Functional impairment associated with post-traumatic stress symptoms in trauma-exposed children and adolescents: a qualitative study of everyday difficulties across life domains

Background: Post-traumatic stress symptoms (PTSS) in children and adolescents are associated with significant functional impairment, a diagnostic criterion for post-traumatic stress disorder (PTSD) in both DSM-5 and ICD-11. However, the range of impaired life domains and specific difficulties experienced within these domains remain underexplored. Objective: This study investigated PTSS-related functional impairment in children and adolescents using qualitative data from trauma-exposed children, adolescents, and caregivers. Methods: Trauma-exposed children and adolescents aged 7–18 years, as well as caregivers of children aged 3–18 years, participated in focus groups and interviews to identify impaired life domains and specific difficulties. Data were analyzed using a mixed deductive–inductive qualitative content analysis approach. Frequencies of reported segments across domains and difficulties, as well as the number of cases reporting impairments, were analyzed for the total sample and in subgroup analyses by informant group, age group, and trauma type. Results: Children, adolescents, and caregivers (N = 32) reported PTSS-related functional impairment across a wide range of life domains (N = 11) and specific difficulties (N = 44). These included peer, family, romantic, and other relationships, school/kindergarten and work functioning, hobbies and leisure activities, health and self-care, going out in public, media use, and finances. Subgroup analyses indicated that reported functional impairment varied by age, trauma type, and informant perspective. Conclusion: PTSS-related functional impairment in youth extends across a broad range of life domains and specific difficulties. Findings highlight the need for more comprehensive assessment of functional impairment and suggest that current measurement approaches may not fully capture its complexity. Focus groups and interviews identified PTSS-related functional impairment across a broad range of life domains in trauma-exposed youth.Children and adolescents experienced 44 PTSS-related functional difficulties across 11 life domains.Subgroup analyses revealed differences in PTSS-related functional impairment by informant groups (youth vs. caregivers), age group (3-6, 7-11, 12-18 years), and trauma type (interpersonal vs. accidental).PTSS-related functional impairment extended beyond commonly assessed domains, highlighting gaps in current measurement approaches. Focus groups and interviews identified PTSS-related functional impairment across a broad range of life domains in trauma-exposed youth. Children and adolescents experienced 44 PTSS-related functional difficulties across 11 life domains. Subgroup analyses revealed differences in PTSS-related functional impairment by informant groups (youth vs. caregivers), age group (3-6, 7-11, 12-18 years), and trauma type (interpersonal vs. accidental). PTSS-related functional impairment extended beyond commonly assessed domains, highlighting gaps in current measurement approaches.