Child PTSD Symptom Scale

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.

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]

Reliability

Reliability refers to whether the scores are reproducible. Internal consistency (whether all of the items measure the same construct) is the most commonly reported type of reliability in studies using the CPSS. Inter-rater reliability (which would measure how similar peoples' responses were if the interviews were repeated again, or different raters listened to the same interview) is more rarely reported.

Rubric for evaluating norms and reliability for the CPSS[lower-alpha 1]
Criterion Rating (adequate, good, excellent, too good[lower-alpha 2]) Explanation with references
Norms Not applicable There are no nationally representative normative data for the CPSS; all of the data are clinical and convenience samples.
Internal consistency Good The functional impairment scale demonstrated low internal consistency, coefficient α = .35. One item related to “general happiness with life” was not related to any of the other impairment items; when this item was removed, internal consistency was good, coefficient α = .89[1]
Inter-rater reliability Not reported Inter-rater reliability has not been reported for the CPSS. Other research has shown that interviewer characteristics can change people's tendencies to disclose information about sensitive or stigmatized behaviors, such as alcohol or drug use,[10][11] and so their willingness to disclose traumatic events could change.
Test-retest reliability (stability) Not reported Retest reliability measures whether people with high scores at one time tend to still have higher scores when completing the CPSS later. Such results have not been published yet.
Repeatability Not reported Repeatability studies would examine whether scores tend to shift over time; these would provide a helpful benchmark for measuring treatment outcomes.

Validity

Validity describes the evidence that an assessment tool measures what it was supposed to measure. There are many different ways of checking validity. For screening measures such as the CPSS, diagnostic accuracy, and discriminative validity are probably the most useful ways of looking at validity.

Evaluation of validity and utility for the CPSS[lower-alpha 1]
Criterion Rating (adequate, good, excellent, too good[lower-alpha 2]) Explanation with references
Content validity Good Items are face valid and cover all three symptom clusters of PTSD from DSM-IV
Construct validity (e.g., predictive, concurrent, convergent, and discriminant validity) Good Multiple studies show screening and treatment sensitivity across a range of age groups and samples
Discriminative validity Excellent CPSS severity was examined against clinical diagnosis using receiver–operator characteristic (ROC) curves, with the area under the curve (AUC) significant in Sample 1 (AUC = .89, p < .001). Since the AUC is less than .90 the rating for discriminative validity is excellent for Sample 1. ROC analysis was inappropriate for Sample 2 as all children were PTSD positive.[1]
Validity generalization Good The CPSS has also been tested in Nepali,[12] Turkish[13] and Norwegian[14] populations. It has also been translated and validated in Spanish.[6]
Treatment sensitivity Not reported It is unclear if the CPSS is sensitive enough to detect symptoms over the course of treatment.
Clinical utility Good It is free to use online (public domain),[15] moderate research base, brief. The CPSS requires little time to administer, so it is less invasive and more practical for the communities, schools, and research settings that will administer the assessment to large groups of children who have 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
Assessment Version Age Length Description
Child PTSD Symptom Scale (CPSS) Self-Report 8-18 26-item
Trauma Symptom Checklist for Children (TSCC) Self-Report 8-16 54-item
Trauma Symptom Checklist for Young Children (TSCYC) Caretaker 3-12 90-item
Parent Report of the Child’s Reaction to Stress Caretaker N/A 79-item
PTSD Scale for DSM-5: Child/Adolescent Version (CAPS-CA-5) Clinician 7+ 30-item

Use in other populations

Versions are available in English and Spanish.[6] The CPSS has also been tested in Nepali,[12] Turkish[13] and Norwegien[14] populations.

The CPSS was used with 479 Turkish children screen for PTSD symptoms related to the 2011 Van earthquake.[13]

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).[12] 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.[16] 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.[12]

See also

Notes

  1. 1 2 Table from Youngstrom et al.,[8] extending Hunsley & Mash, 2008;[9]
  2. 1 2 indicates new construct or category

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 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.
  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 3 "Child PTSD Symptom Scale". International Society for Traumatic Stress Studies. Retrieved 1 December 2016.
  7. ↑ Gillihan, Seth J.; Aderka, Idan M.; Conklin, Phoebe H.; Capaldi, Sandra; Foa, Edna B. "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. ↑ Youngstrom, Eric A. "Evidence-Based Assessment". University of North Carolina at Chapel Hill.
  9. ↑ Hunsley, John; Mash, Eric J., eds. (2008). A Guide to Assessments that Work. Oxford series in clinical psychology. New York, NY: Oxford University Press. ISBN 978-0-19-531064-1. OCLC 314222270.
  10. ↑ Griensven, Frits van; Naorat, Sataphana; Kilmarx, Peter H.; Jeeyapant, Supaporn; Manopaiboon, Chomnad; Chaikummao, Supaporn; Jenkins, Richard A.; Uthaivoravit, Wat; Wasinrapee, Punneporn (2006-02-01). "Palmtop-assisted Self-Interviewing for the Collection of Sensitive Behavioral Data: Randomized Trial with Drug Use Urine Testing". American Journal of Epidemiology. 163 (3): 271–278. doi:10.1093/aje/kwj038. ISSN 0002-9262. PMID 16357109.
  11. ↑ Gribble, James N.; Miller, Heather G.; Cooley, Philip C.; Catania, Joseph A.; Pollack, Lance; Turner, Charles F. (2000-01-01). "The Impact of T-ACASI Interviewing on Reported Drug Use among Men Who Have Sex with Men". Substance Use & Misuse. 35 (6–8): 869–890. doi:10.3109/10826080009148425. ISSN 1082-6084. PMID 10847215.
  12. 1 2 3 4 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: 127. doi:10.1186/1471-244X-11-127. ISSN 1471-244X. PMC 3162495. PMID 21816045.
  13. 1 2 3 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 – via ScienceDirect.
  14. 1 2 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.
  15. ↑ "Summary of free assessment measures" (PDF). Center for School Mental Health. University of Maryland School of Medicine. August 2015. pp. 1, 9.
  16. ↑ 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: 0886260515596536. doi:10.1177/0886260515596536. ISSN 0886-2605. PMID 26270934.

Further reading

  • Cohen, Judith A.; AACAP Work Group on Quality Issues (April 2010). "Practice Parameters for Assessing Children and Adolescents with PTSD". Journal of the American Academy of Child and Adolescent Psychiatry. 49 (4): 414–430. doi:10.1016/j.jaac.2009.12.020. PMID 20410735.
  • Foa, Edna B.; Riggs, David S.; Dancu, Constance V.; Rothbaum, Barbara O. (October 1993). "Reliability and validity of a brief instrument for assessing post-traumatic stress disorder". Journal of Traumatic Stress. 6 (4): 459–473. doi:10.1002/jts.2490060405.
  • CPSS Scale PDF
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