Clinician Administered PTSD Scale for Children and Adolescents
Nader, K.O., Newman, E., Weathers, F.W., Kaloupek, D.G., Kriegler, J.A., & Blake, D.D. (2004). National Center for PTSD Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) Interview Booklet. Los Angeles: Western Psychological Services. Newman, E., Weathers, F.W., Nader, K., Kaloupek, D.G., Pynoos, R.S., Blake, D.D., & Kriegler, J.A. (2004). Clinician-Administered PTSD Scale for Children and Adolescents (CAPSCA)
Interviewer's Guide. Los Angeles: Western Psychological Services.
The CAPS-CA is based on the CAPS, which is considered a gold standard for assessing PTSD in individuals over age 15. It assesses the frequency and intensity of the 17 symptoms of PTSD, with items developed to be consistent with the DSM-IV.
It also evaluates the impact of the symptoms on the child’s social, occupational, and developmental functioning; subjective distress; global severity; and validity of the interview. A global improvement rating since baseline can also be made, as can ratings of associated symptoms and Acute Stress Disorder symptoms.
The measure yields diagnostic information regarding PTSD as well as scores for Reexperiencing, Avoidance and Numbing, Hyperarousal, and total PTSD. When current PTSD is not diagnosed, the interview permits assessment of lifetime PTSD.
For each symptom, frequency is rated on a 5-point scale:
0=none of the time
1=little of the time, once or twice
2=some of the time, once or twice a week
3=much of the time, several times a week
4=most of the time, daily or almost every day
Intensity is also rated on a 5-point scale with specific descriptors for each item, e.g.,
0=not a problem, none
1=a little, minimal distress or disruption of activities
2=some, moderate, distress clearly present but still manageable, some disruption of activities
3=a lot, severe, considerable distress, difficulty dismissing
memories, marked disruption of activities 4=a whole lot, extreme, incapacitating distress, cannot dismiss memories, unable to continue activities
|Reexperiencing||Did you think about [EVENT] even when you didn't want|
to? Did you see pictures in your head (mind) or hear the
sounds in your head (mind) from [EVENT]? What were
|Did you try to stay away from people, things or activities|
that made you think about (remember) what happened?
|Hyperarousal||Have you been getting angry (mad, bothered, annoyed)|
more quickly than you used to?
|Associated Features||Did you think that [EVENT] was your fault?|
|Have there been times when things going on around|
you seemed very strange, when you didn't know
whether it was real or not?
From the manual:
The CAPS-CA is based on the CAPS (also reviewed in this database), the adult version, and was designed to be comparable. The following modifications were made to make the measure more appropriate for children:
1. Added a practice section to introduce respondents to the interview format.
2. Developed a systematic procedure for identifying the relevant timeframe.
3. Developed optional picture response options to correspond to the frequency and intensity anchors.
4. Modified prompt and follow-up questions so as to be appropriate for children aged 8-15 who are seen in inpatient or outpatient settings.
Earlier versions of the CAPS-CA (e.g., CAPS-C) differ slightly from this revision. The latest CAPS-CA was revised in the following ways:
1. Added a more thorough trauma inquiry consistent with DSM-IV Criteria A.
2. Removed reference to “at the worst” for intensity ratings to eliminate confusion as to the time period being asked about.
3. Changed anchors to make them more comprehensive (the descriptors for intensity items are
specific to the items).
4. Added inquiry for lifetime PTSD for cases where the person does not meet criteria of current PTSD.
5. Added questions about acute, chronic, and delayed onset.
6. Added questions related to DSM-IV criteria E and F, symptom duration, and distress and impairment.
7. Changed scoring so that items with questionable validity are no longer included in the score.
8. Removed the “cued” versus “uncued” distinction from the item on intrusive memories because it is not required for diagnosis.
9. Rewrote cues for the intensity prompts to reflect the interviewer’s language rather than the child’s, and reduced tendency to use the measure as a self-report form.
10. Eliminated items that were problematic and not psychometrically useful, such as time skew and general health complaints. The manual reports that a modified parent-reportversion of the CAPS-CA for young children is being developed.
|Internal Consistency||Acceptable||Chronbach's alpha||0.75||0.81||0.78|
The manual reports that a modified parent-report version of the CAPS-CA for young children is being developed.
Erwin, Newman, McMackin, Morrisey, & Kaloupek (2000) used the CAPS-CA with 51 male adolescent offenders recruited from juvenile treatment facilities. They reported the following internal consistencies: Reexperiencing (.81), Numbing (.75), and Arousal (.79). These numbers are reported in the above table, as these are the data cited in the manual.
A number of different studies have provided evidence that the CAPS-CA can be administered reliably by different interviewers.
1. Erwin, Newman, McMackin, Morrisey, & Kaloupek (2000) conducted reliability on 9.8% of 51 interviews and reported a kappa coefficient of .80. These data reported in the table.
2. Carrion, Weems, Ray, & Reiss (2002) reported an intraclass correlation of .97 with a subsample of 10 interviews that were coded by two interviewers: Dr. Carrion and Dr.
Newman (one of the developers of the CAPS-CA).
3. Stallard, Slater, & Velleman (2004) had two interviewers independently rate taped interviews and reported Cohen’s kappa as .85 for 10 tapes and for another 6 tapes as .81.
4. Stallard, Velleman, & Baldwin (2001) reported interrater agreement as 93.1% for four researchers who conducted joint assessments. They did not report the number of interviews for which joint interviews were conducted, or the procedure for conducting these joint interviews.
The CAPS-CA is based on the CAPS. The CAPS manual notes that “the CAPS was written and revised by a team of experts in the field of traumatic stress at the various branches of the National Center for PTSD. The test was based directly on the diagnostic criteria for PTSD in the DSM-III-R and DSM-IV, and represents these criteria faithfully” (Weathers, 2004 p. 7). The CAPS revision that followed the publication of the DSM-IV integrated changes related to changes in PTSD criteria and also reflected formal and informal feedback from CAPS users.
|Validity Type||Not known||Not found||Nonclincal Samples||Clinical Samples||Diverse Samples|
|Sensitive to Change||Yes||Yes|
|Sensitive to Theoretically Distinct Groups||Yes|
The literature reviewed focused only on those studies that used the CAPS-C or CAPS-CA. It should be noted that there are slightly different versions of the CAPS-CA, and it was often difficult to determine which version was used, but the versions should share psychometric properties. The CAPS-CA should also share psychometric properties with the CAPS, adult version, which is reviewed in this database.
CORRELATIONS WITH OTHER MEASURES
1. Erwin et al. (2000) reported that the mean CAPS-CA intensity rating was significantly related to the mean total of the PTSD checklist (r=.64).
2. Carrion et al., (2002) reported a significant correlation between the CAPS-CA total score and the Child PTSD Reaction Index (20-item version: r=.51, p<.05).
3. Chemtob & Carlson (2004) found a significant correlation between CAPS-CA scores and Anger, r=.58, p<.05, although it is unclear which measure was used to assess for anger.
4. Kassam-Adams & Winston (2004) reported a significant correlation between ASD symptoms, assessed using the Child Acute Stress Questionnaire, and CAPS-CA PTSD scores (r=.56, p<.0005).
5. Weems, Saltzman, Reiss, & Carrion (2003) gathered longitudinal CAPS-CA data from 42 children aged 7-14. They present intercorrelations between CAPSCA Time 1 and Time 2 (1 year later) scores. CAPS-CA scores have also been found to correlate with a number of
1. Delahanty, Nugent, Christopher, & Walsh (2005) found that CAPS-CA Total scores were significantly correlated with urinary cortisol levels in a sample of children with acute PTSD related to traumatic injuries. Analyses by gender showed the relationship was significant for boys (r=.52, p<.01) but not for girls (r=.01, p=N.S.), and that for boys, CAPS-CA scores were also related to Epinephrine (r=.46, p<.01) and Norepinephrine levels (r=.41, p<.05).
2. In a sample of 190 children aged 8-17 hospitalized for traffic related injuries, Kassam-Adams, Garcia-España, Fein, & Winston (2005) found that children with full or partial PTSD on the CAPS-CA had significantly higher heart rate at triage than did children with no PTSD.
The measure appears to discriminate between groups.
1. Carrion et al. (2002) reported that children who met criteria for two or three symptom clusters differed significantly from those who met one symptom cluster with regard to distress, social impairment, school impairment, overall impairment, and percent meeting PTSD criteria.
2. In a retrospective data analysis that involved the CAPS-C, Stallard (2003) reported a significant difference between children who developed PTSD and those who did not. Those who developed PTSD were significantly more likely to have perceived life threat during the accident, to have more negative appraisals of trauma sequelae, to endorse more behavioral avoidance since the accident, and to be more likely to use distraction and rumination as coping strategies (assessed using the Kidcope).
3. In a sample of 170 children who had experienced traffic or sporting accidents, Stallard, Velleman, & Baldwin (1999) found significant differences between children diagnosed with PTSD and those who did not meet PTSD criteria. Children meeting PTSD criteria had significantly higher scores on the Impact of Events Scale Total, Intrusion, and Avoidance scales, Beck Depression Inventory, and Revised Children’s Manifest Anxiety Scale.
SENSITIVITY TO CHANGE
1. Kolko, Baumann, & Caldwell (2003) found significant change over time on CAPS-CA scores in a sample of ethnically diverse children (55.9% African
American) referred due to a reported child sexual or physical abuse.
2. In a study examining the efficacy of a group-administered CBT protocol for 17 children (41% African American, 47% White, <1% Asian, <1% Native American) who experienced a single incident stressor, March, Amaya-Jackson, Murray, & Schulte (1998) used the CAPS-C and found statistically significant reductions (40%) immediately after treatment and an additional 40% reduction at posttreatment with improvements maintained at 6-month follow-up. Stressors included accident, assault/exposure to violence, death of loved ones, and natural
3. The CAPS-CA also appears to be sensitive to change resulting from pharmacological intervention. In an open-label study of citalopram, Seedat,
Lockhat, Kaminer, Zungu-Dirwayi, & Stein (2001) found significant reductions (pre- to post-test comparisons) on all CAPS-CA scales following 12 weeks of treatment. The 8 children in this study were aged 12-18 and had experienced traumas including sexual abuse, exposure to domestic violence, physical abuse, shooting, witnessing the death of a friend, rape, and witnessing genocide.
4. Seedat et al. (2002) also reported significant reductions in CAPS-CA scores (total and cluster) in a sample of 24 children aged 10 to 18 who were treated with citalopram over an 8-week period. Trauma exposure included rape/sexual assault, witnessing violence or death, and physical assault.
1. Studies appear to differ with regard to gender differences. Carrion et al.(2002)
found that girls and boys did not differ with regard to clusters B, C, or D, = or to meeting criteria for PTSD.
2. Others (e.g., Delahanty et al., 2005; Stallard, 2003; Stallard, Salter, & Velleman, 2004) report that girls have significantly greater PTSD symptoms and are more likely than boys are to develop PTSD.
USE WITH TRAFFIC ACCIDENTS
As can be seen above, the CAPS-CA and CAPS-C have been used in a number of studies of children who experienced traffic accidents (e.g., Stallard, 2003; Stallard, Velleman, & Baldwin, 1999; Stallard, Velleman, Langsford, & Baldwin, 2001).
1. Salter & Stallard (2004) used the CAPS-C with 158 children aged 7-18 who were involved in road traffic accidents and found that 37% met criteria for posttraumatic stress disorder.
2. Stallard, Velleman, & Baldwin (2001) used the CAPS-C longitudinally with a sample of 40 children aged 5-18 who had experienced road traffic accidents. Children were assessed 6 weeks and 8 months following the accident. They reported that of the 21 children who had PTSD at 6 weeks, 10 continued to fulfill diagnostic criteria at 8 months. They also reported that children who reported talking about the accident were significantly less likely to have PTSD at Time 2 as were children who felt the trauma was understood.
1. In a comparison of adolescents who experienced intra- versus extrafamiliar sexual abuse, Bal, De Bourdeaudhuij, Crombez, & Van Oost (2004) found no differences in the numbers of children who met PTSD criteria using the CAPSCA.
|Not Known||Not Found||Nonclinical Samples||Clinical Samples||Diverse Samples|
Although the CAPS has data on Sensitivity, Specificity, Negative Predictive Value, and Positive Predictive Value, and the CAPS and CAPS-CA most likely
share psychometric properties, there are no data examining the CAPS-CA in this way.
Not much psychometric testing has been conducted on the CAPS-CA, and there are no norms available.
The manual (Weathers, 2004) reports that there is information from only a single study about the characteristics of the CAPS-CA. That study is cited as Newman, McMackin, Morriseey, and Erwin (1997), which was published in Traumatic Stresspoints. Similar data were also published in a peer-reviewed journal article by Erwin, Newman, McMackin, Morrisey, & Kaloupek (2000). This study included 51 male adolescent offenders recruited from juvenile treatment facilities. The mean age was 17.5 years (SD=1.5). The ethnicity/racial background of participants was 57% Caucasian, 28% African American,
12% Hispanic. Specific data regarding reason for incarceration, substance use, and violence in interpersonal relationships are reported in the article.
Of note, while conducting this review, we identified additional articles that reported on the psychometrics of the CAPS-CA, although they are not psychometric studies of the CAPSCA.
Pros & Cons/References
1. Provides an in-depth assessment of PTSD for children and adolescents based on DSMIV criteria, and yields both diagnostic information and continuous symptoms scores.
2. Allows for the assessment of both frequency and intensity of PTSD symptoms. As noted by researchers (e.g., Carrion et al., 2002) there is a utility in assessing both intensity and frequency). Carrion et al. (2002) found, for example, that intensity symptoms predict PTSD diagnosis or functional impairment independently of frequency.
3. Has been shown to be sensitive to treatment.
1. The interview form is somewhat complicated and requires training to administer.
2. The measure is lengthy and is costly to administer with regard to clinician time (Ohan, Myers, & Collett, 2002).
3. Can be cumbersome to administer because respondents are asked to rate frequency and severity of each symptom (Ohan et al., 2002).
4. Psychometric properties are not well researched. Although there have been studies published on the CAPS and the two measures should share psychometric properties, there have been no studies published focusing directly on the psychometrics of the CAPS-CA. NOT A CON, JUST A NOTE: The CAPS requires that the child endorses having experienced at least one traumatic event, which means it would not be an appropriate interview for children who deny exposure.
The references for the manual are:
1. Nader, K.O., Newman, E., Weathers, F.W., Kaloupek, D.G., Kriegler, J.A., & Blake, D.D. (2004). National Center for PTSD Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) Interview Booklet. Los Angeles: Western Psychological Services.
2. Newman, E., Weathers, F.W., Nader, K., Kaloupek, D.G., Pynoos, R.S., Blake, D.D., & Kriegler, J.A. (2004). Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) Interviewer's Guide. Los Angeles: Western Psychological Services.
3. Weathers, F.W. (2004). Clinician-Administered PTSD Scale (CAPS) Technical Manual. Los Angeles: Western Psychological Services. A PsychInfo literature search conducted 9/05 for “Clinician-Administered PTSD Scale for Children” or “Clinician Administered PTSD Scale for Children” or “CAPS-CA” or “CAPS-C” anywhere revealed the measure has been referenced in 42 peer-reviewed journal articles. While conducting the review, we identified an additional two articles that referenced the measure. A sampling of these articles is presented below.
1. Bal, S., De Bourdeaudhuij, I., Crombez, G., Van Oost, P. (2004). Differences in trauma symptoms and family functioning in intra- and extrafamiliar sexually abused adolescents. Journal of Interpersonal Violence, 19(1), 108-123.
2. Carrion, V.G., Weems, C.F., Ray, R., & Reiss, A.L. (2002). Toward an empirical definition of pediatric PTSD: The phenomenology of PTSD symptoms in youth. Journal of the American Academy of Child & Adolescent Psychiatry, 41(2), 166-173.
3. Chemtob, C.M., & Carlson, J.G. (2004). Psychological effects of domestic violence on children and their mothers. International Journal of Stress Management, 11(3), 209-226.
4. Delahanty, D.L., Nugent, N.R., Christopher, N.C., & Walsh, M. (2005). Initial urinary epinephrine and cortisol levels predict acute PTSD symptoms in child trauma victims. Psychoneuroendocrinology, 30(2), 121-128.
5. Erwin, B.A., Newman, E., McMackin, R.A., Morrissey, C., & Kaloupek, D.G. (2000). PTSD, malevolent environment, and criminality among criminally involved male adolescents. Criminal Justice & Behavior, 27(2), 196-215.
6. Kassam-Adams, N., Garcia-España, J.F., Fein, J. A., & Winston, F.K. (2005). Heart rate and posttraumatic stress in injured children. Archives of General Psychiatry, 62(3), 335-340.
7. Kassam-Adams, N., & Winston, F.K. (2004). Predicting child PTSD: The relationship between acute stress disorder and PTSD in injured children. Journal of the American Academy of Child & Adolescent Psychiatry, 43(4), 403-411.
8. Kolko, D.J., Baumann, B.L., & Caldwell, N. (2003). Child abuse victims' involvement in community agency treatment: Service correlates, short-term outcomes, and relationship to reabuse. Child Maltreatment: Journal of the American Professional Society on the Abuse of Children, 8(4), 273-287.
9. March, J.S., Amaya-Jackson, L., Murray, M.C., & Schulte, A. (1998). Cognitive-behavioralpsychotherapy for children and adolescents with posttraumatic stress disorder after a singleincident stressor. Journal of the American Academy of Child & Adolescent Psychiatry, 37(6), 585-593.
10. 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 and Adolescent Psychiatry, 41(12), 1401-1422.
11. Salter, E., & Stallard, P. (2004). Posttraumatic growth in child survivors of a road traffic accident. Journal of traumatic stress, 17(4), 335-340.
12. Seedat, S., Lockhat, R., Kaminer, D., Zungu-Dirwayi, N., & Stein, D.J. (2001). An open trial of citalopram in adolescents with post-traumatic stress disorder. International Clinical Psychopharmacology, 16(1), 21-25.
13. Seedat, S., Stein, D.J., Ziervogel, C., Middleton, T., Kaminer, D., & Emsley, R.A. et al. (2002). Comparison of response to a selective serotonin reuptake inhibitor in children, adolescents and adults with posttraumatic stress disorder. Journal of Child & Adolescent Psychopharmacology, 12(1), 37-46.
14. Stallard, P. (2003). A retrospective analysis to explore the applicability of the Ehlers and Clark (2000) cognitive model to explain PTSD in children. Behavioural and Cognitive Psychotherapy, 31(3), 337-345.
15. Stallard, P., Salter, E., & Velleman, R. (2004). Posttraumatic stress disorder following road traffic accidents: A second prospective study. European child & adolescent psychiatry, 13(3), 172-178.
16. Stallard, P., Velleman, R., Langsford, J., & Baldwin, S. (2001). Coping and psychological distress in children involved in road traffic accidents. British Journal of Clinical Psychology, 40(2), 197-208.
17. Stallard, P., Velleman, R., & Baldwin, S. (2001). Recovery from post-traumatic stress disorder in children following road traffic accidents: The role of talking and feeling understood. Journal of Community & Applied Social Psychology, 11(1), 37-41.
18. Stallard, P., Velleman, R., & Baldwin, S. (1999). Psychological screening of children for post-traumatic stress disorder. Journal of Child Psychology & Psychiatry, 40(7), 1075-1082.
19. Weems, C.F., Saltzman, K.M., Reiss, A.L., & Carrion, V.G. (2003). A prospective test of the association between hyperarousal and emotional numbing in youth with a history of traumatic stress. Journal of Clinical Child & Adolescent Psychology, 32(1), 166-171.
Other Related References
Newman, E., McMackin, R., Morrissey, C., & Erwin, B. (1997). Addressing PTSD and trauma-related symptoms among criminally involved male adolescents. Traumatic Stresspoints, 11(1), 7.