CATS Trauma Screen: Score the Youth and Caregiver Forms

CATS trauma screen

Youth self-report, ages 7 to 17

• Version: Youth self-report on the CATS trauma screen. The ISTSS printing is labeled CATS 7-17. Open the youth form. Do not paste the items into the chart.

• Age band: 7 to 17. At age 6, use the caregiver form for ages 3 to 6 instead.

• Score: Sum symptom items 1 to 20. Each item is 0 (never), 1 (once in a while), 2 (half the time), or 3 (almost always), for the last two weeks. Range 0 to 60. The 15 event items are yes or no. They are not in the total. If none is yes, stop. Do not score a blank symptom page. Five functioning items are yes or no. They are not in the total either.

• Cut-off: 21 or higher is the clinically relevant cut on the ISTSS instrument page. The clinical guide uses the same line for probable PTSD. Under 15 is not clinically elevated. 15 to 20 is moderate trauma-related distress. ISTSS calls 21 a preliminary estimate from an earlier DSM-IV questionnaire.

• Next step: Under 15, a brief review, then validate, normalize, and give anticipatory guidance. At 15 to 20, review with the youth, offer psychoeducation and a coping tip, and offer a trauma-specific treatment if they want it. At 21 or higher, review the result, do a PTSD interview, and offer TF-CBT or another evidence-based trauma-specific treatment. A total is not the diagnosis.

• Chart note: Youth self-report, age 11, last two weeks, total 28 of 0 to 60. At or above 21. Interview owed. Not called PTSD.

Caregiver report, ages 7 to 17

• Version: Caregiver report for the same age band. The ISTSS printing is labeled CATS-C 7-17. Open the caregiver form for ages 7 to 17.

• Age band: 7 to 17. Give this with the youth form when you can. The clinical guide says the pair gives a fuller picture than either form alone.

• Score: Same math as the youth form. Sum symptom items 1 to 20 on the 0 to 3 anchors, last two weeks, range 0 to 60. Event items and the five functioning items stay out of the sum. Do not average this total with the youth total.

• Cut-off: Same bands as the youth form. Under 15, 15 to 20, and 21 or higher. A caregiver total in the moderate band does not pull a youth total of 21 back under the line.

• Next step: Use the same guide steps, and say them to the caregiver as well as the youth. If the two bands disagree, the next step is the interview, not a compromise score. If an endorsed event is current danger at home, review it before they leave. The clinical guide warns that a missed follow-up can leave the child thinking clinicians do not care about their safety.

• Chart note: Caregiver report, age 11, last two weeks, total 18 of 0 to 60. Inside 15 to 20, below 21. Not averaged with the youth total of 28.

Caregiver report, ages 3 to 6

• Version: Caregiver report only. There is no youth self-report in this band. The ISTSS printing is labeled CATS-C 3-6, and the symptom list follows the preschool PTSD criteria. Open the caregiver form for ages 3 to 6.

• Age band: 3 to 6. Do not put a 5-year-old on the 7 to 17 form, and do not put a 7-year-old on this one.

• Score: Sum symptom items 1 to 16. Same 0 to 3 anchors, last two weeks. Range 0 to 48. Fifteen event items, not in the total. Five functioning items, not in the total. One of those functioning items is school or daycare, not school or work.

• Cut-off: The ISTSS page recommends 16 or higher as the clinically relevant cut, range 0 to 48, and calls that cut a preliminary estimate from an earlier questionnaire. The clinical guide bands are different by one point: under 12 is not clinically elevated, 12 to 14 is moderate distress, and 15 or higher is probable PTSD. A total of 15 is below the page cut and inside the guide’s probable band. Write both.

• Next step: Under 12, brief review with the caregiver, then validate and give anticipatory guidance. At 12 to 14, review, psychoeducation, a coping tip, and an offer of trauma-specific treatment if the caregiver wants it. At 15 or higher, interview, and offer TF-CBT or another evidence-based trauma-specific treatment. Do not wait for 16 to book the interview.

• Chart note: Caregiver report, age 5, last two weeks, total 15 of 0 to 48. Guide band 15 or higher, probable. Page cut is 16 or higher. Interview owed. Not called PTSD from the total.

Educational resource for licensed clinicians. A total is not a diagnosis. Match the form to the age, the informant, and the person in front of you.

You already have the numbers. The work is keeping both of them, and not letting a cut finish a diagnosis the interview has not made.

Score the last two weeks, not a past-month total

The CATS trauma screen is a brief measure of potentially traumatic events and of posttraumatic stress symptoms, built to DSM-5. The ISTSS instrument page describes three forms. Youth self-report for ages 7 to 17. Caregiver report for ages 7 to 17. Caregiver report for ages 3 to 6, written to the preschool symptom criteria. Administration is about 15 minutes. There is no copyright or licensing fee. ISTSS names Lutz Goldbeck and Lucy Berliner as the developers. The forms live on that page.

The printed window on each ISTSS form is the last two weeks. A note that says “past month” is a different question. If you changed the stem, write that you did. Do not graph a past-month total on the same line as a last-two-weeks total.

The anchors are the same on all three forms.

Anchor	Label
0	Never
1	Once in a while
2	Half the time
3	Almost always

A 2 is half the time. It is not a separate severity word you invent. Add the symptom items only. The event list is the gate: at least one yes, then the symptom page. Zero yeses, and the assessment stops.

If a referral calls this sheet a CATS trauma screener, score the printing in your hand. A trauma screening questionnaire written for an adult, or any other adult trauma questionnaire, is not this form. PCL-5 score interpretation uses a 0 to 80 past-month total and a different cut. Do not enter a CATS total on that line. Perinatal mental health screening is a different visit. Do not put this total there either.

Use the band that matches the form

The 7 to 17 forms share one range. The preschool form does not. Read the row for the form you actually scored.

Score	Guide label	ISTSS page cut
Under 15	Not clinically elevated	Below 21
15 to 20	Moderate distress	Below 21
21 or higher	Probable PTSD	At or above 21

The preschool caregiver form is a shorter sum, so those bands do not transfer.

Score	Guide label	ISTSS page cut
Under 12	Not clinically elevated	Below 16
12 to 14	Moderate distress	Below 16
15	Probable PTSD	Below 16
16 or higher	Probable PTSD	At or above 16

The ISTSS instrument page states that the page cuts, 21 and 16, are preliminary estimates from an earlier DSM-IV questionnaire. That page reports the international validation as internal consistency from .88 to .94, and a four-cluster structure for the self-report and the caregiver report. Track the total. Do not skip the interview.

The total band and the DSM-5 algorithm are different reads. The clinical guide says a probable call from the algorithm needs the cluster counts on the scoring sheet, plus impairment in at least one of the five functioning items. Follow the sheet that came with the form. Do not rebuild the cluster counts from memory, and write which method you used. A total of 21 with every functioning item marked no is not the same chart line as a total of 21 with school marked yes.

Children with elevated symptoms who do not meet full criteria should still be offered a trauma-focused treatment. The clinical guide says that directly. A moderate band is not a reason to file the form and wait.

If you are still choosing which measure to hand someone, stop and use the scales for mental health matrix. This scoring starts after the CATS is the form in the chart.

Do not average the two informants

For ages 7 to 17, the CATS trauma screen can come back as two different hours. The youth and the caregiver can both be right. A youth who marks school and getting along, and a caregiver who marks nothing, are describing different rooms. Averaging 28 and 18 hides the room the youth just told you about.

Write both totals in one sentence. Write the direction of the gap. Write which functioning items were yes, and who marked them. The next note opens on those two numbers. “Trauma symptoms ongoing” is how a 10-point gap disappears before the interview is even booked.

Ask the questions as a clinical encounter, not as a clipboard you never look at. The clinical guide says that skipping the review can do harm, especially when an event on the list is danger at home. Interview format is the better fit for a younger child, or for a youth who will struggle to read the items. You can still hand the form. Note that you read it aloud if you did.

The guide also states that asking the questions does not by itself cause undue distress, including when you ask before a relationship is established. Distress on a high score is information. It is not a reason to skip the feedback. Validate what they marked, name the band in ordinary words, and tell them what you will do next. Then do that thing.

When the next step is TF-CBT, the sequence is not “start the narrative because the screen was positive.” Coping, psychoeducation, and a caregiver plan come first. That order lives in the TF-CBT guide. A CATS total does not pick the session in which the story gets written.

CATS-2 uses different cuts

If the footer says CATS-2, stop and do not apply the bands above. Sachser and colleagues (2022) validated the Child and Adolescent Trauma Screen 2 for ages 7 to 17, against the CAPS-CA-5, as a measure of DSM-5 PTSD and of ICD-11 PTSD and complex PTSD. On the DSM-5 total, scores of 21 or higher were the efficient screening cut, and scores of 25 or higher were the efficient diagnostic cut. The original guide’s phrase “21 or higher, probable PTSD” is the wrong label for that form.

The same paper reports a separate ICD-11 PTSD scale. On that scale, 7 or higher was the efficient screening cut and 9 or higher the efficient diagnostic cut for detecting probable DSM-5 PTSD on the CAPS-CA-5. Those numbers are not cuts on the 0 to 60 DSM-5 total, and they are not a published ICD-11 diagnosis threshold. Do not treat a 7 on the DSM-5 sum as a positive screen.

CATS-2 is license-free. Score it from the sheet printed on the form you were given. The three ISTSS PDFs are the original CATS, not CATS-2. Ages 3 to 6 stay on the original caregiver form. Do not score a preschool child with a CATS-2 total.

Copy a blank chart line

The filled note above is M.R. These fields are empty so you can write the CATS trauma screen during the hour. Fill them only after you have scored the form in your hand. An empty bracket is not a score.

If a tool drafts the note, you still choose the version, the two totals, and the gap. The clinical documentation workflow can hold the line. It does not decide whether 28 is probable PTSD.

Download the adult trauma worksheets

The adult trauma worksheets are a stabilization pack: consent and pacing, one resource, one stop rule, and a review line. The pack is not the CATS form, and it is not a child measure. Use it when the caregiver needs a sheet of their own between sessions, or when an adult on your caseload needs trauma homework that is not this screen. Keep the official forms on the ISTSS page.

References

• International Society for Traumatic Stress Studies. (n.d.). Child and Adolescent Trauma Screen.
• International Society for Traumatic Stress Studies. (n.d.). Clinical guide for administering the Child and Adolescent Trauma Screen (CATS).
• Sachser, C., Berliner, L., Risch, E., Rosner, R., Birkeland, M. S., Eilers, R., Hafstad, G. S., Pfeiffer, E., Plener, P. L., & Jensen, T. K. (2022). The Child and Adolescent Trauma Screen 2 (CATS-2): Validation of an instrument to measure DSM-5 and ICD-11 PTSD and complex PTSD in children and adolescents. European Journal of Psychotraumatology, 13(2).