International Trauma Questionnaire – Child and Adolescent Version (ITQ-CA)

 It was developed to be consistent with the organising principles of the ICD-11 and is the child/adolescent version of the International Trauma Questionnaire (for adults; ITQ). The ITQ-CA is designed for diagnosis and can discriminate PTSD from CPTSD by employing validated diagnostic rules. The scale has two major subscales with three symptom clusters in each:

— PTSD —

• Re-experiencing
• Avoidance
• Sense of threat

— Disturbances in self-organisation (DSO) —

• Affective dysreglation
• Negative self-concept
• Disturbances in relationships

Disturbances in self-organisation is important in the assessment and diagnosis of CPTSD. The ITQ-CA is useful in the assessment of children and adolescents who have experienced trauma and asks them to answer the questions in relation to a specific traumatic event.

There are two components of scoring and interpretation:

1. Categorical Scoring for the diagnosis of PTSD and CPTSD, and
2. Dimensional Scoring which measures symptom severity.

Categorical Scoring:

For PTSD and CPTSD items, endorsement of a symptom or functional impairment item is defined as a score of 2 or more on at least one item in specific question pairs / groupings (unless otherwise specified below).

PTSD Diagnosis

The diagnosis of PTSD is indicated based on the following criteria:

• Question 1 or 2 = a score of 2 or more on at least one item (re-experiencing) AND
• Question 3 or 4 = a score of 2 or more on at least one item (avoidance) AND
• Question 5 or 6 = a score of 2 or more on at least one item (sense of current threat) AND
• Question 7, 8, 9, 10, or 11 = a score of 1 or more on at least one item (PTSD functional impairment).

PTSD is indicated if the criteria for PTSD are met and CPTSD is NOT met.

CPTSD Diagnosis

The diagnosis of Complex PTSD (CPTSD) is indicated based on the following criteria:

• Question 12 or 13 = a score of 2 or more on at least one item (affective dysregulation) AND
• Question 14 or 15 = a score of 2 or more on at least one item (negative self-concept) AND
• Question 16 or 17 = a score of 2 or more on at least one item (disturbances in relationships) AND
• Question 18, 19, 20, 21, or 22 = a score of 1 or more on at least one item (Disturbances in self-organisation impairment).

CPTSD is diagnosed if the criteria for PTSD are met AND criteria for CPTSD are met.

Dimensional Scoring:

Dimensional scores from 0 to 24 are presented for the two major subscales:

1. Post Traumatic Stress Disorder (PTSD) (sum of items 1 to 6)
2. Disturbances in self-organisation (DSO) (sum of items 12 to 17). In addition, the four factors under each major subscale are presented (raw score from 0 to 8).

Note that the functional impairment factors do not count towards the totals of the major subscales. Each score is presented as a raw score and a scaled score. The scaled scores are between 0 and 10 and are calculated by dividing the raw score by the maximum possible score, times 10. The scaled scores are useful for comparison between symptom clusters as they are all scored out of 10. The dimensional scores can be useful in tracking symptoms at the start, middle and end of treatment to ascertain the level of treatment response.

The ITQ-CA was validated on 136 children in foster care and was found to conform to the same factor structure as the ITQ (Haselgruber et al., 2020a). Examining concurrent validity, moderate to strong bivariate correlations were found between all ITQ-CA scales and PTSD symptom clusters as assessed by the CATS (Haselgruber et al., 2020b). Larger than any other correlation among variables, the strongest correlations were found between ITQ-CA factors and respective CATS subscales: re-experiencing and intrusions (r = 0.73), avoidance from both measures (r = 0.74), threat and hyperarousal (r = 0.84), affective dysregulation and negative alterations (r = 0.84), negative self-concept and negative alterations (r = 0.78), and disturbances in relationships and negative alterations (r = 0.71). For convergent validity, PTSD and DSO correlated moderately to strongly with depression, anxiety and dissociation, whereas PTSD correlated most strongly with dissociation (r = 0.59) and DSO with anxiety (r = 0.63). Lifetime traumatisation correlated moderately with PTSD (r = 0.43) and DSO (r = 0.47).