Adaption of the Child and Adolescent Trauma Screen (CATS) to measure ICD-11 PTSD and Complex PTSD – A validation study

Main objective

1.  Background and project objectives

Current research reveals that more than two thirds of children and adolescents have experienced at least one potentially traumatic event in their lives. Often practitioners struggle with or neglect asking children and adolescents about traumatic experiences. Therefore, standardized screening instruments are of particular value for this population. 

Screening children and adolescents for their trauma history and posttraumatic stress symptoms (PTSS) is recommended as a first step to identify youth needing trauma-focused interventions (Cohen et al., 2010). Moreover, monitoring of PTSS via standardized measures is an important component to evaluate treatment outcomes. Most of the available child trauma questionnaires were developed in English speaking countries based on DSM-III-R or DSM-IV criteria of PTSD (e.g. Foa, Johnson, Feeny, & Treadwell, 2001; Steinberg, Brymer, Decker, & Pynoos, 2004; Kenardy, Spence, & Macleod, 2006; Balaban, 2009). For some of these instruments, subsequent international translations were performed, often neglecting recommended standards of independent forward-backward translations and validation of the translated questionnaires. Thus, the psychometric properties of translated versions are sometimes unknown, limiting their usefulness not only in research but also clinical practice. 

Due to the lack of validated and translated screening and monitoring measures in the child and adolescent trauma literature, our international workgroup has developed and validated parallel language versions of a short screening instrument based on the DSM-5 conceptualization of PTSD (English, Norwegian and German), which has established an internationally comparable standard for measuring PTSS in children and adolescents using developmental adaptations of the language (Sachser et al., 2017).

With the revision of the International Classification of Diseases (ICD-11, Chapter 06: Mental, Behavioral or Neurodevelopmental Disorders) the diagnostic criteria of PTSD will be modified. Compared to the DSM-5 with 20 symptoms, the ICD-11 will employ a conceptualization of PTSD with only 6 “core” symptoms. Since the symptoms of ICD-11 PTSD constitute a subsample of the DSM-5 symptoms, the already well-established CATS can also be used as a measure of ICD-11 PTSD. In addition to PTSD, a new disorder, complex PTSD (CPTSD), will be introduced in the ICD-11 for all age groups. To implement the new diagnostic criteria, the existing measures of PTSS have to be revised. 

As the ICD-11 will be published in 2018, our international workgroup wants to pursue the following aims: 

1. Adapt the CATS for the measurement of ICD-11 PTSD and ICD-11 CPTSD in children and adolescents à CATS Version 2 (CATS-2)
2. Develop a parallel caregiver-report version
3. Translate the CATS questionnaire as well as the CPSS-I-5 into German and Norwegian.
4. Cover the diagnostic criteria of PTSD (DSM-5 and ICD-11) as well as CPTSD at the same time using one flexible and short instrument with corresponding scoring sheets.
5. Validate the CATS-2 in international work groups
6. Test discriminant and convergent validity patterns using a measure of depression (Moods and Feelings Questionnaire Short-Version) and externalizing symptoms (Pediatric Symptom Checklist Short-Version)
7. Provide reliable cut-offs for the current CATS DSM-5 version using the Child Posttraumatic Stress Scale – Interview for DSM-5 (CPSS-I-5) as a gold standard reference
8. Provide open access to  the measure, in order to allow its implementation into clinical practice, outside of funded research.