CDE Detailed Report
Subdomain Name: Mood/Anxiety
CRF: UCLA PTSD Reaction Index for Children
Displaying 51 - 100 of 127
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Question Text | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C55123 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Disaster trauma detail type | UCLAPTSDRIDSM5DsastrTrmaDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Disaster, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Disaster, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Disaster Trauma Details | Earthquake;Fire;Flood;Hurricane;Tornado;Chemical spill;Explosion;Other;Lost Home;Injured | Earthquake;Fire;Flood;Hurricane;Tornado;Chemical spill;Explosion;Other;Lost Home;Injured | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 14:22:46.0 | 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 |
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| C55155 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma loss single type | UCLAPTSDRIDSM5TrmaLossSglTyp | The type of trauma to which the subject/participant was exposed if he or she was only exposed to one type, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type of trauma to which the subject/participant was exposed if he or she was only exposed to one type, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | If only one trauma/loss type is endorsed above, write in the trauma/loss type in this blank | Serious Accidental Injury;Community Violence;Domestic Violence;War/Political Violence;School Violence/Emergency;Physical Assault;Sexual Assault/Rape;Disaster;Physical abuse;Psychological Maltreatment/Emotional Abuse;Neglect;Sexual abuse;Impaired Caregiver;Kidnapping/Abduction;Terrorism;Bereavement;Separation;Forced Displacement;Trafficking/Sexual Exploitation;Bullying;Attempted Suicide;Witnessed Suicide;Illness/Medical Trauma | Serious Accidental Injury;Community Violence;Domestic Violence;War/Political Violence;School Violence/Emergency;Physical Assault;Sexual Assault/Rape;Disaster;Physical abuse;Psychological Maltreatment/Emotional Abuse;Neglect;Sexual abuse;Impaired Caregiver;Kidnapping/Abduction;Terrorism;Bereavement;Separation;Forced Displacement;Trafficking/Sexual Exploitation;Bullying;Attempted Suicide;Witnessed Suicide;Illness/Medical Trauma | Alphanumeric | Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:36:29.0 | 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 |
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| 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) | 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? | False;True | False;True | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 11:25:59.0 | 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 |
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| C55232 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom cause problem school describe text | UCLAPTSDRIDSM5SymCsPrbScDscTxt | The free-text field for describing problems at school caused by the subject/participant's PTSD symptoms, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field for describing problems at school caused by the subject/participant's PTSD symptoms, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Describe | Alphanumeric |
Clinician: Check whether the reactions (thoughts and feelings) above appear to cause clinically significant distress or functional impairment. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 13:30:05.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55134 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Rape assault sexual trauma detail other text | UCLAPTSDRIDSM5RpAstSxTrDtOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Rape assault sexual trauma detail type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Rape assault sexual trauma detail type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Sexual Assault/Rape Trauma Details Other | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 15:33:13.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points | 30 |
Free-Form Entry |
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| C55175 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Nightmare frequency past month grade | UCLAPTSDRIDSM5NghtmrFqPsMGrade | Grade of frequency during the past month that the subject/participant has had nightmares, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has had nightmares, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I have bad dreams about what happened, or other bad dreams | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | 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 |
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| C55197 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Behavior self harm frequency past month grade | UCLAPTSDRIDSM5BhSfHmFqPsMGrade | Grade of frequency during the past month that the subject/participant has harmed him or herself, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has harmed him or herself, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I hurt myself on purpose | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | 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 |
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| C55103 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma type experience age category | UCLAPTSDRIDSM5TrmaTypExpAgCat | Category(ies) of the age(s) selected in 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma type experience age value', as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Category(ies) of the age(s) selected in 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma type experience age value', as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Age(s) Experienced | 1–5 years;6–12 years;13–18 years | 1–5 years (blue);6–12 years (green);13–18 years (red) | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 12:25:43.0 | 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 |
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| C55244 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - DSM-5 symptom code high score | UCLAPTSDRIDSM5DSM5SymCdHiScore | Highest individual score among all symptoms belonging to the DSM-5 symptom code selected in 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - DSM-5 symptom code', as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Highest individual score among all symptoms belonging to the DSM-5 symptom code selected in 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - DSM-5 symptom code', as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Score (0-4) | 0;1;2;3;4 | 0;1;2;3;4 | Numeric Values |
indicate highest score only for DSM-5 Symptom D2; indicate highest score only for DSM-5 Symptom D3; indicate highest score only for DSM-5 Symptom D4; indicate highest score only for DSM-5 Symptom E2 |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 14:56:20.0 | 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 |
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| C55145 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Displacement forced trauma detail reason other text | UCLAPTSDRIDSM5DpcFcTrDtRsnOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Displacement forced trauma detail reason' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Displacement forced trauma detail reason' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Cause of Displacement Other | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 08:37:38.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points | 30 |
Free-Form Entry |
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| 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) | 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? | False;True | False;True | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 10:29:23.0 | 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 |
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| C55209 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Derealization unreality frequency past month grade | UCLAPTSDRIDSM5DrlUrlFqPMGrade | Grade of frequency during the past month that the subject/participant has experienced derealization via feelings of unreality, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has experienced derealization via feelings of unreality, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I feel like things around me are not real, like I am in a dream. | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | 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 |
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| C55124 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Disaster trauma detail other text | UCLAPTSDRIDSM5DstrTrmDtlOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Disaster trauma detail type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Disaster trauma detail type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Disaster Trauma Details Other | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 14:35:41.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points | 30 |
Free-Form Entry |
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| C55156 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma loss most bothersome type | UCLAPTSDRIDSM5TrLsMstBthrTyp | The type of trauma or loss that most bothers the subject/participant at the present time if he or she has experienced more than one trauma or loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type of trauma or loss that most bothers the subject/participant at the present time if he or she has experienced more than one trauma or loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | If more than one trauma/loss type is endorsed, have the child/adolescent choose the trauma/loss experience that BOTHERS THEM THE MOST NOW and identify that trauma/loss type in this blank | Serious Accidental Injury;Community Violence;Domestic Violence;War/Political Violence;School Violence/Emergency;Physical Assault;Sexual Assault/Rape;Disaster;Physical abuse;Psychological Maltreatment/Emotional Abuse;Neglect;Sexual abuse;Impaired Caregiver;Kidnapping/Abduction;Terrorism;Bereavement;Separation;Forced Displacement;Trafficking/Sexual Exploitation;Bullying;Attempted Suicide;Witnessed Suicide;Illness/Medical Trauma | Serious Accidental Injury;Community Violence;Domestic Violence;War/Political Violence;School Violence/Emergency;Physical Assault;Sexual Assault/Rape;Disaster;Physical abuse;Psychological Maltreatment/Emotional Abuse;Neglect;Sexual abuse;Impaired Caregiver;Kidnapping/Abduction;Terrorism;Bereavement;Separation;Forced Displacement;Trafficking/Sexual Exploitation;Bullying;Attempted Suicide;Witnessed Suicide;Illness/Medical Trauma | Alphanumeric | Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:40:53.0 | 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 |
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| 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) | 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? | False;True | False;True | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 11:28:27.0 | 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 |
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| C55233 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Impairment functional school symptom cause indicator | UCLAPTSDRIDSM5ImpFncScSyCsInd | Indicator of whether the subject/participant's PTSD symptoms cause functional impairment at school, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant's PTSD symptoms cause functional impairment at school, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | School | False;True | False;True | Alphanumeric |
check if youth endorses #1 [UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom increase difficulty do well school indicator] or #2 [UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom cause problem other school indicator] below |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 13:33:01.0 | 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 |
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| C55135 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Kidnap abduct trauma detail perpetrator type | UCLAPTSDRIDSM5KnpAbdcTrmDtlTyp | The type field for identifying details about the perpetrator related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Kidnapping/Abduction, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details about the perpetrator related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Kidnapping/Abduction, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Perpetrator | Relative;Position of trust;Acquaintance;Stranger;Other | Relative;Position of trust (teacher, coach, minister);Acquaintance (neighbor etc);Stranger;Other | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 15:35:30.0 | 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 |
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| C55177 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Distress emotional reminder frequency past month grade | UCLAPTSDRIDSM5DsEmRdFqPsMGrade | Grade of frequency during the past month that the subject/participant has experienced emotional distress in response to reminders of the trauma/loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has experienced emotional distress in response to reminders of the trauma/loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | When something reminds me of what happened I get very upset, afraid, or sad | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | 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 |
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| C55198 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Sleep difficult frequency past month grade | UCLAPTSDRIDSM5SlpDfcFqPsMGrade | Grade of frequency during the past month that the subject/participant has had difficulty sleeping, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has had difficulty sleeping, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I have trouble going to sleep, wake up often, or have trouble getting back to sleep. | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | 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 |
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| C55104 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Serious accidental injury trauma detail type | UCLAPTSDRIDSM5SrsAcIjTrmDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Serious Accidental Injury, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Serious Accidental Injury, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Serious Accidental Injury Trauma Details | Motor vehicle;Fall;Dog bite;Hospitalized;Other | Motor vehicle;Fall;Dog bite;Hospitalized;Other | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 12:34:26.0 | 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 |
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| C55245 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - DSM-5 symptom category | UCLAPTSDRIDSM5DSM5SymptomCat | Category of DSM-5 symptom code scores being summed, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Category of DSM-5 symptom code scores being summed, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Symptom Category | B;C;D;E | B;C;D;E | Alphanumeric | Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 15:04:24.0 | 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 |
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| C55146 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Displacement forced trauma detail location | UCLAPTSDRIDSM5DpcFcTrDtlLoc | The type field for details about the site of displacement related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Forced Displacement, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for details about the site of displacement related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Forced Displacement, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Site of Displacement | Trailer;Refugee camp;Relocation center;Other | Trailer;Refugee camp;Relocation center;Other | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 08:40:03.0 | 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 |
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| 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) | 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? | False;True | False;True | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 10:39:55.0 | 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 |
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| C55210 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom bother upset subject participant indicator | UCLAPTSDRIDSM5SxBthUpsSjPtInd | Indicator of whether the subject/participant's symptoms of PTSD bother him or herself, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant's symptoms of PTSD bother him or herself, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Do these reactions (thoughts and feelings) bother or upset you a lot? | No;Yes | No;Yes | Alphanumeric |
Clinician: Check whether the reactions (thoughts and feelings) above appear to cause clinically significant distress or functional impairment. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 12:13:43.0 | 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 |
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| C55125 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Abuse sexual trauma detail type | UCLAPTSDRIDSM5AbsSxlTrmDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Sexual Abuse, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Sexual Abuse, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Sexual Abuse Trauma Details | Forced sexual behavior;Watch something sexual;Penetration occurred;CPS report filed;Investigation conducted;Charges filed;Conviction;Perpetrator removed from home | Forced sexual behavior;Watch something sexual;Penetration occurred;CPS report filed;Investigation conducted;Charges filed;Conviction;Perpetrator removed from home | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 14:38:13.0 | 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 |
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| C55158 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma loss most bothersome describe text | UCLAPTSDRIDSM5TrLsMstBthDscTxt | The free-text field for describing the type of trauma or loss that most bothers the subject/participant currently (if more than one type experienced), or that the he or she experienced (if only one experienced), as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field for describing the type of trauma or loss that most bothers the subject/participant currently (if more than one type experienced), or that the he or she experienced (if only one experienced), as part of the UCLA PTSD Reaction Index DSM | Clinician: Provide a brief description of the trauma/loss type that is most bothersome now | Alphanumeric | Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:48:22.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points | 4000 |
Free-Form Entry |
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| 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) | 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? | False;True | False;True | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 11:32:37.0 | 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 |
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| C55234 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom increase difficulty make get along friend indicator | UCLAPTSDRIDSM5SyInDfMkGAFrInd | Indicator of whether the subject/participant's PTSD symptom(s) increase(s) the difficulty he or she has in making or getting along with friends, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant's PTSD symptom(s) increase(s) the difficulty he or she has in making or getting along with friends, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Do these reactions (thoughts and feelings) make it harder for you to get along with your friends or make new friends? | No;Yes | No;Yes | Alphanumeric |
Clinician: Check whether the reactions (thoughts and feelings) above appear to cause clinically significant distress or functional impairment. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 13:38:45.0 | 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 |
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| C55136 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Terrorism trauma detail type | UCLAPTSDRIDSM5TerismTrDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Terrorism, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Terrorism, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Terrorism Trauma Details | Shooting;Suicide bombing;Bombing;Biological agent;Chemical agent;Radiological agent;Hostages taken;Other | Shooting;Suicide bombing;Bombing (package, vehicle);Biological agent;Chemical agent;Radiological agent;Hostages taken;Other | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 15:40:48.0 | 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 |
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| C55179 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Affect positive difficult experience frequency past month grade | UCLAPTSDRIDSM5AfPDExFqPsMGrade | Grade of frequency during the past month that the subject/participant has had difficulty experiencing positive affect, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has had difficulty experiencing positive affect, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I have trouble feeling happiness or love | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | 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 |
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| C55199 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Affect negative self frequency past month grade | UCLAPTSDRIDSM5AfNgSfFqPsMGrade | Grade of frequency during the past month that the subject/participant has had negative affect about him or herself, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has had negative affect about him or herself, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I feel ashamed or guilty about some part of what happened | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | 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 |
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| C55105 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Illness medical trauma detail person type | UCLAPTSDRIDSM5IlMdTrDtlPsnTyp | The type field for identifying the person involved in the trauma, related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Illness/Medical Trauma, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying the person involved in the trauma, related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Illness/Medical Trauma, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Illness/Medical Trauma Trauma Details | Self;Family;Friend | Self;Family;Friend | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 12:34:26.0 | 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 |
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| C55246 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - DSM-5 symptom category total score | UCLAPTSDRIDSM5DSM5SyCaTotScore | Total score of all DSM-5 symptom code high scores for the DSM-5 symptom category selected in 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - DSM-5 symptom category', as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Total score of all DSM-5 symptom code high scores for the DSM-5 symptom category selected in 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - DSM-5 symptom category', as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Symptom Category Summative Score | Numeric Values |
Category B Total: Sum scores for symptoms B1-B5; Category C Total: Sum scores for symptoms C1 and C2; Category D Total: Sum scores for symptoms D1-D7; Category E Total: Sum scores for symptoms E1-E6 |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 15:09:10.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Free-Form Entry |
0 | 28 | ||||||||
| C55147 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Displacement forced trauma detail location other text | UCLAPTSDRIDSM5DpcFcTrDtlLocOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Displacement forced trauma detail location' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Displacement forced trauma detail location' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Site of Displacement Other | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 08:44:07.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points | 30 |
Free-Form Entry |
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| 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) | 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? | False;True | False;True | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 10:43:50.0 | 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 |
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| C55211 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Distress clinically significant indicator | UCLAPTSDRIDSM5DstrsClnSigInd | Indicator of whether the subject/participant's distress over symptoms of PTSD is clinically significant, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant's distress over symptoms of PTSD is clinically significant, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Clinically Significant Distress | False;True | False;True | Alphanumeric |
check if youth endorses #1 [UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom bother upset subject participant indicator] below |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 12:16:54.0 | 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 |
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| C55126 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Abuse physical trauma detail type | UCLAPTSDRIDSM5AbsPhyTrmDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Physical Abuse, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Physical Abuse, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Physical Abuse Trauma Details | Punched;Kicked;Stabbed;Shaken;Weapon Used;Reported to CPS;Reported to police;Badly physically hurt | Punched;Kicked;Stabbed;Shaken;Weapon Used;Reported to CPS (if a minor);Reported to police;Badly physically hurt | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 14:46:58.0 | 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 |
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| C55159 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Hypervigilant frequency past month grade | UCLAPTSDRIDSM5HpvgFrqPsMoGrade | Grade of frequency during the past month that the subject/participant has felt hypervigilant, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has felt hypervigilant, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I am on the lookout for danger or things that I am afraid of (like looking over my shoulder even when nothing is there). | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | 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 |
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| 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) | 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? | False;True | False;True | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 11:35:58.0 | 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 |
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| C55235 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom cause difficulty make get along friend describe text | UCLAPTSDRIDSM5SyCsDfMGAFrDsTxt | The free-text field for describing difficulty making or getting along with friends caused by the subject/participant's PTSD symptoms, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field for describing difficulty making or getting along with friends caused by the subject/participant's PTSD symptoms, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Describe | Alphanumeric |
Clinician: Check whether the reactions (thoughts and feelings) above appear to cause clinically significant distress or functional impairment. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 13:30:05.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55137 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Terrorism trauma detail other text | UCLAPTSDRIDSM5TerismTrDtlOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Terrorism trauma detail type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Terrorism trauma detail type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Terrorism Trauma Details Other | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 15:45:17.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points | 30 |
Free-Form Entry |
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| C55182 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Avoid thought feel trauma loss try frequency past month grade | UCLAPTSDRIDSM5ATFTLTFqPsMGrade | Grade of frequency during the past month that the subject/participant has shown avoidance of trauma/loss-related thoughts or feelings, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has shown avoidance of trauma/loss-related thoughts or feelings, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I try not to think or have feelings about what happened. | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | 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 |
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| C55200 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Unable recall important part trauma loss frequency past month grade | UCLAPTSDRIDSM5URIPTLfFqPMGrade | Grade of frequency during the past month that the subject/participant has been unable to recall important parts of the trauma/loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has been unable to recall important parts of the trauma/loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I have trouble remembering important parts of what happened | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | 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 |
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| C55107 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Illness medical trauma detail type text | UCLAPTSDRIDSM5IlMdTrDtlTypTxt | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Illness/Medical Trauma, for describing the type of illness or medical trauma, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Illness/Medical Trauma, for describing the type of illness or trauma, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Type | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 12:34:26.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points | 30 |
Free-Form Entry |
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| C55247 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Total scale score | UCLAPTSDRIDSM5TotalScaleScore | Total score for the UCLA PTSD Reaction Index DSM-5, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Total score for the UCLA PTSD Reaction Index DSM-5, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | PTSD-RI Total Scale Score | Numeric Values |
PTSD-RI Total Scale Score: Sum Category B, C, D, and E |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 15:14:12.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Free-Form Entry |
0 | 40 | ||||||||
| C55148 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Traffic exploit sexual trauma detail type | UCLAPTSDRIDSM5TrfExpSxTrDtlTyp | The type field for details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Trafficking/Sexual Exploitation, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Trafficking/Sexual Exploitation, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Trafficking/Sexual Exploitation Trauma Details | Sex for money, food, clothes;Pornography;Sold into prostitution;Sold into slave labor;Other | Sex for money, food, clothes;Pornography;Sold into prostitution;Sold into slave labor (unpaid servant or worker);Other | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 08:51:39.0 | 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 |
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| 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) | 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? | False;True | False;True | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 10:46:10.0 | 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 |
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| C55225 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom cause difficulty get along home indicator | UCLAPTSDRIDSM5SmCsDfGtAlHmInd | Indicator of whether the subject/participant's PTSD symptom(s) make it difficult for him or her to get along with people at home, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant's PTSD symptom(s) make it difficult for him or her to get along with people at home, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Do these reactions (thoughts and feelings) make it harder for you to get along with people at home? | No;Yes | No;Yes | Alphanumeric |
Clinician: Check whether the reactions (thoughts and feelings) above appear to cause clinically significant distress or functional impairment. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 13:20:54.0 | 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 |
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| C55127 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Neglect trauma detail type | UCLAPTSDRIDSM5NglctTrmDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Neglect, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Neglect, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Neglect Trauma Details | Medical;Left alone/unsupervised;School;Failure to promote health;Failure to promote safety;Other;Reported to CPS;Child removed from home;Caregiver removed from home | Medical (did not take to Dr.);Left alone/unsupervised;School;Failure to promote health;Failure to promote safety;Other;Reported to CPS (if a minor);Child removed from home;Caregiver removed from home | 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<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 14:51:26.0 | 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 |
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| C55161 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Thought self negative frequency past month grade | UCLAPTSDRIDSM5ThSfNgFPMGrade | Grade of frequency during the past month that the subject/participant has had overly negative thoughts about him or herself, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has had self-disparaging thoughts, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I have thoughts like 'I am bad.' | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | 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 |
