Evidence-based assessment/Instruments/Child PTSD symptom scale

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

Reliability
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.

Validity
Validity describes the evidence that an assessment tool measures what it was supposed to measure. There are many different ways of checking validity. For screening measures, diagnostic accuracy and 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.

Development and history
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 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.
 * 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.

Impact

 * 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

 * 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.

Scoring instructions and syntax
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
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.

CSV shell for sharing

 * 

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
R code goes here

SPSS code goes here

SAS code goes here

Example page

 * General Behavior Inventory