Assessment of functional impairment related to post-traumatic stress in children and adolescents: a systematic review

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not applicable (narrative synthesis; no pooled effect size calculated)

• Primary Outcome: Identification and characterisation of instruments assessing PTSS-related functional impairment in children and adolescents, including domains covered, scoring methods, and psychometric properties

• Nnt Or Sensitivity: Key descriptive finding: only 20.7% of included publications reported psychometric properties for functional impairment items. Fifteen instruments were identified (13 PTSS-specific, 1 diagnostic interview module, 1 generic functional impairment measure) collectively assessing 11 distinct life domains. Approximately 50% of instruments used dichotomous response formats; the remainder used multi-categorical (Likert-type) scales.

• Confidence Interval: Not reported

Clinical Application

The review does not endorse a specific instrument for clinical use given the identified psychometric limitations. Clinicians should be aware that currently available tools vary substantially in domains covered and scoring methods, and that functional impairment data derived from these instruments should be interpreted cautiously. Selection of instruments should be guided by developmental appropriateness, the specific life domains relevant to the clinical context, and the availability of normative data. In Australia, PTSD assessment in children and adolescents is guided by RACGP and Australian Psychological Society frameworks, with instruments such as the Child PTSD Symptom Scale (CPSS-5), UCLA PTSD Reaction Index, and the Child and Adolescent Trauma Screen (CATS) in common use. The TGA does not regulate psychological assessment instruments, but the Australian Institute of Health and Welfare (AIHW) and state-based child protection services rely on standardised functional impairment data for service planning. This review's finding that functional impairment subscales are poorly validated is directly relevant to Australian clinicians using these tools in medico-legal, child protection, and Medicare-funded mental health contexts. The Better Access initiative and Head to Health programs would benefit from standardised, validated functional impairment metrics to demonstrate treatment outcomes. Aboriginal and Torres Strait Islander children, who experience disproportionate rates of trauma and ACEs, are particularly underserved by instruments lacking cultural validation — a gap this review implicitly highlights. Children and adolescents (aged ≤6 years and ≥7 years) presenting with or at risk of PTSD following trauma exposure or adverse childhood experiences, assessed in clinical, research, or forensic settings

Abstract

Background: Post-traumatic stress disorder (PTSD) often impairs children's and adolescents' functioning across different life domains. Significant functional impairment is a diagnostic criterion for PTSD in both the DSM-5 and the ICD-11, but the methods in terms of domains covered and scoring rules to assess functional impairments are quite inconsistent.Objective: This systematic review evaluates instruments specifically designed to assess post-traumatic stress symptoms (PTSS), PTSS modules within diagnostic interviews, and generic functional impairment measures used to capture PTSS-related functional impairment in children and adolescents.Method: A systematic search was conducted across six databases for studies published between January 2010 and November 2025. Eligible papers included the development or psychometric evaluation of PTSS-specific measures, PTSS modules in diagnostic interview, and generic functional impairment measures validated in samples exposed to trauma or adverse childhood experiences. Data were extracted and categorized based on assessed content domains, scoring methods, and psychometric properties, with results stratified by age group (6 years and younger versus 7 years and older).Results: From 3519 records, 30 papers met the inclusion criteria. Thirteen PTSS-specific instruments, one diagnostic interview module, and one generic functional impairment measure were identified. Together, these instruments assessed 11 different life domains, although considerable variation existed in the domains covered across tools. Scoring methods also varied, with approximately half using dichotomous response formats and the remainder using multi-categorical scales. Psychometric properties of the functional impairment scales were reported in only 20.7% of publications.Conclusion: Current tools for assessing PTSS-related functional impairment in youth lack standardization. There is a critical need for well-validated instruments that comprehensively capture the presence and severity of PTSS-related functional impairment. This systematic review identified and evaluated 15 instruments, comprising PTSS-specific measures, diagnostic interview modules, and generic functional impairment tools, used to assess PTSS-related functional impairment in children and adolescents.The instruments collectively assessed 11 different life domains; however, substantial variability existed in the domains covered, and scoring methods ranged from dichotomous formats to Likert-type scales.Only 20.7% of papers reported psychometric properties for functional impairment items, highlighting the critical need for standardized, developmentally appropriate tools with robust validation in children and adolescents with potentially traumatic experiences.

References

1. 1.Vogt, A. J., Landolt, M. A., Skjærvø, I., Hermann, R. M., Pfeiffer, E., Sachser, C., & Bartels, L. (2026). Assessment of functional impairment related to post-traumatic stress in children and adolescents: a systematic review. European Journal of Psychotraumatology. https://doi.org/10.1080/20008066.2026.2668980