Teaching Recovery Techniques (TRT) to Ukrainian children and adolescents to self-manage post-traumatic stress disorder (PTSD) symptoms following the Russian invasion of Ukraine in 2022 - The first 7 months.

BACKGROUND: The Russian invasion of Ukraine in February 2022 prompted many to provide mental health input, especially trauma management, to Ukrainian children and adolescents (C/A) exposed to it. METHODS: Rapid cascade training of 200 Ukrainian psychologists during 2022 to provide, in pairs, free of charge and without selection, TRT courses of 4-6, 90 min sessions online or face to face to C/A 7 to 23 years in Ukraine and those migrating abroad. CRIES-8 PTSD questionnaires were administered at the beginning and end of the courses during May-December 2022. Age, gender, their geographical war risk, and whether C/A had stayed or migrated elsewhere were collected. A CRIES-8 score of ≥17/40 defined likely PTSD. RESULTS: 3123 C/A completed an initial CRIES-8 questionnaire with matching demographics, 2737 a questionnaire at the end and 1798 both. At entry to TRT, likely PTSD was greater in females (65 %) than males (52 %, p < 0.001) declining with increasing age, particularly in males (p < 0.001). Migration had mixed effects and moving to lower war risk areas or abroad did not reduce PTSD risk. TRT benefited 68 % of C/A overall by reducing CRIES-8 from ≥17 to <17, the rate increasing the more experienced the TRT facilitators became (p < 0.0001). Online and face to face outcomes were the same. LIMITATIONS: The chaos of war prevented capture of all potential C/A questionnaires and long-term repeat testing not yet undertaken. CONCLUSIONS: Even in the chaos of war, effective mental health input can be rapidly and cheaply (c.50 USD/child) provided and should be encouraged.

Therapist-supported online cognitive therapy for post-traumatic stress disorder (PTSD) in young people: protocol for an early-stage, parallel-group, randomised controlled study (OPTYC trial).

INTRODUCTION: Post-traumatic stress disorder (PTSD) is a disabling psychiatric condition that affects a significant minority of young people exposed to traumatic events. Effective face-to-face psychological treatments for PTSD exist. However, most young people with PTSD do not receive evidence-based treatment. Remotely delivered digital interventions have potential to significantly improve treatment accessibility. Digital interventions have been successfully employed for young people with depression and anxiety, and for adults with PTSD. However, digital interventions to treat PTSD in young people have not been evaluated. The Online PTSD Treatment for Young People & Carers (OPTYC) trial will evaluate the feasibility, acceptability and initial indications of clinical efficacy of a novel internet-delivered Cognitive Therapy for treatment of PTSD in young people (iCT-PTSD-YP). METHODS AND ANALYSIS: This protocol describes a two-arm, parallel-groups, single-blind (outcome assessor), early-stage randomised controlled trial, comparing iCT-PTSD-YP with a waiting list (WL) comparator. N=34 adolescents (12-17 years old), whose primary problem is PTSD after exposure to a single traumatic event, will be recruited from 14 NHS Child and Adolescent Mental Health Services in London and southeast England, from secondary schools and primary care in the same region, or via self-referral from anywhere in the UK using the study website. Individual patient-level randomisation will allocate participants in a 1:1 ratio, randomised using minimisation according to sex and baseline symptom severity. The primary study outcomes are data on feasibility and acceptability, including recruitment, adherence, retention and adverse events (AEs). The primary clinical outcome is PTSD diagnosis 16 weeks post-randomisation. Secondary clinical outcomes include continuous measures of PTSD, anxiety and depression symptoms. Regression analyses will provide preliminary estimates of the effect of iCT-PTSD-YP on PTSD diagnosis, symptoms of PTSD, anxiety and depression relative to WL. Process-outcome evaluation will consider which mechanisms mediate recovery. Qualitative interviews with young people, families and therapists will evaluate acceptability. ETHICS AND DISSEMINATION: The study was approved by a UK Health Research Authority Research Ethics Committee (19/LO/1354). For participants aged under 16, informed consent will be provided by carers and the young person will be asked for their assent; participants aged 16 years or older can provide informed consent without their parent or caregiver's involvement. Findings will be disseminated broadly to participants, healthcare professionals, the public and other relevant groups. Study findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN16876240.

Dysfunctional posttraumatic cognitions, posttraumatic stress and depression in children and adolescents exposed to trauma: a network analysis.

BACKGROUND: The latest version of the International Classification of Diseases (ICD-11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re-experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification. METHODS: We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated. RESULTS: The PTSD re-experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms. CONCLUSIONS: Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between-subject with within-subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.

Children and natural disasters.

The number of children affected by natural disasters each year is alarmingly high and can be expected to rise as climate change continues. The mental consequences have been documented not only in the rates of post-traumatic stress symptoms and post-traumatic stress disorder, but also for depression and other mental health problems. To contribute towards the knowledge in this area, this special issue of the European Journal of Psychotraumatology focuses on how children can be prepared for natural disasters and the mental health aspects of such events. It includes articles on communicating risks to children, involving children in disaster risk reduction, and the mental health consequences for children from an earthquake, a volcanic eruption, a flood and a hurricane. In this special issue specifically focusing on children and natural disasters, we hope to enhance our understanding of some of the complex pathways and pave the way for improving our interventions.

La cantidad de niños afectados cada año por desastres naturales es alarmantemente alta y es esperable que aumente a medida que el cambio climático continúa. Las consecuencias mentales se han documentado no solo en tasas de Síntomas de Estrés postraumático (SEPT) y Trastorno por Estrés postraumático (TEPT), sino en depresión y otros problemas de Salud Mental. Para contribuir a un mayor conocimiento, este ejemplar especial del Journal Europeo de Psicotraumatología se focaliza en como pueden prepararse los niños para los desastres naturales y los aspectos de salud mental de dichos eventos. Incluye artículos sobre la comunicación de riesgos a los niños, de involucrarlos en la reducción de riesgo de desastres, y las consecuencias de salud mental para niños por un terremoto, una erupción volcánica, una inundación y un huracán. En este ejemplar especial focalizado específicamente sobre niños y desastres naturales esperamos haber mejorado nuestra comprensión de algunas de los complejos senderos y pavimentado el camino para mejorar nuestras intervenciones.

Mental health of unaccompanied asylum-seeking adolescents previously held in British detention centres.

AIM: To investigate whether the mental health of unaccompanied asylum-seeking children (UASC) was negatively affected by having their ages disputed and being detained. METHOD: Participants within this cross-sectional study were 35 UASC, aged between 13 and 17 when they were detained. Some years later, a team of child mental health professionals interviewed them to assess their current mental health and to determine, as far as possible, the impact that having their age disputed and being detained may have had on their mental health. The Structured Clinical Interview for DSM-IV (SCID-IV), Reactions of Adolescents to Traumatic Stress (RATS), Stressful Life Events (SLE) and Detention Experiences Checklist-UK version (DEC-UK) were administered. RESULTS: The vast majority of UASC reported being negatively affected. Based on diagnostic interviews using the SCID-IV, self-report measures and contemporaneous records, the professionals reported a diagnosis of post-traumatic stress disorder (PTSD) developing in 29% ( n = 10), PTSD exacerbated in 51% ( n = 18), major depressive disorder (MDD) developing in 23% ( n = 8) and MDD exacerbated in 40% ( n = 14). A total of 3 years post-detention, 89% ( n = 31) met diagnostic criteria for psychiatric disorders and reported high PTSD symptoms. CONCLUSION: There was a high prevalence of psychiatric disorder. The additional stress of age dispute procedures and detention was judged to have been harmful.

The impact of fathers' military deployment on child adjustment. The support needs of primary school children and their families separated during active military service: A pilot study.

BACKGROUND: Although direct exposure to war-related trauma negatively impacts children's psychological well-being, little is known about this impact within the context of parental military deployment to a combat zone and 'indirect' experience of the effects of armed conflict. This study investigates the impact of father's military deployment to Afghanistan on child well-being in primary schoolchildren and compares measures of adjustment with a matched group of children with fathers deployed on military training (non-combat) deployment. METHOD: Data were collected within primary schools in 2011-2012 from 52 children aged 8-11 years with fathers deploying to Afghanistan ( n = 26) and fathers deploying on military training ( n = 26) via self-completion of questionnaires assessing symptoms of anxiety, depression, stress and levels of self-esteem. Data were collected in both groups, at pre-, mid- and post-parental deployment. Class teachers and parents (non-deployed) completed a measure of child behaviour and parents completed a measure of parenting stress and general health. RESULTS: Unexpectedly child adjustment difficulties were not significantly raised in children whose parents deployed to Afghanistan. Ratings of behavioural difficulties and depression were low in both groups. However, clinically elevated levels of anxiety and stress symptoms were reported by both groups of children at each stage of deployment. No associations between parental stress, parental mental health and child adjustment were found. CONCLUSION: High levels of children's anxiety and stress reported during fathers' active military service warrant further investigation. Implications for school and health monitoring and CAMHS community liaison work are discussed.

Pilot Study of a Group-Based Psychosocial Trauma Recovery Program in Secure Accommodation in Scotland.

The current study is the first to implement and evaluate a group-based trauma-specific program for adolescents in a secure accommodation facility in Scotland. A randomized control and qualitative pilot study compared an intervention group (n = 10), who received Teaching Recovery Techniques, to a waitlist control group (n = 7). Measures included subjective units of disturbance (SUDs), standardized trauma symptom questionnaires, and analysis of behavior monitoring logs. Adolescent interviews (n = 10) and a presenter focus group (n = 4) assessed program experience and views on future development. Sessions were videoed and analyzed for program adherence. Analysis involved MANOVA, and a quasi-qualitative thematic approach for participant views. Adolescents reported high SUDs and a range of trauma symptoms. A large effect size was found for reduced SUDs (d = 1.10) and positive trends were identified for symptoms and behavior change in the intervention group. Program adaptations included smaller groups, the use of visual materials and liaison with care staff to facilitate generalization. Recommendations are made for program development and large scale evaluation.

Posttraumatic Stress Disorder in Young Children 3 Years Posttrauma: Prevalence and Longitudinal Predictors.

OBJECTIVE: Age-appropriate criteria for posttraumatic stress disorder (PTSD) in young children have been established. The present study investigated the long-term course of such PTSD and its predictors in young children. METHODS: Young children (aged 2-10 years) and parents/caregivers who had attended emergency departments after motor vehicle collisions (MVCs) between May 2004 and November 2005 were assessed at 2 to 4 weeks and 6 months post-MVC; 71 families were re-interviewed 3 years post-MVC. Participants were assessed according to standard DSM-IV criteria for PTSD and a well-validated alternative algorithm for diagnosing PTSD in young children (PTSD-AA). Demographic, trauma-related, and parental mental health variables and intellectual ability were also assessed at baseline. RESULTS: Using an "optimal-report" procedure (a positive diagnosis according to parent or child for older children, or just parent for younger children), 7.0% met criteria for DSM-IV PTSD and 16.9% for PTSD-AA at 3 years. Using parent report alone, these rates were 1.4% and 2.8%, respectively. Parent-child agreement for PTSD and PTSD-AA was no better than chance (Cohen κ = -0.03 and -0.04, respectively). Baseline parent posttraumatic stress relating to the child's trauma, and not trauma severity, was correlated with optimal-report child PTSD-AA at each assessment (r values = 0.29-0.31) and accounted for unique variance in logistic regression models of this outcome at each assessment. CONCLUSIONS: PTSD-AA in young children can persist for years but is underrecognized by parents despite its being shaped to a large extent by parents' own acute traumatic stress in response to the child's trauma.

The latent structure of Acute Stress Disorder symptoms in trauma-exposed children and adolescents.

BACKGROUND: The revision of Acute Stress Disorder (ASD) in the DSM-5 (DSM-5, 2013) proposes a cluster-free model of ASD symptoms in both adults and youth. Published evaluations of competing models of ASD clustering in youth have rarely been examined. METHODS: We used Confirmatory Factor Analysis (combined with multigroup invariance tests) to explore the latent structure of ASD symptoms in a trauma-exposed sample of children and young people (N = 594). The DSM-5 structure was compared with the previous DSM-IV conceptualization (4-factor), and two alternative models proposed in the literature (3-factor; 5-factor). Model fit was examined using goodness-of-fit indices. We also established DSM-5 ASD prevalence rates relative to DSM-IV ASD, and the ability of these models to classify children impaired by their symptoms. RESULTS: Based on both the Bayesian Information Criterion, the interfactor correlations and invariance testing, the 3-factor model best accounted for the profile of ASD symptoms. DSM-5 ASD led to slightly higher prevalence rates than DSM-IV ASD and performed similarly to DSM-IV with respect to categorising children impaired by their symptoms. Modifying the DSM-5 ASD algorithm to a 3+ or 4+ symptom requirement was the strongest predictor of impairment. CONCLUSIONS: These findings suggest that a uni-factorial general-distress model is not the optimal model of capturing the latent structure of ASD symptom profiles in youth and that modifying the current DSM-5 9+ symptom algorithm could potentially lead to a more developmentally sensitive conceptualization.

Culture-sensitive psychotraumatology.

BACKGROUND: Although there is some evidence of the posttraumatic stress disorder (PTSD) construct's cross cultural validity, trauma-related disorders may vary across cultures, and the same may be true for treatments that address such conditions. Experienced therapists tailor psychotherapy to each patient's particular situation, to the nature of the patient's psychopathology, to the stage of therapy, and so on. In addition, culture-sensitive psychotherapists try to understand how culture enhances the meaning of their patient's life history, the cultural components of their illness and help-seeking behaviors, as well as their expectations with regard to treatment. We cannot take for granted that all treatment-seeking trauma survivors speak our language or share our cultural values. Therefore, we need to increase our cultural competencies. METHODS: The authors of this article are clinicians and/or researchers from across the globe, working with trauma survivors in various settings. Each author focused on one or more specific cultural aspects of working with trauma survivors and highlighted the following aspects. RESULTS: As a result of culture-specific individual and collective meanings linked to trauma and trauma-related disorders survivors may be exposed to (self-)stigma in the aftermath of trauma. Patients who are reluctant to talk about their traumatic experiences may instead be willing to write or use other ways of accessing the painful memories such as drawing. In other cultures, community and family cohesion are crucial elements of recovery. While awareness of culture-specific aspects is important, we also need to beware of premature cultural stereotyping. When disseminating empirically supported psychotherapies for PTSD across cultures, a number of additional challenges need to be taken into account: many low and middle income countries have very limited resources available and suffer from a poor health infrastructure. CONCLUSIONS: In summary, culture-sensitive psychotraumatology means assuming an empathic and non-judgmental attitude, trying to understand each individual's cultural background.

An Update on the Clinical Utility of the Children's Post-Traumatic Cognitions Inventory.

The Children's Post-Traumatic Cognitions Inventory (CPTCI) is a self-report questionnaire that measures maladaptive cognitions in children and young people following exposure to trauma. In this study, the psychometric properties of the CPTCI were examined in further detail with the objective of furthering its utility as a clinical tool. Specifically, we investigated the CPTCI's discriminant validity, test-retest reliability, and the potential for the development of a short form of the measure. Three samples (London, East Anglia, Australia) of children and young people exposed to trauma (N = 535; 7-17 years old) completed the CPTCI and a structured clinical interview to measure posttraumatic stress disorder (PTSD) symptoms between 1 and 6 months following trauma. Test-retest reliability was investigated in a subsample of 203 cases. The results showed that a score in the range of 46 to 48 on the CPTCI was indicative of clinically significant appraisals as determined by the presence of PTSD. The measure also had moderate-to-high test-retest reliability (r = .78) over a 2-month period. The Children's Post-Traumatic Cognitions Inventory-Short Form (CPTCI-S) had excellent internal consistency (α = .92), and moderate-to-high test-retest reliability (r = .78). The examination of construct validity showed the model had an excellent fitting factor structure (Comparative Fit index = 0.95, Tucker-Lewis index = 0.91, Root Mean Square Error of Approximation = .07). A score ranging from 16 to 18 was the best cutoff point on the CPTCI-S, in that it was indicative of clinically significant appraisals as determined by the presence of PTSD. Based on these results, we concluded that the CPTCI is a useful tool to support the practice of clinicians and that the CPTCI-S has excellent psychometric properties.

Predictors of Posttraumatic Stress Symptom Trajectories in Parents of Children Exposed to Motor Vehicle Collisions.

OBJECTIVE: Following child trauma, parents are at risk of developing posttraumatic stress disorder (PTSD), either owing to their direct involvement or from hearing of their child's involvement. Despite the potential impact of a parent's development of PTSD on both the parent and child, little is known about what may place a parent at increased risk. METHOD: PTSD symptoms were assessed ≤ 4 weeks, 6 months, and 3 years post-trauma, along with a range of potential risk factors, in a sample of parents of 2-10-year-old children who were involved in a motor vehicle collision. RESULTS AND CONCLUSIONS: Two symptom trajectories were identified: Those parents whose symptoms remained low across all time points and those whose symptoms remained elevated at 6 months post-trauma and declined by 3 years. Subjective threat, thought suppression, and maladaptive cognitions about damage to the child were identified as key predictors of poorer outcomes.

Measurement Issues: Measurement of posttraumatic stress disorder in children and young people - lessons from research and practice.

BACKGROUND: Many young people are exposed to traumatic events and a significant minority of these individuals will go on to experience posttraumatic stress disorder (PTSD). Valid and reliable measurement tools for assessing PTSD are essential and can aid screening, clinical diagnosis, treatment planning and outcome monitoring. METHODS: This article outlines the range of instruments available for these aspects of measurement, including assessment of PTSD in very young children, with a focus on those scales with good clinical utility and sound psychometric properties. FINDINGS: This is a particularly challenging time for clinicians working with children and young people with PTSD: all instruments will need to be revised and updated in order to better reflect the recent revisions to the diagnostic criteria for PTSD with the publication of the DSM-5 and no doubt the anticipated ICD-11. Despite this, measurement tools can still play a vital role in assessing PTSD in children and young people.

Computerised CBT for depressed adolescents: Randomised controlled trial.

BACKGROUND: Depression in adolescents is a common and impairing problem. Effective psychological therapies for depression are not accessed by most adolescents. Computerised therapy offers huge potential for improving access to treatment. AIMS: To test the efficacy of Stressbusters, a Computerised-CBT (C-CBT) programme for depression in young people. METHOD: Multi-site, schools-based, RCT of C-CBT compared to Waiting List, for young people (N = 112; aged 12-16) with significant symptoms of depression, using multiple-informants (adolescents, parents, teachers), with follow-up at 3 and 6 months. RESULTS: Relative to being on a Waiting List, C-CBT was associated with statistically significant and clinically meaningful improvements in symptoms of depression and anxiety according to adolescent self-report; and with a trend towards improvements in depression and anxiety according to parent-report. Improvements were maintained at follow-up. Treatment gains were similar for boys and girls across the participating age range. Treatment effect was partially mediated by changes in ruminative thinking. Teachers rated adolescents as having few emotional or behavioural problems, both before and after intervention. C-CBT had no detectable effect on academic attainment. In the month after intervention, young people who received C-CBT had significantly fewer absences from school than those on the Waiting List. CONCLUSIONS: C-CBT shows considerable promise for the treatment of mild-moderate depression in adolescents.

Thought control strategies and rumination in youth with acute stress disorder and posttraumatic stress disorder following single-event trauma.

OBJECTIVE: Certain thought control strategies for managing the intrusive symptoms of posttraumatic stress disorder (PTSD) are thought to play a key role in its onset and maintenance. Whereas measures exist for the empirical assessment of such thought control strategies in adults, relatively few studies have explored how children and adolescents manage posttraumatic intrusive phenomena. METHODS: In a prospective longitudinal study of 10-16-year-olds with PTSD, who were survivors of road traffic collisions and assaults, a variety of thought control strategies were assessed in the acute phase. These included strategies thought to be protective (reappraisal, social support) as well as maladaptive (distraction, punishment, worry). Ruminative responses to the trauma were assessed at the follow-up assessment. RESULTS: Posttraumatic stress symptoms (PTSS) at each assessment were associated with the use of punishment and reappraisal, whereas social support and rumination were associated with PTSS symptoms at follow-up. Distraction was unrelated to PTSS at any time point. Rumination accounted for variance in PTSS symptoms at follow-up, even when accounting for baseline PTSS, and was found to mediate the relationships between reappraisal and punishment at baseline and PTSS at the follow-up assessment. CONCLUSIONS: The present study found no evidence to support advocating any particular thought control strategy for managing the intrusive symptoms of PTSD in youth in the acute posttrauma phase, and raised concerns over the use of reappraisal coping strategies. The study underscores the importance of ruminative responses in the onset and maintenance of PTSD in trauma-exposed youth.

Reduced autobiographical memory specificity in bereaved Afghan adolescents.

This study investigated the effect of bereavement (father death due to war in Afghanistan) on autobiographical memory specificity in Afghan adolescents living in Iran. Participants consisted of bereaved (n=70) and non-bereaved (n=33) Afghan adolescents. The measures included Farsi versions of the Autobiographical Memory Test, Mood and Feeling Questionnaire, Revised Children's Manifest Anxiety Scale, and Impact of Event Scale. Results indicated that the bereaved group retrieved a significantly lower proportion of specific memories and a significantly greater proportion of extended and categoric memories than the non-bereaved group. Additionally, depression symptoms and reduced autobiographical memory specificity were significantly correlated. These findings suggest that bereaved adolescents have impaired autobiographical memory specificity.

Impact of a stance phase microprocessor-controlled knee prosthesis on level walking in lower functioning individuals with a transfemoral amputation.

BACKGROUND: For individuals with transfemoral amputation, walking with a prosthesis presents challenges to stability and increases the demand on the hip of the prosthetic limb. Increasing age or comorbidities magnify these challenges. Computerized prosthetic knee joints improve stability and efficiency of gait, but are seldom prescribed for less physically capable walkers who may benefit from them. OBJECTIVE: To compare level walking function while wearing a microprocessor-controlled knee (C-Leg Compact) prosthesis to a traditionally prescribed non-microprocessor-controlled knee prosthesis for Medicare Functional Classification Level K-2 walkers. STUDY DESIGN: Crossover. METHODS: Stride characteristics, kinematics, kinetics, and electromyographic activity were recorded in 10 participants while walking with non-microprocessor-controlled knee and Compact prostheses. RESULTS: Walking with the Compact produced significant increase in velocity, cadence, stride length, single-limb support, and heel-rise timing compared to walking with the non-microprocessor-controlled knee prosthesis. Hip and thigh extension during late stance improved bilaterally. Ankle dorsiflexion, knee extension, and hip flexion moments of the prosthetic limb were significantly improved. CONCLUSIONS: Improvements in walking function and stability on the prosthetic limb were demonstrated by the K-2 level walkers when using the C-Leg Compact prosthesis. CLINICAL RELEVANCE: Understanding the impact of new prosthetic designs on gait mechanics is essential to improve prescription guidelines for deconditioned or older persons with transfemoral amputation. Prosthetic designs that improve stability for safety and walking function have the potential to improve community participation and quality of life.

The Child PTSD Symptom Scale: an update and replication of its psychometric properties.

The psychometric properties of the child PTSD Symptom Scale (CPSS) were examined in 2 samples. Sample 1 (N = 185, ages 6-17 years) consisted of children recruited from hospitals after accidental injury, assault, and road traffic trauma, and assessed 6 months posttrauma. Sample 2 (N = 68, ages 6-17 years) comprised treatment-seeking children who had experienced diverse traumas. In both samples psychometric properties were generally good to very good (internal reliability for total CPSS scores = .83 and .90, respectively). The point-biserial correlation of the CPSS with posttraumatic stress disorder (PTSD) diagnosis derived from structured clinical interview was .51, and children diagnosed with PTSD reported significantly higher symptoms than non-PTSD children. The CPSS demonstrated applicability to be used as a diagnostic measure, demonstrating sensitivity of 84% and specificity of 72%. The performance of the CPSS Symptom Severity Scale to accurately identify PTSD at varying cutoffs is reported in both samples, with a score of 16 or above suggested as a revised cutoff.