CATS3-6

Child and Adolescent Trauma Screen (CATS)

Caregiver Report (Ages 3-6)
Child's Name
Caregiver Name
Date

MonthDayYear
Date

Stressful or scary events happen to many children. Below is a list of stressful and scary events that sometimes happen. Mark YES if it happened to the child to the best of your knowledge. Mark NO of it didn't happen to the child.

	Yes	No
Serious natural disaster like a flood, tornado, hurricane, earthquake, or fire.
Serious accident or injury like a car/bike crash, dog bite, sports injury.
Robbed by threat, force or weapon.
Slapped, punched, or beat up in the family.
Slapped, punched, or beat up by someone not in the family.
Seeing someone in the family get slapped, punched or beat up.
Seeing someone in the community get slapped, punched or beat up.
Someone older touching his/her private parts when they shouldn't.
Someone forcing or pressuring sex, or when s/he couldn't say no.
Someone close to the child dying suddenly or violently.
Attacked, stabbed, shot at or hurt badly.
Seeing someone attacked, stabbed, shot at, hurt badly or killed.
Stressful or scary medical procedure.
Being around war.
Other stressful or scary event?

Describe any stressful or scary events.
Which of the above is bothering the child most?

Mark 0, 1, 2 or 3 for how often the child has had the following thoughts, feelings, or problems in the last four weeks: 0 = Never / 1 = Sometimes / 2 = Often / 3 = Almost always

	0	1	2	3
Upsetting thoughts or images about a stressful event. Or re-enacting a stressful event in play.
Bad dreams related to a stressful event.
Acting, playing or feeling as if a stressful event is happening right now.
Feeling very emotionally upset when reminded of a stressful event.
Strong physical reactions when reminded of a stressful event
(sweating, heart beating fast).
Trying not to remember, talk about or have feelings about a stressful event.
Avoiding activities, people, places or things that are reminders of a stressful event. Increase in negative emotional states (afraid, angry, guilty, ashamed, confusion).
Losing interest in activities s/he enjoyed before a stressful event. Including not playing as much.
Acting socially withdrawn.
Reduction in showing positive feelings (being happy, having loving feelings).
Being irritable. Or having angry outbursts without a good reason and taking it out on other people or things.
Being overly alert or on guard.
Being jumpy or easily startled.
Problems with concentration.
Trouble falling or staying asleep.

Total Sum

Please mark YES or NO if the problems you marked interfered with:

	Yes	No
Getting along with others
Hobbies/Fun
School or work
Family relationships
General happiness

	Absent	Present	First Onset (MM/DD/YYYY)	Frequency	Latest Onset (MM/DD/YYYY)
Accident or crash with automobile, plane or boat.
Attacked by an animal.
Man-made disasters (fires, war, etc)
Natural disasters (hurricane, tornado, flood)
Hospitalization or invasive medical procedures
Physical abuse
Sexual abuse, sexual assault, or rape
Accidental burning
Near drowning
Witnessed another person being beaten, raped, threatened with serious harm, shot at seriously wounded, or killed.
Kidnapped
Other traumatic event

	Not At All	Once a week or less/once in a while	2 to 4 times a week/half the time	5 or more times a week/almost always	Everyday
Does your child have intrusive memories of the trauma? Does s/he bring it up on his/her own?
Does your child re-enact the trauma in play with dolls or toys? This would be scenes that look just like the trauma. Or does s/he act it out by him/herself or with other kids?
Is your child having more nightmares since the trauma(s) occurred?
Does your child act like the traumatic event is happening to him/her again, even when it isn't? This is where a child is acting like they are back in the traumatic event and aren't in touch with reality. This is a pretty obvious thing when it happens.
Since the trauma(s) has s/he had episodes when s/he seems to freeze? You may have tried to snap him/her out of it but s/he was unresponsive.
Does s/he get upset when exposed to reminders of the event(s)?
Does your child get physically distressed when exposed to reminders? Like heart racing, shaking hands, sweaty, short of breath, or sick to his/her stomach?"
Does your child try to avoid conversations that might remind him/her of the trauma(s)?
Does your child try to avoid things or places that remind him/her of the trauma(s)?
Does your child have difficulty remembering the whole incident? Has s/he blocked out the entire event?
Has s/he lost interest in doing things that s/he used to like to do since the trauma(s)?
Since the trauma(s), does your child show a restricted range of emotions on his/her face compared to before?
Has your child lost hope for the future? For example, s/he believes will not have fun tomorrow, or will never be good at anything.
Since the trauma(s) has your child become more distant and detached from family members, relatives, or friends?
Has s/he had a hard time falling asleep or staying asleep since the trauma(s)?
Has your child become more irritable, or had outbursts of anger, or developed extreme temper tantrums since the trauma(s)?
Has your child had more trouble concentrating since the trauma(s)?
Has s/he been more "on the alert" for bad things to happen? For example, does s/he look around for danger?
Does your child startle more easily than before the trauma(s)? For example, if there's a loud noise or someone sneaks up behind him/her, does s/he jump or seem startled?
Has your child become more physically aggressive since the trauma(s)? Like hitting, kicking, biting, or breaking things.
Has s/he become more clingy to you since the trauma(s)?
Did night terrors start or get worse after the trauma(s)? Night terrors are different from nightmares: in night terrors a child usually screams in their sleep, they don't wake up, and they don't remember it the next day.
Since the trauma(s), has your child lost previously acquired skills?
Since the trauma(s), has your child developed any new fears about things that don't seem related to the trauma(s)? What about going to the bathroom alone? Or, being afraid of the dark?

	Not At All	Once a week or less/once in a while	2 to 4 times a week/half the time	5 or more times a week/almost always	Everyday
Do (symptoms) substantially "get in the way" of how s/he gets along with you, interfere in your relationship, or make you feel upset or annoyed?
Do these (symptoms) “get in the way" of how s/he gets along with brothers or sisters, and make them feel upset or annoyed?
Do these (symptoms) "get in the way" with the teacher or the class more than average?
Do (symptoms) "get in the way" of how s/he gets along with friends at all - at daycare, school, or in your neighborhood?
Do (symptoms) make it harder for you to take him/her out in public than it would be with an average child?" Is it harder to go out with your child to places like the grocery store? Or to a restaurant?
Do you think that these behaviors cause your child to feel upset?

	Not At All	A Little	Some	A Lot
I was bothered by things that usually don't bother me.
I did not feel like eating, I wasn't very hungry.
I wasn't able to feel happy, even when my family or friends tried to help me feel better.
I felt like I was just as good as other kids.
I felt like I couldn't pay attention to what I was doing.
I felt down and unhappy.
I felt like I was too tired to do things.
I felt like something good was going to happen.
I felt like things I did before didn't work out right.
I felt scared.
I didn't sleep as well as I usually sleep.
I was happy.
I was more quiet than usual.
I felt lonely, like I didn't have any friends.
I felt like kids I know were not friendly or that they didn't want to be with me.
I had a good time.
I felt like crying.
I felt sad.
I felt people didn't like me.
It was hard to get started doing things.

	0	1	2
Child does not remember of denies traumatic or painful experiences thatare know to have occurred.
Child goes into a daze or trance-like state at times or often appears "spaced-out." Teachers may report that he or she "daydreams" frequently in school
Child shows rapid changes in personality. He or she may go from being shy to being outgoing, from feminine to masculine, from timid to aggressive.
Child is unusually forgetful or confused about things that he or she should know, e.g. may forget the names of friends, teachers or other important people, loses possessions or gets easily lost.
Child has a very poor sense of time. He or she loses track of time, may think that it is morning when it is actually afternoon, gets confused about what day it is, or becomes confused about when something has happened.
Child shows marked day-to-day or even hour-to-hour variations in his or her skills, knowledge, food preferences, athletic abilities, e.g. changes in handwriting, memory for previously learned information such as multiplication tables, spelling, use of tools or artistic ability.
Child shows rapid regressions in age-level behavior, e.g. a twelve-year- old starts to use baby-talk sucks thumb or draws like a four-year old.
Child has a difficult time learning from experience, e.g. explanations, normal discipline or punishment do not change his or her behavior.
Child continues to lie or deny misbehavior even when the evidence is obvious.
Child refers to himself or herself in the third person (.g. as she or her) when talking about self, or at times insists on being called by a different name. He or she may also claim that things that he or she did actually happened to another person.
Child has rapidly changing physical complaints such as headache or upset stomach. For example, he or she may complain of a headache one minute and seem to forget about it the next.
Child is unusually sexually precocious and may attempt age-inappropriate sexual behaviour with other children or adults.
Child suffers from unexplained injuries or may even deliberately injure self at times.
Child reports hearing voices that talk to him or her. The voices may be friendly or angry and may come form "imaginary companions" or sound like the voices of parents, friends or teachers.
Child has a vivid imaginary companion or companions. Child may insist that the imaginary companion(s) is responsible for things that he or she has done.
Child has intense outbursts of anger, often without apparent cause and may display unusual physical strength during these episodes.
Child sleepwalks frequently.
Child has unusual nighttime experiences, e.g. may report seeing "ghosts" or that things happen at night that he or she can't account for (e.g. broken toys, unexplained injuries).
Child frequently talks to him or herself, may use a different voice or argue with self at times.
Child has two or more distinct and separate personalities that take control over the child's behavior.

Child and Adolescent Trauma Screen (CATS)

TRAUMATIC EVENTS SCREENING INVENTORY- PARENT REPORT REVISED

YOUNG CHILD PTSD CHECKLIST (YCPC)

Center for Epidemiological Studies Depression Scale for Children (CES-DC)

Child Dissociative Checklist (CDC), Version 3