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Child Stress Disorders Checklist

Last Updated

Purpose

The Child Stress Disorders Checklist (CSDC) is used to assess trauma exposure and resulting anxiety and mood internalization.

Link to Instrument

Link to instrument (Long form). See Key Descriptions for link to Short form.

Acronym CSDC

Area of Assessment

Activities & Participation
Mental Functions

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

CDE Status

Not a CDE—last searched 11/7/2024

Populations

Mental Health

Key Descriptions

  • Long form: 36 items
    o One traumatic event item, 5 immediate response items, and 30 symptom items assessed on five dimensions
    o Completed by an observer with a close relationship to the child (parents, caregivers, teachers, nurses, social workers, etc.)

  • Short form: 4 items (Link to instrument: https://www.healthcaretoolbox.org/sites/default/files/images/pdf/CSDC_SF.pdf)
    o Developed from parent response data to the 30-item CSDC—shortest scale that met selection criteria with an alpha coefficient ≥ 0.80
    o Completed by an observer with a close relationship to the child (parents, caregivers, teachers, nurses, social workers, etc.)
  • Minimum and maximum scores:
    o Short form: Minimum = 0, Maximum = 8
    o Long form: Minimum = 0, Maximum = 70
  • Item scale: 0-2 (0 = not true, 1 = somewhat or sometimes true, 2 = very true or often true)
  • No information about test administration is publicly available

Number of Items

Long form: 36 items
Short form: 4 items

Equipment Required

  • Child Stress Disorders Screening Form (Short Form) or Child Stress Disorders Checklist (Long form)
  • Paper/Pencil

Time to Administer

15 minutes

Time specified is for Long Form and includes 10 minutes for questionnaire completion and 5 minutes for scoring. The Short Form requires about 7 minutes total -- 5 minutes to complete and 2 minutes to score.

Required Training

Training Course

Required Training Description

Should be administered and interpreted by a trained clinician with prior experience in psychological testing/interpretation.

Age Ranges

Preschool Children

2 - 5

years

Children

6 - 12

years

Adolescent

13 - 17

years

Instrument Reviewers

Initially reviewed 2/16/2024 by Colorado State University Doctor of Occupational Therapy students Noelle Morgan Kang, Olivia Hays, Maire Marguerite Klein, Margaret Gibson, and Madeline Fish under the direction of Dr. Patricia Grady-Dominguez, Postdoctoral Fellow, Occupational Therapy.

ICF Domain

Activity
Participation

Measurement Domain

Cognition
Emotion

Professional Association Recommendation

None found – last searched 11/7/2024 

Considerations

  • CSDC requires some training in psychological testing and interpretation to administer.
  • The measurement is short enough to administer in clinical treatment settings.
  • Some items within the CSDC long form are challenging to observe, making them difficult to assess in the acute setting.
  • The CSDC should be used in settings that can ensure appropriate follow-up care when results indicate symptoms of ASD or PTSD in youth.
  • This screen solely incorporates observations and should be supplemented with additional self-report or medical records when available.

Mental Health

back to Populations

Standard Error of Measurement (SEM)

Children who were acutely burned or experienced a traffic crash: (Saxe et al., 2003; n = 84 (43 w/acute burn, mean age = 11.67 (3.20) years, male = 65%; 41 w/experience of a traffic crash, mean age = 10.0 (3.55) years, male = 70%); Long form (36-item) CSDC)

  • SEM (calculated) for children with acute burns (n = 43): 4.11
  • SEM (calculated) for children experiencing a traffic crash (n = 41): 3.05

  

Minimal Detectable Change (MDC)

Children who were acutely burned or experienced a traffic crash: (Saxe et al., 2003; Long form (36-item) CSDC)

  • MDC (calculated) for children with acute burns (n = 43) at 95% CI = 11.39
  • MDC (calculated) for children experiencing a traffic crash (n = 41) at 95% CI = 8.45

Test/Retest Reliability

Children with Injury or Burns: (Bosquet Enlow et al., 2010; n = 147, mean age = 13.11 (3.52) years, age range = 6 to 18, male = 73.5% (32 admitted for an acute burn, mean age = 11.44 (3.55), age range = 6 to 17, male = 75%; 115 admitted for an acute injury, mean age = 13.57 (3.39), age range = 7 to 18, male = 73%); Long form (30 symptom items only) and Short form (4-item) CSDC)

  • Acceptable test-retest reliability for both 30-item (ICC = 0.86, p < .001) and 4-item (ICC = 0.89, p < .001) CSDC scales

 

Children with Burns: (Saxe et al., 2003, 1st administration (n = 34), 2nd administration two days later (n = 23); reported by parents of children with burns; Long form (36-item) CSDC)

  • Acceptable test-retest reliability for Total score (ICC = 0.84)
  • Test-retest reliability for Subscales:
    • Arousal: Acceptable (ICC = 0.74)
    • Numbing and disassociation: Acceptable (ICC = 0.70)
    • Avoidance: Acceptable (ICC = 0.85)
    • Functioning: Not Acceptable (ICC = 0.63)
    • Re-experiencing: Acceptable (ICC = 0.89)

Interrater/Intrarater Reliability

Children with Injury or Burns: (Bosquet Enlow et al., 2010; Long form (30 symptom items only) and Short form (4-item) CSDC)

  • Poor interrater reliability between scores from parents and nurses for 30-item scale (ICC = 0.27, p < .05)
  • Adequate interrater reliability between scores from parents and nurses for 4-item scale (ICC = 0.43, p < .001)

 

Children with Burns: (Saxe et al., 2003; Long form (36-item) CSDC)

  • Adequate interrater reliability for total scores by the parent and primary nurse (ICC = 0.44)
  • Poor interrater reliability for arousal scores by the parent and primary nurse (ICC = 0.36)
  • Poor interrater reliability for numbing and dissociation scores by the parent and primary nurse (ICC = 0.24)
  • Poor interrater reliability for avoidance scores by the parent and primary nurse (ICC = 0.28).
  • Poor interrater reliability for Functioning by the parent and primary nurse (ICC = 0.27)
  • Adequate interrater reliability for Reexperiencing by the parent and primary nurse (ICC = 0.45)

Internal Consistency

Children with Injury or Burns: (Bosquet Enlow et al., 2010; Long form (30 symptom items only) and Short form (4-item) CSDC)

  • Excellent internal consistency for both 30-item (Cronbach’s alpha = 0.93) and 4-item (Cronbach’s alpha = 0.82) CSDC scales

 

Children with Burns: (Saxe et al., 2003; Long form (36-item) CSDC)

  • Excellent internal consistency for children who experienced both traffic crashes and acute burns (Cronbach’s alpha = 0.84, n  = 84).
  • Excellent internal consistency for children with burns (Cronbach’s alpha = 0.83, n = 43)
  • Excellent internal consistency for children in a traffic crash (Cronbach’s alpha = 0.86, n = 86)

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Children with Injury or Burns: (Bosquet Enlow et al., 2010; Long form (30 symptom items only) and Short form (4-item) CSDC; assessed at 3-month follow-up)

  • Poor predictive validity of the 30-item CSDC (r = 0.18) and 4-item CSDC (r = 0.17) at predicting scores on the Child PTSD Reaction Index (CPTSD-RI)
  • Adequate predictive validity of the 30-item CSDC at predicting scores on the Child Behavior Checklist PTSD scale (CBCL-PTSD) (r = 0.31, p < 0.01)
  • Poor predictive validity of the 4-item CSDC at predicting scores on the CBCL-PTSD (r = 0.29, p < 0.05)
  • Adequate predictive validity of the 30-item CSDC (r = 0.35, p < 0.01) and 4-item CSDC (r  = 0.31, p < 0.05) at predicting scores on the Diagnostic Interview for Children and Adolescents (DICA) PTSD Module (DICA PTSD)—Child-rated symptoms
  • Adequate predictive validity of the 30-item CSDC (r = 0.58, p < 0.001) and 4-item CSDC (r = 0.53, p < 0.001) at predicting scores on the DICA PTSD—Parent-rated symptoms

 

Concurrent validity:

Children with Injury or Burns: (Bosquet Enlow et al., 2010; Long form (30 symptom items only) and Short form (4-item) CSDC)

  • Poor concurrent validity between the 30-item CSDC (r = 0.26, p < 0.01) and 4-item CSDC (r  = 0.29, p < 0.01) with the CPTSD-RI
  • Adequate concurrent validity between the 30-item CSDC (r = 0.47, p < 0.001) and 4-item CSDC (r = 0.34, p < 0.001) with the  CBCL-PTSD

 

Children with Burns: (Saxe et al., 2003, Long form (36-item) CSDC)

  • Adequate correlation between the CSDC and Total Body Surface Area Burned (TBSA) when reported by parents following an acute burn (r = 0.56, p < 0.001)
  • Adequate correlation between the CSDC and CPTSD-RI when reported by parents following an acute burn (r = 0.39, p < 0.05)
  • Adequate correlation between the CSDC and CDC when reported by parents following an acute burn (r = 0.49, p < 0.01)
  • Adequate correlation between the CSDC and CBCL-PTSD when reported by parents following an acute burn (r = 0.49, p < 0.01)
  • Adequate correlation between the CSDC and TBSA when reported by nurses following an acute burn (r = 0.43, p < 0.01)
  • Poor correlation between the CSDC and CPTSD-RI when reported by nurses following an acute burn (r = 0.26, p < 0.1)
  • Adequate correlation between the CSDC and CDC when reported by nurses following an acute burn (r = 0.33, p < 0.05)
  • Adequate correlation between the CSDC and CBCL-PTSD when reported by nurses following an acute burn (r = 0.35, p < 0.05)
  • Adequate correlation between the CSDC and CDC when reported by parents at 3 months post-burn (r = 0.59, p < 0.05)
  • Adequate correlation between the CSDC and CBCL-PTSD when reported by parents at 3 months post-burn (r = 0.47, p < 0.05)

 

Children with Acute Burns: (Drake et al., 2006; n = 70; mean age = 1.7, age range = 1 to 4 years; male = 43 (61%); admitted acute burn victims; exclusion criteria: non-English-speaking caregiver or guardian or residence outside of Northeastern U.S.; 36-item CSDC-Burn Version (CSDC-B))

  • There was a significantly greater number PTSD symptoms as reflected in nurse reported CSDC Scores for Large Burns (22.3, n = 8) in comparison to those for medium (11.2, n = 14) and small (5.3, n = 48) burns, p < .001)
  • There was a significant difference in nurse reported CSDC scores for hospital stays longer than 10 days (14.2, n = 22) in comparison to hospital stays in between 5-10 days (6.4, n = 23, p < .01) and between 1-4 days (2.7, n = 21, p < .001)  
  • There was a significant difference in nurse reported CSDC scores for more than 15 dressing changes (16.6, n = 13) in comparison to between 8-15 dressing changes (9.8, n = 18, p < .01) and between 1-7 dressing changes (4.2, n = 35, p < .001)

 

Construct Validity

Convergent validity:

Children with Burns: (Stoddard et al., 2009; n = 70; mean age = 1.97 (0.98), age range = 1-4 years, male = 41 (59%); participants completing baseline and 3 to 6-month follow-ups; 36-item CSDC-Burn Version (CSDC-B))

  • Adequate to excellent convergent validity of the baseline CDSC total score with the total score for the PTSD module of the Diagnostic Interview for Children and Adolescents (DICA-P) given at three time points (r = 0.44, p < 0.001 at baseline; r = 0.57, p < 0.001 at 1-month post-hospitalization; and r = 0.68, p < 0.01 at 3 to 6-months post-hospitalization)
  • Poor, adequate, and excellent convergent validity of the CDSC total score with score from the Posttraumatic Stress Disorder Semi-Structured Interview and Observational Record for Infants and Young Children (PTSDSSI) given at 3 time points (r = 0.28, p < 0.05 at baseline; r = 0.41, p < 0.05 at 1-month post-hospitalization; and r = 0.63, p < 0.05 at 3 to 6-months post-hospitalization)

 

Discriminant validity:

Children with Injury or Burns: (Bosquet Enlow et al., 2010; Long form (30 symptom items only) and Short form (4-item) CSDC)

  • Excellent discriminant validity between the 30-item CSDC (r = 0.28, p < 0.01) and 4-item CSDC (r = 0.15) with the CBCL-Delinquency Scale

Content Validity

Children with Injury or Burns: (Bosquet Enlow et al., 2010; Long form (30 symptom items only) and Short form (4-item) CSDC)

  • Using parents' response data to the 30-item CSDC, 6 items were identified that performed well on the item selection criteria. After pilot testing an earlier version of the scale, two of the items (“child avoids talking about the injury” and “child tries to avoid thinking about the injury”) were eliminated due to concerns reported from scale administrators about the difficulty observers had in assessing these symptoms (p. 324). 

Bibliography

Drake, J. E., Stoddard, F. J., Jr, Murphy, J. M., Ronfeldt, H., Snidman, N., Kagan, J., Saxe, G., & Sheridan, R. (2006). Trauma severity influences acute stress in young burned children. Journal of burn care & research: official publication of the American Burn Association, 27(2), 174–182. https://doi.org/10.1097/01.BCR.0000202618.51001.69

Enlow, M.B., Kassam-Adams, N., & Saxe, G. (2010). The Child Stress Disorders Checklist-Short Form: A four-item scale of traumatic stress symptoms in children. General hospital psychiatry, 32(3), 321–327. https://doi.org/10.1016/j.genhosppsych.2010.01.009

Saxe, G., Chawla, N., Stoddard, F., Kassam-Adams, N., Courtney, D., Cunningham, K., Lopez, C., Hall, E., Sheridan, R., King, D., & King, L. (2003). Child Stress Disorders Checklist: A measure of ASD and PTSD in children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(8), 972-978. https://doi.org/10.1097/01.CHI.0000046887.27264.F3

Stoddard, F.J., Sorrentino, E.A., Ceranoglu, T.A., Saxe, G., Murphy, J.M., Drake, J.E., Ronfeldt, H., White, G.W., Kagan, J., Snidman, N., Sheridan, R.L., Tompkins, R.G. (2009). Preliminary evidence for the effects of morphine on posttraumatic stress disorder symptoms in one- to four-year-olds with burns. Journal of Burn Care & Research, 30(5), 836-843. https://doi.org/10.1097/BCR.0b013e3181b48102

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