Children’s Somatization Inventory (CSI-24)

Abstract

The Children’s Somatization Inventory (CSI-24; Walker, Garber, & Greene, 1991) is a widely utilized self-report measure designed to assess the presence and frequency of somatic symptoms in pediatric populations. It is a refined, shorter version of the original 35-item inventory, which was conceptualized based on symptoms consistent with the DSM-III-R criteria for Somatization Disorder.

The CSI-24 revision, published in 2009, resulted from eliminating 11 items that demonstrated low endorsement rates and weak item-total correlations in the original version. This 24-item scale has since been established as a valid and highly reliable instrument, correlating strongly with the CSI-35 (r=.99), and is suitable for use in both clinical and general community samples, as well as in diverse cultures.

Keywords

Children’s Somatization Inventory, CSI-24, somatization, somatic symptoms, pediatric psychology, functional impairment, chronic pain, psychometric properties.

Authors

L. S. Walker, J. Garber, J. E. Beck, W. Lambert, W. Greene.

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Purpose

The primary purpose of the CSI-24 is to quantitatively measure the frequency and severity of medically unexplained physical symptoms in children and adolescents. It serves as a crucial screening tool for identifying youth who may be experiencing high levels of somatization and require further clinical evaluation.

The inventory is particularly valuable in clinical settings dealing with chronic pain complaints, such as chronic abdominal pain, where somatic symptoms often intersect with psychological distress. Its revised 24-item structure ensures efficient administration while maintaining strong correlation with the original, more extensive 35-item version.

Construct

The CSI-24 measures the psychological construct of somatization, defined as the tendency to experience, communicate, and focus on psychological distress in the form of physical symptoms. These symptoms typically lack a complete medical explanation or are disproportionate to any physical findings.

The 24 items generally correspond to common physical complaints, such as headache, stomach pain, nausea, and fatigue, reflecting the historical criteria for Somatization Disorder as outlined in the DSM-III-R. The scale thus assesses the degree to which a child reports these physical symptoms as a potential manifestation of underlying emotional or psychological factors.

Validity

The validity of the CSI-24 is strongly supported across diverse samples. Although the inventory was initially conceptualized using a predominantly Caucasian clinical sample with a primary complaint of chronic abdominal pain, subsequent research has established its efficacy as a valid measure in general community populations (Lavigne et al., 2012) and in other cultures (Orgiles & Espada, 2013).

Because the CSI-24 correlates highly with the CSI-35 (r=.99, p<.001), it benefits from the established validation evidence of the original measure, which included high concurrent and convergent validity (r>.4) with other recognized measures of somatization. Furthermore, the CSI-24’s construct validity is demonstrated by its expected correlations with measures of associated psychological distress, including anxiety, depression, functional impairment, and quality of life (Lavigne, Saps, & Bryant, 2012).

Reliability

The CSI-24 demonstrates strong reliability, especially concerning its Internal Consistency. Across numerous studies involving various populations, the measure has consistently yielded high Cronbach’s alpha coefficients, ranging from .84 to .92 (Cerutti et al., 2017; Lavigne et al., 2012).

These high alpha values confirm that the 24 items are measuring the same underlying construct consistently. The near-perfect correlation between the revised CSI-24 and the original CSI-35 (r=.99) also reinforces the revised scale’s status as a reliable and psychometrically sound refinement of the original instrument.

Factor Analysis

The Factorial Analysis of the CSI-24 has been subject to some academic debate regarding its underlying structure. While the instrument’s items typically load onto a single primary factor, suggesting a theoretically uni-dimensional measure of somatization, the overall statistical fit of this one-factor model has sometimes been reported as poor (Walker, Garber, & Greene, 1991).

Further research has explored alternative, shorter structures. For instance, a highly condensed 6-item, one-factor instrument has been suggested to demonstrate a better statistical fit and adequate psychometric properties in some samples (Orgiles & Espada, 2013). Despite minor controversies surrounding strict uni-dimensionality, the instrument’s strong utility and standardized factor loadings support its use as a measure of global somatization severity.

Instrument

Test Type: Self-report inventory, frequently utilized with supplementary parent report forms in clinical settings.

Format: 24 items, typically utilizing a Likert-type frequency scale to score the occurrence of symptoms over a specified retrospective time period.

Language Available: English (Original), Spanish (Validated version available, Orgiles & Espada, 2014).

Population Group: Children and Adolescents.

Age Group: Typically utilized for children and adolescents aged 8 to 16 years.

Population Details: Validated in both clinical samples (e.g., chronic abdominal pain patients) and non-clinical community samples. Findings indicate that scores tend to be higher for older children and females, often exhibiting a low to medium effect size (d=0.52). Parent reports are generally lower in school samples and higher in clinical samples compared to associated child reports (Cerutti et al., 2017).

Test Methodology: Assessment of the frequency of 24 specific somatic symptoms corresponding to DSM-III-R criteria for somatization.

Keywords

CSI-24, internal consistency, convergent validity, child report, parent report, factorial structure, DSM-III-R, chronic abdominal pain.

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Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Not provided in source content.

Permissions & Fee and Test Year

The original CSI was conceptualized in 1991 (Walker et al.). The revised and validated CSI-24 was formally published in 2009 (Walker, Beck, Garber, & Lambert, 2009). Information regarding specific permissions, licensing, and usage fees must be obtained directly from the primary author, Dr. Lynn Walker, or the official publisher of the scale.

Reference’s

Cerutti R., Spensieri V., Valastro C., Presaghi F., & Guidetti V. (2017). A comprehensive approach to understand somatic symptoms and their Impact on emotional and psychosocial functioning in children. PLoS ONE, 12(2). doi.org/10.1371/journal.pone.0171867

Laird K., Sherman A., Smith C., & Walker L. (2015). Validation of the abdominal pain index using a revised scoring method. Journal Pediatric Psychology, 40(5). Doi:10.1093/jpepsy/jsu118

Lavigne, S.L., Saps, M., & Bryant, F.B. (2012). Reexamining the factor structure of somatization using the children’s somatization inventory (CSI-24) in a community sample. Journal of Pediatric Psychology, 37, 914-924. Doi:10.1093/jpepsy/jss060

Orgiles, M. & Espada, J. P. (2014). Spanish version of the children’s somatization inventory: factorial structure and psychometric properties in a community sample. International Journal of Behavioural Medicine, 21, 556-560. Doi:10.1007/s12529-013-9335-9

Walker, L. S., Beck, J. E., Garber, J., & Lambert, W. (2009). Children’s somatization inventory: Properties of the revised form (CSI-24). Journal of Pediatric Psychology, 34, 430-440.

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Items of the Children’s Somatization Inventory (CSI-24)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The specific 24 items comprising the Children’s Somatization Inventory (CSI-24) were not provided in the source content.