Trauma Symptom Checklist for Children - Alternate Version

Briere, J. 1996 Description of Measure Purpose To assess the effects of childhood trauma through the childs self-report. Conceptual Organization The 54-item Trauma Symptom Checklist for Children (TSCC) consists of two validity scales (Underresponse and Hyperresponse), six clinical scales (Anxiety, Depression, Posttraumatic Stress, Dissociation, Anger, and Sexual Concerns) and 8 critical items. The measure is written at a level appropriate for the language and reading capabilities of children 8-16 years of age. The TSCC-Alternate Version (TSCC-A) is a shortened version of the TSCC that excludes the 10 items that comprise the Sexual Concerns scale and one critical item relating to sexual issues. The TSCC-A addresses human subjects concerns that children might be upset by reference to sexual issues. It is recommended that the TSCC be used in clinical and forensic settings where sexual victimization is more likely to be found, and the TSCC-A be used in school settings (Briere 1996). Item Origin/Selection Process The TSCC is the childrens version of the Trauma Symptom Checklist for adults. Items for both measures were selected based on factor analyses and consultation with experts in the field of psychopathology. Materials Test and manual are available from the publisher. Time Required 10 minutes

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Administration Method Interviewer-administered to an individual, or to a group. Training Minimal

Scoring Score Types For each item, (e.g., feeling lonely; wanting to yell at people), the child records the frequency with which the statement pertains to her/him on a 4-point scale ranging from 0 (never) to 3 (almost all the time). Raw scale scores are derived by summing the response values for all items comprising the scale, and then dividing by the number of items within the scale. Items comprising each scale are listed below. Anxiety: Items 2, 13, 19, 20, 27, 28, 33, 34, and 41 Depression: Items 6, 7, 12, 17, 21-23, 35, and 43 Anger: Items 5, 11, 14, 16, 18, 30, 31, 38, and 40 Post-traumatic Stress: Items 1, 3, 8-10, 19, 20, 29, 36, and 42 Dissociation: Items 4, 9, 15, 24-26, 32, 37, 39, and 44 Overt Dissociation: Items 9, 15, 24-26, 37, and 39 Fantasy: Items 4, 32, and 44

Several items appear on more than one scale: 9 (Dissociation & PTS), 19 & 20 (PTS & Anxiety) (Briere, 1996). Raw scores on each of the scales can range from 0-27/30, depending on the scale. For comparison purposes, raw scale scores can be transformed into standardized T scores using the conversion tables provided in the manual (see Briere, 1996). T scores differ depending on child sex and age. The TSCC contains 8 critical items and the TSCC-A contains 7 critical items. The critical items examine problems or issues that may need more immediate clinical attention (e.g.,
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potential for harm to self or others; suicidality; fears of being killed; etc.). The critical items on the TSCC include an item related to sexual concerns where as the TSCC-A does not. While nonzero responses to critical items do not necessarily indicate risk for any specific negative psychological outcome, they do indicate a need for further inquiry regarding the level or meaning of the response. Scores on critical items are analyzed individually. That is, no total score can be calculated across all critical items(Briere, 1996). The TSCC includes two validity scales: Underresponse and Hyperresponse. The validity scales tap the childs tendency to either deny or over-report to symptom items. The Underresponse scale (UND) is designed to determine of the child is indiscriminantly marking the 0 (never) response. The scale consists of 10 items least likely to receive a 0 rating in the normative sample. The UND raw score is calculated by summing the number of 0s the child marked plus the number of UND items to which the child refused to respond. Tables are provided in the manual to convert raw scores to T scores for comparative purposes. The author recommends that TSCCs with UND T scores greater than or equal to 70 be considered invalid and those ranging from 65 to 70 be viewed and interpreted with caution (Briere, 1996). The Hyperresponse scale (HYP) is designed to determine of a child is indescriminantly endorsing the 3 (almost all the time) response. The scale consists of eight items to which children in the normative sample infrequently marked 3. HYP raw and T scores are calculated in the same manner as UND raw and T-scores. The author recommends that TSCCs with HYP T scores greater than or equal to 90 be considered invalid, and those ranging from 75 to 89 be interpreted with caution (Briere, 1996). Score Interpretation A higher score reflects greater symptomatology. T scores at or above 65 for any clinical scale are considered clinically significant. Norms and/or Comparative Data The TSCC was normed on 3008 children from three nonclinical samples: 53% female; 44% White, 27% Black, and 22% Hispanic (Briere, 1996). Table 1 shows the normative raw scores for 8-12 year olds in a standardization sample by sex.

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Table 1 about here Caution should be used when comparing scores of LONGSCAN subjects with those obtained from normative samples because the LONGSCAN subjects had the items read to them by the interviewers, while subjects in the normative samples read the items themselves. Psychometric Support Reliability The TSCC clinical scales demonstrate good internal consistency reliability with alpha coefficients for the normative sample ranging from .82 (Depression) to .89 (Anger). In the normative sample the alpha reliability for the validity scales was good for UND ( = .85) and moderate for HYP ( = .66). Internal consistency for the clinical scales was also good in several clinical samples ( = .80 to .89) (Briere, 1996). Validity Results of the TSCC are congruent with those derived from similar measures including the CBCL, the Revised Children's Manifest Anxiety Scale (RCMAS) and the Child Depression Inventory, indicating good concurrent validity. Also, among populations in which trauma symptomatology is expected to be substantial, for example, children with histories of abuse, scores have been high. Among children receiving treatment for traumatic experiences, scores on the TSCC tend to decrease over time (Lanktree & Briere, 1990, 1995). LONGSCAN Use Data Points Age 8 Respondent Child Mnemonic and Version TSA

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Rationale LONGSCAN chose to use the TSCC-A at the Age 8 interview because it is a standardized and valid child self-report measure of internalized distress, and includes symptoms associated with post-traumatic stress disorder. Results Descriptive Statistics Table 1 displays the percentage of children with elevated scores on the two TSCC validity scales. In the normative sample fewer than 2.5% of the total sample had significantly elevated scores on one of theses scales (2% had UND > 70; 1% had HYP > 90). Relative to the TSCC standardization sample a large percentage of LONGSCAN children had elevated scores on one of the TSCC validity scales. Children were more likely to under-report symptoms than over-report. While boys were more likely to underreport symptoms than girls, there was no sex difference in the incidence of over-reporting. Black children and children from the EA site were the most likely to have elevated UND scores. Black children were also more likely than children of other races to have elevated HYP scores. Table 1 about here Although the large number of children scoring above the threshold on the validity scales is a concern, the author recommended (J. Briere, personal communication) that the data for these children remain in the database and be included in all analyses. Tables 2 and 3 show the means and standard deviations of the T scores for each of the clinical scales by race, sex, and study site. Both boys and girls have higher than average scores on all clinical scales except Anger. Multiracial boys demonstrate higher symptoms than other boys across all clinical scales. Similarly, boys at the SW and NW sites report the highest symptoms across clinical scales. The pattern is somewhat different for girls (Table 3). Like boys, the girls at the SW and NW sites have higher scores relative to other girls. However, it is White and Multiracial girls whose TSCC scores are highest. Table 2 about here

Table 3 about here

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For both boys and girls the T score standard deviations are greater than average, indicating wide variability in scores. Given the higher than average scores for boys and girls overall and the large standard deviations seen, it is likely that a number of children are scoring at or above the clinical cutpoint on one or more of the clinical scales. Table 4 shows the percentage of LONGSCAN children scoring in the clinical range on each of the clinical scales by race and study site. Overall, between 8% and 24% of the LONGSCAN children had elevated clinical scale scores indicating that these children have scores that equal or exceed 94% of the standardization sample. A greater percentage of our sample scored in the clinical range on Anxiety than on the other clinical scales. Table 4 about here Hispanic children tended to have the greatest percentage of scores in the clinical range across all scales except Anger. Black children and children of Other races were least likely to have clinically significant scores on Anxiety, PTS. The NW site had the greatest percentage of children in the clinical range across all scales, and the EA site had the lowest percentage. Table 5 shows the percentage of children endorsing specific critical items by race and study site. Of these three critical items the greatest percentage of children endorsed the item indicating they would like to harm, but not kill, themselves. This was also true when the data were analyzed by race and study site. Children were least likely overall, by race, and by study site to endorse the item indicating that they would like to kill themselves. Table 5 about here

Reliability As can be seen in Table 6, internal consistency for the TSCC scales using the LONGSCAN sample was generally good and comparable to alpha reliabilities reported by the author (Briere, 1996). Overall reliability for each of the scales ranged from .76 (Depression) to .85 (Anger). Alpha reliabilities for children of Other races was generally low ( = .20 [Depression] to .63 [Anger]). This may be due to the small sample size of this group. Comparison by study site reveals moderate to good internal consistency. Table 6 about here
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Publisher Information Psychological Assessment Resources, Inc. P.O. Box 998 Odessa, FL 33556 (800) 331-TEST website: http://www.parinc.com/product.cfm?ProductID=150

References and Bibliography Briere, J. (1996). Trauma Symptom Checklist for Children: Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc. Evans, J. J., Briere, J., Boggiano, A. K., & Barrett, M. (1994, January). Reliability and validity of the Trauma Symptom Checklist for Children in a normal sample. Paper presented at the San Diego Conference on Responding to Child Maltreatment, San Diego, CA. Lanktree, C. B., & Briere, J. (1990, August). Early data on the Trauma Symptom Checklist for Children (TSC-C). Paper presented at the annual meeting of the American Psychological Association, Boston, MA. Lanktree, C. B., & Briere, J. (1995). Outcome of therapy for sexually abused children: A repeated measures study. Child Abuse and Neglect, 19, 1145-1155.

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Table 1. Normative Raw Scores by childs sex on the TSCC Scales for 8-12 Year Olds
Anxiety (SD) M 6.1 (3.8) 7.4 (4.1) Depression (SD) M 7.0 (4.0) 7.8 (4.2) Anger (SD) M 8.8 (5.1) 8.3 (5.3) Post-traumatic Stress (SD) M 8.6 (5.3) 9.5 (5.5) Dissociation (SD) M 7.2 (4.9) 7.4 (5.1)

N Males 249 Females 256 Source. Briere, J. (1996)

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Table 1. Percent with elevated scores on the TSCC validity scales by Sex, Race, and Study Site. Age 8 Interview
N 1031 Under-response % 27.3 Hyper-response % 17.4

Total Sex Male 488 14.0 8.7 Female 543 13.3 8.6 Race White 270 5.0 5.0 Black 566 17.9 8.7 Hispanic 60 1.5 0.9 Multiracial 123 2.6 2.7 Other 12 0.3 0.1 Site EA 233 8.1 2.5 MW 142 3.9 2.5 SO 183 4.9 2.6 SW 259 5.8 5.0 NW 214 4.7 4.8 Source. Based on data received at the LONGSCAN Coordinating Center through 6/21/02.

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Table 2. Mean T-Scores for Boys on TSCC Scales by Race and Study Site. Age 8 Interview
N 488 128 263 30 62 5 116 59 81 124 108 Anxiety M (SD) 54.94 (16.42) 55.30 53.98 56.87 57.94 47.60 50.91 56.07 52.35 57.66 57.48 (15.76) (16.51) (13.91) (18.74) (5.86) (14.72) (14.58) (13.84) (17.75) (18.31) Depression M (SD) 51.73 (13.82) 52.52 (12.84) 50.54 (14.39) 51.90 (11.40) 55.21 (14.27) 49.80 (10.57) 47.67 (11.94) 53.63 (14.42) 49.30 (11.94) 54.82 (14.23) 53.33 (14.23) Post-traumatic Stress (SD) M 53.99 (13.41) 54.13 53.07 54.87 57.19 54.00 (13.58) (13.10) (14.20) (14.04) (9.57) Dissociation M (SD) 54.02 (13.22) 53.17 53.94 54.23 56.10 53.40 51.92 53.44 50.78 57.39 55.18 (11.89) (13.73) (13.56) (13.92) (8.47) (12.02) (12.08) (11.65) (14.41) (13.93) Anger M (SD) 46.55 (12.18) 47.60 45.82 44.03 49.32 39.00 44.95 48.34 45.09 46.60 48.35 (11.67) (12.20) (9.19) (14.08) (6.00) (10.35) (13.34) (11.42) (12.20) (13.63)

Total Race White Black Hispanic Multiracial Other Site EA MW SO SW NW

50.52 (11.70) 54.19 (12.16) 51.60 (12.43) 56.43 (13.94) 56.61 (14.86)

Source. Based on data received at the LONGSCAN Coordinating Center through 6/21/02.

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Table 3. Mean T-Scores for Girls on TSCC Scales by Race and Study Site. Age 8 Interview
N 543 142 303 30 61 7 117 83 102 135 106 Anxiety M (SD) 53.47 (14.09) 55.73 51.74 54.73 56.38 51.43 49.15 52.29 52.14 56.06 57.13 (15.05) (13.59) (15.16) (13.14) (10.95) (12.54) (12.72) (13.49) (14.50) (15.36) Depression M (SD) 50.26 (11.96) 51.72 48.95 49.93 53.39 51.14 46.59 49.05 48.37 52.85 53.76 (12.43) (11.46) (13.10) (12.59) (5.18) (9.66) (10.77) (11.07) (12.70) (13.44) Post-traumatic Stress (SD) M 51.97 (11.83) 54.62 50.15 52.13 54.61 53.14 48.64 50.63 50.26 54.60 54.98 (12.82) (11.04) (12.98) (11.74) (7.93) (9.65) (10.46) (12.04) (12.50) (12.70) Dissociation M (SD) 51.35 (11.10) 52.51 50.60 49.53 53.43 49.86 49.99 48.98 49.69 53.41 53.68 (11.32) (10.47) (12.76) (12.67) (9.23) (9.69) (9.15) (11.02) (12.18) (11.86) Anger M (SD) 45.55 (10.37) 46.57 44.85 42.98 47.98 45.29 43.62 45.20 45.01 46.41 47.36 (10.94) (9.92) (11.76) (11.76) (5.12) (8.36) (9.79) (10.89) (10.69) (11.57)

Total Race White Black Hispanic Multiracial Other Site EA MW SO SW NW

Source. Based on data received at the LONGSCAN Coordinating Center through 6/21/02.

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Table 4. Percent scoring in the clinical range on TSCC Clinical Scales by Sex, Race and Study Site. Age 8 Interview
N 1031 488 543 270 566 60 123 12 233 142 183 259 214 Anxiety % 23.7 25.2 22.3 25.6 21.4 30.0 28.5 8.3 15.5 21.8 21.9 27.8 30.4 Depression % 13.0 15.2 11.1 12.6 11.3 13.3 22.0 8.3 5.6 11.3 9.3 18.5 19.7 Post-traumatic Stress % 16.8 20.9 13.1 20.0 13.3 21.7 25.2 -7.7 14.8 12.1 22.0 24.8 Dissociation % 14.3 19.1 9.9 13.0 13.1 15.0 22.8 8.3 9.4 7.0 12.6 19.3 19.6 Anger % 8.2 10.9 5.9 8.9 7.1 3.3 15.5 -3.4 7.8 7.7 9.7 12.6

Total Sex Male Female Race White Black Hispanic Multiracial Other Site EA MW SO SW NW

Source. Based on data received at the LONGSCAN Coordinating Center through 6/21/02.

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Table 5. Percent with positive scores on critical items on the TSCC by Race and Study Site. Age 8 Interview
N 1030 487 543 270 565 60 123 12 232 142 183 259 214 Wanting to hurt self % 21.0 22.8 19.3 23.3 16.8 28.3 30.9 25.0 16.0 16.2 9.8 26.6 32.2 Wanting to hurt other people % 15.6 19.7 12.0 15.9 14.9 15.0 19.5 8.3 15.0 15.6 8.7 17.8 19.6 Wanting to kill self % 9.8 10.5 9.2 14.1 7.1 8.3 14.8 -5.6 6.3 6.0 12.4 16.8

Total Sex Male Female Race White Black Hispanic Multiracial Other Site EA MW SO SW NW

Source. Based on data received at the LONGSCAN Coordinating Center through 6/21/02.

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Table 6. Cronbachs Alpha Statistics for the TSCC Scales by Race and Study Site. Age 8 Interview
Post-traumatic Stress .82 .84 .80 .85 .81 .41 .76 .75 .82 .83 .84

Total Race White Black Hispanic Multiracial Other Site EA MW SO SW NW

Anxiety .80 .82 .79 .79 .80 .50 .79 .74 .76 .81 .83

Depression .76 .77 .77 .77 .74 .20 .68 .74 .74 .78 .79

Dissociation .76 .73 .76 .83 .78 .51 .71 .70 .76 .79 .78

Anger .85 .86 .84 .82 .87 .63 .79 .85 .86 .85 .88

Source. Based on data received at the LONGSCAN Coordinating Center through 6/21/02.

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Trauma Symptom Checklist for Children TSA

"Now, I'm going to ask you about some things that may happen to you. Some of these things may NEVER happen to you and some may happen OFTEN. After each of the things I read, you tell me how often each thing happens to YOU by picking one of these answers. (Hand card and read each answer.) 0 = Never 1 = Sometimes 2 = Lots of times 3 = Almost all of the time R = REFUSED 1. 2. 3. 4. 5. 6. 7. 8. 9. Bad dreams or nightmares. Feeling afraid something bad might happen. Scary ideas or pictures just pop in your head. Pretending you are someone else. Arguing too much. Feeling lonely. Feeling sad or unhappy. Remembering things that happened that you didn't like. Going away in your mind, trying not to think. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 R R R R R R R R R R R R R R R R R R R R

10. Remembering scary things. 11. Wanting to yell and break things. 12. Crying. 13. Getting scared all of a sudden, and don't know why. 14. Getting mad and can't calm down. 15. Feeling dizzy. 16. Wanting to yell at people. 17. Wanting to hurt yourself. 18. Wanting to hurt other people. 19. Feeling scared of men. 20. Feeling scared of women. Rev. 6/08

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0 = Never 1 = Sometimes 2 = Lots of times 3 = Almost all of the time R = REFUSED 21. Washing yourself because you feel dirty inside. 22. Feeling stupid or bad. 23. Feeling like you did something wrong. 24. Feeling like things aren't real. 25. Forgetting things or can't remember things. 26. Feeling like you're not in your body. 27. Feeling nervous or jumpy inside. 28. Feeling afraid. 29. Can't stop thinking about something bad that happened to you. 30. Getting into fights. 31. Feeling mean. 32. Pretending you're somewhere else. 33. Being afraid of the dark. 34. Worrying about things. 35. Feeling like nobody likes you. 36. Remembering things you don't want to remember. 37. Your mind going empty or blank. 38. Feeling like you hate people. 39. Trying not to have any feelings. 40. Feeling mad. 41. Feeling afraid that somebody will kill you. 42. Wishing bad things had never happened. 43. Wanting to kill yourself. 44. Daydreaming. 0 0 0 0 0 0 0 1 1 1 1 1 1 1 2 2 2 2 2 2 2 3 3 3 3 3 3 3 R R R R R R R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 R R R R R R R R

0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3

R R R R R R R R R

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