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UCLA Posttraumatic Stress Disorder Reaction Index for DSM-IV

This instrument assesses reactions to trauma in children and adolescents. It can be used as a self-report (completed on paper, suitable for one to one or group administration) or given verbally where questions are read to the child. The test has excellent psychometric properties, and has been used across a variety of trauma types, age ranges, settings, and cultures.

Author/Publisher Details

Alan M. Steinberg, PhD, Melissa J. Brymer, PsyD, Kelly B. Decker, MA, and Robert S. Pynoos, MD, MPH

Date

©1998, ©2001, Pynoos, Rodriguez, Steinberg, Stuber, & Frederick

Description

The University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index (UCLA-RI) is one of the most widely used instruments for the assessment of traumatized children and adolescents. It has been used around the world after major disasters and catastrophic violence as an integral component of public mental health response and recovery programs.

There are three versions: Child, Adolescent and Parent's Report. Questions match the DSM-IV criterion. Although the instrument was not designed to make a formal diagnosis, it can provide preliminary diagnostic information. In Part I, a brief review of the traumatic experience sets the stage for the subsequent questions, helps the child recall details of the traumatic event (Criterion A1). Part II includes questions related to A1 and A2 criteria which are scored "yes" or "no". Part III asks about the frequency of PTSD symptoms during the past month (rated from 0=none of the time to 4=most of the time). These items map directly onto the DSM-IV PTSD criterion B (intrusion), criterion C (avoidance / numbing), and criterion D (arousal). Twenty of these items assess PTSD symptoms; two additional items assess associated features—fear of recurrence and trauma-related guilt.

The test takes around 20-30 minutes to complete depending on age, reading ability and method of administration. It is suitable for administration by a graduate level student under supervision.

Scoring

Scoring takes around 5-10 minutes. The score sheet provides instructions for calculating a total PTSD severity score, and severity scores for each of the DSM-IV B, C, and D symptom clusters. When criterion A is met, children who meet criteria B, C, and D (using endorsements of "much of the time" and "most of the time" as indicating symptom presence) are scored as having a likely diagnosis of DSM-IV "full" PTSD. Where criterion A is met, children meeting criteria for only two symptom subcategories are scored as "partial" PTSD likely. A cut-off of 38 or greater for a single incident traumatic event has the greatest sensitivity and specificity for detecting PTSD (Rodriguez , Steinberg, Saltzman & Pynoos 2001a, 2001b)

Psychometrics

Validity

All versions show a "dose" relationship for exposure, with higher Reaction Index scores among traumatized samples compared with control subjects.

Convergent Validity

DSM-IV version correlates 0.70 with the PTSD Module of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (Epidemiologic version) and 0.82 in comparison with the Child and Adolescent Version of the Clinician-administered PTSD Scale. A cut-off of 38 has a sensitivity of 0.93 and specificity of 0.87 in detecting PTSD (Rodriguez et al. 2001a, 2001b)

Internal Consistency

Internal consistency across versions: several reports have found Chronbach's alpha to fall in the range of 0.90 (e.g. Roussos et al., 2005)

Test-Retest Reliability

Over the different versions, test-retest reliability has ranged from good to excellent; Roussos et al. (2005) report a test-retest reliability coefficient of 0.84 for the DSM-IV version.

Key/Core References

Benjamin Rolon-Arroyo, Ph.D., Benjamin Oosterhoff, Ph.D., Christopher M. Layne, Ph.D., Alan M. Steinberg, Ph.D., Robert S. Pynoos, M.D., Julie B. Kaplow, Ph.D. (2020) The UCLA PTSD Reaction Index for DSM-5 brief form: A screening tool for trauma-exposed youth
Journal of the American Academy of Child and Adolescent Psychiatry, 59(30), 434-443.

Kaplow, JB, Rolon-Arroyo, B; Layne, CM; Oosterhoff, B; Hill, R; Steinberg, AM; Pynoos, RS.
(2020). Validation of the UCLA PTSD Reaction Index for DSM-5: A developmentally informed assessment tool for youth. Journal of the American Academy of Child and Adolescent Psychiatry, 59(1), 186‐194.