UCLA PTSD Index

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UCLA PTSD Index
Purposeassess PTSD in children and young adults

The University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index for DSM-5 (abbreviated as the UCLA PTSD-RI) is a psychiatric assessment tool used to assess symptoms of PTSD in children and adolescents. [1] 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.

Contents

History

This assessment has evolved since its development in 1985 to include changes made to DSM criteria and to allow for efficiency in assessment. In 1985, Calvin Fredrick worked with the UCLA Trauma Psychiatry Program to develop a measure to screen for PTSD in children and adolescents based on DSM criteria—the UCLA PTSD Reaction Index. [2] This index had 16 "yes" or "no" items. The first major use of this index was used to assess PTSD reactions in elementary school students following a sniper attack on the school. [2] Following the publication of DSM-III, the measure was updated to DSM-III-R version to account for the updated diagnostic criteria of PTSD. This version had 20 items scored on a Likert Scale. The UCLA PTSD Index for DSM-IV is a revised version of the DSM-III-R that reflects the modified diagnostic criteria in the DSM-IV. In the DSM-IV version, child, parent, and adolescent forms and subsequent scoring sheets were developed. The child and adolescent forms were revised to reflect language tailored to children and adolescents in order to combine the child and adolescent forms into one form. The full UCLA PTSD Index was used by the New York State office of Mental health in the Child and Adolescent Treatment Service Programs for children and adolescents affected by the September 11, 2001 attacks in New York City. [2]

In addition, this the assessment has also been proven to be useful across different cultures and in different countries. As a result, it has been translated into many different languages to be administered to children and adolescents that have experienced severe tragedies, such as mass shootings, natural disasters, and terrorism. [2] [3] The assessment was used in Nigeria to measure PTSD in victims of ethno-religious violence. Study found that the UCLA PTSD reaction index was an adequate measure to be used to screen for symptoms of PTSD in children and adolescents in Nigeria. [4] In addition, a study has shown the UCLA PTSD reaction index to be a valid and reliable way of assessing PTSD symptoms in adolescent refugees from Somalia. [5]

Question breakdown and interpretation

Question breakdown

Each index is composed of several parts. The first section is a comprehensive list of trauma types and asks the respondent to indicate which trauma types from the list they have experienced. It screens for lifetime trauma, allowing for trauma exposure to be categorized into multiple categories. Once the trauma exposure(S) has been categorized and identified, a follow up section asks about trauma specific details and the age(s) over which the trauma was experienced. [2] The symptom scale maps directly on to DSM-5 PTSD symptom criteria and asks the respondent how many days in the past month they experienced each symptom using a Likert scale ranging from 0 (None) to 4 (Most of the time). The final section includes questions regarding the extent to which symptoms cause clinically significant distress and interfere with behavior, functioning, and development.

Psychometrics

Reports on psychometric properties for the PTSD index have shown high test-retest reliability and validity, with no significant differences in scores between racial/ethnic groups. [6] Screening results from this index are consistent with the results from other PTSD symptom instruments (PTSD Checklist, PTSD Symptom Scale, and Harvard Trauma Questionnaire). [7]

Changes for DSM-5 criteria

In order to accommodate the changes to the PTSD criteria in the DSM-5, the updated UCLA PTSD index contains 11 new questions that cover the 20 DSM-5 criteria for diagnosis. Questions for Criteria B remained the same. Criteria D was changed to address negative cognitions and mood, and items addressing those symptoms that were formerly in Criteria C were moved to this criteria, leaving only two questions addressing avoidance symptoms in Criteria C. In addition, three questions were added to Criteria D. Finally, questions regarding increased arousal were moved to a new Criteria E, which was expanded by one item. [8] The scoring algorithm (and scoring software) for the UCLA PTSD Reaction Index for DSM-5 allows for a determination of whether criteria for PTSD and for Dissociative Subtype are met. The UCLA PTSD Reaction Index for DSM-5 is available at: www.reactionindex.com.

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 loss of reality as in psychosis.

Psychological trauma is an emotional response caused by severe distressing events such as accidents, violence, sexual assault, terror, or sensory overload.

Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.

Acute stress disorder is a psychological response to a terrifying, traumatic or surprising experience. It may bring about delayed stress reactions if not correctly addressed. Acute stress may present in reactions which include but are not limited to: intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. Reactions may be exhibited for days or weeks after the traumatic event.

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 Structured Clinical Interview for DSM (SCID) is a semi-structured interview guide for making diagnoses according to the diagnostic criteria published in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The development of SCID has followed the evolution of the DSM and multiple versions are available for a single edition covering different categories of mental disorders. The first SCID was released in 1989, SCID-IV was published in 1994 and the current version, SCID-5, is available since 2013.

<span class="mw-page-title-main">DSM-5</span> 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In 2022, a revised version (DSM-5-TR) was published. In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has practical importance. However, not all providers rely on the DSM-5 for planning treatment as the ICD's mental disorder diagnoses are used around the world and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions. The DSM-5 is the only DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the only living document version of a DSM.

Traumatic stress is a common term for reactive anxiety and depression, although it is not a medical term and is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The experience of traumatic stress include subtypes of anxiety, depression and disturbance of conduct along with combinations of these symptoms. This may result from events that are less threatening and distressing than those that lead to post-traumatic stress disorder. The fifth edition of the DSM describes in a section titled "Trauma and Stress-Related Disorders" disinhibited social engagement disorder, reactive attachment disorder, acute stress disorder, adjustment disorder, and post-traumatic stress disorder.

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.

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.

<span class="mw-page-title-main">Prolonged grief disorder</span> Medical condition

Prolonged grief disorder (PGD), also known as complicated grief (CG), traumatic grief (TG) and persistent complex bereavement disorder (PCBD) in the DSM-5, is a mental disorder consisting of a distinct set of symptoms following the death of a family member or close friend. People with PGD are preoccupied by grief and feelings of loss to the point of clinically significant distress and impairment, which can manifest in a variety of symptoms including depression, emotional pain, emotional numbness, loneliness, identity disturbance and difficulty in managing interpersonal relationships. Difficulty accepting the loss is also common, which can present as rumination about the death, a strong desire for reunion with the departed, or disbelief that the death occurred. PGD is estimated to be experienced by about 10 percent of bereaved survivors, although rates vary substantially depending on populations sampled and definitions used.

<span class="mw-page-title-main">Vanderbilt ADHD diagnostic rating scale</span>

The Vanderbilt ADHD Diagnostic Rating Scale (VADRS) is a psychological assessment tool for attention deficit hyperactivity disorder (ADHD) symptoms and their effects on behavior and academic performance in children ages 6–12. This measure was developed by Mark L Wolraich at the Oklahoma Health Sciences Center and includes items related to oppositional defiant disorder, conduct disorder, anxiety, and depression, disorders often comorbid with ADHD.

<span class="mw-page-title-main">ADHD rating scale</span>

The ADHD Rating Scale (ADHD-RS) is a parent-report or teacher-report inventory created by George J. DuPaul, Thomas J. Power, Arthur D. Anastopoulos, and Robert Reid consisting of 18–90 questions regarding a child's behavior over the past 6 months. The ADHD Rating Scale is used to aid in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children ranging from ages 5–17.

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a self-report screening questionnaire for anxiety disorders developed in 1997. The SCARED is intended for youth, 9–18 years old, and their parents to complete in about 10 minutes. It can discriminate between depression and anxiety, as well as among distinct anxiety disorders. The SCARED is useful for generalized anxiety disorder, social anxiety disorder, phobic disorders, and school anxiety problems. Most available self-report instruments that measure anxiety in children look at general aspects of anxiety rather than Diagnostic and Statistical Manual of Mental Disorders (DSM) categorizations. The SCARED was developed as an instrument for both children and their parents that would encompass several DSM-IV and DSM-5 categorizations of the anxiety disorders: somatic/panic, generalized anxiety, separation anxiety, social phobia, and school phobia.

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.

<span class="mw-page-title-main">Child PTSD Symptom Scale</span>

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. 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. 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. 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.

<span class="mw-page-title-main">Kiddie Schedule for Affective Disorders and Schizophrenia</span>

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.

References

  1. "Child and adolescent trauma measures: A review" (PDF). National Center for Social Work Trauma Education and Workforce Development. 2018-11-30.
  2. 1 2 3 4 5 Steinberg, Alan (2004). "The University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index". Current Psychiatry Reports. 6 (2): 96–100. doi:10.1007/s11920-004-0048-2. PMID   15038911. S2CID   27553957.
  3. Murray, Laura K; Bass, Judith; Chomba, Elwyn; Imasiku, Mwiya; Thea, Donald; Semrau, Katherine; Cohen, Judith A; Lam, Carrie; Bolton, Paul (2011-09-24). "Validation of the UCLA Child Post traumatic stress disorder-reaction index in Zambia". International Journal of Mental Health Systems. 5 (1): 24. doi:10.1186/1752-4458-5-24. PMC   3205018 . PMID   21943178.
  4. Katrina A. Korb (September 2013). "Reliability and validity of the UCLA PTSD Reaction Index for DSM-IV in the Nigerian context" (PDF). Nigerian Psychological Research. 1: 25/33. Retrieved 2015-10-20.
  5. Ellis, B. H.; Lhewa, D.; Charney, M.; Cabral, H. (2006). "Screening for PTSD Among Somali Adolescent Refugees: Psychometric Properties of the UCLA PTSD Index". Journal of Traumatic Stress. 19 (4): 547–551. doi:10.1002/jts.20139. PMID   16929510.
  6. Steinberg, Alan M.; Brymer, Melissa J.; Kim, Soeun; Briggs, Ernestine C.; Ippen, Chandra Ghosh; Ostrowski, Sarah A.; Gully, Kevin J.; Pynoos, Robert S. (2013-02-01). "Psychometric Properties of the UCLA PTSD Reaction Index: Part I". Journal of Traumatic Stress. 26 (1): 1–9. doi:10.1002/jts.21780. ISSN   1573-6598. PMID   23417873.
  7. Elhai, Jon D.; Layne, Christopher M.; Steinberg, Alan M.; Brymer, Melissa J.; Briggs, Ernestine C.; Ostrowski, Sarah A.; Pynoos, Robert S. (2013-02-01). "Psychometric Properties of the UCLA PTSD Reaction Index. Part II: Investigating Factor Structure Findings in a National Clinic-Referred Youth Sample". Journal of Traumatic Stress. 26 (1): 10–18. doi:10.1002/jts.21755. ISSN   1573-6598. PMID   23417874.
  8. Hafstad, Gertrud Sofie; Dyb, Grete; Jensen, Tine K.; Steinberg, Alan M.; Pynoos, Robert S. (2014). "PTSD prevalence and symptom structure of DSM-5 criteria in adolescents and young adults surviving the 2011 shooting in Norway". Journal of Affective Disorders. 169: 40–46. doi:10.1016/j.jad.2014.06.055. PMID   25129534.