PTSD: National Center for PTSD

Clinician-Administered PTSD Scale for DSM-5 - Child/Adolescent Version (CAPS-CA-5)

Description

The CAPS-CA-5 is a 30-item clinician-administered PTSD scale based upon DSM-5 criteria for children and adolescents ages 7 and above. It is a modified version of the CAPS-5 that includes age appropriate items and picture response options. Recommended trauma history measures are noted to assist with identifying an index traumatic event.

Similar to the CAPS-5, the CAPS-CA-5 assesses the 20 DSM-5 PTSD symptoms. For each symptom, standardized questions and probes are provided. In addition, questions target the onset and duration of symptoms, subjective distress, impact of symptoms on social functioning, impairment in development, overall response validity, overall PTSD severity, improvement in symptoms since a previous CAPS administration, and specifications for the dissociative subtype (depersonalization and derealization).

The CAPS-CA-5 was designed to be administered by clinicians and clinical researchers who have a working knowledge of PTSD but can also be administered by appropriately trained paraprofessionals.

Changes from Previous CAPS-CA for DSM-IV

Several important revisions were made to the CAPS-CA in updating it for DSM-5:

• CAPS-CA for DSM-IV asked respondents to endorse up to three traumatic events to keep in mind during the interview. CAPS-CA-5 requires the identification of a single index trauma to serve as the basis of symptom inquiry.
• CAPS-CA-5 is a 30-item questionnaire, corresponding to the DSM-5 diagnosis for PTSD. The language of the CAPS-CA-5 reflects both changes to existing symptoms and the addition of new symptoms in DSM-5. CAPS-CA-5 asks questions relevant to assessing the dissociative subtype of PTSD (depersonalization and derealization), but no longer includes other associated symptoms (e.g., gaps in awareness).
• As with previous versions of the CAPS-CA, CAPS-CA-5 symptom severity ratings are based on symptom frequency and intensity (except for amnesia and diminished interest which are based on amount and intensity). However, CAPS-CA-5 items are rated with a single severity score in contrast to previous versions of the CAPS-CA which required separate frequency and intensity scores.
• General instructions and scoring information are included with the CAPS-CA-5.

Scoring

Detailed scoring information is included with the CAPS-CA-5 and should be reviewed carefully before administering. Briefly, the assessor combines information about frequency and intensity of an item into a single severity rating. CAPS-CA-5 total symptom severity score is calculated by summing severity scores for the 20 DSM-5 PTSD symptoms. Similarly, CAPS-CA-5 symptom cluster severity scores are calculated by summing the individual item severity scores for symptoms corresponding to a given DSM-5 cluster: Criterion B (items 1-5); Criterion C (items 6-7); Criterion D (items 8-14); and, Criterion E (items 15-20). A symptom cluster score may also be calculated for dissociation by summing items 29 and 30. PTSD diagnostic status is determined by first dichotomizing each symptom as "present" or "absent," then following the DSM-5 diagnostic rule. A symptom is considered present only if the corresponding item severity score is rated 2 ("moderate/threshold") or higher. The DSM-5 PTSD diagnostic rule requires:

• At least 1 Criterion B symptom
• At least 1 Criterion C symptom
• At least 2 Criterion D symptoms
• At least 2 Criterion E symptoms
• Criterion F is met (disturbance has lasted 1 month)
• Criterion G is met (disturbance causes either clinically significant distress or functional impairment)

Sample Item

In the past month, have you had upsetting thoughts, pictures or sounds of what happened come into your mind when you didn't want them to? Did this happen while you were awake, so not counting dreams?

How did these upsetting thoughts, pictures or sounds of what happened come into your mind?
[If not clear]: Do these unwanted thoughts, pictures or sounds just pop into your head, or do you think about what happened on purpose?

How much do these thoughts, pictures or sounds bother you?

Are you able to put these thoughts, pictures or sounds your mind and think about something else?

How often have you had these thoughts, picture or sounds come into your mind in the past month?

Severity Rating

0. Absent: The respondent denied the problem or the respondent's report doesn't fit the DSM-5 symptom criterion.

1. Mild / subthreshold: The respondent described a problem that is consistent with the symptom criterion but isn't severe enough to be considered clinically significant. The problem doesn't satisfy the DSM-5 symptom criterion and thus doesn't count toward a PTSD diagnosis.

2. Moderate / threshold:The respondent described a clinically significant problem. The problem satisfies the DSM-5 symptom criterion and thus counts toward a PTSD diagnosis. The problem would be a target for intervention. This rating requires a minimum frequency of 2 x month or some of the time (20-30%) PLUS a minimum intensity of Clearly Present.

3. Severe / markedly elevated:The respondent described a problem that is above threshold. The problem is difficult to manage and at times overwhelming, and would be a prominent target for intervention. This rating requires a minimum frequency of 2 x week or much of the time (50-60%) PLUS a minimum intensity of Pronounced.

4. Extreme / incapacitating: The respondent described a dramatic symptom, far above threshold. The problem is pervasive, unmanageable, and overwhelming, and would be a high-priority target for intervention.

Versions

The CAPS-CA-5 is based upon the Clinician-Administered PTSD Scale for DSM-5 developed for use with adults.

Citation

Pynoos, R. S., Weathers, F. W., Steinberg, A. M., Marx, B. P., Layne, C. M., Kaloupek, D. G., Schnurr, P. P., Keane, T. M., Blake, D. D., Newman, E., Nader, K. O., & Kriegler, J. A. (2015). Clinician-Administered PTSD Scale for DSM-5 - Child/Adolescent Version. [Assessment] Available from the National Center for PTSD at www.ptsd.va.gov.

References (CAPS-CA for DSM-IV)

Nader, K., Kriegler, J.A., Blake, D.D., Pynoos, R.S., Newman, E., & Weathers, F.W. (1996). Clinician-Administered PTSD Scale, Child and Adolescent Version. [Assessment] Department of Veterans Affairs National Center for PTSD

Additional Reviews (CAPS-CA for DSM-IV)

Ohan, J. L., Myers, K., & Collett, B. R. (2002). Ten-year review of rating scales. IV: Scales assessing trauma and its effects. Journal of the American Academy of Child & Adolescent Psychiatry, 41: 1401-1422 https://doi.org/10.1097/00004583-200212000-00012

Nader, K. O. (2004). Assessing traumatic experiences in children and adolescents: Self-reports of DSM PTSD Criteria B-D symptoms. In J. Wilson & T. Keane (Eds.), Assessing psychological trauma and PTSD, 2nd ed. (pp. 513-537). Guilford Press.

CAPS Training

To learn about giving a CAPS-5 assessment, which supports administration of a CAPS-CA-5, see our Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) Training Curriculum.

To Obtain Scale

This measure was created in collaboration with staff at VA's National Center for PTSD. To obtain this scale complete the online request form. If you have questions, please email asteinberg@reactionindex.com

VA Providers and Staff can find information on how to download this instrument on the National Center for PTSD Intranet website in the Assessment section.

Back to top

Measure availability: We provide information on a variety of measures assessing trauma and PTSD. These measures are intended for use by qualified mental health professionals and researchers. Measures authored by National Center staff are available as direct downloads or by request. Measures developed outside of the National Center can be requested via contact information available on the information page for the specific measure.