Assessment and Screening Tools For Trauma

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Assessment and Screening Tools for Trauma in Children and Adolescents : A Review
Virginia C. Strand, Teresa L. Sarmiento and Lina E. Pasquale Trauma Violence Abuse 2005 6: 55 DOI: 10.1177/1524838004272559 The online version of this article can be found at: http://tva.sagepub.com/content/6/1/55
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TRAUMA, 10.1177/1524838004272559 Strand et al. VIOLENCE, / ASSESSMENT & ABUSE AND/ SCREENING January 2005TOOLS
ASSESSMENT AND SCREENING TOOLS FOR TRAUMA IN CHILDREN AND ADOLESCENTS

A Review
VIRGINIA C. STRAND TERESA L. SARMIENTO LINA E. PASQUALE

Fordham University
The need for thorough and accurate assessment of trauma in the lives of children and adolescents has become extremely important for the implementation of appropriate interventions. This article reviews 35 measures, 25 in depth and 10 in brief, that are currently available for use by researchers and practitioners. Instruments were divided into four domains: those that screen for (1) both a history of exposure to traumatic events and the presence of symptoms of trauma; (2) only a history of exposure; (3) symptoms of posttraumatic stress disorder (PTSD) or Dissociations; and (4) multiple symptoms of trauma (i.e. depressions, anger, sexual concerns, as well as PTSD). Information about the type of instrument, how trauma is constructed, psychometric properties, and practical issues are addressed for each of the 25 measures. A brief analysis is also provided for each measure.
Key words:
trauma, children, adolescents, standardized assessment measures ences in the lives of children and an understanding of the impact on current functioning. During the past 10 to 15 years, practitioners and researchers interested in trauma in children and adolescents have responded with a widening array of measures for the assessment of trauma. The developments fall broadly into three main areas: (a) the impact of single events, including both man-made and natural disasters (Asarnow, 1999; Jaycox, 2002; Nader, Pynoos, & Fairbanks, 1990; Pfefferbum, 1999; Pynoos et al.,
AS THE CONCERN ABOUT THE EXPOSURE to and experience of traumatic life events in the lives of children and adolescents has come to the forefront for mental health professionals, there has been a corresponding interest in methods of screening and assessment (Feindler, Rathus, & Silver, 2003; Stamm, 1996). The field has increasingly turned to the development and use of standardized assessment measures as the need has become more urgent for an accurate and comprehensive history of traumatic experi-
AUTHORS NOTE: The development of this article was supported in part by funds under grant number SM54316 from the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS) to the Childrens Trauma Consortium of Westchester, of which Children Families Institute for Research, Support and Training is a member. The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS. TRAUMA, VIOLENCE, & ABUSE, Vol. 6, No. 1, January 2005 55-78 DOI: 10.1177/1524838004272559 2005 Sage Publications 55
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TRAUMA, VIOLENCE, & ABUSE / January 2005
1987; Pynoos, Goenjian, & Tashjian, 1993); (b) the impact of interpersonal violence, particularly the impact of child abuse and neglect (Bernstein & Fink, 1998; Briere, 1996; Friedrich et al., 1992; Spaccarelli, 1995; Wolfe, Gentile, Michienzi, Sas, & Wolfe, 1991); and (c) the concern about community violence and war (Foy & Goguen, 1998; Goldin, Levin, & Ake-Persson, 2003; Horowitz, Weine, & Jekel, 1995; Saltzman, Pynoos, Steinberg, Layne, & Aisenberg, 2001). Some have focused specifically on developing measures to capture specific symptoms of psychiatric disorders, particularly dissociation and posttraumatic stress disorder (PTSD; Farrington, Waller, Smerden, & Faupel, 2001; Fletcher, 1996; Foa, Johnson, Feeny, & Treadwell, 2001; Greenwald et al., 2002; Nader et al., 1998; Putnam, 1997; Saigh, 2002). The burgeoning interest is reflected in the development of new instruments. This article reviews 35 instruments specifically designed for children and adolescents, most of which have been developed within the past 5 to 6 years. Twenty-five are discussed in detail, and an additional 10 are summarized in chart form only. By contrast, just 2 years ago, a 10-year review of scales assessing trauma and its effects detailed only 15 instruments (Ohan, Myers, & Collett, 2002). The purpose of this article is to provide clinicians and researchers with an overview of the instruments available for screening and assessment of trauma in children and adolescents. The measures are summarized under three broad categories: (a) those that both measure a history of exposure and assess impact (symptoms), (b) those instruments that only measure a history of exposure to trauma, and (c) those instruments that assess the impact of or symptom distress related to exposure to a traumatic event or events. The impact or symptom section is subsequently divided into two categories: (a) those instruments that measure PTSD and dissociative symptoms and (b) those that attempt to assess symptoms other than or in addition to PTSD. Information on published psychometric properties is summarized, and there is an em-
Type of instrument Does the instrument measure the history of exposure to trauma? Does the instrument measure symptoms related to the experience of traumatic events? How trauma is constructed Does the measure focus on PTSD? Does the measure focus on more complex reactions to trauma? Does the measure focus specifically on one aspect of the impact (e.g., dissociation)? Does the measure focus on a specific triggering event (e.g., sexual abuse)? Psychometric properties What data exist regarding the reliability and validity of this measure? Has this measure been used with normal (other than clinical) populations? Has this instrument been used with diverse (varied ethnic and racial) populations? Practical issues How long does it take to administer the instrument? Is this a self-report, a parent report, or a clinicianadministered instrument? What is the cost? How can one obtain the measure?
phasis in the review on providing practical information. Therefore, details about the availability of the instrument, cost of the instrument, and time needed to administer the instrument are included where available. Key points of the review thus include the following: All 25 instruments described below have published psychometric properties. Items are included as examples from a scale when the measure is free or the authors of the measure have published items elsewhere. Ten other measures are then included in the chart. For these 10, the psychometric analysis is very underdeveloped, or they do not have any published psychometrics, but they are, in some cases, available and appear to have been used. BOTH HISTORY OF EXPOSURE AND SYMPTOMS Only a minority of the instruments reviewed attempt to capture both a history of exposure (i.e., a description of the stressful or traumatic
Strand et al. / ASSESSMENT AND SCREENING TOOLS
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life events or experiences) and the impact of this history on the child or adolescent. All four use PTSD as the measure of symptom distress. Three are intended for use with children and adolescents: the Childhood PTSD Interview (CPTSDI; Fletcher, 1996), the Childrens PTSD Inventory (Saigh et al., 2000), and the When Bad Things Happen Scale (WBTH; Fletcher, 1992). An additional measure, the University of California, Los Angeles, (UCLA) PTSD Reaction Index (Pynoos, Rodriguez, Steinberg, Stuber, & Frederick, 1998), has three versions: one for children, one for adolescents, and one for parents. Two of the four are self-report measures (UCLA PTSD Reaction Index and WBTH), and two are clinician administered (CPTSDI and the Childrens PTSD Inventory). Two of the measures, the CPTSDI and the UCLA PTSD Reaction Index, have parallel parent versions. The suggested benefit of an accompanying parent report is that although children are viewed as good reporters of internal experiences, they are less reliable as reporters of behavior. The converse appears to be true for parents (Greenwald & Rubin, 1999a). Fuller descriptions of each follow.
parent version includes additional questions about behavior symptoms that are not asked of the children. Administration of the measure by a professional or paraprofessional is recommended. Thirty to 40 minutes are needed to complete the interview. Scoring is built into the interview format (Carlson, 1997). Spanish and French transl a t e d ve r s i o n s a re i n t h e p ro c e s s o f development. Psychometric properties. The measure was validated with a small clinical sample of 10 participants with a history of stress exposure and 20 youth from a community setting with no history of significant stress exposure. Fletcher (1996) reported Kuder-Richardson Formula 20 internal consistency coefficients of .52, .80, .76, and .78 for the PTSD exposure, reexperiencing, numbing and avoidance, and increased arousal symptom clusters and a coefficient of .91 overall. However, there was variability in the alpha ranges for DSM-IV Criteria B to D. Convergent validity with other measures developed by the author ranged from moderate to high; the measure was moderately correlated with the Child Behavior Checklist (CBCL; Carlson, 1997). Analysis. A structured interview with modest psychometric properties based on a study with a small sample size. Its potential usefulness clinically lies in its ability to connect symptoms to identifiable events. Contact information. Kenneth E. Fletcher, Department of Psychiatry, University of Massachusetts Medical Center, 55 Lake Ave. North, Worcester, MA 01655; e-mail: Kenneth. fletcher@umassmed.ummed.edu.
CPTSDIChild (CPTSDI-C) and CPTSDIParent (CPTSDI-P)

Target population and age group. Seven to 18 years of age. Purpose. The purpose is to measure PTSD symptoms adhering to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria for a single or multiple identified traumatic events. Description. The CPTSDI-C (Fletcher, 1996), along with a parallel parent version, the CPTSDI-P, are structured interviews that ask the child and parent to identify specific traumatic events. They assess PTSD symptom domains of DSM-IV as well as anxiety, depression, dissociation, omens, survivor guilt, self-blame, fantasy denial, self-destructive behavior or thoughts, antisocial behavior, risk taking, and changed eating behaviors (Carlson, 1997). The
Childrens PTSD Inventory

Target population and age group. Seven to 18 years of age. Purpose. The purpose is to establish the presence or absence of PTSD symptoms. Description. The Childrens PTSD Inventory (Saigh et al., 2000) is a clinician-administered measure with five subscales. The first subtest
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assesses for potential exposure to traumatic events. If the youth does not meet the criteria for significant stress exposure, the interview is terminated. The second, third, and fourth subtests search for symptoms of reexperiencing, avoidance and numbing, and increased arousal, respectively. The last subtest probes for areas of significant distress in a variety of life domains. Scoring and instructions for each subtest are built into the measure (Saigh et al., 2000). For youth with no history of trauma, it takes only 5 minutes to complete the test. Ten to 15 minutes are needed to complete the measure for youth with a history of trauma. Training of the administrator entails 2 hours of professionally supervised analog training with feedback (Saigh et al., 2000). Psychometric properties . Results of the psychometric investigations indicated moderate internal consistency (alpha = .53 to .89) for the five subtests and high internal consistency (alpha = .95) at the diagnostic level. Interrater reliability was 98.1%, suggesting that the instrument elicited virtually identical information as measured by different examiners. Test-retest reliability ranged from good to excellent (Kappas = 0.66 to 1.00; Yasik et al., 2001), indicating that the PTSD Inventory is highly consistent over time (Saigh, 2000). Convergent validity was found with the Revised Childrens Manifest Anxiety Scale, Childrens Depression Inventory, CBCL, and the Junior Eysenck Personality Inventory Neuroticism scale (Yasik et al., 2001). Criterion validity was determined in relation to the Diagnostic Interview for Children and AdolescentsRevised and Structured Clinical Interview for DSM-IV. Analysis. The strong psychometric results suggest good potential for this brief interview instrument. Its usefulness is enhanced by the combination of information on exposure to specific stressful or traumatic events as well as the existence of PTSD symptoms. Contact information. Philip A. Saigh, Box 1, Thorndike Hall, Teachers College, Columbia University, 525 W 120th Street, New York, NY 10027; e-mail: pasaigh@aol.com.
UCLA PTSD Reaction Index for DSM-IV (Child, Adolescent, and Parent)
Target population and age group. Children ages 7 to 12, adolescents ages 13 and older, and parents. Purpose. The purpose is to screen for the presence of any type of traumatic event and the frequen cy of D S M - I V ( A PA, 1 9 9 4 ) P T S D symptoms. Description. This is a client self-report measure; although, it can also be administered in an interview format or in a school classroom (group) setting. Three versions of this brief screening instrument exist: child, adolescent, and parent. The UCLA PTSD Reaction Index (Pynoos et al., 1998) is a revised version of the widely used and researched Child PTSD Reaction Index (CPTSD-RI; Nader et al., 1990). The first section lists 12 very scary, dangerous or violent things that sometimes happen to people. For each one, the respondent may answer yes or no. Items include Being in a bad accident, like a very serious car accident, Being beaten up, shot at or threatened to be hurt badly in your town, and Hearing about the violent death or serious injury of a loved one. Asecond section asks for the respondents feelings during or right after the bad thing that happened. Respondents answer yes or no to 12 questions, such as Were you scared you would die? Was someone else hurt badly? and Did you run around or act like you were very upset? The third section asks the respondent to rate 20 statements on a 5-point Likert-type scale (0 = none of the time and 4 = most of the time), such as How much of the time during the past month . . . I watch out for danger or things I am afraid of . . . I feel grouchy, angry or mad . . . I feel alone inside and not close to people . . . I think that I will not live a long life. The structure of the measure facilitates scoring. The measure was forward and back translated by experienced psychologists for use in Armenia, Bosnia, and Hercegovina (Stuvland, Durakovic-Belko, & Kutlaca, 2001). In the United States, the measure was forward and back translated for use with Spanish-speaking
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students in Los Angeles, California (Saltzman, Steinberg, & Lane, 2001). Psychometric properties. Psychometric properties are under investigation for the UCLA PTSD Reaction Index (Rodriguez, Steinberg, & Pynoos, 1999). It is reported here because of the strong psychometric properties associated with the CPTSD-RI, on which the measure is based. Analysis. Strengths of the measure include the age-specific design, the accompanying parent report form, its ability to capture both a history of traumatic exposure and symptoms consistent with PTSD, and its usage across cultures. Contact information. Robert S. Pynoos, National Center for Child Traumatic Stress, 11150 W. Olympic Blvd., Suite 770, Los Angeles, CA 90064; e-mail: rpynoos@mednet.ucla.edu.
found for the total scale and for PTSD DSM-IV Criteria A to D. Convergent validity was assessed with other measures developed by Fletcher (1996). Low convergent validity (ranging from .21 to .57) with the subscales of the CBCL was also reported. Analysis. A third-grade reading level and the brief completion time enhance the applicability of the measure for use with children in clinical and research settings. Development of psychometric properties with a limited sample restricts the reliability and validity of the findings. Contact information. Kenneth E. Fletcher, Department of Psychiatry, University of Massachusetts Medical Center, 55 Lake Ave. North, Worcester, MA 01655; e-mail: Kenneth. fletcher@umassmed.ummed.edu. HISTORY OF EXPOSURE TO TRAUMA Among the six exposure measures we reviewed, three of the instruments are designed specifically for children and adolescents who are suspected of having been or have been sexually abused (Anatomical Doll Questionnaire [ADQ], Checklist of Sexual Abuse and Related Stressors [C-SARS], and Child Sexual Behavior Inventory [CSBI-I]). One explores for a history of abuse and neglect, including sexual abuse (Child Trauma Questionnaire [CTQ]). One assesses for trauma histories that include events beyond maltreatment and family violence (Traumatic Events Screening Inventory [TESI]), and the Childrens Exposure to Community Violence Survey is unique in its focus on community violence. Three are designed specifically for children (ADQ, CSBI, and the Childrens Exposure to Community Violence Survey). One is designed for adolescents (CTQ). Two focus on both children and adolescents (C-SARS and TESI). Each measure is described in more detail below.
When Bad Things Happen Scale (WBTH)

Target population and age group. Children ages 7 to 14 who have obtained at least a third-grade reading level. Purpose. The purpose is to measure DSM-IV PTSD symptoms in children. Description. The WBTH (Fletcher, 1992) is a self-report measure that assesses childrens and adolescents responses to a traumatic event (i.e., bad thing). The latest version, R4, has 90 items measuring PTSD, anxiety, depression, dissociation, omens, survivor guilt, self-blame, fantasy denial, self-destructive behavior or thoughts, antisocial behavior, risk taking, and changes in eating habits (Carlson, 1997). For each item, children respond using a 3-point Likert-type scale, with 1 = never, 2 = some, and 3 = lots. Ten to 20 minutes are needed to complete the instrument (Fletcher, 2002). Psychometric properties. The CPTSDI and WBTH were validated in the same study of 10 children from a clinical sample with a history of stress exposure and 20 children from a community setting with no history of significant stress exposure. A high Cronbachs alpha (.92) was
Anatomical Doll Questionaire (ADQ)

Target population and age group. Children ages 2 to 7.
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Purpose. The purpose is the assessment of child sexual abuse. Description. The ADQ is a semistructured child interview guided by the use of anatomical dolls. Interviewers and observers observations and perceptions of the childs responses are recorded and compared in five areas: (a) type of abuse, (b) demonstration with dolls, (c) observation of childs affective and expressive behaviors, (d) perceptions of interview quality, and (e) general observations. Scoring is based on a response indicating whether an act or verbalization occurred (Feindler, Rathus, & Silver, 2003; Levy, Markovic, Kalinowski, Ahart, & Torres, 1995). Psychometric properties. Interrater reliability was measured using the phi statistic, where 1 = full agreement and 0 = level of agreement no better than chance alone. There was great variation between the interrater reliability of each of the five areas. In a confirmed diagnosis of sexual abuse, 44% of the children demonstrated sexual abuse acts with the doll, compared to 14% of children, where there was no confirmation of sexual abuse. Very poor interrater reliability was found for child affective expressions (Feindler et al., 2003). Analysis. It is one of the very few instruments designed for preschool-age children using anything other than a verbal format. A considerable variability between observer and interviewer agreement indicates the difficulty in objectively scoring the interview. Contact information. Howard Levy, Grant Hosp, Dept of Pediatrics, Chicago, IL.
Description. This is a 70-item self-report measure (Spaccarelli, 1995; Spaccarelli & Fuchs, 1997) that assesses three types of stressful events (abuse-specific events, abuse-related events, and public disclosure events) associated with sexual abuse by a specified perpetrator. Psychometric properties. With a sample of girls ages 11 to 18, internal consistency for the total measure was high (.93); however, findings varied from low to high for each subscale. Construct validity was established by comparing total event scores on the C-SARS with (a) therapists ratings (r = .36, p < .05), (b) number of types of sexual abuse reported (r = .40, p < .05), and (c) total scores on the CBCL (Feindler et al., 2003; Spaccarelli, 1995). Concurrent validity was not supported because the C-SARS was not associated with symptoms of depression or anxiety. A high correlation was found with the Negative Appraisals of Sexual Abuse Scale (NASAS; Spaccarelli, 1995; Spaccarelli & Fuchs, 1997). Analysis. Of interest because it is one of the few measures that attempts to assess stress for events associated with a disclosure of sexual abuse, it has so far been used with only adolescent girls. Contact information. Steven Spaccarelli, Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, 907 South Wolcott Ave., Chicago, IL 60612.
Child Sexual Behavior Inventory (CSBI-I)

Target population and age group. Parents of children (ages 2 to 12) who may have been sexually abused. Purpose. The purpose is to determine the presence and intensity of childrens sexual behaviors. Description. The CSBI-I is a female caregiver self-report composed of 38 items assessing the childs behavior during the past 6 months. The measure was developed by adapting items
Checklist of Sexual Abuse and Related Symptoms (C-SARS)

Target population and age group. Children and adolescents who experienced sexual abuse. Purpose. The purpose is to assess both reports and degree of stressful events associated with a youths sexual abuse by a specific perpetrator.
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from the CBCL and adding items pertaining to sexual aggression, sexual inhibition, and gender behaviors. Ten to 13 minutes are needed to complete and score the measure. Scores can be assessed for each subscale: (a) CSBI-I total scale, (b) Developmental Related Sexual Behavior, and (c) Sexual Abuse Specific Items (Feindler et al., 2003). Norms controlling for age and gender are provided. Raw scores are converted into t scores (Drach, Wientzen, & Ricci, 2001). French, Spanish, German, and Swedish translated versions are available. The CSBI-I is formatted as a test booklet, and a comprehensive manual is available. Psychometric properties. High internal consistency was found with both a clinical (alpha = .93) and nonclinical (alpha = .82) sample of children ages 2 to 12. Test-retest reliability was also adequate (.85) at both 1-month and 3-month intervals. Sexually abused children scored higher frequencies of sexual behavior then nonsexually abused children, demonstrating discriminate validity. Convergent validity was found with the CBCL (Friedrich et al., 1992). However, in a sample of 247 children in a rural community, no relationship was found between a sexual abuse diagnosis and sexual behavior problems (Drach et al., 2001). Analysis. The CSBI-I is the only standardized measure available to assess sexual behavior problems and sexualized behavior in children who may have been sexually abused. Professionals are cautioned against using sexual behaviors as diagnostic indicators for sexual abuse given some contradictory findings (Drach et al., 2001). Contact information. Psychological Assessment Resources, Inc., 16204 N. Florida Ave., Lutz, FL 33549; e-mail: parinc.com.
Description. This is a 28-item self-report measure that inquires about five types of maltreatment: (a) emotional abuse, (b) physical abuse, (c) sexual abuse, (d) emotional neglect, and (e) physical neglect. It includes three items to screen for false-negative trauma reports. The CTQ does not discriminate between current and past experiences of abuse. The CTQ can be given to both clinical and nonclinical respondents and can be administered either individually or in groups. Scoring results in classification of the level of maltreatment (none, low, moderate, and severe) for each of the five domains can be converted to percentiles. Psychometric properties. Studies of reliability and validity were undertaken with clinical and nonclinical samples in seven studies, involving a total of 2,201 respondents. Internal consistency was satisfactory (.66) to excellent (.92), with the total scale achieving a Cronbachs alpha of .95. Test-retest correlations were high (.79 to .86). Construct validity was robust, with psychiatrically referred groups reporting higher levels of abuse and neglect than nonclinical samples (Bernstein & Fink, 1998). Analysis. This is an easy-to-administer, userfriendly self-report instrument with generally very satisfactory psychometric properties. It probes for only histories of child abuse and neglect. Contact information. The Psychological Corporation, Harcourt Brace & Company, San Antonio, Texas; Web site: psychcorp.com.
Survey of Childrens Exposure to Community Violence

Target population and age group. Children 6 to 10 years old. Purpose. The purpose is to asses the frequency by which a child has been victimized by, witnessed, or heard about 20 forms of violence and violence-related activities in the community. Description. This instrument is both a selfreport and a parent report; two forms exist: a
Child Trauma Questionnaire (CTQ)

Target population and age group. Adolescents 12 and older and adults. Purpose. The purpose is to screen rapidly for histories of child abuse and neglect.
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full version and a screening survey. Information is available only on the full version, which is a 54-item scale yielding information on two subscales: Direct Victimization by Violence and Witnessing Violence in Others. On a scale of 1 (never) to 9 (almost every day), individuals respond to questions such as the following: How many times have you seen someone trying to force their way into somebody elses house or apartment? How many times have you actually seen a seriously wounded person after an incident of violence? How many times have you yourself been chased by gangs or individuals? and How many times have you yourself actually been shot with a gun? It can be administered individually or in groups. Psychometric properties. One study has been undertaken with 165 low-income children from a moderately violent neighborhood in Washington, D.C. Psychometric information is modest; the test-retest coefficient was .82. However, there was no assessment of test-retest reliability, internal consistency, interrater reliability, or criterion validity (Richters & Martinez, 1993). The measure was used in a separate study of 349 primarily African American youth. Evaluation of the internal consistency of the measure resulted in a Cronbachs alpha of .90 (Feigelman, Howard, Li, & Cross, 2000). Analysis. As the authors state,
violence exposure survey instruments developed for this study . . . are a useful . . . starting point for assessing violence exposure. But significant gains in our understanding of the consequences of exposure will require . . . instruments with a much higher degree of fidelity to violence phenomenon. (Richters & Martinez, 1993, p. 20)
Purpose. The purpose is to probe for a history of exposure to traumatic events. Description. This 24-item scale is available as a structured clinical interview measure for children 8 and older (TESI-SRR); a parent version is available for children under 7 (TESI-PRR). The TESI inquires about current and previous injuries, hospitalizations, domestic violence, community violence, disasters, accidents, physical abuse, and sexual abuse. For example, a question asks Has your child ever seen or heard people in your family threaten to seriously harm each other? If the answer is yes, the respondent answers the following questions: Did they threaten to use a weapon? How old was your child the first time, last time, and most stressful time? Was your child present when the threat was made? and Was your child strongly affected by one or more of these experiences? For any event, a childs or parents endorsement of the event meets Criterion A of PTSD. Any event subsequently endorsed as involving an extreme emotional reaction is rated as meeting Criterion A-2 of PTSD. Subsequent questions examine whether the event involved a threat to the childs or anothers physical integrity and whether the childs reactions rise to the level of Criterion B of PTSD. Each form takes 20 to 30 minutes to complete. Psychometric properties. This is a revision of earlier, well-researched scales (TESI-Child [TESI-C] and TESI-Parent [TESI-P]) that had strong psychometric properties (Ribbe, 1996). Research is under way to examine the psychometric properties of the current measures. Analysis. This is a structured interview assessment scale that holds good promise for a comprehensive analysis of childrens exposure to traumatic events and is one of the few measures available to screen for such events with very young children. Contact information. The National Center for PTSD (116-D), VA Medical & Regional Office Center, White River Junction, VT 05009; e-mail: ncptsd@ncptsd.org.
Contact information. John E. Richters, University of Maryland, Department of Human Development and Institute for Child Study, Benjamin Building, Rm. 4104, College Park, MD 20742; email: jrichter@hih.gov.
Traumatic Events Screening Inventory (TESI)

Target population and age group. Children and adolescents ages 6 to 18.
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IMPACT OF TRAUMA: SYMPTOMS AND/OR DISTRESS INDICES A significant amount of energy has been devoted to the development of instruments designed to measure the impact of stressful and traumatic events on children and adolescents, usually in terms of symptom development. These range from narrowly constructed measures for one dimension (i.e., dissociation), such as the Adolescent Dissociative Experience Scale (A-DES) and the Child Dissociative Checklist (CDC), to instruments that attempt to measure multiple trauma symptoms, such as the Pediatric Distress Scale and the Trauma Symptom Checklist for Children (TSCC). Many are designed primarily to evaluate PTSD. These, along with the dissociative measures, are described first, followed by a fuller discussion of the multiple trauma symptom measures.
somewhere or doing something and I dont know why, It feels like there are walls inside my mind, and My body feels as if it doesnt belong to me. A total score as well as scores on four subscales result. The four subscales are (a) dissociative amnesia, (b) absorption and imaginative involvement, (c) passive influence, and (d) depersonalization and derealization (Putnam, 1997). Psychometric properties. Reliability and validity have been studied with both a normal sample of adolescents and a clinical sample (Putnam, 1997). Scale and subscale reliability were very good (Cronbach alpha for full scale was .93 and subscales ranging from .72 to .85), increased scores were associated with a history of trauma, and the instrument was able to distinguish normal adolescents from those with a variety of diagnoses (Armstrong, Putnam, Carlson, Libero, & Smith, 1997; Farrington et al., 2001). Analysis. This is a brief, easy-to-use scale with excellent internal consistency and strong face validity. Larger scale studies are recommended by the authors to cross-validate the findings. Contact information. Judith Armstrong, 501 Santa Monica Blvd., Suite 402, Santa Monica, CA 90401; e-mail: jarmstrong@mizar.usc.edu.
PTSD and Dissociative Measures

Of the six measures reviewed that have been developed to capture dissociative or PTSD symptoms, only one (the CDC) was designed solely for the school-age child. Only two, the ADES and the adolescent version of the Los Angeles Symptom Checklist (LASC), have been developed specifically with the adolescent in mind. The others group children (usually ages 7 or older) with adolescents.
Adolescent Dissociative Experience Scale (A-DES)

Target population and age group. Adolescents ages 12 to 18. Purpose. The purpose is to screen for normal and pathological dissociative experiences. Description. This is a 30-item self-report measure. Statements are worded to reflect experiences and coping skills. Responses to items are indicated on a 10-point Likert-type scale, with 0 = never and 10 = always. Sample items include the following: I have strong feelings that dont seem like they are mine, I find myself going
Child and Adolescent Psychiatric Assessment (CAPA-C, CAPA-P)

Target population and age group. Adolescents 9 to 17 years of age. Purpose. The purpose is to obtain information for psychiatric diagnoses adhering to criteria of the DSM-IV. Description. The CAPA-C is a comprehensive diagnostic interview measure for psychiatric symptoms. A parent interview is available (CAPA-P). The measure is divided into modules. The life events and posttraumatic stress module collects data regarding risk that may result in psychopathology and discriminates be-
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tween PTSD acute, chronic, and delayed diagnoses (Costello et al., 1998). Approximately an hour is needed to complete the interview. Psychometric properties. For the life events and posttraumatic stress module, fair to excellent reliability was found (kappa = .40 to .79). The measure was able to discriminate between a clinical sample and community sample. Intraclass correlations were .72 (child) and .83 (parent) for high-magnitude events and .62 (child) and .58 (parent) for low-magnitude events (Costello et al., 1998). Analysis. The life events and posttraumatic stress module of the CAPA is extensive and allows for the examination of symptoms and history of PTSD as well as the relationship between life events and psychiatric disorders. The module is time consuming and requires a welltrained interviewer. Contact information. Jane Duncan, Developmental Epidemiology Program, Duke University Medical Center, DUMC Box 3454, Durham, NC 27710; e-mail: jduncan@psych.mc. duke.edu.
plete the measure. Six domains of dissociation are assessed: dissociative amnesia, rapid shifts in demeanor and abilities, spontaneous trance states, hallucinations, identity alterations, and aggression or sexualized behaviors (Feindler et al., 2003; Putnam & Peterson, 1994). Psychometric properties. Several studies have established good to excellent (alpha = .96) internal reliability for nonclinical and clinical samples. The measure has discriminated between children diagnosed as having multiple personality disorders and dissociative disorders not otherwise specified and children who were maltreated and children with dissociation from psychiatrically healthy children. Low to moderate validity was found with other child dissociation scales (Ohan et al., 2002; Putnam & Peterson, 1994; Wherry, Jolly, Feldman, Adam, & Manjanatha, 1994). Analysis. The ability of parents, teachers, therapists, clinical staff, or any adult familiar with the child to complete the instrument augments the applicability of the CDC. Reported psychometric properties support the use of the measure, though further clarification of the construct is needed (Ohan et al., 2002). Contact information . Frank W. Putnam, Cincinnati Childrens Hospital Medical Center; e-mail: frank.putnam@chmcc.org.
Child Dissociative Checklist (CDC)

Target population and age group. Parent or caregiver of a 5- to 12-year-old child. Purpose. The purpose is to screen for dissociate symptoms. Description. The CDC (Putnam, Helmer, & Trickett, 1993) is a 20-item parent or adultobserver report of dissociative behaviors. The respondent indicates if the statement is very true (2), sometimes true (1), or not true (0). Sample items include the following: Child is unusually forgetful or confused about things that he or she should know (e.g., may forge the names of friends, teachers, or other important people), Child loses possessions or gets easily lost, Child continues to lie or deny misbehavior even when the evidence is obvious, and Child sleepwalks frequently. The adult should be familiar with the child across various contexts. Approximately 5 minutes are needed to com-
Child PTSD Symptom Scale (CPSS)

Target population and age group. Children ages 8 to 18 who experienced a traumatic event. Purpose. The purpose is to probe for DSM-IV PTSD symptoms in children. Description. The CPSS (Foa et al., 2001) is the child version of Posttraumatic Diagnostic Scale developed by Foa, Riggs, Dancu, and Rothbaum (1993) for adults. The self-report measure assesses the frequency of all PTSD symptoms within the past month as well as includes a 7-item assessment of functional impairment. On a 4-point Likert-type scale, respondents indicate how much they agree with a statement (Foa et al., 2001). Sample state-
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ments include the following: Having bad dreams or nightmares; Trying to avoid activities, people, or places that remind you of the traumatic event; Not feeling close to people around you; and Having trouble falling or staying asleep. A symptom severity score results. The measure can be administered individually or in a group format, and approximately 15 minutes are needed to complete the measure. The measure has been translated into several languages for research in the United States: Spanish, Korean, Russian, and Armenian. Psychometric properties. For the total symptom severity scale, good internal (alpha = .89) and test-retest reliability (.84) were found, and for subscales, moderate to good internal (.70 to .80) and test-retest reliability (.63 to .85) were found. Good convergent validity was found with other PTSD measures (Pearson product-moment correlation coefficient = .80, p < .001; Foa et al., 2001). In a later study (Jaycox, 2002), the measure was used with Spanish-, Korean-, Russian-, and Armenian-speaking immigrant children. Scale internal consistency was high (alpha = .89). A strong correlation between exposure to violence and PTSD symptoms were found. Analysis. Preliminary studies reveal strong psychometric properties. Translation into other languages makes it a potentially useful instrument. An advantage of the measure is the ease and brief time needed to administer it while yielding severity scores and a diagnosis. Contact information. Edna Foa, Center for the Treatment and Study of Anxiety, University of Pennsylvania School of Medicine, Department of Psychiatry, 3535 Market Street, Sixth Floor, Philadelphia, PA 10104; e-mail: foa@mail.med. upenn.edu.
Description. The CAPS-CA was preceded by the CAPS-C (Nader, 1997; Nader et al., 1998), which was in turn modeled after an adult measure, the CAPS. The CAPS-CA is a semistructured clinical interview. There is a diagnostic requirement that the youth must have experienced at least one traumatic event. The measure allows for the evaluation of the frequency and intensity of each PTSD symptom and the impact of the symptoms on social functioning. Thirty minutes to 2 hours are needed to complete the entire interview. Psychometric properties. The adult CAPS and the CAPS-C are widely accepted because of their sound psychometric properties. Currently, psychometric properties for the CAPS-CA are under investigation (Nader et al., 2002). Analysis. The CAPS-CA shows promise as a thorough measure to evaluate exposure to trauma, assess symptom severity, and diagnose current or lifetime diagnosis of PTSD. The extensive time needed to complete an interview may limit its applicability. Contact information. The National Center for PTSD (116-D), VA Medical & Regional Office Center, White River Junction, VT 05009; e-mail: ncptsd@ncptsd.org.
Los Angeles Symptom Checklist (LASC)

Target population and age group. Adolescents. Purpose. The purpose is to measure PTSD and general distress. Description. The LASC (King, King, Lesking, & Foy, 1995) is a 43-item self-report checklist that is modified for use with adolescents (Burton, Foy, Bwanausi, Johnson, & Moore, 1994; Foy, Wood, King, King, & Resnick, 1997). Some items adhere to DSM-IV PTSD criteria, and other items were developed based on clinical experience of more general stress-related problems for adolescents (abusive drinking, pervasive disgust, girlfriend or boyfriend problems, and excessive eating). On a Likert-type scale of 0 (not a problem) to 4 (extreme problem), the adolescent endorses how much of a problem each
Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA)

Target population and age group. Children ages 8 to 15. Purpose. The purpose is to assess and diagnose childrens and adolescents PTSD symptoms.
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symptom is (e.g., feeling disgusted with everything and everybody, feeling tense or nervous, cant make and keep male friends, and eating too much). A total score is achieved by summing responses. The PTSD symptoms can be scored separately from the entire measure, and a continuous score for PTSD can be obtained (Greenwald, 2000). Psychometric properties. Investigations of the psychometric properties of the modified version for adolescents resulted in support for high internal consistency (.95 for the full item set and .90 for the PTSD scale), and the confirmatory factor analysis findings supported three highly correlated factors for the symptom categories of reexperiencing, avoidance and numbing, and arousal (Foy et al., 1997). Analysis. The LASC has been used with a variety of populations in clinical and research settings, thereby enhancing the applicability of the measure. The LASC is one of the first measures to yield a continuous score. Work is needed to further validate the adolescent version of the measure. Contact information. David W. Foy, Graduate S c h o o l o f E d u c a t i o n a n d P s y c h o l o g y, Pepperdine University, 400 Corporate Pointe, Culver City, CA 90230.
dren and adolescents. One (Attribution for Maltreatment Inventory [AFMI]) is designed for adolescents. Each of the nine measures has one or more unique characteristics. The CROPS and PROPS are brief symptom checklists designed to be used jointly by children and their parents. The PEDS, a parent report, qualifies as a brief screening tool and has robust reliability and validity findings. The ACS stands out for its design, which uses a cartoon-based format to assess traumatic stress symptoms. The CITES-R is unique in its focus on the assessment of symptoms in children ages 8 to 16 who are known to have been sexually abused, whereas the NASAS is specific in its focus on assessment of negative cognitive appraisals attributed to sexual abuse. The SAFE targets fears of children who have been sexually abused. The AFMI explores for selfblaming, self-excusing, perpetrator-blaming, and perpetrator-excusing attributions. The TSCC is perhaps the most extensively researched and widely used instrument aimed at capturing symptoms of anger, depression, and sexual concerns, as well as posttraumatic stress. Its companion measure, the TSCYC, although a parent report, is the only measure for preschoolage children designed to measure PTSD, dissociation, and sexual concerns.
Multiple Trauma Symptom Measures

This category includes instruments designed to capture a traumatic impact other than or in addition to PTSD symptoms. Nine measures are discussed in this section. Three have been developed with the school-age or preschool-age child in mind (Angie-Andy Cartoon Scale [ACS], Pediatric Emotional Distress Scale [PEDS], and the Trauma Symptom Checklist for Young Children [TSCYC]). Five (Childrens Impact of Traumatic Events ScaleRevised [CITESR], Child Report of Posttraumatic Symptoms and Parent Report of Posttraumatic Symptoms [CROPS and PROPS], Negative Appraisals of Sexual Abuse [NASAS], Sexual Abuse Fear Evaluation [SAFE], and Trauma Symptom Checklist for Children [TSCC]) target both chil-
Angie-Andy Cartoon Scale (ACS)

Target population and age group. Children ages 6 to 11. Purpose. The purpose is to capture the inner experiences of children exposed to repeated or chronic episodes of violence or other traumatic events. Description. This instrument is designed in a cartoon-based format that presents drawings of a girl or boy who manifests traumatic stress symptoms. The child uses a thermometer response format, pointing to a picture of a thermometer, to indicate never, just a few times, some of the time, and a lot of the time as a response. The original 110-item Angie Andy test takes about 45 minutes to administer. The items result
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in information on six scales: (a) Dysregulation of Affect, (b) Attention or Consciousness, (c) Self-Perception, (d) Relations with Others, (e) Somatization, and (f) System of Meaning. The first two scales form one composite scale measuring the three main constructs associated with posttraumatic stress. The last four scales form a second composite scale: the Total Associated Symptom Scale. Psychometric properties. The authors report excellent internal reliability (Cronbachs alpha = .90 for the Total PTSD scale and .95 for the Total Associated Symptom scale). Promising construct and concurrent validity based on a study with three groups of traumatized children and one nontrauma group are also reported. Children were predominantly Black and Hispanic. The scales differentiated between trauma and nontrauma groups in the predicted direction (Praver, DiGuiseppe, Pelcovitz, Mandel, & Gaiines, 2000). Analysis. This scale has great potential as a symptom measure for young children ages 6 to 11 who may respond well to the format of drawings. However, the 110-item scale is rather lengthy to administer. It has been reduced to 44 items, but psychometric properties of that are not yet available. Contact information. Multi-Health Systems Inc., P.O. Box 950, North Tonawanda, NY 14120; Web site: www.mhs.com.
results in scores on five subscales for each type of maltreatment (self-blaming, cognition, selfblaming effect, self-excusing, perpetrator blaming, and perpetrator excusing; McGee, Wolfe, & Olson, 2001). Psychometric properties. In a study with 160 adolescents from an open child protective caseload, factor analysis confirmed the conceptual structure of each of the five subscales and was stable across the types of maltreatment. Moderate internal reliability was ascertained (mean and median coefficients were .62 and .70, respectively). In a subsample of 33 adolescents, moderate (.68) to high (.98) test-retest reliability was ascertained (McGee et al., 2001). Sexual abuse had the highest reliability and criterion validity (Feindler et al., 2003). Analysis. It is one of the few instruments that explores for attribution of maltreatment; early psychometric work shows promising results. Contact information. Vicky Wolfe, Childrens Hospital of Western Ontario Department of Psychiatry, 800 Commissioners Road East, London, Ontario, Canada N6A 5C2; e-mail: vicky.wolfe@lhsc.on.ca.
Child Report of Posttraumatic Symptoms (CROPS) and Parent Report of Posttraumatic Symptoms (PROPS)
Target population and age group. Children ages 6 to 18. Purpose . The purpose is to screen for posttraumatic symptoms. Description. The CROPS and PROPS are child and parent self-report measures of symptoms that reflect a broad definition of posttraumatic symptomatology rather than being limited to PTSD symptoms for the previous 7 days (Greenwald & Rubin, 1999a). Both instruments can be administered either by paper and pencil or verbally (in an interview format or via telephone). Approximately 5 minutes are needed to complete each measure. The response format for both measures is a 3-point Likert-type scale (0 = none, 1 = some, and 2 = lots). Sample items in-
Attribution for Maltreatment Inventory (AFMI)

Target population and age group. Adolescents with a history of physical, emotional, or sexual abuse; neglect; or exposure to family violence. Purpose. The purpose is to assess an adolescents attribution for maltreatment. Description. The measure comprises four structured interviews, one for each major type of maltreatment: hostile maltreatment, exposure to family violence, sexual abuse, and neglect. Only interviews that are relevant to the adolescents experience are administered. This
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clude I find it hard to concentrate, I do some things that Im probably too old for, I dont feel like doing much, and I am jumpy or nervous. Higher scores reflect more posttraumatic stress symptoms. Cutoff scores have been developed to indicate clinical concern (Soberman, Greenwald, & Rule, 2002). The pair of measures has been used with diverse ethnic, social-economic, national, and international populations, as well as with males and females. Spanish, German, and Bosnian translations exist. Psychometric properties. The measures were validated for use with children ages 8 to 15. To date, five studies have explored the psychometric properties of the test, resulting in excellent internal consistency (.91 for CROPS and .93 for PROPS). Test-retest reliability is reported to be high, with a correlation of .80 (p < .001) on the CROPS and .79 (p < .001) on the PROPS (Greenwald & Rubin, 1999a). Good criterion validity, .60 (p < .001) for CROPS and .56 (p < .001) for the PROPS, was established through a comparison of the CROPS and the PROPS and the Lifetime Incidence of Traumatic Events Scales (Greenwald & Rubin, 1999b). Analysis. These are relatively brief self-report measures with good reliability. Further psychometric studies are warranted to establish firm validity findings. A unique feature is the translation of the instruments into three other languages. Contact information. Sidran Institute, 200 East Joppa Rd., Suite 207, Baltimore, MD 21286; Web site: sidran.org.
scales along four dimensions: (a) PTSD symptoms, (b) eroticism, (c) abuse attribution, and (d) social reactions. It is an interview that takes 10 minutes to 40 minutes to administer. Psychometric properties. Reliability is moderate, with a mean alpha value of .69 for the 11 scales. However, there is some variability, with a range of .56 to .79. The strongest domains are intrusive thoughts and negative reactions to others. Construct validity was supported for the symptom scales (PTSD and eroticism), but the predicted correlations were more modest than anticipated. Construct validity for both the abuse attribution and social support domains was mixed (Chaffin & Shultz, 2001). Convergent and discriminant validity between the CITESR and TSCC was demonstrated across many of the subscales (Crouch, Smith, Ezzell, & Saunders, 1999). Analysis. This instrument is unique in its attempt to capture mediating factors as well as symptom distress in reaction to sexual abuse. Modest psychometric properties warrant further study. Contact information. Vicky Veitch Wolfe, Childrens Hospital of Western Ontario Department of Psychiatry, 800 Commissioners Road East, London, Ontario, Canada N6A 5C2; e-mail: vicky.wolfe@lhsc.on.ca.
Negative Appraisals of Sexual Abuse Scales (NASAS)

Target population and age group . Sexually abused children and adolescents. Purpose. The purpose is to predict a youths adjustment to sexual abuse. Description. The NASAS (Spaccarelli, 1995; Spaccarelli & Fuchs, 1997) is a 56-item selfreport measure that measures perception of threat or harm associated with sexual abuse. Eight theoretical subscales compose the NASAS: (a) Physical Pain or Damage, (b) Negative Self-Evaluation, (c) Global, Negative SelfEvaluation, (d) Sexuality, (e) Loss of Desired Resources, (f) Harm to Relationships and Security,
Childrens Impact of Traumatic Events-Revised (CITES-R)

Target population and age group . Sexually abused children ages 8 to 16. Purpose. The purpose is to assess PTSD, sexualization, and mediating factors in children who have been sexually abused. Description. The CITES-R (Wolfe, 1996; Wolfe et al., 1991) comprises 78 items that fall into 11
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(g) Harm to Others, and (h) Criticism of Others. Items explore for thoughts or feelings about the perpetrator (e.g., Because of what happened to you with that person did it make you think or feel: you did something bad or wrong, you trust people too much, and you might get yelled at or punished (Spaccarelli & Fuchs, 1997). The response format is a 4-point Likerttype scale (1 = not at all, 2 = a little, 3 = sometimes, 4 = a lot). Psychometric properties. For the total scale, high internal consistency was found (.96), and moderate to high internal consistency was found for the subscales. Symptoms of depression and anxiety were correlated with negative appraisals. Support for convergent validity is reported based on findings of a significant, though moderate, correlation with therapists overall ratings of abuse stress (r = .32, p < .05) and with abuse-related stress as measured by the C-SARS (r = .44, p < .01). Some discriminant validity was demonstrated (Spaccarelli, 1995; Spaccarelli & Fuchs, 1997). Analysis. Strong reliability properties enhance the use of the measure with children and adolescents who have been sexually abused to assess their response to abuse and other related stressful events. An advantage is the ability to connect cognitive reactions to particular internalizing symptoms. Contact information. Steven Spaccarelli, Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, 907 South Wolcott Ave., Chicago, IL 60612.
and 4 = very oftenthe parent responds to 17 general behavior items and 4 trauma-specific items (i.e., Has bad dreams, Cries without good reason, Seems to be easily startled, and Seems fearful of things that are reminders of [fill in the blank]. The items focus on specific symptoms empirically related to childhood trauma (Saylor & Swenson, 1999). Cutoff scores are developed for the total scale and each of the subscales (Anxious or Withdrawn, Fearful, and Acting Out). It is not intended to be a diagnostic instrument. Psychometric properties. Factor analysis of the 21 items generated from four samples of 2- to 10-year olds (traumatic event exposure and nontraumatic event exposure) yielded three reliable factors. These are labeled anxious or withdrawn, fearful and acting out. Total and subscale scores demonstrated good internal consistency (factor alpha coefficients ranged from .72 to .78), and both test-retest (coefficients = .56 to .61) and interrater reliability were at satisfactory levels. Discriminant analyses distinguished between trauma exposure and nontrauma exposure groups (Saylor & Swenson, 1999). Analysis. It is among the most robust of the one-page symptom checklists and one of the few targeted for children as young as age 2. Contact information. Dr. Conway Saylor, Department of Psychology, The Citadel, 171 Moultrie Ave., Charleston, SC 29409. The measure is available for free at www.mentalhealth. org/publications/allpubs/SMA95-3022/ default.asp.
Pediatric Emotional Distress Scale (PEDS)

Target population and age group. Children ages 2 to 10. Purpose. The purpose is to detect elevated levels of symptoms and behavior in children following exposure to a stressful or traumatic event. Description. This is a 21-item parent report scale. Employing a 4-point Likert-type rating scale1 = almost never, 2 = sometimes, 3 = often,
Sexual Abuse Fear Evaluation (SAFE)

Target population and age group . Sexually abused children. Purpose. The purpose is to assess abuserelated fears in sexually abused children. Description. The SAFE is a 27-item scale that is part of a larger 80-item Fear Survey Schedule for ChildrenRevised. Two subscales compose the SAFE: Sexual Associated Fears and Interpersonal Discomfort. The 3-point Likert-type scale
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response format facilitates scoring (Feindler et al., 2003). Psychometric properties. High internal reliability was found for both subscales. Validity could not be established (Feindler et al., 2003). Analysis. Psychometric properties suggest its use primarily to assess the degree of fear and distress where sexual abuse has already been established (Feindler et al., 2003). Contact information. Vicky Wolfe, The University of Western Ontario; e-mail: vicky.wolfe@ lhsc.on.ca.
exploration with a clinical sample resulted in findings of strong coefficient alphas as well (Sadowski & Friedrich, 2000). It is standardized on a large sample of racially and economically diverse children, providing norms on age and sex. Analysis. An exceptionally well-evaluated measure, this instrument is useful for rapid assessment. It can be administered quickly and yields statistically reliable and valid information for a variety of domains. Contact information. Psychological Assessment Resources, Inc., 16204 N. Florida Ave., Lutz, FL 33549; Web site: parinc.com.
Trauma Symptom Checklist for Children (TSCC)

Target population and age group. Children ages 8 to 16. Purpose. The purpose is to evaluate the impact of trauma as a manifestation in both symptoms of PTSD and related psychological symptomatology. Description. The TSCC (Briere, 1996) is a selfreport measure with 54 items and is also available in a 44-item alternative version, the TSCC-A, minus items making reference to sexual issues. Items are grouped into two rater validity scales and six clinical scales. The six clinical scales are Anxiety, Depression, Anger, Posttraumatic Stress, Dissociation (with two subscales), and Sexual Concerns. Psychometric properties. This measure has the advantage of extensive administration with normative samples and yields high internal consistency for five of the six scales (alpha range is from .82 to .89). The Sexual Concerns scale has slightly lower internal consistency (alpha = .77). Results indicate strong construct validity (Elliot & Briere, 1994; Evans, Briere, Boggiano, & Barrett, 1994; Singer, Anglin, Song, & Lunghofer, 1995), convergent and discriminant validity (Briere, 1996; Brier & Lanktree, 1995; Evans et al., 1994; Friedrich & Jaworski, 1995), and criterion validity (Diaz, 1994). Results of
Trauma Symptom Checklist for Young Children (TSCYC)

Target population and age group. Children ages 3 to 12. Purpose. The purpose is to measure the behavioral manifestations of complex trauma in children younger than 7. Description. This is a 90-item parent or caretaker report measure. It contains two scales to help determine the validity of caretaker reports and eight clinical scales designed to measure the psychological consequences of exposure to trauma. The eight scales are (a) Posttraumatic StressIntrusion, (b) Posttraumatic Stress Avoidance, (c) Posttraumatic StressArousal (a composite scale Posttraumatic stressTotal), (d) Sexual Concerns, (e) Dissociation, (f) Anxiety, (g) Depression, and (h) Anger or Aggression. Psychometric properties. Findings reported on a multisite analysis suggest good internal reliability, with alpha ranging from .81 for Sexual Concerns to .93 for the PTSD-Total, with an average of .87 across all scales (Briere et al., 2001). The authors report good construct validity for the scales measuring Posttraumatic Stress, Sexual Concerns, and Dissociation but not for the three mood-related scales. The reported study found few rater variable effects. Data are not yet available on a normative population.
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Analysis. One strength of this measure lies in its target population of children younger than 7. However, the mean age in the study exploring reliability and association with abuse experiences was 7.1 years, suggesting that further work with a younger population may need to be undertaken. The respondent validity scales are a strength, particularly because preliminary data suggest little rater variability. The initial study group was mixed ethnically and racially, and findings from the multisite study suggest little racial bias. Contact information. Psychological Assessment Resources, Inc., 16204 N. Florida Ave., Lutz, FL 33549; Web site: parinc.com. SUMMARY AND DISCUSSION No one measure is suited to every situation or condition. Context defines need, and the choice of an instrument will depend on the age of the child, the psychometric rigor desired, user friendliness, the desire to capture a particular construct, the purpose of the assessment whether research or clinicalcost, and accessibility. The good news is that the field reflects a profusion rather than a paucity of measures. From broad to specific constructs of trauma; from brief, 5-minute checklists to 2-hour structured interviews; (and unfortunately, from those with little published psychometric analyses to those with very rigorous reliability and validity studies); the field of screening and assessment has grown enormously during the past decade. There are individual, robust measures, if one is looking for a single instrument to assess exposure or impact. Measures can also be combined depending on the purpose of the assessment and the need for comprehensiveness. Additional good news is that the majority of instruments are available at minimal or no cost. Some generalizations can be made based on the universe of instruments currently available. Those instruments probing for both a history of exposure and an assessment of impact rely heavily on a measure of PTSD as the defining impact symptom. Measures exploring for a history of exposure cluster in specific areas; only
one is a broad trauma measure that explores for a range of exposures (TESI). Of the remainder in this category, three probe for a history of sexual abuse, one explores for a history of community violence, and one for explores a history of child abuse and neglect more generally. Those in the PTSD and Dissociative categories are selfexplanatory, although only two are specific to dissociative symptoms. In the Multiple Trauma Symptom category, five of the measures extend the definition of trauma to include symptoms beyond those associated with PTSD, three are concerned specifically with symptoms associated with the trauma of sexual abuse, and one probes for symptoms related to the impact of four types of maltreatment. Of the 25 measures discussed above, 8 are designed for children only (including the parent version of the TESI). Of these, 3 are self-report measures; 4 rely on parent reports, and 1 is a clinician-administered interview. In comparison, 5 instruments are designed for only adolescents, and all are self-reports. Twelve target both children and adolescents. Two gaps are immediately noticeable: (a) Instruments are not by and large designed to be age specific, raising questions about the influence of age on outcome. Only eight of the measures are designed for a child 10 or younger, and few of these are geared for the very young child. Only fourthe TESI parent report (a history of events measure), the CDC (a parent report and measure of dissociation), the PEDS (a parent report of multiple trauma symptoms), and the TSCYC (a parent report and multiple trauma symptom impact measure)focus on the preschool-age or very young child. (b) The Multiple Trauma Symptom category is noteworthy for the lack of measures designed specifically for adolescents. None of the five adolescent-only measures fall into the Multiple Trauma Symptom category. If in fact it is more likely that children are better reporters of internalizing symptoms and that parents more accurately report externalizing or behavioral symptoms (Greenwald & Rubin, 1999a), then those that provide for both emerge as more comprehensive. Five of the in-
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struments in this review draw on information from both children and parents, at least one in each of the categories (the CPTSDI and UCLA PTSD Index in the History of Exposure and Symptoms category, the TESI in the History of Exposure Only category, the CAPA in the category of PTSD and Dissociative Symptoms, and the CROPS and PROPS in the Multiple Trauma Symptom category). Further psychometric development is warranted for most measures. Some of those with a history of robust psychometric properties with earlier reiterations are in the midst of major revisions (i.e., UCLA PTSD Reaction Index, TESI, CAPS-CA, and ACS); others are new and also actively under development (e.g., TSCYC). Many have some published psychometric strengths but do not appear to be widely available or to be currently actively researched (e.g., Child Posttraumatic Stress Disorder [CPDSDI], NASAS, SAFE). The degree to which a measure is user friendly is often a criterion in the choice of an instrument. In many respects, this criterion favors the self-report measures because they take a shorter time to administer. Of the 25, 11 are client self-reports, and 5 are parent self-reports only. These are fairly evenly distributed across the category of measure (history of exposure, symptom distress, or both). Most of these reported good to very good reliability and validity data. The seven clinician-administered measures are all in interview format and often require a longer period of time to administer. All categories have at least one clinicianadministered instrument, but as a group, these
tended to have less well-developed or studied psychometric properties than the self-report measures. This is likely due in no small measure to the greater complexity of an interview instrument. Worth commenting on are those measures that meet three criteria: promising in terms of psychometric development, free, and accessible. In the category of both History and Symptoms, the UCLA PTSD Reaction Index (separate self-report measures for children, adolescents, and parents) meets these criteria. In the History of Exposure category, the TESI stands out when these three criteria are applied. In the PTSD and Dissociative Symptom category, the CDC (a parent report) and the CAPS-CA (a clinicianadministered instrument) emerge. The PEDS (a parent self-report instrument) meet these criteria in the Multiple Trauma Symptom category. Together, they total five instruments representing each of the four domains that are available at no cost and are easily accessible. The field has come a long way, but instruments are still needed to fill some of the gaps noted above. We also do not yet know enough about how gender and age influence results. Few studies have fully explored for ethnic, racial, or cultural differences, yet clients with diverse backgrounds increasingly represent the majority of clients in mental health settings, especially in urban areas. The need for the ongoing study of psychometric properties remains a challenge. That being said, there is a remarkable and growing variety of assessment tools for the clinician and researcher to aid in the screening and assessment of child and adolescent trauma.
APPENDIX
Measure
Violence PTSD Both exposure and symptoms measures Self-report 12 to 21 20 Yes Yes
Author
Construct Measured Format Age Group
Corresponds Cost and Published Contact Time to to DSM-IV Administer (in minutes) Criteria Psychometrics Information
Horowitz, Weine, & Jekel
Fletcher
No cost, smweine@ uic.edu No cost, kenneth.fletcher@ umassmed.edu Yes Yes Yes $43.00 for 25, psychcorp.com Yes
Adolescent Self-Report Trauma Questionnaire Childhood PTSD Interview Child Parent Childrens PTSD Inventory PTSD Interview Interview Interview 7 to 18 Parent 7 to 18 Yes Yes Yes PTSD PTSD Self-report 20 Self-report 9 to 18 30 to 45 30 to 60 5 (no history) 15 to 20 (with history) 20 to 30 Yes Yes
Saigh
Hyman, Snook, Berna, DuCette, & Kohr Rodriguez, Steinberg, & Pynoos PTSD Self-report Children 7 to 12, adolescents 13 and older, parent 8 to 13 10 to 20
Yes
My Worst Experience Scale UCLA PTSD Index for DSM-IV (Child, Adolescent, Parent) When Bad Things Happen Scale
Fletcher
Yes
Yes
$115.00 per kit, wpspublish.com No cost, rpynoss.mednet. ucla.edu No cost, kenneth.fletcher@ umassmed.edu
Spaccarelli
No No No
Yes Yes Yes
NA NA NA
History of exposure to trauma measures Sexual abuse Self-report Children and NA adolescents Levy, Markovic, Kalinowski, Sexual abuse Interview 2 to 7 NA Ahart, & Torres Spaccarelli Sexual abuse Self-report Children and NA adolescents Abuse and neglect Maltreatment and abuse Parent interview Interview Children and adolescents Children and adolescents 2 to 12 NA
Abusive Sexual Exposure Scale Anatomical Doll Questionnaire Checklist of Sexual Abuse and Related Stressors Checklist for Child Abuse Evaluation
Petty
No
No
Child Abuse and Neglect Interview
Ammerman, Van Hasselt, & Herson
45
No
Yes
Child Sexual Behavior Inventory
Friedrich
10 to 13
No
Yes
Childhood Trauma Questionnaire
Bernstein & Fink
Sexual abuse Parent report and sexual behavior Abuse and Self-report neglect
12 and older
No
Yes
$126.00 for manual and 25 checklists, parinc.com NA, robert.ammerman@ chmcc.org $139.00 for manual and 50 booklets, parinc.com $105.00 for 25 copies and manual, psychcorp.com (continued)
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APPENDIX (continued)
Measure
Children NA No Yes
Author
Construct Measured Format Age Group
Corresponds Cost and Published Contact Time to to DSM-IV Administer (in minutes) Criteria Psychometrics Information
No cost, vicky.wolfe@ lhsc.on.ca $12.00 for five copies of each form, sidran.org Yes Yes Yes No cost, jrichter@ nih.gov No cost, ncptsd@ ncptsd.org
History of Victimization Form Lifetime Incidence of Traumatic Events students and parents 8 and older 6 to 10 10 10 NA No No No
Wolfe, Wolfe, Gentile, & Bourdeau Greenwald
Survey of Childrens Richters & Saltzman Exposure to Community Violence Ippen, Ford, Racusin, Traumatic Events Acker, Bosquet, Rogers, Screening Inventory Self-Report Revised Ellis, Schiffman, Ribbe, Parent-Report Revised Cone, Lukovitz, & Edwards 6 to 18 8 or younger 20 to 30 20 to 30 Yes Yes
No No
Maltreatment Self-report and abuse Exposure to trauma Self-report Parent report Exposure to Parent report community violence Lifetime exposure to traumatic Self-report or events interview Parent report or interview
Impact of traumaSymptoms and distress indices: PTSD and dissociative measures Adolescent Dissociative Armstrong, Putnam, & Normal and Self-report 11 to 18 15 to 30 No Experience Survey Carlson pathological dissociation 9 to 18 90 Yes
Yes
Yes
$3.00 for printing and mailing, jarmstrong@ mizar.usc.edu $65.00, jduncan@ psych.mcduke.edu 60 Yes Yes $65.00, jduncan@ psych.mcduke.edu 5 No Yes
Symptoms for Interview psychiatric diagnoses PTSD Interview symptoms 9 to 18 Dissociative symptoms Self-report Self-report Parent report 5 to 12
Child and Adolescent Angold, Cox, Prendergast, Psychiatric Rutter, & Simonoff Assessment (CAPA-C) The Life Events and Angold, Cox, Prendergast, Posttraumatic Stress Rutter, & Simonoff Module of CAPA-C Child Dissociative Putnam Checklist 8 to 18 8 to 12
Foa, Johnson, Feeny, & Treadwell Jones
15 5 to 10
Yes
Yes Yes
No cost, frank.putnam@ chmcc.org No cost, foa@ mail.med.upenn.edu No cost, rtjones@ vt.edu Interview 7 to 18 30 to 120 Intrusion and avoidance only Yes Yes No cost, National Center for PTSD, ncptsd@ncptsd.org Interview Adolescents and adults 10 to 20 Reexperience, Yes avoidance, numbing, and hyperarousal No cost, dfoy@ pepperdine.edu
Child PTSD Symptom Scale Child Reaction to Traumatic Events Scale Clinician-Administered PTSD Scale for Children and Adolescents Los Angeles Symptom Checklist
Nader, Kriegler, Blake, Pynoos, Newman, & Weathers
Foy, Wood, King, King, & Resnick
PTSD symptoms Psychological response to stressful life Stress, trauma adaptation, and PTSD PTSD
Angie/Andy Cartoon Trauma Scale Yes Yes
Impact of traumaSymptoms and distress indices: Multiple trauma symptom measures Praver, Pelcovitz, & PTSD, Self-report 6 to 12 45 No Deguiseppe violence, and abuse Attributions for McGee & Wolfe Hostile Interview Adolescents NA No Maltreatment Interview maltreatment Child Report of PostGreenwald & Rubin PTS Self-report 6 to 18 5 to 10 Yes Traumatic Symptoms symptoms Yes PTS symptoms Interview 8 to 16 20 to 40 Yes Yes Parent report 6 to 18 5 to 10 Yes Yes
Parent Report of PostTraumatic Symptoms
Greenwald & Rubin
Childrens Impact of Traumatic Events Scale Revised
Wolfe, Gentile, Michienzi, Sas, & Wolfe
$36.00 reusable booklet and scoring sheets, mhs.com No cost, vicky.wolfe@ lhsc.on.ca $12.00 for five copies of each form, sidran.org $12.00 for five copies of each form, sidran.org No cost, vicky.wolfe@ lhsc.on.ca
Feelings and Emotions Experienced During Sexual Abuse Self-report Children and adolescents NA
Wolfe & Birt
Self-report
Children and adolescents
NA
Yes
Yes
No cost, vicky.wolfe@ lhsc.on.ca
Negative Appraisals of Sexual Abuse Scale
Spaccarelli
No
Yes
NA
Pediatric Emotional Distress Scale Parent report 2 to 10
Saylor & Swenson
NA
No
Yes
No cost, conway.saylor@ citadel.edu
Wolfe & Wolfe Self-report Caretaker report Parent report 8 to 16 3 to 12
Self-report
Children
NA 10 to 20 10 to 20
No No No
Yes Yes Yes
Briere
Briere
PTS, eroticism, perceptions of support, and abuse Emotional reactions to sexual abuse Negative cognitive appraisals associated with sexual abuse Symptoms following a stressful or traumatic event Abuse related fears PTS, PTSD symptoms PTS, PTSD symptoms Behavior associated with sexual abuse Preschool-age children NA No
No cost, vicky.wolfe@ lhsc.on.ca $127.00 for intro. Kit, parinc.com Available 2004, parinc.com Yes NA, jcohen1@ wpahs.org
Sexual Abuse Fear Evaluation Trauma Symptom Checklist for Children Trauma Symptom Checklist for Young Children Weekly Behavior Report
Cohen & Mannarino
NOTE: DSM-IV = Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994); PTSD = posttraumatic stress disorder; UCLA = University of California, Los Angeles; PTS = posttraumatic stress; NA = not applicable.
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Drach, K., Wientzen, J., & Ricci, L. (2001). The diagnostic utility of sexual behavior problems in diagnosing sexual abuse in a forensic child abuse evaluation clinic. Child Abuse & Neglect, 25(4), 489-503. Elliot, D. M., & Briere, J. (1994). Forensic sexual abuse evalua t i o n s o f o l d e r c h i l d re n : Di s c l o s ure s a n d symptomatology. Behavioral Sciences and the Law, 12(3), 261-277. Evans, J. J., Briere, J., Boggiano, A. K., & Barrett, M. (1994, January). Reliability and validity of the Trauma Symptom Checklist for Children in a normal sample. Paper presented at the San Diego Conference on Responding to Child Maltreatment, San Diego, CA. Farrington, A., Waller, G., Smerden, J., & Faupel, A. W. (2001). The Adolescent Dissociative Experience Scale: Psychometric properties and differences in scores across age groups. Journal of Nervous and Mental Disorders, 189(10), 722-727. Feigelman, S., Howard, D. E., Li, X., & Cross, S. I. (2000). Psychosocial and environmental correlations of violence perpetrations among African American urban youth. Journal of Adolescent Health, 27(3), 202-209. Feindler, E., Rathus, J., & Silver, L. (2003). Assessment of family violence: A handbook for research and practitioners. Washington, DC: American Psychological Association. Fletcher, K. (1992). When bad things happen. Unpublished manuscript, University of Massachusetts Medical Center, Worcester. Fletcher, K. (1996). Preliminary psychometrics of four new measures of childhood PTSD. Paper presented at the International Research Conference on Trauma and Memory, Durham, NH. Fletcher, K. (2002). Instructions for use of four measures of childhood PTSD and the Dimensions of Stressful Events (DOSE) Rating Scale. Unpublished manuscript, University of Massachusetts Medical Center, Worcester. Foa, E., Johnson, K., Feeny, N., & Treadwell, K. R. (2001). The child PTSD symptom scale: A preliminary examination of its psychometric properties. Journal of Clinical Child Psychology, 30(3), 376-384. Foa, E., Riggs, D., Dancu, D., & Rothbaum, B. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 6, 459-473. Foy, D. W., & Goguen, C. (1998). Community violencerelated PTSD in children and adolescents. PTSD Research Quarterly, 9(4). Retrieved October 30, 2002, from http://www.dartmouth.edu/dms/ptsd Foy, D. W., Wood, J., King, D., King, L., & Resnick, H. (1997). Los Angeles Symptom Checklist: Psychometric evidence with an adolescent sample. Assessment, 4(4), 377384. Friedrich, W., Grambsch, P., Damon, L., Hewitt, S., Koverola, C., Lang, R., et al. (1992). Child Sexual Behavior Inventory: Normative and clinical comparisons. Psychological Assessments, 4(3), 303-311. Friedrich, W. N., & Jaworski, T. M. (1995). Measuring dissociation and sexual behaviors in adolescents and children. Unpublished manuscript.
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Goldin, S., Levin, L., & Ake-Persson, L. (2003). Child war trauma: A comparison of clinician, parent and child assessment. Journal of Psychiatry, 57(3), 173-183. Greenwald, R. (2000). Child trauma measures for research and practice. Retrieved November 12, 2002, from htttp:// www.childtrauma.com.mezpost.html Greenwald, R., & Rubin, A. (1999a). Assessment of posttraumatic symptoms in children: Development and preliminary validation of parent and child scales. Research on Social Work Practice, 9, 61-75. Greenwald, R., & Rubin, A. (1999b). Brief assessment of childrens post-traumatic symptoms: Development and preliminary validation of parent and child scales. Research on Social Work Practice, 9(1), 61-76. Greenwald, R., Rubin, A., Jurkovic, G., Wiedemann, J., Russell, A., OConnor, M., et al. (2002). Psychometrics of the CROPS & PROPS in multiple cultures/translation. R e t r i e v e d De c e m b e r 1 2 , 2 0 0 3 , f ro m h t t p : / / www.childtrauma.com/postrops.html Horowitz, K., Weine, S., & Jekel, J. (1995). PTSD symptoms in urban adolescent girls: Compounded community trauma. Journal of American Academy of Adolescent Psychiatry, 34(10), 1353-1361. Jaycox, L. (2002). Violence exposure, posttraumatic stress disorder, and depressive symptoms among recent immigrants school children. Journal of the American Academy of Child Adolescents, 41(9), 1104-1110. King, L., King, D., Lesking, G., & Foy, D. (1995). The Los Angeles Symptom Checklist: A self-report measure of posttraumatic stress disorder. Assessment, 2, 1-17. Levy, H., Markovic, J., Kalinowski, M., Ahart, S., & Torres, H. (1995). Child sexual abuse interviews: The use of anatomical dolls and the reliability of information. Journal of Interpersonal Violence, 10(3), 334-353. McGee, R., & Wolfe, D. (1990). Development of a record of maltreatment experiences. Unpublished manuscript, the Institute for the Prevention of Child Abuse, Toronto, Ontario, Canada. McGee, R., Wolfe, R., & Olson, J. (2001). Multiple maltreatment, attribution of blame, and adjustment among adolescents. Development & Psychopathology, 13(4), 827-846. Nader, K. O. (1997). Assessing traumatic experiences in children. In J. Wilson & T. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 291-348). New York: Guilford. Nader, K. O., Kriegler, J., Blake, D., Pynoos, R., Newman, E., & Weather, F. (2002). The Clinician-Administered PTSD Scale, Child and Adolescent Version (CAPS-CA). White River Junction, VT: National Center for PTSD. Nader, K. O., Newman, E., Weathers, F. W., Kaloupek, D. G., Kriegler, J. A., Blake, D. D., et al. (1998). ClinicianAdministered PTSD Scale for children and adolescents for DSM-IV, CAPS-CA. White River Junction, VT: National Center for PTSD and UCLA Trauma Psychiatry Program. Nader, K. O., Pynoos, R., & Fairbanks, L. (1990). Childhood PTSD reactions one year after a sniper attack at their school. American Journal of Psychiatry, 147(11), 15261530.
Ohan, J., Myers, K., & Collett, B. (2002). Ten-year review of rating scale IV: Scales assessing trauma and its effects. Academy Child Adolescent Psychiatry, 41(12), 1401-1422. Petty, J. (1990). Checklist for child abuse evaluations. Lutz, FL: Psychological Assessment Resources. Pfefferbaum, B., Nixon, S., & Tucker, P. (1999). Posttraumatic stress responses in bereaved children after the Oklahoma City bombing. Journal of the American Academy of Child & Adolescent Psychiatry, 38(11), 13721379. Praver, F., DiGuiseppe, R., Pelcovitz, D., Mandel, F., & Gaines, R. (2000). A preliminary study of a cartoon measure for childrens reactions to chronic trauma. Child Maltreatment, 5(3), 273-285. Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. New York: Guilford. Putnam, F. W., Helmer, K., & Trickett, P. K. (1993). Development, reliability and validity of a child dissociation scale. Child Abuse & Neglect, 17(6), 731-741. Putnam, F. W., & Peterson, G. (1994). Further validation of the child dissociative checklist. Dissociation, 7(4), 204211. Pynoos, R., Frederick, C., Nader, K., Arroyo, W., Steinberg, A., Eth, S., Nunez, F., & Fairbanks, L. (1987). Life threat and posttraumatic stress in school-age children. Archives of General Psychiatry, 44, 1057-1063. Pynoos, R., Goenjian, A., & Tashjian, M. (1993). Posttraumatic stress reactions in children after the 1988 American earthquake. British Journal of Psychiatry, 163, 239-247. Pynoos, R., Rodriguez, N., Steinberg, A., Stuber, M., & Frederick, C. (1998). The UCLA PTSD reaction index for DSM IV (Revision 1). Los Angeles: UCLA Trauma Psychiatry Program. Ribbe, D. (1996). Psychometric review of Traumatic Events Screening Inventory for Children (TESI-C). In B. H. Stamm (Ed.), Measurement of stress, trauma, and adaptation (pp. 386-387). Lutherville, MD: Sidran. Richters, J. E., & Martinez, P. (1993). The NIMH community violence project: I. Children as victims of and witnesses to violence. Psychiatry, Interpersonal and Biological Processes, 56, 7-21. Sadowski, C. M., & Friedrich, W. N. (2000). Psychometric properties of the Trauma Symptom Checklist for Children (TSCC) with psychiatrically hospitalized adolescents. Child Maltreatment, 5(5), 364-372. Saigh, P. A. (2000). Diagnosing child-adolescent posttraumatic stress disorder. New York: Graduate School and University Center, City University of New York. Saigh, P. A. (2002). The Childrens Post Traumatic Stress Disorder-Inventory (CPTSD-I). New York, NY. Saigh, P. A., Yasik, A., Oberfield, R., Green, B., Halamandaris, P., Rubenstein, H., et al. (2000). The Childrens PTSD Inventory: Development and reliability. Journal of Traumatic Stress, 13(3), 369-380. Saltzman, W. R., Pynoos, R. S., Steinberg, A. M., Layne, C. M., Aisenberg, E. (2001). Trauma and grief-focused intervention for adolescents exposed to community
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violence: Results of a school-based screening and group treatment approach. Group Dynamics, 5(4), 291-303. Saltzman, W., Steinberg, A., & Layne, C. (2001). A developmental approach to school-based treatment of adolescents exposed to trauma and traumatic loss. Journal of Child & Adolescent Group Therapy, 11(2-3), 43-56. Saylor, C. F., & Swenson, C. C. (1999). The Pediatric Emotional Distress Scale: A brief screening measure for young children exposed to traumatic events. Journal of Clinical Child Psychology, 28(1), 70-81. Singer, M. I., Anglin, T. M., Song, L. Y., & Lunghofer, L. (1995). Adolescents exposure to violence and associated symptoms of psychological trauma. Journal of the American Medical Association, 273(6), 477-482. Soberman, G. B., Greenwald, R., & Rule, D. L. (2002). A controlled study of eye movement desensitization and reprocessing (EMDR) for boys with conduct problems. In R. Greenwald (Ed.), Trauma and juvenile delinquency: Theory, research, and intervention (pp. 217-235). New York: Haworth Maltreatment & Trauma. Spaccarelli, S. (1995). Measuring abuse, stress, and negative cognitive appraisals in child sexual abuse: Validity data on two new scales. Journal of Abnormal Child Psychology, 23(6), 703-726. Spaccarelli, S., & Fuchs, L. (1997). Variability in symptoms expression among sexually abused girls: Developing multivariate models. Journal of Clinical Child Psychology, 26(1), 24-35. Stamm, H. (1996). Measurement of stress, trauma, and adaptation. Lutherville, MD: Sidran. Stuvland, R., Durakovic-Belko, E., & Kutlaca, M. (2001). Evaluation of the psychosocial projects in primary and secondary schools in Bosnia and Herzegovina 1992-1998. Bosnia and Herzegovina: UNICEF. Wherry, J., Jolly, J., Feldman, J., Adam, B., & Manjanatha, S. (1994). The Child Dissociative Checklist: Preliminary finding of a screening measure. Journal of Child Sexual Abuse, 3(3), 51-66. Wolfe, V. V. (1996). Measuring post-traumatic stress disorder: The Childrens Impact of Traumatic Events Scale Revised. APSAC Advisor, 9(2), 25-26. Wolfe, V. V., & Birt, J. (1993). The Feelings and Emotions Experienced During Sexual Abuse Scale. London, Ontario, Canada: London Health Sciences Center.
Wolfe, V. V., Gentile, C., Michienzi, T., Sas, L., & Wolfe, D. (1991). The Childrens Impact of Traumatic Events Scale: A measure of post-sexual abuse PTSD symptoms. Behavioral Assessment, 13(4), 359-383. Wolfe, V. V., & Wolfe, D. (1986). The Sexual Abuse Fear Evaluation. London, Ontario, Canada: London Health Sciences Center. Yasik, A., Saigh, P., Oberfield, R., Green, B., Halamandaris, P., McHugh, M., et al. (2001). The validity of the Childrens PTSD Inventory. Journal of Traumatic Stress, 14, 81-94.
Virginia C. Strand, D. S. W., is Associate Professor and Director of the Children and Families Institute for Research, Support and Training (Children FIRST) at Fordham University Graduate School of Social Service. Dr. Strand is an experienced educator, trainer, program evaluator, and clinician. She has published in the field of child welfare and childrens mental health, particularly in the evaluation and treatment of standardized trauma assessment measures in community-based mental health services for children and adolescents. Teresa L. Sarmiento, M. S. W., is a doctoral candidate at Fordham University Graduate School of Social Service and a former doctoral fellow at Children FIRST. Her work experience has been in the area of juvenile delinquency and violence prevention. Her current research interests are child trauma, special education, and child maltreatment in relationship to juvenile delinquency. Lina E. Pasquale, M. A., serves as the Research Coordinator for the Childrens Trauma Consortium of Westchester County, NY, a joint project of Children FIRST at Fordham University Graduate School of Social Services and three mental health agencies. Her work experience includes research experience in the evaluation of an intervention program for adolescents with a history of trauma.

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Trauma,http://tva.sagepub.

com/ Violence, & Abuse

>> Version of Record - Dec 1, 2004 What is This?

ASSESSMENT AND SCREENING TOOLS FOR TRAUMA IN CHILDREN AND ADOLESCENTS

VIRGINIA C. STRAND TERESA L. SARMIENTO LINA E. PASQUALE

TRAUMA, VIOLENCE, & ABUSE / January 2005

Strand et al. / ASSESSMENT AND SCREENING TOOLS

CPTSDIChild (CPTSDI-C) and CPTSDIParent (CPTSDI-P)

Childrens PTSD Inventory

TRAUMA, VIOLENCE, & ABUSE / January 2005

Strand et al. / ASSESSMENT AND SCREENING TOOLS

When Bad Things Happen Scale (WBTH)

Anatomical Doll Questionaire (ADQ)

TRAUMA, VIOLENCE, & ABUSE / January 2005

Child Sexual Behavior Inventory (CSBI-I)

Checklist of Sexual Abuse and Related Symptoms (C-SARS)

Strand et al. / ASSESSMENT AND SCREENING TOOLS

Survey of Childrens Exposure to Community Violence

Child Trauma Questionnaire (CTQ)

TRAUMA, VIOLENCE, & ABUSE / January 2005

Traumatic Events Screening Inventory (TESI)

Strand et al. / ASSESSMENT AND SCREENING TOOLS

PTSD and Dissociative Measures

Adolescent Dissociative Experience Scale (A-DES)

Child and Adolescent Psychiatric Assessment (CAPA-C, CAPA-P)

TRAUMA, VIOLENCE, & ABUSE / January 2005

Child Dissociative Checklist (CDC)

Child PTSD Symptom Scale (CPSS)

Strand et al. / ASSESSMENT AND SCREENING TOOLS

Los Angeles Symptom Checklist (LASC)

Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA)

TRAUMA, VIOLENCE, & ABUSE / January 2005

Multiple Trauma Symptom Measures

Angie-Andy Cartoon Scale (ACS)

Strand et al. / ASSESSMENT AND SCREENING TOOLS

Attribution for Maltreatment Inventory (AFMI)

TRAUMA, VIOLENCE, & ABUSE / January 2005

Negative Appraisals of Sexual Abuse Scales (NASAS)

Childrens Impact of Traumatic Events-Revised (CITES-R)

Strand et al. / ASSESSMENT AND SCREENING TOOLS

Pediatric Emotional Distress Scale (PEDS)

Sexual Abuse Fear Evaluation (SAFE)

TRAUMA, VIOLENCE, & ABUSE / January 2005

Trauma Symptom Checklist for Children (TSCC)

Trauma Symptom Checklist for Young Children (TSCYC)

Strand et al. / ASSESSMENT AND SCREENING TOOLS

TRAUMA, VIOLENCE, & ABUSE / January 2005

Construct Measured Format Age Group

Horowitz, Weine, & Jekel

Yes Yes Yes

Child Abuse and Neglect Interview

Ammerman, Van Hasselt, & Herson

Child Sexual Behavior Inventory

Childhood Trauma Questionnaire

Bernstein & Fink

Construct Measured Format Age Group

Wolfe, Wolfe, Gentile, & Bourdeau Greenwald

Foa, Johnson, Feeny, & Treadwell Jones

Nader, Kriegler, Blake, Pynoos, Newman, & Weathers

Foy, Wood, King, King, & Resnick

Angie/Andy Cartoon Trauma Scale Yes Yes

Parent Report of PostTraumatic Symptoms