Comparing the Diagnostic Accuracy of Five Instruments for Detecting Posttraumatic Stress Disorder in Youth

Abstract

OBJECTIVE To compare diagnostic accuracy of five posttraumatic stress disorder (PTSD) measures in a large outpatient sample of youths aged 11 to 18 years. METHOD Index tests included a parent report (a rationally-derived scale from the Child Behavioral Checklist), a teacher report (the Teacher Report Form), and three youth reports-a PTSD scale from the Youth Self Report (YSR), Child PTSD Symptom Scale, and Child and Adolescent Trauma Survey. Interviews with the youth and caregiver using Schedule for Affective Disorders and Schizophrenia for School-age Children generated criterion diagnoses of PTSD. Diagnoses were blind to scores on the index tests. RESULTS Based on consensus diagnoses (N=458), 10% of youth had PTSD. Area under the curve (AUC) from receiver operating characteristic analyses and multilevel likelihood ratios evaluated test performance. All youth reports (AUCs .67-.73) outperformed the teacher report (AUCs .42-.48) at identifying PTSD. The YSR outperformed the caregiver reports (AUCs .57-.58). Combining tests did not improve prediction of PTSD. The YSR predicted PTSD even after controlling for a self-reported traumatic event, but checklist ratings of traumatic events had no incremental value after controlling for YSR scores. When a youth endorsed few symptoms, the likelihood of the youth having PTSD was low. Very high scores on the YSR were associated with a moderate increase in the likelihood of PTSD diagnosis. CONCLUSION The YSR appeared to be a useful diagnostic aid for youth PTSD, and could facilitate differential diagnosis of youth PTSD in outpatient settings.

Differential Estimation of Treatment Effect Between Clinician‐Administered and Self‐Reported PTSD Assessments

“…Whereas some researchers have reported strong convergence between C‐A and S‐R measures for this population (Gillihan, Aderka, Conklin, Capaldi, & Foa, 2013), others have questioned the utility of singular data sources when estimating the presence, severity, and level of functioning associated with pediatric expressions of PTSD (Cohen et al, 2017). This contention appears justified when considering conflicting evidence among samples of children and adolescents related to diagnostic accuracy (You, Youngstrom, Feeny, Youngstrom, & Findling, 2017), rates of agreement between S‐R and case record accounts of maltreatment (Negriff, Schneiderman, & Trickett, 2017), and the factor structure used to depict PTSD scores (McKinnon et al, 2016).…”

Clinical Decision-Making Following Disasters: Efficient Identification of PTSD Risk in Adolescents

“…Through the use of ROC procedures, improved assessment protocols have been developed for a wide range of pediatric mental health disorders including bipolar disorder (Youngstrom, Freeman, & Jenkins, 2009), mood disorders (Youngstrom, 2014), and anxiety disorders (Elkins, Carpenter, Pincus, & Comer, 2014; Van Meter et al, 2014). Most relevant to the present study, ROC approaches have also been applied to improving assessment protocols for PTSD in community (Suliman, Kaminer, Seedat, & Stein, 2005) and outpatient settings (You, Youngstrom, Feeny, Youngstrom, & Findling, in press), paving the way for more targeted referrals and interventions for individual who suffer from these symptoms. The present study seeks to build off these past studies by a) assessing PTSD specifically within a post-disaster context and b) including a wide-range of individual, interpersonal, and event-related vulnerabilities as part of the protocol.…”

Substance use disorder and posttraumatic stress disorder symptomology on behavioral outcomes among juvenile justice youth

“…Items are rated from 0 ( not true ) to 2 ( very true or often true ) and scale scores are converted into T-scores with scores of 65 or greater indicating elevations in symptoms severity. The scale has been shown to have high internal consistency among youth ( α =.75–85) 39,43 .…”