Abstract
Childhood is a developmental period associated with high risk of posttraumatic stress disorder (PTSD). Available validated pencil-and-paper diagnostic tools can be difficult for younger children to engage with given format and length. This study investigated psychometric properties of a briefer, more interactive game version of the Child PTSD Symptom Scale for DSM-5 (CPSS-5). Participants (n = 49) were children attending primary care appointments between 8 to 12 years of age who were exposed to a DSM-5 Criterion A trauma. Participants completed the 6-item screening version of the CPSS-5 delivered in mobile tablet game format (the CPSS-5 Screen Team Game) and a self-report version of the full CPSS-5 (CPSS-5-SR) before their medical appointments. The mobile game showed adequate internal consistency (α = 0.79), was significantly positively correlated to the total CPSS-5-SR (r = .74, p < .001, n = 49), and with the total of the six identical items of the CPSS-5-SR (r = .79, p < .001, n = 49), demonstrating good convergent validity. Receiver operating characteristic (ROC) analyses revealed a cut-off score of 9 on the screening game as indicative of probable PTSD. Implementation of this screening game into primary care settings could be a low-burden method to greatly increase the detection of pediatric PTSD for referral to appropriate integrated care interventions.
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Acknowledgements
The authors are very appreciative of the creativity, generosity and talent provided by the graduate students (with support from their faculty mentors) from Carnegie Mellon University who created the CPSS-5 Screen Team Game as part of their graduate training. The authors would also like to express their sincerest appreciation to Hallie Tannahill, the post-baccalaureate research assistant who assisted on the initial set-up of the study and assisted the first author in establishing the recruitment sites and procedures. The authors are also grateful for Savannah Simon and Maham Ahmad, two undergraduate research assistants, who contributed their time to data collection for the study. In addition, the authors would like to thank the following community sites and the support staff, nurses, clinicians and administrators working at these clinics who collaborated on this study by allowing the research staff to come on site to collect the data presented here: Children’s Hospital of Pennsylvania (CHOP) South Philadelphia Primary Care Clinic, CHOP Karabots West Philadelphia Pediatric Care Center, and Joseph J. Peters Institute of Philadelphia. A special thanks to our pediatrics colleagues Dr. Steven Berkowitz, Dr. Kari Draper, and Dr. Terri Behin-Aein for their support and facilitation of the project at the various primary care clinics. Finally, this work could not be done without the participation of the children who were brave enough to share their stories with our research team in order to help other youth who might have undetected PTSD symptoms in primary care settings. We are deeply thankful to each of you.
Funding
This work was primarily funded by the Penn Undergraduate Mentorship Program (PURM) awarded to Dr. Anu Asnaani through the Center for Undergraduate Research and Fellowships. The CPSS-5 Screen Team Game items were derived from a previous psychometric study on the CPSS-5 (PI: Asnaani) that was funded through a Clinical Translational Science Award given by the Community Engagement Action Research (CEAR) Core (8UL1TR000003) at the University of Pennsylvania, also awarded to Dr. Asnaani. The original CPSS-5 measure from which the CPSS-5 Screen Team Game items were derived were devised by Drs. Edna Foa and Sandra Capaldi.
In addition, the idea behind placing the CPSS-5 Screen items into a more interactive, game format was conceived by co-authors Dr. Judith Cohen and Dr. Anthony Mannarino. The final product of the CPSS-5 Screen Team Game was developed through a collaboration between the Center for Traumatic Stress in Children and Adolescents at Allegheny Hospital and the Entertainment Technology Center of Carnegie Mellon University, with support from the Highmark VITAL Program. The CPSS-5 Screen Team Game will be available at no cost from the Apple Store and Google Play.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation at the University of Pennsylvania and the Children’s Hospital of Pennsylvania and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients being included in the study.
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Asnaani, A., Narine, K., Suzuki, N. et al. An Innovative Mobile Game for Screening of Pediatric PTSD: a Study in Primary Care Settings. Journ Child Adol Trauma 14, 357–366 (2021). https://doi.org/10.1007/s40653-020-00300-6
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DOI: https://doi.org/10.1007/s40653-020-00300-6