ITQ-CG: The First Caregiver-Report Measure for Complex PTSD in Children

Assessing complex PTSD in children has a measurement problem. The adult ITQ is the gold standard for ICD-11 PTSD and cPTSD — widely translated, well-validated, adopted across research and clinical settings globally. The child and adolescent version (ITQ-CA) followed. But young children cannot reliably self-report on symptoms like emotional dysregulation, negative self-concept, and interpersonal disturbances. These are the defining features of cPTSD. And without a caregiver-report instrument calibrated to ICD-11 criteria, clinicians had no standardized way to assess them.

That gap is now closed.

What the ITQ-CG Measures

The instrument mirrors the structure of the adult ITQ and the child self-report ITQ-CA. It assesses the six symptom clusters defined by ICD-11: three for PTSD (re-experiencing, avoidance, hyperarousal) and three for disturbances in self-organization (affect dysregulation, negative self-concept, disturbed relationships). Caregivers rate each item based on observed behavior and reported experience.

The validation study enrolled 326 children and adolescents attending a child and adolescent psychiatry department. After excluding cases with missing data or no trauma exposure, the final analytic sample was 223. Confirmatory factor analysis tested the ICD-11 two-factor higher-order model — PTSD and DSO loading onto cPTSD — and found support for this structure. This matters because it means the caregiver-report version captures the same latent construct as the self-report and adult versions.

Four Classes, One Critical Distinction

Latent class analysis revealed four groups: a cPTSD class, a PTSD-only class, a DSO-only class, and a low-symptoms class. The cPTSD class — children rated by caregivers as having both PTSD symptoms and disturbances in self-organization — showed the highest rates of comorbid psychopathology and functional impairment. This replicates what adult ITQ studies have consistently found: cPTSD is not just "more PTSD." It is a qualitatively different presentation with a heavier clinical burden.

Concurrent validity was fair to moderate — caregiver reports and child self-reports agreed at acceptable levels but were not identical. This is expected and clinically useful. Caregivers observe behavior; children report internal experience. The two perspectives complement each other rather than duplicate.

Why This Changes Pediatric Trauma Practice

Before the ITQ-CG, clinicians working with traumatized children under 10 — or children with cognitive limitations affecting self-report — had no ICD-11-aligned screening tool. They could use general trauma checklists. They could use clinical interview. But they could not systematically screen for the specific cPTSD construct that ICD-11 introduced.

The instrument is free. It is brief enough for routine clinical use. And it is designed to complement, not replace, the child self-report version when the child is old enough.

If you work with traumatized children and your assessment battery still relies on pre-ICD-11 instruments, the ITQ-CG fills the most important gap in pediatric trauma measurement. It gives you a validated, freely available tool to assess the condition that ICD-11 defined but that — until now — could only be formally measured in children who could self-report.