The Child Posttraumatic Stress Disorder Checklist in a Sample of South African Youth Establishing Factorial Validity Friederike Frank-Schultz, MA (Clinical Psychology),* Pamela Naidoo, DPhil,*Þ Karen J. Cloete, PhD,þ and Soraya Seedat, MBChB, FC Psych, PhDþ Abstract: To address the diverse health effects of posttraumatic stress disorder (PTSD) in youth, reliable and valid screening and diagnostic instruments that can be adapted to the specific context in which they are used, are required. Here, we assessed the psychometric properties (factorial validity, concurrent validity, and internal consistency) of the Child PTSD Checklist in treatment-seeking youth using secondary data. The scale demonstrated high internal consistency (Cronbach > = 0.93). Exploratory factor analysis revealed a three-factor structure (anxiety and avoidance, anger and dissociation, and depressive symptoms) that accounted for 41.9% of the total variance. Concurrent validity was fair between the Child PTSD Checklist and the diagnostic Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version when assessing for PTSD. The Child PTSD Checklist seems to be a promising tool for assessing PTSD in trauma-exposed youth in clinic settings. However, further studies are needed to address the checklist’s broader utility. Key Words: Posttraumatic stress disorder, psychometric properties, South Africa, trauma, youth. (J Nerv Ment Dis 2012;200: 692Y698) E pidemiological surveys indicate that posttraumatic stress disorder (PTSD) is one of the most commonly observed psychiatric dis- orders in communities affected by disaster and violence (Galea et al., 2005). It has further been suggested that the lifetime prevalence of PTSD, globally, has been on the increase (Deykin, 1999). Although a multitude of factors may be contributory, the worldwide rise of in- terpersonal violence seems to be a distinct contributing factor (Seedat et al., 2004; Ward et al., 2001). Current rates of PTSD may thus be reflective of violent and dangerous societal living conditions, which, in turn, increase the vulnerability to traumatic event exposure. Given the exceptionally high rates of violent crime in South Africa (SA), it is not surprising that posttraumatic stress symptoms are common in the population (Esterhuyse et al., 2007). In the past, high rates were often attributed to the country’s apartheid struggle and related political vio- lence (Edwards, 2005). However, despite the end of apartheid and ar- rival of democracy, PTSD remains a considerable public health concern. The rates of PTSD in children and adolescents seem to exceed those documented for adults (Esterhuyse et al., 2007; Seedat et al., 2004), with South African youth exposed to high levels of community violence and what has become known as a ‘‘culture of violence’’ (Govender and Killian, 2001). Imperative aspects of intervention and prevention include the availability of accurate measuring instruments, critically important for the identification and treatment of the disorder. Although several screening and diagnostic instruments for PTSD are in use (Suliman et al., 2005), most have originated in the United States. However, because measuring tools are sensitive to administrative, environmental, cultural, and linguistic factors, they must be validated in each new patient population in which they are used. An additional challenge is presented by the diagnosis of PTSD in children and adolescents who often manifest symptoms differently compared with adults (Cohen, 1988; Hawkins and Radcliff, 2006). Furthermore, even though clinically useful instruments are available, many have been criticized on the grounds of their poor diagnostic capability, time- consuming nature, unwieldy format, and lack of established psycho- metric properties (Amaya-Jackson et al., 1995; Lonigan et al., 2002), particularly in cross-cultural samples (Suliman et al., 2005). The Child PTSD Checklist was designed by Amaya-Jackson et al. (1995) to overcome some of the above-mentioned problems. The checklist consists of 28 items and corresponds to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) symptom criteria of PTSD (Amaya-Jackson et al., 1995; American Psychiatric Association, 2000). To date, it has been used in various trauma populations and demonstrates acceptable psychometric prop- erties (Esterhuyse et al., 2007; Lipschitz et al., 2000). In terms of its reliability, satisfactory to excellent results have been obtained in American adolescents (Amaya-Jackson et al., 1995; Lipschitz et al., 2000; Newman and Amaya-Jackson, 1996). Studies have also re- vealed good concurrent and construct validity (Lipschitz et al., 2000; Newman and Amaya-Jackson, 1996). Although the Child PTSD Checklist is a relatively widely used measurement in the South African context, limited research on its psychometric properties has been conducted (Esterhuyse et al., 2007). The only published South African study (Esterhuyse et al., 2007) revealed excellent internal consistency (> = 0.82) in a sample of 186 Venda-speaking and 151 Northern Sotho adolescents, however in- formation on its factorial validity was not reported. The primary aim of this study was to establish the validity of the Child PTSD Checklist with respect to its accuracy in measuring the theoretical constructs of PTSD as specified by the DSM-IV-TR (American Psychiatric Association, 2000). It was hypothesized that the Child PTSD Checklist would maintain the three-factor structure reflective of the three DSM-IV-TR symptom clusters. The PTSD symp- toms clusters proposed by the DSM-IV-TR include persistent reex- periencing, avoidance, and increased arousal (American Psychiatric Association, 2000). In terms of concurrent validity, it was assumed that high levels of agreement would be established between the Child PTSD Checklist, a self-report measure of PTSD, and the Kiddie Sched- ule for Affective Disorders and Schizophrenia, Present and Lifetime ver- sion (K-SADS-PL), a semistructured diagnostic interview that is regarded as the gold standard for diagnosing PTSD. A secondary aim was to evaluate the checklist’s reliability in measuring PTSD symptoms. ORIGINAL ARTICLE 692 www.jonmd.com The Journal of Nervous and Mental Disease & Volume 200, Number 8, August 2012 *Department of Psychology, University of the Western Cape, Bellville; †Population Health, Health Systems and Innovation (PHHSI), Human Sciences Research Council (HSRC), Cape Town, and the University of the Western Cape, Bellville; and ‡Department of Psychiatry, University of Stellenbosch, Tygerberg, South Africa. Send reprint requests to Karen J. Cloete, PhD, University of Stellenbosch, Faculty of Medicine Health Sciences, Department of Psychiatry, PO Box 19063, Tygerberg 7505, South Africa. E-mail: kjc@sun.ac.za. Copyright * 2012 by Lippincott Williams & Wilkins ISSN: 0022-3018/12/20008Y0692 DOI: 10.1097/NMD.0b013e31826140e7 Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.