Child Posttraumatic Stress Symptom Scale–Parent Form (C-PTSS-PF)

Child Posttraumatic Stress Symptom Scale–Parent Form (C-PTSS-PF) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Child Posttraumatic Stress Symptom Scale–Parent Form (C-PTSS-PF) Mustafa Tayyip Kurt, Idris KAYA, Ibrahim YILDIRIM, Ali CEKIC This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8810156/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Traumatic experiences have profound effects on children’s mental health and functioning; however, their responses differ from those of other age groups due to unique developmental characteristics. In Turkey, there is a significant lack of standardized parent-report tools designed to assess posttraumatic stress symptoms (PTSS) specifically in early childhood. This study aimed to develop a valid and reliable measurement tool, based on parental reports, to assess PTSS in early childhood. Data were collected from 1,035 parents of children who directly experienced the February 6, 2023, earthquakes in Kahramanmaraş, Turkey. The scale’s item pool was developed through literature reviews, interviews, and expert evaluations. Results from exploratory factor analysis (EFA) identified a four-factor scale structure explaining 47.05% of the total variance, while confirmatory factor analysis (CFA) supported these findings with acceptable fit indices. The scale demonstrated high internal consistency, as evidenced by Cronbach’s alpha (.93) and McDonald’s omega (.93) coefficients. Additionally, multigroup CFA confirmed measurement invariance, indicating structural equivalence across mother and father groups. The scale, consisting of 23 items and four subscales—(1) hyperarousal and re-experiencing, (2) need for safety, (3) anger, and (4) avoidance—can be considered a valid and reliable tool. Biological sciences/Biochemistry Biological sciences/Zoology Posttraumatic stress symptoms Scale development Early childhood Parent Figures Figure 1 1. INTRODUCTION Trauma can be defined as events that disrupt an individual's emotional and mental integrity, that they find difficult to cope with, that threaten their life, or that deeply undermine their sense of safety. Traumatic experiences in children have the potential to disrupt developmental continuity and undermine resilience [ 1 ]. Especially in early childhood, identifying and assessing symptoms in this age group becomes more complex because children have limited cognitive capacity to make sense of traumatic events [ 2 ]. Therefore, the need for age-specific and parent-based measurement tools for young children cannot be overlooked [ 3 ]. The use of reliable and valid measurement tools is crucial for the accurate diagnosis of mental health problems such as post-traumatic stress disorder (PTSD) and the development of appropriate intervention plans [ 4 ]. Considering that the symptoms of early childhood differ from those of adolescents and adults, there is a need for measurement tools specifically designed for children. The DSM-5 states that PTSD is not a diagnosis limited to adults but can also occur in early childhood with some differences [ 5 ]. Traumatic experiences can affect children's emotional, cognitive, behavioral, and physical responses, as well as their social lives [ 6 ]. While trauma fundamentally causes emotional regulation difficulties in children, it has also been observed to trigger intense fear, anxiety, shame, guilt, and sudden outbursts of anger [ 7 – 10 ]. In behavioral and social contexts, regressive behaviors, repetition of traumatic themes in play, aggression or social withdrawal, and avoidance of peer relationships are notable maladaptive responses [ 11 – 14 ]. Traumatic experiences affect children's cognitive structure and cause emotional and behavioral problems. Indeed, especially in early childhood, owing to their limited logical thinking capacity, trauma can cause cognitive distortions and self-blaming beliefs in children and can lead to difficulties in cognitive functions such as attention and learning [ 15 , 16 ]. Finally, within this framework, trauma can also have physical effects on children, such as sleep disorders, somatic complaints, and appetite changes [ 17 , 18 ]. A meta-analysis examining the prevalence of PTSD after trauma in preschool children revealed that 21.5% of the children had PTSD [ 19 ]. A meta-analysis examining the prevalence of PTSD in children after earthquakes reported that the rate of PTSD in children varied between 2.5% and 60% in different studies [ 20 ]. However, a longitudinal study also revealed that children continued to show signs of trauma 12–18 months after the earthquake [ 21 ]. These findings provide insights into the effects of trauma on children and indicate that natural disasters are a significant source of trauma for children. On February 6, 2023, earthquakes measuring 7.7 and 7.6 magnitude struck Kahramanmaraş, Turkey, affecting 11 provinces. Approximately 14 million people were affected; over 50,000 people lost their lives, and over 100,000 were injured [ 22 ]. It has been reported that more than 7 million children were directly and indirectly affected by the earthquakes [ 23 ]. These natural disasters are not limited to physical destruction; they also have serious psychological and social impacts. The psychological effects caused by disasters can trigger intense feelings of fear, helplessness, and horror in individuals, leading to traumatic experiences [ 24 ]. Identifying the mental health problems that a trauma affects a large population, such as an earthquake, can cause is critical for prevention and intervention efforts. This requires measurement tools that can perform rapid and accurate screening. Accurately identifying children at risk for PTSD is also important for early intervention, and such interventions will contribute to the prevention of both PTSD and other mental health problems. Numerous scales have been developed in different languages to assess children's PTSS levels, and various studies examining the psychometric properties of these scales have been conducted [ 25 – 33 ]. In the Turkish literature, studies have been conducted on children's trauma symptoms [ 34 – 39 ]. However, these studies have been mostly reviews or conducted with relatively older children, and few studies have focused on early childhood. This may be related to the difficulties of collecting data from young children and the limited availability of standard measurement tools in this area. Indeed, no measurement tool has been found in Turkey to assess PTSS in early childhood on the basis of parental reports. This situation is thought to hinder the development of widespread, systematic, and reliable assessment practices in both research and practice. Therefore, despite the existence of similar examples internationally, the development and contribution to the literature of a valid and reliable measurement tool specific to this age group in the Turkish context has become a scientific and clinical necessity. Therefore, the aim of this study is to develop a developmentally appropriate, culturally valid, and reliable measurement tool that assesses the level of PTSS in children in early childhood on the basis of parental reports. 2. METHOD The study aimed to develop a measurement tool and was designed using quantitative approaches. The framework determined by DeVellis and Thorpe [ 40 ] was followed in the measurement tool development process. 2.1. Study group and procedure The study group consisted of parent of children who directly experienced the February 6, 2023, earthquakes in Kahramanmaraş, Turkey. All procedures were conducted in accordance with the ethical standards outlined in the Helsinki Declaration. Before initiating the data collection process, the requisite ethical and legal permissions were obtained from Gaziantep University’s Social Sciences and Humanities Ethics Committee (decision no. 1, January 25, 2024, dated). Informed consent was obtained before the scales were completed, and clearly stated that participation in the study was voluntary and that the data would be kept confidential. The data were collected via a digital form disseminated to parents in collaboration with the school administration. Data were collected between 15 and 18 months after the earthquake. During the EFA phase of the data collection process, 387 children's parents participated in the study, whereas 648 children's parents participated in the CFA and measurement invariance phases. Table 1 shows the demographic characteristics of the study group. Table 1 Demographic characteristics of children and parents who participated in the study during the EFA and CFA/measurement invariance phases EFA CFA/Measurement Invariance Variables N M SD n % M SD Child Gender Female 194 50.1 304 46.9 Male 193 49.9 344 53.1 Child Age ≤ 4 21 5.4 20 3.1 5 106 27.4 5.81 .82 129 19.9 5.93 .72 6 186 48.1 376 58.0 ≥ 7 74 19.1 123 19.0 Respondent Mother 346 89.4 533 85.3 Father 37 9.6 80 12.3 Other 4 1.0 15 2.3 Mother's Age Range 21–53 387 100 33.49 .28 648 100 33.27 .21 Father's Age Range 24–60 387 100 38.74 .29 648 100 37.50 .22 As shown in the table, the study group distribution is gender balanced, and the age range is diverse, representing different stages of early childhood. The fact that the form was largely filled out by mothers indicates that the assessments are primarily based on mothers' observations. Furthermore, the wide age range of the mothers and fathers allowed the scale to be tested on different groups in terms of sociodemographic diversity. In this context, the measurement invariance analyses of the scale also evaluated the consistency of construct validity across groups, taking into account demographic variables between mothers and fathers. 2.2. Scale development stages During the scale development process, a systematic approach was adopted in line with psychometric principles, taking into account the validity and reliability criteria in the literature [ 19 , 40 , 41 ]. First, a literature review was conducted on trauma and responses specific to early childhood, and then similar scales were examined to determine the scope of the scale. A Likert-type scale format was preferred in the construction of the scale, allowing participants to rate their opinions. A 5-point Likert-type rating scale (lowest score 0 and highest score 4) was used to enable individuals to assess the extent to which they agreed with the relevant statements. In this scale, responses to the items were rated between "Never" and "Always" on the basis of the frequency of the symptoms observed in children in the previous month. When creating an item pool, the goal is to identify all possible items that cover the structure the scale aims to measure [ 40 ]. First, a comprehensive literature review on PTSD in early childhood was conducted. In particular, the childhood trauma criteria in the DSM-5 [ 5 ] and the ICD-11 diagnostic criteria [ 42 ] were examined. In addition, studies addressing PTSD in childhood have been conducted to identify period-specific symptom expressions [ 30 , 37 , 39 , 43 ]. Various qualitative interviews were subsequently conducted to develop the item pool. In this context, interviews were conducted with parents who had directly experienced the earthquake (n = 5), preschool teachers working in schools in the earthquake zone (n = 8), and school counselors (n = 6). This process increased the comprehensiveness of the scale and ensured that the item contents were supported by field data. At the end of this process, an item pool containing 41 items specific to early childhood was created. The statements in the item pool were subsequently edited to be linguistically simple and understandable. To ensure the linguistic consistency of the scale, three linguistic experts evaluated the comprehensibility, grammatical accuracy, and fluency of the items. Following the creation of the item pool, the 41-item scale form was submitted for expert review to assess the scale's content validity. The Lawshe technique was used to evaluate the scale's content validity. As a result of the experts' evaluation of the items, the content validity ratio (CVR) was calculated for each item [ 44 ]. In this process, the scale items were sent to 12 experts working in the field of psychology and competent in the field of trauma, and each item was requested to be evaluated in terms of content. The experts evaluated the appropriateness of the items in relation to the construct they measured and ensured that the necessary adjustments were made by examining their conceptual clarity. As a result of the expert evaluations, 17 items were determined to be appropriate for the scale's content. Nine items were excluded from the scale because they were outside the scope or contained similar expressions. Fifteen items were revised in terms of language, and the expressions were updated. In line with expert recommendations, 1 new item was added, increasing the scale's comprehensiveness. In line with expert opinions, the scale was prepared for pilot testing, with a final item pool consisting of 33 items [ 44 ]. In this study, a pretest was conducted with 14 mothers and 4 fathers with children in early childhood and different educational levels to examine whether the form obtained after expert review was understandable and usable by parents. During the application, each item was read aloud, and the parent was asked to evaluate whether they understood the item. The application revealed that all the items had a high level of comprehensibility. During the process, the parents did not provide any feedback indicating that any item was not understood. To test whether the scale maintains the same factor structure between the mother and father groups, measurement invariance analysis was conducted. In the measurement invariance analysis phase, the multidimensional confirmatory factor analysis approach was used [ 45 ]. Measurement invariance was tested by progressively adding constraints. Configural invariance, metric invariance, scalar invariance, and strict invariance were tested in sequence. Measurement invariance was assessed using the criteria ΔCFI ≤ 0.01 and ΔRMSEA ≤ 0.015 [ 46 ]. 2.3. Determining scale reliability After the EFA and CFA stages, the reliability and internal consistency of the scale were evaluated. Cronbach's alpha (α) and McDonald's omega (Ω) reliability coefficients were calculated to determine the internal consistency of the scale [ 47 ]. 2.4. Data analysis stage In the EFA stage of data analysis, the factor structure of the scale was examined via maximum likelihood and varimax rotation to facilitate interpretation of the obtained factor structure. The validity of the structure obtained from EFA in a different sample was examined via CFA. In the first stage of CFA, missing observations in the data obtained from the study group were checked, and missing data analysis was performed. The missing data rate was less than 5%, and the EM method was used to determine that the missing data were randomly distributed (sig. = .37, p > .05), and the missing data were imputed via the EM method. Z scores were subsequently calculated to identify extreme outliers in the dataset. Data outside the − 3 and + 3 limits in the z score distribution were considered outliers and excluded from the analysis after logical testing. In this context, a total of 37 data points that did not fall within the − 3 to + 3 range and were considered outliers in the logical test were excluded from the analysis. This was done because concerns that outliers would significantly skew the analysis results. The GFI, CFI, RMSEA, and SRMR fit indices were examined within the scope of the CFA [ 48 ]. In the final stage, to determine the cutoff scores of the scale, data were collected from 149 additional individuals in addition to the 1035 data points in the research process; thus, the responses of a total of 1184 individuals to the 23 common items used in the EFA and CFA stages were analyzed. The obtained total score distributions were classified to represent low, medium, and high levels, taking into account the mean and standard deviation values; additionally, the clinical significance of the cutoff scores was evaluated on the basis of the opinions of seven experts specializing in trauma and child psychology. 3. RESULTS 3.1. Content validity findings The content validity of the scale items was assessed via the Lawshe technique. In the initial analysis, the content validity index (CVI) was found to be .55, which was below the minimum threshold of 0.56 accepted by a panel of 12 experts [ 44 ]. Accordingly, 17 items were retained, 9 items were removed, and 15 items were revised with linguistic corrections. The second evaluation, conducted on the updated item pool, strengthened the content validity. After the items were removed, the overall CVI was calculated for the scale and found to be 0.65. Since this value is above the threshold of .56 for 12 experts determined by Lawshe [ 44 ], the content validity of the scale was considered to be established. Furthermore, following the content validity analyses, one new item was added to the scale on the basis of expert recommendations. 3.2. EFA findings The Kaiser‒Meyer‒Olkin sample adequacy coefficient, which assesses the adequacy of the working group, was found to be .94. This value indicates that the dataset is suitable for factor analysis [ 49 ]. Accordingly, the sample size used in the study was adequate for factor analysis. Furthermore, Bartlett's sphericity test yielded a statistically significant result, χ²(253) = 3754.83 (p< .01). Since it also met the p < .05 criterion, the correlation matrix between the variables was found to be suitable for factor analysis [ 50 ]. In this context, considering the multivariate normal distribution property of the data, the maximum likelihood method was preferred for factor analysis [ 51 ]. These findings indicate that the necessary assumptions for examining the factor structure of the scale were met. Before EFA, the scale consisted of 33 items. During the analysis, 10 items with factor loadings below .30 or low loadings on more than one factor were removed from the scale, and the EFA process was repeated to obtain the most appropriate four-factor structure. Table 2 shows the factor structure of the scale resulting from EFA, the explained variance ratios, the item rotated factor loadings and the communalities ( h 2 ). Table 2 Explained variance, rotated factor loadings, communalities ( h 2 ), and eigenvalues of factors Rotated Factor Loadings Factor 1 h 2 F 1 F 2 F3 F4 I7 .560 .641 .305 I5 .489 .592 I19 .349 .529 I13 .562 .522 ,462 I25 .291 .511 I10 .465 .485 .459 I11 .541 .483 .385 I6 .323 .481 I27 .381 .443 I1 .315 .427 I22 .363 .410 .333 Factor 2 I15 .560 .672 I30 .602 .649 I14 .586 .467 .592 I32 .458 .303 .557 I29 .512 ,412 .500 Factor 3 I23 .708 .822 I20 .519 .654 I31 .552 .357 574 I24 .531 .533 .366 Factor 4 I8 .338 .579 I16 .428 , 546 I3 .388 .516 Total variance explained: 47.045% 16.175 13.587 10.604 6.679 Note: Extraction method: maximum likelihood; rotation method: varimax rotation; item loadings on the factors are bold. *p < .01. The communalities (( h 2 ) ranged between .291 and .708. When the initial eigenvalues were examined, the scale exhibited a four-factor structure, and the eigenvalues of these four factors were above 1. As a result of the EFA, the total variance explained by the factors in the scale was found to be 47.05%. The first factor explained 16.18% of the variance, the second factor explained 13.59%, the third factor explained 10.60%, and the fourth factor explained 6.68%. These findings indicate that interpreting the scale's structure as four factors is appropriate. Furthermore, this four-factor structure was evaluated as consistent with the conceptual framework that the scale aims to measure. The first factor includes 10 items under the heading "hyperarousal and re-experiencing"; the second factor includes 6 items under the heading "need for safety"; the third factor includes 4 items under the heading "anger"; and the fourth factor includes 3 items under the heading "avoidance." This factor distribution indicates that the scale is suitable for measuring early childhood trauma symptoms in different dimensions. Following EFA, CFA was performed on a new sample to validate the factor structure of the scale. 3.3. CFA findings CFA was performed on the model consisting of 23 items and 4 subdimensions obtained from 648 participants. The items that received modification suggestions from the experts in the analysis were evaluated, and modifications were made to the items deemed appropriate. The model diagram is presented in Fig. 1 . The correlations between model factors ranged from .66 to .91, and the factor loadings of the items under each factor ranged from .43 to .74. All loadings are positive. Furthermore, modifications can be made to the model to improve fit values in accordance with the theoretical structure [ 52 ]. In this context, modifications were made between the items "Reenacts experiences in play" and "Draws experiences in pictures." Playing and drawing are forms of expression that children frequently resort to in the process of processing their traumatic experiences. Research shows that children can consciously or unconsciously reenact the events they have experienced in their play [ 5 ] or drawings [ 53 ]. In addition, one modification was made between the items "They worry that something bad will happen to their loved ones" and "They fear that the event they experienced will happen again." Research shows that children exposed to traumatic events experience intense anxiety about something bad happening to their loved ones and fear the possibility of the event they experienced happening again [ 34 , 54 ]. As a result, the modification process improved the fit values, and a modification consistent with the theoretical structure was achieved. Table 3. Fit index values Fit Indices Good Fit Acceptable Fit Current Study Fit CFI .95 ≤ CFI < 1.00 .90 ≤ CFI<.95 .88 Acceptable/Borderline GFI .90 ≤ NFI ≤ 1.00 .85 ≤ NFI < .90 .87 Acceptable RMSEA 0 ≤ RMSEA ≤ 0.05 .05 < RMSEA<.08 .07 Acceptable SRMR 0 ≤ SRMR < 0.05 .05 ≤ SRMR<.08 .05 Acceptable (Byrne, 2013; Hu & Bentler, 1999; Marsh et al., 1988; Suhr, 2008; Tabachnick & Fidell, 2013) X²= 998.22, df = 222, p<.01; CFI= .88; GFI=.87; RMSEA= .07 [90% CI: .069, .078]; SRMR= .05. On the basis of these findings, the four-factor structure of the scale has been confirmed, the model generally fits well, and the scale supports construct validity. 3.4. Measurement invariance findings Table 4 Measurement invariance χ2 (p<.05) sd SRMR TLI CFI RMSEA (95% CI) ΔRMSEA ΔCFI Configural 1459.25 448 0.06 0.829 0.849 0.084 (0.080–0.089) - - Metric 1,475.85 467 0.062 0.837 0.849 0.083 (0.078–0.087) 0.001 0.000 Scalar 1,511.891 486 0.063 0.840 0.847 0.082 (0.077–0.086) 0.001 0.002 Strict 1581.91 509 0.066 0.841 0.840 0.082 (0.077–0.086) 0.000 0.007 Measure invariance was assessed on the basis of ΔCFI ≤ 0.01 and ΔRMSEA ≤ 0.015 values (Chen, 2007). As a result of the measurement invariance tests, all the configural, metric, scalar, and strict invariance steps were satisfied [ 45 ]. The fact that the CFI and RMSEA changes are within acceptable limits [ 46 ] indicates that the scale provides a stable structure for the mother and father forms and that the two groups perceive the scale similarly. These findings show that the scale has similar psychometric properties for both groups. 3.5. Reliability analysis findings Using CFA data, both Cronbach's alpha (α) and McDonald's omega ω coefficients were calculated as .93 at the general scale level, and these results indicate that the scale is a reliable measurement tool with internal consistency. 3.6. Determination of the cutoff score The cutoff scores for the developed scale were determined in three groups via the arithmetic mean and standard deviation values on the basis of the total score distribution. The cutoff values of 30.65 and 47.39 obtained from the scale were calculated by subtracting and adding one standard deviation from the mean. At this point, in a normally distributed dataset, grouping can be performed as follows: the group with a low risk for posttraumatic stress disorder (0–30 point range), the subthreshold PTSD group (31–47 point range), and the high-risk group for PTSD (48–92 point range). In a normally distributed dataset, 68.26% of the population falls within one standard deviation above and below the arithmetic mean. Approximately one-third of the population falls within the 31–47 point range. The high-risk group, comprising 15.87% of the population, has a score of 48 or higher. To examine the validity of the cutoff scores determined by statistical methods in the field of mental health, an evaluation was conducted with seven experts, and all the experts reported the determined score ranges as meaningful, applicable, and psychometrically acceptable. Furthermore, the obtained distributions are consistent with the international literature; the 15–30% range reported in previous studies on the prevalence of posttraumatic stress symptoms in children parallels the findings obtained from the scale [ 55 , 56 ]. These results indicate that the scale provides reliable reference values for clinical applications. 4. DISCUSSION This study aimed to develop a measurement tool to assess posttraumatic symptoms in children during early childhood (ages 3–8), primarily seeking evidence of validity and reliability. According to the findings obtained from the initial EFA, the four factors explain approximately half (47.05%) of the total variance, which falls within the 40–50% explained variance limits considered acceptable in social science research [ 57 , 58 ] and is considered sufficient in terms of the scale's construct validity. The model fit values obtained from the CFA conducted on a different sample after the EFA indicate that the four-factor structure of the developed scale fits the data at an acceptable level. When examining the goodness-of-fit indices, although the CFI (.88) value is slightly below the acceptance threshold (.90), it can be said to be acceptable [ 59 ]. The other fit indices, GFI, RMSEA, and SRMR, are also generally within the acceptable fit levels suggested in the literature [ 48 , 60 ]. In particular, the RMSEA and SRMR values being below .08 indicate that the model is within good limits in terms of error variance. In scale development studies targeting children, model fit values are often at an "acceptable" level rather than in the "excellent" range due to the diversity of behavioral responses and developmental differences [ 61 , 62 , 63 ]. In this context, considering the characteristics of the sample and the multidimensional structure of the developed scale, the fit indices obtained in this study are evaluated as providing sufficient model fit in line with the literature. In addition, the Cronbach's alpha and McDonald's omega values (.93) obtained in the reliability analyses indicate that the developed scale has high internal consistency. While values above .70 are considered acceptable in the literature, values of .90 and above represent a very high level of reliability [ 40 , 47 ]. In conclusion, validity analyses demonstrated the appropriateness of the developed measurement tool in terms of content and construct validity. Furthermore, since the tool can be completed by both mothers and fathers, an invariance analysis was conducted on the basis of parent type, and the results indicated that the scale did not cause any change in the measured construct when completed by either group of parents [ 45 , 46 ]. Finally, the cutoff score for the scale was determined. On the basis of these results, the C-PTSS-PF, consisting of 23 items and four subscales (1) hyperarousal and re-experiencing, (2) need for safety, (3) anger, and (4) avoidance, is a valid and reliable tool for measuring trauma symptoms in young children who have experienced an earthquake through parent-based assessment. A review of the international literature indicates that while there are many instruments for measuring PTSD in young children [ 32 , 70 , 71 , 74 ], there are limitations regarding the validity and reliability of these instruments [ 64 , 72 , 19 ]. In Turkey, there are tools for assessing PTSD in children over the age of seven [ 73 ]. When tools for measuring posttraumatic stress symptoms in younger children are examined, only one tool focuses directly on PTSD symptoms in children [ 34 ]), but this scale is a teacher report and covers children up to six years of age. In addition, mental health professionals in Turkey assess PTSD symptoms in young children largely through clinical interview-based forms. Considering that this developed scale can offer rapid screening, especially for identifying children at risk, and can reach a wide audience through parents, it can fill a gap in the field. Especially after natural disasters affect large populations, such as earthquakes, valid and reliable measurement tools that enable rapid screening and reach large populations may be critical in planning mental health services. The developed scale was developed in line with literature reviews on theoretical frameworks related to trauma and posttraumatic stress disorder, as well as the standards of the international diagnostic systems DSM-5 and ICD-11 [ 5 , 42 ]. The World Health Organization's ICD-11 and the American Psychiatric Association's DSM-5 systematically and developmentally sensitively define the symptoms of PTSD, indicating the effects of trauma on individuals' emotional, cognitive, and social functioning [ 5 , 42 ]. These theoretical and diagnostic frameworks guided the creation of the scale's item pool and subscales. In addition, the item pool and subscales related to posttraumatic stress symptoms in early childhood were created with reference to the literature on PTSD in children [ 9 , 11 , 65 ]. We believe that this scale assesses PTSD symptoms in early childhood in line with theoretical and diagnostic systems. The first subscale of the scale, hyperarousal and re-experiencing, is a combination of two core symptom clusters of posttraumatic stress symptoms in children. These symptoms are among the most common symptoms that emerge after trauma in young children. These two symptoms are highlighted in the DSM-5 and ICD-11, which are international diagnostic systems that identify how PTSD manifests in children [ 5 , 42 ]. Although these two symptom clusters are grouped differently in diagnostic manuals [e.g., re-experiencing (B Cluster) and hyperarousal (D Cluster) in DSM-5], a positive correlation between these clusters is observed in measurement tools developed for children [ 66 ].However, considering that posttraumatic symptoms in young children tend to manifest more intensely in behavioral terms [ 42 ], it is expected that responses such as reenacting the trauma in play, difficulty falling asleep, and startle responses, which are included in the scale, would be placed in the same behavioral dimension. Indeed, the EFA and CFA results of the relevant dimension and the high Cronbach's alpha internal consistency value indicate that the items can be evaluated together. The second subdimension of the developed measurement tool is the need for safety. This dimension refers to situations such as children struggling to separate from their parents after trauma, clinging, constant anxiety, and the need for control. Traumatic experiences can have negative effects on children's sense of safety and attachment systems [ 67 ]. In addition, it has been reported that children become more clingy and dependent on their caregivers to maintain or regain homeostasis in highly stressful situations [ 68 ]. The Diagnostic Infant and Preschool Assessment (DIPA), which assesses PTSD in preschool children, also indicates separation anxiety from caregivers among posttraumatic stress symptoms in children. The fact that the data were collected from parents of children who experienced earthquake trauma may have also contributed to the prominence of the need for safety in children. Parents who experienced the trauma themselves may have adopted from whom the data were collected may have experienced earthquake trauma themselves, leading them to adopt a more protective attitude toward their children, which in turn may have increased the children's need for safety. Within the scope of this finding, focusing on the re-establishment of safety and trust is critically important in posttraumatic intervention efforts for children. The third subscale of the scale, the anger subscale, includes items such as sudden anger outbursts after trauma, increased aggressive behavior, and conflicts in peer relationships. After traumatic experiences, children may develop internalizing problems such as anxiety and fear, as well as externalizing problems such as anger [ 7 , 8 , 9 , 10 ]. Notably, externalizing problems such as crying, anger, and aggression are more intense than internalizing problems are, especially in young children [ 72 ]. In addition, the DSM-5 defines angry behavior, excessive irritability, and unexplained outbursts of anger in children after trauma as post-traumatic symptoms [ 5 ]. This subdimension may be an indicator of children's observable expression of their emotions. Anger outbursts were highlighted in the behavioral response subdimension of a teacher-reported scale assessing trauma symptoms in preschool children after an earthquake [ 34 ]. The Trauma Symptom Checklist for Young Children (TSCYC), a commonly used tool for measuring trauma symptoms in children, has a direct subscale called "Anger/Aggression" [ 74 ]. Consequently, following an event such as an earthquake that eliminates the sense of control and creates intense fear/horror, "anger" can be considered an expression of the child's inability to cope. The final subscale of the scale, "avoidance," involves difficulty remembering and expressing posttraumatic experiences and avoiding talking about events. The DSM-5 PTSD diagnostic criteria clearly state the avoidance of feelings, thoughts, and conversations related to the event [ 5 ]. This avoidance may include fear of confronting negative emotions. Feelings of guilt, which may be triggered by the egocentric thinking typical of this age group, may also contribute to avoidance. This study has several limitations. One limitation is that the data were collected from parents. Although it is quite difficult to collect data directly from children in this age group, there may be some doubts about the reliability of the data collected from parents. Parents' personal concerns and expectations, mental health issues, limited observations and knowledge about their children, and a tendency to view their children in a more favorable light than they actually are may increase the likelihood of biased data [ 69 ]. In this context, the fact that the parents from whom the data were collected had also experienced earthquake trauma may have influenced the information they provided about their children. Another important limitation of the study in this context may be that the data were collected only from parents of children who experienced earthquake trauma. Indeed, many traumas in children can result from abuse, war, accidents, etc. Another important limitation of the study is that convergent and divergent validity studies could not be conducted. While the scale development process was planned, these types of validity were examined; however, no measurement tool was found that assesses PTSD and other mental health disorders in this age group of children on the basis of parental evaluation. Existing measurement tools are either designed for older age groups or are tools based directly on clinical observation and interviews. To mitigate the impact of this limitation, expert opinions were sought at different stages, and different samples were used in the EFA and CFA processes. Future researchers should conduct convergent and divergent validity studies and evaluate the scale's consistency with clinical observations to eliminate this limitation. In addition, researchers may be advised to compare the results of this scale with those of a teacher-reported scale for children experiencing trauma [ 34 ]. Finally, different researchers can test whether the scale yields valid and reliable results for different types of trauma (e.g., sexual abuse, accidents, war, etc.). Declarations Authors and Affiliations Mustafa Tayyip KURT, MsC Guidance and Psychological Counseling Program, Gaziantep Education Faculty, Gaziantep University, 27470, Turkey ORCID: 0009-0004- 1226-8247 Idris Kaya, PhD Guidance and Psychological Counseling Program, Gaziantep Education Faculty, Gaziantep University, 27470, Turkey ORCID: 0000-0001-9562-3347 İbrahim YILDIRIM, PhD Department of Measurement and Evaluation in Education, Gaziantep Education Faculty, Gaziantep University, 27470, Turkey ORCID: 0000-0002-4137-2025 Ali ÇEKİÇ, PhD Guidance and Psychological Counseling Program, Gaziantep Education Faculty, Gaziantep University, 27470, Turkey ORCID: 0000-0002-7893-268X Corresponding author: Idris Kaya Email: [email protected] Phone: 0090 507 340 48 02 Contributions This manuscript is derived from the first author’s master’s thesis. The second author, as the thesis advisor, supervised the introduction and discussion sections and the data collection processes. The third author, as the thesis advisor, supported the methodology and findings. The fourth author reviewed and edited the study as a whole, providing feedback. Declaration of interest: We have no conflicts of interest to disclose. All authors have reviewed and approved the final manuscript for publication. Funding This study was supported by the Scientific and Technological Research Council of Türkiye (TUBITAK) under Grant Number 223K243. The authors thank TUBITAK for their support. Data availability The data that support the findings of this study are available on request from the corresponding author. Ethics declarations The requisite ethical and legal permissions were obtained from Gaziantep University’s Social Sciences and Humanities Ethics Committee (Decision No. 1, dated January 25, 2024). The scale clearly stated that participation in the study was voluntary and that the data would be kept confidential. References Fairbank, J. A., Putnam, F. W. & Harris, W. W. 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Child Revised Impact of Event Scale (CRIES): Validity and reliability study of Turkish version. Neuropsychiatr. Invest. 59 , 1–6 (2021). Karakaya, I. et al. Çocuk ve gençler için klinisyen tarafından uygulanan travma sonrası stres bozukluğu ölçeği (TSSB-ÖÇE): Güvenilirlik ve geçerlik çalışması. Cocuk Genclik Ruh Sagligi Derg. 14 , 13–24 (2007). Olçay-Gül, S., Olgunsoylu, D. & Ünal, S. Travmatik stres belirti ölçeği geliştirme çalışması. Ankara Univ. Egit. Bilim. Fak. Derg. 48 , 165–184 (2015). Sapmaz, Ş. Y. et al. DSM-5 travma sonrası stres belirtileri şiddet ölçeği çocuk formunun Türkçe güvenilirliği ve geçerliliği. Noro-Psikiyatr. Ars. 54 , 205–208 (2017). DeVellis, R. F. Ölçek geliştirme: Kuram ve uygulamalar (trans. Totan, T.) (Nobel Akademik Yayıncılık, 2014). Erkuş, A. Psikolojide ölçme ve ölçek geliştirme (Pegem Akademi, 2019). World Health Organization. International statistical classification of diseases and related health problems (11th rev. ed.) (WHO, 2019). Şar, V., Öztürk, P. E. & İkikardeş, E. Çocukluk çağı ruhsal trauma ölçeğinin Türkçe uyarlamasının geçerlilik ve güvenilirliği. Turkiye Klinikleri J. Med. Sci. 32 , 1054–1063 (2012). Lawshe, C. H. A quantitative approach to content validity. Pers. Psychol. 28 , (1975). Meredith, W. Measurement invariance, factor analysis and factorial invariance. Psychometrika 58 , 525–543 (1993). Chen, F. F. Sensitivity of goodness of fit indices to lack of measurement invariance. Struct. Equ. Modeling 14 , 464–504 (2007). Kalkbrenner, M. T. Choosing between Cronbach’s coefficient alpha, McDonald’s coefficient omega, and coefficient H. Meas. Eval. Couns. Dev. 57 , 93–105 (2024). Hu, L. T. & Bentler, P. M. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct. Equ. Modeling 6 , 1–55 (1999). Kaiser, H. F. & Rice, J. “Little Jiffy, Mark IV.” Educ. Psychol. Meas. 34 , 111–117 (1974). Pektaş, S. Doğrulayıcı faktör analizi. In İleri istatistik uygulamaları (eds. Şen, S. & Yıldırım, İ.) 185–210 (Nobel Akademik Yayıncılık, 2024). Fabrigar, L. R., Wegener, D. T., MacCallum, R. C. & Strahan, E. J. Evaluating the use of exploratory factor analysis in psychological research. Psychol. Methods 4 , 272 (1999). Schreiber, J. B., Nora, A., Stage, F. K., Barlow, E. A. & King, J. Reporting structural equation modeling and confirmatory factor analysis results: A review. J. Educ. Res. 99 , 323–338 (2006). Robinson, C. M. Children and trauma: Unexpected resistance and justice in film and drawings. Humanities 7 , 19 (2018). France, J. M. et al. Anxiety, fear extinction, and threat-related amygdala reactivity in children exposed to urban trauma. J. Exp. Psychopathol. 13 , (2022). Charitaki, S., Pervanidou, P., Tsiantis, J., Chrousos, G. & Kolaitis, G. Posttraumatic stress reactions in young victims of road traffic accidents. Eur. J. Psychotraumatol. 8 , (2017). Vasileva, M. & Petermann, F. Posttraumatic Stress Symptoms in Preschool Children in Foster Care. J. Trauma. Stress 30 , 472–481 (2017). Field, A. Discovering statistics using IBM SPSS statistics (6th ed.) (SAGE Publications, 2024). Tabachnick, B. G. & Fidell, L. S. Using Multivariate Statistics (6th ed.) (Pearson Education, 2013). Van Laar, S. & Braeken, J. Understanding the Comparative Fit Index: It is All about the Base!. Pract. Assess. Res. Eval. 26 , 26 (2021). Byrne, B. M. Structural equation modeling with AMOS: Basic concepts, applications, and programming (2nd ed.) (Routledge, 2013). Marsh, H. W., Balla, J. R. & McDonald, R. P. Goodness-of-fit indexes in confirmatory factor analysis: The effect of sample size. Psychol. Bull. 103 , 391 (1988). Lecavalier, L., Gadow, K. D., DeVincent, C. J. & Edwards, M. C. Validation of DSM-IV model of psychiatric syndromes in children with autism spectrum disorders. J. Autism Dev. Disord. 39 , 278–289 (2009). Suhr, D. Step your way through path analysis. West. Users SAS Softw. Conf. Proc. 15 , 2017 (2008). Stover, C. S. & Berkowitz, S. Assessing violence exposure and trauma symptoms in young children: A critical review of measures. J. Trauma. Stress 18 , 707–717 (2005). Pynoos, R. S., Steinberg, A. M. & Piacentini, J. C. A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders. Biol. Psychiatry 46 , 1542–1554 (1999). Harris, S. E. Development of the Early Childhood Traumatic Stress Screen (Marquette University, 2016). Cruz, D., Lichten, M., Berg, K. & George, P. Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Front. Psychiatry 13 , 800687 (2022). Lyons-Ruth, K. & Jacobvitz, D. Attachment disorganization. In Handbook of attachment: Theory, research, and clinical applications (eds. Cassidy, J. & Shaver, P. R.) 520–554 (The Guilford Press, 1999). Briere, J. & Elliott, D. M. Psychological assessment of interpersonal victimization effects in adults and children. Psychotherapy 34 , 353 (1997). Gigengack, M. R. et al. Accuracy of the Diagnostic Infant and Preschool Assessment (DIPA) in a Dutch sample. Compr. Psychiatry 100 , 152177 (2020). Scheeringa, M. S. & Haslett, N. The reliability and criterion validity of the Diagnostic Infant and Preschool Assessment. Child Psychiatry Hum. Dev. 41 , 299–312 (2010). Moner, N., Soubelet, A., Barbieri, L. & Askenazy, F. Assessment of PTSD and posttraumatic symptomatology in very young children: A systematic review. J. Child Adolesc. Psychiatr. Nurs. 35 , 7–23 (2022). Örengül, A. C., Küçükardalı, R. S., Karal, B. N. & Gormez, V. Psychometric Assessment of the UCLA PTSD Reaction Index for DSM-5 Brief Form in a Clinical Sample of Turkish Youth. Child Psychiatry Hum. Dev. 1–9 (2025). Briere, J. et al. The Trauma Symptom Checklist for Young Children (TSCYC): Reliability and association with abuse exposure in a multisite study. Child Abuse Negl. 25 , 1001–1014 (2001). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 01 May, 2026 Reviewers agreed at journal 22 Apr, 2026 Reviewers agreed at journal 23 Mar, 2026 Reviewers invited by journal 06 Mar, 2026 Editor assigned by journal 06 Mar, 2026 Editor invited by journal 16 Feb, 2026 Submission checks completed at journal 12 Feb, 2026 First submitted to journal 12 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8810156","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":602388366,"identity":"e016f76d-c9c1-4d8b-9ea7-5cece35b7bfb","order_by":0,"name":"Mustafa Tayyip Kurt","email":"","orcid":"","institution":"Gaziantep University","correspondingAuthor":false,"prefix":"","firstName":"Mustafa","middleName":"Tayyip","lastName":"Kurt","suffix":""},{"id":602388367,"identity":"6c29d73c-0664-42c5-b61b-d528b484d02a","order_by":1,"name":"Idris KAYA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBACNoYEZhAtByIOPCBFizFYSwJx9kC0JDaA2cRo4GNPYDb42WaXPj/s8EOgLXZyug2EHMbzgDmxty05d+PtNAOglmRjswOEtEgkMB/gbWPO3Tg7AaTlQOI2YrQc/NtWn244O/0D8VqSedsOJ8hL5xBrC8/DZmOZc8cNN0jnFBxIMCDCL/LtyYcl35RVy8vPTt/84UOFnRxBLQwMjA0MjGwMDAZglQYElcPAH6B1DUSrHgWjYBSMgpEGAC8OQlCiZLyFAAAAAElFTkSuQmCC","orcid":"","institution":"Gaziantep University","correspondingAuthor":true,"prefix":"","firstName":"Idris","middleName":"","lastName":"KAYA","suffix":""},{"id":602388368,"identity":"9004c2cd-2877-4c3e-95ac-ac9032197a93","order_by":2,"name":"Ibrahim YILDIRIM","email":"","orcid":"","institution":"Gaziantep University","correspondingAuthor":false,"prefix":"","firstName":"Ibrahim","middleName":"","lastName":"YILDIRIM","suffix":""},{"id":602388369,"identity":"b605fb2b-a739-400c-bded-8a9f5e3966c1","order_by":3,"name":"Ali CEKIC","email":"","orcid":"","institution":"Gaziantep University","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"CEKIC","suffix":""}],"badges":[],"createdAt":"2026-02-06 18:39:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8810156/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8810156/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104546765,"identity":"7c259ed5-176e-4680-bf14-019b9d5ee4ce","added_by":"auto","created_at":"2026-03-13 07:29:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":171029,"visible":true,"origin":"","legend":"\u003cp\u003eCFA diagram of the scale\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8810156/v1/16fe6964f422ffe905d5ae00.png"},{"id":104835252,"identity":"fe7ca3ed-2d8a-44a4-8122-d9fe004cc735","added_by":"auto","created_at":"2026-03-17 17:42:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1220747,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8810156/v1/63f27047-0d39-47d2-977a-d93214abc3d6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Child Posttraumatic Stress Symptom Scale–Parent Form (C-PTSS-PF)","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eTrauma can be defined as events that disrupt an individual's emotional and mental integrity, that they find difficult to cope with, that threaten their life, or that deeply undermine their sense of safety. Traumatic experiences in children have the potential to disrupt developmental continuity and undermine resilience [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Especially in early childhood, identifying and assessing symptoms in this age group becomes more complex because children have limited cognitive capacity to make sense of traumatic events [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Therefore, the need for age-specific and parent-based measurement tools for young children cannot be overlooked [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The use of reliable and valid measurement tools is crucial for the accurate diagnosis of mental health problems such as post-traumatic stress disorder (PTSD) and the development of appropriate intervention plans [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Considering that the symptoms of early childhood differ from those of adolescents and adults, there is a need for measurement tools specifically designed for children.\u003c/p\u003e \u003cp\u003eThe DSM-5 states that PTSD is not a diagnosis limited to adults but can also occur in early childhood with some differences [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Traumatic experiences can affect children's emotional, cognitive, behavioral, and physical responses, as well as their social lives [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. While trauma fundamentally causes emotional regulation difficulties in children, it has also been observed to trigger intense fear, anxiety, shame, guilt, and sudden outbursts of anger [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In behavioral and social contexts, regressive behaviors, repetition of traumatic themes in play, aggression or social withdrawal, and avoidance of peer relationships are notable maladaptive responses [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Traumatic experiences affect children's cognitive structure and cause emotional and behavioral problems. Indeed, especially in early childhood, owing to their limited logical thinking capacity, trauma can cause cognitive distortions and self-blaming beliefs in children and can lead to difficulties in cognitive functions such as attention and learning [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Finally, within this framework, trauma can also have physical effects on children, such as sleep disorders, somatic complaints, and appetite changes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA meta-analysis examining the prevalence of PTSD after trauma in preschool children revealed that 21.5% of the children had PTSD [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A meta-analysis examining the prevalence of PTSD in children after earthquakes reported that the rate of PTSD in children varied between 2.5% and 60% in different studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, a longitudinal study also revealed that children continued to show signs of trauma 12\u0026ndash;18 months after the earthquake [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These findings provide insights into the effects of trauma on children and indicate that natural disasters are a significant source of trauma for children.\u003c/p\u003e \u003cp\u003eOn February 6, 2023, earthquakes measuring 7.7 and 7.6 magnitude struck Kahramanmaraş, Turkey, affecting 11 provinces. Approximately 14\u0026nbsp;million people were affected; over 50,000 people lost their lives, and over 100,000 were injured [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. It has been reported that more than 7\u0026nbsp;million children were directly and indirectly affected by the earthquakes [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. These natural disasters are not limited to physical destruction; they also have serious psychological and social impacts. The psychological effects caused by disasters can trigger intense feelings of fear, helplessness, and horror in individuals, leading to traumatic experiences [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Identifying the mental health problems that a trauma affects a large population, such as an earthquake, can cause is critical for prevention and intervention efforts. This requires measurement tools that can perform rapid and accurate screening. Accurately identifying children at risk for PTSD is also important for early intervention, and such interventions will contribute to the prevention of both PTSD and other mental health problems.\u003c/p\u003e \u003cp\u003eNumerous scales have been developed in different languages to assess children's PTSS levels, and various studies examining the psychometric properties of these scales have been conducted [\u003cspan additionalcitationids=\"CR26 CR27 CR28 CR29 CR30 CR31 CR32\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In the Turkish literature, studies have been conducted on children's trauma symptoms [\u003cspan additionalcitationids=\"CR35 CR36 CR37 CR38\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. However, these studies have been mostly reviews or conducted with relatively older children, and few studies have focused on early childhood. This may be related to the difficulties of collecting data from young children and the limited availability of standard measurement tools in this area. Indeed, no measurement tool has been found in Turkey to assess PTSS in early childhood on the basis of parental reports. This situation is thought to hinder the development of widespread, systematic, and reliable assessment practices in both research and practice. Therefore, despite the existence of similar examples internationally, the development and contribution to the literature of a valid and reliable measurement tool specific to this age group in the Turkish context has become a scientific and clinical necessity. Therefore, the aim of this study is to develop a developmentally appropriate, culturally valid, and reliable measurement tool that assesses the level of PTSS in children in early childhood on the basis of parental reports.\u003c/p\u003e"},{"header":"2. METHOD","content":"\u003cp\u003eThe study aimed to develop a measurement tool and was designed using quantitative approaches. The framework determined by DeVellis and Thorpe [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] was followed in the measurement tool development process.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study group and procedure\u003c/h2\u003e \u003cp\u003eThe study group consisted of parent of children who directly experienced the February 6, 2023, earthquakes in Kahramanmaraş, Turkey. All procedures were conducted in accordance with the ethical standards outlined in the Helsinki Declaration. Before initiating the data collection process, the requisite ethical and legal permissions were obtained from Gaziantep University\u0026rsquo;s Social Sciences and Humanities Ethics Committee (decision no. 1, January 25, 2024, dated). Informed consent was obtained before the scales were completed, and clearly stated that participation in the study was voluntary and that the data would be kept confidential. The data were collected via a digital form disseminated to parents in collaboration with the school administration. Data were collected between 15 and 18 months after the earthquake. During the EFA phase of the data collection process, 387 children's parents participated in the study, whereas 648 children's parents participated in the CFA and measurement invariance phases. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the demographic characteristics of the study group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of children and parents who participated in the study during the EFA and CFA/measurement invariance phases\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eEFA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c11\" namest=\"c8\"\u003e \u003cp\u003eCFA/Measurement Invariance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eChild Gender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e46.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e53.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eChild Age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e5.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eRespondent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e85.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother's Age Range\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e33.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather's Age Range\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e38.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e37.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in the table, the study group distribution is gender balanced, and the age range is diverse, representing different stages of early childhood. The fact that the form was largely filled out by mothers indicates that the assessments are primarily based on mothers' observations. Furthermore, the wide age range of the mothers and fathers allowed the scale to be tested on different groups in terms of sociodemographic diversity. In this context, the measurement invariance analyses of the scale also evaluated the consistency of construct validity across groups, taking into account demographic variables between mothers and fathers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Scale development stages\u003c/h2\u003e \u003cp\u003eDuring the scale development process, a systematic approach was adopted in line with psychometric principles, taking into account the validity and reliability criteria in the literature [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. First, a literature review was conducted on trauma and responses specific to early childhood, and then similar scales were examined to determine the scope of the scale. A Likert-type scale format was preferred in the construction of the scale, allowing participants to rate their opinions. A 5-point Likert-type rating scale (lowest score 0 and highest score 4) was used to enable individuals to assess the extent to which they agreed with the relevant statements. In this scale, responses to the items were rated between \"Never\" and \"Always\" on the basis of the frequency of the symptoms observed in children in the previous month.\u003c/p\u003e \u003cp\u003eWhen creating an item pool, the goal is to identify all possible items that cover the structure the scale aims to measure [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. First, a comprehensive literature review on PTSD in early childhood was conducted. In particular, the childhood trauma criteria in the DSM-5 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and the ICD-11 diagnostic criteria [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] were examined. In addition, studies addressing PTSD in childhood have been conducted to identify period-specific symptom expressions [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Various qualitative interviews were subsequently conducted to develop the item pool. In this context, interviews were conducted with parents who had directly experienced the earthquake (n\u0026thinsp;=\u0026thinsp;5), preschool teachers working in schools in the earthquake zone (n\u0026thinsp;=\u0026thinsp;8), and school counselors (n\u0026thinsp;=\u0026thinsp;6). This process increased the comprehensiveness of the scale and ensured that the item contents were supported by field data.\u003c/p\u003e \u003cp\u003eAt the end of this process, an item pool containing 41 items specific to early childhood was created. The statements in the item pool were subsequently edited to be linguistically simple and understandable. To ensure the linguistic consistency of the scale, three linguistic experts evaluated the comprehensibility, grammatical accuracy, and fluency of the items. Following the creation of the item pool, the 41-item scale form was submitted for expert review to assess the scale's content validity. The Lawshe technique was used to evaluate the scale's content validity. As a result of the experts' evaluation of the items, the content validity ratio (CVR) was calculated for each item [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. In this process, the scale items were sent to 12 experts working in the field of psychology and competent in the field of trauma, and each item was requested to be evaluated in terms of content. The experts evaluated the appropriateness of the items in relation to the construct they measured and ensured that the necessary adjustments were made by examining their conceptual clarity.\u003c/p\u003e \u003cp\u003eAs a result of the expert evaluations, 17 items were determined to be appropriate for the scale's content. Nine items were excluded from the scale because they were outside the scope or contained similar expressions. Fifteen items were revised in terms of language, and the expressions were updated. In line with expert recommendations, 1 new item was added, increasing the scale's comprehensiveness. In line with expert opinions, the scale was prepared for pilot testing, with a final item pool consisting of 33 items [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, a pretest was conducted with 14 mothers and 4 fathers with children in early childhood and different educational levels to examine whether the form obtained after expert review was understandable and usable by parents. During the application, each item was read aloud, and the parent was asked to evaluate whether they understood the item. The application revealed that all the items had a high level of comprehensibility. During the process, the parents did not provide any feedback indicating that any item was not understood.\u003c/p\u003e \u003cp\u003eTo test whether the scale maintains the same factor structure between the mother and father groups, measurement invariance analysis was conducted. In the measurement invariance analysis phase, the multidimensional confirmatory factor analysis approach was used [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Measurement invariance was tested by progressively adding constraints. Configural invariance, metric invariance, scalar invariance, and strict invariance were tested in sequence. Measurement invariance was assessed using the criteria ΔCFI\u0026thinsp;\u0026le;\u0026thinsp;0.01 and ΔRMSEA\u0026thinsp;\u0026le;\u0026thinsp;0.015 [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Determining scale reliability\u003c/h2\u003e \u003cp\u003eAfter the EFA and CFA stages, the reliability and internal consistency of the scale were evaluated. Cronbach's alpha (α) and McDonald's omega (Ω) reliability coefficients were calculated to determine the internal consistency of the scale [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Data analysis stage\u003c/h2\u003e \u003cp\u003eIn the EFA stage of data analysis, the factor structure of the scale was examined via maximum likelihood and varimax rotation to facilitate interpretation of the obtained factor structure. The validity of the structure obtained from EFA in a different sample was examined via CFA. In the first stage of CFA, missing observations in the data obtained from the study group were checked, and missing data analysis was performed. The missing data rate was less than 5%, and the EM method was used to determine that the missing data were randomly distributed (sig. = .37, p \u0026gt; .05), and the missing data were imputed via the EM method. Z scores were subsequently calculated to identify extreme outliers in the dataset. Data outside the \u0026minus;\u0026thinsp;3 and +\u0026thinsp;3 limits in the z score distribution were considered outliers and excluded from the analysis after logical testing. In this context, a total of 37 data points that did not fall within the \u0026minus;\u0026thinsp;3 to +\u0026thinsp;3 range and were considered outliers in the logical test were excluded from the analysis. This was done because concerns that outliers would significantly skew the analysis results. The GFI, CFI, RMSEA, and SRMR fit indices were examined within the scope of the CFA [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. In the final stage, to determine the cutoff scores of the scale, data were collected from 149 additional individuals in addition to the 1035 data points in the research process; thus, the responses of a total of 1184 individuals to the 23 common items used in the EFA and CFA stages were analyzed. The obtained total score distributions were classified to represent low, medium, and high levels, taking into account the mean and standard deviation values; additionally, the clinical significance of the cutoff scores was evaluated on the basis of the opinions of seven experts specializing in trauma and child psychology.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Content validity findings\u003c/h2\u003e \u003cp\u003eThe content validity of the scale items was assessed via the Lawshe technique. In the initial analysis, the content validity index (CVI) was found to be .55, which was below the minimum threshold of 0.56 accepted by a panel of 12 experts [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Accordingly, 17 items were retained, 9 items were removed, and 15 items were revised with linguistic corrections. The second evaluation, conducted on the updated item pool, strengthened the content validity. After the items were removed, the overall CVI was calculated for the scale and found to be 0.65. Since this value is above the threshold of .56 for 12 experts determined by Lawshe [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], the content validity of the scale was considered to be established. Furthermore, following the content validity analyses, one new item was added to the scale on the basis of expert recommendations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2. EFA findings\u003c/h2\u003e \u003cp\u003eThe Kaiser‒Meyer‒Olkin sample adequacy coefficient, which assesses the adequacy of the working group, was found to be .94. This value indicates that the dataset is suitable for factor analysis [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Accordingly, the sample size used in the study was adequate for factor analysis. Furthermore, Bartlett's sphericity test yielded a statistically significant result, χ\u0026sup2;(253)\u0026thinsp;=\u0026thinsp;3754.83 (p\u0026lt; .01). Since it also met the p \u0026lt; .05 criterion, the correlation matrix between the variables was found to be suitable for factor analysis [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. In this context, considering the multivariate normal distribution property of the data, the maximum likelihood method was preferred for factor analysis [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. These findings indicate that the necessary assumptions for examining the factor structure of the scale were met. Before EFA, the scale consisted of 33 items. During the analysis, 10 items with factor loadings below .30 or low loadings on more than one factor were removed from the scale, and the EFA process was repeated to obtain the most appropriate four-factor structure. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the factor structure of the scale resulting from EFA, the explained variance ratios, the item rotated factor loadings and the communalities (\u003cem\u003eh\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExplained variance, rotated factor loadings, communalities (\u003cem\u003eh\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e), and eigenvalues of factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eRotated Factor Loadings\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eh\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.560\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.641\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.489\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.592\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.349\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.529\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.562\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.522\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.291\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.511\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.465\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.485\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.541\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.483\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.323\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.481\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.381\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.443\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.315\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.427\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.363\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.410\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFactor 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.560\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.672\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.602\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.649\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.586\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.592\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.458\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.557\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.512\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.500\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFactor 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.708\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.822\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.519\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.654\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.552\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e574\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.531\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.533\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.366\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFactor 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.338\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.579\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.428\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e,\u003cb\u003e546\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.388\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.516\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal variance explained: 47.045%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e16.175\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e13.587\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e10.604\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e6.679\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNote: Extraction method: maximum likelihood; rotation method: varimax rotation; item loadings on the factors are bold. *p \u0026lt; .01.\u003c/p\u003e \u003cp\u003eThe communalities ((\u003cem\u003eh\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e) ranged between .291 and .708. When the initial eigenvalues were examined, the scale exhibited a four-factor structure, and the eigenvalues of these four factors were above 1. As a result of the EFA, the total variance explained by the factors in the scale was found to be 47.05%. The first factor explained 16.18% of the variance, the second factor explained 13.59%, the third factor explained 10.60%, and the fourth factor explained 6.68%. These findings indicate that interpreting the scale's structure as four factors is appropriate. Furthermore, this four-factor structure was evaluated as consistent with the conceptual framework that the scale aims to measure.\u003c/p\u003e \u003cp\u003eThe first factor includes 10 items under the heading \"hyperarousal and re-experiencing\"; the second factor includes 6 items under the heading \"need for safety\"; the third factor includes 4 items under the heading \"anger\"; and the fourth factor includes 3 items under the heading \"avoidance.\" This factor distribution indicates that the scale is suitable for measuring early childhood trauma symptoms in different dimensions. Following EFA, CFA was performed on a new sample to validate the factor structure of the scale.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3. CFA findings\u003c/h2\u003e \u003cp\u003eCFA was performed on the model consisting of 23 items and 4 subdimensions obtained from 648 participants. The items that received modification suggestions from the experts in the analysis were evaluated, and modifications were made to the items deemed appropriate. The model diagram is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe correlations between model factors ranged from .66 to .91, and the factor loadings of the items under each factor ranged from .43 to .74. All loadings are positive.\u003c/p\u003e \u003cp\u003eFurthermore, modifications can be made to the model to improve fit values in accordance with the theoretical structure [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. In this context, modifications were made between the items \"Reenacts experiences in play\" and \"Draws experiences in pictures.\" Playing and drawing are forms of expression that children frequently resort to in the process of processing their traumatic experiences. Research shows that children can consciously or unconsciously reenact the events they have experienced in their play [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] or drawings [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. In addition, one modification was made between the items \"They worry that something bad will happen to their loved ones\" and \"They fear that the event they experienced will happen again.\" Research shows that children exposed to traumatic events experience intense anxiety about something bad happening to their loved ones and fear the possibility of the event they experienced happening again [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. As a result, the modification process improved the fit values, and a modification consistent with the theoretical structure was achieved.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;3. Fit index values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFit Indices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood Fit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcceptable Fit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCurrent Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFit\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.95\u0026thinsp;\u0026le;\u0026thinsp;CFI\u0026thinsp;\u0026lt;\u0026thinsp;1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.90\u0026thinsp;\u0026le;\u0026thinsp;CFI\u0026lt;.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAcceptable/Borderline\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.90\u0026thinsp;\u0026le;\u0026thinsp;NFI\u0026thinsp;\u0026le;\u0026thinsp;1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.85\u0026thinsp;\u0026le;\u0026thinsp;NFI \u0026lt; .90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAcceptable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRMSEA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026thinsp;\u0026le;\u0026thinsp;RMSEA\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.05\u0026thinsp;\u0026lt;\u0026thinsp;RMSEA\u0026lt;.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAcceptable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSRMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026thinsp;\u0026le;\u0026thinsp;SRMR\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.05\u0026thinsp;\u0026le;\u0026thinsp;SRMR\u0026lt;.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAcceptable\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e(Byrne, 2013; Hu \u0026amp; Bentler, 1999; Marsh et al., 1988; Suhr, 2008; Tabachnick \u0026amp; Fidell, 2013)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eX\u0026sup2;= 998.22, df\u0026thinsp;=\u0026thinsp;222, p\u0026lt;.01; CFI= .88; GFI=.87; RMSEA= .07 [90% CI: .069, .078]; SRMR= .05. On the basis of these findings, the four-factor structure of the scale has been confirmed, the model generally fits well, and the scale supports construct validity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Measurement invariance findings\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeasurement invariance\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eχ2 (p\u0026lt;.05)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003esd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSRMR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTLI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRMSEA (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eΔRMSEA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eΔCFI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfigural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1459.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.084 (0.080\u0026ndash;0.089)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,475.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.837\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.083 (0.078\u0026ndash;0.087)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScalar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,511.891\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.847\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.082 (0.077\u0026ndash;0.086)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStrict\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1581.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.082 (0.077\u0026ndash;0.086)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMeasure invariance was assessed on the basis of ΔCFI\u0026thinsp;\u0026le;\u0026thinsp;0.01 and ΔRMSEA\u0026thinsp;\u0026le;\u0026thinsp;0.015 values (Chen, 2007).\u003c/p\u003e \u003cp\u003eAs a result of the measurement invariance tests, all the configural, metric, scalar, and strict invariance steps were satisfied [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The fact that the CFI and RMSEA changes are within acceptable limits [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] indicates that the scale provides a stable structure for the mother and father forms and that the two groups perceive the scale similarly. These findings show that the scale has similar psychometric properties for both groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.5. Reliability analysis findings\u003c/h2\u003e \u003cp\u003eUsing CFA data, both Cronbach's alpha (α) and McDonald's omega ω coefficients were calculated as .93 at the general scale level, and these results indicate that the scale is a reliable measurement tool with internal consistency.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.6. Determination of the cutoff score\u003c/h2\u003e \u003cp\u003eThe cutoff scores for the developed scale were determined in three groups via the arithmetic mean and standard deviation values on the basis of the total score distribution. The cutoff values of 30.65 and 47.39 obtained from the scale were calculated by subtracting and adding one standard deviation from the mean. At this point, in a normally distributed dataset, grouping can be performed as follows: the group with a low risk for posttraumatic stress disorder (0\u0026ndash;30 point range), the subthreshold PTSD group (31\u0026ndash;47 point range), and the high-risk group for PTSD (48\u0026ndash;92 point range). In a normally distributed dataset, 68.26% of the population falls within one standard deviation above and below the arithmetic mean. Approximately one-third of the population falls within the 31\u0026ndash;47 point range. The high-risk group, comprising 15.87% of the population, has a score of 48 or higher.\u003c/p\u003e \u003cp\u003eTo examine the validity of the cutoff scores determined by statistical methods in the field of mental health, an evaluation was conducted with seven experts, and all the experts reported the determined score ranges as meaningful, applicable, and psychometrically acceptable. Furthermore, the obtained distributions are consistent with the international literature; the 15\u0026ndash;30% range reported in previous studies on the prevalence of posttraumatic stress symptoms in children parallels the findings obtained from the scale [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. These results indicate that the scale provides reliable reference values for clinical applications.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThis study aimed to develop a measurement tool to assess posttraumatic symptoms in children during early childhood (ages 3\u0026ndash;8), primarily seeking evidence of validity and reliability. According to the findings obtained from the initial EFA, the four factors explain approximately half (47.05%) of the total variance, which falls within the 40\u0026ndash;50% explained variance limits considered acceptable in social science research [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] and is considered sufficient in terms of the scale's construct validity. The model fit values obtained from the CFA conducted on a different sample after the EFA indicate that the four-factor structure of the developed scale fits the data at an acceptable level. When examining the goodness-of-fit indices, although the CFI (.88) value is slightly below the acceptance threshold (.90), it can be said to be acceptable [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. The other fit indices, GFI, RMSEA, and SRMR, are also generally within the acceptable fit levels suggested in the literature [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. In particular, the RMSEA and SRMR values being below .08 indicate that the model is within good limits in terms of error variance. In scale development studies targeting children, model fit values are often at an \"acceptable\" level rather than in the \"excellent\" range due to the diversity of behavioral responses and developmental differences [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. In this context, considering the characteristics of the sample and the multidimensional structure of the developed scale, the fit indices obtained in this study are evaluated as providing sufficient model fit in line with the literature. In addition, the Cronbach's alpha and McDonald's omega values (.93) obtained in the reliability analyses indicate that the developed scale has high internal consistency. While values above .70 are considered acceptable in the literature, values of .90 and above represent a very high level of reliability [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn conclusion, validity analyses demonstrated the appropriateness of the developed measurement tool in terms of content and construct validity. Furthermore, since the tool can be completed by both mothers and fathers, an invariance analysis was conducted on the basis of parent type, and the results indicated that the scale did not cause any change in the measured construct when completed by either group of parents [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Finally, the cutoff score for the scale was determined. On the basis of these results, the C-PTSS-PF, consisting of 23 items and four subscales (1) hyperarousal and re-experiencing, (2) need for safety, (3) anger, and (4) avoidance, is a valid and reliable tool for measuring trauma symptoms in young children who have experienced an earthquake through parent-based assessment.\u003c/p\u003e \u003cp\u003eA review of the international literature indicates that while there are many instruments for measuring PTSD in young children [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e], there are limitations regarding the validity and reliability of these instruments [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In Turkey, there are tools for assessing PTSD in children over the age of seven [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. When tools for measuring posttraumatic stress symptoms in younger children are examined, only one tool focuses directly on PTSD symptoms in children [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]), but this scale is a teacher report and covers children up to six years of age. In addition, mental health professionals in Turkey assess PTSD symptoms in young children largely through clinical interview-based forms. Considering that this developed scale can offer rapid screening, especially for identifying children at risk, and can reach a wide audience through parents, it can fill a gap in the field. Especially after natural disasters affect large populations, such as earthquakes, valid and reliable measurement tools that enable rapid screening and reach large populations may be critical in planning mental health services.\u003c/p\u003e \u003cp\u003eThe developed scale was developed in line with literature reviews on theoretical frameworks related to trauma and posttraumatic stress disorder, as well as the standards of the international diagnostic systems DSM-5 and ICD-11 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The World Health Organization's ICD-11 and the American Psychiatric Association's DSM-5 systematically and developmentally sensitively define the symptoms of PTSD, indicating the effects of trauma on individuals' emotional, cognitive, and social functioning [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. These theoretical and diagnostic frameworks guided the creation of the scale's item pool and subscales. In addition, the item pool and subscales related to posttraumatic stress symptoms in early childhood were created with reference to the literature on PTSD in children [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. We believe that this scale assesses PTSD symptoms in early childhood in line with theoretical and diagnostic systems.\u003c/p\u003e \u003cp\u003eThe first subscale of the scale, hyperarousal and re-experiencing, is a combination of two core symptom clusters of posttraumatic stress symptoms in children. These symptoms are among the most common symptoms that emerge after trauma in young children. These two symptoms are highlighted in the DSM-5 and ICD-11, which are international diagnostic systems that identify how PTSD manifests in children [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Although these two symptom clusters are grouped differently in diagnostic manuals [e.g., re-experiencing (B Cluster) and hyperarousal (D Cluster) in DSM-5], a positive correlation between these clusters is observed in measurement tools developed for children [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e].However, considering that posttraumatic symptoms in young children tend to manifest more intensely in behavioral terms [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], it is expected that responses such as reenacting the trauma in play, difficulty falling asleep, and startle responses, which are included in the scale, would be placed in the same behavioral dimension. Indeed, the EFA and CFA results of the relevant dimension and the high Cronbach's alpha internal consistency value indicate that the items can be evaluated together.\u003c/p\u003e \u003cp\u003eThe second subdimension of the developed measurement tool is the need for safety. This dimension refers to situations such as children struggling to separate from their parents after trauma, clinging, constant anxiety, and the need for control. Traumatic experiences can have negative effects on children's sense of safety and attachment systems [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. In addition, it has been reported that children become more clingy and dependent on their caregivers to maintain or regain homeostasis in highly stressful situations [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. The Diagnostic Infant and Preschool Assessment (DIPA), which assesses PTSD in preschool children, also indicates separation anxiety from caregivers among posttraumatic stress symptoms in children. The fact that the data were collected from parents of children who experienced earthquake trauma may have also contributed to the prominence of the need for safety in children. Parents who experienced the trauma themselves may have adopted from whom the data were collected may have experienced earthquake trauma themselves, leading them to adopt a more protective attitude toward their children, which in turn may have increased the children's need for safety. Within the scope of this finding, focusing on the re-establishment of safety and trust is critically important in posttraumatic intervention efforts for children.\u003c/p\u003e \u003cp\u003eThe third subscale of the scale, the anger subscale, includes items such as sudden anger outbursts after trauma, increased aggressive behavior, and conflicts in peer relationships. After traumatic experiences, children may develop internalizing problems such as anxiety and fear, as well as externalizing problems such as anger [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Notably, externalizing problems such as crying, anger, and aggression are more intense than internalizing problems are, especially in young children [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. In addition, the DSM-5 defines angry behavior, excessive irritability, and unexplained outbursts of anger in children after trauma as post-traumatic symptoms [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This subdimension may be an indicator of children's observable expression of their emotions. Anger outbursts were highlighted in the behavioral response subdimension of a teacher-reported scale assessing trauma symptoms in preschool children after an earthquake [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The Trauma Symptom Checklist for Young Children (TSCYC), a commonly used tool for measuring trauma symptoms in children, has a direct subscale called \"Anger/Aggression\" [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. Consequently, following an event such as an earthquake that eliminates the sense of control and creates intense fear/horror, \"anger\" can be considered an expression of the child's inability to cope.\u003c/p\u003e \u003cp\u003eThe final subscale of the scale, \"avoidance,\" involves difficulty remembering and expressing posttraumatic experiences and avoiding talking about events. The DSM-5 PTSD diagnostic criteria clearly state the avoidance of feelings, thoughts, and conversations related to the event [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This avoidance may include fear of confronting negative emotions. Feelings of guilt, which may be triggered by the egocentric thinking typical of this age group, may also contribute to avoidance.\u003c/p\u003e \u003cp\u003eThis study has several limitations. One limitation is that the data were collected from parents. Although it is quite difficult to collect data directly from children in this age group, there may be some doubts about the reliability of the data collected from parents. Parents' personal concerns and expectations, mental health issues, limited observations and knowledge about their children, and a tendency to view their children in a more favorable light than they actually are may increase the likelihood of biased data [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. In this context, the fact that the parents from whom the data were collected had also experienced earthquake trauma may have influenced the information they provided about their children. Another important limitation of the study in this context may be that the data were collected only from parents of children who experienced earthquake trauma. Indeed, many traumas in children can result from abuse, war, accidents, etc.\u003c/p\u003e \u003cp\u003eAnother important limitation of the study is that convergent and divergent validity studies could not be conducted. While the scale development process was planned, these types of validity were examined; however, no measurement tool was found that assesses PTSD and other mental health disorders in this age group of children on the basis of parental evaluation. Existing measurement tools are either designed for older age groups or are tools based directly on clinical observation and interviews. To mitigate the impact of this limitation, expert opinions were sought at different stages, and different samples were used in the EFA and CFA processes. Future researchers should conduct convergent and divergent validity studies and evaluate the scale's consistency with clinical observations to eliminate this limitation. In addition, researchers may be advised to compare the results of this scale with those of a teacher-reported scale for children experiencing trauma [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Finally, different researchers can test whether the scale yields valid and reliable results for different types of trauma (e.g., sexual abuse, accidents, war, etc.).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMustafa Tayyip KURT, MsC\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGuidance and Psychological Counseling Program, Gaziantep Education Faculty, Gaziantep University, 27470, Turkey\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eORCID: 0009-0004- 1226-8247\u003c/p\u003e\n\n\u003cp\u003eIdris Kaya, PhD\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGuidance and Psychological Counseling Program, Gaziantep Education Faculty, Gaziantep University, 27470, Turkey\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eORCID: 0000-0001-9562-3347\u003c/p\u003e\n\n\u003cp\u003eİbrahim YILDIRIM, PhD\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDepartment of Measurement and Evaluation in Education, Gaziantep Education Faculty, Gaziantep University, 27470, Turkey\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eORCID: 0000-0002-4137-2025\u003c/p\u003e\n\n\u003cp\u003eAli \u0026Ccedil;EKİ\u0026Ccedil;, PhD\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGuidance and Psychological Counseling Program, Gaziantep Education Faculty, Gaziantep University, 27470, Turkey\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eORCID: 0000-0002-7893-268X\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCorresponding author:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIdris Kaya\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003ePhone: 0090 507 340 48 02\u003c/p\u003e\n\n\u003cp\u003eContributions\u003c/p\u003e\n\u003cp\u003eThis manuscript is derived from the first author\u0026rsquo;s master\u0026rsquo;s thesis. The second author, as the thesis advisor, supervised the introduction and discussion sections and the data collection processes. The third author, as the thesis advisor, supported the methodology and findings. The fourth author reviewed and edited the study as a whole, providing feedback.\u003c/p\u003e\n\n\u003cp\u003eDeclaration of interest: We have no conflicts of interest to disclose. All authors have reviewed and approved the final manuscript for publication.\u003c/p\u003e\n\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Scientific and Technological Research Council of T\u0026uuml;rkiye (TUBITAK) under Grant Number 223K243. The authors thank TUBITAK for their support.\u003c/p\u003e\n\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author.\u003c/p\u003e\n\n\u003cp\u003eEthics declarations\u003c/p\u003e\n\u003cp\u003eThe requisite ethical and legal permissions were obtained from Gaziantep University\u0026rsquo;s Social Sciences and Humanities Ethics Committee (Decision No. 1, dated January 25, 2024). The scale clearly stated that participation in the study was voluntary and that the data would be kept confidential.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eFairbank, J. A., Putnam, F. W. \u0026amp; Harris, W. W. \u003cem\u003eChild traumatic stress: Prevalence, trends, risk, and impact\u003c/em\u003e (2014).\u003c/li\u003e\n\u003cli\u003eVanderzee, K. L., Sigel, B. A., Pemberton, J. R. \u0026amp; John, S. G. 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Dev.\u003c/em\u003e 1\u0026ndash;9 (2025).\u003c/li\u003e\n\u003cli\u003eBriere, J. \u003cem\u003eet al.\u003c/em\u003e The Trauma Symptom Checklist for Young Children (TSCYC): Reliability and association with abuse exposure in a multisite study. \u003cem\u003eChild Abuse Negl.\u003c/em\u003e \u003cstrong\u003e25\u003c/strong\u003e, 1001\u0026ndash;1014 (2001).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Posttraumatic stress symptoms, Scale development, Early childhood, Parent","lastPublishedDoi":"10.21203/rs.3.rs-8810156/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8810156/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTraumatic experiences have profound effects on children\u0026rsquo;s mental health and functioning; however, their responses differ from those of other age groups due to unique developmental characteristics. In Turkey, there is a significant lack of standardized parent-report tools designed to assess posttraumatic stress symptoms (PTSS) specifically in early childhood. This study aimed to develop a valid and reliable measurement tool, based on parental reports, to assess PTSS in early childhood. Data were collected from 1,035 parents of children who directly experienced the February 6, 2023, earthquakes in Kahramanmaraş, Turkey. The scale\u0026rsquo;s item pool was developed through literature reviews, interviews, and expert evaluations. Results from exploratory factor analysis (EFA) identified a four-factor scale structure explaining 47.05% of the total variance, while confirmatory factor analysis (CFA) supported these findings with acceptable fit indices. The scale demonstrated high internal consistency, as evidenced by Cronbach\u0026rsquo;s alpha (.93) and McDonald\u0026rsquo;s omega (.93) coefficients. Additionally, multigroup CFA confirmed measurement invariance, indicating structural equivalence across mother and father groups. The scale, consisting of 23 items and four subscales\u0026mdash;(1) hyperarousal and re-experiencing, (2) need for safety, (3) anger, and (4) avoidance\u0026mdash;can be considered a valid and reliable tool.\u003c/p\u003e","manuscriptTitle":"Child Posttraumatic Stress Symptom Scale–Parent Form (C-PTSS-PF)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-13 07:29:07","doi":"10.21203/rs.3.rs-8810156/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-01T13:51:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300853104031275147489530065010510581679","date":"2026-04-22T20:09:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"131841471723493745370234226642218762482","date":"2026-03-23T16:48:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-06T09:14:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-06T08:32:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-16T13:15:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-12T12:02:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-02-12T11:47:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"20257bda-eb82-4ab3-a36a-179145bf4b16","owner":[],"postedDate":"March 13th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-01T13:51:46+00:00","index":97,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":64106468,"name":"Biological sciences/Biochemistry"},{"id":64106469,"name":"Biological sciences/Zoology"}],"tags":[],"updatedAt":"2026-03-13T07:29:07+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-13 07:29:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8810156","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8810156","identity":"rs-8810156","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}