The Trichotillomania Scale for Children: Development and Validation

Abstract

Trichotillomania (TTM) is a chronic impulse control disorder characterized by repetitive hair-pulling resulting in alopecia. Although this condition is frequently observed in children and adolescents, research on pediatric TTM has been hampered by the absence of validated measures. The aim of the present study was to develop and test a new self-report measure of pediatric TTM, the Trichotillomania Scale for Children (TSC), a measure that can be completed by children and/or their parents. One hundred thirteen children meeting self-report criteria for TTM, and 132 parents, provided data over the internet. An additional 41 child-parent dyads from an outpatient clinic also provided data. Replicated principal components analysis, with elimination of poorly-loading items, yielded two components, which we labeled Severity (five items) and Distress/Impairment (seven items). The TSC total score and subscales showed adequate internal consistency and test-retest reliability. Parent-child agreement was good in the internet sample, but more modest in the clinic sample. Children's TSC scores correlated significantly with other measures of TTM severity, although some exceptions were noted. Parents' TSC scores correlated significantly with other measures of parent-rated TTM severity in the internet sample, but showed more attenuated relationships with child- and interviewer-rated TTM severity in the clinic sample. The present results suggest that the TSC may be a useful measure of TTM for child and adolescent samples, although additional clarification of convergent validity is needed.

Depression, anxiety, and functional impairment in children with trichotillomania

“…[16] Participants in this subgroup satisfied the following criteria: (1) both parent and child reported child hair pulling, resulting in noticeable hair loss; (2) child reported he/she ''never/almost never'' (0-10% of the time) pulled hair because voices (like an imaginary friend) told them to do so and ''never/almost never'' (0-10% of the time) pulled because they believed small bugs were crawling on them; (3) the parent reported that they did not always pull as the result of physical causes (e.g., skin conditions, physical illness, or injury) or the use of medications, drugs, or alcohol; and (4) either the parent or the child reported that the hair pulling resulted in at least ''mild to moderate'' impairment (a score of 3 or greater on a 9-point Likert-type scale) in routine social, role, or academic functioning. The DSM-IV-TR requirement of some minimal level of tension before pulling (Criterion B) that is relieved contingent on a pulling episode (Criterion C) was not required for diagnosis in the present sample or other research from our group, [12] given research suggesting that children and adolescents are less likely to endorse antecedents and consequences of pulling as compared to adults with TTM. [7,9] Child demographics.…”

“…The Trichotillomania Scale for Children [12] is a 12-item self-report instrument used to assess severity and distress of hair pulling. For this study, we used the 5-item severity scale (child-reported) derived by Tolin et al [12] This scale has good internal consistency (a 5 .76) and test-retest reliability (r 5 .81); construct validity with the Clinician's Global Impression-Severity and NIMH Trichotillomania Severity Scale has also been documented.…”

“…For this study, we used the 5-item severity scale (child-reported) derived by Tolin et al [12] This scale has good internal consistency (a 5 .76) and test-retest reliability (r 5 .81); construct validity with the Clinician's Global Impression-Severity and NIMH Trichotillomania Severity Scale has also been documented. [12] Again, this study is restricted to child-reported symptoms, given demonstrations of reliable endorsement of symptoms in recent studies of youth with TTM. [12,13] Child depressive symptoms.…”

“…[12] Again, this study is restricted to child-reported symptoms, given demonstrations of reliable endorsement of symptoms in recent studies of youth with TTM. [12,13] Child depressive symptoms. The Children's Depression Inventory (CDI) [18] is a 27-item self-report scale for assessing depression in children.…”

“…Specifically, we examined: (1) the extent to which the CA-TIP sample endorsed clinically significant symptoms of depression and anxiety, (2) the demographic correlates of comorbid depressive and anxiety symptoms, (3) the relationship between depression/anxiety and functional impairment, and (4) the degree to which depressive and anxiety symptoms mediate the relation between TTM severity and functional impairment in youth with TTM. Recent findings suggest strong concordance between parent and child reports and good reliability of child report of symptoms in youth with TTM (e.g., [11][12][13] ). Additionally, studies suggest children are often good reporters of internalizing states.…”