The Child and Adolescent Trauma Screen: A Psychometric Review

Background and Purpose: Validated measures of trauma symptoms are imperative to gauge the level of clinical interventions needed and assist researchers in developing effective interventions for individuals affected by such experiences. A recent review found that current trauma screens are lacking in psychometric evidence (Eklund et al., 2018).The Child and Adolescent Trauma Screen (CATS; Sascher et al., 2017) is a measure that is used in clinical and research samples of children due to its availability at no-cost, brevity, and measurement of both exposure and trauma symptomology. This systematic review examines the CATS psychometric properties across 13 empirical studies.

Methods:The electronic search was conducted between August and December 2019 in the database PsychINFO, as well as in databases within Web of Science and ProQuest. Finally, articles were obtained via reference harvesting utilizing ‘‘Cited by’’ link in Google Scholar to identify grey literature citing the original psychometric study of the CATS (Sachser et al., 2017). Search terms included: “Child and Adolescent Trauma Screen”. From the initial 88 studies identified for review, Covidence identified 44 duplicates, 15 were excluded during the title and abstract screening, and 16 were excluded during the full-text review, leaving 13 publications for the review.

Results:The sample sizes ranged from fourteen to 10,157 youths. Participants ranged in ages from 6 to 18 years on self-report and 3 to 6 years for the parent preschool-report. Seven of the twelve (58.3%) studies were with asylum-seeking or refugee youth. The studies reviewed reported excellent reliability, with one study reporting fair reliability for the self-report scale (α= .73 to .93). The caregiver-report also showed excellent reliability, with one study reporting fair reliability (α=.75 to .94). Two studies reported on the symptoms subscale, which had good to excellent reliability in their samples (Symptom subscale α=.765; α= 0.93). Although only examined in one study, the CATS demonstrated good test-retest reliability (r=.70; p<.001). The original psychometric study examined inter-rater reliability using intraclass correlations (ICC) in a U.S. sample and a Norway sample, yielding fair ICC for the U.S sample (ICC=.58; 95%CI: .44-.69), and excellent ICC in the Norway sample (ICC=.75; 95%CI: .54-.86). Four studies utilized professional translators or utilization of forward-backward translation into participants’ respective languages, resulting in lower reliability in comparison to the original psychometric studies.

Conclusions and Implications:The review synthesized literature on the psychometric properties of CATS. The current literature demonstrates the support for use of the measure in research and practice with children. The CATS has been utilized in various populations, internationally, and has shown moderate to strong validity and reliability in measuring trauma exposure and symptomology. However, future research should examine the preschool-report form in various populations. Only two studies have sought to explore explicitly the psychometric properties of CATS (Sascher et al., 2017; 2018), yielding a need for more research into the exploration of its reliability and validity within varying populations and ages. Additionally, more research should be conducted exploring the efficacy of the translated versions of CATS with different populations.