Diagnostic Interview for Children and Adolescents Acute Stress Disorder Module
Miller, A.B., Saxe, G., Stoddard, F., Bartholomew, D., Hall, E., Lopez, C., Kaplow, J., C. Koenen, K., Bosquet, M., & Reich, W. (2004). Reliability and validity of the DICA-ASD. Poster presented at the meeting of the International Society for Traumatic Stress Studies, New Orleans, LA.
The DICA-ASD is a semi-structured clinical interview that provides a measure of self-reported Acute Stress Disorder symptomatology and diagnosis. It was adapted from the PTSD module of the DICA.
It consists of one item that assesses for the event and child’s age at the time of the event, 3 items that assess for the DSM-IV A2 ASD criteria, and 40 symptom items that correspond to the DSMIV criteria for ASD and assess Dissociation, Reexperiencing, Avoidance, and Arousal.
3-point scale(1=No, 2=Sometimes, 3=Yes)
|Dissociation||At the time of the ___ (TRAUMATIC EVENT) did you|
feel spaced out or dazed?
|Reexperiencing||Have you ever been really upset because you saw|
something that reminded you of the ____ (TRAUMATIC
|Avoidance||Do you try not to think or talk about ____ (TRAUMATIC|
|Arousal||Since the ____ (TRAUMATIC EVENT), do you have a|
lot more trouble than usual falling asleep or staying
|Internal Consistency||Acceptable||Cronbach's Alpha||0.76||0.93||0.85|
Saxe (manuscript in preparation) reports the following reliability data. Details regarding the sample can be found under “Population Used to Develop the Measure.”
INTERNAL CONSISTENCY (alpha)
Total DICA-ASD (Note: 3 items were not included):
Whole Sample (.88), Burn subsample (.93), Injury subsample (.84)
Dissociation Items: Whole Sample (.80), Burn subsample (.86), Injury subsample (.76)
Data are not provided on the reliability of Reexperiencing, Avoidance, or Arousal clusters;
but it can be assumed that they have good reliability, given that they are part of the DICAPTSD module.
Two interviewers conducted 23 interviews. Cohen’s kappa for ASD diagnosis was 1.00 (perfect interrater agreement).
The DICA-ASD is based on the DICA-PTSD. New items tapping dissociation were adapted from the Peritraumatic Dissociative Experiences Questionnaire and the Child PTSD Reaction Index, two widely used and widely accepted measures.
|Validity Type||Not known||Not found||Nonclincal Samples||Clinical Samples||Diverse Samples|
|Sensitive to Change|
|Sensitive to Theoretically Distinct Groups|
Saxe (manuscript in preparation) reports the following data:
Those diagnosed with ASD using the DICA-ASD had significantly higher scores on the CBCL PTSD scale, the PTSD Reaction Index, and the Child Stress
Disorder Checklist (both Nurse and Parent reports) than those who did not meet criteria. Support for discriminant validity was found in that the diagnostic grouping
(based on the DICA-ASD) did not differ on the CBCL Thought Problems or Delinquency scales.
|Not Known||Not Found||Nonclinical Samples||Clinical Samples||Diverse Samples|
NOT A CON: The measure is still under construction, but is promising and is important, as it yields both ASD symptomatology and diagnostic information obtained through Child Self-Report.
1. The data provided support the validity of DICA-ASD diagnosis but do not examine the validity of ASD symptomatology, as assessed by the DICA-ASD.
2. Diagnostic sensitivity and specificity need to be established testing the measure against alternate diagnostic measure.
3. Reliability was examined for the total DICA-ASD score and the Dissociation score but not for the other scales. While the other scales are from the DICA-PTSD and should share reliability, it would be helpful to know the reliability with regard to detecting symptoms immediately following trauma exposure.
(Details from Saxe, manuscript in preparation)
Psychometrics were examined with 140 children in the immediate aftermath of a burn (n=41) or injury (n=99).
1. The mean age of the injury sample was 13.73 (SD=3.50)
Gender: 71% boys, 29% girls
Ethnicity: 34% White, 45% Black, 17% Hispanic, and 2% Asian
Injuries included 33% pedestrian struck, 23% motor vehicle accident, 16% falls, 8%
stabbing, 7% assault, 5% gunshot wound, and 7% other
2. The mean age of the burn sample was 11.67 (SD=3.47)
Gender: 80.5% % boys, 19.5% girls
Ethnicity: 73% White, 12% Black, 5% Hispanic, 2% Native American, and 2% Multiracial
Mechanisms of burn: 51% fire, 22% scalding, 14% other, 3% chemical, and 3% explosion.
Pros & Cons/References
1. This is the one of the few measures that yields both a diagnosis and measure of ASD symptomatology. The measure is especially important, given the importance of detecting Acute Stress Disorder in children who have been exposed to traumas, and the importance of understanding the relation between ASD and PTSD.
2. The measure allows for assessment of ASD using Child Report.
1. There is limited published data using the measure. More research is needed to establish the measure's psychometrics.
2. The data provided support the validity of DICA-ASD diagnosis but do not examine the validity of ASD symptomatology, as assessed by the DICA-ASD.
3. Diagnostic sensitivity and specificity need to be established testing the measure against alternate diagnostic measure.
4. Similar to other diagnostic measures (e.g., DISC, SCID, C-PTSDI) for individual items, there is no coding of intensity, which may limit the measure’s statistical power and ability to detect potential change. Individuals may decrease in the intensity of a specific symptom while still meeting criteria for that symptom.
This is a new measure with no published references.