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CRTES-R - Child's Reaction to Traumatic Events Scale-Revised

A 23-item self-report measure designed to assess psychological responses to stressful life events. The measure is based on the Horowitz Impact of Events Scale and was initially modified to assess Intrusion and Avoidance symptoms based on DSM-III-R criteria. The scale was recently modified to include assessment of Arousal and to update the items with regard to DSM-IV criteria.




Jones, Russell, T., Ph.D.

Jones, R. T., Fletcher, K., & Ribbe D. R. (2002). Child’s Reaction to Traumatic Events Scale-Revised (CRTES-R): A self-report traumatic stress measure.

Contact Information: 
Domain Assessed: 
Traumatic Stress
Age Range: 
Measure Type: 
General Assessment
Measure Format: 


Number of Items: 
Average Time to Complete (min): 
Reporter Type: 
Average Time to Score (min): 
Children answer items in response to the past 7 days.
Response Format: 

4-point frequency rating scale: 4-point frequency rating scale: 0=not at all, 1=rarely, 3=sometimes, 5=often

Materials Needed: 
Sample Items: 
DomainsScaleSample Items
Total ScoreAvoidanceI tried not to remember.
IntrusionI thought about it when I didn't mean to.
Information Provided: 
Areas of Concern/Risks
Continuous Assessment
Raw Scores


Training to Administer: 
Prior Experience in Psych Testing/Interpretation

Parallel or Alternate Forms

Parallel Forms: 
Alternate Forms: 
Different Age Forms: 
Altered Version Forms: 
Alternative Forms Description: 

The CRTES is based on the Horowitz Impact of Events Scale. The scale, originally called the HIES-C, was revised to make items more appropriate for children. Later revisions were conducted to update the scale with respect to DSM-IV criteria. The difference between the CRTES (15 items), and the
CRTES-Revised (23 items) appears to be the addition of 8 items that assess for Arousal symptoms (consistent with DSM-IV criteria).


Clinical Cutoffs: 
Clinical Cutoffs Description: 

A low distress total score is 0-14; moderate distress,15-27; high distress, 28 and higher (Jones et al., 2003).

Internal ConsistencyAcceptableCronbach's alpha0.860.860.86
Parallel/Alternate Forms
References for Reliability: 

There are no reliability data for the current 23-item CRTES-R. However, given that the difference between this and the earlier CRTES is the addition of 8 items to tap Arousal, it is likely that the scales share reliability at least with regard to Avoidance and Intrusion scales.

Reliability data for the original 15-item CRTES are as follows:
1. Jones, Fletcher, & Ribbe (2003) reported alphas for a sample of 167 children between the ages of 4 and 20 years who had experienced residential fires: Total Scale=.86, Avoidance=.77, Intrusion=.85.

The following reliability data have been reported for the HIES-C:
1. Jones, Ribbe, & Cunningham (1993) reported alphas for a sample of children who had experienced a hurricane: Total Scale=.85, Avoidance=.72, Intrusion=.84.

2. Cunningham, Jones, & Yang (1994) reported alphas for a sample of African-American children living in a high-crime, low-income neighborhood: Total Scale =.73, Avoidance =.73, Intrusion =.68.

Content Validity Evaluated: 
References for Content Validity: 

The CRTES is based on the Horowitz Impact of Events Scale. The scale, originally called the HIES-C, was revised to make items more appropriate for children. Later revisions were conducted to update the scale with respect to DSM-IV criteria. The difference between the CRTES (15 items), and the CRTES-Revised (23 items) appears to be the addition of 8 items that assess for Arousal symptoms (consistent with DSM-IV criteria).

References for Construct Validity: 

This is a relatively new measure that is still under construction, and psychometrics are being gathered within the context of an NIMH-funded study.
For an earlier version of the measure, the authors reported that symptomatology as assessed using the HIES-C was associated with degree of perceived danger

and life threat (Jones, Ribbe, Cunningham, & Weddle, 1993).
Jones et al. (2003): Data collected, using the 15-item CRTES with 167 children who had experienced residential fires, were subjected to a principle axis factor analysis with a varimax rotation followed by a promax rotation revealed.

The analyses revealed the presence of 2 factors based on a screen plot. Factors accounted for 46.54% of the variance and were labeled as follows: 1) Intrusion (35.49% of variance), and 2) Avoidance (11.04% of the variance). The authors reasoned that lower variance may have been found for Avoidance due to the difficulty children have in reporting these symptoms. The factor analysis supports the distinction between the avoidance and intrusion scales of the CRTES, although there was considerable overlap of loadings on both factors and two items failed to load on either factor above 0.40.

A higher order factor analysis resulted in a single factor, providing support that the measure assesses a single PTSD dimension. Boys and girls did not differ on their total CRTES scores or on the Avoidance subscale, but girls scored significantly higher than did boys on Intrusion. Child’s age was not correlated with total or subscale scores.

References for Criterion Validity: 

Sensitivity and Specificity were determined through an ROC analysis with total CRTES scores compared to diagnosis based on the DICA. A cutoff of 29 or above for the 15 items was identified as having good Sensitivity (83.3%) and Specificity (70.5%).

Overall Psychometric Limitations: 

1. While earlier versions of the measure have been researched with data showing evidence of reliability, the current version has no published data in peer-reviewed journal articles.
2. As noted above, additional psychometrics are being gathered through an NIMH-funded study.


Translation Quality: 
Language:TranslatedBack TranslatedReliableGood PsychometricsSimilar Factor StructureNorms AvailableMeasure Developed for this Group
1. Spanish Yes

Population Information

Population Used for Measure Development: 

Information regarding the development of the current 23-item CRTES was not available. The 15-item CRTES was used with 167 children aged 4-20 who had experienced residential fires.

Most were aged 8-16; only two were below the age of 6.

Of the 145 for whom gender information was available, 76 (52.4%) were girls and 69 (47.6%) were boys (Jones, Fletcher, & Ribbe, 2003). No other data regarding demographics or SES were available.

Populations with which Measure Has Demonstrated Reliability and Validity: 
Natural Disaster

Pros & Cons/References


1. The measure is based on a well-known measure for assessing PTSD symptomatology in adults.
2. An earlier version has been used with children who have experienced fires. Few other measures have been used for this specific trauma group.
3. Preliminary psychometrics for the 15-item measure are promising with regard to Specificity and Sensitivity.
4. There is a Spanish version of the measure.
5. The measure is free.
6. The measure is brief.


1. The measure has recently been altered to assess for symptoms of Arousal, consistent with the DSM-IV. While this change is potentially useful, additional psychometrics are needed on the reliability and validity of this altered version. In addition, the original version has not been widely used or researched. Research is needed on test-retest reliability and convergent and discriminant validity with other PTSD measures.

2. The measure has not been widely used compared to other trauma symptom measures.

3. The items appear to be asking about symptomatology with regard to one specific event. Although this is a common feature of many trauma questionnaires, this may be problematic for children who have experienced multiple traumas.

4. While the measure is said to be for children aged 6-18, younger children may have difficulty with the wording and with concepts assessed. Research is needed to determine the extent to which younger children comprehend the items and are able to report on these internal experiences using these questions.

Author Comments: 

Since the measure is currently undergoing psychometric evaluation, the author requests that users share their results with his lab. The author provided feedback on this review, which was integrated.


A PsychInfo search (7/05) of "Child's Reaction to Traumatic Events Scale" or “CRTES” anywhere revealed that it has been referenced in 7 peer-reviewed articles. The articles are listed below.

1. Cook-Cottone, C. (2004). Childhood posttraumatic stress disorder: Diagnosis, treatment, and school reintegration. School Psychology Review, 33(1), 127-139.

2. Foa, E.B., Johnson, K.M., Feeny, N.C., & Treadwell, K. R.H. (2001). The child PTSD symptom scale: A preliminary examination of its psychometric properties. Journal of Clinical Child Psychology, 30(3), 376-384.

3. Gurwitch, R.H., Kees, M., & Becker, S.M. (2002). In the face of tragedy: Placing children's reactions to trauma in a new context. Cognitive & Behavioral Practice, 9(4), 286-

4. Ohan, J.L., Myers, K., & Collett, B.R. (2002). Ten-year review of rating scales. IV: Scales assessing trauma and its effects. Journal of the American Academy of Child & Adolescent Psychiatry, 41(12), 1401-1422.

5. Phelps, L.F., McCart, M.R., & Davies, W.H. (2002). The impact of community violence on children and parents: Development of contextual assessments. Trauma Violence & Abuse, 3(3), 194-209.

6. Ruggiero, K.J., Morris, T.L., & Scotti, J.R. (2001). Treatment for children with posttraumatic stress disorder: Current status and future directions. Clinical Psychology: Science & Practice, 8(2), 210-227.

7. Saxe, G., Chawla, N., Stoddard, F., Kassam-Adams, N., Courtney, D., Cunningham, K., et al. (2003). Child stress disorders checklist: A measure of ASD and PTSD in children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(8), 972-978.

Developer of Review: 
Lorinda Ho
Editor of Review: 
Chandra Ghosh Ippen, Ph.D.
Last Updated: 
Wednesday, January 15, 2014