Pediatric Emotional Distress Scale

Submitted by mholliday on Tue, 10/16/2012 - 09:37

Overview

Acronym: 
PEDS
Author(s): 
Saylor, Conway F.
Citation: 

Saylor, C.F, Swenson, C. C., Reynolds, S.S., & Taylor, M.
(1999). The Pediatric Emotional Distress Scale: A brief screening
measure for young children exposed to traumatic events. Journal
of Clinical Child Psychology, 28:1, 70-81.

Saylor C.F. (2002). The Pediatric Emotional Distress Scale
(PEDS). Available from Conway Saylor, PhD, Department of
Psychology, The Citadel, 171 Moultrie Avenue, Charleston, SC
29409 (conway.saylor@citadel.edu).

Obtain(Email/Website): 

conway.saylor@citadel.edu / http://www.nctsn.org

Cost: 
Free
Copyrighted: 
No
Measure Description: 

This 21-item parent-report measure was designed to rapidly
assess and screen for elevated symptomatology in children
following exposure to a stressful and/or traumatic event. It is not
intended to be a diagnostic instrument. It consists of behaviors
that have been identified in the literature as associated with
experiencing traumatic events and consists of 17 general
behavior items and 4 trauma-specific items.

The measure yields scores on the following scales: 1)
Anxious/Withdrawn, 2) Fearful, and 3) Acting Out. Of the 4
trauma-specific items, 2 loaded on a separate Talk/Play factor.

Domain(s) Assessed : 
Traumatic Stress
Anxiety/Mood (Internalizing Symptoms)
Externalizing Symptoms
Language(s) : 
English
Spanish
Age Range: 
2-10
Measure Type: 
Screening
# of Items: 
21
Measure Format: 
Questionnaire
Average Time to Complete (min): 
7
Reporter Type: 
Parent/Caregiver
Average Time to Score (min): 
4
Periodicity: 
last month
Response Format: 

4-item Likert rating scale: 1) Almost Never, 2) Sometimes, 3) Often, and 4) Very Often)

Materials Needed: 
Paper/Pencil
Sample Item(s): 
DomainsScaleSample Items
TotalActing OutHas temper tantrums.
 Anxious/WithdrawnSeems sad and withdrawn.
 FearfulRefuses to sleep alone.
Information Provided: 
Areas of Concern/Risks
Clinician Friendly Output
Raw Scores
Strengths

Parallel/Alternate Forms

Parallel Form: 
No
Alternate Form: 
No
Different Age Forms: 
No
Altered Version Forms: 
Yes
Describe Alternative Forms: 

The author notes that they are currently testing a version used in a post-9/11 media study that asks parents to rate retrospectively both behavior prior to the trauma and behavior since the trauma. Please contact the author should you want additional information.

Psychometrics

Notes on Psychometric Norms: 

Means and standard deviations for 475 children (see "Population Used to
Develop Measure") are presented in Saylor (1999) for the full sample and
separately for trauma-exposed and non-trauma-exposed children by age (2-
5 and 6-10) and gender. This sample was not considered a normative
sample because they were not represented that way in the article and
because, with the exception of the Children’s Evaluation Center, they appear
to be gathered from a predominantly White, upper-middle-class sample and
do not appear to be a true normative sample.

Analyses of means suggest that there were no differences based on
gender. The only age difference is that younger children scored significantly
higher on the acting-out factor. Age analyses examined age differences
between children aged 2-5 and those aged 6-10.

Clinical Cutoffs: 
Yes
If Yes, Specify Cutoffs: 
Overall Sample: Anxious/Withdrawn = >9.5, Acting out = >13.5, Fearful = >8.5, Total = >27.5; Saylor et al. (1999) suggest using different cutoffs for scales based on maternal education.
Reliability: 
Type:RatingStatisticsMinMaxAvg
Test-Retest- # days: 42AcceptablePearson's r0.550.610.58
Internal ConsistencyAcceptableCronbach's alpha0.720.850.77
Inter-raterAcceptablePearson's r0.470.650.59
Parallel/Alternate Forms
References for Reliability: 

Saylor et al. (1999) report the data reported below and in the table.

TEST-REST RELIABILITY: 6-8 week interval examined with 102 families from the Utah
sample (see Population Used to Develop Measure)
PEDS Total (.56), Anxious/Withdrawn (.58), Fearful (.55), Acting Out (.61)

INTERNAL CONSISTENCY: (Cronbach’s alpha)
PEDS Total (.85), Anxious/Withdrawn (.74), Fearful (.72), Acting Out (.78)

INTERRATER RELIABILITY: Assessed examining correlations between 111 married
mothers and fathers in the Utah sample.
PEDS Total (.65), Anxious/Withdrawn (.58), Fearful (.47), Acting Out (.64)

OTHER STUDIES
A study of 29 homeless children (Page & Nooe, 1999) aged 2-10 (M=68.6 months, 59%
White, 32% African American) used the 17-item PEDS and reported the following alphas:
Total (.84), Anxious/Withdrawn (.62), Fearful (.21), Acting Out (.87). Given the low
internal consistency of the Fearful subscale, they excluded it from further analyses.

References for Content Validity: 

The author notes that they recently collected norms on a sample of 800 children from Spain.
Please contact the author for more information. From Saylor et al. (1999).

Through discussions with expert investigators who had studied the effects of an earthquake
in Southern California and a hurricane in South Carolina, 17 items were identified. Items
were identified from checklists (Child Behavior Checklist, the Reaction Index, the Revised
Children’s Manifest Anxiety Scale, Eyberg Checklist) as having been useful with children
exposed to natural disasters. Four items were added that were considered characteristic of
traumatized children based on the DSM-III-R criteria and outcome literature.

Doctoral-level psychologists also read items and identified those that were redundant,
inappropriate for children aged 2-10, or too difficult for a parent with an 8th-grade reading
level to understand.

Construct Validity: 
Validity TypeNot knownNot foundNonclincal SamplesClinical SamplesDiverse Samples
Convergent/ConcurrentYes
DiscriminantYesYes
Sensitive to ChangeYesYes
Intervention Effects
Longitudinal/Maturation Effects
Sensitive to Theoretically Distinct GroupsYesYes
Factorial ValidityYesYes
References for Construct Validity: 

Saylor et al. (1999):
Concurrent validity analyses were conducted with 50 children being evaluated for
possible sexual abuse victimization. PEDS Scores have been found to correlate
with scores on related measures. Total PEDS and Acting Out scores were
correlated with the ECBI (r=.62, p<.001 and r=.86, p<.001, respectively).
Smaller correlations were seen with the PEDS Anxiety/Withdrawn and Fearful
factors and the ECBI (r=.42, p<.007 and r=.32, p<.04, respectively). This would
be expected, given that the ECBI does not measure internalizing/anxiety
symptoms. Total PEDS was significantly correlated with PTSD symptoms
assessed using the parents’ report on the Reaction Index (r=.62, p<.001) as was
the Fearful factor (r=.59, p<.001), and the Anxious/Withdrawn Factor (r=.62,
p<.001). The Talk/Play factor, however, was not related to the Reaction Index
scores or to the ECBI.

1. In a study examining the effects of indirect exposure to the 9-11 attacks
(Saylor, Cowart, Lipovsky, Jackson, & Finch (2003), PEDS total scores were
related to exposure to negative media images (r=.23 p<.002) and positive media
images (r=.22, p<.002). The PTSD subscale of the PEDS was also related to
exposure to negative and positive media images (r=.24, p<.001 and r=.29,
p<.001, respectively).

2. Page, & Nooe (1999) reported that homeless children scored higher
compared to norms (with numbers >1 SD above mean). In this sample, they
reported significant correlations among scales (with the exception of the Fearful
scale, which did not have good internal consistency and was not used)?????:
Anxiety and Acting Out (r=.58, p<.01), Acting Out and Total (r=.92, p<.01), and
Total and Anxiety (r=.78, p<.01). A composite risk index was significantly related
to PEDS Anxiety (r=.51, p<.01) and Total (r=.40, p<.05) scores, with
demographic variables controlled. PEDS scores were significantly related to
variables associated with being homeless, with all scores related to the number
of cities in which the family had lived, and the Anxiety scale significantly
correlated with the number of schools the child had attended (r=.49, p<.01).
The measure has been used in a large study examining 1,739 children’s
exposure to community violence. Of the 565 children for whom demographics
were available: 35% African American, 23.6% Caucasian, 34% unknown. Age:
32.2% age 5 or under. Children were referred to the Children Who Witness
Violence Program of Cuyahoga County, Ohio, for evaluation and services
following exposure to violence.

Violence included domestic violence (87%) and much smaller numbers for other
violence including homicide, shooting, completed suicide, and sexual assault.
Clinicians and caregivers completed the PEDS and both groups reported that
high percentages of children aged 2-7 were experiencing clinically significant
levels of anxiety (92% of clinicians and 85% of caregivers). In addition, both
rated “8 of every 10 children to have clinically significant problems with acting out
behavior.”

3. The PEDS has been shown to differentiate between different groups of
children including trauma-exposed and non-trauma-exposed children (Saylor et
al., 1999) and children with different types of trauma (Stokes et al., 1995).
Swenson et al., (1996) compared preschoolers who experienced a Class IV
hurricane 14 months earlier to peers with no history of exposure to natural
disaster. Hurricane-exposed children showed significantly higher behavior
problems, anxiety, and withdrawal. Stokes et al. (1995) compared PEDS scores
for children who had experienced possible sexual abuse, a Class IV hurricane,
severe negative life events, or no trauma. Children with possible sexual abuse
had the highest scores on all PEDS subscales. Those with negative life events
or exposure to a hurricane had higher scores than those with no known trauma.
4. Swenson, Brown, & Sheidow (2003) studied 37 children aged 6-13 (M=9.5,
SD=2.1) with substantiated cases of physical abuse. 54% were female, 46%
male; 62% were African American, 32% were Caucasian. Over time, significant
reductions were found for PEDS scores and for scores on the Children’s
Depression Inventory and Child Behavior Checklist, regardless of whether the
child had received treatment.

FACTOR ANALYSES (Saylor et al., 1999)
Principal components analysis with an oblique rotation of the first 17 items of the
scale suggested three factors based on the interpretability and simplicity of the
structure. All factors had eigen values >1.5. The factors were labeled: 1) Acting
Out, 2) Fearful, and 3) Anxious/Withdrawn.

The full scale (all 21 items) was factor analyzed using data from trauma-exposed
children (the Hurricane and Children’s Evaluation Center samples described
under “Population Used to Develop Measure”). The authors report that for nontrauma-
exposed children, parents did not complete the additional 4 trauma items
and so were not included in this analysis. The factor analysis yielded identical
factors for the 17 items. Two of the trauma items loaded on a fourth factor,
labeled Talk/Play. One trauma item (“Avoids talking about the traumatic event
when asked”) loaded on the Anxious/Withdrawn factor, and the other (“Seems
fearful of things that are reminders of the trauma”) loaded on the Fearful factor.

Criterion Validity: 
Not KnownNot FoundNonclinical SamplesClinical SamplesDiverse Samples
Predictive Validity:
Postdictive Validity:
References for Criterion Validity: 

Saylor et al. (1999) report that PEDS scores alone do not appear to predict
trauma-exposed versus non-trauma-exposed status, but PEDS scores blocked
by maternal education correctly classified 78% of the cases; 9.5% false positive
rate and 12.5% false negative rate.

Overall Psychometric Limitations: 

1. Ohan, Myers, & Collett (2002) suggest that scores should not be used to determine
whether the child has been abused or exposed to trauma because sensitivity and specificity
studies have compared traumatized to nonclinical, nontraumatized samples but have not
compared traumatized children to other clinical samples.

2. In addition, it should be noted that classification rates were based not only on PEDS
scores but also on PEDS scores cutoffs based on maternal education.

3. The majority of the studies appear to have used the 17-item PEDS. There are 4 specific
items that were added. The factor analysis reveals that 2 of the items load on a 4th factor,
but studies do not appear to use this 4th factor. In addition, the data do not appear to
support the validity of the factor (lack of correlations with either the Reaction Index or ECBI).
However, this may be due to the fact that it has only two items.

4. While Saylor et al. (1999) report means and standard deviations for 475 children, the
sample does not appear to be a representative sample, and caution should be used if these
data are used for normative purposes.

Translation Quality

Language(s) Other Than English: 
Language:Translated234567
1. SpanishYesYesYes
2.
3.
4.
5.
6.
7.
8.
9.
10.

Population Information

Population Used For Measure Development: 

POPULATION USED TO DEVELOP MEASURE
From Saylor et al. (1999)

Four samples of children were used in the psychometric study:

1. UTAH SAMPLE: 182 children aged 2-10 (M=7); 50% female; 91% White, 1% African
American, 8% Other; 97% of mothers attended or completed college; 91% of mothers
were married. Children were attending a university-sponsored school in Logan, Utah.

2. BOSTON SAMPLE: 64 children enrolled in a university-affiliated developmental
kindergarten. Children were aged 2-10 (M=7.9); 50% female; 95% White, 5% African
American; 93% of mothers attended or completed college; 92% of mothers were married.

3. HURRICANE SAMPLE: 179 children (mean age=3.6), recruited from two large private
schools, who had been directly exposed to Hurricane Hugo (in Charleston, South
Carolina); 47% female, 53& male; 99% White, 1% Other; 75% of mothers attended or
completed college, 15% attended vocational school, and 10% attended or completed high
school; 96% of mothers were married.

4. CHILDREN’S EVALUATION CENTER: 50 children (mean age=7.9), recruited from an
outpatient evaluation center for children and adolescents, who may have been sexually
abused. 59% female, 41% male; 91% Caucasian, 9% African American; 52% of mothers
attended or completed high school, 17% attended vocational school, and 31% attended or
completed college; 65% were married, 8% were divorced, and 21% had another marital
status.

Measure has demonstrated evidence of reliability and validity in which populations?: 
Sexual Abuse
Natural Disaster
Community Violence
Other
Use with Diverse Populations: 
Population Type: 123456
1. Developmental disability
2. Disabilities
3. Lower socio-economic statusYesYes
4. Rural populations
5. Special needsYes

Pros & Cons/References

Pros: 

1. It screen for symptoms commonly seen in trauma-exposed children.

2. It is brief.

3. Individuals items are clearly written and easy to understand.

4. Items are derived from widely accepted measures.

5. The measure is free.

Cons: 

1. As noted by Feeney, Foa, Treadwell, & March (2004), the measure does not assess all
PTSD symptoms (it was not designed for this purpose), and therefore does not provide a
true measure of PTSD symptomatology. Also, the Reexperiencing factor may be
problematic, given that it consists of 2 items.


2. While psychometrics are promising, more research is needed. Concurrent validity was
examined only with a clinical sample. Also, as suggested by Ohan, Myers, & Collett (2002),
more research is needed to determine whether the PEDS can distinguish between traumaexposed
children and other clinical samples.


3. Little research has been conducted with diverse samples.


4. While Saylor et al. (1999) report means and standard deviations for 475 children, the
sample does not appear to be a representative sample, and caution should be used if
these data are used for normative purposes.


5. Although Saylor et al. (1999) found good internal consistency for all scales, Page &
Nooe (1999) found low internal consistency for the Fearful subscale (alpha=.21).


6. The measure was developed for children aged 2-10; however, examination of the mean
age of the children in the different studies suggests that few studies have used the
measure with younger children. More research is needed with younger children.

Author Comments : 

The author read the review and provided comments, which were integrated. He also provided permission to post the Spanish and English versions of the measure on nctsn.org

References: 

A PsychInfo literature search (7/05) of "Pediatric Emotional Distress Scale" or “PEDS”
anywhere revealed that the measure has been referenced in 10 peer-reviewed journal
articles. Two additional references were identified while conducting the review. A sampling
of these articles is included below.


1. Drotar, D., Flannery, D., Day, E., Friedman, S., Creeden, R., Gartland, H., et al. (2003).
Identifying and responding to the mental health service needs of children who have
experienced violence: A community-based approach. Clinical Child Psychology &
Psychiatry, 8(2), 187-203.


2. Feeny, N. C., Foa, E. B., Treadwell, K. R. H., & March, J. (2004). Posttraumatic stress
disorder in youth: A critical review of the cognitive and behavioral treatment outcome
literature. Professional Psychology: Research & Practice, 35(5), 466-476.


3. Ohan, J. L., Myers, K., & Collett, B. R. (2002). Ten-year review of rating scales. IV:
Scales assessing trauma and its effects. Journal of the American Academy of Child &
Adolescent Psychiatry, 41(12), 1401-1422.


4. Page, T. F., & Nooe, R. M. (1999). Relationships between psychosocial risks and stress
in homeless children. Journal of Social Distress & the Homeless, 8(4), 255-267.


5. Saylor, C. F., Cowart, B. L., Lipovsky, J. A., Jackson, C., & Finch, A. J. J. (2003). Media
exposure to September 11: Elementary school students' experiences and posttraumatic
symptoms. American Behavioral Scientist, 46(12), 1622-1642.


6. Saylor, C. F., Swenson, C. C., Reynolds, S. S., & Taylor, M. (1999). The pediatric
emotional distress scale: A brief screening measure for young children exposed to traumatic
events. Journal of Clinical Child Psychology, 28(1), 70-81.


7. Stokes, S., Saylor, C. F., Swenson, C. C., & Daugherty, T. (1995). Comparison of
children’s behaviors following three types of stressors. Child Psychiatry and Human
Development, 26, 113-123.


8. Strand, V. C., Sarmiento, T. L., & Pasquale, L. E. (2005). Assessment and screening
tools for trauma in children and adolescents: A review. Trauma, Violence, & Abuse, 6(1), 55-
78.
9. Swenson, C. C., Brown, E. J., & Sheidow, A. (2003). Medical, legal, and mental health
service utilization by physically abused children and their caregivers. Child Maltreatment:
Journal of the American Professional Society on the Abuse of Children, 8(2), 138-144.


10. Swenson, C. C., Saylor, C. F., Powell, M. P., Stokes, S. J., Foster, K. Y., & Belter, R.
W. (1996). Impact of a natural disaster on preschool children: Adjustment 14 months after a
hurricane. American Journal of Orthopsychiatry, 66(1), 122-130.

Developer of Review: 
Virginia Strand, D. S. W., & Chandra Ghosh Ippen, Ph.D.
Editor of Review: 
Chandra Ghosh Ippen, Ph.D., & Madhur Kulkarni, M.S.
Last Updated: 
Tue, 02/18/2014
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