The CRAFFT test is a valid means of screening adolescents for substance-related problems and disorders, which may be common in some general clinic populations.

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Objective To develop and test the validity and reliability of the Withdrawal Assessment Tool - Version 1 (WAT-1) for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Design Prospective psychometric evaluation. Pediatric critical care nurses assessed eligible at-risk pediatric patients for the presence of 19 withdrawal symptoms and rated the patient’s overall withdrawal intensity using a numeric rating scale (NRS) where 0 indicated no withdrawal and 10 indicated worst possible withdrawal. The 19 symptoms were derived from the Opioid and Benzodiazepine Withdrawal Score (OBWS), the literature and expert opinion. Setting: Two Pediatric Intensive Care Units (PICU) in university-affiliated academic children’s hospitals. Patients 83 pediatric patients, median age 35 months (IQR: 7months -10 years), recovering from acute respiratory failure who were weaning from more than 5 days of continuous infusion or round-the-clock opioid and benzodiazepine administration. Interventions Repeated observations during analgesia and sedative weaning. A total of 1040 withdrawal symptom assessments were completed, with a median (IQR) of 11 (6-16) per patient over 6.6 (4.8-11) days. Measurements and Main Results Generalized linear modeling was used to analyze each symptom in relation to withdrawal intensity ratings, adjusted for site, subject and age group. Symptoms with high redundancy or low levels of association with withdrawal intensity ratings were dropped, resulting in an 11-item (12-point) scale. Concurrent validity was indicated by high sensitivity (.872) and specificity (.880) (WAT-1 ≥3 predicting NRS ≥4). Construct validity was supported by significant differences in drug exposure, length of treatment and weaning from sedation, length of mechanical ventilation and intensive care unit stay for patients with WAT-1 scores ≥3 compared to those with lower scores. Conclusions The WAT-1 shows excellent preliminary psychometric performance when used to assess clinically important withdrawal symptoms in the PICU setting. Further psychometric evaluation in diverse at-risk groups is needed.