Psychometric Properties of the UCLA PTSD Reaction Index: Part I
TL;DR: Psychometric characteristics of the UCLA PTSD Reaction Index for DSM IV (PTSD-RI) derived from a large sample of children and adolescents evaluated at National Child Traumatic Stress Network centers are presented.
Abstract: This article presents psychometric characteristics of the UCLA PTSD Reaction Index for DSM IV (PTSD-RI) derived from a large sample of children and adolescents (N = 6,291) evaluated at National Child Traumatic Stress Network centers. Overall mean total PTSD-RI score for girls was significantly higher as compared with boys. Age-related differences were found in that overall mean total PTSD-RI scores and within sex groups were higher among those aged 7-9 years and 16-18 years. There were no significant differences in mean total PTSD-RI scores across racial/ethnic groups. The PTSD-RI total scale displayed good to excellent internal consistency reliability across age ranges, sex, and racial/ethnic groups (α = .88-.91). Correlations of PTSD-RI scores with PTS subscale scores on the TSCC-A for the entire sample and within sex, age, and ethnic/racial groups provided evidence of convergent validity, although not discriminant validity. In contradistinction to previously reported 4-factor models, an exploratory factor analysis revealed 3 factors that mostly reflected the underlying dimensions of PTSD in DSM IV. PTSD-RI scores were associated with increased odds ratios for functional/behavior problems (odds ratio [OR] = 1-1.80). These findings are striking in light of the wide range of trauma exposures, age, and race/ethnicity among subjects.
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TL;DR: The results indicate that justice-involved youth report high rates of trauma exposure and that this trauma typically begins early in life, is often in multiple contexts, and persists over time.
Abstract: Background: Up to 90% of justice-involved youth report exposure to some type of traumatic event. On average, 70% of youth meet criteria for a mental health disorder with approximately 30% of youth meeting criteria for post-traumatic stress disorder (PTSD). Justice-involved youth are also at risk for substance use and academic problems, and child welfare involvement. Yet, less is known about the details of their trauma histories, and associations among trauma details, mental health problems, and associated risk factors. Objective: This study describes detailed trauma histories, mental health problems, and associated risk factors (i.e., academic problems, substance/alcohol use, and concurrent child welfare involvement) among adolescents with recent involvement in the juvenile justice system. Method: The National Child Traumatic Stress Network Core Data Set (NCTSN-CDS) is used to address these aims, among which 658 adolescents report recent involvement in the juvenile justice system as indexed by being detained or under community supervision by the juvenile court. Results: Age of onset of trauma exposure was within the first 5 years of life for 62% of youth and approximately one-third of youth report exposure to multiple or co-occurring trauma types each year into adolescence. Mental health problems are prevalent with 23.6% of youth meeting criteria for PTSD, 66.1% in the clinical range for externalizing problems, and 45.5% in the clinical range for internalizing problems. Early age of onset of trauma exposure was differentially associated with mental health problems and related risk factors among males and females. Conclusions: The results indicate that justice-involved youth report high rates of trauma exposure and that this trauma typically begins early in life, is often in multiple contexts, and persists over time. Findings provide support for establishing trauma-informed juvenile justice systems that can respond to the needs of traumatized youth.
347 citations
Cites background from "Psychometric Properties of the UCLA..."
...Psychometric properties are fairly robust with good to excellent internal reliability across age, racial/ ethnic groups, and gender (Steinberg et al., 2004, 2013)....
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TL;DR: In this paper, the literatures on trauma-informed approaches and multitiered frameworks for school-based service delivery are connected with the goal to provide suggestions toward building blueprints for trauma- informed service delivery in schools.
Abstract: Recognition of the benefits to trauma-informed approaches is expanding, along with commensurate interest in extending delivery within school systems. Although information about trauma-informed approaches has quickly burgeoned, systematic attention to integration within multitiered service delivery frameworks has not occurred yet is essential to accurate, durable, and scalable implementation. In addition, there is a critical need to concurrently build a strong evidence base regarding trauma-informed service delivery in schools. In this paper, the literatures on trauma-informed approaches and multitiered frameworks for school-based service delivery are connected with the goal to provide suggestions toward building blueprints for trauma-informed service delivery in schools. Drawing from the literature on implementation blueprints for school-wide positive behavior supports, sections are organized around current knowledge about trauma-informed approaches with regard to blueprints for (a) implementation, (b) professional development, and (c) evaluation. Critical issues, strategy recommendations, and directions for research are discussed.
261 citations
Cites background from "Psychometric Properties of the UCLA..."
...…in screening, increases in PTSD-RI total scores have been associated with significant increases in the probability of endorsing other academic, social, emotional, and behavioral problems, including suicidality, self-injurious behavior, and alcohol and other substance use (Steinberg et al., 2013)....
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...In support of its specific use in screening, increases in PTSD-RI total scores have been associated with significant increases in the probability of endorsing other academic, social, emotional, and behavioral problems, including suicidality, self-injurious behavior, and alcohol and other substance use (Steinberg et al., 2013)....
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...Large-scale analyses of data collected from 6291 children ages 7–18 using the DSM IV version of the instrument revealed adequate to good evidence for the reliability and validity of resulting data (Steinberg et al., 2013)....
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TL;DR: The state of resilience research is reviewed, with a focus on recent work, as it pertains to protecting children from the health impacts of early adversity, finding evidence for 5 modifiable resilience factors to improve children’s long- and short-term health outcomes.
Abstract: Childhood adversity is highly prevalent and associated with risk for poor health outcomes in childhood and throughout the life course. Empirical literature on resilience over the past 40 years has identified protective factors for traumatized children that improve health outcomes. Despite these empirical investigations of resilience, there is limited integration of these findings into proactive strategies to mitigate the impact of adverse childhood experiences. We review the state of resilience research, with a focus on recent work, as it pertains to protecting children from the health impacts of early adversity. We identify and document evidence for 5 modifiable resilience factors to improve children's long- and short-term health outcomes, including fostering positive appraisal styles in children and bolstering executive function, improving parenting, supporting maternal mental health, teaching parents the importance of good self-care skills and consistent household routines, and offering anticipatory guidance about the impact of trauma on children. We conclude with 10 recommendations for pediatric practitioners to leverage the identified modifiable resilience factors to help children withstand, adapt to, and recover from adversity. Taken together, these recommendations constitute a blueprint for a trauma-informed medical home. Building resilience in pediatric patients offers an opportunity to improve the health and well-being of the next generation, enhance national productivity, and reduce spending on health care for chronic diseases.
217 citations
TL;DR: For example, the authors evaluated the independent and additive predictive effects of psychological maltreatment on an array of behavioral problems, symptoms, and disorders in a large national sample of clinic-referred children and adolescents drawn from the National Child Traumatic Stress Network Core Data Set (CDS).
Abstract: For this study, we evaluated the independent and additive predictive effects of psychological maltreatment on an array of behavioral problems, symptoms, and disorders in a large national sample of clinic-referred children and adolescents drawn from the National Child Traumatic Stress Network Core Data Set (CDS; see Layne, Briggs-King, & Courtois, 2014). We analyzed a subsample of 5,616 youth with lifetime histories of 1 or more of 3 forms of maltreatment: psychological maltreatment (emotional abuse or emotional neglect), physical abuse, and sexual abuse. Measures included the University of California, Los Angeles Posttraumatic Stress Disorder–Reaction Index (Steinberg et al., 2004), Child Behavior Checklist (Achenbach & Rescorla, 2004), and 27 diagnostic and CDS-specific clinical severity indicators. Psychologically maltreated youth exhibited equivalent or greater baseline levels of behavioral problems, symptoms, and disorders compared with physically or sexually abused youth on most indicators. The co-occurrence of psychological maltreatment with physical or sexual abuse was linked to the exacerbation of most outcomes. We found that the clinical profiles of psychologically maltreated youth overlapped with, yet were distinct from, those of physically and/or sexually abused youth. Despite its high prevalence in the CDS, psychological maltreatment was rarely the focus of intervention for youth in this large national sample. We discuss implications for child mental health policy; educational outreach to providers, youth, and families; and the development or adaptation of evidence-based interventions that target the effects of this widespread, harmful, yet often overlooked form of maltreatment.
186 citations
Cites background or methods from "Psychometric Properties of the UCLA..."
...Nevertheless, equivalent PTSD-RI scores across PM, SA, and PA groups, coupled with the finding that the PM group was as likely as the PA group to receive a clinician rating of PTSD, provides support for both the inclusion of PM as a qualifying stressor for PTSD as well as healthy skepticism concerning the diagnostic utility of excluding PM from PTSD Criterion A (Van Hooff, McFarlane, Bauer, Abraham, & Barnes, 2009)....
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...Further, compared with the SA group, the PM SA group had significantly higher scores on the CBCL-Ext., estimated difference 2.62, SE 0.86; p 0.0024, and CBCL-Int. composite scales, estimated difference 2.14, SE 0.84; p 0.0107, as well as marginally higher scores on the PTSD-RI, estimated difference 2.15, SE 1.09; p 0.0495 (see Table 1 for group comparison details)....
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...CBCL subscale & PTSD-RI total scale scores....
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...Female status was associated with significantly higher PTSD-RI scores (Steinberg et al., 2004) and with a significantly higher frequency (7 of 27; 26...
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...Compared with the PA group, the PM PA group had significantly higher CBCL-Int. scores (Achenbach & Rescorla, 2004), estimated difference 2.66, SE 0.62; p .0001, and PTSD-RI scores (Steinberg et al., 2004), estimated difference 2.45, SE 0.81; p 0.0025....
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TL;DR: Amygdala and hippocampal volume were reduced among children with maltreatment exposure and were negatively associated with SCR to the CS+ during early conditioning in the total sample, although these associations were negative only among non-maltreated children and were positive among maltreated children.
185 citations
Additional excerpts
...The PTSD-RI generates a PTSD symptom severity score and an analog diagnosis and has good internal consistency and convergent validity (Steinberg et al, 2013)....
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References
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TL;DR: Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumAs.
Abstract: Background: Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode. Methods: Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey. Results: The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years. Conclusions: Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas. (Arch Gen Psychiatry. 1995;52:1048-1060)
9,690 citations
TL;DR: Results suggest the K-SADS-PL generates reliable and valid child psychiatric diagnoses.
Abstract: Objective To describe the psychometric properties of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) interview, which surveys additional disorders not assessed in prior K-SADS, contains improved probes and anchor points, includes diagnosis-specific impairment ratings, generates DSM-III-R and DSM-IV diagnoses, and divides symptoms surveyed into a screening interview and five diagnostic supplements. Method Subjects were 55 psychiatric outpatients and 11 normal controls (aged 7 through 17 years). Both parents and children were used as informants. Concurrent validity of the screen criteria and the K-SADS-PL diagnoses was assessed against standard self-report scales. Interrater ( n = 15) and test-retest ( n = 20) reliability data were also collected (mean retest interval: 18 days; range: 2 to 38 days). Results Rating scale data support the concurrent validity of screens and K-SADS-PL diagnoses. Interrater agreement in scoring screens and diagnoses was high (range: 93% to 100%). Test-retest reliability κ coefficients were in the excellent range for present and/or lifetime diagnoses of major depression, any bipolar, generalized anxiety, conduct, and oppositional defiant disorder (.77 to 1.00) and in the good range for present diagnoses of posttraumatic stress disorder and attention-deficit hyperactivity disorder (.63 to .67). Conclusion Results suggest the K-SADS-PL generates reliable and valid child psychiatric diagnoses. J. Am. Acad. Child Adolesc. Psychiatry , 1997, 36(7): 980–988.
8,742 citations
Journal Article•
TL;DR: A set of criteria based upon biostatistical considerations for determining the interrater reliability of specific adaptive behavior items in a given setting was presented and guidelines for differentiating type of adaptive behavior that are statistically reliable from those that are reliable in a clinical or practical sense were delineated.
Abstract: A set of criteria based upon biostatistical considerations for determining the interrater reliability of specific adaptive behavior items in a given setting was presented. The advantages and limitations of extant statistical assessment procedures were discussed. Also, a set of guidelines for differentiating type of adaptive behavior that are statistically reliable from those that are reliable in a clinical or practical sense was delineated. Data sets were presented throughout in order to illustrate the advantages of recommended statistical procedures over other available ones.
2,017 citations
"Psychometric Properties of the UCLA..." refers methods in this paper
...The correlation between the total scale PTSD-RI score and the PTS subscale of the TSCC-A, which is in the excellent range (Cicchetti & Sparrow, 1981) provides strong evidence of convergent validity....
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TL;DR: Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs.
Abstract: Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants.
1,815 citations
"Psychometric Properties of the UCLA..." refers result in this paper
...…of higher PTSD-RI total scores among girls compared with boys is consonant with the majority of findings in the child and adult literature across a variety of trauma types (Cohen et al., 2010; Kimerling, Ouimette, & Wolfe, 2002; Tolin & Foa, 2006; Vernberg, Silverman, La Greca, & Prinstein, 1996)....
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TL;DR: Results generally support the hypothesis that exposure to interpersonal violence increases the risk of these disorders and of diagnostic comorbidity.
Abstract: With a national household probability sample of 4,023 telephone-interviewed adolescents ages 12–17, this study provides prevalence, comorbidity, and risk-factor data for posttraumatic stress disorder (PTSD), major depressive episode (MDE), and substance abuse/dependence (SA/D). Roughly 16% of boys and 19% of girls met criteria for at least 1 diagnosis. Six-month PTSD prevalence was 3.7% for boys and 6.3% for girls, 6-month MDE prevalence was 7.4% for boys and 13.9% for girls, and 12-month SA/D prevalence was 8.2% for boys and 6.2% for girls. PTSD was more likely to be comorbid than were MDE and SA/D. Results generally support the hypothesis that exposure to interpersonal violence (i.e., physical assault, sexual assault, or witnessed violence) increases the risk of these disorders and of diagnostic comorbidity. Limited information exists about the prevalence and comorbidity of posttraumatic stress disorder (PTSD), major depressive episode (MDE), and substance abuse/dependence (SA/D) among probability samples of adolescents. The extent to which interpersonal violence increases risk of these disorders also remains understudied. We examined these issues using data from the National Survey of Adolescents (NSA). In addition to presenting national prevalence and comorbidity data for these three disorders, we tested the hypothesis that exposure to interpersonal violence increases risk of each disorder and of comorbidity. To date, the best estimates of these mental health problems and their comorbidity among younger age groups at the national level come from the National Comorbidity Survey (NCS; Kessler et al., 1994; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Kessler
1,511 citations
"Psychometric Properties of the UCLA..." refers background in this paper
...This may be due to a moderate degree of theoretical relatedness of these constructs, which may underlie their frequent co-occurrence (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Kilpatrick et al., 2003)....
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...This may be due to a moderate degree of theoretical relatedness of these constructs, which may underlie their frequent co-occurrence (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Kilpatrick et al., 2003)....
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