Semi-structured caregiver report measure used to assess PTSD in children 0-7 years of age. The measure assesses whether the child has experienced 11 specific traumas or an alternative trauma; and collects data regarding the first occurrence, last occurrence, and the number of times the event occurred. It includes questions for caregivers and collection of information for observation of the child during the interview.
It also includes a section for measuring functional impairment and distress, which are additional components needed for making a diagnosis. The interview provides diagnostic information based on the DSM-IV.
This interview has been used in a series of studies that have proposed and validated a set of diagnostic criteria that is a developmentally sensitive alternative to the DSM-IV. Clinicians who are interested in the DC: 0-3 definition of PTSD may find this measure useful because the DC: 0-3 criteria were based on this work. A diagnosis can also be made using the empirically validated alternative algorithm for young children.
Overview
PTSDSSI
Sheeringa, M.S., Zeanah, C.H. (1994). PTSD Semi-Structured Interview and Observation Record for Infants and Young Children. Department of Psychiatry and Neurology, Tulane University Health Sciences Center, New Orleans.
Administration
Mixed response format: 0=No, 1=Sometimes, 2=Yes
Caregiver is asked the onset, duration, and frequency of the symptoms endorsed. Clinician also observes interaction of parentchild.
| Domains | Scale | Sample Items |
|---|---|---|
| PTSD-Related Symptomatology (child) | Re-experiencing | Has your child made repeated statements or questions about the event? Did he appear distressed by these? |
| Avoidance | Since the event has your child tried to avoid places or persons or things connected to the event? | |
| Hyperarousal | Since the trauma has your child had a hard time going to bed or falling asleep? | |
| Alternate criteria | Did your child lose some skills he had learned before? Did he lose toileting skills, become mute, or lose some speech skills? |
Training
Parallel or Alternate Forms
Psychometrics
A clinician-friendly scoring algorithm is provided to help diagnose PTSD using either the alternative algorithm or the DSM-IV algorithm.
| Type: | Rating | Statistics | Min | Max | Avg |
|---|---|---|---|---|---|
| Test-Retest | Not reported | ||||
| Internal Consistency | Not reported | ||||
| Inter-rater | Kappa | 0.29 | 1 |
The range of kappas from .29 to 1.0 were for individual PTSD items in the Scheeringa et al. (2001) study. The median kappa was .74. The average was not reported. In a second study, the kappa for all PTSD items was 0.75. The kappa for the full diagnosis was 0.74 in Scheeringa et al. (2001) and 0.79 in Scheeringa et al. (2003).
Panel of experts in the field of infant and young child mental health reviewed the items.
| Validity Type | Not known | Not found | Nonclincal Samples | Clinical Samples | Diverse Samples |
|---|---|---|---|---|---|
| Convergent/Concurrent | Yes | Yes | |||
| Discriminant | Yes | Yes | |||
| Sensitive to Change | Yes | ||||
| Intervention Effects | Yes | Yes | |||
| Longitudinal/Maturation Effects | Yes | ||||
| Sensitive to Theoretically Distinct Groups | Yes | ||||
| Factorial Validity | Yes |
Children who reached PTSD diagnosable criteria on the PTSD semi-structured interview scored higher on CBCL Internalizing and Total scores compared to healthy controls (Sheeringa, Zeanah, Myers, & Putnam, 2003). No children in a control sample of children met criteria for PTSD based on the measure as compared to 3 of the children in the traumatized sample (Sheeringa, Peebles, Cook & Zeanah, 2001).
Children diagnosed with PTSD at Time 1, exhibited greater symptomatology than those not diagnosed 1 and 2 years later, providing evidence for the
predictive validity of the measure. In addition, PTSD diagnosis at Time 1, predicted diagnosis 2 years later (Scheeringa, Zeanah, Myers, & Putnam, 2005). Children with higher levels of PTSD symptoms and less positive discipline from caregivers showed decreased heart period (increased heart rate) and decreased parasympathetic activity in response to a trauma stimulus (Scheeringa, Zeanah, Myers, & Putnam, 2004).
Lieberman, Van Horn, & Ghosh Ippen (2005) report significant changes in PTSD symptomatology, using this measure, for treatment versus comparison group children. The sample was ethnically and socioeconomically diverse. Mothers were 36.8% Latina, 25% White, 14.5% African American, 10.5% Asian, and 13.2% Mixed or Other. Income: 41% of families had incomes below the federal poverty level. The measure was administered in English and Spanish.
| Not Known | Not Found | Nonclinical Samples | Clinical Samples | Diverse Samples | |
|---|---|---|---|---|---|
| Predictive Validity: | Yes | ||||
| Postdictive Validity: | Yes |
1. The control sample of children in the Sheeringa et al. (2001) study included males only.
2. Data are not provided regarding test-retest validity or internal consistency. The psychometrics have been primarily examined by the first author and his colleagues. More research is needed.
Translations
| Language: | Translated | Back Translated | Reliable | Good Psychometrics | Similar Factor Structure | Norms Available | Measure Developed for this Group |
|---|---|---|---|---|---|---|---|
| 1. Hebrew | Yes | ||||||
| 2. German | Yes | ||||||
| 3. Spanish | Yes | Yes |
Population Information
The measure was developed with a sample of 20 children identified through a literature search of previously published studies. Inclusion criteria included that the “infants had experienced a traumatic event (or series of events) before the age of 48 months and had been evaluated before the age of 48 months, and there were clinical data about individual cases.” Sufficient data either published in the article or provided by the author were also
required.
A second sample of 12 cases came from a university-based outpatient child psychiatry clinic (n=9) and infant intervention program in a shelter for homeless adolescents (Scheeringa, Zeanah, Drell, & Larrieu, 1995). The interview went through modified versions based on a study of 15 clinic patients (Scheeringa, Peebles, Cook, & Zeanah, 2001) and 62 non-clinic subjects (Scheeringa, Zeanah, Myers, & Putnam, 2003).
| Population Type: | Measure Used with Members of this Group | Members of this Group Studied in Peer-Reviewed Journals | Reliable | Good Psychometrics | Norms Available | Measure Developed for this Group |
|---|---|---|---|---|---|---|
| 1.Lower socio-economic status | Yes |
Pros & Cons/References
1. Most thorough PTSD assessment for children under 6 years of age. Includes both parent report and direct observation of the child.
2. Measure developed specifically for young children and includes symptoms relevant to young children.
3. Measure allows for assessment of trauma exposure, symptomatology, and functional impairment.
1. Requires strong clinical skills and understanding of child development to administer the measure.
2. It is relatively long to administer. However, the amount of time is appropriate, given the importance of this measure and the need to assess these constructs in an accurate and valid way.
3. Psychometrics have been examined only by authors, and with relatively small samples of children.
4. There is no coding of frequency or duration, which limits the ability to use these fields for data analysis and, like other similar diagnostic measures (e.g., DISC, SCID), there is no measure of intensity.
A PsychInfo literature search (6/05) of “Posttraumatic Stress Disorder Semi-Structured Interview and Observational Record” or “PTSDSSI” anywhere and contact with the author revealed that the measure has been referenced in 8 peer-reviewed journal articles.
Carter, A., Briggs-Gowan, M.J., & Davis, N.O. (2004). Assessment of young children’s social-emotional development and psychopathology: Recent advances and recommendations for practice. Journal of Child Psychology and Psychiatry, 45(1), 109-134.
Lieberman, A.F., Van Horn, P.J., & Ghosh Ippen, C. (2005). Toward evidence-based treatment: Child-Parent Psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child & Adolescent Psychiatry, 44(12), 1241-1248.
Sheeringa, M.S., Peebles, C.D., Cook, C.A., & Zeanah, C.H. (2001). Toward establishing procedural, criterion and discriminant validity for PTSD in early childhood. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 52-60.
Sheeringa, M.S., & Zeanah, C.H. (1995). Symptom expression and trauma variables in children under 48 months of age. Infant Mental Health Journal, 16, 259-270.
Sheeringa, M.S., Zeanah, C.H., Drell, M.J., & Larrieu, J.A. (1995). Two approaches to the diagnosis of posttraumatic stress disorder in infancy and early childhood. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 191-200.
Scheeringa, M.S., Zeanah, C.H., Myers, L., & Putnam, F.W. (2005). Predictive validity in a prospective follow-up of PTSD in preschool children. Journal of the American Academy of Child & Adolescent Psychiatry. 44(9):899-906.
Scheeringa, M.S., Zeanah, C.H., Myers, L., & Putnam, F.W. (2004). Heart period and variability findings in preschool children with posttraumatic stress symptoms. Biological Psychiatry, 55(7), 685-691.
Sheeringa, M.S., Zeanah, C.H., Myers, L., & Putnam, F.W. (2003). New findings on alternative criteria for PTSD in preschool children. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 561-570.