The Child Behavior Checklist as a Screening Instrument for PTSD in Refugee Children

Abstract

Thousands of refugees who have entered Europe experienced threatening conditions, potentially leading to post traumatic stress disorder (PTSD), which has to be detected and treated early to avoid chronic manifestation, especially in children. We aimed to evaluate and test suitable screening tools to detect PTSD in children. Syrian refugee children aged 4–14 years were examined using the PTSD-semi-structured interview, the Kinder-DIPS, and the Child Behavior Checklist (CBCL). The latter was evaluated as a potential screening tool for PTSD using (i) the CBCL-PTSD subscale and (ii) an alternative subscale consisting of a psychometrically guided selection of items with an appropriate correlation to PTSD and a sufficient prevalence (presence in more than 20% of the cases with PTSD). For both tools we calculated sensitivity, specificity, and a receiver operating characteristic (ROC) curve. Depending on the sum score of the items, the 20-item CBCL-PTSD subscale as used in previous studies yielded a maximal sensitivity of 85% and specificity of 76%. The psychometrically guided item selection resulted in a sensitivity of 85% and a specificity of 83%. The areas under the ROC curves were the same for both tools (0.9). Both subscales may be suitable as screening instrument for PTSD in refugee children, as they reveal a high sensitivity and specificity.

Mental Health Screening Approaches for Resettling Refugees and Asylum Seekers: A Scoping Review

“…Eleven studies were identified that investigated mental health screening approaches specific to refugee children and adolescents [ 52 , 57 , 58 , 59 , 61 , 62 , 67 , 82 , 89 , 97 , 100 ]. Children and adolescents between the ages of 6 months to 18 years old were included and all identified screening programs were completed post-arrival to the resettlement country.…”

“…Children and adolescents between the ages of 6 months to 18 years old were included and all identified screening programs were completed post-arrival to the resettlement country. All studies included adolescent populations (ages 10–18) and fewer studies included children below the age of 10 [ 58 , 59 , 82 , 89 , 100 ]. The programs reported that there is variability in the timing of presentations of mental health disorders; thus, an early assessment of the psychological needs of children and families allows for timely targeted support [ 58 , 59 ].…”

“…Children and adolescent screening programs focused on a wider range of conditions which consider critical developmental stages. The psychological factors screened for included: emotional problems, conduct problems, hyperactivity, peer problems and prosocial behavior, stressful life events, PTSD [ 82 , 100 ], anxiety, depression [ 58 , 59 , 67 , 97 ], and somatization disorder [ 58 ]. Health risk behaviours, health-related quality of life, and physical and psychosocial well-being, including physical functioning, body pain, emotional problems, self-esteem, and family cohesion were also screened for [ 57 , 62 ].…”

“…Various “child-centered” approaches were described. Two studies, consistent with trauma-informed care guidelines, offered children the possibility to be accompanied by a person they trusted as support [ 82 , 100 ]. In contrast, another study recommended seeing adolescents alone during consultations [ 62 ].…”

“…A total of 25 studies evaluated the validity of mental health screening tools among a cumulative sample of N = 4341 refugees and asylum seekers [ 42 , 44 , 46 , 48 , 50 , 52 , 55 , 64 , 65 , 66 , 67 , 70 , 72 , 80 , 82 , 86 , 87 , 89 , 95 , 99 , 100 , 101 , 105 , 106 ]. All of the included studies followed a cross-sectional study design.…”