The Child PTSD Symptom Scale (CPSS) was designed to assess PTSD diagnostic criteria and symptom severity among children and adolescents aged between 8-18. It was developed in 2001 in the US by Edna Foa, PhD, based on the PTSD Symptom Scale (PSS), (Child PTSD Symptom Scale, n.d.), which is a longer scale requiring more in-depth details on the trauma experienced and level of functional impairment (PTSD Symptom Scale, n.d.). The symptoms covered are based on the definitions and criteria from the DSM-IV (Child PTSD Symptom Scale, n.d.), however the CPSS was adapted to include developmentally appropriate language to maximize children’s understanding of the items (Foa, 2001). It can be administered by a qualified practitioner in the form of a semi-structured interview and used as a diagnostic tool. It can also be used as a self-report measure. Furthermore, it has been administered for research purposes in communities where large groups of children have experienced trauma (Kohrt, Jordans, Tol, Luitel, Maharjan, & Upadhaya, 2011). The scale includes 26 items, which are divided into 2 event, 17 symptom and 7 functional impairment items. See examples below. The symptom items are divided into 3 subscales: re-experiencing, avoidance and hyper-arousal behaviours, each measured on a 4-point frequency scale from 0 (not at all or only at one time) to 3 (5 or more times a week/almost always). The functional impairment items are measured as absent (0) or present (1), (Foa, 2001).
(Event item) Please write down your most distressing event:
(Re-experiencing symptom item) Below is a list of problems that kids sometimes have after experiencing an upsetting event. Read each one carefully and circle the number (0-3) that best describes how often that problem has bothered you IN THE LAST 2 WEEKS.
0 1 2 3 Having bad dreams or nightmares
(Functional impairment item) Indicate below if the problems you rated in Part 1 have gotten in the way with any of the following areas of your life DURING THE PAST 2 WEEKS.
Y N Chores and duties at home
A total score is measured by adding the scores for each symptom item and calculating a total score between 0-51. Higher scores indicate more severe symptoms (Foa, 2001) and the clinical cutoff appropriate for diagnosing PTSD is 15 or greater (Child PTSD Symptom Scale, n.d.). The scale has been found to have both high sensitivity and specificity (Child PTSD Symptom Scale, 2001). The range of the total score for functional impairment is 0-7 with a higher score indicating greater functional impairment (Foa, 2001). The CPSS has high internal consistency and test-retest reliability for both total score and the three subscales of symptom items (Foa, Johnson, Feeny, & Treadwell, 2001). For the functional impairment items, no measure of internal consistency or test-retest reliability was found. The CPSS has been tested against the Child PTSD Reaction Index (CPTSD-RI) and convergent validity was established. Correlations of the CPSS with depression and anxiety measures were found to be lower than those of the CPTSD-RI. This result is expected therefore divergent validity was also established (Foa et al., 2001).
The scale was used with children in Nepal following a decade of war. The avoidance subscale items were found to be inefficient in measuring symptom severity as children reported that avoidance was a necessary survival technique in a war stricken environment rather than an indicator of pathology (Kohrt, Jordans, Tol, Luitel, Maharjan, & Upadhaya, 2011).
The Perform Well website provides measurement tools and practical knowledge for human services professionals, www.performwell.org. The CPSS can be found under Find Survey/Assessments. The tools freely available online have not been updated to the DSM-5 criteria, however updated interview (CPSS-5-I) and self-report (CPSS-5-SR) versions can be obtained directly from the author and another for self-report however these are not freely available online. The differences in the updated self-report version include some changes in the wording of instructions, symptom items based on the last month, a 5-point frequency scale and additional symptom items measuring negative cognitions and mood.
Foa, E. B., Johnson, K. M., Feeny, N. C., & Treadwell, K. R. H. (2001). The Child PTSD Symptom Scale: A preliminary examination of its psychometric properties [Abstract]. Journal of Clinical Child Psychology, 30, 376-384.
Kohrt, B.A., Jordans, M.J.D., Tol, W.A., Luitel, N.P., Maharjan, S.M., & Upadhaya, N. (2011). Validation of cross-cultural child mental health and psychosocial research instruments: adapting the Depression Self-Rating Scale and Child PTSD Symptom Scale in Nepal. BMC Psychiatry, 11, 127-144.