Young Child PTSD Checklist

Abstract

The Young Child PTSD Checklist (YCPC) is a specialized, developmentally-sensitive psychological assessment tool designed for the evaluation of PTSD symptoms in very young children. Unlike tools designed for older populations, the YCPC is completed by a primary caregiver and accounts for the unique ways that traumatic stress manifests during early childhood. The instrument is structured into three main sections: a screening for twelve potential traumatic events, a detailed checklist covering 24 specific PTSD symptoms, and six items assessing associated functional impairment.

Keywords

Young Child PTSD Checklist, YCPC, Post-Traumatic Stress Disorder, Early Childhood Trauma, Preschool Assessment, Caregiver Report, Functional Impairment, Michael Scheeringa.

Authors

Michael Scheeringa, MD, MPH

Purpose

The primary purpose of the YCPC is to provide a standardized, yet developmentally appropriate, method for clinicians and researchers to screen for and assess the presence and severity of PTSD symptoms following exposure to potentially life-threatening events in young children. By relying on caregiver observation, the scale captures behavioral and emotional changes that might not be accessible through direct child interview at this age.

The instrument is particularly valuable for identifying symptoms corresponding to the DSM criteria as adapted for the early childhood population, ensuring accurate diagnostic consideration for conditions often overlooked or misdiagnosed in this age bracket. The inclusion of a traumatic events checklist helps ensure that the diagnostic process meets the necessary A criterion (exposure to actual or threatened death, serious injury, or sexual violence) as defined in standard diagnostic manuals.

Construct

The YCPC measures the construct of Post-Traumatic Stress Disorder (PTSD) as experienced and expressed by children in the preschool and early school-age range, reflecting the unique developmental presentation of traumatic stress. The scale operationalizes the core symptom clusters adapted from the DSM criteria: intrusion (e.g., intrusive memories, nightmares, re-enactment in play); avoidance (e.g., avoiding reminders, emotional numbing); and alterations in arousal and reactivity (e.g., hypervigilance, irritability, startle response).

A critical component of the construct measured is functional impairment. The YCPC includes specific items dedicated to assessing how the reported symptoms interfere with the child’s relationships with family, peers, and teachers, as well as their general ability to participate in typical activities (e.g., public outings). This focus ensures that the clinical significance, beyond mere symptom presence, is documented.

Validity

The validity of the YCPC is supported by its strong foundation in research focused on early childhood trauma, particularly the work validating the related Diagnostic Infant and Preschool Assessment (DIPA), which shares many items. Studies focusing on the YCPC and DIPA have demonstrated robust criterion validity, showing significant correlations between YCPC scores and independent clinical diagnoses of PTSD in young children. The scale exhibits high content validity, as its items directly reflect the developmentally modified criteria for PTSD.

Furthermore, evidence suggests strong discriminant validity, confirming that the YCPC effectively differentiates between children diagnosed with PTSD and those presenting with other anxiety disorders or externalizing behaviors, or those exposed to trauma but not meeting full diagnostic criteria.

Reliability

The YCPC demonstrates excellent internal consistency, a key measure of reliability, particularly across the various symptom clusters. High inter-rater reliability is also typically reported, which is crucial given that the scale is a parent- or caregiver-report measure. This suggests that different observers tend to rate the child’s symptoms similarly, enhancing the trustworthiness of the scores.

Test-retest reliability studies, while dependent on the stability of the child’s clinical state, generally show acceptable stability over short periods for children whose traumatic exposure is resolved, confirming the scale’s consistency in measurement over time.

Factor Analysis

Factor analytical studies of the YCPC generally support a factor structure that aligns with the established DSM criteria for PTSD, adapted for the developmental stage of the young child. While earlier models often identified a three-factor structure (Re-experiencing, Avoidance/Numbing, and Hyperarousal), more recent analyses in the early childhood population often support a four-factor or five-factor model that better separates developmental features like emotional regulation difficulties and specific avoidance behaviors, reflecting the nuances of trauma presentation in preschoolers.

Instrument

Test Type: Screening and Diagnostic Checklist (Caregiver Report)

Format: Paper-and-pencil checklist administered to the primary caregiver.

Language Available: Primarily English (translations may exist but require verification).

Population Group: Children exposed to traumatic events.

Age Group: Early Childhood (typically 3 to 7 years old).

Population Details: Used in clinical, research, and forensic settings to assess trauma exposure and resulting symptomatology.

Test Methodology: Caregiver rates the frequency of 24 symptoms over the last two weeks using a 5-point Likert scale (0=Not at all to 4=Everyday). A separate section assesses functional impairment.

Keywords

Childhood trauma, PTSD symptoms, Developmental assessment, Symptom checklist, Michael Scheeringa, Criterion Validity, Reliability.

Authors

Author ORCID Identifier: Not available in source content.

Affiliation Email addresses: [email protected] (Tulane University, New Orleans, LA)

Correspondence Address: Tulane University, New Orleans, LA

Permissions & Fee and Test Year

The Young Child PTSD Checklist was developed by Michael Scheeringa in 2010. According to the author’s statement, the form may be reproduced and used for free for research and clinical purposes, but it must not be sold. Permissions for use should be directed to the author via the provided email address. The associated work validating the core items was published in 2010.

Reference’s

Scheeringa, S. & Haslett, N. (2010). The Reliability and Criterion Validity of the Diagnostic Infant and Preschool Assessment: A New Diagnostic Instrument for Young Children. Child Psychiatry and Human Development, 41(3), 299-31.

For additional information regarding the scale’s development, contact Michael Scheeringa, MD, MPH, at [email protected].

Items of the Young Child PTSD Checklist

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

The YCPC begins with identification fields:

• Name
• ID
• Date

TRAUMATIC EVENTS

AN EVENT MUST HAVE LED TO SERIOUS INJURY OR BE PERCEIVED AS IF IT COULD HAVE LED TO SERIOUS INJURY TO THE CHILD, OR TO ANOTHER PERSON (USUALLY A LOVED ONE) AND THE CHILD WITNESSED IT.

0 = Absent 1 = Present
Frequency is the number of events the child can remember. Generally, children start remembering events around 3 years of age.

P1. Accident or crash with automobile, plane or boat. 0 1 / / First Onset Frequency / / Latest Onset
P2. Attacked by an animal. 0 1 / / / /
P3. Man-made disasters (fires, war, etc) 0 1 / / / /
P4. Natural disasters (hurricane, tornado, flood) 0 1 / / First Onset Frequency / / Latest Onset
P5. Hospitalization or invasive medical procedures 0 1 / / / /
P6. Physical abuse 0 1 / / / /
P7. Sexual abuse, sexual assault, or rape 0 1 / / First Onset Frequency / / Latest Onset
P8. Accidental burning 0 1 / / / /
P9. Near drowning 0 1 / / / /
P10. Witnessed another person being beaten, raped, threatened with serious harm, shot at seriously wounded, or killed. 0 1 / / First Onset Frequency / / Latest Onset
P11. Kidnapped 0 1 / / / /
P12. Other: 0 1 / / First Onset Frequency / / Latest Onset

YCPC

• ID
• Date

Write down ALL the life‐threatening traumatic events (if Traumatic Events page not used, Rater writes in the events from interview):

Parent:
Below is a list of symptoms that children can have after life‐threatening events. Circle the number (0‐4) that best describes how often the symptom has bothered your child in the LAST 2 WEEKS.

• Not at all
• Once a week or less / once in a while
•  2 to 4 times a week / half the time
•  5 or more times a week /  almost always
•  Everyday

• 1. Does your child have intrusive memories of the trauma? Does s/he bring it up on his/her own?
• 2. Does your child re-enact the trauma in play with dolls or toys? This would be scenes that look just like the trauma. Or does s/he act it out by him/herself or with other kids?
• 3. Is your child having more nightmares since the trauma(s) occurred?
• 4. Does your child act like the traumatic event is happening to him/her again, even when it isn’t? This is where a child is acting like they are back in the traumatic event and aren’t in touch with reality. This is a pretty obvious thing when it happens.
• 5. Since the trauma(s) has s/he had episodes when s/he seems to freeze? You may have tried to snap him/her out of it but s/he was unresponsive.
• 6. Does s/he get upset when exposed to reminders of the event(s)?

For example, a child who was in a car wreck might be nervous while riding in a car now. Or, a child who was in a hurricane might be nervous when it is raining.
Or, a child who saw domestic violence might be nervous when other people argue. Or, a girl who was sexually abused might be nervous when someone touches her.
7. Does your child get physically distressed when exposed to reminders? Like heart racing, shaking hands, sweaty, short of breath, or sick to his/her stomach?

Think of the same type of examples as in #6.

• 8. Does your child try to avoid conversations that might remind him/her of the trauma(s)?

For example, if other people talk about what happened, does s/he walk away or change the topic?

• 9. Does your child try to avoid things or places that remind him/her of the trauma(s)?

For example, a child who was in a car wreck might try to avoid getting into a car.
Or, a child who was in a flood might tell you not to drive over a bridge.
Or, a child who saw domestic violence might be nervous to go in the house where it
occurred. Or, a girl who was sexually abused might be nervous about going to bed because that’s where she was abused before.

• 10. Does your child have difficulty remembering the whole incident? Has s/he blocked out the entire event?
• 11. Has s/he lost interest in doing things that s/he used to like to do since the trauma(s)?
• 12. Since the trauma(s), does your child show a restricted range of emotions on his/her face compared to before?
• 13. Has your child lost hope for the future? For example, s/he believes will not have fun tomorrow, or will never be good at anything.
• 14. Since the trauma(s) has your child become more distant and detached from family members, relatives, or friends?
• 15. Has s/he had a hard time falling asleep or staying asleep since the trauma(s)?
• 16. Has your child become more irritable, or had outbursts of anger, or developed extreme temper tantrums since the trauma(s)?
• 17. Has your child had more trouble concentrating since the trauma(s)?
• 18. Has s/he been more “on the alert” for bad things to happen? For example, does s/he look around for danger?
• 19. Does your child startle more easily than before the trauma(s)? For example, if there’s a loud noise or someone sneaks up behind him/her, does s/he jump or seem startled?
• 20. Has your child become more physically aggressive since the trauma(s)? Like hitting, kicking, biting, or breaking things.
• 21. Has s/he become more clingy to you since the trauma(s)?
• 22. Did night terrors start or get worse after the trauma(s)? Night terrors are different from nightmares: in night terrors a child usually screams in their sleep, they don’t wake up, and they don’t remember it the next day.
• 23. Since the trauma(s), has your child lost previously acquired skills? For example, lost toilet training?

Or, lost language skills?
Or, lost motor skills working snaps, buttons, or zippers?

• 24. Since the trauma(s), has your child developed any new fears about things that don’t seem related to the trauma(s)?
  What about going to the bathroom alone? Or, being afraid of the dark?

FUNCTIONAL IMPAIRMENT

Do the symptoms that you endorsed above get in the way of your child’s ability to function in the following areas?

• Hardly ever / none 
• Some of the time
• About half the days
• More than half the days
• Everyday

• 25. Do (symptoms) substantially “get in the way” of how s/he gets along with you, interfere in your relationship, or make you feel upset or annoyed?
• 26. Do these (symptoms) “get in the way” of how s/he gets along with brothers or sisters, and make them feel upset or annoyed?
• 27. Do these (symptoms) “get in the way” with the teacher or the class more than average?
• 28. Do (symptoms) “get in the way” of how s/he gets along with friends – at daycare, school, or in your neighborhood?
• 29. Do (symptoms) make it harder for you to take him/her out in public than it would be with an average child?
  Is it harder to go out with your child to places like the grocery store? Or to a restaurant?
• 30. Do you think that these behaviors cause your child to feel upset?

© Michael Scheeringa, MD, MPH, 2010, Tulane University, New Orleans, LA. [email protected]. This form may be reproduced and used for free, but not sold, without further permission from the author.