UCLA PTSD Index

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The UCLA PTSD Index is a psychiatric assessment tool used to assess symptoms of PTSD in children and young adults.[1] This assessment consists of three indexes: a children's index, an adolescent's index, and a parent index. Questions may differ among the indexes depending on the target age, however the indexes are identical in format. The target age groups for this assessment are children between 7-12 and adolescents above age 13. The UCLA PTSD Index has also been translated into Spanish.

The UCLA PTSD Index has been updated for the DSM-5.

History

This assessment has evolved since its development in 1985 to include changes made to DSM criteria and to allow for efficiency in assessment. In 1985, Calvin Fredrick worked with the UCLA Trauma Psychiatry Program to develop a measure to screen for PTSD in children and adolescents based on DSM criteria—the UCLA PTSD Reaction Index.[2] This index had 16 "yes" or "no" items. The first major use of this index was used to assess PTSD reactions in elementary school students following a sniper attack on the school.[2] Following the publication of DSM-III, the measure was updated to DSM-III-R version to account for the updated diagnostic criteria of PTSD. This version had 20 items scored on a Likert Scale. The UCLA PTSD Index for DSM-IV is a revised version of the DSM-III-R that reflects the modified diagnostic criteria in the DSM-IV. In the DSM-IV version, child, parent, and adolescent forms and subsequent scoring sheets were developed. The child and adolescent forms were revised to reflect language tailored to children and adolescents in order to combine the child and adolescent forms into one form. Currently, the full PTSD Index is being used by the New York State office of Mental health in the Child and Adolescent Treatment Service Programs for children and adolescents affected by the September 11, 2001 attacks in New York City.[2]

In addition, this the assessment has also been proven to be useful across different cultures and in different countries. As a result, it has been translated into many different languages to be administered to children and adolescents that have experienced severe tragedies, such as mass shootings, natural disasters, and terrorism.[2][3] The assessment was used in Nigeria to measure PTSD in victims of ethno-religious violence. Study found that the UCLA PTSD reaction index was an adequate measure to be used to screen for symptoms of PTSD in children and adolescents in Nigeria.[4] In addition, a study has shown the UCLA PTSD reaction index to be a valid and reliable way of assessing PTSD symptoms in adolescent refugees from Somalia.[5]

Question breakdown and interpretation

Question breakdown

Each index is composed of three parts. The first section part a list of frightening or dangerous events and asks the respondent to indicate which item(s) from the list they have experienced. It screens for lifetime trauma, allowing for trauma exposure to be categorized into either community violence, natural disasters, medical trauma, and abuse. Once the trauma exposure has been categorized and identified, a follow up interview will focus in on the results of this section, allowing for clinicians to specify questions.[2] This part also establishes whether a traumatic event was experienced or not.

The second part asks the respondent to explain the incident from section one and to answer a set of questions about his/her reactions and emotions during and immediately following the event.[2] The third part asks the respondent how frequently they experienced common responses that align with the traumatic event on a Likert scale ranging from 0 (None) to 4 (Most). Two additional symptom questions were added to part 2 of the adolescent version because authors of the index found through their research that guilt and recurrence of the trauma are salient components to PTSD in adolescents, affecting the child’s view of the trauma and the degree to which the experience traumatized the child.[2]

According to the DSM-IV, there are specific criteria that must be met in order for an individual to be diagnosed with PTSD. Certain questions in the UCLA PTSD Index address these criteria. The breakdown is as follows:

  • Criteria A, exposure to traumatic event: at least one yes in section one and at least one yes in section two
  • Criteria B, re-experiencing: at least one symptom from section 3 questions 2, 3, 4, 5, 6, and 18 (as well as 21 on the parent version)
  • Criteria C, avoidance: at least one symptom from section 3 questions 7, 8, 9, 10 or 11, 15, 17, 19
  • Criteria D, increased arousal: at least two symptoms from section 3 questions 1, 4, 12, 13, 16

Scoring interpretation

If all four criteria are present then a full PTSD diagnosis is very likely. A partial PTSD diagnosis is likely if the respondent exhibits criteria A along with either B and C, C and D, or D and B.

Psychometrics

Reports on psychometric properties for the PTSD index have shown high test-retest reliability and validity, with no significant differences in scores between racial/ethnic groups.[6] Screening results from this index are consistent with the results from other PTSD symptom instruments (PTSD Checklist, PTSD Symptom Scale, and Harvard Trauma Questionnaire).[7]

Limitations

One limitation that has been stated focuses on the "yes/no" answer format of the second part of the assessment. Researchers have suggested that it be modified to a Likert scale to increase sensitivity across exposure groups of the various traumatic events.[2]

Changes for DSM-V criteria

In order to accommodate for the updated PTSD criteria in the new DSM-5, the UCLA PTSD now contains 11 new questions that cover the 20 DSM-5 criteria for diagnosis. Questions for Criteria B remained the same. Criteria D was changed to address negative cognitions and mood, and items addressing those symptoms that were formerly in Criteria C were moved to this criteria, leaving only two questions addressing avoidance symptoms in Criteria C. In addition, three additional questions were added to Criteria D. Finally, questions regarding increased arousal were moved to a new Criteria E, which was expanded by one item.[8]

References

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External links

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