Post-Traumatic Stress and ADHD Symptoms Among Children in the Gaza Strip Since 2023: A Cross-Sectional Study

Background Armed conflict exposes children to repeated traumatic events that may substantially increase the risk of psychological disorders. In the Gaza Strip, prolonged hostilities since October 2023 have resulted in widespread displacement, physical injury, bereavement, and severe socioeconomic disruption. Post-traumatic stress disorder (PTSD) and attention-deficit/hyperactivity disorder (ADHD) are among the most commonly reported psychiatric conditions in conflict-affected children. However, few studies have directly compared mental health outcomes between physically injured and non-injured children within the same war-exposed population. This study aimed to assess the prevalence and severity of PTSD and ADHD symptoms among children in Gaza and to examine associations with injury status, socioeconomic factors, and maternal mental health. Methods A cross-sectional study was conducted between April and October 2025 across four governorates in the Gaza Strip. A total of 603 children and adolescents aged 1–17 years were recruited using convenience sampling from schools, hospitals, clinics, and displacement shelters. ADHD symptoms were assessed using the Arabic version of the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), and PTSD symptoms were measured using the Arabic Child PTSD Symptom Scale for DSM-5 (CPSS-V). Descriptive statistics, t-tests, non-parametric tests, ANOVA, and correlation analyses were performed using R (version 4.3.1). Statistical significance was defined as p < 0.05. Results Among 603 participants (median age 9 years; 52.1% male), 45.4% had sustained conflict-related physical injuries. Injured children had significantly higher PTSD symptom severity compared to non-injured children (median 30 vs 17; p < 0.001). Lower socioeconomic status and poorer maternal mental health were strongly associated with higher PTSD severity (p < 0.001). ADHD symptom scores were significantly higher in males (p < 0.001) and were inversely associated with parental education. A moderate positive correlation was observed between ADHD and PTSD symptom severity (ρ = 0.54, p < 0.001). Conclusions Children in Gaza exposed to armed conflict demonstrate substantial PTSD and ADHD symptom burden, particularly those with physical injuries, lower socioeconomic status, and maternal psychological distress. The coexistence of ADHD and PTSD symptoms highlights the need for integrated, trauma-informed mental health interventions in conflict settings. These findings underscore the urgent necessity for targeted psychological screening and support services for war-affected children.