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).

Scoring

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.

References

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.

Child Anxiety Life Interference Scale (CALIS)

Commonly, clinical measures of children’s anxiety focus on the assessment of disorder symptoms to support formal diagnoses. This has led to assessments of anxiety symptom impact or “anxiety life interference” becoming less common, despite reductions in these impairments contributing to clients’ treatment satisfaction (Lyneham, et. al., 2013). Consequently, the Child Anxiety Life Interference Scale (CALIS; Lyneham, et. al., 2013) was developed to provide a psychometrically supported method of evaluating the impact that children’s anxiety has on their life, as well as on the life of their parents.

Developed at the Centre for Emotional Health at Macquarie University in Sydney, Australia, the CALIS consists of one 10-item scale administered to children, and two 9-item scales administered to parents. The scale administered to children evaluates self-reported anxiety life interference; the scales administered to parents evaluate child anxiety life interference relative to the child’s life, and child anxiety life interference relative to the parents’ life. All items, which relate to common activities (e.g. “being with friends outside of school” or “your career choice”), are rated on a five-point Likert scale (0 = not at all, 4 = a great deal), with higher scores indicating higher anxiety life interference.

Psychometric Properties

Currently, psychometric data for the CALIS is based exclusively on one evaluative study (Lyneham, et. al., 2013); this study administered the scale to 622 Australian or American children with anxiety disorders, aged between 6 and 17 years.

According to this study, the CALIS demonstrates moderate internal consistency, with Cronbach’s Alphas ranging from .84 for children to .90 for mothers. The CALIS also demonstrates moderate inter-rater reliability between parents and children, which is consistent with previous studies that have identified differences in children and parents’ perceptions of anxiety (Niditch & Varela, 2011). Lastly, the CALIS demonstrates strong test-retest reliability; pre- and post-waitlist administrations of the CALIS produced significant correlations.

Clinical Utility

The use of the CALIS in clinical settings is supported by psychometric data that indicates that it is a significant, valid and reliable measure of anxiety life interference. The CALIS contributes to the development of a comprehensive understanding of a child’s experience of anxiety by using multiple raters to evaluate its impact across multiple activities. Additionally, the CALIS can be used to inform treatment decisions by indicating the domains in which a child is most significantly impaired, as well as provide an indication of overall treatment efficacy. However, due to limited evaluations of the scale’s psychometric properties, the CALIS should be used and interpreted with caution; limited data relating to the impact that cultural differences may have on psychometric properties. Furthermore, Lyneham et. al. (2013) advise that the CALIS be used in conjunction with symptom-specific scales, as it cannot independently support a diagnosis of anxiety.

CALIS freely available from: http://www.mq.edu.au/

References

Lyneham, H., Sburlati, E., Abbott, M., Rapee, R., Hudson, J., Tolin, D., & Carlson, S. (2013). Psychometric properties of the Child Anxiety Life Interference Scale (CALIS). Journal of Anxiety Disorders, 27(7), 711-9.  doi: 10.1016/j.janxdis.2013.09.008

Niditch, L., & Varela, R. (2011). Mother-child disagreement in reports of child anxiety: Effects of child age and maternal anxiety. Journal of Anxiety Disorders, 25(3), 450-5. doi: 10.1016/j.janxdis.2010.11.009

Substances and Choices Scale (SACS)

The Substances and Choices Scale (SACS) is an adolescent alcohol and other drug (AOD) use measurement instrument with high acceptability, validity and reliability. It has utility in screening and measuring outcome and can be used to enhance the identification and treatment of AOD difficulties in adolescents across a range of health settings.

The SACS a one-page pencil and paper self-report questionnaire for adolescents aged 13 -18 years. It takes about 5 minutes to complete and is free of charge. It can be completed alone or in association with the young person’s health or social agency worker. It is structured in a similar format to the Strengths and Difficulties Questionnaire (SDQ) and the two instruments can be used together if a broader perspective on a young person’s functioning is required. The SACS can assist in identifying young people at risk of AOD problems, guide future treatment or referral options and can measure outcomes as young people progress through the treatment process. Electronic online versions are also available.

The SACS is divided into 3 sections:

  • Section A (12 items) records the number of occasions the young person has used a variety of substances in the last month. The aim of this first section is to monitor occasions and range of substance use.
  • Section B (10 items) measures addictive behaviours, harms and consequences of substance use. Scoring this section yields the ‘SACS difficulties score’ from 0 to 20 which can be used to screen or measure change through a treatment episode.
  • Section C covers tobacco use.

There are clinical and community versions of the SACS which differ only in terms of the content of Section A, with the community version listing a limited number of substances. The SACS difficulties score (Section B) is the same in both versions thus the psychometric properties of each version are the same. The use of the clinical version is encouraged where possible to get a clearer perspective of a young person’s substance use.

References

Christie, G., Marsh, R., Sheridan, J., Wheeler, A., Suaalii-Sauni, T., Black, S., & Butler, R. (2007). The Substances and Choices Scale (SACS) – the development and testing of a new alcohol and other drug screening and outcome measurement instrument for young people. Addiction, 102(9), 1390-1398.

Eating Disorder Diagnostic Scale (EDDS)

The Eating Disorder Diagnostic Scale (EDDS; Stice, Telch, & Rizvi, 2000) is a 22-item self-report questionnaire designed to measure Anorexia nervosa, Bulimia nervosa, and Binge-eating disorder symptomatology aligned with the DSM-IV diagnostic criteria.

The scale is comprised of a combination of Likert ratings, dichotomous scores, behavioural frequency scores, and open-ended questions asking for weight and height. The first four questions assess attitudinal symptoms of Anorexia and Bulimia within the past 3 months. The next four items measure the frequency of uncontrollable food consumption, with a focus on the number of days per week over the past 6 months (a criterion for Binge-eating disorder), and number times per week over the last 3 months (a criterion for Bulimia). The following four items measure frequency of compensatory behaviours. Lastly, individuals are asked to record their height, weight, presence of menstrual cycles and birth control pill use.

There are two further scales used in the EDDS that differentiate between eating disorders and deviance from healthy eating pathology. The diagnostic scale may be used to inform diagnosis of Anorexia, Bulimia and Binge-eating disorders. Stice et al. (2000) have developed a scoring algorithm to accompany this scale to determine score cut-offs. The symptom composite scale may be used to create a continuous composite score of disordered eating pathology.

Psychometric Development & Validation

The EDDS went through a rigorous development and validation process with careful adherence to a number of steps. The developers first generated a pool of items to assess DSM-IV eating disorder diagnostic criteria. These items were evaluated by a panel of 14 eating disorder experts, followed by revision to eventually produce the final EDDS to test for reliability and validity against an American female sample aged 13 to 65 years inclusive of those with and without eating disorders.

Results revealed excellent 1-week test-retest reliability for Anorexia (kappa = .95), and adequate test-retest coefficients for Bulimia (kappa = .71) and Binge-eating disorder (kappa = .75). The overall symptom composite test-retest reliability was also strong (kappa = .87). Likewise, internal consistency of the overall symptom composite score was robust (Cronbach’s α = .91). These reliability magnitudes reflect Shrout’s (1998) psychometric rule-of-thumb whereby kappa values above .8 represent high reliability, values between .4 and .8 indicate moderate agreement, and values less than .4 suggest poor reliability.

Content validity results generated by the 14 eating disorder experts revealed that items within the scale adequately reflected the DSM-IV diagnostic criteria for Anorexia, Bulimia, and Binge-eating disorder. Consistently, data also suggested that the EDDS possessed convergent validity by comparing participants with eating disorders with their non-diagnosis control counterparts; with higher scores reported for those with eating disorders than those without.

Strengths & Weaknesses

The EDDS has an abundance of strengths. It is short and quick to complete. With only 22 items, it takes only a few minutes to complete the entire instrument. It is sensitive to change over time; that is, the EDDS has the versatility of being used as a screening tool at the beginning stages of assessment, a diagnostic tool in supporting eating disorder diagnostic criteria, and lastly it may also be used for treatment monitoring and evaluation.

However, the EDDS is not without its limitations. In at least one study, the EDDS has been found to generate a large number of ‘false positives’ (Lee et al., 2007), indicating a weakness in specificity. Conversely, this may not necessarily be a negative drawback considering that when used as a screening tool it is preferable to be able to identify more people as false positives than run a risk of missing out on detecting potential cases of eating disorders. This is because eating disorders, though low in prevalence compared to other clinical disorders, has one the highest mortality rates amongst psychiatric conditions (Arcelus, Mitchell, Wales, & Nielsen, 2011). Additional weaknesses include gender and cultural insensitivity. Different attitudes towards food consumption for gender was found to be reinforced by differing cultural ideals–which were not adequately captured in the EDDS (Lee et al., 2007). Similarly, eating disorder pathology and risk factors were not invariant across Caucasian American women and African American women (Kelly et al., 2012).

Conclusion

Overall, the EDDS is a short and quick to complete self-assessment tool that is versatile to use as a screening measure, diagnostic instrument, and treatment evaluation and monitoring tool for the assessment of Anorexia, Bulimia, and Binge-eating disorder. Its tendency to detect more false positives need not necessarily be a weakness given the vulnerability of the eating disorder population as having some of the most severe mortality and prognosis rates amongst mental conditions. The lack of gender and cultural sensitivity warrants further modifications and refinements by researchers so that this tool can adequately capture the individual nuances that exist both within and between minority groups.

Access

The EDDS is freely available following this link: http://www.ori.org/files/Static%20Page%20Files/EDDS.pdf. Information regarding scoring and interpretation may be found here: http://www.ori.org/files/Static%20Page%20Files/SticeTelch00.pdf.

References

Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731. doi:10.1001/archgenpsychiatry.2011.74

Kelly, N. R., Mitchell, K. S., Gow, R. W., Trace, S. E., Lydecker, J. A., Bair, C. E., & Mazzeo, S. (2012). An evaluation of the reliability and construct validity of eating disorder measures in white and black women. Psychological Assessment, 24(3), 608-617. doi:10.1037/a0026457

Lee, S. W., Stewart, S. M., Striegel-Moore, R. H., Lee, S., Ho, S-Y., Lee, P. W. H., …Lam, T-H. (2007). Validation of the eating disorder diagnostic scale for use with Hong Kong adolescents. International Journal of Eating Disorders, 40(6), 569-574. doi:10.1002/eat

Shrout, P. (1998). Measurement reliability and agreement in psychiatry. Statistical Methods in Medical Research, 7(3), 301-317. doi:10.1191/096228098672090967

Stice, E., Telch, C. F., & Rizvi, S. L. (2000). Development and validation of the eating disorder diagnostic scale: A brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychological Assessment, 12(2), 123-131. doi:10.1037//1040-3590.12.2.123

Kutcher Generalised Social Anxiety Disorder Scale for Adolescents (K-GSADS-A)

The Kutcher Generalised Social Anxiety Scale for Adolescents (K-GSAD-A) is an instrument developed to monitor the symptom severity of social anxiety problems in children or adolescents (11-17 years of age) over time (Brooks & Kutcher, 2004). It was developed by Professor Stanley Kutcher (an expert in child and adolescent mental health) in conjunction with input from doctors and nurses with many years’ experience in treating and monitoring the symptoms of adolescents with social anxiety. When it was developed in 1999, no such clinician-rated scales existed. Psychometric properties of this scale were evaluated in a later drug trial study using adolescent subjects from the USA, South Africa, Canada and Belgium (Brooks & Kutcher, 2004).

Psychometric Properties

Items

The K-GSAD-A has three sections. In section A there are 18 items relating to fear and avoidance (of social situations). Each item is rated on two scales, the first being discomfort/anxiety/distress experienced, and the second being avoidance. Items are rated using a four-point scale of strength of fear/avoidance, ranging from 0= ‘never’, 1= ‘mild’, 2= ‘moderate’, and 3= ‘severe’. In section B, the respondent is asked for three of their most feared social situations which are also rated on the above four-point scales. Section C consists of 11 items relating to affective and somatic distress measured on the same scale.

Reliability

Cronbach’s alphas of the instrument (subscales and total) averaged between .74 and .96 across the 5 assessments times of the 16 week trial. Thus the internal consistency was at least acceptable (in most social science research), and is in the majority of cases excellent.

Test-retest reliability was found to be on the lower end of adequate, as adolescents in the placebo condition had a test-retest intraclass correlation of .64 across a 4-week interval. This means that the adolescents that did not receive the drug had a somewhat similar score at baseline and at 4 weeks, meaning that there was a minimal level of consistency and reproducibility.

Validity

There were moderate correlations between the K-GSADS-A Total Score (see below) and two illness-nonspecific clinician rated measures in the expected direction (see Brooks & Kutcher, 2004). There was also a very strong correlation between the K-GSADS-A and another clinician rated measure of paediatric social anxiety (the LSAS-CA) which was new and recently validated when this paper was written. The K-GSADS-A additionally strongly correlated with a scale designed very similarly to itself, however was self-reported (the SPAI; Brooks & Kutcher, 2004). All the above correlations therefore demonstrated convergent validity. On the other hand, a depression measure was shown to correlate weakly indicating divergent validity.

Sensitivity to change

Changes between the 5 assessment occasions mirrored corresponding changes in other instruments (see Brooks & Kutcher, 2004)

Subscale scores

The Fear and Anxiety Score is made of Items A 1-18, using the anxiety column. The Avoidance Score is made of Items A 1-18, using the avoidance column. The Affective Distress Score is made of Items C 1-5, while the Somatic Distress Score is made of Items C 6 – 11. The Total K-GSADS-A Score is made of the addition of the four subscale scores.

Interpretation of scores

Diagnostic categories are not associated with particular score ranges. Rather, scores should be assessed in relation to the young person’s baseline score to see if there is a worsening of social anxiety (increase in scores) or a possible improvement (reduction in score).

Access and uses

K-GSADS-A is available at no cost at http://teenmentalhealth.org/product/kutcher-generalized-social-anxiety-scale-adolescents-kgsads/ under ‘toolbox’. Suitable administrators include mental health specialists, as well as doctors, nurses and social workers who have experience working with socially anxious adolescents. More recently, the test has been use in a normative sample in Pakistan to show that female adolescents have an increased level of social anxiety compared to males (Inam, Khalil, Tahir, & Abioudullah, 2014). A negative correlation with social anxiety and emotional intelligence was also found (Inam et al., 2014.

References

Brooks, S. J., & Kutcher, S. (2004). The Kutcher Generalized Social Anxiety Disorder Scale for Adolescents: Assessment of its evaluative properties over the course of a 16-week pediatric psychopharmacotherapy trial. Journal of Child and Adolescent Psychopharmacology, 14(2), 273-286. doi: 10.1089/1044546041649002

Inam, A., Khalil, H., Tahir, W. B., & Abiodullah, M. (2014). Relationship of emotional intelligence with social anxiety and social competence of adolescents. Nurture, 8(1), 20-29. Retrieved from https://search-proquest-com.ezproxy.lib.monash.edu.au/docview/1807744503?accountid=12528

Children’s Somatization Inventory (CSI-24)

Background
The Children’s Somatization Inventory (CSI-24; Walker, Garber, & Greene., 1991) is a revised version from the original Children’s Somatization Inventory conceptualized by Walker and Colleagues in 1991. The original version of the CSI consisted of 35 items corresponding with symptoms consistent with the DSM-III-R criteria for Somatization Disorder. In 2009 the CSI was reviewed and a shorter version, consisting of 24 items, was created. The revised version was the result of eliminating 11 items that were rarely endorsed and had low item-total correlations.
There has been some controversy over the factorial structure of the instrument. Factorial Analysis of the CSI-24 found it not to be considered a strictly uni-dimentional instrument as although its items load onto one factor, with positive standardized factor loadings, the fit was found to be poor (Walker, Garber, & Greene., 1991). Further research has suggested that a 6-item one factor instrument demonstrates a better fit and adequate psychometric properties (Orgiles & Espada, 2013).
Validation
The inventory was conceptualized using a predominantly Caucasian clinical sample with a primary complaint of chronic abdominal pain, but this instrument has since been found a valid measure in community populations (Lavigne, Saps, & Bryant., 2012) and other cultures (Orgiles & Espada, 2013)
Psychometric properties
The CSI-24 has been found to correlate highly with the CSI-35 (– r=.99, p<.001; Walker et al., 2009) and hence has been considered a refined version of the original measure. The CSI-35 has been examined in numerous studies and has evidence of high concurrent and convergent validity (r>.4) with other measures of somatization, and good support from a number of studies for it’s construct validity.

  • Internal Consistency alpha .84-.92 (Cerutti et al., 2017; Lavigne, Saps, & Bryant., 2012)
  • Validity for the CSI-24 has been demonstrated in its correlation as expected with measures of anxiety, depression, functional impairment and quality of life (Lavigne, Saps, & Bryant., 2012)
  • Scores for older children and females tend to be higher with a low to medium effect size (d=0.52) (Walker et al., 2009).
  • Parent report has been shown to be lower in school samples and higher in clinical samples than the associated child report (Cerutti et al., 2017).

References

Cerutti R., Spensieri V., Valastro C., Presaghi F., & Guidetti V. (2017). A comprehensive approach to understand somatic symptoms and their Impact on emotional and psychosocial functioning in children. PLoS ONE, 12(2). doi.org/10.1371/journal.pone.0171867

Laird K., Sherman A., Smith C., & Walker L. (2015). Validation of the abdominal pain index using a revised scoring method. Journal Pediatric Psychology, 40(5). Doi:10.1093/jpepsy/jsu118

Lavigne, S.L., Saps, M., & Bryant, F.B. (2012). Reexamining the factor structure of somatization using the children’s somatization inventory (CSI-24) in a community sample. Journal of Pediatric Psychology, 37, 914-924. Doi:10.1093/jpepsy/jss060

Orgiles, M. & Espada, J. P. (2014). Spanish version of the children’s somatization inventory: factorial structure and psychometric properties in a community sample. International Journal of Behavioural Medicine, 21, 556-560. Doi:10.1007/s12529-013-9335-9

Walker, L. S., Beck, J. E., Garber, J., & Lambert, W. (2009). Children’s somatization inventory: Properties of the revised form (CSI-24). Journal of Pediatric Psychology, 34, 430-440.

Short Mood and Feelings Questionnaire – Child self-report (SMFQ-C)

The Short Mood and Feelings Questionnaire (SMFQ; Angold et al.,1995) is a 13-item self-report questionnaire designed to measure core depressive symptomology in children and adolescents aged 6- 17 years old. More specifically, it assesses the presence of affective and cognitive symptoms of depression that have been experienced in the past 2 weeks. Items are rated on a 3-point Likert scale (not true = 0; sometimes true = 1; not true = 2). Example items include ‘I felt miserable or unhappy’ and ‘I cried a lot’. Scores are calculated by summing the point values on each item response. Total SMFQ scores range from 0 – 26. There are no prescribed cut points for the SMFQ. Instead, it is advised that the user utilise their discretion and clinical judgement to assess scores on a case by case basis (Angold & Costello, 1987). However, it has been suggested that higher scores, such as those over 12, suggest greater severity in depressive symptoms and may indicate the presence of depression (Wood, Kroll, Moore & Harrington, 1995). The SMFQ has also been shown to a useful measurement of clinical remission (Wood, Kroll, Moore & Harrington, 1995).

The SMFQ is a unidimensional factor structure with 13 items loading from .36 to .78 (Angold et al. 1995; Kuo, Vander Stoep & Stewart, 2005). It emerged from the original 33- item MFQ developed by Angold, Costello, Pickles and Winder (1987), which was based off the DMS-III-R and ICD-10 diagnostic criteria for depressive disorders. The shortened 13- item version is characterised by the cognitive and affective items from the original MFQ item pool, however it also includes tiredness, restlessness and poor concentration (Angold & Costello, 1995). The high correlations between the MFQ and the shortened SMFQ indicates that little information was lost when more than half of the original items where removed. The SMFQ correlates moderately highly with the depression scales on the Child Depression Inventory (CDI) and the Diagnostic Interview Schedule for Children indicating good criterion validity. Furthermore, good discriminate validity is demonstrated though clear distinctions between psychiatric and paediatric, depressed and non-depressed, populations. Internal reliability is high (Cronbach’s alpha = 0.85), with 60% sensitivity and 85% specificity with a cut off score of 8 or more (Angold & Costello, 1995). In addition, one-year rank order stability coefficients ranged from .28 to .48 (Messer, 1995).

The SMFQ has shown to be a valid and reliable measurement of cognitive and affective depressive symptomology in children and adolescents aged between 6 and 17 years old. Whilst it is inexpensive and brief to administer, score and interpret, there are some notable limitations to its application. Firstly, it is inappropriate to use the SMFQ as a diagnostic tool for depression. It is unable to distinguish between children and adolescents with depression only, from those with anxiety only, comorbid anxiety, or comorbid conduct disorder (Kent, Vostanis, Feehan, 1997). As such, its uses should be strictly limited to screening the presence and severity of depression, as an indication of progress and remission during treatment, and in research. Secondly, its uses are restricted to children and adolescence between the ages of 6 and 17. Finally, the accuracy of self-reporting may be compromised by reading and comprehensive abilities, mood at time of administration and the child’s ability to accurately identify and report their feelings. Children’s understanding and attributions of the symptoms measured in the SMFQ may become more refined with age, leading us to rationalize that age may decrease error associated with self-reporting, thus clinicians may need to take greater care in administration and interpretation of the SMFQ in younger children (Messer, 1995).

The English version of the SMFQ has been translated into 3 languages including Arabic, Spanish and Norwegian. However, psychometric evaluations on these translated versions are somewhat limited. The SMFQ is freely available to the public and can be accessed through multiple online sources, such as the website for the Centre for Developmental Epidemiology at Duke University. At present, the MFQ suite is comprised of six different versions; adult self-report, child self-report and parent report of child. Each is available in 13 and 33 item versions. This is important to note as it has been suggested that while child-self reports discriminate depression status better than parent reports, using both makes for a more accurate evaluation than either does alone (Angold & Costello, 1995). However, it is essential to consider a combination of sources when assessing any clinically significant presentations of depression, such as multiple self and/or observer rating scales, interviews with parents, caregivers and teachers, and other sources to assist in building a sound clinical picture to inform differential diagnoses and inform appropriate interventions.

References

Angold, A., Costello, E.J., Messer, S.C., Pickles, A., Winder, F., & Silver, D. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescence. International Journal of Methods in Psychiatric Research, 5, 237- 249.

Angold, A., Costello, E. J., Pickles, A., & Winder, F. (1987). The development of a questionnaire for use in epidemiological studies of depression in children and adolescents. London: Medical Research Council Child Psychiatry Unit.

Kent, L., Vostanis, P., & Feehan, C. (1997). Detection of major and minor depression in children and adolescents: Evaluation of the Mood and Feelings Questionnaire. Journal of Child Psychology and Psychiatry, 38(5), 565- 573.

Kuo, E.S., Vander Stoep, A., & Stewart, D.G. (2005). Using the Short Mood and Feelings Questionnaire to detect depression in detained adults. Assessment, 12(4), 374- 383.

Messer, S.C., Angold, A., Costello, J., Loeber, R., Van Kammen, W., & Stouthamer-Lober, M. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescence: Factor composition and structure across development. International Journal of Methods in Psychiatric Research, 5, 251- 262.

Wood, A., Kroll, L., Moore, A., & Harrington, R. (1995). Properties of the Mood & Feelings Questionnaire in adolescent psychiatric outpatients: A research note. Journal of Child Psychology and Psychiatry, 36(2), 327-334.

Values in Action Character Strengths Youth Survey (VIA-YS)

The VIA Institute is a not-for-profit organization established by Dr Martin Seligman and Dr Christopher Peters in 2001. They wanted to create a research institute that focuses on investigating positive human strengths rather than on categorizing deficits and disorders. They originally created the VIA Adult Survey of 240 items based on their research into Character Strengths and Virtues.

The VIA Character Strengths Youth Survey was later developed to reach a wide range of respondents and so, to open up more research opportunities.  The survey aims to help participants recognize their strengths and for them to then learn how to capitalize on these.  The survey is free www.viacharacter.org, it is focused on youths aged between 10 – 17 years old and is available in 18 different languages. The original survey had a total of 198 items, however the new amended version has 96 items in order to improve usability.

In order for the survey to be scored, all questions must be completed.  The items use a 5-point Likart Scale ranging from; “Very much like me” to “Not like me at all”.  A sample item, “I am not a show off” asks the respondent to decide how much the statement is like them. The instructions state that there is no right or wrong answer and asks the respondent to be as honest as possible. If the participant receives a high score on a certain scale, it means that they strongly identify with that scales associated strengths. A score report is delivered with feedback, ranking the participants character strengths from 1 – 24 with the top 4 – 7 strengths considered as signature strengths.

The short form comprises of 4 items for each of the 24 character strengths.  From a sample of 12,549 youth surveys, 4 items were selected with the highest corrected item-total correlations from each of the 24 character strength scales. These items were all then reworded to make them easier to understand. Findings showed that the 96 item VIA Youth Survey is more efficient and equally valid than the 198 item VIA Youth Survey. This new short form was compared to the original 198-item form in 2 samples (n = 157 & n = 172 – mean age 15 years). The results were nearly exactly the same with reliability alpha coefficients ranging from 0.69 (Social Intelligence) to 0.95 (Spirituality) across 2 samples for each of the 24 Character strengths. Test-Retest reliability over a 4-month period was > 0.70.

A supplementary report for helping youth with developmental disabilities was recently created to assist in making the survey more accessible to as many individuals as possible.  Some suggestions this report offers include: dividing the measure into smaller sections; reading the items allowed to the youth; providing words of neutral encouragement ie “your best guess is fine” and dividing the responses into a two part decision ie “is this like you or NOT like you?”.  There are also item specific recommendations such as: “I am a show off” instead of “I am not a show off”, thus eliminating the negative and “I am excited about many things” instead of “I have a lot of enthusiasm”, which makes the wording easier to understand.

 

 

Child Attitude Toward Illness Scale (CATIS)

The CATIS is 13-item self-report measure developed in the United States. It was originally designed for children with epilepsy, but has been validated for use with asthma, and is considered applicable to a range of chronic conditions because of its adaptability and strong validity. The original development study validated the CATIS for 8 -12 year olds. Subsequent studies have demonstrated the CATIS validity for use with 11 – 17 years (Heimlich et al., 2000), and 8 – 22 year olds (Ramsey et al., 2016).

The CATIS structure allows the administrator to adjust each item to correspond with child/adolescent’s specific illness. For example:

How good or bad do you feel it is that you have [insert specific illness]?

Each items is rated on a 5-point scale

Very Good – A Little Good – Not Sure – A Little Bad – Very Bad.

To score the CATIS items are summed and divided by 13, after the necessary reverse scores are calculated. Higher scores indicate a more positive attitude towards the condition. The possible ranges of score is 13 to 65.

Why was the scale developed?

Research has shown that young people who could focus on the positive aspects of their condition had more favourable treatment outcomes and recovery from illness compared to those who did not. Research has also shown that children who viewed themselves as different and less worthy than their peers because of their illness were likely to become withdrawn, socially isolated, have poor self-concept, lowered academic functioning, and behavioural problems. The CATIS was developed to measure these favourable/unfavourable attitudes and was one of the first measures to directly ask children their attitudes about having a chronic condition.

There is strong evidence regarding high levels of internalised stigma across multiple health conditions. For people with a chronic illness, internalised stigma may manifest as:
feelings of disappointment and guilt for becoming ill, feelings of inferiority compared to others because of their illness, as well as low self-esteem and self-efficacy.

A more recent focus on Self-Management models for those with chronic conditions encompasses the development in people with chronic illness to develop skills to manage health behaviours, skills to manage illness in the context of everyday life. Also important is that patients develop understanding the interactive nature of these issues in the context of family, community, and healthcare settings. The negative cognitive appraisals of self and illness associated with internalised stigma (due to illness) can impact the success of self-management skill development. Young people may instead engage in maladaptive behaviours that impede treatment efficacy and worsen disease course.

CATIS Psychometric Properties
In the original scale development the internal reliability for the total scale had a coefficient alpha of .80. The test-retest was good with difference between the means at time 1 (M = 3.09, SD = 0.65) and time 2 (M = 3.30, SD = 0.75) being statistically significant t(47) = 3.1, p < .01.  Confirmatory factor analysis was carried out to confirm the single dimension of the scale. They used the goodness-of-fit (GFI) index which was considered better for assessing single factor and is a measure of its relative variance and covariance, was .86. The coefficient of determination was .53, and the t values testing the relationship between latent variables were all over 2.0. Lamda values ranged from .33 to .84 and these results supported the unitary construct of the scale.

A recent systematic review of the literature on internalised stigma instruments (Stevelink et al., 2012) assessed 21 scale development studies using a comprehensive quality criteria framework for psychometric properties, including: Content validity, internal consistency, criterion validity, construct validity, reproducibility, responsiveness, floor and ceiling effects, and interpretability. These criteria were applied by two or more independent raters and a consensus determined regarding the results. They found that the CATIS was one of two instrument that received the most positive ratings.

Even more recently there was systematic review of the literature on the CATIS (Ramsey et al., 2016). It confirmed the robust reliability and validity of the CATIS across different chronic illnesses. The review also highlighted the CATIS’ good generalisability, affordability and determined it was good for both research and clinical contexts. But they highlighted some limitations too. Because the CATIS is delivered in different settings and via different methods, adapted to different illnesses and ages, it has limited cross study utility. They also noted that there have been no studies looking at minimum cognitive capabilities required for the CATIS (for those with developmental delays or IDs), no cross-cultural comparison research, and sparse evidence for the CATIS’ predictive validity. The CATIS also has no norm because clinicians can use and interpret the findings as they see fit. They determined that, while it was a good and useful scale, more research would be advantageous.

References

Austin, J. K., & Huberty, T. J. (1993). Development of the child attitude toward illness scale. Journal of Pediatric Psychology18(4), 467-480.

Heimlich, T. E., Westbrook, L. E., Austin, J. K., Cramer, J. A., & Devinsky, O. (2000). Brief report: Adolescents’ attitudes toward epilepsy: further validation of the Child Attitude Toward Illness Scale (CATIS). Journal of Pediatric Psychology25(5), 339-345.

Ramsey, R. R., Ryan, J. L., Fedele, D. A., Mullins, L. L., Chaney, J. M., & Wagner, J. L. (2016). Child Attitude Toward Illness Scale (CATIS): A systematic review of the literature. Epilepsy & Behavior59, 64-72.

Stevelink, S. A. M., Wu, I. C., Voorend, C. G., & van Brakel, W. H. (2012). The psychometric assessment of internalized stigma instruments: A systematic review. Stigma Research and Action2(2).

Strengths and Difficulties Questionnaire (SDQ)

The Strengths and Difficulties Questionnaire (SDQ) (Goodman, 2007) is a 25-item screening questionnaire for children aged 3- 16 years that screens for difficulties in four areas; emotional symptoms, conduct problems, hyperactivity/ inattention and peer relationship problems in addition to strengths in prosocial behavior. Goodman’s inclusion of these scales is based on a factor analysis of an expanded version of the Rutter Parent Questionnaire (Elander & Rutter, 1996) (Goodman, 2004). Goodman (2007) aimed to develop a tool that reflected contemporary concerns (e.g. prosocial behavior, concentration), could be administered as both a multi informant instrument and as a self- report instrument and could be one page in length. The instrument was originally developed in the United Kingdom. Norms for Australia are readily available on the sdq.com website. Australian norms have also recently been developed for children aged 4 to 6 years (Kremer et al., 2015)

The SDQ scores are based on informant reports from parents and teachers for younger children and self- report measure for adolescents aged 11- 16 years of age (Goodman et al., 1998). An extended version is available that assesses the impact of difficulties in terms of chronicitiy, distress, social impairment and burden on others (Goodman & Soctt, 1999). A further version of the SDQ is available that includes two additional questions measuring the impact of the intervention. It has been found to be a useful outcome measure of Australian CAMHS services (Mathai, Anderson & Bourne, 2003).

The SDQ was initially tested against the Rutter Parent Questionnaire and found to have good concurrent validity. The SDQ is generally considered to have acceptable reliability and validity. The teacher version of the SDQ has been found to have high internal consistency with Cronbach’s alpha coefficients ranging from .70 (Peer Problems) to .88 (Hyperactivity/ Inattention) (Goodman, 2001). The reliability for the parent rated scales ranges from .57 (peer problems and prosocial behavior) to .84 (hyperactivity/ inattention (Goodman, 2001). The SDQ has been shown to be significantly better than the Child Behaviour Checklist (CBCL) at detecting inattention and hyperactivity and as good as the CBCL at detecting internalizing and externalizing problems (Goodman & Scott, 1999). SDQ assessments have been found to correlate to a moderate to high level with clinician diagnoses in both a community and a clinical sample (Mellor, 2005).

While reliability and validity are generally considered to be acceptable a recent systematic review of the psychometric properties of the SDQ (Kersten et al., 2016) concluded that the SDQ can be used to compare groups but does not have adequate sensitivity for clinical decision making.  Further, agreement between informants has been found to be low (.24 to .45) (Kersten et al., 2016). The discriminant ability of parent and teachers versions in detecting mental health problems is better in clinical samples than in community samples (Stone, Otten, Engels, Vermulst & Jannsens, 2010).

The SDQ is available in over 60 languages (sdq.org) including Auslan (Cornes & Broqn, 2015). A recent study (Williamson et al., 2014) noted that while the SDQ is appropriate for Aboriginal children living in an urban environment there were some aspects of the questionnaire that could be improved (e.g. the wording of some items and little focus on community connectedness). The SDQ can be used as a screening tool in a range of settings, for research and to measure the impact of an intervention. The instrument asks informants to base their ratings on the past six months. Each item is scored on a 3-point ordinal scale where 0=not  true, 1= somewhat true and 2= certainly true. Scores for scales 1- 4 are summed to provide a total difficulties score. Children are categorized as being in one of three score ranges; within the normal range (< 80th percentile), within the borderline range (90-90th percentile) and within the clinically significant range (>90th percentile). Scoring templates and computerized scoring is available from the SDQ website www.sdq.org. Australian norms are available on the sdq website.

References

 Cornes, A. J. & Broqn, M. P. (2012). Mental health of Australian deaf adolescents: An investigation using an Auslan version of the strengths and difficulties questionnaire, Deafness and Educational International, 14, 161- 175

Elander, J., & Rutter, M. (1996). Use and development of the Rutter Parents’ and Teachers’ Scales. International Journal of Methods in Psychiatric Research, 6, 63-78.

Goodman, R. (1994). A modified version of the Rutter parent questionnaire including items on children’s strengths: A research note. Journal of Child Psychology and Psychiatry, 35, 1483-1494.

Goodman R (1997) The Strengths and Difficulties Questionnaire: A Research Note. Journal of Child Psychology and Psychiatry, 38, 581-586.

Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of The American Academy of Child and Adolescent Psychiatry, 40(11), 1337–1345.

Goodman, R., Meltzer, H., & Bailey, V. (1998). The Strengths and Difficulties Questionnaire: A pilot study on the validity of the self-report version. European Child & Adolescent Psychiatry, 7(3), 125–130.

Goodman, R. (1999). The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. Journal of Child Psychology and Psychiatry and Allied Disciplines, 40(5), 791–799.

Kersten, P., Czuba, K., Mc Pherson. K., Dudley, M., Elder, H., Tauroa, R. & Vandal, A. (2016). A systematic review of evidence for the psychometric properties of the Strengths and Difficulties Questionnaire, International Jounral of Behavioral Development, 40, 64-75

Kremer, P., De Silva, A., Cleary, J., Santoro, G., Weston, K., Steele, E. Nolan, T. & Waters, E. (2015). Normative data for the Strengths and Difficulties Questionnaire for young children in Australia, Journal of Peadiatrics and Child Health, 51, 970-975

Mathai, J., Anderson, P., & Bourne, A. (2003). Use of the Strengths and Difficulties Questionnaire as an outcome measure in a child and adolescent mental health service. Australasian Psychiatry, 11(3), 334–337.

Mellor, D. (2005). Normative data for the strengths and difficulties questionnaire in Australia. Australian Psychologist. 40, 215–22.

Stone, L.L., Otten, R., Engels, R., Vermulst, A.A., Janssens, J.M. (2010) Psychometric properties of the parent and teacher versions of the strengths and difficulties questionnaire for 4-to 12-year-olds: a review. Clinical child and family psychology review 13: 254–274. doi: 10.1007/s10567-010-0071-2

Williamson, A., McElduff, P., Dadds, M., D’Este, C., Redman, S., Raphael, B., Daniels, J. & Eades, S. (2014). The construct validity of the Strengths and Difficulties Questionnaire for Aboriginal children living in urban New South Wales Australia, Australian Psychologist 49, 163- 170.