Child PTSD Symptom Scale

The Child PTSD Symptom Scale (CPSS) provides clinicians with a psychometrically robust tool to evaluate post-traumatic stress symptoms in children and…

Questions: 24
Duration: 10 min
Original title: Child PTSD Symptom Scale
Adaptation: Child PTSD Symptom Scale
Authors: Foa, E.B., Johnson, K.M., Feeny, N.C., & Treadwell, K.R.H.
Created: 2001

The Child PTSD Symptom Scale (CPSS) provides clinicians with a psychometrically robust tool to evaluate post-traumatic stress symptoms in children and adolescents aged 8 to 18. Developed by Edna Foa and colleagues, this self-report measure translates the diagnostic criteria for PTSD into developmentally accessible language. It allows young patients to report their internal experiences without requiring them to recount the traumatic event itself in detail, helping to open the conversation and move past misdiagnosis before deeper trauma work begins.

Beyond symptom counting, the CPSS integrates a dedicated functional impairment section, ensuring that clinicians can evaluate how post-traumatic stress interferes with the child’s daily life, from schoolwork to family relationships. It serves as a reliable baseline assessment, providing a structured way to identify the distinct symptom clusters and post-traumatic reactions.

Using a validated measure like the CPSS helps mental health professionals track treatment progress systematically. By administering it periodically throughout trauma-focused therapy, clinicians can monitor symptom reduction and adapt their interventions to the child's evolving clinical needs.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

24/ 51

Self-report questionnaire intended for children and adolescents aged 8 to 18 who have experienced a traumatic event. It assesses the presence and frequency of the 17 post-traumatic stress disorder symptoms as defined by the DSM-IV (re-experiencing, avoidance, hyperarousal) as well as the functional impact of symptoms on daily life (school, family, friends, leisure, general mood).

051

For information

Cut-off≥ 11Probable PTSD

Original screening threshold, established based on the score distribution of children with high vs low symptomatology.

Foa et al. (2001)View the study ↗

Cut-off≥ 15Probable PTSD (clinical threshold)

Elevated threshold used in clinical practice, more restrictive than the original threshold of 11.

Foa et al. (2001)View the study ↗

Scoring

Sum per subscale and total symptom score (0-51); functional impact score (0-7), total score from 0 to 51, response option scoring varies by item (see each question).

Hyperarousal (Criterion D)

6/ 15

Hyperarousal: sleep disturbances, irritability, hypervigilance, startle reactions.

items 13, 14, 15, 16, 17

015

Avoidance and numbing (Criterion C)

12/ 21

Avoidance of trauma reminders and emotional numbing.

items 6, 7, 8, 9, 10, 11, 12

021

Functional impact

4/ 7

Impact of symptoms on daily life (school, leisure, relationships, family tasks).

items 18, 19, 20, 21, 22, 23, 24

Re-experiencing (Criterion B)

6/ 15

Trauma re-experiencing: intrusive memories, nightmares, flashbacks, and distress at reminders.

items 1, 2, 3, 4, 5

015

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What the test measures

The CPSS evaluates the presence and severity of post-traumatic stress symptoms and their impact on daily life. It structures the child's self-report around the core dimensions of PTSD:

Re-experiencing: Intrusive thoughts, nightmares, physiological reactivity, and psychological distress triggered by trauma reminders.
Avoidance and Numbing: Efforts to evade trauma-related thoughts or external reminders, alongside emotional detachment and loss of interest.
Hyperarousal: Symptoms of increased autonomic nervous system reactivity, including sleep disturbances, irritability, concentration difficulties, and hypervigilance.
Functional Impairment: The degree to which these symptoms disrupt essential developmental domains, such as peer relationships, school performance, and family dynamics.

This instrument is specifically validated for children and adolescents who have been exposed to a traumatic event.

When and why to use it

Clinicians incorporate the CPSS into pediatric trauma assessments to structure the clinical evaluation and guide treatment planning. It is primarily used for:

Intake baseline: To map the child's initial symptom profile and functional limitations before beginning trauma-focused therapy.
Screening and case formulation: To identify clinical levels of post-traumatic stress using the DSM-IV algorithm and map the differential diagnosis.
Monitoring change: To track fluctuations in symptom severity over time, allowing the clinician to evaluate the effectiveness of the intervention.
Guiding psychoeducation: To help young patients and their families recognize that their distressing internal experiences are expected symptoms of trauma, exploring why trauma stays present-tense.

A validated scale provides an objective symptom count and functional baseline, moving beyond general clinical impression to systematically map the architecture of the child's distress and determine if further evaluation of ICD-11 CPTSD architecture is warranted.

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The questions

Below is a list of problems that kids sometimes have after experiencing an upsetting event. Read each item carefully and indicate how often that problem has bothered you DURING THE PAST TWO WEEKS. Then, for the second part, indicate YES or NO if the problems you checked have interfered with different areas of your life.
1. Having upsetting thoughts or images about the event pop into your head when you don't want them to.
Probes for the presence of involuntary, intrusive cognitive recollections of the traumatic event.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
2. Having bad dreams or nightmares.
Assesses trauma-related sleep disturbances presenting as distressing dreams.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
3. Acting or feeling like the event is happening all over again.
Evaluates the occurrence of dissociative flashbacks or intense behavioral re-enactments of the trauma.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
4. Feeling upset when you think about or hear about the event.
Measures the child's psychological reactivity and emotional distress when exposed to trauma reminders.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
5. Having physical reactions (for example, sweating, a racing heart) when something reminds you of the event.
Identifies autonomic physiological arousal triggered by trauma cues.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
6. Trying not to think, talk, or have feelings about the event.
Probes cognitive and emotional avoidance strategies used to manage distress.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
7. Trying to avoid activities, people, or places that remind you of the event.
Assesses behavioral avoidance of external triggers associated with the traumatic event.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
8. Not being able to remember an important part of the event.
Evaluates the presence of dissociative amnesia concerning crucial aspects of the trauma.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
9. Being much less interested in or almost stopping things you used to enjoy.
Measures anhedonia and diminished participation in previously enjoyed activities.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
10. Feeling distant or cut off from the people around you.
Probes for feelings of alienation, detachment, or estrangement from others.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
11. Having trouble feeling your emotions (for example, not being able to cry or feel loving feelings).
Assesses restricted affect and the inability to experience positive emotions.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
12. Feeling like your future plans or dreams won't come true (for example, that you won't get a job, get married, or have kids).
Evaluates the presence of a foreshortened sense of future.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
13. Having trouble falling or staying asleep.
Measures baseline sleep continuity disturbances associated with hyperarousal.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
14. Being irritable or having angry outbursts.
Probes for emotional dysregulation presenting as irritability or angry outbursts.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
15. Having trouble concentrating (for example, losing track of a TV show, forgetting what you just read, not paying attention in class).
Assesses cognitive impairments in focus and attention secondary to trauma exposure.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
16. Being on guard or watchful (checking what's happening around you, even when it's not necessary).
Evaluates hypervigilance and an exaggerated sense of environmental threat.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
17. Being easily startled (for example, when someone walks up behind you).
Measures the physiological startle response to unexpected but benign stimuli.
- Not at all
- Once a week or less / sometimes
- 2 to 4 times a week / half the time
- 5 or more times a week / almost always
18. Have the problems you checked above interfered with praying?
Checks if trauma symptoms disrupt the child's religious or spiritual practices.
- No
- Yes
19. Have the problems you checked above interfered with doing chores or your responsibilities at home?
Assesses functional impairment concerning the child's daily household responsibilities.
- No
- Yes
20. Have the problems you checked above interfered with your relationships with friends?
Evaluates the impact of trauma symptoms on peer socialization.
- No
- Yes
21. Have the problems you checked above interfered with your hobbies or having fun?
Probes whether the symptoms interfere with the child's recreational and leisure pursuits.
- No
- Yes
22. Have the problems you checked above interfered with your schoolwork?
Measures the extent to which academic performance is hindered by post-traumatic distress.
- No
- Yes
23. Have the problems you checked above interfered with your relationships with your family?
Assesses the disruption of family dynamics and interpersonal functioning at home.
- No
- Yes
24. Have the problems you checked above interfered with your overall happiness?
Evaluates the broader subjective impact of symptoms on the child's overall well-being.
- No
- Yes