Scribd
Upload
747 views2 pages

ITQ CA PTSD CPTSD Trauma - Form

The document is an International Trauma Questionnaire for children and adolescents (ITQ-CA) that assesses symptoms related to post-traumatic stress disorder (PTSD) and complex PTSD. It contains 22 questions about problems commonly experienced after stressful or traumatic events, such as bad dreams, intrusive thoughts, avoidance behaviors, hypervigilance, and changes in beliefs and feelings. Respondents indicate how much each problem has bothered them in the past month on a 5-point scale. The questionnaire also asks if any problems have interfered with relationships, school, activities, or happiness.

Uploaded by

Saurav Das
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
747 views2 pages

ITQ CA PTSD CPTSD Trauma - Form

The document is an International Trauma Questionnaire for children and adolescents (ITQ-CA) that assesses symptoms related to post-traumatic stress disorder (PTSD) and complex PTSD. It contains 22 questions about problems commonly experienced after stressful or traumatic events, such as bad dreams, intrusive thoughts, avoidance behaviors, hypervigilance, and changes in beliefs and feelings. Respondents indicate how much each problem has bothered them in the past month on a 5-point scale. The questionnaire also asks if any problems have interfered with relationships, school, activities, or happiness.

Uploaded by

Saurav Das
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

NovoPsych

International Trauma Questionnaire – Child and Adolescent


Version (ITQ-CA)
Instructions:
Below are problems people can have after an upsetting or a stressful event. Thinking about that event,
select how much the following things have bothered you in the PAST MONTH.

Never A little bit Sometimes A lot Almost Always

1 Bad dreams reminding me of what happened. 0 1 2 3 4

Pictures in my head of what happened. Feels like it is


2
happening right now.
0 1 2 3 4

Trying not to think about what happened. Or to not


3
have feelings about it.
0 1 2 3 4

Staying away from anything that reminds me of what


4
happened (people, places, things, situations, talks).
0 1 2 3 4

Being overly careful (checking to see who is around


5
me).
0 1 2 3 4

6 Being jumpy. 0 1 2 3 4

Yes No

Have any of the above problems interfered with


7
getting along with friends?
1 0

8 Have they interfered with getting along with family? 1 0

9 Have they interfered with your school work? 1 0

Have they interfered with anything else that is


10
important to you (hobbies, other relationships)?
1 0

11 Have they interfered with your general happiness? 1 0

Never A little bit Sometimes A lot Almost Always


Below are problems people report after traumatic or stressful events. They are about how you feel,
what you believe about yourselves and others. Select how much the following things have bothered
12 you in the past month. 0 1 2 3 4
Having trouble calming down when I am upset (angry, scared or sad).

Not being able to have any feelings or feeling empty


13
inside.
0 1 2 3 4

14 Feeling like a failure. 0 1 2 3 4

Page 1 of 2
NovoPsych

Never A little bit Sometimes A lot Almost Always

15 Thinking I am not a good person. 0 1 2 3 4

16 Not feeling close to other people. 0 1 2 3 4

17 Having a hard time staying close to other people. 0 1 2 3 4

Yes No

Have any of the above problems interfered with


18
getting along with friends?
1 0

19 Have they interfered with getting along with family? 1 0

20 Have they interfered with your schoolwork? 1 0

Have they interfered with anything else that is


21
important to you (hobbies, other relationships)?
1 0

22 Have they interfered with your general happiness? 1 0

Developer Reference:
Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., ... Hyland, P. (2018). The
International Trauma Questionnaire: Development of a self-report measure of ICD-11 PTSD and complex
PTSD. Acta psychiatrica Scandinavica, 138(6), 536–546.

Page 2 of 2

Powered by TCPDF (www.tcpdf.org)

You might also like