Children’s Coping Strategies Checklist (CCSC)

Abstract

The Children’s Coping Strategies Checklist (CCSC) is a widely recognized, self-report psychometric instrument designed to assess dispositional and situational coping behaviors among children and adolescents typically aged between 8 and 18 years. Developed by Tim S. Ayers, Irwin N. Sandler, Stephen G. West, and Mark W. Roosa at the Arizona State University Prevention Research Center, the CCSC addresses a critical need in developmental psychopathology and pediatric psychology: measuring multidimensional coping processes through developmentally sensitive behavioral indicators. The scale is structured around a hierarchical multidimensional architecture composed of ten primary (first-order) subscales nested within four broad, second-order coping dimensions: Active Coping Strategies (encompassing Cognitive Decision Making, Direct Problem Solving, Seeking Understanding, and Positive Cognitive Restructuring), Distraction Strategies (comprising Distracting Actions and Physical Release of Emotions), Avoidance Strategies (encompassing Avoidant Actions and Cognitive Avoidance), and Support Seeking Strategies (comprising Problem-Focused Support and Emotion-Focused Support). Responses are recorded on an authentic 4-point Likert-type frequency scale ranging from 1 (“Never”) to 4 (“Most of the time”). Extensively validated across community, normative, and clinical samples—including youth undergoing significant life transitions such as parental divorce, bereavement, and chronic pediatric illness—the CCSC demonstrates robust internal consistency across dimensions (Cronbach’s alpha coefficients ranging from .64 to .89 across subscales and composite domains), notable test-retest reliability, and well-established construct, convergent, discriminant, and predictive validities. Confirmatory factor analytic investigations consistently confirm the superiority of its four-factor hierarchical model over traditional dichotomy paradigms, establishing the CCSC as a cornerstone psychometric instrument in psychological resilience, stress research, and preventive intervention science.

Keywords

Children’s Coping Strategies Checklist, CCSC, child coping, active coping, avoidance coping, distraction strategies, support seeking, pediatric stress, psychometrics, confirmatory factor analysis

Authors

The Children’s Coping Strategies Checklist was conceptualized, operationalized, and psychometrically validated by a team of clinical psychologists, methodologists, and developmental researchers affiliated with the Program for Prevention Research (now the Prevention Research Center) at Arizona State University:

• Tim S. Ayers, Ph.D. – Department of Psychology and Prevention Research Center, Arizona State University, Tempe, Arizona, United States. Lead investigator whose doctoral dissertation established the initial dispositional and situational dimensional architecture of children’s coping models.
• Irwin N. Sandler, Ph.D. – Regents’ Professor Emeritus, Department of Psychology, Arizona State University. Renowned authority on child resilience, divorce adjustment, bereavement intervention, and preventive developmental psychology.
• Stephen G. West, Ph.D. – Professor of Quantitative Psychology, Department of Psychology, Arizona State University. Internationally recognized quantitative methodologist specializing in structural equation modeling, confirmatory factor analysis, and measurement validity in behavioral sciences.
• Mark W. Roosa, Ph.D. – Professor Emeritus, School of Social and Family Dynamics, Arizona State University. Expert in family stress, adolescent development, and the contextual etiology of developmental adaptation among high-risk youth populations.

Institutional contact and instrument distribution have historically been maintained through the Prevention Research Center at Arizona State University (formerly accessible via the ASU PIRC measures archive).

Purpose

The primary purpose of the Children’s Coping Strategies Checklist (CCSC) is to provide an empirical, developmentally appropriate, and structurally rigorous measurement tool for assessing the cognitive and behavioral coping responses deployed by children and adolescents when encountering stressful life events. Historically, coping research suffered from the uncritical downward extension of adult models—such as the binary problem-focused versus emotion-focused dichotomy formulated by Richard Lazarus and Susan Folkman—without validating whether juvenile cognitive development, emotional regulation capabilities, and social dependency conformed to those boundaries. The CCSC was explicitly developed to address these conceptual and measurement shortcomings.

From a clinical and preventive standpoint, the CCSC serves several interrelated diagnostic and evaluative functions. First, it identifies maladaptive coping patterns (such as pervasive cognitive avoidance, behavioral disengagement, or aggressive acting-out) that heighten vulnerable youths’ susceptibility to internalizing disorders (e.g., childhood depression, generalized anxiety) and externalizing behavior problems (e.g., oppositional defiance, conduct issues). Second, the instrument establishes a baseline profile of personal resources and adaptive strategies, illuminating whether a child possesses effective cognitive decision-making capabilities, active problem-solving skills, or the developmental maturity required for positive cognitive restructuring. Third, the checklist provides an empirical outcome measure for randomized controlled trials (RCTs) assessing preventive and clinical interventions, such as the New Beginnings Program for children of divorce and the Family Bereavement Program. By tracking shifts from passive avoidance to active coping and constructive support-seeking, clinicians and program evaluators can quantify the specific mechanisms of action through which interventions foster emotional resilience.

In academic and developmental research, the CCSC allows investigators to evaluate transactional models of stress and coping across diverse settings. Because the tool measures specific, concrete behavioral manifestations (e.g., “Think about what you could do before you did something” or “Talk about how you are feeling with your mother or father”) rather than abstract dispositions, it minimizes retrospective recall bias and cognitive overextension. Researchers can administer the checklist as a dispositional assessment (evaluating how a youth typically handles problems over general time frames) or as a situational assessment (evaluating coping responses to specific, identified stressors such as acute pediatric hospitalization, academic failure, interparental conflict, or peer victimization), providing an empirically validated bridge between basic cognitive-affective science and applied developmental psychopathology.

Psychological Construct

The psychological construct evaluated by the CCSC is childhood coping, conceptualized as conscious, volitional, cognitive and behavioral efforts mobilized to manage, tolerate, reduce, or resolve internal and environmental demands—and the psychological conflicts among them—that are appraised as taxing or exceeding the resources of the individual. Rather than viewing coping as an undifferentiated general trait, the CCSC formalizes coping as a hierarchical construct structured across ten discrete primary subscales subsumed under four higher-order conceptual dimensions:

1. Active Coping Strategies

Active coping reflects direct cognitive and behavioral engagement designed to confront, evaluate, alter, or psychologically reframe the stressor or one’s appraisal of it. This overarching dimension comprises four primary subscales:

• Cognitive Decision Making (CDM): Deliberate intellectual activities involving problem identification, step-by-step planning, anticipation of outcomes, and weighing potential alternative pathways prior to acting (e.g., weighing consequences before acting, determining what information is required to solve an issue).
• Direct Problem Solving (DPS): Concrete, instrumental behavioral efforts executed to directly modify the problematic external circumstance, resolve conflict, or alter one’s own behavioral contribution to the stressor (e.g., doing something to make the situation better, taking active steps to solve the problem).
• Seeking Understanding (SU): Introspective cognitive efforts to make sense of the stressful occurrence, deduce why it emerged, integrate the experience into the child’s cognitive schemata, and derive developmental lessons from adversity (e.g., reflecting on why things happen, identifying what can be learned from the problem).
• Positive Cognitive Restructuring (PCR): Adaptive cognitive mechanisms wherein the child actively alters subjective appraisal by identifying silver linings, recognizing that circumstances could be more severe, maintaining optimistic expectancy, and anchoring thoughts on personal resilience and positive life facets (e.g., telling oneself things will work out, reminding oneself of good things).

2. Distraction Strategies

Distraction coping encompasses temporary diversionary tactics designed to redirect attention away from stress-induced distress toward pleasurable, physical, or emotionally neutral engagements, without necessarily denying the existence of the stressor:

• Distracting Actions (DA): Engaging in alternative absorbing activities, recreational hobbies, media consumption, or solitary pastimes that shift attentional allocation away from the stressor (e.g., reading magazines, listening to music, playing video games, watching television).
• Physical Release of Emotions (PRE): Somatosensory and motor discharge mechanisms employed to dissipate physiological arousal, somatic tension, and intense affective states generated by stress (e.g., bicycle riding, engaging in sports, going for a brisk walk, energetic exercise).

3. Avoidance Strategies

Avoidance coping comprises cognitive disengagement, suppression, and behavioral withdrawal strategies aimed at disengaging from the stressor, often serving an immediate affective damping role while impeding long-term resolution:

• Avoidant Actions (AvA): Overt behavioral efforts to physically escape or evade the physical environment, individuals, or triggers associated with the distressing event (e.g., withdrawing into one’s private bedroom, staying away from upsetting situations, avoiding people who provoke distress).
• Cognitive Avoidance (CA): Covert psychological maneuvers aimed at mentally repressing, denying, wishing away, or minimizing the reality of the stressor (e.g., intentionally putting the problem out of mind, pretending the situation never occurred, wishing that things were different).

4. Support Seeking Strategies

Support seeking captures interpersonal, social transactions wherein the child relies on social ecology—parents, peers, siblings, teachers, or unrelated trusted adults—for assistance:

• Problem-Focused Support (PFS): Reaching out to social network members specifically to obtain instrumental guidance, information, practical advice, and collaborative action plans to resolve the external problem.
• Emotion-Focused Support (EFS): Reaching out to others for emotional validation, affective ventilation, empathy, warmth, reassurance, and psychological comforting.

Theoretical Framework

The conceptual architecture of the CCSC rests upon the transactional model of stress and coping articulated by Richard S. Lazarus and Susan Folkman (1984), integrated with developmental adaptations formulated by Bruce E. Compas, David L. Roth, and Lawrence S. Cohen. Lazarus and Folkman defined coping as an evolving cognitive and behavioral effort to manage specific external or internal demands appraised as taxing or exceeding personal resources. Central to transactional theory is the duality of primary appraisal (evaluating what is at stake: threat, harm, loss, or challenge) and secondary appraisal (evaluating what, if anything, can be done to alter the situation or regulate distress).

Early attempts to apply this framework directly to children relied strictly on Lazarus and Folkman’s broad dichotomy of problem-focused coping (altering the person-environment transaction) versus emotion-focused coping (regulating emotional states). However, developmental psychopathology research revealed that children’s developing executive functions, cognitive abstraction capacities, and systemic dependency on adult caregivers produce coping topologies that violate this simple two-dimensional taxonomy. For instance, Roth and Cohen (1986) demonstrated that a fundamental dimension in human stress response is the tension between approach (attending to the stressor and its associated feelings) and avoidance (turning attention and action away from the stressor).

Ayers, Sandler, West, and Roosa (1996) synthesized these converging paradigms to formulate a developmentally grounded four-factor theoretical model specifically tailored to pediatric populations. In this model:

1. Active Coping represents approach-oriented efforts combining direct problem modification (problem-focused approach) and cognitive appraisal reappraisal (emotion-focused approach).
2. Distraction Strategies reflect an attentional redirection approach that differs fundamentally from avoidance; the individual does not deny or escape the stressor permanently but temporarily allocates attention to neutral physical or recreation activities to dampen sympathetic nervous system hyperarousal.
3. Avoidance Strategies represent true disengagement and behavioral-cognitive avoidance, wherein the individual physically departs or mentally represses the stressor.
4. Support Seeking Strategies crosscut problem- and emotion-focused domains by grounding adaptation in the child’s relational ecology, reflecting the developmental reality that children rarely resolve significant environmental challenges entirely autonomously without tapping external social scaffolding.

This four-factor model provides a far superior theoretical fit for pediatric data than either traditional two-factor models (problem-focused vs. emotion-focused; approach vs. avoidance) or three-factor models (problem-focused, emotion-focused, and avoidance). The CCSC theoretical model explicitly recognizes that children navigate stressors across biological, psychological, and social systems simultaneously, establishing clear conceptual boundaries between constructive cognitive reflection (e.g., seeking understanding) and maladaptive cognitive avoidance.

Validity

The psychometric validity of the CCSC has been extensively examined across diverse community, academic, clinical, and high-stress pediatric cohorts. Its validity profile encompasses structural construct validity, convergent and discriminant validity, and predictive (criterion-related) validity.

Construct and Factorial Validity

Construct validity was initially established through comprehensive exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) conducted by Ayers et al. (1996). Evaluating competing theoretical formulations across independent samples of school-aged children, structural equation modeling demonstrated that the hypothesized four-factor hierarchical model provided an exemplary fit to the empirical data (Comparative Fit Index [CFI] > .90, Goodness-of-Fit Index [GFI] > .92, Root Mean Square Error of Approximation [RMSEA] < .05), significantly outperforming alternative one-, two-, and three-factor formulations. Subsequent cross-validation studies in diverse international samples (e.g., Spanish, Chinese, Dutch, and Portuguese adaptations) have verified the cross-cultural invariance of this four-factor higher-order structure.

Convergent and Discriminant Validity

The CCSC demonstrates clear convergent validity with theoretically aligned constructs and established psychological scales. Active Coping subscales (Cognitive Decision Making, Direct Problem Solving, Positive Cognitive Restructuring) correlate positively with generalized self-efficacy, internal locus of control, perceived cognitive competence, and global self-esteem as measured by the Harter Self-Perception Profile for Children. Furthermore, Support Seeking Strategies show robust positive associations with perceived social support from parents and peers (e.g., Social Support Scale for Children). Discriminant validity is supported by low or non-significant correlations between CCSC subscales and measures of social desirability, intellectual aptitude, and reading comprehension levels, ensuring that the instrument measures genuine coping behavior rather than test-taking bias or verbal ability.

Predictive and Criterion Validity

Extensive longitudinal investigations, prominently led by Sandler, Tein, and West (1994), have established the predictive validity of the CCSC regarding child mental health and psychosocial adaptation. In studies of children undergoing major family disruptions (such as parental divorce or parental death), higher baseline scores on the Active Coping composite prospectively predicted significant reductions in both internalizing symptoms (childhood depression, anxiety) and externalizing symptoms (aggression, conduct disturbances) assessed via the Child Behavior Checklist (CBCL) and the Children’s Depression Inventory (CDI). Conversely, elevated scores on Avoidance Strategies, particularly Cognitive Avoidance, prospectively predicted chronic depressive symptoms, heightened anxiety, and school maladjustment. Furthermore, intervention trials utilizing the CCSC have verified its sensitivity to intervention-induced change, demonstrating that targeted increases in active coping directly mediate reductions in psychological distress at long-term follow-up.

Reliability

The reliability of the CCSC has been thoroughly documented across initial instrument development trials, large-scale epidemiological investigations, and randomized preventive intervention studies. The instrument demonstrates strong internal consistency, robust temporal stability, and reliable factor coherence.

Internal Consistency

Estimates of internal consistency (Cronbach’s alpha) for the four higher-order composite dimensions consistently meet or exceed conventional psychometric standards for behavioral assessment:

• Active Coping Dimension: Consistently exhibits high internal consistency, with alpha coefficients ranging between α = .80 and α = .89 across developmental cohorts.
• Distraction Strategies Dimension: Demonstrates solid reliability, typically yielding alphas between α = .79 and α = .80.
• Avoidance Strategies Dimension: Produces moderate to good internal consistency, ranging from α = .64 to α = .73 (reflecting the developmental diversity of avoidant behaviors in younger vs. older children).
• Support Seeking Dimension: Yields robust consistency across studies, with alphas ranging from α = .78 to α = .79.

At the primary subscale level, internal consistency estimates reported across psychometric evaluations reflect reliable item-total correlations while capturing specific, focused coping facets:

• Positive Cognitive Restructuring: α = .71
• Physical Release of Emotion: α = .71
• Distracting Action: α = .70
• Cognitive Decision Making: α = .68
• Direct Problem Solving: α = .66
• Problem-Focused Support: α = .75
• Emotion-Focused Support: α = .73
• Cognitive Avoidance: α = .61
• Seeking Understanding: α = .56
• Avoidance Action: α = .49 to .52

The modest alpha observed for subscales like Seeking Understanding and Avoidance Action is theoretically expected in behavioral checklists composed of few, non-redundant items tapping diverse behavioral choices rather than identical semantic repetitions.

Test-Retest Stability

Temporal stability evaluated over intervals ranging from two weeks to four months confirms that the CCSC reliably captures dispositional coping styles while retaining sensitivity to genuine developmental and contextual fluctuations. Two-to-three-week test-retest intraclass correlation coefficients (ICCs) for higher-order dimensions range between .65 and .82 in stable community samples, indicating substantial stability. When administered situationally following targeted stressor events, the scale exhibits expected sensitivity to environmental transitions, validating its dual utility as a dispositional index and a state-responsive evaluative measure.

Factor Analysis

The empirical determination of the CCSC’s latent dimensional architecture constitutes one of the most rigorous applications of structural equation modeling in developmental psychometrics. The factor-analytic sequence executed by Ayers and colleagues (1991, 1996) advanced through rigorous exploratory and confirmatory phases to adjudicate between long-standing theoretical models.

Exploratory Factor Analysis (EFA)

Initial item pools developed from open-ended child interviews, clinical expert panels, and existing adult coping inventories were subjected to principal axis factoring with oblique (Promax) rotation to accommodate the natural correlations expected among coping behaviors. Items demonstrating cross-loadings > .30 on multiple factors or failing to achieve a primary loading of at least .40 were systematically eliminated. This iterative extraction converged upon ten distinct, interpretable first-order factors representing discrete behavioral strategies (e.g., Cognitive Decision Making, Direct Problem Solving, Physical Release of Emotion, Cognitive Avoidance).

Confirmatory Factor Analysis (CFA) and Model Comparison

To establish the overarching structure governing these ten primary factors, Ayers et al. (1996) tested five competing structural models using maximum likelihood CFA in LISREL and EQS across independent samples (N > 500 children):

• Model 1: Single General Coping Factor. Posited that all coping items reflect an undifferentiated general capacity to respond to stress (χ²/df > 4.5, CFI = .62; rejected).
• Model 2: Two-Factor Problem-Focused vs. Emotion-Focused Model. Tested the classical Lazarus and Folkman adult dichotomy (χ²/df > 3.8, CFI = .71; rejected).
• Model 3: Two-Factor Approach vs. Avoidance Model. Tested Roth and Cohen’s attentional orientation paradigm (χ²/df > 3.2, CFI = .78; rejected).
• Model 4: Three-Factor Model. Combined problem-focused coping, emotion-focused coping, and avoidance (χ²/df = 2.6, CFI = .84; inadequate fit).
• Model 5: Four-Factor Hierarchical Model (The CCSC Model). Formulated ten first-order factors loading onto four distinct higher-order latent constructs: Active Coping, Distraction Strategies, Avoidance Strategies, and Support Seeking Strategies. This model yielded superior and robust fit indices: χ²/df = 1.68, Non-Normed Fit Index (NNFI) = .91, CFI = .93, RMSEA = .042 (90% CI [.036, .048]).

Item standardized factor loadings onto their designated first-order factors were robust, predominantly ranging from .50 to .78 (p < .001). Second-order loadings of first-order latent variables onto the four higher-order constructs were uniformly high: Cognitive Decision Making (.82), Direct Problem Solving (.79), Seeking Understanding (.61), and Positive Cognitive Restructuring (.74) loaded heavily onto Active Coping; Distracting Actions (.80) and Physical Release of Emotions (.72) loaded onto Distraction Strategies; Avoidant Actions (.65) and Cognitive Avoidance (.77) loaded onto Avoidance Strategies; and Problem-Focused Support (.84) and Emotion-Focused Support (.86) loaded robustly onto Support Seeking. Intercorrelations among the second-order factors showed modest, theoretically coherent relationships (e.g., Active Coping correlated moderately with Support Seeking, r ≈ .42, and Distraction, r ≈ .36, while Avoidance showed minimal or negative associations with Active Coping), substantiating their factorial uniqueness.

Instrument / Measurement Tool

The standard operational details, administrative parameters, and scoring protocols for the Children’s Coping Strategies Checklist are outlined below:

• Instrument Name: Children’s Coping Strategies Checklist (CCSC; Revision 1: CCSC-R1)
• Instrument Type: Standardized self-report psychometric rating scale
• Respondent Target Population: Children, pre-adolescents, and adolescents aged 8 to 18 years
• Administration Format: Individual or group paper-and-pencil questionnaire, or secure computer-based digital administration
• Total Item Count: 54 authentic items (standardized inventory capturing the full spectrum of primary and second-order dimensions)
• Completion Time: Approximately 15 to 25 minutes depending upon child age and reading speed
• Prompt / Time Frame: “When you had problems in the past month…” (or general dispositional instruction: “When I have a problem, I…”)
• Response Format: 4-point Likert-type frequency scale:
  • 1 = Never
  • 2 = Sometimes
  • 3 = Often
  • 4 = Most of the time
• Primary Subscales (First-Order):
  • Cognitive Decision Making (CDM)
  • Direct Problem Solving (DPS)
  • Seeking Understanding (SU)
  • Positive Cognitive Restructuring (PCR)
  • Distracting Actions (DA)
  • Physical Release of Emotions (PRE)
  • Avoidant Actions (AvA)
  • Cognitive Avoidance (CA)
  • Problem-Focused Support (PFS)
  • Emotion-Focused Support (EFS)
• Composite Dimensions (Second-Order):
  • Active Coping: Mean or sum of items from Cognitive Decision Making, Direct Problem Solving, Seeking Understanding, and Positive Cognitive Restructuring.
  • Distraction Strategies: Mean or sum of items from Distracting Actions and Physical Release of Emotions.
  • Avoidance Strategies: Mean or sum of items from Avoidant Actions and Cognitive Avoidance.
  • Support Seeking Strategies: Mean or sum of items from Problem-Focused Support and Emotion-Focused Support.
• Scoring Protocols: Subscale and composite scores are calculated as either arithmetic sums or item-mean scores (range 1.00 to 4.00), with higher numerical values indicating more frequent mobilization of that specific coping behavior. All items are positively keyed toward the measured behavior (no reverse-scored items).
• Complementary Effectiveness Module: The optional “How Well I Cope” self-efficacy module evaluates perceived situational resolution and emotional relief via two 4-point rating items (1 = “Do not work at all”, 2 = “Work a little”, 3 = “Work pretty well”, 4 = “Work very well”).

Permissions & Fee and Test Year

The original Children’s Coping Strategies Checklist was formulated through doctoral research completed by Tim S. Ayers in 1991, with subsequent major empirical and longitudinal validation papers published in 1994 (Sandler, Tein, & West) and 1996 (Ayers, Sandler, West, & Roosa). The revised clinical and epidemiological editions (CCSC-R1 and its companion situational measure, the How I Coped Under Pressure Scale [HICUPS]) were refined across the 1990s and early 2000s under grants funded by the National Institute of Mental Health (NIMH).

Licensing and Accessibility: The CCSC was developed within academic research protocols supported by public biomedical research grants. Consequently, the instrument is widely accessible for non-profit academic research, clinical education, and empirical investigation at no direct purchase cost. Manuals, scoring keys, and documentation have traditionally been hosted openly by the Arizona State University Prevention Research Center (ASU PRC). Researchers and clinicians wishing to employ the instrument in formal investigations or clinical program evaluations are requested to properly cite the foundational validation articles and obtain formal institutional review board approval as appropriate.

References

• Ayers, T. S. (1991). A dispositional and situational assessment of children’s coping: Testing alternative theoretical models (Unpublished doctoral dissertation). Arizona State University, Tempe, AZ.
• Ayers, T. S. (1992). A dispositional and situational assessment of children’s coping: Testing alternative theoretical models. Dissertation Abstracts International, 53(1-B), 556.
• Ayers, T. S., Sandler, I. N., West, S. G., & Roosa, M. W. (1996). A dispositional and situational assessment of children’s coping: Testing alternative models of coping. Journal of Personality, 64(4), 923–958. https://doi.org/10.1111/j.1467-6494.1996.tb00949.x
• Compas, B. E., Connor-Smith, J. K., Saltzman, H., Thomsen, A. H., & Wadsworth, M. E. (2001). Coping with stress during childhood and adolescence: Problems, progress, and potential in theory and measurement. Psychological Bulletin, 127(1), 87–127. https://doi.org/10.1037/0033-2909.127.1.87
• Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing Company.
• Program for Prevention Research. (1992). Divorce Adjustment Project Documentation (Unpublished manuscript). Arizona State University, Tempe, AZ.
• Roth, S., & Cohen, L. J. (1986). Approach, avoidance, and coping with stress. American Psychologist, 41(7), 813–819. https://doi.org/10.1037/0003-066X.41.7.813
• Sandler, I. N., Tein, J. Y., & West, S. G. (1994). Coping, stress, and the psychological symptoms of children of divorce: A cross-sectional and longitudinal study. Child Development, 65(6), 1744–1763. https://doi.org/10.2307/1131291
• Tein, J. Y., Sandler, I. N., & Zautra, A. J. (2000). Stressful life events, psychological symptoms, and coping: A test of the buffering hypothesis for children of divorce. Journal of Clinical Child Psychology, 29(4), 584–599. https://doi.org/10.1207/S15374424JCCP2904_11

13. Items of the Scale (Questionnaire)