Beyond Criterion A: Employing a Three-Level Framework for Conceptualizing Youth Stressor Severity and Posttraumatic Stress Symptoms
- 1Department of Psychology, University of South Carolina, Columbia, United States
- 2Department of Psychology, Harvard University, Cambridge, United States
- 3The Ballmer Institute for Children’s Behavioral Health, University of Oregon, Eugene, United States
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.
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BibTeX
@article{nygaard2026beyond,
title = {{Beyond Criterion A: Employing a Three-Level Framework for Conceptualizing Youth Stressor Severity and Posttraumatic Stress Symptoms}},
author = {Malena A. Nygaard and Stephanie M. Hernandez and Aaron Corn and Srividya Mehendale and Julie M. Petersen and Sarah Kate Bearman},
journal = {Journal of Child \& Adolescent Trauma},
year = {2026},
month = jun,
doi = {10.1007/s40653-026-00933-z},
url = {https://doi.org/10.1007/s40653-026-00933-z},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Beyond Criterion A: Employing a Three-Level Framework for Conceptualizing Youth Stressor Severity and Posttraumatic Stress Symptoms
AU - Malena A. Nygaard
AU - Stephanie M. Hernandez
AU - Aaron Corn
AU - Srividya Mehendale
AU - Julie M. Petersen
AU - Sarah Kate Bearman
PY - 2026
DA - 2026/06/30
JO - Journal of Child & Adolescent Trauma
DO - 10.1007/s40653-026-00933-z
UR - https://doi.org/10.1007/s40653-026-00933-z
AB - 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.
SN - 1936-1521
SN - 1936-153X
ER -