Child Stress Disorders Checklist CSDC

Transcription

1 MEASURE NAME: Acronym: CSDC Basic Description Author(s): Author Contact: Author Citation: To Obtain: Glenn Saxe, M.D. Dr. Glenn Saxe, Chairman Department of Child and Adolescent Psychiatry Boston University School of Medicine Dowling 1 North, One Boston Medical Center Place Boston, MA glenn.saxe@bmc.org Saxe, G.N. (2001). (CSDC) (v /01). National Child Traumatic Stress Network and Department of Child and Adolescent Psychiatry, Boston University School of Medicine. Saxe, G., Chawla, N., Stoddard, F., Kassam-Adams, N., Courtney, D., Cunningham, K., Lopez, C., Sheridan, R., King, D., & Kind, L. (2003). Child stress disorders checklist: A measure of ASD and PTSD in children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(8), The measure is available on the website listed below and through the first author: Website: Cost per copy (in US $): Copyright: Description: Dr. Glenn Saxe, Chairman Department of Child and Adolescent Psychiatry Boston University School of Medicine Dowling 1 North, One Boston Medical Center Place Boston, MA glenn.saxe@bmc.org $0.00 The (CSDC) is an observerreport measure designed for use as a screening instrument for traumatic stress symptoms in children. It measures symptoms of Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PSTD). The CDSC assesses for the trauma and DSM-IV A2 criteria for PTSD and ASD. It yields a total score as well as scores for Reexperiencing, Increased Arousal, Avoidance, Numbing and Dissociation, and Impairment in Functioning. Theoretical Orientation Summary: The measure can be completed by multiple types of observers who may have contact with a child including caregivers, nurses, teachers, and social service workers. DSM-IV PTSD and Acute Stress Disorder symptomatology 1

2 Domains Assessed: Languages Available: Acute Stress Disorder (child) Posttraumatic stress symptoms (child) Dissociation (child) Trauma history (child) English Age Range: # of Items: Time to Complete (min): Time to Score (min): Periodicity: Response Format: Measure Type: Measure Format: Reporter: Education Level: Screening Questionnaire Other month (scale instructions are now or within the past month) 0=not true, 1=somewhat or sometimes true, 2=very true or often true Materials Needed: (check all that apply) Material Notes: Paper and pencil Computer Video equipment Testing stimuli Physiological equipment Other Age range and education needed to complete the measure were determined through consultation with the authors and by examining the characteristics of those who participated in the psychometric studies. Sample Items: Domains Scale Sample Items Total Reexperiencing Child reports uncomfortable memories of the event. Increased Arousal Child startles easily. For example, he or she jumps when hears sudden or loud noises. Avoidance Child avoids doing things that remind him or her of the event. Numbing and Child seems "spaced out" or in a daze. Dissociation Impairment in Child has difficulty getting along with friends, Functioning schoolmates, or teachers. Notes (additional scales and domains): The first item focuses on identifying the traumatic event. The next five symptoms correspond to the DSM-IV A2 PTSD and ASD criteria. The 30 symptom items may be broken down into 5 subscales: 1) Re-experiencing, 2) Avoidance, 3) Numbing and Dissociation, 4) Increased Arousal, and (5) Impairment in Functioning. A total score may also be obtained by summing the 30-symptom item scores. 2

3 Information Provided: (check all that apply) Diagnostic information DSM-III Diagnostic information DSM-IV Strengths Areas of concerns/risks Program evaluation information Continuous assessment Raw Scores Standard Scores Percentile Graph (e.g., of elevated scale) Dichotomous assessment Clinical friendly output Written feedback Other Training Training to Administer: (check all that apply) Training to Interpret: (check all that apply) Training Notes: None Via manual/video Prior experience psych testing & interpretation None Must be a psychologist Training by experienced clinician (<4 hours) Training by experienced clinician ( 4 hours) Must be a psychologist Via manual/video Training by experienced clinician (<4 hours) Prior experience psych Training by experienced testing & interpretation clinician ( 4 hours) The authors report that the measure is not difficult to administer. Bachelor-level assistants can be trained to administer the measure. It was designed to be completed by parents, nurses, teachers, and social service workers. Parallel or Alternate Forms Parallel Forms? No Alternate Forms: No Forms for Different Ages: No If so, are forms comparable: Any Altered Versions of Measure: Describe: The measure was formerly called the Child Stress Reaction Checklist (Saxe, 1997). There is also a Screening Form (CSDC-SF), Saxe & Bosquet (2004), which consists of the first 5 items from this questionnaire and is available at -Screening%20Form2.pdf. The CSDC-SF is also reviewed in this database. Population Used to Develop Measure Scale development was conducted with three subsamples (Saxe, 1997; Saxe et al., 2003): 1. Burn victims (n=43): Children averaged years of age (SD=3.20); 35% female, 65% male; 67% White, 21% Black, 4% Hispanic, 4% Native American. 2. Children experiencing traffic accidents (n=41): Children were aged 5-17 (M=10, SD=3.55); 30% female, 70% male; 42% White, 46% Black, 2% Hispanic, 10% Asian 3

4 American. 3. Clinic sample of children with abuse histories (n=45). Psychometrics Global Rating (scale based on Hudall Stamm, 1996): Basic properties established by author(s) Norms: No For separate age groups: For clinical populations: Separate for men and women: For other demographic groups: Notes: Clinical Cutoffs: Specify Cutoffs: Used in Major Studies: Specify Studies: No No 4

5 Reliability: Type: Rating Statistics Min Max Avg Test-Retest-# days: 2 Acceptable r Internal Consistency: Acceptable Cronbach's alpha Inter-Rater: Parallel/Alternate Forms: Questionnable Intraclass correlation Notes: Data reported in the above table are summarized from Saxe et al. (2003). TEST-RETEST RELIABILITY Burn sample: 2 days Total Score (.84), Arousal (.74), Numbing and Dissociation (.70), Avoidance (.85), Functioning (.63), and Reexperiencing (.89) INTERNAL CONSISTENCY Whole sample: alpha=.84 Burn sample: alpha=.83 MVA sample: alpha=.86 INTERRATER RELIABIILTY Burn sample: between parent and primary nurse (intraclass correlations) Total score (.44), Arousal (.36), Numbing and Dissociation (.24), Avoidance (.28), Functioning (.27), Reexperiencing (.45) Reliability data were also reported by Saxe (1997) in three samples of children: 1) children with burns (n=43), 2) children experiencing a motor vehicle accident (n=41), and 3) children experiencing child abuse (n=45). TEST-RETEST RELIABILITY 2-day interval, Total Score (r=0.84), subscale correlation range: INTERNAL CONSISTENCY Full sample: Cronbach s alpha=.091 Burn sample: 0.83 MVA sample: 0.92 Child abuse sample: 0.93 INTERRATER RELIABILITY Burn sample: parent and primary nurse as reporters Total Score (r=0.43) All subscales significant (range= ) with exception of Avoidance subscale Content Validity: The measure is based on DSM-IV ASD and PTSD symptomatology. No other information was provided regarding content validity. 5

6 Construct Validity: (check all that apply) Validity Type Convergent/Concurrent Discriminant Sensitive to Change Intervention Effects Longitudinal/Maturation Effects Sensitive to Theoretically Distinct Groups Factorial Validity Notes: Postdictive Validity: Not known Not found Nonclinical Clinical Samples Samples Diverse Samples Significant correlations between CSDC scores and scores on the Child Behavior Checklist PTSD Scale, Child Dissociation List, and the Child PTSD Reaction Index provide evidence of validity: CBCL-PTSD: Parent Report (r=.39, p<.05) CDC: Parent Report (r=.49, p<.01), Nurse Report (r=.33, p<.05) CPTSD-RI: Parent Report (r=.49, p<.01), Nurse Report (r=.35, p<.05) Three-month CSDC Reexperiencing, Numbing, and Dissociation scores were significantly lower than were scores during acute hospitalization, suggesting the measure is sensitive to change. 2. Bosquet, Saxe, & Kassam-Adams (2004) also examined the validity of the CSDC. Similar to Saxe et al. (2003), they reported significant correlations between the Total Parent Score and the CPTSD-RI (r=.29, p<.01), CBCL-PTSD (r=.56, p<.001), and CDC (r=.47, p<.001). Discriminant validity was shown by lower correlations with CBCL Thought Problems (r=.31, p<.01) and CBCL-Delinquency scales (r=.21, p=n.s.). Nurse reports on the CSDC were correlated with scores on the CBCL-PTSD (r=.43, p<.001) and CDC (r=.37, p<.01). As expected, they were not correlated with CBCL Thought Problems or CBCL Delinquency scores. Criterion Validity: (check all that apply) Measures used as criterion: Diagnostic Interview for Children and Adolescents (DICA), CBCL-PTSD, CDC, CPTSD-R Not known Not found Nonclinical Clinical Diverse Samples Samples Samples Predictive Validity: 6

7 Sensitivity Rate(s): Specificity Rate(s): Positive Predictive Power: Negative Predictive Power: Notes: No data on Sensitivity or Specificity. Saxe et al. (2003) reported that Parent CSDC scores were also related to CDC and CBCL-PTSD scores 3 months later (r=.59, p<.05 and r=.47, p<.05, respectively), but they were not significantly related to CPTSD-RI scores (r=.38, p=n.s.). Bosquet et al. (2004) found that Parent CSDC scores predicted CPTSD-RI, CBCL-PTSD, CDC scores 3 months later. They also predicted Parent and Child reports on the Diagnostic Interview for Children and Adolescents (DICA) 3 months later, and Child DICA reports 6 months later. Nurse reports also significantly predicted Parent DICA reports 3 months later (r=.41, p<.01) Limitations of Psychometrics and Other Comments Regarding Psychometrics: Initial development data indicates adequate reliability and validity. Further validation with broader samples of children would be useful including use with other trauma populations and diverse samples. In addition, data regarding the measure s ability to detect change due to treatment are needed. While the total scale appears to have adequate interrater reliability, given that most studies report interrater correlations around this level, many of the other scales had much lower interrater reliability (assessed using an intraclass correlation), suggesting that nurses and parents may differ in their ability to detect symptoms of Avoidance, Functioning, and Numbing and Dissociation. Consumer Satisfaction No information. 7

8 Languages Other than English Language: Translation Quality (check all that apply) 1= Has been translated 2= Has been translated and back translated - translation appears good and valid. 3= Measure has been found to be reliable with this language group. 4= Psychometric properties overall appear to be good for this language group. 5= Factor structure is similar for this language group as it is for the development group. 6 = Norms are available for this language group. 7= Measure was developed for this language group Use with Trauma Populations Populations for which measure has demonstrated evidence of reliability and validity: Physical abuse Natural disaster Terrorism Sexual abuse Neglect Use with Diverse Populations Population Type: Domestic Violence Community violence Medical trauma 1 1. Developmental disability 2. Disabilities 3. Lower socio-economic status 4. Rural populations Notes (including other diverse populations): Accidents Imprisonment Witness death Assault War/combat Degree of Usage: (check all that apply) Immigration related trauma Kidnapping/hostage Traumatic loss (death) Other USE WITH DIVERSE POPULATIONS RATING SCALE 1. Measure is known (personal communication, conference presentation) to have been used with members of this group. 2=Studies in peer-reviewed journals have included members of this group who have completed the measure. 3=Measures have been found to be reliable with this group. 4=Psychometric properties well established with this group. 5=Norms are available for this group (or norms include a significant proportion of individuals from this group) 6=Measure was developed specifically for this group

9 Pros and Cons/Qualitative Impression Pros: 1. The measure is unique in assessing both Acute Stress Disorder and Posttraumatic Stress Disorder Symptomatology using the observer report. 2. The measure is based on DSM-IV criteria for Acute Stress Disorder and Posttraumatic Stress Disorder. 3. Additional benefits include assessment of exposure and reaction to the traumatic event, impairment in functioning, and symptoms of dissociation, in addition to PTSD symptomatology. 4. The measure is free and easily available. Cons: 1. Psychometrics have been examined only by the first author. 2. The measure has yet to be examined in terms of ability to detect change due to treatment and relationship to diagnostic classifications (sensitivity and specificity). 3. Although the measure is designed for children aged 2-18 and was used with this age range in the psychometric study, examination of the actual items suggests that it may not be an appropriate screen for younger children, given that a number of items would not apply to them. 4. The wording on some of the items is somewhat technical, most likely because items were derived from the DSM-IV. THIS IS NOT A CON, JUST INFORMATION: For many of the items, the wording refers to the event, suggesting that the measure was not designed for a chronic or multiply traumatized population. It was designed to screen for ASD and PTSD symptoms following an event. 9

10 References (Representative sampling of publications, presentations, psychometric references) Published References: A PsychInfo search of the words Child Stress Disorder Checklist and CSDC anywhere (6/05) revealed that the measure has been referenced in 3 peer-reviewed journal articles. Two are review articles. 1. Cardeña, E., & Weiner, L. A. (2004). Evaluation of dissociation throughout the lifespan. Psychotherapy: Theory, Research, Practice, Training. Educational Publishing Foundation, 41(4), Saxe, G., Chawla, N., Stoddard, F., Kassam-Adams, N., Courtney, D., Cunningham, K., et al. (2003). Child stress disorders checklist: A measure of ASD and PTSD in children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(8), Vostanis, P. (2004). The impact, psychological sequelae and management of trauma affecting children. Current Opinion in Psychiatry, 17(4), Other Related Resources Unpublished References: A PsychInfo search of the words Child Stress Disorder Checklist and CSDC anywhere (6/05) revealed that the measure has been referenced in 2 conferences and 0 dissertations. 1. Saxe, G.N. (1997). The Child Stress Reaction Checklist: A Measure of ASD and PTSD in Children. Presented at the International Society for Traumatic Stress Studies, 13th Annual Meeting, Montreal. 2. Bosquet, M., Saxe, G.N., & Kassam-Adams, N. (2004). A 4-item screener for ASD and PTSD in children. Poster presented at the meeting of the International Society for Traumatic Stress Studies, New Orleans, Louisiana. Number of Published References: (based on author provided information and a PsychInfo search, not including dissertations) Number of Unpublished References: (based on a PsychInfo search of unpublished doctoral dissertations) Author Comments: The author provided comments, which were integrated. 3 2 Citation for Review: Editor of Review: Last Updated: PDF Available: Trauma Center Staff Chandra Ghosh Ippen, Ph.D. 8/30/2005 yes This project was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views, policies and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS. 10