Young Mania Rating Scale (YMRS)

The Young Mania Rating Scale (YMRS) is a Clinician administered tool used to rate the severity of symptoms of mania (Young, Biggs, Ziegler & Meyer, 1978) across clinical and research settings. The YMRS was originally developed in 1978 and normed with psychiatric inpatients based on a semi structured interview and observations over an 8 hour period. Today the YMRS combines the clients self-report of symptoms of mania over the past 48 hours with the clinician observations during interview (Miller, Johnson & Eisner, 2009) and is now a commonly used tool to screen for manic symptoms and monitor the severity of manic symptoms (Lukasiewicz et al., 2013). Used to assess the severity of manic symptoms, this tool is often used to monitor the progress of interventions (Miller, Johnson & Eisner, 2009).

It is an 11 item scale assessing mood, motor activity/ energy levels, interest in sex, sleep, irritability, rate and frequency of speech, flight of ideas, grandiosity, aggressive behaviour, appearance, and insight into current presentation. It should be noted that the YMRS does not map onto the DSM 5 criteria for mania as it does not account for distractibility, increases in goal directed activity or excessive involvement in pleasurable activities that have a potential fir painful consequences (DSM-5). As such this tool is not a diagnostic assessment.

Each item is composed of 5 explicitly defined levels of severity.  Severity ratings for 7 items are scored on a scale of 0 -4. The remaining 4 items are double weighted to account for poor cooperation of client when unwell and are scored on a scale of 0 – 8. Item ratings are sum to produce a total score between 0 -60. A score <29 indicates that the person is experiencing “severe” mania (Wciorka et al., 2011).

Although weighting items increases the complexity of scoring and interpreting, it has not affected the psychometric properties of the scale. The YMRS is reported to have high interrater reliability for total scores (0.93) and individual item scores (0.66 -0.92) (Young et al., 1978). It also has been found to have good internal reliability, with Cronback alpha coefficients ranging from 0.8 – 0.91. The YMRS has demonstrated high convergent validity with other assessment measures of mania including the Bech-Rafaelsen Mania Rating Scale (Spearman’s Rho = 0.90). Furthermore, the YMRS statistically differentiates between clients; before and 2 weeks after treatment (Young et al., 1978); mania from symptoms of ADHD (Serrano, Ezpeleta, Alda, Matalí, & San, L., 2011). Finially, the YMRS has demonstrated validity across cultural populations including Korea (Seon-Cheol & Joonjo, 2016) and Poland (Wciorka et al., 2011).


Lukasiewicz, M., Gerard, S., Besnard, A., Falissard, B., Perrin, E., Sapin, H., Tohen, M., Reed, C., Azorin, J.-M. and The emblem study group (2013), Young Mania Rating Scale: how to interpret the numbers? Determination of a severity threshold and of the minimal clinically significant difference in the EMBLEM cohort. Int. J. Methods Psychiatr. Res., 22: 46–58. doi:10.1002/mpr.1379

Miller, C. J., Johnson, S. L., & Eisner, L. (2009). Assessment Tools for Adult Bipolar Disorder. Clinical Psychology : A Publication of the Division of Clinical Psychology of the American Psychological Association16(2), 188–201.

Seon-Cheol, P., & Joonjo, C. (2016). Using the Young Mania Rating Scale for Identifying Manic Symptoms in Patients with Schizophrenia. Yonsei medical Journal, 57, 1298-1299.

Serrano, E., Ezpeleta, L., Alda, J., Matalí, J., & San, L. (2011). Psychometric Properties of the Young Mania Rating Scale for the Identification of Mania Symptoms in Spanish Children and Adolescents with Attention Deficit/Hyperactivity Disorder. Psychopathology, 44(2), 125-132.

Wciorka, J., Schaeffer, E., Switaj, P., Waszkiewicz, J., Krasuska, K., Wegrzyn, J., & Wozniak, P. (2011). Bech-Rafaelsen Mania Scale and Young Mania Rating Scale–comparison of psychometric properties of the two instruments for rating a manic syndrome. Psychiatry Poland, 45, 61-78.

Young, R.C., Biggs, J.T., Ziegler, V.E., & Meyer, D.A. (1978). The rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429-435.

Yale Global Tic Severity Scale (YGTSS)

The Yale Global Tic Severity Scale (YGTSS) is a tool used to quantify the severity of Tic symptoms in individuals aged 6-17, and is currently one of the most commonly used tools in Tic assessments (Scahill, 2013). The YGTSS is made up of a semi-structured interview, followed by a questionnaire where individuals are asked to rate the severity of their Tic symptoms (both motor and vocal) in domains such as: number, frequency, intensity, complexity, and interference (Leckman et al., 1989). There is also an impairment scale, where the individual rates how the Tic impacts on their daily life and activities (Leckman et al., 1989).


When scoring the YGTSS, the tool gives ratings in 5 domains: Total Motor Tic Score, Total Verbal Tic Score, Total Tic Score (Motor + Verbal), Overall Impairment Rating, and Global Severity Score. When calculating the Global Severity score, it is found by adding together the total motor, verbal and impairment scores. The Total Tic Severity Score has a range of 0-50, and the Global Severity Score has a range of 0- 100. A higher score on all scales suggests a more severe Tic, or a greater impact the Tic has on the person’s life.

The tool is therefore designed to measure severity of an individual’s Tic, and not to diagnose or classify an individual’s Tic disorder. In clinical work, the YGTSS may be used to track changes in Tic behavior, or to investigate if a treatment is reducing symptoms (Storch et al., 2011).

Psychometric Properties

Reliability and Validity: Research into the YGTSS has shown that is possessed good convergent and discriminative reliability. Storch et al., compared scores on the YGTSS to other clinical ratings and found there was no significant relations to OCD severity (r .01–.15), parent ratings of externalizing and internalizing behavior (r.07–.20), child ratings of depression (r .02–.26) and anxiety (r .06 –.28)(2013) .

It has also been found to have good inter-rater reliability (Kircanski et al., 2010, Leckman et al., 1989, Storch et al. 2011). Internal consistency was also high, with Cronbach’s alpha reliability coefficients for the Total Motor Tic Score ( .92 and .92), Total Phonic Tic Score (.93 and .93), and Total Tic Score ( .93 and .94) at first and second administrations (Storch et al., 2013).

The YGTSS has been used widely, and has translated versions in Canada (French), Spanish and Polish. The YGTSS can also be administered to the parent and child jointly, to increase reliability of answers and reduce any bias.

Critical Analysis

Strengths: The YGTSS is a short, easy to use tool which asks individuals to reflect on their symptoms over the past 7-10 days, therefore it can also easily be used multiple times over the course of treatment to gauge how the individual is going. The multiple scales and interview used in the YGTSS enables a lot of information to be provided about the severity and interference the Tic symptoms are having on the individual (Storch, 2011).

Weaknesses: The YGTSS has only been used in a child and adolescent population (6-17 years old), its use with individuals over 17 years has not be psychometrically tested. The YGTSS is only a measure of the severity of Tic symptoms, and does not aid clinicians in deciding a treatment response for these symptoms (Storch, 2011). Bias can always play a role in self report measures, such as the YGTSS, and clinicians should be cautious of this.


Kircanski, K., Woods, D., Chang, S., Ricketts, E., & Piacentini, J. (2010). Cluster analysis of the Yale Global Tic Severity Scale (YGTSS): Symptom dimensions and clinical correlates in an outpatient youth sample. Journal of Abnormal Child Psychology, 38(6), 777-88.

Leckman, J. F., Riddle, M. A., Hardin, M. T., Ort, S. L., Swartz, K. L., Stevenson, J., et al. (1989). The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 566–573.

Scahill, D. (2013). Yale Global Tic Severity Scale. Encyclopedia of Autism Spectrum Disorders. Springer New York. 3415.

Selles, R., Murphy, T., Obregon, D., Storch, E., & Lewin, A. (2013). Treatment decisions for chronic tic disorders. Clinical Practice, 10(6), 765-780.

Storch, E. A., Murphy, T. K., Fernandez, M., Krishnan, M., Geffken, G. R., Kellgren, A. R., & Goodman, W. K. (2007). Factor-analytic study of the Yale Global Tic Severity Scale. Psychiatry research, 149(1), 231-237.

Storch, E., De Nadai, A., Lewin, A., McGuire, J., Jones, A., Mutch, P., Murphy, T. (2011). Defining Treatment Response in Pediatric Tic Disorders: A Signal Detection Analysis of the Yale Global Tic Severity Scale. Journal of Child and Adolescent Psychopharmacology, 21(6), 621-7.

Storch, E. A., Murphy, T. K., Geffken, G. R., Sajid, M., Allen, P., Roberti, J. W., & Goodman, W. K. (2005). Reliability and validity of the Yale Global Tic Severity Scale. Psychological assessment, 17(4), 486.

Penn State Worry Questionnaire for Adults (PSWQ-A)

Developed in America in 1990, the Penn State Worry Questionnaire for Adults (PSWQ) is the measure most frequently used to assess trait pathological worry in adults (Meyer, Miller, Metzger, & Borcovec, 1990). The PSWQ is a 16-item self-report questionnaire, derived from a factor analysis of 161 items believed to be related to worry. It is intended to measure an individual’s disposition to worry, as well as the frequency, intensity, and tendency for worry to be generalised (Meyer et al., 1990). Respondents are asked to rate each item on a 5-point Likert scale ranging from 1 (“not at all typical of me”) to 5 (“very typical of me”). Eleven of the items are positively scored in the direction of pathological worry (e.g. “my worries overwhelm me”), while the remaining five items require reverse scoring and indicate worry is not a problem (e.g. “I never worry about anything”). The scores from each item are added together to yield a total score that ranges from 16-80, with higher scores representing higher levels of pathological worry (Meyer et al., 1990).

The PSWQ is not a diagnostic tool; however, it is useful as a screening tool to detect pathological worry, and to evaluate therapeutic changes on worry (Meyer et al., 1990). It also successfully distinguishes GAD from other anxiety disorder groups, such as Post Traumatic Stress Disorder (Brown, Antony, & Barlow, 1992). Most GAD patients tend to show higher PSWQ scores (above 50), although some people with other diagnoses may sometimes report PSWQ levels similar to those with GAD (e.g. depression in Starcevic, 1995). This may be the result of high levels of comorbid GAD, or possibly because the DSM-IV does not allow a diagnosis of GAD if symptoms occur during episodes of other disorders (Chelminski & Zimmerman, 2003).

The PSWQ has been shown to have good internal reliability in samples consisting of older adults with GAD (Generalised Anxiety Disorder), community samples, and undergraduates, with cronbach alphas ranging from .88 to .95 (Startup & Erickson, 2006). It has also demonstrated favourable test-retest reliability over 8-10 weeks in a sample of college students (r= 0.92) (Meyer et al., 1990). In both clinical and community samples, the PSWQ has shown high convergent validity with other worry questionnaire measures, such as The Worry Domains Questionnaire (r=.67) (Tallis, Eysenck, & Mathews, 1992), and the student worry scale (r=.59) (Davey, Hampton, Farrell, & Davidson, 1992), and has shown high discriminant validity as it correlates significantly with anxiety and depression as measured by the State Trait Anxiety Inventory (trait r= .64-.79, state r = .49) (Meyer et al., 1990; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983) and the Beck Depression Inventory (r= .36-.62) (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961; Meyer et al., 1990).

It is also important to consider whether scores remain stable across demographic groups, or if any individual factors impact the PSWQ’s psychometric properties. With the regard to gender, no differences have been found (Meyer et al., 1990). In addition, the PSWQ has demonstrated to be valid in cross cultural populations, yielding good psychometric properties in samples in Korea (Lim Kim, Lee & Kwon, 2008), India (Parikh & Chhibber, 2016), and Germany (Stöber, 1995). In contrast to ethnicity, age is a factor that may influence PSWQ scores. Older adults have reported significantly lower scores than younger adults in both community (Gillis et al., 1995) and clinical samples (Hopko et al., 2003). Furthermore, older age may also impact the psychometric properties, as the PSWQ has demonstrated reasonable internal reliability and validity for this age group, but poor test-retest reliability (Davey & Wells, 2006). When a test has poor test-retest reliability, it makes it unclear whether the data is an accurate representation of a participant’s performance or whether extraneous variables interfered.

A major limitation of the PSWQ is that it does not capture worry changes over short periods of time. In some situations, a more frequent assessment of pathological worry is needed. To meet the need for a more frequent worry assessment, Stober and Bittencourt (1998) developed the PSQW- Past Week for weekly assessments of worry which also has good psychometric properties. Overall, the PSWQ appears to have sound psychometric properties and sensitivity to treatment change. It is a good choice for research and clinical studies to assess the intensity of pathological worry and to discriminate GAD from other disorders (Turk, Heimberg, & Mennin, 2004).


Beck, A.T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.

Brown, T. A., Antony, M. M., & Barlow, D. H. (1992). Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behaviour Research and Therapy, 30(1), 33-37.

Chelminski, I., & Zimmerman, M. (2003). Pathological worry in depressed and anxious patients. Journal of Anxiety Disorders, 17(5), 533-546

Davey, G. C., Hampton, J., Farrell, J., & Davidson, S. (1992). Some characteristics of worrying: Evidence for worrying and anxiety as separate constructs. Personality and Individual Differences, 13(2), 133-147.

Davey, G., & Wells, A. (2006). Worry and its psychological disorders. Chichester, England: Wiley. Gillis, M. M., Haaga, D. A., & Ford, G. T. (1995). Normative values for the Beck Anxiety Inventory, Fear Questionnaire, Penn State Worry Questionnaire, and Social Phobia and Anxiety Inventory. Psychological Assessment, 7(4), 450.

Hopko, D.R., Stanley, M.A., Reas, D.L., Wetherell, J.L., Beck, J.G., Novy, M.D., Averill, P. M. (2003). Assessing worry in older adults: confirmatory factor analysis of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model. Psychological Assessment, 15, 173–183.

Lim, Y. J., Kim, Y. H., Lee, E. H., & Kwon, S. M. (2008). The Penn State Worry Questionnaire: Psychometric properties of the Korean version. Depression and Anxiety, 25(10).

Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28(6), 487-495.

Parikh, S., & Chhibber, K. (2016). Use of the Penn State Worry Questionnaire to identify individuals with GAD: An Indian perspective. Journal Psychology and Clinical Psychiatry, 6(5).

Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.

Startup, H. M., & Erickson, T. M. (2006). The Penn State Worry Questionnaire (PSWQ). In G. C. L. Davey, & A. Wells (Eds.), Worry and Its Psychological Disorders: Theory, Assessment and Treatment, 101-119. Chichester: Wiley.

Starcevic, V. (1995). Pathological worry in major depression: A preliminary report. Behaviour Research and Therapy, 33(1), 55-56.

Stöber, J. (1995). Worrying: A comparison of three questionnaires concerning everyday worries. Zeitschrift fuer Differentielle und Diagnostische Psychologie, 16, 50-63.

Stoeber, J., & Bittencourt, J. (1998). Weekly assessment of worry: an adaptation of the Penn State Worry Questionnaire for monitoring changes during treatment. Behaviour Research and Therapy, 36(6), 645-656.

Tallis, F., Eysenck, M., & Mathews, A. (1992). A questionnaire for the measurement of nonpathological worry. Personality and Individual Differences, 13(2), 161-168.

Turk, C. L., Heimberg, R. G., & Mennin, D. S. (2004). Assessment of worry and generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, and D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice, 219–247. New York: Guilford.

Geriatric Depression Scale (GDS)

The Geriatric Depression Scale was developed by Yesavage, Brink, Rose, Lum, Huang, Adey, and Leirer (1982). It was designed specifically for the aged, as a screening instrument for depression. The scale

  • Originally contained 100 items, but was condensed to 30 Is a self-administered test, but can be used in observer-administered formats also
  • The 30 items are yes/no questions.

Later, Sheik & Yesavage (1986) created a short form of the GDS (GDS-SF), which contained 15 items. The original can be referred to as the GDS- Long Form (GDS-LF). Literature is divided in terms of the short form being a suitable substitute (Aikman& Oehlert, 2001; Holroyd & Clayton, 2000).

Cut-off scores for different severities of depression are as follows:

For the long form: Normal 0 – 10, Mild 11 – 20, Moderate to Severe 21 – 30.

For the short form: Normal 0 – 4, Mild 5 – 9, Moderate to Severe 10 – 15.

Validation and Psychometric properties

The scale has a high degree of internal consistency, with a Chronbach’s alpha coefficient of .94, and split-half reliability score of .94. Test retest reliabilities of .85 (p < .001) for one week apart (Yesavage et. al., 1982) and .85 (p < .001) for one month apart (Parmelee, Lawton & Katz, 1989) show that within the time limits, scores reflect stable individual differences.

The GDS is a valid tool for discriminating symptom severity, and presence vs absence based on DSM-IV criteria, but not among different diagnostic groups. It should not be used as a single diagnostic measure (Watson, Zimmerman, Cohen, & Dominik, 2009).

The GDS has high correlations with the Zung Self-Rating Depression Scale (SDS) and the Hamilton Rating Scale for Depression (HRS-D) (.84 and .83 respectively); further evidence of validity.

Sensitivity (true positives) and specificity (true negatives) with a cutoff of 11 were 84% and 95% respectively, and they were 80% and 100% respectively at a cutoff of 14; providing evidence for scores of 11+ to be considered a possible indicator of depression.

Validity and reliability are unaffected by pertinent individual difference factors such as age, education, gender, race, and culture (Marc, Raue & Bruce, 2008; Rait et. al., 1999; Harralson et. al., 2002).

Critical Analysis

Overall, the GDS-LF is a reliable and valid measure of depression in aged individuals. It is…

  • Easy to administer (self-administered or observer)
  • A simple scale to complete (yes/no responses), especially for older adults
  • Useful in a variety of settings; nursing homes and the community, with medical inpatients, medical outpatients, and day-treatment clients
  • Shown to maintain it’s reliability and validity when administered by phone (Burke, Roccaforte, Wengel, Conley & Potter (1995)
  • Adequate in screening mildly demented subjects (McGivney, Mulvihill & Taylor, 1994)

Its few weaknesses include the possibility of over-diagnosing depression (Lesher & Berryhill, 1994), the inclusion of items/terms that could be seen as western value judgments (Sansoni et. al., 2007) and that it is not a useful or valid tool for screening cognitively impaired patients (Holroyd & Clayton, 2000).

It is a useful screening tool for depression in older adults.


Original Source, and Various Translations:

Online Version:


Aikman, G. G., & Oehlert, M. E. (2001). Geriatric Depression Scale: long form versus short form. Clinical Gerontologist, 22(3-4), 63-70.

Burke, W. J., Roccaforte, W. H., Wengel, S. P., Conley, D. M., & Potter, J. F. (1995). The reliability and validity of the Geriatric Depression Rating Scale administered by telephone. Journal of the American Geriatrics Society43(6), 674-679.

Harralson, T. L., White, T. M., Regenberg, A. C., Kallan, M. J., Ten Have, T., Parmelee, P. A., & Johnsons, J. C. (2002). Similarities and differences in depression among black and white nursing home residents. The American journal of geriatric psychiatry, 10(2), 175-184

Holroyd & Clayton (2000). Measuring Depression in the Elderly: Which Scale is Best? Medscape. Retrieved 20/08/2017 from

Lesher, E. L., & Berryhill, J. S. (1994). Validation of the geriatric depression scale‐short form among inpatients. Journal of clinical psychology, 50(2), 256-260.

Marc, L. G., Raue, P. J., & Bruce, M. L. (2008). Screening performance of the 15-item geriatric depression scale in a diverse elderly home care population. The American Journal of Geriatric Psychiatry, 16(11), 914-921.

McGivney, S. A., Mulvihill, M., & Taylor, B. (1994). Validating the GDS depression screen in the nursing home. Journal of the American Geriatrics Society, 42(5), 490-492

Parmelee, P. A., Lawton, M. P., & Katz, I. R. (1989). Psychometric properties of the Geriatric Depression Scale among the institutionalized aged. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1(4), 331.

Rait, G., Burns, A., Baldwim, R. Morley, M., Chew-Graham, C., St Leger, A. S., & Abas, M. (1999). Screening for depression in African-Caribbean elders. Family practice, 16(6), 591-595

Sheikh, J.I., & Yesavage, J.A. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165-173.

Watson, L. C., Zimmerman, S., Cohen, L. W., & Dominik, R. (2009). Practical depression screening in residential care/assisted living: five methods compared with gold standard diagnoses. The American Journal of Geriatric Psychiatry, 17(7), 556-564.

Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of psychiatric research, 17(1), 37-49.

Disruptive Behaviour Disorder Rating Scale (DBDRS)

The DBD parent/teacher rating scale is a screening tool designed to aid in the diagnostic process for a number of child psychopathologies, particularly externalising disorders. The DBD rating scale was initially created to further build upon an existing tool created by the same authors, the Swanston, Nolan and Pelham (SNAP) rating scale. The SNAP listed the DSM-III symptoms of attention-deficit disorder (ADD) in a rating scale format. The DSM-III-R brought changes to the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD) and so the authors sought to create a new teacher rating scale to reflect these amendments that would be comparable to the original SNAP rating scale in its effectiveness for providing information required to aid in the diagnostic process. In addition, all three disruptive behaviour disorder categories were included in the new DBD rating scale.


The DBD rating scale consists of 42 items related to symptoms of Conduct disorder (16 items), ODD (8 items), ADHD-Inattention (9 items), ADHD- hyperactivity/ Impulsivity (9 items). These items relate directly to the 36 DSM-III-R diagnostic criteria for Conduct Disorder, Oppositional Defiance Disorder and Attention Deficit Hyperactivity Disorder and are randomly ordered across diagnostic categories. Each item is rated on a four-point scale ranging from not at all (0) to very much (3). Teachers also have the option to check “don’t know” for any item. The DBD rating scale can be used to aid in diagnosis of children in regular classroom settings. There are two ways to determine if a child meets the criteria for DSM diagnoses of Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, or Conduct Disorder. The first method involves counting symptoms for each disorder using the Disruptive Behaviour Disorders (DBD) rating scale. The second method involves comparing the target child’s factor scores on the DBD Rating Scale to established norms. The DBD rating scale has been translated and adapted for the assessment of childhood behavioural problems in Pakistani children. In addition the tool was translated into Georgian using back translation back-translation. The DBD rating scale was also used to generate normative values and percentile charts for Nigerian children.

Psychometric properties

A validation study used a sample of 931 boys that attended regular classrooms aged 5-14 years. Criterion and construct validity was found to be satisfactory. A factor analysis revealed three factors: one reflecting ODD and a number of CD symptoms, one comprised of ADHD impulsivity/overactivity symptoms and one on which ADHD symptoms of inattention loaded highly. Conditional probability analysis revealed several prominent symptoms of ADHD had poor predictive power; contrastively combinations of symptoms from the two ADHD factors had good predictive power. Combinations of ODD symptoms demonstrated very high predictive power.  Due to high teacher ratings of “don’t know”, conduct disorder was found to have lower predictive power. It is anticipated by the authors that the parent rating scale will have a higher predictive power on the CD symptoms. The study also noted that within the elementary school age range oppositional and certain CD symptoms demonstrated a high degree of covariation in the observations by teachers.

The DBD Rating Scale demonstrates good internal consistency for the DSM-III-R categories for Conduct Disorder, Oppositional Defiance Disorder and Attention Deficit Hyperactivity Disorder with coefficient alphas of .81, .95 and .95 respectively.


The tool can be accessed from a number of reputable websites including Researchgate and The Center for School Mental Health website as provided-—And-Google-Doc-Link-to-Measures-Saved.pdf

The rating scale is available as a free download, permission is not required, and access is unrestricted.


Bzhalava, V., & Inasaridze, K. (2017). Disruptive Behavior Disorder (DBD) Rating Scale for Georgian Population. arXiv preprint arXiv:1702.03409.

Loona, M. I., & Kamal, A. (2011). Translation and adaptation of disruptive behaviour disorder rating scale. Pakistan Journal of Psychological Research26(2), 149.

Ofovwe, G. E., & Ofovwe, C. E. (2010). Disruptive Behaviour Disorder (DBD) Rating Scale for Attention Deficit/Hyperactivity Disorder: Normative Values and Percentile Charts for Nigerian Children Aged 6 to 15 Years. Nigerian Hospital Practice6(1-2).

Pelham, W. E., Gnagy, E. M., Greenslade, K. E., & Milich, R. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child & Adolescent Psychiatry31(2), 210-218.

Birleson Depression Self-Rating Scale for Children (DSRS-C)

Peter Birleson first developed a self-rating scale for depression in childhood (DSRS-C) in 1978 as part of a Masters of Philosophy Thesis at the University of Edinburgh (Birleson, 1978, 1981). The now 18-item self-rating scale emerged from a longer 37-item inventory associated with major depressive syndromes in childhood (Birleson, Hudson, Buchanan, & Wolff, 1987). The DSRS-C tool is based on the operational definition of depressive disorder, implying a duration of a specific affective behaviour pattern where there is impairment in a child’s or adolescent’s ability to effectively function in his/her environment (Birleson, 1981).

The DSRS-C measures the direction of disturbances felt in the past week by children and adolescents aged between 8 to 14 years of age. Subjects are asked to select one of the following options; “Most of the time,” “Sometimes,” or “Never.” The scores for the scale are 2, 1, or 0. Responses to items are simply scored in the direction of disturbance. For example; depressive items are scored 2 (i.e. “I feel so sad I can hardly stand it”), “sometimes” items are scored 1 (i.e. “I get tummy aches”), and non-depressive items score 0 (i.e. “I look forward to things as much as I used to”) (Birleson, et al. 1987). The 18 scores are then summed to give the total score. For items 1, 2, 4, 7, 8, 9, 11, 12, 13 and 16 ‘mostly’ scores 0, ‘sometimes’ scores 1 and ‘never’ scores 2. For items 3, 5, 6, 10, 14, 15, 17 and 18 ‘mostly’ scores 2, ‘sometimes’ scores 1 and ‘never scores 0. Higher scores indicate stronger depressive tendencies and the maximum score is 36 (Denda, Kako, Kitagaea, & Koyama, 2006).

In terms of psychometric properties in determining a valid and reliable psychometric test, 18 of the original 37 items were found to separate depressed groups from others in a statistically significant way, thus 18 items were retained and now comprise the current DSRS-C (Birleson, 1981; Birleson, et al. 1987). The DSRS-C has shown sound psychometric properties in clinical samples (Birleson, et al. 1987) and community samples (Kaplan, Hong, & Weingold, 1984). Reliability and validity of the self-rating scale was found to be satisfactory (Birleson, 1981). Individual items for the DSRS-C had correlations of between .65 and .95. Test-retest reliability of the DSRS-C for the maladjustment group was .80, thus showing a highly satisfactory degree of stability (Birleson, 1981). Furthermore, internal consistency estimated by split-half reliability coefficient, was found to be .86 (Birleson, 1981). The English version of the DSRS-C has been translated into 11 languages, including Arabic, Arabic (Syria), Chinese, Dari, Hindi, Italian, Japanese, Khmer, Norwegian, Pashto and Russian. Not all of the translated versions however have been psychometrically evaluated.

In regard to its limitations, given that the DSRS-C is a self-rating scale, it is possible to establish rapport whilst interviewing children/adolescents, thus consequently increasing the validity of response (Birleson, et al. 1987). Furthermore, whilst the DSRS-C is easy to administer, shorter scales are less robust in eliminating error due to misunderstanding items or response set (Birleson, et al. 1987). Moreover, self-evaluation is dependent on the individual’s mood at that particular time, thus meaning there are a number of external factors that could potentially influence response to items. It is also important to note that young children may experience difficulty in reporting their depression, as age increases the expression of depressive symptoms, thus children/adolescents may tend to underestimate or overestimate their feelings (Birleson, et al. 1987; Kaplan, Hong, & Weingold, 1984).

The DSRS-C is a freely available tool to the public and can be accessed through multiple sources on the internet. It is important to note that the DSRS-C was never intended to be used as a diagnostic tool for depression in children and adolescents, but rather to measure moderate to severe depression in childhood This is because the instrument does not include; the assessment of other symptoms, the developmental status of a child, the history of disturbances or its context (Birleson, 1978, 1981). Health professionals may however use the tool as a quick and cost-effective screener for depression before administering costly diagnostic measures (Denda, et al. 2006).


Denda, K., Kako, Y., Kitagawa, N., & Koyama, T. (2006). Assessment of Depressive Symptoms in Japanese School Children and Adolescents using the Birleson Depression Self-Rating Scale. Journal of Psychiatry in Medicine, 36, (2), 231-24. doi: 10.2190/3YCX-H0MT-49DK-C61Q

Birelson, P. (1978). A Self-Rating Scale for Depressive Disorder in Childhood. M. Phil. Thesis, University of Edinburgh.

Birleson, P. (1980). Teenage Suicide. Journal of Maternal and Child Health, 5, 238-245.

Birelson, P. (1981). The Vlaidity OF Depressive Disorder in Childhood and the Development of a Self-Rating Scale: A Research Report. Journal of Psychology and Psychiatry, 22, 73-88.

Birmaher, B. R., Williamson, D. E., et al. (1996). Childhood and Adolescent Depression: A Review of the Past Ten Years, Part I. Journal of Am Acad Child Adolesc Psychiatry, 35, 1427-1439.

Kaplan, S. L., Hong, G. K., & Weinhold, C. (1984). Epidemiology of Depressive Symptomatology in Adolescents. Journal of American Academy of Child Psychiatry, 140, 620-622.

Positive and Negative Syndrome Scale (PANSS)

The Positive and Negative Syndrome Scale (PANSS) is a rating scale, designed on the premise that schizophrenia comprises of: positive syndrome, pertaining to productive symptoms; and negative syndrome, pertaining to deficit features (Depp et al, 2010). This clinical tool is employed: 1) upon an inpatient’s admission 2) at the outset of taking a new medication and 3) weeks/ months into treatment to gauge the effect of the intervention (Opler et al., 2006). PANSS has been published officially across 40 languages following internationally valued and sanctioned guidelines under the Multi Health Systems (MHS) Translation Policy (Khan et al, 2013). Validation studies conducted in 1994, conducted reliability and validity studies among 100 DSM-III-R schizophrenic patients. Cuesta and Peralta (1994) much like Opler (1987) found that the scores were normally distributed; while the construct validity was adequate, the positive and negative subscales when compared to Scales for the Assessment of Positive/Negative Symptoms, depicted high criterion validity. However the internal consistency was insufficient and factorial validity of the positive scale was poor. The scale was seemingly developed on the basis of independent components; furthermore, it oversimplified the negative and positive symptoms. PANSS has since had alternate versions released – PANSS – SCI which accompanies a structured clinical interview and IQ –PANSS, which acquires information from informants such as family/case workers (MHS, 2006). Despite complications with respect to length and ability to measure cognitive functioning, PANSS is considered a competent “stand-alone” clinical screening tool for psychosis due to its clinical predicting power and outcome.

Newer studies communicate the following psychometric properties:
Adequate Internal consistencies for positive (α = 0.73: Acceptable), negative (α = 0.83: Good), and general psychopathology (α = 0.79: Good) subscales. Good test-retest reliability with Pearson correlation coefficients at 0.80, 0.68, and 0.60 for the positive, negative and psychopathology subscales. Positive and negative scales showed good inter-rater reliability. Interclass correlation coefficients of 0.72 and 0.80, respectively. Inter-rater reliability was moderate (0.56) for the general psychopathology scale.


Canadian Agency for Drugs and Technologies in Health. (2011) A systematic review of combination and high dose atypical antipsychotic therapy in patients with schizophrenia. Ottawa: CADTH

Cuesta, M. J., & Peralta, V. (1995). Psychopathological dimensions in schizophrenia. Schizophrenia Bulletin, 21(3), 473-482.

Kay SR, Opler LA, Fiszbein A. Positive and Negative Syndrome Scale (PANSS; 2006) manual. Toronto, Ontario: MultiHealth Systems, Inc.

Khan, A., Christian Yavorsky, C., Liechti, S., Opler, M., Rothman, B., Diclemente, G., Lucic, L., Jovic, S., Inada, T. and Yang, L. (2013). Available at: http://A rasch model to test the cross-cultural validity in the positive and negative syndrome scale (PANSS) across six geo-cultural groups [Accessed 17 Sep. 2017].

Kumari S, Malik M, Florival C, Manalai P, Sonje S (2017) An Assessment of Five (PANSS, SAPS, SANS, NSA-16, CGI-SCH) commonly used Symptoms Rating Scales in Schizophrenia and Comparison to Newer Scales (CAINS, BNSS). J Addict Res Ther 8: 324. doi: 10.4172/2155-6105.1000324

Maust, D., Cristancho, M., Gray, L., Rushing, S., Tjoa, C. and Thase, M. (2012). Psychiatric rating scales. [online] Available at: [Accessed 17 Sep. 2017].

Opler, L. A., Opler, M. G. and Malaspina, D. 2006. Reducing guesswork in schizophrenia treatment: PANSS can target and gauge therapy, predict outcomes in clinical practice. Current Psychiatry, 5: 76–84.

Taylor, Grantley W; McCarley, Robert W; Salisbury, Dean F (2013) Early auditory gamma band response abnormalities in first hospitalized schizophrenia. Suppl Clin Neurophysiol 62:131-45




Bush-Francis Catatonia Rating Scale (BFCRS)

The Bush- Francis Catatonia Rating Scale (BFCRS) is a standardised, quantifiable examination of catatonia designed to screen and diagnose the possibility of catatonia.  The BSRCS was designed by Bush, Fink, Petrides, Dowling and Francis in 1996 and is based on descriptors of catatonia from the literature and motor signs identified in the DSM-III, IV and ICD-10 criteria.

The BFCRS consists of a 23- item rating scale with the first 14 items comprising the Bush Francis Catatonia Screening Instrument (BFCSI).  For screening, items 1-14 are marked as absent (0) or present (3).  The presence of two or more of the screening items for 24 hours or longer meets the diagnosis for catatonia proposed by Bush et al.  For severity, items 1-23 are rated using a scale of 0-3.  The total BFCRS score is the sum of responses to all 23 items. The rating scale is accompanied by a standardised examination procedure consisting of nine steps.   Sample procedures are: To assess for Echopraxia, the examiner scratches his head in an exaggerated way.  To assess for Automatic Obedience, the examiner reaches into his pocket and states, ‘Stick out your tongue. I want to stick a pin in it.” (Bush et al., 1996)

The BFCRS was tested on a sample of 28 acutely ill patients presenting with catatonic syndrome from an acute psychiatric inpatient clinic and a university hospital.  No information on gender is available (Wong, Ungvari, Leung and Tang, 2007). Both the BFCRS and the BFCSI showed a high inter-rater reliability: r= 0.93 and r = 0.95 respectively.  Test re-test reliability was not studied because of the fluctuating course of the catatonic syndrome.

Validity was harder to assess because of the lack of established diagnostic criteria. Diagnostic agreement between cases in the BFCSI and previously published criteria for catatonia ranged from 75 – 100% (Bush et al., 1996). Validity of the scale was also examined by comparison with the sources from which it was derived. Of the 23 items, 96% were included in at least two sources (Bush et al.). The only language the BFCRS has been translated into is Portuguese and the scale remained as reliable and valid as in the original instrument (Santos Nunes et al., 2017).

The BFCRS is currently the preferred rating scale for the detection of catatonia due to its five minute administration time and reliability and validity.  However, recent research found that the BFCRS-0 and BFCRS-R may be more suitable for a schizophrenic population (Wong et al., 2007).  Wilson, Niu, Nicolson, Levine and Heckers (2015) also found it to have low reliability at the low severity level but good reliability at the moderate to severe level.

The BFCRS and examination procedure is freely available and can be accessed online at: Bush, G., Fink, M., Petrides, G., Dowling, F., Francis, A. (1996). Catatonia.1. Rating scale and standardized examination. Acta Psychiatrica Scandinavica, 93, 129-136.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Bush, G., Fink, M., Petrides, G., Dowling, F., Francis, A. (1996). Catatonia.1. Rating scale and standardized examination. Acta Psychiatrica Scandinavica, 93, 129-136.

Bush, G., Fink, M., Petrides, G., Dowling, F., Francis, A. (1996). Catatonia. II. Treatment with lorazepam and electroconvulsive therapy. Acta Psychiatrica Scandinavica, 93, 137-143.

Santos Nunes, A. L.,  Filgueiras, A., Nicolato, R., Alvarenga, J. M., Silveira, A. S., Assis da Silva, R., Cheniaux, E. (2017). Development and validation of the Bush-Francis Catatonia Rating Scale – Brazilian version. Arq Neuropsiquiatr, 75, 44-49.

Sienaert, P., Rooseleer, J., & De Fruyt, J. (2011). Measuring Catatatonia: A systematic review of rating scales. Journal of Affective Disorders, 135, 1-9. doi: 10.1016/j.jad.2011.02.012

Tandon, R., Heckers, S., Bustillo, J., Barch, D.M., Gaebel, W., Gur, R.E., … Carpenter, W. (2013). Catatonia in DSM-5. Schizophrenia Research, 150, 26-30. doi: 10.1016/j.schres.2013.04.034

Wilson, J. E., Niu, K., Nicolson, S. E., Levine, S. Z., & Heckers, S. (2015). The diagnostic criteria and structure of catatonia. Schizophrenia Research, 164, 256-262.

Wong, E., Ungvari, G.S., Leung, S.K., Tang, W.K. (2007). Rating Catatonia in patients with chronic schizophrenia: Rash analysis of the Bush-Francis Catatonia Rating Scale. International Journal of Methods in Psychiatric Research, 16, 161-170. doi: 10.1002/mpr.224



SCOFF Questionnaire

Background: The SCOFF questionnaire (Morgan, Reid and Lacey, 1999) is a five item measure, developed to serve as a simple, easy to remember screening tool for eating disorders.  The instrument was designed for use by professionals and non-professionals alike and can be used in primary health care settings. The SCOFF items were developed via focus groups with eating disordered patients and specialists in the field (Morgan et al, 1999).  Questions can be administered orally or in written format (Perry et al, 2002).

Population: Screening tool that can be used in general population to identify people who may be at risk or have an eating disorder.

Measurement: The SCOFF Questionnaire is a five-question screening tool designed to clarify suspicion that an eating disorder might exist rather than to make a diagnosis. The questions can be delivered either verbally or in written form.

 S – Do you make yourself Sick because you feel uncomfortably full?

C – Do you worry you have lost Control over how much you eat?

O – Have you recently lost more than One stone (6.35 kg) in a three-month period?

F – Do you believe yourself to be Fat when others say you are too thin?

F – Would you say Food dominates your life?

An answer of ‘yes’ to two or more questions warrants further questioning and more comprehensive assessment. A further two questions have been shown to indicate a high sensitivity and specificity for bulimia nervosa. These questions indicate a need for further questioning and discussion.

  1. Are you satisfied with your eating patterns?
  2. Do you ever eat in secret?

Scoring:  Each “yes” response to the five yes/no questions on the SCOFF is summed for the total score. Scores of 2 or greater were originally set a cut-off point for maximum sensitivity to detect anorexia and Bulimia nervosa (Morgan et al, 1999). A cut-off point of 3 has been suggested as the best compromise between sensitivity and specificity.

Psychometrics: A meta analyses of 15 studies examining the utility of the SCOFF found that the 5 questions of the SCOFF constitute a highly efficient tool for the detection of eating disorders, even by a non-specialist, in several languages.  Its use as a screening tool is highly recommended.

Strengths: Readability, ease of use, time efficient, effective, available and validated in other languages.

Limitations: SCOFF is a Self-report measure, may be less effective for male and older people who may present with different symptomology, does not screen for excess exercise, past weight loss

Access: Free and easily accessible.  The SCOFF was developed in the United Kingdom but items have been adapted for use in the United States (Morgan et al, 1999; Parker, Lyons and Bonner, 2005).  German, Finnish, Spanish and Japanese translations of the SCOFF have also been developed.


Botella, J., Sepúlveda, A., Huang, H. and Gambara, H. (2013). A Meta-Analysis of the Diagnostic Accuracy of the SCOFF. The Spanish Journal of Psychology, 16. Doi:10.1017/sjp.2013.92

Garcia, F., Grigioni, S., Chelali, S., Meyrignac, G., Thibaut, F. and Dechelotte, P. (2010). Validation of the French version of SCOFF questionnaire for screening of eating disorders among adults. The World Journal of Biological Psychiatry, 11(7), pp.888-893. Doi:10.3109/15622975.2010.483251.

Garcia-Campayo, J., Sanz-Carrillo, C., Ibañez, J., Lou, S., Solano, V. and Alda, M. (2005). Validation of the Spanish version of the SCOFF questionnaire for the screening of eating disorders in primary care. Journal of Psychosomatic Research, 59(2), pp.51-55. Doi:10.1016/j.jpsychores.2004.06.005.

Lähteenmäki, S., Aalto-Setälä, T., Suokas, J., Saarni, S., Perälä, J., Saarni, S., Aro, H., Lönnqvist, J. and Suvisaari, J. (2009). Validation of the Finnish version of the SCOFF questionnaire among young adults aged 20 to 35 years. BMC Psychiatry, 9(1). Doi:10.1186/1471-244X-9-5.

Morgan, J., Reid, F. and Lacey, J. (1999). The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ, 319(7223), pp.1467-1468. Doi:10.1136/bmj.319.7223.1467.

Pannocchia, L., Fiorino, M., Giannini, M. and Vanderlinden, J. (2011). A Psychometric Exploration of an Italian Translation of the SCOFF Questionnaire. European Eating Disorders Review, 19(4), pp.371-373. Doi:10.1002/erv.1105.

Perry, L., Morgan, J., Reid, F., Brunton, J., O’Brien, A., Luck, A. and Lacey, H. (2002). Screening for symptoms of eating disorders: Reliability of the SCOFF screening tool with written compared to oral delivery. International Journal of Eating Disorders, 32(4), pp.466-472. Doi:10.1002/eat.10093.

Solmi, F., Hatch, S., Hotopf, M., Treasure, J. and Micali, N. (2014). Validation of the SCOFF questionnaire for eating disorders in a multiethnic general population sample. International Journal of Eating Disorders, 48(3), pp.312-316. Doi:10.1002/eat.22373.


Short Post-Traumatic Stress Disorder Rating Interview (SPRINT)

The SPRINT is a brief, global assessment for post-traumatic stress disorder (PTSD) that assesses symptoms of intrusion, avoidance, numbing and arousal, and related aspects of PTSD (somatic distress, stress vulnerability and impairment in function). Developed by Connor & Davidson (2001) for use with adults (18+ years), its design followed a need for a less time consuming, yet structured PTSD-specific measure.

The SPRINT is an eight-item self-report, with one item corresponding to each of the above symptoms, which is measured on a five-point likert scale (e.g. 0 = not at all, 4 = very much). The SPRINT includes two additional items that allows for the measurement of global improvement and symptom change over time, particularly useful for following up treatment. The assessment takes 5-10 minutes to complete. Sample items include:

How much have you been bothered by unwanted memories, nightmares, or reminders of the event?

How much would you get upset when stressful events or setbacks happen to you?


Scores from each item are summed to attain a final score. The maximum score is 32 and represents the most severe symptom state, while a cutoff score of 14 has been suggested by authors to warrant further assessment using a structured interview for PTSD.

Psychometric properties

The SPRINT has demonstrated good test-retest reliability (ICC = .78), high internal consistency (α = .88), good convergent validity against a comparable PTSD symptom measure (Davidson Trauma Scale [DTS], r = .73) and good divergent validity against the Sheehan Social Support Scale (r = .10). A score of 14-17 has been associated with a 96% diagnostic accuracy. The SPRINT is sensitive to treatment effects, again significantly correlating with the DTS (r = .66). The SPRINT has also been found to correlate with the gold standard diagnostic assessment tool for PTSD, the Clinician Administered PTSD Scale (CAPS; Vaishnavi, Connor & Davidson, 2006).

Use & Availability

The SPRINT is time efficient, reliable, valid and freely available at, along with further information. The SPRINT is particularly useful in settings where rapid assessment is desirable, however it is not as comprehensive as the CAPS.


Connor, K. M., & Davidson, J. R. T. (2001). SPRINT: A brief global assessment of post-traumatic stress disorder. International Clinical Psychopharmacology, 16(5), 279-284.

National Center for Posttraumatic Stress Disorder. (2016). SPRINT. Retrieved from

Vaishnavi, S., Payne, V., Connor, K., & Davidson, J. R. T. (2006). A comparison of the SPRINT and CAPS assessment scales for posttraumatic stress disorder. Depression and Anxiety, 0, 1-4. doi: 10.1002/da.20202