Child Stress Disorders Checklist

Overview

Acronym:

CSDC

Author(s):

Glenn Saxe, M.D.

Citation:

Saxe, G.N. (2001). Child Stress Disorders Checklist (CSDC) (v.4.0-11/01). National Child Traumatic Stress Network and Department of Child and Adolescent Psychiatry, Boston University School of Medicine.

Saxe, G., Chawla, N., Stoddard, F., Kassam-Adams, N., Courtney, D., Cunningham, K., Lopez, C., Sheridan, R., King, D., & Kind, L. (2003). Child stress disorders checklist: A measure of ASD and PTSD in children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(8), 972-978.

Obtain(Email/Website):

glenn.saxe@bmc.org / http://www.nctsnet.org/nctsn_assets/acp/hospital/CSDC.pdf

Cost:

Free

Copyrighted:

Yes

Measure Description:

The Child Stress Disorders Checklist (CSDC) is an observer report measure designed for use as a screening instrument for traumatic stress symptoms in children. It measures symptoms of Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PSTD).
The CDSC assesses for the trauma and DSM-IV A2 criteria for PTSD and ASD. It yields a total score as well as scores for Reexperiencing, Increased Arousal, Avoidance, Numbing and Dissociation, and Impairment in Functioning.

The measure can be completed by multiple types of observers who may have contact with a child including caregivers, nurses, teachers, and social service workers.

Domain(s) Assessed :

Trauma Exposure/Reminders

Externalizing Symptoms

Language(s) :

English

Age Range:

2-18

Measure Type:

Screening

Measure Format:

Questionnaire

Average Time to Complete (min):

Reporter Type:

Other

Average Time to Score (min):

Periodicity:

1 month (scale instructions are now or within the past month)

Response Format:

0=not true, 1=somewhat or sometimes true, 2=very true or often true

Materials Needed:

Paper/Pencil

Sample Item(s):

Domains	Scale	Sample Items
Total	Reexperiencing	Child reports uncomfortable memories of the event.
	Increased Arousal	Child startles easily. For example, he or she jumps when hears sudden or loud noises.
	Avoidance	Child avoids doing things that remind him or her of the event.
	Numbing and Dissociation	Child seems "spaced out" or in a daze.
	Impairment in Functioning	Child has difficulty getting along with friends, schoolmates, or teachers.

Information Provided:

Areas of Concern/Risks

Continuous Assessment

Raw Scores

Training

Training to Interpret:

Prior Experience Psych Testing/Interpretation

Parallel/Alternate Forms

Parallel Form:

Alternate Form:

Different Age Forms:

Altered Version Forms:

Yes

Describe Alternative Forms:

The measure was formerly called the Child Stress Reaction Checklist (Saxe, 1997).

There is also a Child Stress Disorders Checklist Screening Form (CSDC-SF), Saxe & Bosquet (2004), which consists of the first 5 items from this questionnaire and is available at http://www.nctsnet.org/nctsn_assets/acp/hospital/CSDC-Screening%20Form2.pdf.

The CSDC-SF is also reviewed in this database.

Psychometrics

Clinical Cutoffs:

Reliability:

Type:	Rating	Statistics	Min	Max	Avg
Test-Retest-# days: 2	Acceptable	r	0.63	0.89	0.78
Internal Consistency	Acceptable	Cronbach's alpha	0.83	0.86	0.85
Inter-rater	Questionnable	Intraclass correlation	0.24	0.45	0.34
Parallel/Alternate Forms

References for Reliability:

Data reported in the above table are summarized from Saxe et al. (2003).

TEST-RETEST RELIABILITY
Burn sample: 2 days
Total Score (.84), Arousal (.74), Numbing and Dissociation (.70), Avoidance (.85),
Functioning (.63), and Reexperiencing (.89)

INTERNAL CONSISTENCY
Whole sample: alpha=.84
Burn sample: alpha=.83
MVA sample: alpha=.86

INTERRATER RELIABIILTY
Burn sample: between parent and primary nurse (intraclass correlations)
Total score (.44), Arousal (.36), Numbing and Dissociation (.24), Avoidance (.28),
Functioning (.27), Reexperiencing (.45)

Reliability data were also reported by Saxe (1997) in three samples of children: 1) children
with burns (n=43), 2) children experiencing a motor vehicle accident (n=41), and 3)
children experiencing child abuse (n=45).

TEST-RETEST RELIABILITY 2-day interval, Total Score (r=0.84), subscale correlation range: 0.63-0.89

INTERNAL CONSISTENCY
Full sample: Cronbach’s alpha=.091
Burn sample: 0.83
MVA sample: 0.92
Child abuse sample: 0.93

INTERRATER RELIABILITY
Burn sample: parent and primary nurse as reporters
Total Score (r=0.43)
All subscales significant (range=0.30-0.51) with exception of Avoidance subscale

References for Content Validity:

The measure is based on DSM-IV ASD and PTSD symptomatology. No other information was provided regarding content validity.

Construct Validity:

Validity Type	Not known	Clinical Samples	Diverse Samples
Convergent/Concurrent		Yes	Yes
Discriminant		Yes	Yes
Sensitive to Change		Yes
Intervention Effects	Yes
Longitudinal/Maturation Effects
Sensitive to Theoretically Distinct Groups		Yes
Factorial Validity

References for Construct Validity:

Significant correlations between CSDC scores and scores on the Child Behavior Checklist PTSD Scale, Child Dissociation List, and the Child PTSD Reaction Index provide evidence of validity:

CBCL-PTSD: Parent Report (r=.39, p<.05)
CDC: Parent Report (r=.49, p<.01), Nurse Report (r=.33, p<.05)
CPTSD-RI: Parent Report (r=.49, p<.01), Nurse Report (r=.35, p<.05)
Three-month CSDC Reexperiencing, Numbing, and Dissociation scores were significantly lower than were scores during acute hospitalization, suggesting the measure is sensitive to change.

2. Bosquet, Saxe, & Kassam-Adams (2004) also examined the validity of the CSDC. Similar to Saxe et al. (2003), they reported significant correlations
between the Total Parent Score and the CPTSD-RI (r=.29, p<.01), CBCL-PTSD (r=.56, p<.001), and CDC (r=.47, p<.001).

Discriminant validity was shown by lower correlations with CBCL Thought Problems (r=.31, p<.01) and CBCL-Delinquency scales (r=.21, p=N.S.).

Nurse reports on the CSDC were correlated with scores on the CBCL-PTSD (r=.43, p<.001) and CDC (r=.37, p<.01). As expected, they were not correlated with CBCL Thought Problems or CBCL Delinquency scores.

Criterion Validity:

	Not Known	Not Found	Nonclinical Samples	Clinical Samples	Diverse Samples
Predictive Validity:				Yes
Postdictive Validity:

References for Criterion Validity:

No data on Sensitivity or Specificity.
Saxe et al. (2003) reported that Parent CSDC scores were also related to CDC and CBCL-PTSD scores 3 months later (r=.59, p<.05 and r=.47, p<.05,
respectively), but they were not significantly related to CPTSD-RI scores (r=.38, p=N.S.).

Bosquet et al. (2004) found that Parent CSDC scores predicted CPTSD-RI, CBCL-PTSD, CDC scores 3 months later.

They also predicted Parent and Child reports on the Diagnostic Interview for Children and Adolescents (DICA) 3 months later, and Child DICA reports 6
months later.

Nurse reports also significantly predicted Parent DICA reports 3 months later (r=.41, p<.01)

Population Information

Population Used For Measure Development:

Scale development was conducted with three subsamples (Saxe, 1997; Saxe et al., 2003):

1. Burn victims (n=43): Children averaged 11.67 years of age (SD=3.20); 35% female, 65% male; 67% White, 21% Black, 4% Hispanic, 4% Native American.

2. Children experiencing traffic accidents (n=41): Children were aged 5-17 (M=10, SD=3.55); 30% female, 70% male; 42% White, 46% Black, 2% Hispanic, 10% Asian American.

3. Clinic sample of children with abuse histories (n=45).

Measure has demonstrated evidence of reliability and validity in which populations?:

Medical Trauma

Accidents

Other

Pros & Cons/References

Pros:

1. The measure is unique in assessing both Acute Stress Disorder and Posttraumatic Stress Disorder Symptomatology using the observer report.

2. The measure is based on DSM-IV criteria for Acute Stress Disorder and Posttraumatic Stress Disorder.

3. Additional benefits include assessment of exposure and reaction to the traumatic event, impairment in functioning, and symptoms of dissociation, in addition to PTSD symptomatology.

4. The measure is free and easily available.

Cons:

1. Psychometrics have been examined only by the first author.

2. The measure has yet to be examined in terms of ability to detect change due to treatment and relationship to diagnostic classifications (sensitivity and specificity).

3. Although the measure is designed for children aged 2-18 and was used with this age range in the psychometric study, examination of the actual items suggests that it may not be an appropriate screen for younger children, given that a number of items would not apply to them.

4. The wording on some of the items is somewhat technical, most likely because items were derived from the DSM-IV.

THIS IS NOT A CON, JUST INFORMATION: For many of the items, the wording refers to “the event,” suggesting that the measure was not designed for a chronic or multiply traumatized population. It was designed to screen for ASD and PTSD symptoms following an event.

References:

A PsychInfo search of the words “Child Stress Disorder Checklist” and “CSDC” anywhere (6/05) revealed that the measure has been referenced in 3 peer-reviewed journal articles.
Two are review articles.

1. Cardeña, E., & Weiner, L. A. (2004). Evaluation of dissociation throughout the lifespan. Psychotherapy: Theory, Research, Practice, Training. Educational Publishing Foundation, 41(4), 496-508.

2. Saxe, G., Chawla, N., Stoddard, F., Kassam-Adams, N., Courtney, D., Cunningham, K., et al. (2003). Child stress disorders checklist: A measure of ASD and PTSD in children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(8), 972-978.

3. Vostanis, P. (2004). The impact, psychological sequelae and management of trauma affecting children. Current Opinion in Psychiatry, 17(4), 269-273.

Editor of Review:

Chandra Ghosh Ippen, Ph.D.

Last Updated:

Tue, 08/30/2005