Screening for PTSD and functional impairment in trauma-exposed young children: evaluation of alternative CBCL-PTSD subscales

Abstract

The Child Behavior Checklist (CBCL 1.5–5 years) posttraumatic stress disorder (PTSD) subscale by Dehon & Scheeringa (2006) as a screener for PTSD in trauma-exposed young children has yielded inconsistent results so far. Therefore, the aim of this study was to create and examine the validity of alternative CBCL-PTSD subscales and compare them to the existing CBCL-PTSD subscale based on the DSM-5 PTSD diagnostic criteria for children 6 years and younger. Further, the CBCL-PTSD subscales were examined regarding their usefulness in screening for posttraumatic stress-related functional impairment. The sample comprised 116 trauma-exposed young children (Mage = 3.42 years, SDage = 1.21 years, female = 49.1%). The psychometric properties of the existing CBCL-PTSD subscale as well as the alternative subscales based on expert rating (CBCL-PTSD-17) and based on variable importance (CBCL-PTSD-6) were evaluated by means of receiver operating characteristic curves, sensitivity, specificity, positive predictive values, and negative predictive values. Area under the curves for all three investigated CBCL-PTSD subscales were good to excellent for PTSD and functional impairment. Further, all three CBCL-PTSD subscales showed high sensitivity for PTSD and functional impairment. Considering the length and the performance of the three investigated subscales, the CBCL-PTSD-6 appears to be a promising and clinically useful CBCL-PTSD subscale as a screener for PTSD and functional impairment due to the easiest and most practicable application. For purposes of discriminant validation of the CBCL-PTSD-6, young children without a history of trauma should be compared to young children with trauma history.