PTSD Page –51

Table 1: Key Symptoms and Clusters for the Diagnosis of PTSD Using DSM-5 and ICD-11
Clusters/Symptoms DSM-5 ICD-11
Adult criteria Young child criteria PTSD Complex PTSD
Re-experiencing
Intrusive memories ü ü * *
Nightmares ü ü ü ü
Flashbacks ü ü ü ü
Psychological distress ü ü
Physiological reactions ü ü
Avoidance
Avoidance of internal cues (e.g., thoughts, memories) ü ü ü
Avoidance of external cues ü ü ü
Physical (e.g., activities, places) ü
Interpersonal (e.g., people, conversations) ü
Cognitions/Mood
Inability to recall trauma ü
Negative beliefs ü
Blame for event ü
Negative emotional state ü ü
Anhedonia ü ü
Detachment/estrangement ü
Inability to feel positive emotions ü ü
Socially withdrawn play ü
Arousal
Irritability/anger ü ü
Reckless/self-destructive ü
Hypervigilance ü ü ü ü
Startle response ü ü ü ü
Concentration ü ü
Insomnia ü ü
Complex
Affect dysregulation ü
Beliefs about worthlessness/defeat ü
Feelings of shame/guilt ü
Difficulty sustaining relationships ü
Difficulty feeling close to others ü
Note. The DSM-5 Young Child criteria are intended for Children 6 Years and Younger but may be useful for older children as well.
* Intrusive memories must be vivid and accompanied by feelings of being immersed in the traumatic event in the present
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Table 2: Starter Kit of Measures for Screening and Assessing PTSD in Youth

Measure Assesses Versions Ages Comments/Source

Child PTSD Symptom • Trauma Exposure (7 items) • Child Self Report 8 – 18 years Good correspondence between the
Scale for DSM-5 • PTSD Symptoms (20 items) • Clinician Interview versions; PTSD rates higher with child
(CPSS-5) • Functioning (7 items) • Caregiver Report (in report.
• Includes a Screen for PTSD development) Foa et al. (2018)
(6 items) • English Language http://www.episcenter.psu.edu/
• Multiple languages sites/default/files/CPSS-V%20
for DSM-IV version Scoring%20%26%20Psychometrics.pdf

UCLA Child/ • Trauma Exposure (23 items) • Child Self Report 7 – 18 years Widely used measure of PTSD
Adolescent PTSD • PTSD Symptoms (27 items) • Clinician Interview symptomatology.
Reaction Index for • Functioning (9 items) • Caregiver Report Training video available at
DSM-5 (PTSD-RI-5) • Includes a dissociative • English, Spanish, https://www.nctsn.org/print/967
subtype (4 items) German, Arabic Pynoos et al. (2015); Elhai et al.
(2013); Steinberg et al. (2013).
Young Child PTSD • Trauma Exposure (12 items) • Caregiver Report 1 – 6 years Scheering & Haslett (2010)
Checklist (YCPC) • PTSD Symptoms (24 items) Available at:
• Functioning (6 items) http://www.midss.org/content/young-
child-ptsd-checklist
Child Behavior • PTSD Symptoms (14 item • Parent report 11-18 years Strongest support is for the Youth Self
Checklist- version is recommended) • Youth report Report version of this measure; mixed
Posttraumatic Stress • (Teacher report not findings for this measure with
Disorder Scale (CBCL- recommended) preschool aged children.
PTSD) Ruggiero & McLeer (2000); You et al.
(2017).
International Trauma • Adult based ITQ has 12 • Youth report 11 – 18 years Youth measure is currently under
Questionnaire (ITQ) – items development. Based on the ICD-11
Youth Version criteria for PTSD. Adult-based ITQ is
freely available.
See Cloitre et al. (2018).
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Table 3: Resources for Child and Adolescent Measures of PTSD and Trauma Exposure

Resource Website Type of Information

National Center for PTSD https://www.ptsd.va.gov/professional/assessment/child/ Includes information on a variety of measures

index.asp assessing trauma and PTSD in youth. These
measures are intended for use by qualified
mental health professionals and researchers.

National Child Traumatic https://www.nctsn.org/treatments-and- Measures Database: Includes reviews of tools

Stress Network practices/screening-and-assessments/measure-reviews that measure children's experiences of trauma,
their reactions to it, and other mental health and
trauma-related issues

International Society for https://www.istss.org/assessing-trauma.aspx Trauma Assessment Tools: Includes test

Traumatic Stress Studies: materials, treatment manuals and other
Trauma Assessment Tools assessment resources, focused on PTSD
assessment and treatment
American Psychological https://www.apa.org/ptsd- PTSD Assessment Instruments: Includes
Association guideline/assessment/index.aspx interview and self-report instruments used with
adults. Includes DSM-5 versions of widely
used measures.

National Center for Mental https://www.ncmhjj.com/resources/review-child- Lists the profiles of 29 tools that screen youth
Health and Juvenile Justice adolescent-trauma-screening-tools/ for trauma including the number of items, target
age, accessibility, languages, and empirical
support

Evidence-based Prevention http://www.episcenter.psu.edu/newvpp/tfcbt/evaluation- Lists a wide variety of clinical assessment tools

and Support Center (PA tools#Other%20Clinical%20Assessment%20Tools relevant for evaluating trauma exposure and
Department of Human PTSD in youth and for monitoring comorbid
Services) symptomatology and risk factors for poor
recovery.
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Table 4. Rating Scales and Checklist for Assessing PTSD in Children and Adolescents

Posttraumatic Stress Informant Trauma Cost/ # of Reference / Source

Assessment Measures Type Access Items

Ages 7 years and above

Child PTSD Symptom Scale for Child Multiple Free 27 https://www.nctsn.org/measures/child-ptsd-symptom-scale
DSM-5 (CPSS-5-SR) Parent/ Types
Caregiver
UCLA PTSD Reaction Index for Child Multiple Cost/ 31 https://www.ptsd.va.gov/professional/assessment/child/ucla_ch
Children/Adolescents – DSM-5 Parent/ Types Contact ild_reaction_dsm-5.asp
(PTSD-RI-5) Caregiver Authors
Child Trauma Screening Child Mainly Free 10 https://www.nctsn.org/measures/child-trauma-screening-
Questionnaire (CTSQ) Medical questionnaire
Kenardy, Spence, & Macleod (2006)
Children’s Revised Impact of Child War Free 13 http://www.childrenandwar.org/measures/
Events Scale (CRIES-8) Disasters Smith, Perrin, Dyregrov, & Yule (2002)

Trauma Symptoms Checklist for Child Multiple Cost/ 54 https://www.nctsn.org/measures/trauma-symptom-checklist-

Children (TSCC) Types Contact children
Authors Briere J. (1996). Nilsson, Wadsby, & Svedin (2008).
Child’s Reaction to Traumatic Child Natural Free 23 https://www.nctsn.org/measures/childs-reaction-traumatic-
Events Scale-Revised disasters; events-scale-revised [
Accident/ Based on Horowitz Impact of Events Scale.
Fires Jones, Fletcher, & Ribbe (2002). Napper et al. (2004)

Ages 6 years and younger

Young Child PTSD Checklist* Parent/ Multiple Free 42 http://www.midss.org/content/young-child-ptsd-checklist
(YCPC) Caregiver Types
Trauma Symptom Checklist for Parent/ Multiple Cost/ 90 https://www.nctsn.org/measures/trauma-symptom-checklist-
Young Children (TSCYC) Caregiver Types; Contact young-children
Grief/ Author Briere (2005).
Loss

*Also a 6-item screener version, as well as a version for older youth (and a 6-item screener for youth)
 PTSD Page –55
Table 5. Clinician Administered Structured Interviews and Scales for Diagnosing PTSD in Children and Adolescents

Interviews Informant Ages # of Items Reference / Source / More Details

Comprehensive Diagnostic Interviews with a PTSD Module
Schedule for Affective Disorders Child 6-18 years 18 PTSD items See Weissman (2011) and:
and Schizophrenia for School Age Parent/ https://en.wikipedia.org/wiki/Kiddie_Schedule_for_Aff
Children (K-SADS) Caregiver ective_Disorders_and_Schizophrenia

Anxiety Disorders Interview Child 7-17 years 26 PTSD items Silverman & Albano (1996).
Schedule, Child Version (ADIS-C) Parent/
Caregiver
Children’s Interview for Psychiatric Child 6 – 18 years 31 PTSD items Weller et al. (1999); Young et al. (2016).
Symptoms (ChIPS) Parent/
Caregiver
Diagnostic Infant and Preschool Parent/ Age 6 and 46 PTSD items Scheeringa, M.S. (2004). Retrieved from
Assessment (DIPA) Caregiver younger http://www.infantinstitute.com/
https://medicine.tulane.edu/node/18891

Diagnostic Interviews Specific to PTSD

UCLA PTSD Reaction Index for Child 7 – 18 years 31 https://www.ptsd.va.gov/professional/assessment/child/
Children/Adolescents – DSM-5 Parent/ ucla_child_reaction_dsm-5.asp
(PTSD-RI-5) Caregiver The National Center for Child Traumatic Stress offers a
(interview format) training video administration and scoring of the PTSD
Reaction Index for DSM-5, available at:
https://www.nctsn.org/resources/administration-
and-scoring-ucla-ptsd-reaction-index-dsm-5-video
Children’s PTSD Inventory Child 6 – 18 years 50 https://www.nctsn.org/measures/childrens-ptsd-
(CPTSD-I) inventory
Saigh, P.A. (2004).
Clinician-Administered PTSD Scale Child 7 – 18 years 30 https://www.ptsd.va.gov/professional/assessment/child/
for DSM-5 - Child/Adolescent caps-ca.asp
Version (CAPS-CA-5) Pynoos et al., (2015).
Available from the National Center for PTSD at
www.ptsd.va.gov.
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Table 6: Risk and Resilience Factors and Potential Treatment Moderators for Youth with PTSD

Factor Variable Association with PTSD Assessment or Treatment Implications

or Treatment Outcome
Preexisting Youth Age Younger more vulnerable than older youth Demographic characteristics typically evaluated
Characteristics in routine clinical assessments.
Gender Girls report more PTSD symptoms than boys Older youth may benefit more from cognitive-
Ethnicity Minority youth report more PTSD than non- behavioral interventions than younger youth.
minority youth and may be slower to recover
Psychological Youth with pre-existing anxiety and depression Assess anxiety and depression as part of a
Functioning- are related to greater PTSD after trauma comprehensive assessment either by use of
Anxiety and exposure. Anxiety and depression commonly checklist, rating scales, or comprehensive
Depression co-occur with PTSD (comorbidity) and could structured interviews (see chapters on anxiety
impede treatment outcome unless addressed. and depression in this volume).
Trauma History Youth with prior trauma exposure may be more See chapter sections on assessing trauma
vulnerable to PTSD. Trauma history may exposure by rating scales, checklists, or
influence treatment outcome. interviews. Also assess parental exposure to the
same index traumatic event.
Trauma Exposure Life threat Life threat may be critical to the emergence of These dimensions of trauma exposure are
PTSD. Greater life threat associated with typically assessed by ratings scales and
PTSD severity in dose-response relationship. interviews for PTSD, as noted in this chapter
Loss/disruption Loss and disruption are associated with youths’
PTSD symptoms and interfere with recovery.
Post-trauma Social Support Important for mitigating the impact of trauma Assess youths’ social support from multiple
Environment and reducing PTSD symptoms. Important sources using a validated checklist such as the
moderator of treatment outcome. Child and Adolescent Social Support Scale
(Malecki & Demarey, 2002).
Parental Distress Parental functioning contributes to youth Assess parental functioning as a routine part of
and PTSD. When problematic, parental functioning a comprehensive assessment, especially if
Psychopathology could impede youth’s treatment outcome (e.g., parent was exposed to the index trauma (e.g.,
maternal depression associated with poorer shooting, terrorist attack, accident).
treatment outcome for youth with PTSD; The PHQ-9 (for parental depression), and the
Dorsey et al 2017). GAD-7 (for parental anxiety) may be useful
(see Kroenke et al., 2010).
Major Life Events Youth who encounter major life stressors while Assess and monitor major life events by asking
recovering from a traumatic event have a child and parent about stressful events that have
slower recovery. occurred recently, such as the death or illness of
 PTSD Page –57
a family member, parental separation or
divorce, etc. (See La Greca et al., 2010)
Youths’ Coping strategies Negative coping strategies, especially those Assess and monitor youths’ coping strategies
Psychological reflecting poor emotion regulation, predict using developmentally appropriate measures
Resources chronicity of PTSD symptoms. Positive coping such as the KidCope (Spirito et al., 1988)
could be promoted in treatment for PTSD.
Other Potentially Co-morbid Common conditions comorbid with PTSD have Assess for comorbidity with PTSD by
Important elevations in implications for treatment planning. administering a comprehensive structured
Treatment anxiety, Current treatments for PTSD may have little interview. Rating scales and checklists (as
Moderators depression, or impact on these co-occurring conditions. described in other chapters of this volume) also
substance use may be useful.
Conditions to Rule ADHD, N/A. Use of a comprehensive diagnostic interview
Out (Differential Specific Phobia, should enable clinicians to rule in or rule out
Diagnosis) Bipolar Disorder, these diagnoses. Obtaining details about the
Physical onset and worsening of symptoms may help
Disorders that determine if symptoms are trauma-related.
mimic PTSD