UCLA Posttraumatic Stress Disorder Reaction Index
This instrument assesses reactions to trauma in children and adolescents. It can be used as a self-report (completed on paper, suitable for one to one or group administration), or given verbally where questions are read to the child. The test has excellent psychometric properties, and has been used across a variety of trauma types, age ranges, settings, and cultures.
Alan M. Steinberg, PhD, Melissa J. Brymer, PsyD, Kelly B. Decker, MA, and Robert S. Pynoos, MD, MPH
Melissa Brymer, National Center for Child Traumatic Stress, 11150 West Olympic Boulevard, Suite 650, Los Angeles, CA 90064
©1998, ©2001, Pynoos, Rodriguez, Steinberg, Stuber, & Frederick
The University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index (UCLA-RI) is one of the most widely used instruments for the assessment of traumatized children and adolescents. It has been used around the world after major disasters and catastrophic violence as an integral component of public mental health response and recovery programs.
There are three versions: Child, Adolescent and Parent's Report. Questions match the DSM-IV criterion. Although the instrument was not designed to make a formal diagnosis, it can provide preliminary diagnostic information. In Part I, a brief review of the traumatic experience sets the stage for the subsequent questions, helps the child recall details of the traumatic event (Criterion A1). Part II includes questions related to A1 and A2 criteria which are scored "yes" or "no". Part III asks about the frequency of PTSD symptoms during the past month (rated from 0=none of the time to 4=most of the time). These items map directly onto the DSM-IV PTSD criterion B (intrusion), criterion C (avoidance / numbing), and criterion D (arousal). Twenty of these items assess PTSD symptoms; two additional items assess associated features--fear of recurrence and trauma-related guilt.
The test takes around 20-30 minutes to complete depending on age, reading ability and method of administration. It is suitable for administration by a graduate level student under supervision.
Scoring takes around 5-10 minutes. The score sheet provides instructions for calculating a total PTSD severity score, and severity scores for each of the DSM-IV B, C, and D symptom clusters. When criterion A is met, children who meet criteria B, C, and D (using endorsements of "much of the time" and "most of the time" as indicating symptom presence) are scored as having a likely diagnosis of DSM-IV "full" PTSD. Where criterion A is met, children meeting criteria for only two symptom subcategories are scored as "partial" PTSD likely. A cut-off of 38 or greater for a single incident traumatic event has the greatest sensitivity and specificity for detecting PTSD (Rodriguez , Steinberg, Saltzman & Pynoos 2001a, 2001b)
All versions show a "dose" relationship for exposure, with higher Reaction Index scores among traumatized samples compared with control subjects.
DSM-IV version correlates 0.70 with the PTSD Module of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (Epidemiologic version) and 0.82 in comparison with the Child and Adolescent Version of the Clinician-administered PTSD Scale. A cut-off of 38 has a sensitivity of 0.93 and specificity of 0.87 in detecting PTSD (Rodriguez et al. 2001a, 2001b)
Internal consistency across versions: several reports have found Chronbach's alpha to fall in the range of 0.90 (e.g. Roussos et al., 2005)
Test re-test reliability
Over the different versions, test-retest reliability has ranged from good to excellent; Roussos et al. (2005) report a test-retest reliability coefficient of 0.84 for the DSM-IV version.
Goenjian A.K., Najarian L.M., Steinberg A.M., Fairbanks L.A., Tashjian M., Pynoos R.S. (2000) A prospective study of post-traumatic stress, anxiety and depressive reactions after earthquake and violence. American Journal of Psychiatry 157:911-916.
Rodriguez, N., Steinberg, A.S., Saltzman, W.S. & Pynoos, R.S. (2001a) PTSD Index: psychometric analyses of the adolescent version. Symposium conducted at the Annual Meeting of the International Society for Traumatic Stress Studies, New Orleans: LA.
Rodriguez, N., Steinberg, A.S., Saltzman, W.S. & Pynoos, R.S. (2001b) PTSD Index: preliminary psychometric analyses of child and parent versions. Symposium conducted at theAnnual Meeting of the International Society for Traumatic Stress Studies, New Orleans , LA.
Goenjian A.K., Molina L., Steinberg A.M., Fairbanks L.A., Alvarez M.L., Pynoos R.S. (2001) Posttraumatic stress and depressive reactions among adolescents in Nicaragua after Hurricane Mitch. American Journal of Psychiatry 158:788-794.
Roussos, A., Goenjian, A. K., Steinberg, A. M., Sotiropoulou, C., Kakaki, M., Kabakos, C., Karagianni, S., & Manouras, V. (2005). Posttraumatic stress and depressive reactions among children and adolescents after the 1999 earthquake in Ano Liosia, Greece. American Journal of Psychiatry, 162, 530-537.
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.
Also available in Spanish and in short form by contacting the authors.