Development and Psychometric Evaluation of Child Acute Stress Measures in Spanish and English

Clinicians and researchers need tools for accurate early assessment of children's acute stress reactions and acute stress disorder (ASD). There is a particular need for independently validated Spanish‐language measures. The current study reports on 2 measures of child acute stress (a self‐report checklist and a semistructured interview), describing the development of the Spanish version of each measure and psychometric evaluation of both the Spanish and English versions. Children between the ages of 8 to 17 years who had experienced a recent traumatic event completed study measures in Spanish (n = 225) or in English (n = 254). Results provide support for reliability (internal consistency of the measures in both languages ranged from .83 to .89; cross‐language reliability of the checklist was .93) and for convergent validity (with later PTSD symptoms, and with concurrent anxiety symptoms). Comparing checklist and interview results revealed a strong association between severity scores within the Spanish and English samples. Differences between the checklist and interview in evaluating the presence of ASD appear to be linked to different content coverage for dissociation symptoms. Future studies should further assess the impact of differing assessment modes, content coverage, and the use of these measures in children with diverse types of acute trauma exposure in English‐ and Spanish‐speaking children.     

The Acute Stress Checklist for Children (ASC-Kids): development of a child self-report measure

This project aimed to develop and validate a brief, practical self-report measure of acute stress disorder (ASD) reactions (including ASD diagnostic criteria) in children and adolescents. A draft measure was reviewed for content validity by an expert panel, piloted with youth, and revised for clarity and coverage of key constructs. The new 29-item Acute Stress Checklist for Children (ASC-Kids) was administered to 176 youth age 8 to 17 who had a recent injury or intensive care unit admission. The ASC-Kids demonstrated strong test-retest reliability and internal consistency, as well as concurrent and predictive validity with other traumatic stress measures. Results of exploratory factor analyses were consistent with current conceptualizations of acute traumatic stress reactions. The ASC-Kids is a promising measure of child acute stress reactions.     

Brief Practical Screeners in English and Spanish for Acute Posttraumatic Stress Symptoms in Children

With millions of children experiencing acute traumatic events, validated screening tools are needed in both research and service contexts. We aimed to identify and evaluate short forms of the Acute Stress Checklist for Children in English (ASC‐Kids) and Spanish (Cuestionario de Estrés Agudo‐Niños [CEA‐N]), using data from 4 samples (Ns of 254, 225, 176, and 80) of children with recent acute trauma. Confirmatory factor analyses of the full checklist in the largest sample guided item selection for 6‐item and 3‐item short forms. Across samples, both short forms (ASC‐6/ASC‐3 in English; CEA‐6/CEA‐3 in Spanish) were correlated with acute stress disorder (ASD) symptom severity on the full checklist (r = .79 to .92), and on an interview measure (r = .52 to .62). Receiver operating curve analyses for each short form detecting current ASD status showed high areas under the curve (.76 to .95). Cutoff scores identified based on Sample 1 provided acceptable sensitivity (.59 to 1.00) and specificity (.57 to .86) across samples. Children scoring above the cutoff on each screener reported greater concurrent impairment from ASD symptoms and more severe posttraumatic stress 3 months later. These very brief measures could expand clinicians’ and researchers’ ability to screen for acute posttraumatic stress in children.     

Screening for PTSD in a Substance Abuse Sample: Psychometric Properties of a Modified Version of the PTSD Symptom Scale Self-Report

The high rate of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients has been documented in research protocols, but there is evidence that it is markedly under-diagnosed in clinical settings. To address the need for a brief self-report measure to identify SUD patients who may benefit from further assessment and/or treatment for PTSD, the psychometric properties of a modified version of the PTSD Symptom Scale Self-Report (PSSSR) were examined in a treatment-seeking SUD sample (N = 118). The modified version of the PSS-SR, which measures both frequency and severity of PTSD symptoms, demonstrated good internal consistency reliability and was correlated with other self-report measures of trauma-related symptomatology. Comparisons between a structured PTSD diagnostic interview and the modified PSS-SR indicated that 89% of the PTSD positive patients were correctly classified by the modified PSS-SR. The clinical relevance of these findings was discussed.     

An Update on the Clinical Utility of the Children's Post‐Traumatic Cognitions Inventory

The Children's Post‐Traumatic Cognitions Inventory (CPTCI) is a self‐report questionnaire that measures maladaptive cognitions in children and young people following exposure to trauma. In this study, the psychometric properties of the CPTCI were examined in further detail with the objective of furthering its utility as a clinical tool. Specifically, we investigated the CPTCI's discriminant validity, test‐retest reliability, and the potential for the development of a short form of the measure. Three samples (London, East Anglia, Australia) of children and young people exposed to trauma (N = 535; 7–17 years old) completed the CPTCI and a structured clinical interview to measure posttraumatic stress disorder (PTSD) symptoms between 1 and 6 months following trauma. Test‐retest reliability was investigated in a subsample of 203 cases. The results showed that a score in the range of 46 to 48 on the CPTCI was indicative of clinically significant appraisals as determined by the presence of PTSD. The measure also had moderate‐to‐high test‐retest reliability (r = .78) over a 2‐month period. The Children's Post‐Traumatic Cognitions Inventory‐Short Form (CPTCI‐S) had excellent internal consistency (α = .92), and moderate‐to‐high test‐retest reliability (r = .78). The examination of construct validity showed the model had an excellent fitting factor structure (Comparative Fit index = 0.95, Tucker‐Lewis index = 0.91, Root Mean Square Error of Approximation = .07). A score ranging from 16 to 18 was the best cutoff point on the CPTCI‐S, in that it was indicative of clinically significant appraisals as determined by the presence of PTSD. Based on these results, we concluded that the CPTCI is a useful tool to support the practice of clinicians and that the CPTCI‐S has excellent psychometric properties.     

Validation of the Persistent Complex Bereavement Disorder (PCBD) Checklist: A Developmentally Informed Assessment Tool for Bereaved Youth

The inclusion of Persistent Complex Bereavement Disorder (PCBD) in the DSM‐5 appendix signifies a call for research regarding the distinguishing features and clinical utility of proposed PCBD criteria. Rigorously constructed tools for assessing PCBD are lacking, especially for youth. This study evaluated the validity and clinical utility of the PCBD Checklist, a 39‐item measure designed to assess PCBD criteria in youth aged 8 to18 years. Test construction procedures involved: (a) reviewing the literature regarding developmental manifestations of proposed criteria, (b) creating a developmentally informed item pool, (c) surveying an expert panel to evaluate the clarity and developmental appropriateness of candidate items, (d) conducting focus groups to evaluate the comprehensibility and acceptability of items, and (e) evaluating psychometric properties in 367 bereaved youth (M_age = 13.49, 55.0% female). The panel, clinicians, and youth provided favorable content validity and comprehensibility ratings for candidate items. As hypothesized, youth who met full PCBD criteria, Criterion B (e.g., preoccupation with the deceased and/or circumstances of the death), or Criterion C (e.g., reactive distress and/or social/identity disruption) reported higher posttraumatic stress and depressive symptoms than youth who did not meet these criteria, η_p² = .07–.16. Youth who met Criterion C reported greater functional impairment than youth who did not, η_p² = .08–.12. Youth who qualified for the “traumatic bereavement specifier” reported more frequent posttraumatic stress symptoms than youth who did not, η_p² = .04. Findings support the convergent, discriminant, and discriminant‐groups validity, developmental appropriateness, and clinical utility of the PCBD Checklist.     

Dissociative symptoms and the acute stress disorder diagnosis in children and adolescents: a replication of the Harvey and Bryant (1999) study

Acute stress disorder (ASD) is a good predictor of posttraumatic stress disorder in adult populations, although the emphasis on dissociation symptoms within the diagnosis has been questioned. Recent studies suggest that ASD may also have application to children and adolescents. The present study examined properties of ASD within youth. A large (N = 367) multisite sample of 6- to 17-year-old children and adolescents exposed to motor vehicle accidents completed interviews or self-report questionnaires regarding their acute stress symptoms. The study found evidence supporting the suggestion that the dissociative criterion of ASD is excessively strict in youth, and that there is less overlap between dissociative symptoms than in adults. The implications of these findings for how ASD is applied to youth are discussed.     

Psychological characteristics and physiological reactivity to acute stress in mothers of children with autism spectrum disorder

Stress related to parenting a child with autism spectrum disorder can differently affect caregiver's physiological reactivity to acute stress. Here, parental stress levels, psychological characteristics, and coping strategies were assessed alongside measures of heart rate, heart rate variability, and cortisol during a psychosocial stress test in mothers of children with ASD (M‐ASD, n = 15) and mothers of typically developing children (n = 15). M‐ASD reported significantly higher levels of parental stress, anxiety, negative affectivity, social inhibition, and a larger preference for avoidance strategies. M‐ASD showed larger heart rate and cortisol responses to the psychosocial stress test. A positive relationship was found between parental stress levels and the magnitude of the cortisol stress response in both groups. The present findings indicate exaggerated physiological reactivity to acute psychosocial stress in M‐ASD and prompt further research to explore the role of individual differences in mediating the effects of parental stress on physiological stress responses.     

Predictors of acute stress following mild traumatic brain injury

The aim of this study was to investigate the predictors of acute stress disorder (ASD) following mild traumatic brain injury (MTBI). Patients who sustained MTBI following a motor vehicle accident (n = 48) were assessed with a structured interview within 18 days of the trauma for the presence of ASD and administered the Beck Depression Inventory (BDI), Coping Style Questionnaire, Dissociative Experiences Scale, and the Eysenck Personality Inventory. ASD was diagnosed in 14.6% of patients and 4.2% were diagnosed with sub syndromal ASD. BDI scores and avoidant coping were significant predictors of ASD and acute stress severity. This study provides further evidence that traumatic stress reactions occur following MTBI and highlights the possibility of identifying those who may benefit from early intervention.     

Eye Movement Desensitization and Reprocessing (EDMR) Treatment for Combat-Related Posttraumatic Stress Disorder

Despite the clinical and social impact of posttraumatic stress disorder (PTSD), there are few controlled studies investigating its treatment. In this investigation, the effectiveness of two psychotherapeutic interventions for PTSD were compared using a randomized controlled outcome group design. Thirty five combat veterans diagnosed with combat-related PTSD were treated with either (a) 12 sessions of eye movement desensitization and reprocessing, EMDR (n = 10), (b) 12 sessions of biofeedback-assisted relaxation (n = 13), or (c) routine clinical care, serving as a control (n = 12). Compared with the other conditions, significant treatment effects in the EMDR condition were obtained at posttreatment on a number of self-report, psychometric, and standardized interview measures. Relative to the other treatment group, these effects were generally maintained at 3-month follow-up. Psychophysiological measures reflected an apparent habituation effect from pretreatment to posttreatment but were not differentially affected by treatment condition.     

Dissociative Symptoms in Acute Stress Disorder

This study provides a profile of symptoms, and particularly dissociative symptoms, in the diagnosis of acute stress disorder (ASD) following motor vehicle accidents (MVAs). Consecutive adult non-brain-injured admissions to a major trauma hospital (N = 92) were assessed between 2 days and 4 weeks following an MVA. Presence of ASD was determined by a structured clinical interview. The occurrence of full and subsyndromal ASD was approximately 13% and 21%, respectively. The majority of those who met criteria for subsyndromal ASD did not meet the ASD criteria for dissociation. At least 80% of individuals who reported derealization also reported reduced awareness and depersonalization. This significant overlap between dissociative symptoms questions the discriminatory power and conceptual independence of the dissociative criteria. These findings suggest the need for a more refined conceptual and operational understanding of dissociative symptoms in the acute trauma stage.     

Predictors of Acute Stress Following Motor Vehicle Accidents

The aim of this study was to investigate the predictors of acute stress following motor vehicle accidents (MVA). Sixty-two consecutive adult admissions to a hospital were assessed between two days and four weeks following a MVA. Participants were assessed for acute stress disorder (ASD) with a structured clinical interview and administered the Beck Depression Inventory (BDI), Coping Style Questionnaire, Dissociative Experiences Scale, and the Eysenck Personality Inventory. The prevalences of full and sub-syndromal ASD were 16.1% and 14.5%, respectively. BDI, history of psychiatric treatment, history of posttraumatic stress disorder (PTSD), and history of previous MVA accounted for 61% of the variance of acute stress severity. The findings indicate that predictors of acute stress severity are comparable to the predictors of PTSD and highlight the possibility of identifying those who may benefit from early treatment.     

Mutual influence of posttraumatic stress disorder symptoms and chronic pain among injured accident survivors: A longitudinal study

The relationship between acute stress disorder (ASD), posttraumatic stress disorder symptoms (PTSD), and chronic pain was investigated in a longitudinal study of injured accident victims (N = 323, 64.7% men). Assessments took place 5 days (T1), 6 (T2) months, and 12 (T3) months postaccident. Relations between pain and posttraumatic stress symptoms were tested by structural equation modeling. Subjects diagnosed with full or subsyndromal PTSD at T2 and at T3 (14 and 19%) reported significantly higher pain intensity. Cross‐lagged panel analysis yielded a mutual maintenance of pain intensity and ASD or PTSD symptoms across T2. Across the second half year, PTSD symptoms impacted significantly on pain but not vice versa. Clinicians need to pay careful attention to PTSD symptoms in accident survivors suffering from chronic pain.     

Psychometrics of a Brief Trauma Symptom Screen for Youth in Residential Care

Trauma screening is an important element for providing trauma‐informed services to youth in residential care. Unfortunately, lack of time and resources may deter clinicians from conducting trauma screening at intake. This study tested the psychometric properties of the Brief Trauma Symptom Screen for Youth (BTSSY), which could be used during intake into residential care. Participants included 572 youth, ages 10–18 years (M = 14.28 years, SD = 2.31), of whom 58.9% were boys, 78.7% were Caucasian, 51.7% were youth receiving services in residential care, 15.6% were youth with clinical needs, and 32.7% were typically developing youth from the local community. Participants completed the BTSSY; other questionnaires of psychopathology, childhood maltreatment, and symptomology of posttraumatic stress disorder (PTSD); and diagnostic interviews, which were conducted by licensed psychiatrists. The total BTSSY score had a good composite reliability (CR) of .80 and was valid based on a significant positive correlation, r = .64, with the UCLA PTSD–Reaction Index. The BTSSY score was also fair, area under the curve = .75, at detecting a diagnosis of PTSD from a psychiatrist. Significant group differences in the BTSSY scores were found between youth with a diagnosis of PTSD and the other two groups, with moderate‐to‐large effect sizes, ds = 0.73–1.22. Preliminary results indicated the BTSSY may be a useful screening tool for identifying youth at residential care intake who may need additional assessment for PTSD. Limitations and implications for future research and practice are discussed.     

Disorder‐ and Treatment‐Specific Therapeutic Competence Scales for Posttraumatic Stress Disorder Intervention: Development and Psychometric Properties

Although the assessment of therapeutic competence in psychotherapy research is essential for examining its possible associations with treatment outcomes, it is often neglected due to high costs and a lack of valid instruments. This study aimed to develop two therapeutic competence scales that assess disorder‐specific and treatment‐specific therapeutic competence, and to examine these scales’ psychometric properties along with those of the already established Cognitive Therapy Scale (CTS) in a posttraumatic stress disorder (PTSD) sample. Using an inductive procedure, two rating scales for assessing disorder‐specific and treatment‐specific competence were constructed. The psychometric properties of these scales and those of the CTS were assessed in a sample of 30 videotaped sessions of eight patients from a multicenter study in which PTSD related to child abuse was treated using cognitive processing therapy. Two raters assessed therapeutic competence in 30 videotaped psychotherapy sessions. Interrater reliability, internal consistency, and content validity were determined. The scales (all items and total scores) demonstrated good to excellent interrater reliability, intraclass correlation coefficients (ICCs) = .67 to .97, and internal consistency, Cronbach's α = .73 to .92. The PTSD experts’ ratings confirmed good internal validity. We found statistically significant associations with therapeutic adherence, r = .62 to .85; p < .001; and therapeutic alliance, r = .47, p < .001. These preliminary data imply that the two newly developed competence scales and the CTS can be reliably used to assess different types of therapeutic competence in PTSD samples and may be useful as possible predictors of treatment outcomes.     

Quality of Life in Ethiopia's Street Youth at a Rehabilitation Center and the Association With Trauma

Quality of life (QOL) tends to be lower among the homeless than the general population, and traumatic events experienced on the streets have a negative impact on QOL. Low‐income countries face a high number of street youth, yet little research has been performed so far on QOL, trauma, and posttraumatic stress disorder (PTSD) among this group. This study aimed at examining the QOL of a sample of Ethiopian street youth within a rehabilitation program and at exploring whether the street youth have experienced traumatic events and show posttraumatic stress symptoms. We interviewed 84 street youths with the World Health Organization Quality of Life Questionnaire (WHOQOL‐BREF) and the Diagnostic Interview for Children and Adolescents (DICA). Mean QOL scores differed significantly between the groups assessed at the beginning and at the end of the program (Cohen's d = 0.48). Eighty‐three percent of the Ethiopian street youths had experienced traumatic events, and 25.0% met criteria for PTSD according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. QOL did not differ between those with and without PTSD symptoms. These findings show the high rate of traumatic events among Ethiopian street youth and the importance for rehabilitation programs that focus on improving QOL. The results of the study may have cultural limitations.     

The relationship between acute stress disorder and posttraumatic stress disorder in injured children

This study indexed the relationship between acute stress disorder (ASD) and subsequent posttraumatic stress disorder (PTSD) in injured children. Consecutive children between 7-13 years admitted to a hospital after traumatic injury (n = 76) were assessed for ASD. Children were followed up 6-months posttrauma (n = 62), and administered the PTSD Reaction Index. Acute stress disorder was diagnosed in 10% of patients, and 13% satisfied criteria for PTSD. At 6-months posttrauma, PTSD was diagnosed in 25% of patients who were diagnosed with ASD. Acute stress reactions that did not include dissociation provided better prediction of PTSD than full ASD criteria. These findings suggest that the current ASD diagnosis is not optimal in identifying younger children who are high risk for PTSD development.     

Validation of the Pittsburgh Sleep Quality Index Addendum for Posttraumatic Stress Disorder (PSQI‐A) in U.S. Male Military Veterans

Sleep disturbances are core symptoms of posttraumatic‐stress disorder (PTSD), yet they bear less stigma than other PTSD symptoms. Given the growing number of returning military veterans, brief, valid assessments that identify PTSD in a minimally stigmatizing way may be useful in research and clinical practice. The study purpose was to evaluate the psychometric properties of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI‐A), and to examine its ability to identify PTSD cases among U.S. male military veterans. Male military veterans (N = 119) completed the PSQI‐A, as well as measures of sleep quality, combat exposure, posttraumatic stress, depression, and anxiety. Veterans with PTSD had higher PSQI‐A identified disruptive nocturnal behaviors than veterans without PTSD. The PSQI‐A had good internal consistency and convergent validity with sleep quality, combat exposure, PTSD symptoms, depression, and anxiety. A cutoff score ≥ 4 provided an area under the curve = .81, with 71% sensitivity, 82% specificity, and 60% positive and 83% negative predictive value for a clinical diagnosis of PTSD; correct classification was 74%. The PSQI‐A is a valid measure to possibly detect PTSD among male military veterans. Assessment of disruptive nocturnal behaviors may provide a cost‐effective, nonstigmatizing approach to PTSD screening without directly probing for trauma exposure(s).     

A Parental Tool to Screen for Posttraumatic Stress in Children: First Psychometric Results

The Children's Revised Impact of Event Scale (CRIES‐13) is a brief self‐report measure designed to screen children for posttraumatic stress disorder (PTSD). This study investigates the psychometric properties of a Dutch version of the CRIES‐13–parent version and evaluates its correlation with the child version. A sample of 59 trauma‐exposed children (8 years–18 years) and their parents completed an assessment including the CRIES‐13 (child/parent version) along with the Anxiety Disorders Interview Schedule for DSM‐IV: Parent version. Results demonstrated good internal consistency (α = .87) with acceptable values for the 3 subscales. A strong correlation (r = .73) with another measure of PTSD and lower correlations with a behavioral measure (r = .15 to .38) were found, confirming the convergent/divergent validity. A cutoff score ≥ 31 emerged as the best balance between sensitivity and specificity, and correctly classified 83.6% of all children as having a diagnosis of PTSD. This study provides support for the reliability and validity of the CRIES‐13–parent version as a screening measure for posttraumatic stress in children.     

Convergent and Discriminant Validity of the Perinatal PTSD Questionnaire (PPQ): A Preliminary Study

We evaluated the validity of the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) as a measure of posttraumatic stress symptomatology. Mothers of high-risk infants (N = 91) and healthy, full-term infants (N = 51) answered the PPQ and two other convergent measures of posttraumatic stress disorder symptoms, the Impact of Event Scale (IES) and the Penn Inventory (PI). The Need for Cognition Scale (NCS) was used as a divergent measure. Correlations among the convergent measures were significantly greater than the correlation between the PPQ and NCS. High-risk mothers also scored higher than normal mothers on the PPQ and IES. The results support the validity of the PPQ.