Evidence-based assessment/Instruments/Child PTSD symptom scale

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Lead section[edit | edit source]

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.[2] 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.

Psychometrics[edit | edit source]

Steps for evaluating reliability and validity[edit | edit source]

Click here for instrument reliability table

Reliability[edit | edit source]

Not all of the different types of reliability apply to the way that questionnaires are typically used. Internal consistency (whether all of the items measure the same construct) is not usually reported in studies of questionnaires; nor is 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). Therefore, make adjustments as needed.

Reliability refers to whether the scores are reproducible. Unless otherwise specified, the reliability scores and values come from studies done with a United States population sample. Here is the rubric for evaluating the reliability of scores on a measure for the purpose of evidence based assessment.

Evaluation for norms and reliability for the CPSS (table from Youngstrom et al., extending Hunsley & Mash, 2008; *indicates new construct or category)
Criterion Rating (adequate, good, excellent, too good*) Explanation with references
Norms Adequate Multiple convenience samples and research studies, including both clinical and nonclinical samples[citation needed]
Internal consistency (Cronbach’s alpha, split half, etc.) Excellent; too good for some contexts Alphas routinely over .94 for both scales, suggesting that scales could be shortened for many uses[citation needed]
Interrater reliability Not applicable Designed originally as a self-report scale; parent and youth report correlate about the same as cross-informant scores correlate in general[3]
Test-retest reliability (stability Good r = .73 over 15 weeks. Evaluated in initial studies,[4] with data also show high stability in clinical trials[citation needed]
Repeatability Not published No published studies formally checking repeatability


Instrument rubric table: Validity[edit | edit source]

Click here for instrument validity table

Validity[edit | edit source]

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, diagnostic accuracy and w:discriminative validity are probably the most useful ways of looking at validity. Unless otherwise specified, the validity scores and values come from studies done with a United States population sample. Here is a rubric for describing validity of test scores in the context of evidence-based assessment.

Evaluation of validity and utility for the CPSS (table from Youngstrom et al., unpublished, extended from Hunsley & Mash, 2008; *indicates new construct or category)
Criterion Rating (adequate, good, excellent, too good*) Explanation with references
Content validity Excellent Covers all 3 clusters of DSM-IV diagnostic symptoms for PTSD, and provides a scale of functional impairment.[1]
Contruct validity (e.g., predictive, concurrent, convergent, and discriminant validity) Very good Shows Convergent validity with the Child PTSD Reaction Index (CPTSD-RI), Pearson product-moment correlation = 0.80, p<0.001.[1]
Discriminative validity Excellent Multiple studies show that GBI scores discriminate cases with unipolar and bipolar mood disorders from other clinical disorders
Validity generalization Good Used both as self-report and caregiver report; used in college student[5][6] as well as outpatient[7][8][9] and inpatient clinical samples; translated into multiple languages with good reliability
Treatment sensitivity Good Multiple studies show sensitivity to treatment effects comparable to using interviews by trained raters, including placebo-controlled, masked assignment trials[10][11] Short forms appear to retain sensitivity to treatment effects while substantially reducing burden[11][12]
Clinical utility Good Free (public domain), strong psychometrics, extensive research base. Biggest concerns are length and reading level. Short forms have less research, but are appealing based on reduced burden and promising data


Development and history[edit | edit source]

Click here for instructions for development and history
  • Why was this instrument developed? Why was there a need to do so? What need did it meet?
  • What was the theoretical background behind this assessment? (e.g. addresses importance of 'negative cognitions', such as intrusions, inaccurate, sustained thoughts)
  • How was the scale developed? What was the theoretical background behind it?
  • If there were previous versions, when were they published?
  • Discuss the theoretical ideas behind the changes.

The instrument was developed in order to address the issues that the previous child PTSD assessment, namely the CPST-RI, failed to consider. Specifically, the CPSS was created to ensure that the symptoms of flashbacks, feelings of a shortened future, memory gaps of the trauma, irritability or anger, and hypervigilance are assessed for children at risk of having PTSD[4]The CPSS was developed using the PTDS (Posttraumatic Diagnostic Scale) scale as a model of a well-validated assessment for adults (2001); researchers modified it to make it more comprehensible for children. It has one question for every of the 17 symptoms mentioned in DSM IV and includes a section assessing relationships and school-work (2001). The seven items added to assess daily functioning were made child-relevant. The changes were made in order to create a practical scale that could better assess each symptom cluster in PTSD,  and could be used efficiently with groups of children in setting such as schools, while requiring less administration time.[4]

Impact[edit | edit source]

  • What was the impact of this assessment? How did it affect assessment in psychiatry, psychology and health care professionals?
  • What can the assessment be used for in clinical settings? Can it be used to measure symptoms longitudinally? Developmentally?

Use in other populations[edit | edit source]

  • How widely has it been used? Has it been translated into different languages? Which languages?

The CPSS has been translated into multiple languages including Armenian, Chinese, German, Hebrew, Korean, Norwegian, Polish, Russian, Spanish, and Swedish[13].

Scoring instructions and syntax[edit | edit source]

We have syntax in three major languages: R, SPSS, and SAS. All variable names are the same across all three, and all match the CSV shell that we provide as well as the Qualtrics export.

Hand scoring and general instructions[edit | edit source]

Click here for hand scoring and general administration instructions

The CPSS contains a total of 26 questions, the first two of which are free-response items about the patient's most recent distressing event. The next 17 items have the patient report the frequency of a symptom over a two-week period on a 0 (not at all) to 3 (almost always) Likert scale. The last 7 items inquire if the patient has had functional impairment in certain areas the last two weeks, and these items are scored Yes or No.

The ratings of the first 17 items on the CPSS are summed and have a range of 0-51. The CPSS scoring sheet generally divides this range into PTSD severity, increasing from below threshold (0-10) to moderate (21-25) to extremely severe (41-51).

The last portion of the CPSS has a separate impairment severity score with a range of 0-7. A "No" on an item is graded a 0, and a "Yes" on an item is graded a 1.[14]


CSV shell for sharing[edit | edit source]

Click here for CSV shell
  • <Paste link to CSV shell here>

Here is a shell data file that you could use in your own research. The variable names in the shell corresponds with the scoring code in the code for all three statistical programs.

Note that our CSV includes several demographic variables, which follow current conventions in most developmental and clinical psychology journals. You may want to modify them, depending on where you are working. Also pay attention to the possibility of "deductive identification" -- if we ask personal information in enough detail, then it may be possible to figure out the identity of a participant based on a combination of variables.

When different research projects and groups use the same variable names and syntax, it makes it easier to share the data and work together on integrative data analyses or "mega" analyses (which are different and better than meta-analysis in that they are combining the raw data, versus working with summary descriptive statistics).

R/SPSS/SAS syntax[edit | edit source]

Click here for R code

R code goes here


Click here for SPSS code

SPSS code goes here


Click here for SAS code

SAS code goes here


See also[edit | edit source]

Here, it would be good to link to any related articles on Wikipedia. For instance:

External links[edit | edit source]

Example page[edit | edit source]

References[edit | edit source]

Click here for references
  1. 1.0 1.1 1.2 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. http://dx.doi.org/10.1207/S15374424JCCP3003_9. 
  2. Cite error: Invalid <ref> tag; no text was provided for refs named :12
  3. Achenbach, TM; McConaughy, SH; Howell, CT (March 1987). "Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity.". Psychological Bulletin 101 (2): 213–32. PMID 3562706. 
  4. 4.0 4.1 4.2 Depue, Richard A.; Slater, Judith F.; Wolfstetter-Kausch, Heidi; Klein, Daniel; Goplerud, Eric; Farr, David (1981). "A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: A conceptual framework and five validation studies.". Journal of Abnormal Psychology 90 (5): 381–437. doi:10.1037/0021-843X.90.5.381.  Cite error: Invalid <ref> tag; name ":0" defined multiple times with different content
  5. Cite error: Invalid <ref> tag; no text was provided for refs named :1
  6. Alloy, LB; Abramson, LY; Hogan, ME; Whitehouse, WG; Rose, DT; Robinson, MS; Kim, RS; Lapkin, JB (August 2000). "The Temple-Wisconsin Cognitive Vulnerability to Depression Project: lifetime history of axis I psychopathology in individuals at high and low cognitive risk for depression.". Journal of abnormal psychology 109 (3): 403–18. PMID 11016110. 
  7. Cite error: Invalid <ref> tag; no text was provided for refs named :2
  8. Klein, Daniel N.; Dickstein, Susan; Taylor, Ellen B.; Harding, Kathryn (1989). "Identifying chronic affective disorders in outpatients: Validation of the General Behavior Inventory.". Journal of Consulting and Clinical Psychology 57 (1): 106–111. doi:10.1037/0022-006X.57.1.106. 
  9. Youngstrom, EA; Findling, RL; Danielson, CK; Calabrese, JR (June 2001). "Discriminative validity of parent report of hypomanic and depressive symptoms on the General Behavior Inventory.". Psychological assessment 13 (2): 267–76. PMID 11433802. 
  10. Findling, RL; Youngstrom, EA; McNamara, NK; Stansbrey, RJ; Wynbrandt, JL; Adegbite, C; Rowles, BM; Demeter, CA et al. (January 2012). "Double-blind, randomized, placebo-controlled long-term maintenance study of aripiprazole in children with bipolar disorder.". The Journal of clinical psychiatry 73 (1): 57–63. PMID 22152402. 
  11. 11.0 11.1 Youngstrom, E; Zhao, J; Mankoski, R; Forbes, RA; Marcus, RM; Carson, W; McQuade, R; Findling, RL (March 2013). "Clinical significance of treatment effects with aripiprazole versus placebo in a study of manic or mixed episodes associated with pediatric bipolar I disorder.". Journal of child and adolescent psychopharmacology 23 (2): 72–9. PMID 23480324. 
  12. Ong, ML; Youngstrom, EA; Chua, JJ; Halverson, TF; Horwitz, SM; Storfer-Isser, A; Frazier, TW; Fristad, MA et al. (1 July 2016). "Comparing the CASI-4R and the PGBI-10 M for Differentiating Bipolar Spectrum Disorders from Other Outpatient Diagnoses in Youth.". Journal of abnormal child psychology. PMID 27364346. 
  13. 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. http://doi.apa.org/getdoi.cfm?doi=10.1037/a0029553. 
  14. "Prolonged Exposure Therapy for Post-Traumatic Stress Disorder". Society of Clinical Psychology.




References[edit | edit source]