Beyond Criterion A: Employing a Three-Level Framework for Conceptualizing Youth Stressor Severity and Posttraumatic Stress Symptoms

Abstract Children experiencing persistent posttraumatic stress symptoms can receive a diagnosis of post-traumatic stress disorder (PTSD), opening the gate to trauma-focused services. However, many youths are undiagnosed due to complex presentations or because their stressor exposure does not meet Criterion A (“Exposure to actual or threatened death, serious injury, or sexual violence…”; American Psychiatric Association, 2022, p. 302), despite impairing symptoms. The current study applies a novel, three-level framework based on increasingly strict stressor criterion to conceptualize stressor exposures and explore associated symptoms. We employed a convergent parallel, QUAL + quan design to analyze phone-administered baseline assessments of the UCLA PTSD Reaction Index for 438 caregiver-youth dyads seeking treatment as part of a larger randomized controlled trial in U.S. community mental health clinics. Through framework analysis of assessor notes, the following theme developed: Some stressor types do not meet Criterion A but are reported as significant stressors . In the quantitative results, fewer stressors met the increasingly strict severity criteria; yet there were cases of elevated symptoms for non-Criterion A stressors ( n = 149). Findings support applying a three-level framework to youth trauma exposures.