Development and initial validation of the Odense Child Trauma Screening: a story stem screening tool for preschool and young schoolchildren

BACKGROUND: Early identification of young children exposed to trauma who are at risk of developing post-trauma symptomatology such as posttraumatic stress disorder (PTSD) or other emotional or behavioral problems is important for allocating appropriate treatment and preventing long-term consequences. However, assessment of young children exposed to trauma is challenging because children may not be able to talk about their trauma or trauma reactions. Story stem tools combine storytelling and play to access the internal world of young children and can be used in the assessment of children exposed to trauma. OBJECTIVE: To examine reliability and validity of a new story stem tool, the Odense Child Trauma Screening (OCTS). OCTS was developed to screen for play-based behavior and narrative representations indicative of traumatization in preschool and young schoolchildren. METHOD: Forty-nine Danish children aged 4.5–8.9 years (M = 6.6, SD = 1.2) participated in the OCTS. Participants included a risk sample of 31 children exposed to traumas and a community sample of 18 children. Caregivers were interviewed about child symptoms of PTSD, major depressive disorder (MDD), and reactive attachment disorder (RAD) and answered the Strengths and Difficulties Questionnaire (SDQ). The community sample completed OCTS test-retests. RESULTS: Interrater reliability proved excellent (ICC = .96-1.00). Test-retest reliability was acceptable (ICC = .66). Significant moderate correlations were found between the OCTS total score and scales of PTSD, MDD and RAD and the SDQ Total Difficulties Scale. The ability of the OCTS to discriminate between children from the risk and community sample was good. CONCLUSIONS: The study provided preliminary evidence of reliability and validity of the OCTS as a screening tool for young children exposed to trauma. OCTS shows promise as a standardized, age-appropriate informant-based screening measure applicable for clinical assessment.