UCLA PTSD Reaction Index

Abstract

The UCLA PTSD Reaction Index, officially known as the University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index, is a standardized measure designed to assess the presence and severity of PTSD symptoms in children and adolescents following a traumatic exposure. Developed by Pynoos, Rodriguez, Steinberg, Stuber, & Frederick (1998), the scale was initially structured to align with the diagnostic criteria outlined in the DSM-IV, and has since been updated to reflect DSM-5 criteria, including the assessment of Dissociative Symptoms.

The instrument incorporates a two-part methodology: a self-report trauma history screener to identify the index trauma, followed by a detailed symptom checklist where respondents rate the frequency of 22 to 31 specific post-traumatic reactions over the past month using a 5-point Likert scale. It is widely regarded as a critical tool for both clinical diagnosis and longitudinal research into the psychosocial effects of trauma on youth.

Keywords

UCLA PTSD Reaction Index, PTSD, Post-traumatic Stress Disorder, Child assessment, Adolescent trauma, Psychological scale, DSM-IV, DSM-5, Trauma history, Psychopathology, Self-report.

Authors

Robert S. Pynoos, N. Rodriguez, Alan M. Steinberg, Marguerite Stuber, Christina Frederick, Michael J. Brymer, K. B. Decker, S. Kim, C. Ghosh, S. A. Ostrowski, K. Gulley, E. C. Briggs, Brittany Beyerlein.

Purpose

The primary purpose of the UCLA PTSD Reaction Index is to provide a reliable and valid measure for quantifying the symptomatology of Post-traumatic Stress Disorder in youth populations. It enables clinicians to systematically assess the four distinct symptom clusters—intrusion, avoidance, negative alterations in cognitions and mood, and hyperarousal—required for a formal PTSD diagnosis.

The scale is instrumental in clinical practice for identifying youth who require intervention and monitoring treatment response over time. In research contexts, it allows for standardized data collection across diverse traumatic events, aiding in the understanding of risk and resilience factors following exposure to violence, disaster, or abuse. The inclusion of the trauma history profile ensures that the reported symptoms are contextually linked to a specific, qualifying traumatic event.

Construct

The UCLA PTSD Reaction Index measures the psychological construct of Post-traumatic Stress Disorder, aligning its structure with the corresponding diagnostic criteria established by the American Psychiatric Association. The index assesses the severity of emotional, cognitive, and physiological reactions that occur as a direct consequence of experiencing or witnessing a terrifying event.

The instrument is designed to capture the full spectrum of post-traumatic reactions, including affective disturbances (e.g., trouble feeling happiness or love), behavioral changes (e.g., hypervigilance, arguments), and somatic complaints (e.g., headaches, stomach aches related to reminders). Modern versions also specifically measure depersonalization and derealization phenomena, which are characteristic of the Dissociative Subtype of PTSD.

Validity

The validity of the UCLA PTSD Reaction Index is supported by its strong congruence with the DSM criteria, ensuring high content validity. Criterion validity has been demonstrated through its ability to correlate highly with established structured diagnostic interviews for PTSD, confirming its utility as an effective screening and severity measure.

Studies, including those published by Steinberg et al. (2013), have provided robust evidence regarding the scale’s Psychometric properties, confirming its ability to accurately discriminate between youth who meet criteria for PTSD and those who do not. The comprehensive nature of the trauma history screener further enhances the ecological validity of the symptom assessment by grounding the reported reactions in a specific, lived experience.

Reliability

The scale possesses high internal consistency, which is a key indicator of measurement Reliability. Across various trauma samples, the UCLA PTSD Reaction Index consistently yields high Cronbach’s alpha coefficients, specifically reported in the source material as ranging from α = .88–.91. This range indicates that the items within the index are highly correlated and reliably measure the overall severity of post-traumatic stress.

Furthermore, strong test-retest Reliability has been documented in literature, suggesting that scores remain stable over time when the underlying clinical status of the child or adolescent has not changed significantly. This stability is crucial for monitoring treatment efficacy and making reliable comparisons in longitudinal research studies.

Factor Analysis

Early factor analysis of the UCLA PTSD Reaction Index (DSM-IV Revision) typically supported a factor structure that mirrored the tripartite model of DSM-IV. However, subsequent revisions aligned with DSM-5 have prompted studies exploring more complex models.

Contemporary factor analytic studies often support a four-factor or five-factor model, reflecting the increased differentiation of symptoms in the DSM-5 criteria. The inclusion of items specifically targeting Dissociative Symptoms allows for the extraction of a separate factor representing the dissociative subtype, thereby confirming the multidimensional nature of post-traumatic stress presentation in youth.

Instrument

Test Type: Self-Report Questionnaire and Structured Interview (Trauma History Screener).

Format: 5-point Likert scale (0=NONE, 1=LITTLE, 2=SOME, 3=MUCH, 4=MOST) rating the frequency of symptoms over the past month.

Language Available: English (Original), with numerous translations available globally.

Population Group: Children and Adolescents.

Age Group: Typically used for youth aged 6 to 18 years.

Population Details: Utilized in clinical, school, and research settings with youth exposed to various forms of trauma, including natural disasters, community violence, abuse, and bereavement.

Test Methodology: Administration begins with the Trauma History Profile (Part I & II) to identify exposure to potentially traumatic events. This is followed by the symptom index, where the child or adolescent rates the frequency of symptoms relative to the identified index trauma.

Keywords

Trauma screening, Psychological measurement, Child psychology, Psychometric properties, Symptom severity, Dissociative Symptoms, Hyperarousal, Avoidance, Intrusion, Pediatric mental health, Comorbidity.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: For information about obtaining the PTSD Reaction Index for DSM-5, please contact Preston Finley at [email protected].

Correspondence Address: UCLA Trauma Psychiatry Program, Los Angeles, CA.

Permissions & Fee and Test Year

The foundational version, the UCLA PTSD Reaction Index for DSM-IV (Revision 1), was published in 1998 by the UCLA Trauma Psychiatry Program. For current permissions, fees, and updated versions (e.g., DSM-5 compliant versions), users are directed to contact the UCLA Trauma Psychiatry Program via the provided email address.

The instrument is widely used in academic and non-profit settings, often available upon request for research purposes. The original PDF resources for this instrument can be accessed here: http://www.lopdf.net/d/Children-Coping-with-Stress.pdf and http://www.nctsn.org/nctsn_assets/pdfs/mediasite/ptsd-training.pdf.

Reference’s

• Pynoos, R., Rodriguez, N., Steinberg, A., Stuber, M., & Frederick, C. (1998). The UCLA PTSD Reaction Index for DSM-IV (Revision 1). Los Angeles, CA: UCLA Trauma Psychiatry Program.
• Steinberg, A. M., Brymer, M. J., Decker, K. B., & Pynoos, R. S. (2004). The University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index. Current Psychiatry Reports, 6, 96-100.
• Steinberg, A. M., Brymer, M. J., Kim, S., Ghosh, C., Ostrowski, S. A., Gulley, K., Briggs, E. C., & Pynoos, R. S. (2013). Psychometric properties of the UCLA PTSD Reaction Index: Part 1. Journal of Traumatic Stress, 26, 1-9.

Items of the UCLA PTSD Reaction Index

HOW MUCH OF THE TIME DURING THE PAST MONTH

1. I watch out for danger or things that I am afraid of.
2. When something reminds me of what happened, I get very upset, afraid, or sad.
3. I have upsetting thoughts, pictures, or sounds of what happened come into my mind when I do not want them to.
4. I feel grouchy, angry, or mad.
5. I have dreams about what happened or other bad dreams.
6. I feel like I am back at the time when the bad thing happened, living through it again.
7. I feel like staying by myself and not being with my friends.
8. I feel alone inside and not close to other people.
9. I try not to talk about, think about, or have feelings about what happened.
10. I have trouble feeling happiness or love.
11. I have trouble feeling sadness or anger.
12. I feel jumpy or startle easily, like when I hear a loud noise or when something surprises me.
13. I have trouble going to sleep or I wake up often during the night.
14. I think that some part of what happened is my fault.
15. I have trouble remembering important parts of what happened.
16. I have trouble concentrating or paying attention.
17. I try to stay away from people, places, or things that make me remember what happened.
18. When something reminds me of what happened, I have strong feelings in my body, like my heart beats fast, my head aches, or my stomach aches.
19. I think that I will not live a long life.
20. I have arguments or physical fights.
21. I feel pessimistic or negative about my future.
22. I am afraid that the bad thing will happen again.

Scoring: 0=NONE, 1=LITTLE, 2=SOME, 3=MUCH, 4=MOST

UCLA PTSD Reaction Index for Children/Adolescents (Extended Items)

1. I am on the lookout for danger or things that I am afraid of (like looking over my shoulder even when nothing is there).
2. I have thoughts like “I am bad.”
3. I try to stay away from people, places, or things that remind me about what happened.
4. I get upset easily or get into arguments or physical fights.
5. I feel like I am back at the time when the bad thing happened, like it’s happening all over again.
6. I feel like what happened was sickening or gross.
7. I don’t feel like doing things with my family or friends or other things that I liked to do.
8. I have trouble concentrating or paying attention.
9. I have thoughts like, “The world is really dangerous.”
10. I have bad dreams about what happened, or other bad dreams.
11. When something reminds me of what happened I get very upset, afraid, or sad.
12. I have trouble feeling happiness or love.
13. I try not to think about or have feelings about what happened.
14. When something reminds me of what happened, I have strong feelings in my body like my heart beats fast, my head aches or my stomach aches.
15. I am mad with someone for making the bad thing happen, not doing more to stop it, or to help after.
16. I have thoughts like “I will never be able to trust other people.”
17. I feel alone even when I am around other people.
18. I have upsetting thoughts, pictures or sounds of what happened come into my mind when I don’t want them to.
19. I feel that part of what happened was my fault.
20. I hurt myself on purpose.
21. I have trouble going to sleep, wake up often, or have trouble getting back to sleep.
22. I feel ashamed or embarrassed over what happened.
23. I have trouble remembering important parts of what happened.
24. I feel jumpy or startle easily, like when I hear a loud noise or when something surprises me.
25. I feel afraid or scared.
26. I do risky or unsafe things that could really hurt me or someone else.
27. I want to get back at someone for what happened.

With Dissociative Symptoms (Dissociative Subtype)

28. I feel like I am seeing myself or what I am doing from outside my body (like watching myself in a movie).
29. I feel not connected to my body, like I’m not really there inside.
30. I feel like things around me look strange, different, or like I am in a fog.
31. I feel like things around me are not real, like I am in a dream.

SELF-REPORT TRAUMA HISTORY:

In interviewing the child/adolescent, ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. Has anything like this ever happened to you?

1. Provide a brief description of what happened: ________________________

Below is a list of other scary or violent things that can happen. For each question, check “Yes” if this has happened to you; check “No” if this did NOT happen to you. Trauma History Profile: Part II (self-report screener)

2. Were you in a disaster, like an earthquake, wildfire, hurricane, tornado or flood?
3. Were you in a bad accident, like a serious car accident or fall?
4. Were you in a place where a war was going on around you?
5. Were you hit, punched, or kicked very hard at home? (DO NOT INCLUDE play fighting between brothers and sisters.)
6. Did you see a family member being hit, punched or kicked very hardat home? (DO NOT INCLUDE play fighting between brothers and sisters).
7. Were you beaten up, shot at, or threatened to be hurt badly in your school, neighborhood or town?
8. Did you see someone who was beaten up, shot at or killed?
9. Did you see a dead body (do not include funerals)?
10. Did someone touch your private parts when you did not want them to? (DO NOT INCLUDE visits to the doctor.)
11. Did you see or hear about the violent death or serious injury of a loved one or friend?
12. Did you have a painful or scary medical treatment when you were very sick or badly injured?
13. Were you ever forced to have sex with someone against your will?
14. Has anyone close to you died?
15. OTHER than the things described above, has ANYTHING ELSE ever happened to you that was REALLY SCARY OR UPSETTING?