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The Network Structure of PTSD Symptoms in Children and Adolescents Exposed to Potentially Traumatic Events: A Systematic Review

Alberto Misitano,Annalisa Tarantino,Febe Geddo,Annalisa Oppo,B. Forresi

Published 2025 in Children

ABSTRACT

Highlights What are the main findings? Physiological reactivity to trauma-related cues emerged as a recurrently central symptom in PTSD networks among youth. Robust associations were observed between symptoms belonging to the same PTSD cluster. Preliminary evidence suggests a trend toward increased global connectivity with greater time since exposure. What is the implication of the main finding? Heightened physiological reactivity deserves specific attention in future studies. Further in-depth investigation of contextual factors shaping PTSD network structures is needed. Abstract Background: Exposure to potentially traumatic events (PTEs) during childhood and adolescence is relatively common and may result in the development of post-traumatic stress disorder (PTSD). Recent studies have demonstrated the utility of the network approach for examining PTSD symptoms. However, to date, no systematic review has focused exclusively on network-analytic evidence from child and adolescent samples, who require developmental specific evidence to inform clinical practice. Therefore, the present review aimed to summarize network-analytic studies investigating PTSD symptoms among trauma-exposed youth. Methods: Guided by the PRISMA guidelines, a systematic search for network-analytic studies exploring the symptom structure of PTSD-only in children and adolescents was conducted using PubMed and EBSCOHost. The methodological quality of included studies was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Twelve studies (n = 12498; k = 18) were retrieved, with seven rated as of fair quality. Studies examined DSM-IV (n = 10) and DSM-5 (n = 2) PTSD symptoms in children and/or adolescents exposed to PTEs (mostly natural disasters). Although central symptoms varied, heightened physiological reactivity consistently emerged among the most central. The strongest associations were observed between symptoms within the same PTSD cluster, and preliminary evidence suggests that network connectivity may increase with time since exposure. Conclusions: Heightened physiological reactivity to trauma-related cues appears to be a clinically relevant feature of youth exposed to PTEs, warranting consideration in assessment and intervention. Clinical and methodological implications and future directions for pediatric PTSD research are discussed.

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