Screening and Assessment Measures for Use in AF-CBT

Screening and Assessment Measures
for Use in AF-CBT
(Version #7, 8-6-2015)
David J. Kolko, Ph.D., ABPP, Elissa J. Brown, Ph.D. and Laurel Zelnik
Note: We acknowledge the input from several colleagues in this document: Tracy Fehrenbach, Colleen Lang, Anna
Loiterstein, Jennifer McQuaid, Komal Sharma-Patel, Kiara Porro, Kevin Rumbarger, Vanessa Rodriquez, Lisa Rosenfeld,
and Carole Campbell Swiecicki.
Table of Contents
I. Purpose of Intake and Outcome Assessment in AF-CBT ................................................................................. 3
II. General Guidelines for Administration of Self-Report and Interview Measures ........................................... 3
III. Overview of Appropriate Assessment Targets/Measures in AF-CBT ............................................................ 5
IV. Screening Measures and Guidelines for Selecting Cases Appropriate for AF-CBT ....................................... 6
V. Information about Measures Recommended for Use in AF-CBT .................................................................. 6
Screen for AF-CBT Family Eligibility................................................................................................................. 7
General Guidelines for Identifying Appropriate Cases for AF-CBT ..................................................................8
Alabama Parenting Questionnaire ...................................................................................................................9
Background ........................................................................................................................................................ 9
Scoring................................................................................................................................................................ 9
Alabama Parenting Questionnaire – APQ (School Age Version)....................................................................10
Alabama Parenting Questionnaire – APQ (School Age Version – Español) ...................................................12
Brief Child Abuse Potential Inventory – B-CAP ..............................................................................................14
Background ...................................................................................................................................................... 14
Validity ............................................................................................................................................................. 14
Scoring.............................................................................................................................................................. 15
Brief CAP Inventory Form (B-CAP) .................................................................................................................16
Inventario del PAN (B-CAP) ............................................................................................................................18
Child PTSD Symptom Scale (CPSS) and Trauma Screen .................................................................................20
Background ...................................................................................................................................................... 20
1
Validity ............................................................................................................................................................. 20
Scoring.............................................................................................................................................................. 20
Trauma Screen ...............................................................................................................................................21
The Child PTSD Symptom Scale (CPSS) – Part I ..............................................................................................22
The Child PTSD Symptom Scale (CPSS) – Part II .............................................................................................23
Trauma Screen (Español) ..............................................................................................................................24
The Child PTSD Symptom Scale (CPSS) – Part I (Español) .............................................................................25
The Child PTSD Symptom Scale (CPSS) – Part II (Español) ............................................................................26
Strengths and Difficulties Questionnaire.................................................................................................27
Scoring.............................................................................................................................................................. 27
Strengths and Difficulties Questionnaire - SDQ .............................................................................................30
Strengths and Difficulties Questionnaire - SDQ .............................................................................................31
Cuestionario de Capacidades y Dificultades (SDQ-Cas) ................................................................................32
References .....................................................................................................................................................34
© 2012 Kolko & Brown
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I. Purpose of Intake and Outcome Assessment in AF-CBT
Assessment is an important part of good treatment. Therefore, we encourage practitioners who use AF-CBT to: (1)
conduct an initial intake assessment that yields clinically-relevant information that can help to guide treatment, (2)
collect ongoing information over the course of treatment designed to monitor treatment response on key clinical
targets, and (3) conduct a discharge assessment using some of the assessment measures collected at intake to provide
information about the impact of outcome of treatment. These three related functions are important to provide
feedback about treatment needs, course/response, and outcome.
What we mean by assessment is the collection of any referral record or report (e.g., CPS documents or caseworker
reports, medical or health records) and other documents, formal standardized instruments, clinical interviews, and
ongoing observations made to understand case needs/characteristics, clinical course and/or treatment outcome. Some
assessments may be directed towards understanding individual characteristics; others may focus on family-system
characteristics. Likewise, some information may reflect on specific topics related to verbal and physical aggression (e.g.,
harsh discipline, swearing, arguments) or PTSD-related symptoms, whereas other information may reflect more general
topics or targets (e.g., social skills). It is important to consider all of these sources of potentially useful information in
both selecting treatment components and in adapting treatment to the needs of the family.
II. General Guidelines for Administration of Self-Report and Interview Measures
The following are general guidelines for administration.
It is helpful to identify an order for administration of any questionnaires or forms. Each questionnaire has slightly
different rating scales and instructions for administration; yet, there are general instructions to keep in mind when
administering questionnaires.
Explain purpose of assessment and how information will be used (and who will have access to the results)
•
•
•
Purpose -- information needed to get your perspective on problems or issues for which you are here, guide
treatment, identify your needs/goals, etc.
Format/methods – we use existing forms that are designed to help us learn about different aspects of your life
that may be relevant to our work here together, such as xx, yy, and zz (e.g., parenting practices, social behavior,
and how things are at home)
Who has access to the data – it’s for me, your clinician, etc.; won’t/will be shared with xx. Stays in our records
and is confidential, etc.
Setting the Environment
•
•
•
Place the measures on the table where the participant can follow as you read the items aloud.
Have the visuals for each questionnaire available.
Have stickers available for use as reinforcement as necessary (particularly with younger children).
Instructions for the Administrator
With Caregivers
• Do your best to maintain a neutral, but friendly, disposition: read the items and record the answers without
making too much eye contact in order to give the participant a sense of privacy when answering; try not to make
reaffirming statements such as “good” or “everybody says that.” When praising or encouraging a respondent,
compliment them on taking their time to think before answering. Ask if they understand the items. You might
3
•
also want to remind caregivers that their input is important, as they are “the most important person” in their
child’s life.
It is preferred that the clinician read all the questions aloud to caregivers whose literacy is questionable.
However, if an adult participant insists on completing a measure on his/her own, read 3-4 questions from each
measure and the corresponding response options aloud first, and then allow the participant to finish each
measure on his/her own. Ideally, the administrator will stay in the room with the caregiver, so that s/he is
available to answer any questions. If the caregiver completes the measures themselves, make sure you skim
each measure when the caregiver is finished, to assure that all questions were answered.
With Children
• Be creative, enthusiastic, and use variation in your rate and tone of speech to keep child’s attention. Use
reinforcers, such as stickers, as needed to motivate the child to keep working. Offer children short breaks as
needed, either for stretching, snacking, or use of the bathroom. If possible, avoid giving breaks in the middle of a
measure. Use lots of praise but do not praise a specific type of answer. For example, if a child says “Yes, I like
school” in response to a questions, avoid making judgments about the value of this response such as “that’s
great” or “I bet you do.” Rather, periodically thank the child for his/her general behavior like taking his/her time,
thinking before answering, asking for clarification, or working so hard.
• Our default is to read all questions to child participants. Again, if an older child or adolescent conveys
understanding of the measure and its scaling, read 3-4 questions and the corresponding response options aloud,
and then allow the participant to finish the measure on his/her own.
With Caregivers and Children
• Always read the instructions printed on the questionnaire and review the response choices before beginning.
Use the visuals and re-explain the answer choices as needed.
• Avoid using the term “test” when administering the questionnaires. Rather, use the term survey or question
pages, even if it says “test form” in the directions.
• Read each response option (e.g., T/F, always/sometimes/never) for at least the first and second items. For the
rest of the items, read response options after every few items.
o If a subject responds to a question with an inappropriate response (e.g., saying “yes” to a T/F option),
ask them to choose a specific option from the scale.
• If the participant seems to be responding carelessly (i.e., yes to all questions, responding before the question is
complete), encourage him/her to listen to the entire question and think for at least a couple of seconds before
responding.
• If a participant inquires about reasons for questionnaire administration, you can indicate that you are trying to
learn more about him/her (e.g., “I’m trying to get to know you better”; “I want to know your point of view”).
• If a “red flag” arises during administration of a questionnaire (e.g., self-harm, suicidal ideation or report of
additional abuse experiences), stay with the protocol for administering assessments. The administration of the
questionnaire packet should rarely be interrupted to address these issues. The administrator should follow the
particular organization’s policy for handling the issues that come up.
Trouble Shooting
Misunderstanding questions
• When a child is wavering in their answer, or if they want the question to be more specific, try not to “interpret”
the question or the child’s response by way of comments, facial expression, or repeating previous responses.
4
•
•
Rather, encourage the child to be clear in their response by asking them to pick the best answer for them, even
if making that decision is hard.
Be careful when administering questions with a double negative. Help the child understand what the question is
asking by rearranging the words in the question if necessary. Do not put the question into your own words.
Rewording a question by changing the order of the words is okay. The next step would be to define a particular
word or phrase in the sentence. Avoid interpreting the meaning of an entire question:
o First, repeat the question. If the participant continues to look to you for guidance, restate the question
again using the exact words from the item but stating them in a different order. Reframing a question
should always be the last resort. Standardization of administration is extremely important.
o If the participant does not understand the meaning of a particular word in the item, you may choose a
simple synonym of the word to use in the question.
o If the participant is not sure of the specific meaning of the question but generally understands,
encourage him/her to answer the question the best as they can based on their understanding.
Specifically, you can instruct the participant to “use your best guess.”
o If it is clear that the participant has no understanding of the question, this must be noted on the
questionnaire and the item may be skipped.
III. Overview of Appropriate Assessment Targets/Measures in AF-CBT
AF-CBT is recommended for cases with significant abusive/aggressive behavior in the caregiver, externalizing or
aggressive behaviors in the child/adolescent, and/or heightened levels of conflict or coercion in the family. The latest
version of AF-CBT can accommodate cases with or without post-traumatic stress (PTS) symptoms, which may help to
address related trauma or violence-specific symptoms. Thus, the current version of AF-CBT is designed to be helpful
with cases who present with any or all of the following characteristics: 1) Child exhibits significant EXT behavior (e.g.,
defiance, oppositionality, aggression, antisocial behavior); 2) Caregiver exhibits significant EXT behavior (verbal and
physical aggression) and/or has allegation, or is at-risk for child physical abuse (e.g., limited positive and/or heightened
negative parenting skills, anger arousal/hostility); or 3) Family has high level of conflict/coercion and may be at risk for
physical aggression/abuse (e.g., frequent verbal and physical escalation; safety threats). As noted above, an important
secondary target of AF-CBT includes child/adolescent trauma-related symptoms, notably, PTSD, depression, anxiety, and
anger.
We have identified assessment measures based on some general inclusion criteria that are used to identify appropriate
candidates for AF-CBT. The recommended measures can be completed on paper, one-to-one or group administration,
or via interview. They have good psychometric properties (i.e., reliability, validity), and have been used across a variety
of trauma types, age ranges, settings, and cultures. Most also are available in the public domain (i.e., free of charge).
We certainly recognize that many families referred for AF-CBT may present with problems or concerns in other areas
which are relevant to clinical case conceptualization and which, to varying degrees, have been addressed in this
treatment (e.g., limited readiness/willingness to change, child maladaptive attributions, such as self-blame; child social
skills problems, caregiver’s inappropriate developmental expectations and views of child’s intentions). Further, other
measures may be needed to assess changes in competencies or skills learned in each phase of AF-CBT.
TF-CBT (Cohen et al., 2007) is generally regarded as the general treatment of choice for child/adolescent PTSD. So, we
assume that most of the child/adolescent cases with primary PTSD (and in the absence of individual externalizing
problems or family conflict/coercion) will get TF-CBT or similar interventions. Further, if there is serious caregiver
5
psychopathology (trauma history, PTSD, substance abuse, etc.) on top of the above, we would recommend MST-CAN
(Swenson et al., 2010).
IV. Screening Measures and Guidelines for Selecting Cases Appropriate for AF-CBT
On the next pages you will find some materials designed to help you identify appropriate cases for AF-CBT. The first
document is a measure that lists some of the eligibility criteria we use to determine if a case is appropriate for this
treatment. The primary items look for caregiver physical abuse, high risk behavior, or physical discipline, family conflict,
children externalizing behavior/aggression or trauma symptoms secondary to this caregiver/family history. This
information can be obtained based on direct questions with a caregiver and/or based on a review of collateral
informants or secondary materials/documents. The second document is an algorithm that outlines a pathway for
understanding how to integrate the answers to these screening questions with other information about a case that
might be used to support or contraindicate the use of AF-CBT in that case. We offer this algorithm as a general pathway
to guide your decision-making about the appropriateness of the case for AF-CBT. It bears noting that the pathway is
informed by both clinical and empirical considerations, but that it is not an empirically validated tool. In addition, we
realize that there may be other important criteria that must be taken into consideration to ultimately decide which
treatment a given family should and will get.
V. Information about Measures Recommended for Use in AF-CBT
Appended to the end of this file are several measures recommended for use in AF-CBT. We have chosen to include the
Alabama Parenting Questionnaire (APQ), the Brief Child Abuse Potential Inventory (B-CAP), the Child PTSD Symptom
Scale (CPSS), and the Strengths and Difficulties Questionnaire (SDQ). For each measure, we have included some
background information, scoring guidelines, and a copy of the item content of each instrument in both English and
Spanish.
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Screen for AF-CBT Family Eligibility
(v.6; 8.6.15)
Name:
Staff:
Date:
/
/
Sources of Info:
Misc:
Criteria for Eligibility: 1, 2, and 3 are “Yes,” plus any 4 or any 5 is a “Yes”.
Yes
1. Child is age 5-17
No
Unsure
Yes
No
Yes
No
Yes
No
Yes
No
Unsure
4b. Caregiver has done something that resulted or could have resulted in an
injury/harm to child
Yes
No
Unsure
4c. Caregiver has likely used some type of excessive or harsh physical
discipline with child
Yes
No
Unsure
4d. Caregiver and child/family have conflicts and/or heated arguments, which
may include caregiver verbal aggression/abuse
Yes
No
Unsure
5a. Child has a pattern of exhibiting oppositional, argumentative, and/or
explosive/angry behaviors
Yes
No
Unsure
5b. Child has been verbally or physically aggressive, and/or exhibited other
high-risk behaviors
Yes
No
Unsure
5c. Child has trauma symptoms related to physical discipline or family
conflict
Yes
No
Unsure
5d. Child has a history of conflict, excessive or harsh physical discipline, or
physical abuse or being injured by a caregiver.
Yes
No
Unsure
2. A caregiver (biological, foster, or kinship) will participate in services
3. Child and caregiver appear appropriate for AF-CBT (i.e., they are willing, if
they are separated, there is possibility of reunification; they are now or
soon could be available, could participate adequately, and could benefit)
4a. Caregiver has an allegation or report of suspected physical abuse
Comments: ________________________________________________________________________________________
7
General Guidelines for Identifying Appropriate
Cases for AF-CBT
8
Alabama Parenting Questionnaire
One comprehensive measure that captures caregiver behavior and does not require a cost or any copyright restriction is
the Alabama Parenting Questionnaire (APQ; Paul Frick, developer). We are suggesting that the APQ be used as a parent
self-report and as a child report on the same parental practices. The 42 item scale includes six individual factors: Positive
Parenting, Parental Involvement, Poor Parental Monitoring/Supervision, Inconsistent Discipline, Corporal Punishment,
and Other Discipline. The items that load onto each scale are listed in the table below. On the next page is the proposed
clinical cutoff for identifying families who could be considered as showing a “problem” on a given scale. For example,
parents reporting a score that is less than or equal to 24 on the positive parenting practices scale can be considered as
using too little positive parenting. We have included both the English and Spanish versions in the next few pages.
Background
Frick, P. J. (1991). Alabama parenting questionnaire. University of Alabama: Author
Shelton, K. K., Frick, P. J., & Wootton, J. (1996). Assessment of parenting practices in families of elementary school-age
children. Journal of Clinical Child Psychology, 25(3), 317-329
Elgar, F. J., Waschbusch, D. A., Dadds, M. R., & Sigvaldason, N. (2007). Development and validation of a short form of the
alabama parenting questionnaire. Journal of Child and Family Studies, 16(2), 243-259. doi:10.1007/s10826-0069082-5
Scoring
Scale
1 = Never
2 = Almost Never
3 = Sometimes
4 = Often
5 = Always
Use the chart below to total up all the items for each individual factor.
Clinical Cutoffs Chart
Alabama Parenting Questionnaire (APQ) - Caregiver report
Individual Factors
Items (Sum)
Positive Parenting Practices
(2,5,13,16,18,27)
Parental Involvement
(1,4,7,9,11,14,15,20,23,26)
Poor Parental Monitoring/Supervision (6,10,17,19,21,24,28, 29,30,32)
Inconsistent Discipline
(3,8,12,22,25,31)
Corporal Punishment
(33,35,38)
Other Discipline
(34,36,37,39,40, 41,42)
9
Problem Cutoff
< 21
< 35
> 18
> 18
>7
n/a
Alabama Parenting Questionnaire – APQ
(School-age Version)
Parent Form
Parent Completing Form (Circle one):
Mother
Father
Other:
Instructions
The following are a number of statements about your family. Please rate each item as to how often it TYPICALLY occurs
in your home. The possible answers are (1)Never, (2) Almost Never, (3) Sometimes, (4) Often, and (5) Always. Please
answer all items.
1. You have a friendly talk with your child.
2. You let your child know when he/she is doing a good job with
something
3. You threaten to punish your child and then do not actually
punish him/her
4. You volunteer to help with special activities that your child is
involved in (such as sports, boy/girl scouts, church youth groups)
5. You reward or give something extra to your child for obeying
you or behaving well
6. Your child fails to leave you a note or to let you know where
he/she is going
7. You play games or do other fun things with your child
8. Your child talks you out of punishing him/her after he/she has
done something wrong
9. You ask your child about his/her day at school
10. Your child stays out in the evening past the time he/she is
supposed to be home
11. You help your child with his/her homework
12. You feel that getting your child to obey you is more trouble than
it is worth
13. You compliment your child when he/she does something well
14. You ask your child what his/her plans are for the coming day
15. You drive your child to a special activity
16. You praise your child if he/she behaves well
17. Your child is out with friends you do not know
18. You hug or kiss your child when he/she has done something well
19. Your child goes out without a set time to be home
Never
1
Almost
Never Sometimes Often Always
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
1
1
1
1
1
1
2
2
2
2
2
2
2
3
3
3
3
3
3
3
4
4
4
4
4
4
4
5
5
5
5
5
5
5
20. You talk to your child about his/her friends
1
2
3
4
5
21. Your child is out after dark without an adult
1
2
3
4
5
10
Never
Almost
Never Sometimes Often Always
22. You let your child out of a punishment early (e.g., lift restrictions
earlier than you originally said)
1
2
3
4
5
23. Your child helps plan family activities
1
2
3
4
5
24. You get so busy that you forget where your child is and what
he/she is doing
1
2
3
4
5
25. Your child is not punished when he/she has done something
wrong
1
2
3
4
5
26. You attend PTA meetings, parent/teacher conference, or other
meetings at your child’s school
1
2
3
4
5
27. You tell your child that you like it when he/she helps out around
the house
1
2
3
4
5
28. You don’t check that your child comes home at the time he/she
is supposed to
1
2
3
4
5
29. You don’t tell your child where you are going
1
2
3
4
5
30. Your child comes home from school more than an hour past the
time you expect him/her
1
2
3
4
5
31. The punishment you give your child depends on your mood
32. Your child is at home without adult supervision
1
1
2
2
3
3
4
4
5
5
33. You spank your child with your hand when he/she has done
something wrong
1
2
3
4
5
1
1
2
2
3
3
4
4
5
5
1
2
3
4
5
1
2
3
4
5
38. You hit your child with a belt, switch, or other object when
he/she has done something wrong.
1
2
3
4
5
39. You yell or scream at your child when he/she has done
something wrong
1
2
3
4
5
40. You calmly explain to your child why his/her behavior was wrong
when he/she misbehaves
1
2
3
4
5
41. You use time out (make him/her sit or stand in a corner) as a
punishment
1
2
3
4
5
42. You give your child extra chores as a punishment
1
2
3
4
5
34. You ignore your child when he/she is misbehaving
35. You slap your child when he/she has done something wrong
36. You take away privileges or money from your child as a
punishment
37. You send your child to his/her room as a punishment
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Alabama Parenting Questionnaire - APQ
(School-age Version – Español)
Parent Form
Nombre del nino/Codigo:
Persona que RESPONDE:
Fecha:
Instrucciones
Las siguientes afirmaciones se refieren a situaciones sobre su familia. Por favor, evalue cada item segun lo que ocurre
habitualmente en su hogar. Las posibles respuestas son:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
Tiene charlas amistosas con su hijo
Le hace saber a su hijo cuando está haciendo un buen trabajo
Amenaza con castigar a su hijo y luego realmente no lo hace
Ayuda a su hijo en actividades propias (actividades que le
gustan) en las que participa
Premia o da algo extra a su hijo cuando le obedece o se porta
bien
Su hijo no le deja notas ni le dice adónde va
Juega o hace otras cosas divertidas con su hijo
Su hijo le convence para que no lo castigue después de haberse
portado mal
Le pregunta a su hijo sobre cómo le ha ido el día en el colegio
Su hijo sigue estando fuera por la tarde/noche pasada la hora en
que se supone que debería estar en casa
Ayuda a su hijo con sus deberes
Siente que el hecho de conseguir que su hijo le obedezca le da
tantos problemas que no le compensa
Felicita a su hijo cuando hace algo bien
Le pregunta a su hijo qué va a hacer durante el día
Lleva a su hijo a sus actividades preferidas
Alaba a su hijo cuando se porta bien
Su hijo sale con amigos a los que usted no conoce
Abraza o besa a su hijo cuando ha hecho algo bien
Su hijo sale sin tener una hora límite para volver a casa
Habla con su hijo sobre sus amigos
Permite que su hijo pueda escaparse de un castigo enseguida
Su hijo colabora en las decisiones familiares
Está tan ocupado que olvida dónde está su hijo y qué está
haciendo
12
Nunca
1
1
1
Casi
Nunca
2
2
2
A
A Veces Menudo Siempre
3
4
5
3
4
5
3
4
5
1
2
3
4
5
1
2
3
4
5
1
1
2
2
3
3
4
4
5
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
1
2
3
4
5
24. No castiga a su hijo cuando hace algo malo
25. Acude a las reuniones de los padres con los profesores o a otras
reuniones de la escuela de su hijo
26. Le dice a su hijo que le gusta cuando colabora en casa
27. No controla que su hijo vuelva a casa a la hora que debería
hacerlo
28. No le dice a su hijo adónde se va usted
29. Su hijo vuelve a casa después de la escuela una hora más tarde
de lo esperado
30. El castigo que le da a su hijo depende de su estado de ánimo
31. Su hijo está en casa sin supervisión de ningún adulto
32. Pega a su hijo con la mano cuando ha hecho algo malo
33. Ignora a su hijo cuando se ha portado mal
34. Abofetea a su hijo cuando hace algo malo
35. Quita privilegios o dinero a su hijo como castigo
36. Envía a su hijo a su habitación como castigo
37. Golpea a su hijo con un cinturón u otro objeto cuando hace algo
malo
38. Da voces o grita a su hijo cuando hace algo malo
39. Explica calmadamente a su hijo por qué su conducta fue
errónea cuando se ha portado mal
40. Usa "tiempo fuera " como castigo (es decir, manda a su hijo a
una habitación, un rincón o lo sienta en una silla para que se
esté un tiempo como castigo)
41. Pone a su hijo tareas extra como castigo
13
Nunca
1
Casi
Nunca
2
A
A Veces Menudo Siempre
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
1
1
1
1
1
1
2
2
2
2
2
2
2
3
3
3
3
3
3
3
4
4
4
4
4
4
4
5
5
5
5
5
5
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Brief Child Abuse Potential Inventory – B-CAP
We also recommend administering to caregivers the Brief Child Abuse Potential Inventory (B-CAP; Ondersman et al.,
2005), which is based on the full version of the Child Abuse Potential Inventory (Milner, 1986), because of its utility in
helping to identify caregivers who may be at high risk for physical abuse or child maltreatment (heightened abuse
potential). The B-CAP has 24 items that form 9 factors, two of which are used to determine validity (e.g., random
responses and lying), and seven others which are used to capture overall abuse risk potential. One of these factors, the
Family Conflict Scale, is included within the overall abuse risk and is also shown as a separate subscale in the table below
due to its importance to AF-CBT. The clinical cutoff that reflects heightened risk potential based on a modest criterion is
9 (Ondersman et al., 2005). The next few pages contain the B-CAP in both English and Spanish.
Background
Ondersman, S. J., Chaffin, M., Simpson, S., & LeBreton, J. (2005). The Brief Child Abuse Potential inventory: Development
and validation. Journal of Clinical Child and Adolescent Psychology, 34, 301-311.
A brief version of the Child Abuse Potential Inventory (CAP) was developed using a development sample of N = 1470, and
cross-validated using an additional sample of N = 713. Items were selected to maximize: (a) CAP variance accounted for;
(b) prediction of future child protective services reports; (c) item invariance across gender, age, and ethnicity; (d) factor
stability; and (e) readability and acceptability. On cross-validation, scores from the resulting 24-item risk scale
demonstrated an internal consistency estimate of .89, a stable 7-factor structure, and substantial correlations with the
CAP abuse risk score (r = .96). The CAP risk cut-off was predicted with 93% sensitivity and 93% specificity (area under the
ROC curve = .98), and the BCAP and CAP demonstrated similar patterns of external correlates. The BCAP may be useful as
a time-efficient screener for abuse risk.
In the development study cited above, a B-CAP cutoff of 9 best predicted the risk distinction of the full CAP using the
cutoff of 166, and a B-CAP cutoff of 12 best predicted the CAP cutoff of 215. These cutoffs were based on a particular
sample of relatively high-risk parents, and may not represent the best possible cutoffs for use in other samples or for
other settings.
Validity
The B-CAP contains two validity scales – the Random Response Scale and the Lie Scale.
If any item on the Random Response Scale is not correctly endorsed (i.e. if they are endorsed as “agree” for normal
scored items, or endorsed as “disagree” for reverse scored items) this indicates that the B-CAP may not be valid as
respondents may simply be selecting random responses.
If more than 4 items from the Lie Scale are endorsed as “disagree” this indicates that the B-CAP may not be valid as the
respondents may not be accurately representing the information.
14
Scoring
This chart demonstrates the scoring criteria for the B-CAP. Typically, items endorsed as “agree” should be given a score
of 1. Items marked with a [*reverse score] should be reverse scored (any item endorsed as “disagree” should be given a
score of 1).
Please note, these item numbers refer to the item numbers on this Brief-CAP, and they do not correspond to the items on
the original CAP.
Individual Factors
Validity Scales:
Random Response Scale
2 (*reverse score), 18, 28
Lie Scale
4, 9, 15, 21, 26, 34
Content Scales:
Abuse Risk Scale
Family Conflict Scale
Items (Sum)
Sum all remaining items
1, 3, 5-8, 10-17, 19,-20,
22-25, 27, 29-33
(Note: Reverse score #1,
23, & 29)
6, 13, 17
Problem Cutoff
Any item endorsed as “agree” (If any item endorsed,
the information may be invalid)
>4 items endorsed as “disagree” (Information may be
invalid if >4 of these items is endorsed as such)
>9 endorsed as “agree” except reverse scored items
(High scores [>9] suggest greater risk for or likelihood
of child maltreatment)
>2 endorsed as “agree” (Moderate family conflict)
15
Brief CAP Inventory Form (B-CAP)
Name:
Age:
Gender:
Marital Status: Single
Race:
Black
White
Other (specify)
Number of children in home
Date:
ID#:
Male
Female
Married
Separated
Divorced
Widowed
Hispanic
Am. Indian
Highest Grade Completed
Instructions
The following questionnaire includes a series of statements which may be applied to yourself. Read each of the
statements and determine if you AGREE or DISAGREE with the statement. If you do agree with a statement, mark the
box in the agree column. If you disagree with a statement, mark the box in the disagree column. Be honest when giving
your answers. Remember to read each statement; it is important not to skip any statement.
Disagree
1. I am a happy person
2. I know what is the right and wrong way to act
3. People have caused me a lot of pain
4. I sometimes act without thinking
5. I am often lonely inside
6. My family fights a lot
7. Everything in a home should always be in its place
8. I often feel very upset
9. Sometimes I have bad thoughts
10. I sometimes worry that I will not have enough to eat
11. I am easily upset by my problems
12. Sometimes I feel all alone
13. My family has problems getting along
14. Children should never disobey
15. I sometimes lose my temper
16. I often feel worthless
17. My family has many problems
18. It is okay to let a child stay in dirty diapers for a while
19. I am often upset and do not know why
20. Children should be quiet and listen
21. I sometimes fail to keep all of my promises
22. I often feel very alone
23. My life is good
24. I am often upset
16
Agree
Disagree
Agree
25. Other people have made my life unhappy
26. I sometimes say bad words
27. I am often depressed
28. Children should not learn how to swim
29. My life is happy
30. I sometimes worry that my needs will not be met in the world
31. I often feel alone
32. A child needs very strict rules
33. Other people have made my life hard
34. People sometimes take advantage of me
The CAP Inventory is copyrighted by Joel S. Miner. Ph.D. (1986). The subset of items contained in the B-CAP is being used
with his permission by participants in an approved training program in AF-CBT.
17
Inventario del PAN (B-CAP)
Nombre:
Fecha:
ID#:
Edad:
Sexo: Masculino
Femenino
Estado Civil: Soltero
Casado
Separado
Divorciado
Viudo
Raza:
Black
White
Hispanic
Am. Indian
Otro (specify)
Numero de Hijos
Ultimo año de studios terminado
Instrucciones
El siguiente cuestionario incluye una serie de declaraciones las cuales podrían ser aplicadas a Ud. mismo. Lea cada una
de las declaraciones y determine si Ud. está de acuerdo o en desacuerdo con la declaración. Si Ud. está de acuerdo con
una declaración, circule A para indicar acuerdo. Si Ud. está en desacuerdo con una declaración, circule DA para indicar
desacuerdo. Recuerde leer cada declaración; es importante no omitir ninguna oración.
A
1. Yo soy una persona feliz
2. Yo sé cual es la forma correcta e incorrect de actuar
3. La gente me ha causado mucho dolor
4. Yo algunas veces actύo sin pensar
5. Yo a menudo estoy solitario (a) adentro
6. Mi familia pelea mucho
7. Cada cosa en un hogar debería estar siempre en su lugar
8. Yo a menudo me siento muy turbado (a)
9. Algunas veces yo tengo malos pensamientos
10. Yo algunas veces me perocupo que me tender suficiente para
comer
11. Yo soy fácilmente trastornado (a) por mis problemas
12. Algunas veces yo me siento completamente solo (a) en el mundo
13. Mi familia tiene problemas en llevársela bien
14. Los niños nunca deberían desobedecer
15. Yo algunas veces pierdo la paciencia
16. Yo a menudo siento que no valgo nada
17. Mi familia tiene muchos problemas
18. Está bien dejar a un niño con los pañales sucios por un rato
19. Yo estoy a menudo trastornada (o) y no sé por qué
20. Los niños deberían estar callados y escuchar
21. Yo fallo algunas veces en mantener todas mis promesas
22. Yo a menudo me siento muy solo (a)
23. Mi vida es Buena
18
DA
A
DA
24. Yo estoy a menudo turbado (a)
25. Otras personas han hecho mi vida infeliz
26. Yo algunas veces digo mala palabras
27. Yo estoy a menudo deprimido (a)
28. Los niños no deberían aprender a nadir
29. Mi vida es feliz
30. Yo algunas veces me preocupo que mis necesidades no serán
satisfechas
31. Yo a menudo me siento solo (a)
32. Un niño necesita relas muy estrictas
33. Otras personas han hecho mi vida difícil
34. La gente algunas veces toma ventaja de mí
The CAP Inventory is copyrighted by Joel S. Miner. Ph.D. (1986). The subset of items contained in the B-CAP is being used
with his permission by participants in an approved training program in AF-CBT.
19
Child PTSD Symptom Scale (CPSS)
and Trauma Screen
We also recommend administering to children the Trauma Screen, a 15 item questionnaire designed to provide
information on what specific events are underlying any PTSD symptoms the child is experiencing. There is also a four
item part that assesses how the child felt while they were experiencing the traumatic event, which is taken from item A2
in the DSM IV; this is included to allow for diagnosis in addition to symptom severity. This scale was created by
researchers at the University of Washington as a complement to the Child PTSD Symptom Scale.
The Child PTSD Symptom Scale is a questionnaire designed to measure post traumatic stress disorder severity in children
aged 8-18. The second part contains questions about daily functioning and is designed to measure severity of
impairment. It is made up of 17 items in part 1 and 7 items in part 2. We suggest that the primary trauma from the
Trauma Screen be used here. It takes about 20 minutes to administer as an interview measure and 10 minutes to
complete as a self-report. The next few pages contain both the Trauma Screen and the CPSS in both English and Spanish.
Background
Foa, E. B., Johnson, K. M., Feeny, N. C., Treadwell, K. R. H. (2001). The Child PTSD Symptom Scale: A preliminary
examination of its psychometric properties. Journal of linical Child Psychology, 30, 376–384.
The Child PTSD Symptom Scale (CPSS) is a child version of the Foa et al. (1997) Posttraumatic Diagnostic Scale (PTDS) for
adults. The CPSS maps on DSM-IV criteria, and yields a PTSD total score as well as scores on the re-experiencing,
avoidance and hyperarousal subscales. The CPSS has 24-items, 17 of which correspond to the DSM-IV symptoms. In the
first part of the questionnaire, respondents are asked to "fill in the number that best describes how often that problem
has bothered [him/her] IN THE LAST TWO WEEKS." Answers are on a Likert-type scale. 0 is not at all, 1 is once a week or
less/once in a while, 2 is 2 to 4 times a week/half the time, and 3 is 5 or more times a week/almost always. In the second
part of the questionnaire, respondents are asked about functional impairment, or how much the problems indicated in
section one have interfered with specific areas of life. These 7 questions are scored dichotomously as absent (0) or
present (1). Scores range from 0 -- 7, with higher scores indicating greater functional impairment.
Validity
In the original article (Foa et al., 2001) internal consistency ranged from .70 - .89 for the total and symptom scores.
Retest reliability was good to excellent (.84 for total, .85 for re-experiencing, .63 for avoidance, and .76 for
hyperarousal). Convergent validity was high: the CPSS correlated .80 with the Child Posttraumatic Stress Reaction Index
(Pynoos et al., 1986). A discriminant functional analysis indicated that a linear combination of the 3 subscales
significantly discriminated between diagnostic groups (Wilks lambda = .33, X2 (3) = 79.1, p<.0001). The CPSS subscales
correctly classified 94.7% of the cases.
Scoring
Each of the 17 items corresponding to the DSM-IV criteria is rated on a scale from 0 to 3; thus, the total score ranges
from 0 to 51. While the original article found that a score of 11 was an appropriate clinical cutoff score, they also
mentioned that clinical experience shows that a score of 15 is most appropriate in PTSD. We have chosen to use the
higher cutoff value here (>15) because we want to ensure a clinically significant level of PTSD.
20
Trauma Screen
Name:
Date:
Instructions
Many children go through frightening or stressful events. Below is a listed of frightening or stressful events that can
happen. Mark YES if you have experienced any of these events. Mark NO if you have not experienced these events.
Yes
No
1. A severe natural disaster such as a flood, tornado, hurricane, earthquake, or fire
2. Serious accident or injury caused by a car or bike crash, being bitten by a dog, or caused by
playing sports
3. Being robbed by threat, force, or weapon
4. Being slapped, punished, or beaten by a relative
5. Being slapped, knifed, or beaten by a stranger
6. Seeing a relative get slapped, punished, or beaten
7. Seeing somebody in your community being slapped, punished, or beaten
8. Being touched in your sexual/private parts by an adult/someone older who should not be
touching you there
9. Being forced/pressured to have sex at a time when you could not say no
10. A family member or somebody close dying suddenly or in a violent way
11. Being attacked, shot, stabbed, or seriously injured
12. Seeing someone be attacked, shot, stabbed, or seriously injured or killed
13. Having a stressful or frightening medical procedure
14. Being around a war
15. Any other stressful or frightening event
Describe:
____________________________________________________
Which of these events bothers you most? ________________________________________________________________
If you answered NO to all of the above questions, stop. If you answered YES to any of the above questions, please
answer the following questions.
When the event happened, did you feel:
Fear that you were going to die or be seriously injured?
Fear that someone else was seriously hurt?
Unable to help yourself?
Shame or disgust?
21
Yes
No
The Child PTSD Symptom Scale (CPSS) – Part I
Instructions
Below is a list of problems that kids sometimes have after experiencing an upsetting event. Read each one carefully and
circle the number (0-3) that best describes how often that problem has bothered you IN THE LAST 2 WEEKS.
Please write down your most distressing event (this should be the event you listed in the Trauma Screen):
Length of time since the event:
0
1
2
3
Not at all or only at one
time
Once a week or less/
once in a while
2 to 4 times a week/
half the time
5 or more times a
week/almost always
1. Having upsetting thoughts or images about the event that came into your head when
you didn’t want them to
0
1
2
3
2. Having bad dreams or nightmares
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
6. Trying not to think about, talk about, or have feelings about the event
0
1
2
3
7. Trying to avoid activities, people, or places that remind you of the traumatic event
0
1
2
3
8. Not being able to remember an important part of the upsetting event
0
1
2
3
9. Having much less interest or doing things you used to do
0
1
2
3
10. Not feeling close to people around you
0
1
2
3
11. Not being able to have strong feelings (for example, being unable to cry or unable to
feel happy)
0
1
2
3
12. Feeling as if your future plans or hopes will not come true (for example, you will not
have a job or getting married or having kids)
0
1
2
3
13. Having trouble falling asleep
0
1
2
3
14. Feeling irritable or having fits of anger
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
3. Acting or feeling as if the event was happening again (hearing something or seeing a
picture about it and feeling as if you are there again)
4. Feeling upset when you think about it or hear about the event (for example, feeling
scared, angry, sad, guilty, etc)
5. Having feelings in your body when you think about or hear about the event (for
example, breaking out into a sweat, heart beating fast)
15. Having trouble concentrating (for example, losing track of a story on the television,
forgetting what you read, not paying attention in class)
16. Being overly careful (for example, checking to see who is around you and what is around
you)
17. Being jumpy or easily startled (for example, when someone walks up behind you)
22
The Child PTSD Symptom Scale (CPSS) – Part II
Instructions
Indicate below if the problems you rated in Part 1 have gotten in the way with any of the following areas of your life
DURING THE PAST 2 WEEKS.
Yes
1. Chores and duties at home
2. Relationships with friends
3. Fun and hobby activities
4. Schoolwork
5. Relationships with your family
6. General happiness with your life
23
No
Trauma Screen (Español)
Nombre:
Fecha:
Instrucciones
Muchos niños pasan por eventos espantosos o estresantes. Abajo es una lista de eventos espantosos o estresantes que
pueden suceder. Marca Si, si has vivido alguno de estos eventos. Marca No, si no has vivido alguno de estos eventos.
Sí
No
1. Desastre natural que fue grave, como un inundación, tornado, huracán, terremoto o
incendio/lumbre
2. Accidente grave o herida seria casuado por un choque de autos o bicicletas, ser mordido por un
perro, o herida causado por jugando un deporte
3. Ser robado con amenaza, fuerza o arma.
4. Cacheteado/a, puñeteado/a o golpeado/a por un familiar
5. Cacheteado/a, puñeteado/a o golpeado/a por alguien desconocido
6. Ver un familiar ser cacheteado/a o, puñeteado/a o golpeado/a.
7. Ver alguien en tu comunidad ser cacheteado/a o, puñeteado/a o golpeado/a.
8. Ser tocado por un adulto o alguien mayor en tus partes sexuales/ privadas cuando no debieron
9. Ser forzado/a o presionado/a en tener sexo o en un tiempo en cuando no pudiste decir no
10. Un familiar o persona cercana moriendose de repente o de una manera violenta
11. Ser atacado, cucheteado, disparado o lastimado gravemente
12. Ver alguien ser atacado, cucheteado, disparado, lastimado gravemente, o matado
13. Procedimiento médico estresante o atemorizante
14. Estar al rededor de una guerra
15. Algun otro evento estresante o espantoso
Describa:
____________________________________________________
Cual de los eventos te molesta mas? ____________________________________________________________________
Si es que contestaste NO a las preguntas arriba, PARA. Si es que contestaste SÍ para alguna de las preguntas arriba,
porfavor contesta las siguientes preguntas.
En cuando sucedio el evento, que sentiste?
Miedo que me iba morir o que fuera gravemente herido
Miedo que alguien mas moriera o fuera lastimado
Sin poder ayudarme a mi mismo/a
Verguenza o asco
24
Sí
No
The Child PTSD Symptom Scale (CPSS) –
Part I (Español)
Instrucciones
Marca 0, 1, 2 o 3 para indicar con frecuencia has tenido los siguientes problemas en los ultimos dos semanas.
Please write down your most distressing event (this should be the event you listed in the Trauma Screen):
Length of time since the event:
0
Nunca
1
De vez en cuando
2
La mitad del tiempo
3
Casi siempre
1. Has tenido pensamientos o imagenes molestos sobre el evento aunque tu no querias
pensar en eso
0
1
2
3
2. Has tenido sueños malos o pesadillas
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
6. Has tratado de no pensar, hablar, o de tener sentimientos acerca del evento
0
1
2
3
7. Has tratado de evitar actividades, personas, o lugares que te hacen recorder el evento
traumatic (por ejemplo, no querer jugar afuera o ir a la escuela)
0
1
2
3
8. Has tenido dificultad en recorder una parte importante del evento
0
1
2
3
9. Has tenido mucho menos intéres o no has hecho las cosas que acostumbrabas hacer
0
1
2
3
10. Has tenido mucho menos intéres o no has hecho las cosas que acostumbrabas hacer.
0
1
2
3
11. Has tenido dificultad en en tener sentimientos Fuertes (por ejemplo, no poder llorar o
sentirte muy feliz)
0
1
2
3
12. Has sentido como sit us planes del future o tus esperanzas no se harán realidad
0
1
2
3
13. Has tenido dificultad en quedarte o mantenerte dormido(a)
0
1
2
3
14. Te has sentido irritable o has tenido momentos de enojo
0
1
2
3
15. Has tenido dificultad en concentrarte
0
1
2
3
16. Has estado demasiado cuidadoso(a) y atento(a)
0
1
2
3
17. Te has asustado o te has sorprendido facilmente
0
1
2
3
3. Has actuado o has sentido como si el evento estuviera pasando de Nuevo (has
escuchado algo o visto algo que te recuerda del evento y te has sentido como si
estuviera pasando otra vez)
4. Te has sentido mal cuando piensas o escuchas algo sobre el evento (por ejemplo:
sintiéndote asustado(a), enojado(a), triste o culpable)
5. Has tenido sensaciones en tu cuerpo cuando piensas o escuchas algo acerca del evento
(por ejemplo: sudando de repente, el corazón palpitando rápido)
25
The Child PTSD Symptom Scale (CPSS) –
Part II (Español)
Instrucciones
Ahora dí si los problemas que acabas de mencionar en la Parte 1 te han molestado conlas siguientes cosas.
Marque Sí o No.
Sí
1. Que haceres y obligaciones en casa
2. Con tus amistades
3. En hacer cosas divertidas
4. En hacer tu tarea
5. Llevarte bien con tu familia
6. Ser feliz con tu vida
26
No
Strengths and Difficulties Questionnaire
One comprehensive measure that captures child externalizing behavior (e.g., ODD/CD, aggression), as well as other
relevant child problems, and that does not require a cost for use of a hard copy form is the Strengths and Difficulties
Questionnaire (SDQ; Robert Goodman). The SDQ is 25-item clinical rating scale, completed by caregivers on 3-16 year
olds. The subscales include: Total Difficulties, Emotional symptoms, Conduct problems, Hyperactivity, Peer problems,
and Prosocial Behavior. There is one measure for children ages 4-10 and another measure for youth ages 11-17 for the
English version; the Spanish version is for all ages (4-17). Both the English and Spanish versions are included.
Scoring
Scoring the Informant-Rated Strengths and Difficulties Questionnaire
The 25 items in the SDQ comprise 5 scales of 5 items each. It is usually easiest to score all 5 scales first before
working out the total difficulties score. ‘Somewhat True’ is always scored as 1, but the scoring of ‘Not True’
and ‘Certainly True” varies with the item, as shown below scale by scale. For each of the 5 scales, the score
can range from 0 to 10 if all 5 items were completed. Scale score can be prorated if at least 3 items were
completed.
Not True
Somewhat
True
Certainly
True
Often complains of headaches, stomach-aches…
0
1
2
Many worries, often seems worried
0
1
2
Often unhappy, downhearted or tearful
0
1
2
Nervous or clingy in new situations…
0
1
2
Many fears, easily scared
0
1
2
Conduct Problems Scale
Not True
Somewhat
True
Certainly
True
Often has temper tantrums or hot tempers
0
1
2
Generally obedient, usually does what…
2
1
0
Often fights with other children or bullies them
0
1
2
Often lies or cheats
0
1
2
Steals from home, school or elsewhere
0
1
2
Emotional Symptoms Scale
27
Not True
Somewhat
True
Certainly
True
Restless, overactive, cannot stay still for long
0
1
2
Constantly fidgeting or squirming
0
1
2
Easily distracted, concentration wanders
0
1
2
Thinks things out before acting
2
1
0
Sees tasks through to the end, good attention span
2
1
0
Not True
Somewhat
True
Certainly
True
Rather solitary, tends to play alone
0
1
2
Has at least one good friend
2
1
0
Generally liked by other children
2
1
0
Picked on or bullied by other children
0
1
2
Gets on better with adults than with other children
0
1
2
Not True
Somewhat
True
Certainly
True
Considerate of other people’s feelings
0
1
2
Shares readily with other children
0
1
2
Helpful if someone is hurt, upset or feeling ill
0
1
2
Kind to younger children
0
1
2
Often volunteer to help others
0
1
2
Hyperactivity Scale
Peer Problems Scale
Prosocial Scale
The Total Difficulties Score is generated by summing the scores from all the scales except the prosocial scale.The
resultant scores can range from 0 to 40 (and is counted as missing if one of the component scores is missing).
Interpreting Symptom Scores and Defining “Caseness” from Symptom Scores
Although SDQ scores can often be used as continuous variables, it is sometimes convenient to classify scores as normal,
borderline and abnormal. Using the banding in the table shown below, an abnormal score on one or both of the total
difficulties scores can be used to identify likely “cases” with mental health disorders. This method is helpful in detecting
mental health problems, and is best when combined with information gathered from multiple informants. It does,
however, overestimate difficulties. Approximately 10% of a community sample will score in the abnormal band on any
given score, and a further 10% will score in the borderline range. The exact proportions vary by country, age and gender
(see SDQ website for normative data). You may want to set the threshold higher when avoiding false positives is
important, and set the threshold lower when avoiding false negatives is more important.
28
Strengths and Difficulties Questionnaire (SQD) -- Caregiver Report
Clinical Cutoff Category
Scale
Normal
Borderline
Total Difficulties Score
0-13
14-16
Emotional Symptoms Score
0-3
4
Conduct Problems Score
0-2
3
Hyperactivity Score
0-5
6
Peer Problems Score
0-2
3
Prosocial Behavior Score
6-10
5
Abnormal
17-40
5-10
4-10
7-10
4-10
0-4
Strengths and Difficulties Questionnaire (SQD) -- Teacher Report
Clinical Cutoff Category
Scale
Normal
Borderline
Total Difficulties Score
0-11
12-15
Emotional Symptoms Score
0-4
5
Conduct Problems Score
0-2
3
Hyperactivity Score
0-5
6
Peer Problems Score
0-3
4
Prosocial Behavior Score
6-10
5
Abnormal
16-40
6-10
4-10
7-10
5-10
0-4
29
Strengths and Difficulties Questionnaire - SDQ
P or T 4-10
Instructions
For each item, please mark the box for Not True, Somewhat True or Certainly True. It would help us if you answered all
items as best you can even if you are not absolutely certain. Please give your answers on the basis of your child’s
behavior over the last six months. Thank you very much for your help.
Not True
1.
Considerate of other people’s feelings
2.
Restless, overactive, cannot stay still for long
3.
Often complains of headaches, stomach-aches, or sickness
4.
Shares readily with other young people, for example toys, treats, pencils
5.
Often loses temper
6.
Rather solitary, prefers to play alone
7.
Generally well behaved, usually does what adults request
8.
Many worries or often seems worried
9.
Helpful if someone is hurt, upset or feeling ill
Somewhat Certainly
True
True
10. Constantly fidgeting or squirming
11. Has at least one good friend
12. Often fights with other children or bullies them
13. Often unhappy, depressed or tearful
14. Generally liked by other children
15. Easily distracted, concentration wanders
16. Nervous in new situations, easily loses confidence
17. Kind to younger children
18. Often lies or cheats
19. Picked on or bullied by other children
20. Often volunteers to help others (parents, teachers, other children)
21. Thinks things out before acting
22. Steals from home, school or elsewhere
23. Gets along better with adults than with other children
24. Many fears, easily scared
25. Good attention span, sees work through to the end
Signature_____________________________________________________________________
Date_______________
Parent/Teacher/Other (please specify):__________________________________________________________________
30
Strengths and Difficulties Questionnaire - SDQ
P or T 11-17
Instructions
For each item, please mark the box for Not True, Somewhat True or Certainly True. It would help us if you answered all
items as best you can even if you are not absolutely certain. Please give your answers on the basis of your child’s
behavior over the last six months. Thank you very much for your help.
Not True
1.
Considerate of other people’s feelings
2.
Restless, overactive, cannot stay still for long
3.
Often complains of headaches, stomach-aches, or sickness
4.
Shares readily with other young people, for example CDs, games, food
5.
Often loses temper
6.
Would rather be alone than with other young people
7.
Generally well behaved, usually does what adults request
8.
Many worries or often seems worried
9.
Helpful if someone is hurt, upset or feeling ill
Somewhat Certainly
True
True
10. Constantly fidgeting or squirming
11. Has at least one good friend
12. Often fights with other young people or bullies them
13. Often unhappy, depressed or tearful
14. Generally liked by other young people
15. Easily distracted, concentration wanders
16. Nervous in new situations, easily loses confidence
17. Kind to younger children
18. Often lies or cheats
19. Picked on or bullied by other young people
20. Often volunteers to help others (parents, teachers, children)
21. Thinks things out before acting
22. Steals from home, school or elsewhere
23. Gets along better with adults than with other young people
24. Many fears, easily scared
25. Good attention span, sees chores or homework through to the end
Signature_____________________________________________________________________
Date_______________
Parent/Teacher/Other (please specify):__________________________________________________________________
31
Cuestionario de Capacidades
y Dificultades (SDQ-Cas)
P or T 4-16
Instrucciones
Por favor, ponga una cruz en el cuadro que usted cree que corresponde a cada una de las preguntas: No es cierto, Un
tanto cierto, Absolutamente cierto. Nos sería de gran ayuda si respondiese a todas las preguntas lo major que pudiera,
aunque no esté completamente seguro/a de la respuesta, o le parezca una pregunta rara. Por favor, responda a las
preguntas basándose en el comportamiento del niño/a durante los ύltimos seis meses o durante el presente curso
escolar. Muchas gracias por su ayuda.
No es
cierto
1.
Tiene en cuenta los sentimientos de otras personas
2.
Es inquieto/a, hiperactivo/a, no puede permanecer quieto/a por mucho
tiempo
3.
Se queja con frecuencia de dolor de cabeza, de estómago o de náuseas
4.
Comparte frecuentemente con otros niños/as chucherías, juguetes,
lápices, etc
5.
Frecuentemente tiene rabietas o mal genio
6.
Es más bien solitario/a y tiende a jugar solo/a
7.
Por lo general es obediente, suele hacer lo que le piden los adultos
8.
Tiene muchas preocupaciones, a menudo parece inquieto/a o preocupado/a
9.
Ofrece ayuda cuando alguien resulta herido, disgustado, o enfermo
10. Está continuamente moviéndose y es revoltoso
11. Tiene por lo menos un/a buen/a amigo/a
12. Pelea con frecuencia con otros niños/as o se mete con ellos/ellas
13. Se siente a menudo infeliz, desanimado o lloroso
14. Por lo general cae bien a los otros niños/as
15. Se distrae con facilidad, su concentración tiende a dispersarse
16. Es nervioso/a o dependiente ante nuevas situaciones, fácilamente pierde
la confianza en sí mismo/a
17. Trata bien a los niños/as más pequeños/as
18. A menudo miente o engaña
19. Los otros niños se meten con él/ella o se burlan de él/ella
20. A menudo se ofrece para ayudar (a padres, maestros, otros niños)
21. Piensa las cosas antes de hacerlas
22. Roba cosas en casa, en la escula o en otros sitios
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Un tanto Absolutacierto mente cierto
No es
cierto
Un tanto Absolutacierto mente cierto
23. Se lleva major con adultos que con otros niños/as
24. Tiene muchos miedos, se asusta fácilamente
25. Termina lo que empieza, tiene Buena concentracíon
Firma_____________________________________________________________________
Fecha_________________
Madre/padre/maestro/otros (indique, por favor:) _________________________________________________________
33
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Frick, P. J. (1991). Alabama parenting questionnaire. University of Alabama: Author
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Milner, J. S. (1986).The Child Abuse Potential Inventory: Manual (Second edition), Psytec Corporation, Webster, N.C.
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