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

THE CHILDREN’S IMPACT OF EVENT SCALE (13)

CRIES-13



The Impact of Events Scale (IES) was originally developed

by Horowitz et al (1979) to monitor the main phenomena

of re-experiencing the traumatic event and of avoidance of

that event and the feelings to which it gave rise. Hence, this

15 item, four-point scale, has two subscales of Intrusion and

Avoidance.

It was not originally designed to be used with children, but

it has been successfully used in a number of studies with

children aged 8 years and older. However, two separate

large scale studies (Yule’s of 334 adolescent survivors of

a shipping disaster, and Dyregrov’s of children in Croatia)

found that a number of items are misinterpreted by children.

These separate studies identied identical factor structures

of the IES and these were used to select eight items that best

reected the underlying factor structure and so produced a

shortened version – the IES-8 for children.

With the dominance of DSM-IV, Weiss and Marmar (1997),

working with adults, added items to reect symptoms of

increased physiological arousal, although Horowitz had

found that these did not form a separate factor. We also

decided to develop 5 items that were designed to reect

the 5 DSM-IV Cluster D symptoms of arousal. Thus the

present version is designed for use with children aged 8

years and above who are able to read independently. It

consists of 4 items measuring Intrusion, 4 items measuring

Avoidance and 5 items measuring Arousal – hence it is

called the CRIES-13.

The development of this instrument has been largely

undertaken by colleagues working under the auspices of

the Children and War Foundation which was established

to support good quality research studies into the effects of

war and disasters on children. Good studies require good,

accessible measures. We are most grateful to Dr Mardi

Horowitz for agreeing to allow us to make this version

freely available to clinicians and researchers through this

web-site.

In making this children’s IES-13 freely available, all we

ask is that those who use it send us copies of their results

so that we can continue to improve the measure for the

benet of children.

We will make available copies of the instrument in

different languages as the scale is properly translated and

back-translated. Any clinician or researcher wishing to

make such a translation should get in touch with us rst in

case a translation is already underway.

Administration

The IES is self completed and can therefore be administered

in groups.

Scoring

There are 8 items that are scored on a four-point scale:

Not at all = 0

Rarely = 1

Sometimes = 3

Often = 5

There are three sub-scales:

Intrusion = sum of items 1+4+8+9

Avoidance = sum of items 2+6+7+10

Arousal = sum of items 3+5+11+12+13

The layout has been designed so that scoring can be easily

done in the three columns on the right hand side. The total

for each sub-scale can be entered at the bottom of each

column.

Evaluation and psychometric status

At this point in time (June 2003), only one published study

has used the 13-item version. Psychometric data relevant

to the reliability and validity of the 8-item version were

presented in Yule (1997). There, it was reported that the

total score on the 8-item IES correlated highly with the total

score on the 15-item version of which it was part (r = +.95,

P <. 001).

The two versions of IES correlated with a symptom

count based on the number of DSM symptoms present

in adolescents following an acute trauma as follows:

15-IES = 0.7551; 8-IES, r = 0.6970. Thus, on this

relatively independent measure, the short form still

correlates very highly and there is not too much attrition

with the shorter scale.

THE CHILDREN’S IMPACT OF EVENT SCALE (13) CRIES-13



In an analysis of the scores of 87 survivors of the sinking of

the Jupiter, it was found that the 62 children who received a

DSM diagnosis of PTSD scored 26.0 on the 8-item version

while the 25 who did not reach DSM criteria for a diagnosis

of PTSD only scored 7.8 (P < 0.001). Using these data, it

was found that a combined score (Intrusion + Avoidance) of

17 or more misclassied fewer than 10% of the children.

The 13-item version was used in a survey of 2,976 children

aged 9-14 years who had experienced the war in Mostar,

Bosnia (Smith, Perrin, Dyregrov and Yule, 2002). The

scale was translated into Bosnian and back-translated by

a separate Bosnian speaker to establish its accuracy. No

major differences were found between boys and girls in

respect of the factors identied and so only the total results

are presented here.

The Scales had satisfactory internal consistency. Cronbach

alphas were as follows:

Intrusion = 0.70; Avoidance = 0.73; Arousal = 0.60;

Total = 0.80

The analysis revealed a three-factor solution corresponding

to the three hypothesised sub-scales. The solution

accounted for 49.3% of the total variance.

Despite the theoretical criticisms often made against using

such self-completed scales in different cultures, the IES

has now been applied in a variety of cultures, including

studies with children. It is now clear that posttraumatic

stress symptoms in children are more similar across cultures

than they are different. Indeed, Intrusion and Arousal are

robust factors of the Impact of Event Scale in children from

different cultures.

We remind people using the scales that one cannot make a

clinical diagnosis from scores on the self-completed scales

alone. A proper clinical diagnosis relies on much more

detailed information obtained from a structured interview

that assesses not only the presence and severity of stress

symptoms, but also the impact on the child’s overall social

functioning.

At present, there are no studies that have used the IES-13

and validated it against an independent clinical diagnosis.

Therefore, for screening purposes we recommend that

people use the results from the Intrusion and Avoidance

THE CHILDREN’S IMPACT OF EVENT SCALE (13) CRIES-13

scales only. If the sum of the scores on these two scales is

17 or more, then the probability is very high that that child

will obtain a diagnosis of PTSD.

References:

Dyregrov, A., Kuterovac, G. & Barath, A.(1996) Factor

analysis of the Impact of Event Scale with children in war.

Scandinavian Journal of Psychology, 36, 339-350.

Horowitz, M. J., Wilner, N., and Alvarez, W. (1979). Impact

of event scale: A measure of subjective stress. Psychosom.

Med., 41, 209-218

Kuterovac, G., Dyregrov, A.& Stuvland, R. (1994) Children

in war: A silent majority under stress. British Journal of

Medical Psychology, 67, 363-375.

Smith, P., Perrin, S., Dyregrov, A. & Yule, W. (2002)

Principal components analysis of the Impact of Event Scale

with children in war. Personality and Individual Differences,

Weiss, D. S., & Marmar, C. R. (1997). The impact of

event scale-revised. In J. P. Wilson, & T. M. Keane (Eds.),

Assessing Psychological Trauma and PTSD. New York: The

Guilford Press.

Yule, W. (1992) Post Traumatic stress disorder in child

survivors of shipping disasters: The sinking of the “Jupiter”.

J. Psychother. Psychosomatics, 57, 200-205.

Yule, W. (1997) Anxiety, Depression and Post-Traumatic

Stress in Childhood. In I. Sclare (Ed) Child Psychology

Portfolio. Windsor: NFER-Nelson

Yule, W., Ten Bruggencate, S & Joseph, S. (1994) Principal

components analysis of the Impact of Event Scale in

children who survived a shipping disaster. Personality and

Individual Differences, 16, 685-691.

CRIES-13

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

THE CHILDREN’S IMPACT OF EVENT SCALE (13) CRIES-13



Ofce use only

Not at

all

Rarely Some-

times

Often

In Av Ar

1. Do you think about it even when you don’t mean to? [ ] [ ] [ ] [ ]

2. Do you try to remove it from your memory [ ] [ ] [ ] [ ]

Do you have difculties paying attention or

concentrating

[ ] [ ] [ ] [ ]

4. Do you have waves of strong feelings about it [ ] [ ] [ ] [ ]

Do you startle more easily or feel more nervous

than you did before it happened?

[ ] [ ] [ ] [ ]

Do you stay away from reminders of it (e.g. places

or situations)

[ ] [ ] [ ] [ ]

7. Do you try not talk about it [ ] [ ] [ ] [ ]

8. Do pictures about it pop into your mind? [ ] [ ] [ ] [ ]

9. Do other things keep making you think about it? [ ] [ ] [ ] [ ]

10. Do you try not to think about it? [ ] [ ] [ ] [ ]

11. Do you get easily irritable [ ] [ ] [ ] [ ]

12.

Are you alert and watchful even when there is no

obvious need to be?

[ ] [ ] [ ] [ ]

13. Do you have sleep problems? [ ] [ ] [ ] [ ]

Revised Child Impact of Event Scale

Below is a list of comments made by people after stressful life Event. Please tick each item showing how frequently these

comments were true for you during the past seven days. If they did not occur during that time please tick the ‘not at all’ box.

Name: …………………………………………………………………………… Date: ………………………………………

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