CDE Detailed Report
Subdomain Name: Mood/Anxiety
CRF: content
Displaying 1 - 50 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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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| 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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| 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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| 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 | ||||||||
| 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 |
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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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| C55138 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bereavement trauma detail relationship type | UCLAPTSDRIDSM5BrvmtTrDtlRlnTyp | The type field for identifying details about the subject/participant's relationship with the decedent related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Bereavement, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details about the subject/participant's relationship with the decedent related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Bereavement, as part of the UCLA PTSD Reaction Index DSM | Deceased | Parent;Sibling;Friend;Other;Other relative | Parent;Sibling;Friend;Other;Other relative | 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 15:47:21.0 | 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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| C55184 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Reactive physical reminder frequency past month grade | UCLAPTSDRIDSM5RaPhRdFqPsMGrade | Grade of frequency during the past month that the subject/participant has experienced physical reactivity 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 physical reactivity 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 have strong feelings in my body like my heart beats fast, my head aches or my stomach aches. | 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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| 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) | 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? | 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 11:38:12.0 | 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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| C55236 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Impairment functional peer relationship symptom cause indicator | UCLAPTSDRIDSM5ImpFncPRSyCsInd | Indicator of whether the subject/participant's PTSD symptoms cause functional impairment in his or her peer relationships, 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 in his or her peer relationships, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Peer Relationships | False;True | False;True | Alphanumeric |
check if youth endorses #1 [UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom increase difficulty make get along friend 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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| C55149 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bully trauma detail type | UCLAPTSDRIDSM5BullyTrDtlTyp | The type field for details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Bullying, 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 Bullying, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Bullying Trauma Details | Verbal insults;Threats of physical harm;Sexual comments;Rumors at school/internet;Other | Verbal insults;Threats of physical harm;Sexual comments;Rumors at school/internet;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 08:56:54.0 | 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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| C55201 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Startle reaction heighten frequency past month grade | UCLAPTSDRIDSM5StRcHifFqPMGrade | Grade of frequency during the past month that the subject/participant has had a heightened startle reaction, 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 a heightened startle reaction, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I feel jumpy or startle easily, like when I hear a loud noise or when something surprises me. | 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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| C55112 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Violence community trauma detail type | UCLAPTSDRIDSM5VlcCmtyTrmDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Community Violence, 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 Community Violence, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Community Violence Trauma Details | Robbery;Mugging;Killed;Gang-Related;High Crime Community;Drug Traffic;Other | Robbery;Mugging;Killed;Gang-Related;High Crime Community;Drug Traffic;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 13:53:49.0 | 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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| C55248 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - DSM-5 PTSD diagnosis status | UCLAPTSDRIDSM5DSM5PTSDDgnsStat | Status(es) of DSM-5 PTSD diagnosis, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Status(es) of DSM-5 PTSD diagnosis, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | DSM-5 PTSD Diagnosis | B;C;D;E;F;G;One or more dissociative symptoms present | One or more Category B symptoms present;One or more Category C symptoms present;Two or more Category D symptoms present;Two or more Category E symptoms present;Symptom duration greater than one month;Symptoms cause clinically significant distress or impairment;One or more dissociative symptoms present | Alphanumeric |
If symptom score is 3 or 4, then score symptom as "present." For question #4, #10, and #26; use a rating of 2 or more for symptom presence. Then determine whether one or more B symptoms are present; whether one or more C symptoms are present; whether two or more D symptoms are present; and whether two or more E symptoms are present. If one or more Dissociative Symptoms are present, then assign Dissociative Subtype. |
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 15:17:35.0 | 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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| C55162 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Reminder physical avoid frequency past month grade | UCLAPTSDRIDSM5RdPhAvFqPsMGrade | Grade of frequency during the past month that the subject/participant has avoided physical reminders of the trauma or 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 avoided physical reminders of the trauma or loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I try to stay away from people, places, or things that remind me 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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| 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) | 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? | 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 10:50:21.0 | 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 |
||||||||
| C55226 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom cause trouble home indicator | UCLAPTSDRIDSM5SmCsTrblHmInd | Indicator of whether the subject/participant's PTSD symptom(s) cause him or her to get in trouble 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) cause him or her to get in trouble at home, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Do these reactions (thoughts and feelings) get you into trouble 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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| C55128 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Abuse psychological emotional trauma detail type | UCLAPTSDRIDSM5AbsPsyEmTrDtTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Psychological Maltreatment/Emotional 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 Psychological Maltreatment/Emotional Abuse, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Psychological Maltreatment/Emotional Abuse Trauma Details | Berating/humiliating;Threatened abandonment;Excessive punishment;Other | Berating/humiliating;Threatened abandonment;Excessive punishment;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 14:56:23.0 | 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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| C55139 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bereavement trauma detail death reason | UCLAPTSDRIDSM5BrvmtTrDtlDthRsn | The type field for identifying details about the cause of death related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Bereavement, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details about the cause of death related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Bereavement, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Cause of Death | Natural Causes;Natural disaster;Accident;Homicide;Suicide;Other | Natural Causes (illness, age);Natural disaster;Accident (car, drowning);Homicide;Suicide;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 15:51:34.0 | 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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| C55188 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Blame other exaggerated frequency past month grade | UCLAPTSDRIDSM5BlOrExFqPsMGrade | Grade of frequency during the past month that the subject/participant has exagerratedly blamed others for 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 exagerratedly blamed others for the trauma/loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I am mad with someone for making the bad thing happen, not doing more to stop it, or to help after | 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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| 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) | 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? | 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 11:40:46.0 | 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 |
||||||||
| C55237 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom increase difficulty do important thing peer indicator | UCLAPTSDRIDSM5SyInDfDoITPInd | Indicator of whether the subject/participant's PTSD symptom(s) cause(s) him or her difficulty in doing important things that his or her peers are doing, 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) cause(s) him or her difficulty in doing important things that his or her peers are doing, 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 do important things that other kids your age are doing? | No;Yes | No;Yes | Alphanumeric |
Clinician: Check whether the reactions (thoughts and feelings) above appear to cause clinically significant distress or functional impairment.s |
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 14:25:18.0 | 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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| C55150 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bully trauma detail other text | UCLAPTSDRIDSM5BullyTrDtlOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bully 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) - Bully trauma detail type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Bullying 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 | 2017-04-21 09:03:18.0 | 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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| C55202 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Affect negative fear frequency past month grade | UCLAPTSDRIDSM5AfNgFrFqPMGrade | Grade of frequency during the past month that the subject/participant has felt fearful, 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 fearful, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I feel afraid or scared | 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 |
||||||||
| C55114 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Violence domestic trauma detail type | UCLAPTSDRIDSM5VcDomTrmDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Domestic Violence, 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 Domestic Violence, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Domestic Violence Trauma Details | Witnessed bad fight;Witnessed sexual assault;Threatened harm;Weapon Used;Serious Injury;Report Filed | Witnessed bad fight;Witnessed sexual assault;Threatened harm;Weapon Used;Serious Injury;Report Filed | 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 14:01:19.0 | 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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| C55163 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Flashback frequency past month grade | UCLAPTSDRIDSM5FlshbFqPsMoGrade | Grade of frequency during the past month that the subject/participant has had flashbacks of the trauma or 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 had flashbacks of the trauma or loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I feel like I am back at the time when the bad thing happened, like it's happening all over again. | 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 |
||||||||
| 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) | 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? | 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 11:00:54.0 | 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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| C55227 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom cause other problem home indicator | UCLAPTSDRIDSM5SmCsOthPbHmInd | Indicator of whether the subject/participant's PTSD symptom(s) cause problems other than getting into trouble or difficulty getting along 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) cause problems other than getting into trouble or difficulty getting along at home, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Do these reactions (thoughts and feelings) cause some other problem 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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| C55129 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Abuse psychological emotional trauma detail other text | UCLAPTSDRIDSM5AbsPsyEmTrDtlOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Abuse psychological emotional trauma detail type' specifying Psychological Maltreatment/Emotional Abuse, 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) - Abuse psychological emotional trauma detail type' specifying Psychological Maltreatment/Emotional Abuse, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM- | Psychological Maltreatment/Emotional Abuse 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 15:00:04.0 | 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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| C55140 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bereavement trauma detail death cause other text | UCLAPTSDRIDSM5BvmtTrDtDthCsOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bereavement trauma detail death 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) - Bereavement trauma detail death reason' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Cause of Death 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 15:56:31.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points | 50 |
Free-Form Entry |
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| C55189 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Irritable aggressive frequency past month grade | UCLAPTSDRIDSM5IrAgFqPsMoGrade | Grade of frequency during the past month that the subject/participant has been irritable or aggressive, 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 irritable or aggressive, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I get upset easily or get into arguments or physical fights | 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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| 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) | 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? | 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 11:43:30.0 | 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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| C55238 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom cause developmental progress other problem indicator | UCLAPTSDRIDSM5SyCsDvPgOtPrInd | Indicator of whether the subject/participant's PTSD symptom(s) cause(s) problems of developmental progression other than difficulty in doing important things that his or her peers are doing, 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 problems of developmental progression other than difficulty in doing important things that his or her peers are doing, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Other | No;Yes | No;Yes | Alphanumeric |
Clinician: Check whether the reactions (thoughts and feelings) above appear to cause clinically significant distress or functional impairment.s |
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 14:25:18.0 | 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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| C55151 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Suicide attempt trauma detail method type | UCLAPTSDRIDSM5ScdAtTrDtlMthTyp | The type field for details of method related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Attempted Suicide, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for details of method related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Attempted Suicide, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Method | Drug;Hanging;Drowning;Firearm;Other | Drug;Hanging;Drowning;Firearm;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 09:14:21.0 | 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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| 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) | 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? | 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 09:43:11.0 | 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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| C55203 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Behavior risky frequency past month grade | UCLAPTSDRIDSM5BhvRskFqPMGrade | Grade of frequency during the past month that the subject/participant has engaged in risky behavior, 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 engaged in risky behavior, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I do risky or unsafe things that could really hurt me or someone else. | 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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| C55117 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - School violence emergency trauma detail type | UCLAPTSDRIDSM5SchVcEmTrDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying School Violence/Emergency, 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 School Violence/Emergency, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | School Violence/Emergency Trauma Details | Shooting;Stabbing;Fire;Suicide;Bomb threat;Assault;Other | Shooting;Stabbing;Fire;Suicide;Bomb threat;Assault;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 14:07:44.0 | 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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| C55164 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Affect negative disgust frequency past month grade | UCLAPTSDRIDSM5AfNgDgFqPsMGrade | Grade of frequency during the past month that the subject/participant has felt disgust about the trauma or 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 felt disgust about the trauma or loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I feel like what happened was sickening or gross | 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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| 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) | 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? | 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 11:04:24.0 | 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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| C55228 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom cause problem home describe text | UCLAPTSDRIDSM5SymCsPrbHmDscTxt | The free-text field for describing problems at home 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 home 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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| C55130 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Caregiver impaired trauma detail impairment type | UCLAPTSDRIDSM5CrgvImTrDtIptTyp | The type field for identifying details of the impairement related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Impaired Caregiver, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details of the impairement related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Impaired Caregiver, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Impairment Due to | Medical illness;Mental health problem;Alcohol use/abuse/addiction;Drug use/abuse/addiction | Medical illness;Mental health problem;Alcohol use/abuse/addiction;Drug use/abuse/addiction | 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 15:02:04.0 | 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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| C55141 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Separation trauma detail cause type | UCLAPTSDRIDSM5SepTrmDtlCsTyp | The type field for identifying causal details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Separation, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying causal details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Separation, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Cause of Separation | Parents divorced;Parents separated;Parent deported;Parent hospitalized;Parent/sibling incarcerated;Child placed in foster care;As refugee, separated from relatives/close friends in country of origin;Other | Parents divorced;Parents separated;Parent deported;Parent hospitalized;Parent/sibling incarcerated;Child placed in foster care;As refugee, separated from relatives/close friends in country of origin;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 15:58:50.0 | 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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| C55191 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Negative assumption self frequency past month grade | UCLAPTSDRIDSM5NgAsSfFqPsMGrade | Grade of frequency during the past month that the subject/participant has made overly negative assumptions 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 made overly negative assumptions about him or herself, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I have thoughts like 'I will never be able to trust other people.' | 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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| 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) | 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? | 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 11:45:21.0 | 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 |
