of traumatic events experienced. Regarding psychiatric correlates, separation anxiety showed the strongest association with PTSD (OR = 12.13), although generally, increased comorbid psychopathology was associated with greater odds of PTSD. Notably, even after remission from PTSD, children with a history of PTSD exhibited significantly higher odds of developing new psychiatric disorders. A substantial proportion (37%) of children with lifetime PTSD did not receive mental health treatment. Conversely, lifetime PTSD was strongly associated with the utilization of mental health services, even after accounting for comorbid psychiatric diagnoses and sociodemographic factors.

This study provides the most comprehensive analysis of preadolescent PTSD to date, revealing a lifetime prevalence that aligns with a pattern of increasing PTSD prevalence across development (2.17% in preadolescents, 4.7% in adolescents, and 7.3% in adults). The strong association between sexual minority status and PTSD highlights a critical need for further research into the mechanisms underlying this risk in this young population. The findings also underscore the significant impact of economic insecurity on PTSD risk, suggesting that efforts to mitigate economic hardship may contribute to PTSD prevention. The high comorbidity with other psychiatric disorders, particularly separation anxiety, underscores the complexity of PTSD and the importance of comprehensive assessment and treatment. The low 2-week prevalence suggests that PTSD may not follow a chronic course in preadolescence, unlike in adults, emphasizing the need for longitudinal studies to track its trajectory. The high rate of untreated PTSD is a major concern, given its long-term clinical consequences.

This study demonstrates that while most children with PTSD experience remission, a history of PTSD significantly increases the risk of future psychiatric problems. The high rate of untreated PTSD highlights an urgent need for improved access to mental health services and interventions for this population. Future research should explore risk and resilience factors, particularly for sexual minority children and those facing economic hardship, and implement longitudinal studies to track PTSD trajectory and develop effective prevention and intervention strategies.

The cross-sectional design and retrospective nature of data collection limit the ability to fully establish causal relationships. The low prevalence of current PTSD restricted the analysis of its correlates. Future prospective longitudinal studies are needed to gain a more complete understanding of the development, course, and treatment of PTSD in preadolescents. Furthermore, exploring the mechanisms underlying the strong association between sexual minority status and PTSD is crucial.