> ## Documentation Index > Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt > Use this file to discover all available pages before exploring further. # CPSS-5 — scoring and PTSD cutoffs for children > How to score the Child PTSD Symptom Scale for ages 8 to 18, the severity cutoff, and how it maps to DSM-5 PTSD criteria. The CPSS-5 is the dominant pediatric self-report PTSD measure. It maps DSM-5 PTSD the same way the PCL-5 does for adults, but the wording is calibrated for ages 8-18 and the response anchors translate frequency to terms kids actually use ("once a week or less," "4-5 times a week"). If you do Trauma-Focused CBT, child or adolescent EMDR, or any pediatric trauma work, this is the screener and outcome measure that fits the developmental level. ## What it measures DSM-5 PTSD severity in children and adolescents, organized into the same four diagnostic clusters as the PCL-5 plus a functional impairment block: * **Cluster B — Intrusion (items 1-5).** Memories, dreams, flashbacks, upset reactions, physical reactions. * **Cluster C — Avoidance (items 6-7).** Avoiding internal and external reminders. * **Cluster D — Cognition and Mood (items 8-14).** Amnesia, negative beliefs, self-blame, negative emotions, anhedonia, detachment, numbing. * **Cluster E — Arousal and Reactivity (items 15-20).** Irritability, risk-taking, hypervigilance, startle, concentration, sleep. * **Functional impairment (items 21-27).** School, friends, family, fun activities, daily routines, behavior with family, behavior in general. The items reference "the event." Before administering, name the index trauma with the child in conversation — the instructional prompt references "the upsetting experience your therapist has already talked about with you." ## When to use it * **Pediatric trauma assessment** when PTSD is part of the differential. * **Pre/post Trauma-Focused CBT** (TF-CBT) and similar pediatric protocols. * **Treatment response monitoring** every 2-4 weeks during active trauma work. * **Outcome documentation at discharge.** ## How clients fill it out Twenty-seven items rated 0-4. The frequency anchors are written for kids: 0 (Not at all), 1 (Once a week or less / once in a while), 2 (2-3 times a week / half the time), 3 (4-5 times a week / almost always), 4 (6 or more times a week / almost always). Reading level is grade 5 — most 8-year-olds can complete with light support. Younger children or those with reading difficulties: read the items aloud and let the child point or say the number. Five to ten minutes. ## Scoring and severity cutoffs ### Symptom severity (items 1-20) Sum of the 20 symptom items. Range 0-80. | Total | Band | | ----- | -------------------------------------------- | | 0-10 | Minimal | | 11-20 | Mild | | 21-30 | Moderate | | 31-80 | Severe — probable PTSD (Foa 2018 cutoff ≥31) | A total of **31 or higher** is the cutoff for probable PTSD (Foa et al. 2018). ### DSM-5 cluster subscales The four clusters and the functional impairment block surface as separate subscales on the result: | Subscale | Items | | ------------------------------ | ----- | | Cluster B — Intrusion | 1-5 | | Cluster C — Avoidance | 6-7 | | Cluster D — Cognition/Mood | 8-14 | | Cluster E — Arousal/Reactivity | 15-20 | | Functional impairment | 21-27 | The strict DSM-5 algorithm for a child is: cluster B ≥1 item rated ≥1, C ≥1 item ≥1, D ≥2 items ≥1, E ≥2 items ≥1, plus ≥1 functional impairment item ≥1. Inspect per-item responses when you need the strict algorithm — the total ≥31 cutoff is the primary screening flag. ## Sensitive items Several items live in inherently sensitive territory: * **Item 9** — negative beliefs about self / world. * **Item 10** — self-blame. * **Item 16** — risk behaviors, including unprotected sex. The whole instrument is in a trauma context — every item presumes a known traumatic event the child has discussed with you. Frame and debrief accordingly. ## Risk flagging The CPSS-5 doesn't include a suicide item, but item 16 (risk behaviors) and the trauma context warrant pairing with the adolescent-appropriate suicide assessment in your jurisdiction (C-SSRS is one option) at intake and at any inflection point. ## CPSS-5 vs PCL-5 Same DSM-5 criteria, different age. The CPSS-5 is the version written for ages 8 to 18, in language a child can answer honestly, and it adds seven items on how the symptoms interfere with school, friendships and home. The [PCL-5](/clinical-templates/screening/pcl-5) was validated in adults. For anyone in the 8–18 range the CPSS-5 is the instrument. The overlap at the top of that range is a judgment call — a seventeen-year-old in adult services may be better served by the PCL-5 if that's the measure the rest of their file uses, and the scores are not interchangeable either way. ## Is it free to use? **Yes.** Free clinical use, per the Center for the Treatment and Study of Anxiety at UPenn. ## Citation Foa, E. B., Asnaani, A., Zang, Y., Capaldi, S., & Yeh, R. (2018). "Psychometrics of the Child PTSD Symptom Scale for DSM-5 for trauma-exposed children and adolescents." *Journal of Clinical Child & Adolescent Psychology,* 47(1): 38-46. Free clinical use per the University of Pennsylvania Center for the Treatment and Study of Anxiety. Verbatim canonical wording. ## When not to use it * **The client is an adult.** Use the PCL-5 or, for ICD-11, the ITQ. * **The trauma history hasn't been established.** Name the index event in conversation first. * **The child is under 8.** The CPSS-5 is validated 8-18. Pre-school trauma assessment is a clinician-administered space — CPSS-5 self-report isn't the right fit. ## Related articles The adult DSM-5 PTSD counterpart. The ICD-11 measure — adults only. How a template flows from picker to session note.