Trauma Symptom Checklist for Children (TSCC)

Devised By:  John Briere  1996.

There are many traumatic events that may befall children and there is clear evidence that such experiences can produce a plethora of negative psychological effects.  Nevertheless, there are few multiscale tests of childhood post-traumatic symptomatology and none that have been standardized on large samples of boys and girls from general populations.  The TSCC was designed by Briere to address this lack.  It evaluates children’s responses to unspecified traumatic events in a number of different symptom domains and is standardized on a large sample of racially and economically diverse children from a variety of urban and suburban environments, providing norms according to age and sex (Briere, 1996).

Type of Instrument:

The Trauma Symptom Checklist for Children (TSCC) is a self-report measure of ‘post-traumatic distress and related psychological symptomatology’ in male and female children aged 8 – 16 years.  It is useful in the evaluation of children who have experienced traumatic events, including physical and sexual assault, victimization by peers, major losses, the witnessing of violence done to others and natural disasters  (Briere, 1996). The instrument is suitable for individual or group administration. 

Description:

The TSCC consists of 54 items that yield two validity scales (Under-response and Hyperresponse); six clinical scales (Anxiety, Depression, Anger, Posttraumatic Stress, Dissociation (with 2 subscales); and eight critical items. Table 1 presents a brief description of  the scales of the TSCC.

Table 1:  Brief Description of TSCC Validity and Clinical Scales

Validity

    Underresponse (UND) Reflects a tendency toward denial, a general underendorsement response set, or a need to appear unusually symptom-free.

    Hyperresponse (HYP) Indicates a general overresponse to TSCC items, a specific need to appear especially symptomatic, or a state of being overwhelmed by traumatic stress.

Clinical

    Anxiety (ANX)                Generalized anxiety, hyperarousal, worry, specific fears (e.g. of men, women, or both; of the dark, of being killed); episodes of free-floating anxiety; and a sense of impending danger.

    Depression (DEP)   Feelings of sadness, unhappiness, and loneliness; episodes of tearfulness; depressive cognitions such as guilt and self-denigration; and self-injuriousness and suicidality.

    Anger (ANG) Angry thoughts, feelings, and behaviours, including feeling mad, feeling mean and hating others; having difficulty de-escalating anger; wanting to yell at or hurt people; arguing or fighting.

    Posttraumatic Stress (PTS) Posttraumatic symptoms including intrusive thoughts, sensations, and memories of painful past events; nightmares; fears; and cognitive avoidance of painful feelings.

    Dissociation (DIS) Dissociative symptomatology, including derealization; one’s mind going blank; emotional numbing; pretending to be someone else or somewhere else; day-dreaming; memory problems and dissociative avoidance.  Has two subscales:  DIS-O (Overt Dissociation) and DIS-F (Fantasy).

    Sexual Concerns (SC) Sexual thoughts or feelings that are atypical when they occur earlier than expected or with greater than normal frequency; sexual conflicts; negative responses to sexual stimuli; and fear of being sexually exploited.  Has two subscales (SC-P (Sexual preoccupation) and SC-D ( Sexual Distress).

Source : (Briere, !996, p.2)

The TSCC is available in two versions: the full 54 item test that includes 10 items tapping sexual symptoms and preoccupation and a 44 item alternate version (TSCC-A) that makes no reference to sexual issues.  In the interests of more complete evaluation the full TSCC is recommended over the TSCC-A unless there are factors that preclude its use.  The items of the TSCC are contained in a carbonless test booklet in which the child directly writes his or her responses.  The child is presented with a list of thoughts, feelings and behaviours and is asked to mark how often each of these things happens to him or her.  Each item is rated on a four-point scale anchored at 0 (never) and 3 (almost all of the time).  The TSCC takes 15-20 minutes to complete for most children (Briere, 1996).

Reliability:

Reliability analysis of the TSCC scales in the normative sample demonstrated high internal consistency for five of the six clinical scales (}’s range from .82 to .89) as presented in Table 2.  The remaining clinical scale, SC, was moderately reliable (}=.77).  The four clinical subscales varied in reliability with DIS-O and SC-P having relatively high internal consistency (}’s of .81) and the shorter DIS-F and SC-D scales being somewhat less reliable (}’s of .58 and .64 respectively).  The two validity scales UND and HYP had coefficients of .85 and .66 respectively.  As indicated in Table 2, the reliability of TSCC clinical scales was also generally high in several other samples.  However, because the subscales and validity scales had yet to be formalized when these studies were run, reliability coefficients were not determined for these indices (Briere, 1996).

Table 2. Reliability of the TSCC Scales in the Standardization Samples and Three Child Abuse Centres.

TSCC scale (no of items) Standardization Sample a Child Abuse Centre 1b Child Abuse Centre 2c Child Abuse Centre 3d

Underresponse (10)

.85

-

-

-

Hyperresponse (8)

.66

-

-

-

Anxiety (9)

.82

.86

.83

.84

Depression (9)

.86

.89

.85

.85

Anger (9)

.89

.89

.87

.89

Posttraumatic Stress(10)

.87

.86

.85

.87

Dissociation (10)

.83

.89

.80

.88

    DIS-0 (7)

.81

-

-

-

    DIS-F (3)

.58

-

-

-

Sexual Concerns(10)

.77

.78

.67

.78

    SC-P (7)
    SC-D (4)

.81
.64

-
-

-
-

-
-

Mean Clinical Scalee

.84

.86

.81

.85

aN=3,008.  b Lanktree and Briere (1995b) sample n=105.   CElliot and Briere (1994) sample, n = 399.   dNelson-Gardell (1995) sample, n =103.    eMean } across six TSCC clinical scales (subscales not included).

Note:  For the two validity scales (UND & HYP) and the four clinical subscales (DIS-O, DIS-F. SC-P, SC-D) for all three child abuse samples, reliability is not reported.

Source:  (Briere, 1996, p.29).

Validity:

Content Validity:  Seventy-five items were initially developed to tap six domains: anxiety, depression, anger, posttraumatic stress, dissociation, and sexual concerns or preoccupation.  After consultation with clinicians who specialized in the treatment of traumatized children, 21 items were ultimately discarded as redundant or less meaningful indicators of the domains of interest.  The 54 items of the resultant measure were then included in several studies of child abuse impacts (Elliot & Briere, 1994; Friedrich, 1991; Lanktree & Briere, 1995b), where reliability and validity analyses suggested no further need for scale refinement (Briere, 1996).

Convergent & Discriminant Validity:  Convergent and Discriminant validity were established by analyses of covariance with other available measures. TSCC scales correlated most with scales of similar content (concurrent validity) and least with scales of less similar content (discriminant validity).  Briere and Lanktree (1995) found significant intercorrelations  (see Table 3) between the TSCC and the Youth and Parent Report versions of the Child behaviour Checklist (CBCL), and the Children’s Depression Inventory (CDI).

Table 3:                  Correlation of TSCC Clinical Scales with CBCL and CDI Scores in a Child Abuse Centre Samplea.   (N’s range from 51 – 66 because of missing data:  *p=<.05, **p<.01)

TSCC Scales

 

ANX

DEP

PTS

SC

DI

ANG

CBCL-P-1

.16

.22*

.23*

.08

.09

.08

CBCL-P-E

.31**

.26*

.22*

.21*

.13

.27*

CBCL-Y-1

.78**

.82**

.75**

.51**

.68**

.55*

CBCL-Y-E

.47**

.48**

.53**

.62**

.65**

.68**

CDI

.54**

.73**

.64**

.45**

.60**

.59**

Source : (Briere, 1996, p.30)

As can be seen in Table 3, the CDI correlated most with the DEP scale of the TSCC and least with the SC scale.  Also, as might be expected with a self-report instrument, TSCC scales tended to correlate best with CBCL Youth-report scores as compared to CBCL Parent-report scores.  CBCL youth report internalization correlated most with ANX, DEP and PTS, whereas Youth Report CBCL Externalization was most associated with SC,DIS and ANG.  Because anxiety, depression and posttraumatic stress are more internalized symptoms, and sexual and angry behaviours are more externalized, these data suggest significant convergent validity for the TSCC (Briere, 1996).

Further evidence of convergent and discriminant validity is found in Evans et al. (1994)  subsample study of 387 children found TSCC scores were significantly correlated (p <.01) with the CDI and the Revised Children’s Manifest Anxiety Scale (RCMAS) (ANX - .45 & .63; DEP .68 & .63; ANG - .57 & .51; PTS - .51 & .60; DIS - .51 & .56; respectively) and in Smith, Saunders, Swenson and Crouch (1995), study of 39 children identified as sexual abuse victims.  They examined the relationship between the TSCC and the Revised Children’s Impact of Traumatic Events Scale (CITES-R).  They found that in those instances that pairs of TSCC and CITES-R measured similar or equivalent constructs, the relevant scales were most correlated of all possible CITES-R/TSCC scale pairs.  Specifically, the TSCC PTS scale correlated highest with the Intrusive Thoughts CITES-R scale, the TSCC DEP scale correlated highest (positively and negatively respectively) with the CITES-R Self-blame and Empowerment scales, and the TSCC SC scale correlated highest with the CIOTES-R Sexual Anxiety and Eroticism scales.  Finally, the CITES-R Avoidance scale correlated second highest with the TSCC DIS scale, (r = .60).  Freidrich and Jaworski (1995) examined the correlation between the TSCC SC and DIS scales and both the Child Sexual Behaviour Inventory (CSBI) and the Child Dissociation Checklist (CDC).  They found that the SC was significantly related to CSBI scores but not to CDC scores whereas the DIS scale related to CDC scores but not to CSBI scores (Briere, 1996).

Construct Validity:                

As a measure of posttraumatic stress and related symptomatology, the TSCC should not only correlate with other similar measures, scale scores should also:
           a)                be higher in samples of children with traumatic histories
           b)                increase in the presence of more severe trauma, and 
           c)                decrease in response to therapeutic interventions.

In the normative sample studies by Singer et al. (1995) and Evans et al. (1994) they found that respondent’s experience of stressful life events were associated with and predicted by significant amounts of variance in all TSCC-A scales.  These scales were, in each instance, more powerful predicators of life stressors than were the CDI or the RCMAS.  In child abuse and trauma centre samples several studies provide data that support the construct validity of the TSCC.  Elliot and Briere (1994) found that sexually abused children scored higher on each of the TSCC scales than non-abused children.  In addition, among those with sexual abuse histories, disclosure status was predicted by TSCC scores.  Elliot, McNeil, Cox and Bauman (1995) examined the TSCC scores of 302 girls as they predicted specific types of abuse history.  Using multivariate analyses that examined the relationship between each abuse type and TSCC scales, they found that childhood sexual abuse was uniquely related to all TSCC scales except ANG.  Physical abuse was uniquely associated with all scales except SC and neglect was specifically related to DEP and DIS. Lanktree and Briere (1995a) examined the TSCC scores in relation to therapy designed to reduce the impacts of sexual victimization.  They found a time specific reduction according to scale: After three months of treatment all TSCC scales but SC had reduced significantly; after six months there were further reductions in ANX, DEP and PTS, and decreased SC; after 9 months ANX and PTS scores continued to decrease and at 1 year those still in treatment showed further decreases in ANX, DEP, and PTS scales.  Collectively, these data support the construct validity of the TSCC.

Criterion  (or Predictive) Validity: Evidence that the TSCC taps posttraumatic distress is demonstrated in two studies where TSCC scores are highest after more severe trauma and specific scales differentiate trauma type.  Smith, Swenson, Hanson and Saunders (1994) found that each of the six scales related to specific aspects of childhood trauma.   PTS, DIS and ANX were related to traumatic events that involved perceptions of life threat; ANG and DEP were negatively correlated with clinician ratings of parental support following abuse disclosure; and sexual assault victims who had experienced penetration had higher SC scores.  Briere and Lanktree (1995) found that sexual penetration was most associated with TSCC scales reflecting trauma and sexual distress; PTS, SC and DIS.  Finally, Diaz, (1994)  examined the relative ability of several measures and variables to discriminate 81 sexually abused girls from 151 controls and found that the PTS, DEP and ANX scales of the TSCC were significant discriminators with PTS and DEP being the most powerful over other variables, including the CBCL-Y; the Rosenberg Self-Esteem Scale (Rosenberg, 1995); a measure of suicidality and substance abuse history (Briere, 1996).

Scoring Method:

The TSCC materials consist of the Professional manual, a TSCC Booklet and age and sex appropriate profile forms.  Respondents answer each item directly into the carbonless test booklet and this is hand scored by the examiner.  Two profile forms (male and female) which allow raw score conversions to T scores are provided.  A graph of the profile may be drawn to visually portray the respondent’s scores relative to the normative sample. 

Scoring is completed by tearing off the perforated strip at the top of the TSCC booklet and removing the top sheet.  Demographic information and item scores are reproduced on the bottom (score) sheet. There may be instances when not all items of the TSCC have been completed.  Missing items are marked and totalled.  If Total Missing is 6 or more the TSCC should be considered invalid.  If a child has not responded to every item, determine the number of missing values for each scale.  The number of missing items for each scale determines whether or not any score for that scale should be calcualted. Each item is transcribed into spaces indicated on the profile form and a score for each clinical scale is calculated.  Critical items are marked with shading on the scoring sheet.  Raw scores are then converted into Standard Scores and a TSCC profile is plotted. For all clinical scales except SC and its subscales, T scores at or above 65 are considered clinically significant.  T scores in the range of 60 through 65 are suggestive of difficulty or may represent subclinical symptomatology.  For SC scale and its subscales SC-P and SC-D, T scores at or above 70 are considered clinically significant.  Each of the critical items also requires attention in interpretation but a non-zero response does not necessarily mean a child is at risk.  Normative data for non-zero responses and interpretative guides are available in the professional manual.    The TSCC can be administered and scored by individuals who do not have formal training in clinical psychology or related fields.  TSCC data should not be considered in isolation.  The evaluator is advised to include the TSCC in a battery of relevant standardized test findings in the context of one or more clinical interviews and to use corollary information (i.e. from parents, teachers, medical personnel, etc) as necessary  (Breire, 1996).

Norms:

Normative data for the TSCC represent 3,008 children, combined from three nonclinical samples:

a)             2,399 school children participating in a study of the impacts of neighbourhood violence in six different urban and suburban locations (Singer et al. 1995);

b)                   387 school children who were part of a larger study on the effects of stressful life events (Evans et al. 1994); and

c)             222 children who were relatives of medical patients undergoing routine examinations at the Mayo Clinic (Freidrich, 1995).

The sample of 3,800 children well represents gender (53% female) and race (44% Caucasian, 27% Black, and 22%v Hispanic).  Various analyses were performed on the normative data to assess the influence of demographic variables on raw scores.  This procedure suggested that the primary age break was 8-12 years and 13-16 years with relatively few significant TSCC age differences occurring within these groups.  Sex was also found to be an important variable upon which to standardize TSCC scales.  The small magnitude of variance for race differences (ranging from 0.1% - 1.5%) were deemed insufficient for separate norms to be derived.  Based upon age and sex groupings normative data with T score conversions were derived.  Normative data and T score conversions are presented in detail in the professional manual (Briere, 1996).

The actual questionnaire is not available here as it is copyrighted.  However, it can be accessed from the publisher, Psychological Assessment Resources Inc. at P.O. Box 998, Odessa, Fl 33556, or from  ACER at 347 Camberwell Road, Camberwell, Victoria (03 9835 7447).

References:

Briere, J. (1996) Trauma Symptom Checklist for Children: Professional Manual.  Florida: Psychological Assessment Resources Inc.

Briere, J., & Lanktree, C.B. (1995) The Trauma Symptom Checklist for Children (TSCC): Preliminary psychometric characteristics.  Unpublished manuscript, Dept. of Psychiatry, University of Southern California School of medicine.  Cited in Briere, J. (1996) Trauma Symptom Checklist for Children: Professional Manual.  Florida: Psychological Assessment Resources Inc.

Diaz, J. (1994).  The impact of sexual abuse on adolescent females: factors influencing subsequent psychological adjustment and sexual behaviour.  Unpublished doctoral dissertation.  Columbia University, New York.  Cited in Briere, J. (1996) Trauma Symptom Checklist for Children: Professional Manual.  Florida: Psychological Assessment Resources Inc.

Elliot, D. M., & Briere, J. (1994) Forensic Sexual Abuse evaluations in older children: Disclosures and symptomatology.  Behavioural Sciences and the Law, 12, 261-277.

Elliot, D.M., & Briere, J. (1995).  Posttraumatic stress associated with delayed recall of sexual abuse: A general population study.  Journal of Traumatic Stress, 8, 629-647.

Evans, J.J., & Briere, J., Boggiano, A.K. & Barrett, M. (1994)  Reliability and validity of the Trauma Symptom Checklist for Children in a normative sample.  Paper presented at the San Diego Conference on responding to Child Maltreatment.  Cited in Briere, J. (1996)  Trauma Symptom Checklist for Children : Professional Manual.  Florida: Psychological Assessment Resources Inc.

Friedrich, W. N. (1991)  Sexual behaviour in sexually abused children.  In J. Briere (Ed.), Treating Victims of Child Abuse (pp. 15- 28). San Francisco: Jossey-Bass.

Friedrich, W.N. (1995).  Unpublished dataset.  Mayo Clinic, Rochester, MN.  Cited in Briere, J. (1996)  Trauma Symptom Checklist for Children : Professional Manual.  Florida: Psychological Assessment Resources Inc.

Freidrich, W.N., & Jaworski, T.M. (1995).  Measuring dissociation and sexual behaviours in adolescents and children.  Unpublished manuscript, Mayo Clinic, Rochester, MN. Cited in Briere, J. (1996)  Trauma Symptom Checklist for Children : Professional Manual.  Florida: Psychological Assessment Resources Inc.

Lanktree, C.B. & Briere, J. (1995a)  Outcome of therapy for sexually abused children: A repeated measures study.  Child Abuse and Neglect, 19, 1145-1155.

Lanktree, C.B., & Briere, J. (1995b) Early data on the new Sexual Concerns and Dissociation Subscales of the TSCC.  Unpublished manuscript, Dept. of Psychiatry, University of Southern California School of Medicine.  Cited in Briere, J. (1996)  Trauma Symptom Checklist for Children: Professional Manual.  Florida: Psychological Assessment Resources Inc.

Nelson-Gardell, D. (1995).  Validation of a treatment outcome measurement tool: Research for and with human service agencies.  Paper presented at the 35th annual workshop of the national Association for Welfare Research and Statistics, Jackson, New York.  Cited in Briere, J. (1996)  Trauma Symptom Checklist for Children: Professional Manual. Florida: Psychological Assessment Resources Inc.

Rosenberg, M.  (1965)  Society and the adolescent self-image.  Princeton, NJ: Princeton University Press.

Singer, M.I., Anglin, T.M., Song, L.Y. & Lunghofer, L. (1995).  Adolescents’ exposure to violence and associated symptoms of psychological trauma.  Journal of the American Medical Association, 273, 477-482.

Smith, D.W., Saunders, B.E., Swenson, C.C., & Crouch, J. (1995). Trauma Symptom Checklist for Children and Children’s Impact of Traumatic Events-Revised scores in sexually abused children.  Unpublished manuscript. Cited in Briere, J. (1996)  Trauma Symptom Checklist for Children: Professional Manual.  Florida: Psychological Assessment Resources Inc.

Smith, D.W., Swenson, C.C. Hanson, R.F., & Saunders, B.E. (1994) Poster session presented at the second annual colloquium of the American Professional Society on the Abuse of Children, Boston.  Cited in Briere, J. (1996)  Trauma Symptom Checklist for Children: Professional Manual.  Florida: Psychological Assessment Resources Inc.

Above written by: Ms. Marianne Townsend

Reviewed, edited and approved by: Dr. Grant J. Devilly