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CDE Detailed Report
This report contains detailed information about the selected CDEs.
Note: If at least one CDE was selected from a copyright- or trademark-protected instrument/scale then all of the CDEs from that instrument/scale are included in this report.
Disease: Sport Related Concussion
SubDisease: Comprehensive
Sub-Domain: Mood/Anxiety
CRF: UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Item count: 127 (127 distinct CDEs)
CDE ID
CDE Name
Variable Name
Definition / Description
Question Text
Permissible Value
Description
Data Type
Instructions
References
Population
Classification (e.g., Core)
Version #
Version Date
Aliases for Variable Name
CRF Module / Guideline
© or TM
Sub-Domain
Domain
Previous Title
Size
Input Restrictions
Min Value
Max Value
Measurement Type
LOINC ID
SNOMED
caDSR ID
CDISC ID
C55077
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Injury accidental serious indicator
UCLAPTSDRIDSM5InjryAccdlSrsind
Indicator of whether the subject/participant has ever been in or seen an accident in which someone could have been hurt or killed, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Serious Accidental Injury: Have you ever been in a bad accident (like a serious car, bus, train or bicycle accident or a bad fall) where you or someone else was or could have been badly hurt or killed? Have you ever seen a bad accident where someone was badly hurt or killed?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55078
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Illness medical trauma indicator
UCLAPTSDRIDSM5IllnsMdclTrmaInd
Indicator of whether the subject/participant has ever been or seen someone so sick that the subject/participant feared the sick person might die, or has ever had a fearful or painful medical treatment, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Illness/Medical Trauma: Have you ever been so sick that you and your parents (or people taking care of you) were scared that you might die? Did you have a medical treatment that was very scary or painful? Did you ever see someone you really care about get so sick that you were scared they might die?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55079
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Violence community witness fear indicator
UCLAPTSDRIDSM5VcCtyWtnsFearInd
Indicator of whether the subject/participant has ever witnessed or feared violence in his or her neighborhood, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Community Violence: Did you ever see a bad fight or shooting in your neighborhood, like between gangs? Were you afraid of getting badly hurt or killed? Have you seen someone mugged, robbed, stabbed or killed in your neighborhood?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55080
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Violence domestic witness indicator
UCLAPTSDRIDSM5VlncDmstWitnsInd
Indicator of whether the subject/participant has ever witnessed violence, or verbal or sexual abuse, between resident adults at home, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Domestic Violence: Have you ever seen adults you live with get in a bad fight with each other, where someone got punched, kicked or hit with something? Have adults you live with threatened to hurt each other? Have you ever seen an adult you live with forced to do something sexual by another adult you live with?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55081
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - School violence emergency indicator
UCLAPTSDRIDSM5SchlVlncEmgcyInd
Indicator of whether the subject/participant has ever been involved in or present for violence or an emergency at school, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
School Violence/Emergency: Were you ever at school when something really scary happened, like a shooting, a stabbing, a fire, where you or someone got badly beaten up or someone attempted or committed suicide?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55082
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Assault physical suffer witness indicator
UCLAPTSDRIDSM5AsltPhySfrWtsInd
Indicator of whether the subject/participant has ever been badly hurt by someone who is or was not a member of his or her family, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Physical Assault: Have you ever been badly physically hurt (punched, kicked, stabbed, shaken) by someone outside of your family or who was not taking care of you? Have you ever been badly hurt (punched, kicked, stabbed) by someone outside your family, like someone in your neighborhood or a stranger?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55083
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Disaster involve witness present indicator
UCLAPTSDRIDSM5DstrInvWtsPstInd
Indicator of whether the subject/participant has ever been involved in, witness to, or present for a natural disaster or significant industrial accident, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Disaster: Have you ever been in a natural disaster, like a hurricane, tornado, earthquake, flood or wildfire where you were hurt or could have been hurt or killed? Have you been in a natural disaster where you saw someone badly hurt or killed? Have you been in a place where there was a chemical spill or explosion?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55084
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Abuse sexual suffer witness indicator
UCLAPTSDRIDSM5AbsSxlSfrWtsInd
Indicator of whether the subject/participant has ever been subjected to or witnessed sexual abuse, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Sexual Abuse: Did someone who was taking care of you ever force you to do something sexual? Did someone taking care of you ever make you watch something sexual?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55085
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Abuse physical suffer witness indicator
UCLAPTSDRIDSM5AbsPhySfrWtsInd
Indicator of whether the subject/participant has ever been subjected to or witnessed severe physical child abuse by a family member or caregiver, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Physical Abuse: Have you ever been badly hurt (punched, kicked, stabbed, shaken) by someone who is in your family or was taking care of you? Have you seen another child in your family being badly physically hurt by a parent, caregiver or legal guardian?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55086
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Neglect suffer indicator
UCLAPTSDRIDSM5NeglctSuffrInd
Indicator of whether the subject/participant has ever been neglected by an unimpaired caregiver or other adult responsible for him or her, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Neglect: Has there ever been a time when someone who should have been taking care of you didn’t , like they didn’t take you to a doctor when you were really sick, they left you alone for too long, didn’t make sure you were going to school or didn’t do their best to keep you healthy or safe?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55087
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Abuse psychological emotional suffer indicator
UCLAPTSDRIDSM5AbsPsyEmoSfrInd
Indicator of whether the subject/participant has ever suffered psychological maltreatment or emotional abuse at home or by his or her family, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Psychological Maltreatment/Emotional Abuse: Did anyone in your family ever keep telling you that you are no good, keep yelling at you or keep threatening to or send you away? Were you often punished at home in ways that felt very unfair?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55088
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Caregiver impaired indicator
UCLAPTSDRIDSM5CrgvrImprdInd
Indicator of whether the subject/participant has ever been dependent upon someone who was unable to care for him or her, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Impaired Caregiver: Was there ever a time when someone who was supposed to take care of you couldn’t , like they were too sick, they were so sad they stayed in bed or they had a drinking or drug problem?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55089
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Rape assault sexual suffer witness indicator
UCLAPTSDRIDSM5RpAstSxSfrWtsInd
Indicator of whether the subject/participant has ever suffered or witnessed rape or other sexual assault by a non-family, non-resident adult, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Sexual Assault/Rape: Did someone outside your family ever force you to do something sexual? Did you ever see someone else being forced to do something sexual?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55090
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Kidnap abduct suffer indicator
UCLAPTSDRIDSM5KnpAbdctSfrInd
Indicator of whether the subject/participant has ever been kidnapped or abducted, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Kidnapping/Abduction: Have you ever been stolen or kidnapped (taken somewhere against your will) by someone without the permission of your parent or legal guardian?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55091
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Terrorism present for indicator
UCLAPTSDRIDSM5TerismPsntFrInd
Indicator of whether the subject/participant was ever present for an act of terrorism, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Terrorism: Were you ever there when a terrorist attack happened, like a bombing, chemical attack or where people were taken hostage?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55092
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bereavement indicator
UCLAPTSDRIDSM5BereavmntInd
Indicator of whether the subject/participant has ever had someone to whom he or she was close die, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Bereavement: Has someone you really cared about ever died?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55093
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Separation familiar responsible adult indicator
UCLAPTSDRIDSM5SepFamRspAdtInd
Indicator of whether the subject/participant has ever been separated from a familiar adult who was responsible for him or her, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Separation: Were you ever separated for a long time from someone you depend on, like a parent went to jail or was hospitalized, or you were placed in foster care?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55094
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - War violence political presence witness indicator
UCLAPTSDRIDSM5WrVcPolPscWtsInd
Indicator of whether the subject/participant has ever lived in a country experiencing, or seen someone injured or killed in, war or political violence, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
War/Political Violence: Have you lived in a country where a war or armed conflict was happening (like soldiers or armed groups were fighting)? Did you see people who had been badly hurt or killed in a war or armed conflict?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55095
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Displacement forced suffer indicator
UCLAPTSDRIDSM5DsplcmtFrcSfrInd
Indicator of whether the subject/participant has ever been forcibly displaced from his or her residence by war, violence, or disaster, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Forced Displacement: Have you ever been forced to move out of your house due to war, armed conflict or disaster, like having to move to a trailer or refugee camp?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55097
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Traffic exploit sexual suffer indicator
UCLAPTSDRIDSM5TrfcExptSxSfrInd
Indicator of whether the subject/participant has ever been trafficked or exploited for labor or sex, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Trafficking/Sexual Exploitation: Have you ever done sexual things for money, food, clothes or protection? Were you ever sold to someone to work for them? Have you been forced into prostitution or pornography?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55096
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bully suffer peer indicator
UCLAPTSDRIDSM5BulySfrPeerInd
Indicator of whether the subject/participant has ever been bullied by a peer, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Bullying: Has someone your age or a student at your school ever bullied you, like kept calling you dirty names, making sexual comments, threatening to beat you up or spreading mean rumors around school or online?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55098
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Suicide attempt indicator
UCLAPTSDRIDSM5SuicdAtmptInd
Indicator of whether the subject/participant has ever attempted suicide, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Attempted Suicide: Have you ever tried to kill yourself?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55099
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Suicide witness indicator
UCLAPTSDRIDSM5SuicdWtnsInd
Indicator of whether the subject/participant has ever seen someone after that person attempted or committed suicide, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Witnessed Suicide: Have you ever seen someone after he/she attempted or committed suicide?
True;False;
True;False;
Alphanumeric
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I’m going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55100
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type
UCLAPTSDRIDSM5TraumaDetailTyp
The type of trauma experienced by the subject/participant for which details are being provided, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Trauma Type
Serious Accidental Injury;Illness/Medical Trauma;Community Violence;Domestic Violence;School Violence/Emergency;Physical Assault;Disaster;Sexual abuse;Physical abuse;Neglect;Psychological Maltreatment/Emotional Abuse;Impaired Caregiver;Sexual Assault/Rape;Kidnapping/Abduction;Terrorism;Bereavement;Separation;War/Political Violence;Forced Displacement;Trafficking/Sexual Exploitation;Bullying;Attempted Suicide;Witnessed Suicide;
Serious Accidental Injury;Illness/Medical Trauma;Community Violence;Domestic Violence;School Violence/Emergency;Physical Assault;Disaster;Sexual abuse;Physical abuse;Neglect;Psychological Maltreatment/Emotional Abuse;Impaired Caregiver;Sexual Assault/Rape;Kidnapping/Abduction;Terrorism;Bereavement;Separation;War/Political Violence;Forced Displacement;Trafficking/Sexual Exploitation;Bullying;Attempted Suicide;Witnessed Suicide;
Alphanumeric
TRAUMA/LOSS DETAILS: For each experience endorsed on the Trauma/Loss History Screening Questions form, place a check mark to indicate whether the specified trauma details were present, whether the child/adolescent was a victim, witness or learned about* the trauma, and the age(s) over which the trauma occurred. (Both of these forms may be updated over the course of treatment as additional information about trauma history is revealed or as additional traumas occur.) *Learned about only refers to indirect exposure in learning aversive details of violent personal assault, homicide, suicide, serious accident, or serious injury to a close relative or friend. It does not include learning about death due to natural causes.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C55101
UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma event role type
UCLAPTSDRIDSM5TrmaEvntRolTyp
Type specifying the degree of involvement of the subject/participant with the traumatic event type specified in 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type', as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5)
Role in Event
Victim;Witness;Learned about;
Victim;Witness;Learned about;
Alphanumeric
TRAUMA/LOSS DETAILS: For each experience endorsed on the Trauma/Loss History Screening Questions form, place a check mark to indicate whether the specified trauma details were present, whether the child/adolescent was a victim, witness or learned about* the trauma, and the age(s) over which the trauma occurred. (Both of these forms may be updated over the course of treatment as additional information about trauma history is revealed or as additional traumas occur.) *Learned about only refers to indirect exposure in learning aversive details of violent personal assault, homicide, suicide, serious accident, or serious injury to a close relative or friend. It does not include learning about death due to natural causes.
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los
Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.
2004;6:96–100.
Pediatric
Exploratory
1.0
4/20/2017
Aliases for variable name not defined
UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5)
Mood/Anxiety
Outcomes and End Points
  
Multiple Pre-Defined Values Selected
       
12-15-2018
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