Child PTSD Symptom Scale

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The Child PTSD Symptom Scale (CPSS) is a free checklist designed for children and adolescents to report traumatic events and symptoms that they might feel afterward. [1] The items cover the symptoms of posttraumatic stress disorder (PTSD), specifically, the symptoms and clusters used in the DSM-IV. Although relatively new, there has been a fair amount of research on the CPSS due to the frequency of traumatic events involving children. The CPSS is usually administered to school children within school boundaries, or in an off-site location to assess symptoms of trauma. [1] Some, but not all, people experience symptoms after a traumatic event, and in serious cases, these people may not get better on their own. Early and accurate identification, especially in children, of experiencing distress following a trauma could help with early interventions. [2] The CPSS is one of a handful of promising measures that has accrued good evidence for reliability and validity, along with low cost, giving it good clinical utility as it addresses a public health need for better and larger scale assessment.

Contents

Overview

The CPSS questionnaire covers the symptoms of PTSD, specifically in youth, using the definitions and criteria from DSM-IV. The current edition of the DSM (DSM-V) made changes to the diagnosis of PTSD, and new research needs to ascertain whether the DSM changes alter the accuracy of the CPSS. CPSS stands for Child PTSD Symptom Scale, CPSS-I is the CPSS Interview, and CPSS-SR is the CPSS Self Report.

The CPSS consists of 26 self-report measures to childhood PTSD diagnostic symptoms developed by Edna Foa, that assesses PTSD diagnostic criteria and symptom severity in children ages 8 to 18. [1] It includes 2 event items, 17 symptom items, and 7 functional impairment items. Symptom items are rated on a 4-point frequency scale (0 = "not at all" to 3 = "5 or more times a week"). [3] The CPSS gives a total symptom severity scale score (ranging from 0 to 51) and a total severity of impairment score (ranging from 0 to 7). [1] [3] The length of time to administer the test varies depending on who is administering the test, but it is shorter than other childhood PTSD exams such as the CPTSD-RI (Child Posttraumatic Stress Reaction Index), CITES-2 (Children's Impact of Traumatic Events Scale-Revised), and CPTSDI (Children's PTSD Inventory). [4] The CPSS saves money and time by involving minimal interaction with clinicians to administer and is generally used to treat large groups of children at a time after a traumatic event. [1]

History

The test was created by Edna B. Foa and colleagues in 2001 as an adaptation to The PTSD Symptom Scale (PSS) created by Foa, Riggs, Dancu, & Rothbaum in 1993. [1] [5] The changes made between these two versions were mainly to make the vocabulary more easily understandable for youth. [3]

The original version of the CPSS by Foa established a clinical cutoff score greater than or equal to 11 and yielded 95% sensitivity and 96% specificity. However, it has since been established that a clinical cutoff score of 15 is more appropriate. [6]

The CPSS was created with the intention of quickly and efficiently assessing all PTSD symptoms in many children. The following DSM-IV criteria for PTSD needed to be assessed in the three symptom clusters using a 7 item assessment: re-experiencing, avoidance, arousal symptoms [7] and trauma-related functional impairments. [1] The severity of the symptoms above also needed to be assessed, and the CPSS would need to be able to predict the onset of PTSD symptoms in a child if they were to experience trauma. The test needed to be a more practical length for use in schools, research, and communities at large where children experienced trauma. [1]

Assessment

Psychological assessment is a psychological evaluation process used by clinicians, in order to help them properly produce a hypothesis from the collected patient information. The Child PTSD Symptom Scale is a self-report assessment that clinicians use to diagnose PTSD symptoms and their severity in children ages 8–18. However, PTSD can be diagnosed much earlier than 8 years of age, and sometimes the victim fears who report their traumatic experiences. Therefore, other measures, such as teacher and caregiver assessments, must be conducted.

Child PTSD Measures
AssessmentVersionAgeLengthDescription
Child PTSD Symptom Scale (CPSS)Self-Report8-1826-item
Trauma Symptom Checklist for Children (TSCC) [8] Self-Report8-1654-item
Trauma Symptom Checklist for Young Children (TSCYC)Caretaker3-1290-item
Parent Report of the Child's Reaction to StressCaretakerN/A79-item
PTSD Scale for DSM-5: Child/Adolescent Version (CAPS-CA-5) [9] Clinician7+30-item

Use in other populations

Versions are available in English and Spanish. [6] The CPSS has also been tested in Nepali, [10] Turkish [11] and Norwegian [12] populations.

The CPSS was used with 479 Turkish children screen for PTSD symptoms related to the 2011 Van earthquake. [11]

Limitations

The CPSS scale assesses avoidance and change of activities, which may not accurately reflect pathology. This could possibly result in higher PTSD prevalence estimations. In a study, the CPSS scale correctly classified 72.2% of children. Nearly one-quarter of children were misclassified and 5.6% were misclassified (false negative). [10] CPSS is a self-reporting assessment and is, therefore, subject to social desirability bias. Social desirability bias influences respondents to answer questions in a way that presents them more favorably to others. This interferes with the purpose of the assessment and prevents clinicians from properly screening for PTSD.

The CPTSD-RI, along with all other assessments attempting to measure the severity of child PTSD, had several limitations. First, the CPTSD-RI did not assess for all of the PTSD symptoms and thus could not provide an accurate assessment of PTSD severity. Additionally, the CPTSD-RI did not assess for functional impairment related to experience with trauma, a limit of many other self-report assessments. These limitations can be combatted by structured interviews given by trained therapists in schools or in a clinical setting. This, however, is problematic because personal interviews are expensive for the families or schools that take part in them, especially when large groups of children are studied, and time-consuming. [13] Thus, the CPSS was created to combat these limitations without the need for a supplemental interview. [1] Validated screening tests like the CPSS tests the efficacy of treatment techniques. Without CPSS, the treatments would have no valid test, and children who have experienced trauma will not get the help they require. [10]

See also

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Dissociation is a concept that has been developed over time and which concerns a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a false perception of reality as in psychosis.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences, with extreme examples being violence, rape, or a terrorist attack. The event must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se.

Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception. People with dissociative disorders use dissociation as a defense mechanism, pathologically and involuntarily. The individual experiences these dissociations to protect themselves. Some dissociative disorders are triggered by psychological trauma, but depersonalization-derealization disorder may be preceded only by stress, psychoactive substances, or no identifiable trigger at all.

Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) is a test to rate the severity of obsessive–compulsive disorder (OCD) symptoms.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

<span class="mw-page-title-main">Daniel Schechter</span> American neuroscientist

Daniel S. Schechter is an American and Swiss psychiatrist known for his clinical work and research on intergenerational transmission or "communication" of violent trauma and related psychopathology involving parents and very young children. His published work in this area following the terrorist attacks on the World Trade Center in New York of September 11, 2001 led to a co-edited book entitled "September 11: Trauma and Human Bonds" (2003) and additional original articles with clinical psychologist Susan Coates that were translated into multiple languages and remain among the first accounts of 9/11 related loss and trauma described by mental health professionals who also experienced the attacks and their aftermath Schechter observed that separation anxiety among infants and young children who had either lost or feared loss of their caregivers triggered posttraumatic stress symptoms in the surviving caregivers. These observations validated his prior work on the adverse impact of family violence on the early parent-child relationship, formative social-emotional development and related attachment disturbances involving mutual dysregulation of emotion and arousal. This body of work on trauma and attachment has been cited by prominent authors in the attachment theory, psychological trauma, developmental psychobiology and neuroscience literatures

Trauma Screening Questionnaire abbreviated as (TSQ) is a questionnaire developed for screening of posttraumatic stress disorder. The TSQ was adapted from the PTSD Symptom Scale – Self-Report Version (PSS-SR). This self-reported assessment scale consists of 10 items, which cover one of the main signs of PTSD. Each item is answered with binary yes or no responses. Overall assessment is done by total score, and the total score higher than 5 indicates on likelihood of PTSD. The TSQ is considered as a valid assessment scale for screening of posttraumatic stress disorder.

PTSD Symptom Scale – Self-Report Version (PSS-SR) is a 17-item self-reported questionnaire to assess symptoms of posttraumatic stress disorder. Each of the 17 items describe PTSD symptoms which respondents rate in terms of their frequency or severity using a Likert-type scale ranging from 0 to 3. Ratings on items are summed to create three subscales – re-experiencing, avoidance coping, and psychological hyperarousal – as well as a total score. All items of the PSS-SR should be answered, and assessment is done by total score. The total score higher than 13 indicates on likelihood of PTSD.

Jon Elhai is a professor of clinical psychology at the University of Toledo. Elhai is known for being an expert in the assessment and diagnosis of Posttraumatic stress disorder (PTSD), forensic psychological assessment of PTSD, and detection of fabricated/malingered PTSD; as well as in internet addictions.

Because of the substantial benefits available to individuals with a confirmed PTSD diagnosis, which causes occupational impairment, the distinct possibility of false diagnoses exist, some of which are due to malingering of PTSD. Malingering of PTSD consists of one feigning the disorder. Post-traumatic stress disorder (PTSD) is an anxiety disorder that may develop after an individual experiences a traumatic event. In the United States, the Social Security Administration and the Department of Veterans Affairs each offer disability compensation programs that provide benefits for qualified individuals with mental disorders, including PTSD. Malingering can lead to a decline in research and subsequent treatment for PTSD as it interferes with true studies. Insurance fraud may also come about through malingering, which hurts the economy.

The Trauma Symptom Inventory (TSI) is a psychological evaluation/assessment instrument that taps symptoms of Posttraumatic stress disorder and other posttraumatic emotional problems. It was originally published in 1995 by its developer, John Briere. It is one of the most widely used measures of posttraumatic symptomatology.

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in 2006. The goal of TF-CBT is to provide psychoeducation to both the child and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war. More recently, TF-CBT has been applied to and found effective in treating complex posttraumatic stress disorder.

The University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index for DSM-5 is a psychiatric assessment tool used to assess symptoms of PTSD in children and adolescents. This assessment battery includes four measures: the Child/Adolescent Self-Report version; the Parent/Caregiver Report version; the Parent/Caregiver Report version for Children Age 6 and Younger; and a Brief Screen for Trauma and PTSD. Questions may differ among the indexes depending on the target age, however the indexes are identical in format. The target age groups for this assessment are children and adolescents between 7-18 and children age 6 and younger. Versions of the UCLA PTSD Reaction Index for DSM-5 have been translated into many languages, including Spanish, Japanese, Simplified Chinese, Korean, German, and Arabic. The DSM-IV version of the UCLA PTSD Reaction Index Index has been updated for DSM-5.

The Clinically Administered PTSD Scale (CAPS) is an in-person clinical assessment for measuring posttraumatic stress disorder (PTSD). The CAPS includes 30 items administered by a trained clinician to assess PTSD symptoms, including their frequency and severity. The CAPS distinguishes itself from other PTSD assessments in that it can also assess for current or past diagnoses of PTSD.

The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) is a semi-structured interview aimed at early diagnosis of affective disorders such as depression, bipolar disorder, and anxiety disorder. There are different versions of the test that have use different versions of diagnostic criteria, cover somewhat different diagnoses and use different rating scales for the items. All versions are structured to include interviews with both the child and the parents or guardians, and all use a combination of screening questions and more comprehensive modules to balance interview length and thoroughness.

The Connor–Davidson Resilience Scale (CD-RISC) was developed by Kathryn M. Connor and Jonathan R.T. Davidson as a means of assessing resilience. The CD-RISC is based on Connor and Davidson's operational definition of resilience, which is the ability to "thrive in the face of adversity." Since its development in 2003, the CD-RISC has been tested in several contexts with a variety of populations and has been modified into different versions.

References

  1. 1 2 3 4 5 6 7 8 9 Foa, Edna B.; Johnson, Kelly M.; Feeny, Norah C.; Treadwell, Kimberli R. H. (2001-08-01). "The Child PTSD Symptom Scale: A Preliminary Examination of its Psychometric Properties". Journal of Clinical Child & Adolescent Psychology. 30 (3): 376–384. doi:10.1207/S15374424JCCP3003_9. ISSN   1537-4416. PMID   11501254. S2CID   9334984.
  2. ↑ Ramos, S.M., & Boyle, G.J. (2001). Ritual and medical circumcision among Filipino boys: Evidence of post-traumatic stress disorder. In G.C. Denniston, F.M. Hodges, & M.F. Milos (Eds.), Understanding Circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem (Ch. 14, pp. 253-270). New York: Kluwer/Plenum. ISBN   0-306-46701-1 ISBN   978-0306-46701-1
  3. 1 2 3 "The Child PTSD Symptom Scale (CPSS)". National Center for PTSD. U.S. Department of Veterans Affairs. 23 February 2016. Retrieved 2016-11-17.
  4. ↑ "List of All Measures - PTSD: National Center for PTSD". www.ptsd.va.gov. Retrieved 2016-12-01.
  5. ↑ Burkett, Whitney. "Child PTSD Symptom Scale (CPSS)". PerformWell. Retrieved 2016-11-17.
  6. 1 2 "Child PTSD Symptom Scale". International Society for Traumatic Stress Studies. Archived from the original on 6 October 2019. Retrieved 1 December 2016.
  7. ↑ Gillihan, Seth J.; Aderka, Idan M.; Conklin, Phoebe H.; Capaldi, Sandra; Foa, Edna B. (2013). "The Child PTSD Symptom Scale: Psychometric properties in female adolescent sexual assault survivors". Psychological Assessment. 25 (1): 23–31. doi:10.1037/a0029553. PMC   3779054 . PMID   22867010.
  8. ↑ Briere, John (1996). "Trauma Symptom Checklist for Children". doi:10.1037/t06631-000.{{cite journal}}: Cite journal requires |journal= (help)
  9. ↑ Nader, K.; Kriegler, K. A.; Blake, D. D.; Pynoos, R. S.; Newman, E.; Weathers, F. W. (1996). "Clinician-Administered PTSD Scale For Children and Adolescents". doi:10.1037/t08962-000.{{cite journal}}: Cite journal requires |journal= (help)
  10. 1 2 3 Kohrt, Brandon A.; Jordans, Mark JD; Tol, Wietse A.; Luitel, Nagendra P.; Maharjan, Sujen M.; Upadhaya, Nawaraj (2011-01-01). "Validation of cross-cultural child mental health and psychosocial research instruments: adapting the Depression Self-Rating Scale and Child PTSD Symptom Scale in Nepal". BMC Psychiatry. 11 (1): 127. doi: 10.1186/1471-244X-11-127 . ISSN   1471-244X. PMC   3162495 . PMID   21816045.
  11. 1 2 Kadak, Muhammed Tayyib; Boysan, Murat; Ceylan, Nesrin; Çeri, Veysi (August 2014). "Psychometric properties of the Turkish version of the Child PTSD Symptom Scale". Comprehensive Psychiatry. 55 (6): 1435–1441. doi:10.1016/j.comppsych.2014.05.001. PMID   24928279.
  12. ↑ Hukkelberg, Silje; Ormhaug, Silje M.; Holt, Tonje; Wentzel-Larsen, Tore; Jensen, Tine K. (2014-01-01). "Diagnostic utility of CPSS vs. CAPS-CA for assessing posttraumatic stress symptoms in children and adolescents". Journal of Anxiety Disorders. 28 (1): 51–56. doi:10.1016/j.janxdis.2013.11.001. ISSN   1873-7897. PMID   24361907.
  13. ↑ Stewart, Regan W.; Ebesutani, Chad; Drescher, Christopher F.; Young, John (2015-08-12). "The Child PTSD Symptom Scale An Investigation of Its Psychometric Properties". Journal of Interpersonal Violence. 32 (15): 2237–2256. doi:10.1177/0886260515596536. ISSN   0886-2605. PMID   26270934. S2CID   22152179.

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