Which DSM-5-TR criterion for pediatric PTSD specifies that symptoms must cause clinically significant distress or impairment?

• A. Exposure to trauma
• B. Intrusion
• C. Impairment
• D. Dissociation

Answer: (C)

The key thing this item tests is that a PTSD diagnosis requires symptoms to cause clinically significant distress or impairment. In the DSM-5-TR, the clusters of symptoms (intrusion, avoidance, negative alterations in cognition and mood, and arousal) describe what PTSD looks like, but they only count toward a diagnosis if they translate into real-world problems for the child. That threshold—distress or impairment in functioning—keeps the diagnosis tied to clinically meaningful impact, not just the presence of distressing thoughts or memories.

In kids, this impairment can show up in different ways, such as declining school performance, trouble with peers, behavior changes at home, or regression in development. Because children express distress and manage functioning differently than adults, recognizing impairment helps ensure the condition is truly affecting the child’s daily life.

The other options describe types of symptoms (being exposed to trauma, reexperiencing intrusion symptoms, or dissociative experiences), but they don’t by themselves establish that the symptoms are producing meaningful impairment. Therefore, the criterion specifying clinically significant distress or impairment is the best fit.