Childhood Trauma Questionnaire

## **What is childhood trauma?** Children are, sadly, not exactly free from experiencing traumatic events. Children can get traumatized by a wide variety of unfortunate things, including emotional and physical neglect, child abuse/childhood abuse (e.g., physical, psychological, and/or sexual abuse), school shootings, substance use disorder or exposure to people who use substances, war crimes, illnesses, natural disasters, etc. Childhood trauma exposure leads to post-traumatic stress disorder, meaning everything they've suffered (e.g., childhood maltreatment/child physical abuse, loss, natural disasters, etc.) will manifest in various ways as they live, and they influence behavioral patterns, emotions, feelings, loss of interest, declining relationships or difficulties forging bonds, nightmares, and more (The National Child Traumatic Stress Network, 2023). Given that trauma is complex, it's important for mental health professionals to really get into the weeds and find the root of a person's trauma, which could reach as far as the person's childhood experiences. Only by getting to the roots can both the professionals and the client determine what needs to be faced and what treatments they need for them to work through their trauma and heal over time.

## **What is the Childhood Trauma Questionnaire?** The Childhood Trauma Questionnaire is a valuable tool that enables mental healthcare professionals and trauma experts to gain a deeper understanding of their patients, facilitating more effective discussions as they progress through their treatment program. The one we're discussing is the Childhood Trauma Questionnaire - Short Form version. It used to be a seventy-item questionnaire (Bernstein et al, 1997), but this one is the twenty-eight-item version (Bernstein et al., 2003), a more brief screening version. The questions revolve around five different types of childhood trauma/adverse childhood experiences, which are: physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect. Here are some of the items that need to be answered by the patient: - I did not have enough to eat when - I was hit so hard that I had to see a doctor - My parents were too drunk/too high to take care of me - I was punished with a belt, board, cord, or another hard object - My family said hurtful or insulting things to me - Someone molested me - Someone tried to make me do sexual things or watch sexual things - Someone in my family hated me Most of these items are emotionally challenging, so do not be surprised if your patient has a hard time answering this questionnaire. The Childhood Trauma Questionnaire is normally used during a patient's initial assessment. This is when the healthcare professional doesn't know anything about the patient, so to find ways to help them work through their trauma, professionals tend to issue assessments for them to answer to get to know the patient and have them open up. The questionnaire is not just used to get the patient to open up during discussions. This questionnaire is also used when healthcare professionals are at the point where they are supposed to develop a care plan for their patients. This is one of the best times to issue this questionnaire to their patients because the scores they will get will help shape what goes into their respective care plans. So long as the healthcare professional is highly trained in dealing with and caring for patients who have had childhood traumas, as well as those with PTSD, they are more than welcome to use this questionnaire. Psychometricians and researchers can also use fully-accomplished questionnaires to determine the commonalities and outcomes of childhood trauma regarding how people think, act, and what they feel like years after going through traumatic experiences. This can also be used by them to evaluate the efficacy of care plans implemented by professionals. ### **Is this tool reliable?** The Childhood Trauma Questionnaire went through validation studies. A group of researchers used this on a specific clinical population (adolescent psychiatric population) of 398 male and female adolescents (aged 12 to 17) who were admitted to an inpatient psychiatric hospital. These adolescents were given copies of the CTQ to answer as part of a comprehensive examination. Findings were combined with structured interviews with 190 therapists of those who were admitted, data that includes information and ratings about child abuse and neglect, and information gathered from families, other clinicians, and agencies (Bernstein et al., 1997). Through all of these bits of information, they've identified five rotated factors: emotional abuse, emotional neglect, sexual abuse, physical abuse, and physical neglect. Researchers have determined that all these factors had extremely high internal consistency in the clinical and community samples they've assessed. It also had good convergent and discriminant validity, good sensitivity for all forms of maltreatment, and good levels of specificity. Given all of this, it's deemed that the CTQ has great psychometric properties. It is a sensitive, valid, and reliable tool when assessing adolescents for childhood trauma (Bernstein et al., 1997). ### **Why should I use it?** Getting to know the patient is the first step for any healthcare professional focusing on helping patients work through their problems, especially traumas. But that first step may not be easy. Depending on the patient, it might just be a massive mountain to climb, given that traumas and other forms of childhood adversity are not exactly things people are normally willing to discuss. Using assessments such as the Childhood Trauma Questionnaire helps them open up because having them answer assessments is a way to get to know patients, even if you'll only get a simple background of them. The Childhood Trauma Questionnaire can frame discussions with the patient moving forward and get them to elaborate on their traumatic experiences. Just make sure to assure them that everything will be kept confidential, there won't be any judgment, and that you can be trusted.

## **How to use the Childhood Trauma Questionnaire** Please remember that the version of the Childhood Trauma Questionnaire is the Childhood Trauma Questionnaire Short Form (CTQ-SF). ### **Step 1: Administer this questionnaire to your patient** There are two ways to go about administering this questionnaire to your patient: - You can conduct this like an interview during your first appointment with them. If you opt for this, do not expect them to answer. Given that childhood trauma is a difficult subject to talk about, even among close family/friends, it's even more complicated when talking about it to professionals and strangers. Before anything, you have to make them feel they can trust you and that your clinical space is safe for them. - The second choice is to hand them a copy of the questionnaire and have them answer it on time. This gives them the distance, space, and time to think about their childhood traumas and answer accordingly. Just make sure to agree on when you should receive a fully-accomplished questionnaire. ### **Step 2: Accomplish the questionnaire** Now, how do they answer the items? It's simple. They just have to select any one of the following per item: - Never true = 1 - Rarely true = 2 - Sometimes true = 3 - Often true = 4 - Very often true = 5 Some items have the inverse, though. These specific items are Items 2, 5, 7, 13, 19, 26, and 28. So, “Never true” is equal to 5, and “Very often true” is equal to 1. ### **Step 3: Calculate the scores** Once you receive a fully completed questionnaire, it's time for you to calculate the scores. You will be tallying the scores per childhood trauma type, and they are arranged as such: - Physical Abuse: Items 9, 11, 12, 15, and 17 - Emotional Abuse: Items 3, 8, 14, 18, and 25 - Sexual Abuse: Items 20, 21, 23, 24, and 27 - Physical Neglect: Items 1, 2, 4, 6, and 26 - Emotional Neglect: Items 5, 7, 13, 19, and 28 Don't forget the Items with the inverse scoring! Besides those five categories, there is another one called “Minimization/Denial,” which tries to measure if the patient is still positing that their family is great despite having answered items related to family that would say otherwise. For that section, you only need to look at Items 10, 16, and 22. For each of these, if the patient answers “Very often true,” it's equivalent to 1 point. If they picked other answers, then it's equivalent to 0. The maximum score that they can get for Minimization/Denial is 3. As for interpreting the scores, here are the cut-off scores and designations per type:  Just so you know, if the level of abuse is “None” for the particular childhood trauma type, it doesn't mean that they don't have trauma. Always refer to their answers. There might be something there beyond what the number tries to say. Step 4: Determine the next steps based on the scores Once you have calculated the scores, the next step is to determine how you can assist your patient in addressing their childhood traumas. For instance, if they score high in emotional abuse and neglect, you might develop a plan that includes providing relevant worksheets and facilitating discussions aimed at enhancing their emotional regulation skills. Consider incorporating self-esteem exercises based on their scores. It's essential to tailor your care plan specifically to each patient's needs. You can explore our [Care Plan Template](https://www.carepatron.com/templates/care-plan) to further structure and organize your approach. Make sure to consider child health, childhood neglect, potential long-term health consequences of trauma, experiences of clinical samples, experiences of domestic violence/those who are physically abused, student samples, community samples, normative data gathered from other tests, etc. This

## **Other trauma-related tools** Even though the Childhood Trauma Questionnaire has great factor structure and other psychometric properties, it would be best not to rely solely on it. There are other tools you can use to cover more ground and to help you better understand your patient. Here are some that we can provide you: - **[Trauma Symptom Checklist (TSC-40)](https://www.carepatron.com/templates/trauma-symptom-checklist-tsc-40)**: This is a research tool developed by John Briere, Ph.D. and Marsha Runtz, Ph.D. Its purpose is to act as a self-report measure that zooms into symptoms of post-traumatic stress in traumatized patients as a result of childhood or adult experiences. Patients/clients/respondents answering this only need to rate themselves between 0 and 3 per item. - **[Trauma Timeline Worksheet](https://www.carepatron.com/templates/trauma-timeline-worksheet)**: Once you've established trust and rapport with your clients, and they're open to go deeper into the roots of their trauma, you can have them answer the Trauma Timeline Worksheet to help them reflect and recall traumatic experiences and what their emotional and physical reactions were. Being cognizant of these can help both of you uncover how this has shaped them over time. - **[Ranking Your Trauma Symptoms PTSD Worksheet](https://www.carepatron.com/templates/ranking-your-trauma-symptoms-ptsd-worksheets)**: This worksheet helps your clients determine which of their symptoms affect them the most, and the information they can provide through this worksheet can help you determine what to focus on first when developing treatment, management, and intervention plans.

## **References** Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., ... & Zule, W. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child abuse & neglect, 27(2), 169-190. https://doi.org/10.1037/t09716-000 Bernstein, D. P., Ahluvalia, T., Pogge, D., & Handelsman, L. (1997). Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population. Journal of the American Academy of Child & Adolescent Psychiatry, 36(3), 340–348. https://doi.org/10.1097/00004583-199703000-00012 The National Child Traumatic Stress Network. (2023). About child trauma. https://www.nctsn.org/what-is-child-trauma/about-child-trauma