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.

Development

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.

Use

The tool can be accessed from a number of reputable websites including Researchgate and The Center for School Mental Health website as provided- http://csmh.umaryland.edu/media/SOM/Microsites/CSMH/docs/Resources/ClinicianTools/Summary-of-Free-Assessment-Measures—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.

References

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.

Child and Adolescent Disruptive Behaviour Inventory (CADBI)

The Child and Adolescent Disruptive Behaviour Inventory (CADBI), Burns, et al., (2001a) is a 25-item parent and teacher questionnaire designed to assess a range of problem behaviours that often occur in childhood and adolescence. The CADBI has being used in research on disruptive behaviours in children. The CADBI was created by Julie Rusby from the University of Washington State. Dr. Leonard Burns, also from the University of Washington State, has collected CADBI data in various studies in the United States, as well as several other countries.

There is no age range specified for this measure, therefore clinical judgement would need to be used when deciding if this instrument is appropriate to use with your clients. However, the CADBI has been tested in multiple validation studies with children and adolescence aged 3 to 18. The CADBI can be used as a screening and diagnostic tool. The CADBI consists of three subscales that assess oppositional defiant behaviour, inattention and hyperactivity/impulsivity. Sample items from the oppositional defiant behaviour subscales include: “Annoys peers on purpose,” “Loses temper or gets angry with adults when doesn’t get own way” and “refuses to obey adult’s requests or rules.” The wording of the items is the same as the description of the symptoms in the DSM-IV with one exception, the term “often” was not included in the description (Burns, et al., 2001). Each item is rated on an 8-point Likert scale from one (“Never in the past month”) to eight (“10 or more times per day”). This measure can be administered in approximately ten minutes.

Several studies provide support for the reliability and validity of the CADBI as a measure of disruptive behavior (Burns, & Walsh, 2002). Teacher ratings on the oppositional defiant behaviour, inattention and hyperactivity/impulsivity dimensions predicted observer ratings of the same dimension in a classroom, demonstrating the predictive validity of the CADBI (correlation coefficient r = .64-.69).  The same researchers also found test-retest values for the subscales at 3-month interval; (correlation coefficient r = .86-.94) (Burns, & Walsh, 2002).  The scale has demonstrated high levels of internal consistency (Cronbach’s α = .91-.97), and structural validity (Burns, & Walsh, 2002).  According to Gomez et al., (2005), the scale was validated on 1475 Australian children Mean Age=8.28 using the DSM-IV AD/HD Rating Scale.

This measure assesses all of the specific diagnostic criteria for Oppositional Defiant Disorder, Conduct Disorder and Attention Deficit/ Hyperactivity Disorder. The close mapping of items against the diagnostic criteria in the DSM IV is an advantage of this measure over others, such as, the Child Behaviour Checklist.  Although, the scale does not provide enough information to make diagnoses (Burns, et al., 2001a).

Many instruments that measure disruptive behaviour in children and adolescents face the issue of being too long, while others are under copy write and too costly. This can be discouraging to parents (Burns, et al., 2001a). The creators of the CADBI sought to create a free and valid instrument that has a moderate number of items to help facilitate the cooperation of parents. The CADBI is freely available from many websites including the ‘Center on Early Adolescence’ http://measures.earlyadolescence.org/measures/view/40/

References

Burns, GL., Taylor, TK., & Rusby, J. C. (2001a) Child and Adolescent Disruptive Behavior Inventory 2.3: Parent Version. Pullman: Washington State University, Department of Psychology

Burns, G. L., & Walsh, J. A. (2002). The Influence of ADHD-Hyperactivity/Impulsivity Symptoms on the Development of Oppositional Defiant Disorder Symptoms in a 2-year Longitudinal Study. Journal of Abnormal Child Psychology, 30, 245-256.

Burns, G. L., Boe, B., Walsh, J. A., Sommers-Flanagan, R., & Teegarden, L. A. (2001). A Confirmatory Factory Analysis on the DSM-IV ADHD and ODD Symptoms: What is the Best Model for th Organization of These Symptoms? Journal of Abnormal Psychology, 29, 339-349.

Gomez, R., Burns, G., Walsh, L., & Hafetz, J. (2005). A Multitrait–Multisource Confirmatory Factor Analytic Approach to the Construct Validity of ADHD and ODD Rating Scales with Malaysian Children. Journal of Abnormal Child Psychology, 33(2), 241-254.

Vanderbilt Assessment Scales (VAS)

The Vanderbilt Assessment Scales (parent/teacher) were created in 2002 by the American Academy of Pediatrics (AAP) and the National Initiative for Children’s Healthcare Quality (NICHQ) at the completion of a project aimed to create and implement a model of care for children with ADHD. The VAS is a brief scale completed by parents and teachers that assesses ADHD symptoms of inattention and hyperactivity along with conduct disorder, oppositional defiance disorder, anxiety, depression and academic performance (Fields & Hale, 2011).
Psychometric Properties
The scale has good internal reliability with Cronbach’s alpha coefficient of > .90 (parent) and >.89 (teacher) (Wolraich et al., 2002; Wolraich et al., 2013). Test-retest reliabilities were assessed as adequate (r >.80) (Bard et al., 2013). Interrater reliability, between the two scales is very low (r=.27 – .34) (Wolraich et al., 2002).
The four factor structure of the scale confirms it is a valid measure of inattention, hyperactivity, conduct disorder/oppositional defiance disorder, anxiety/depression. Convergent validity is evidenced by the moderate to high correlations with the Diagnostic Interview Schedule for Children-IV Parent Version (Bard et al., 2013; Collett et al., 2003).
The parent scale produced sensitivity measure (true positives) of 80% and specificity (true negatives) of 75% when predicting a diagnosis of ADHD. However when the parent and teacher scales were combined positive predictive value fell to 19% and the negative predictive value increased to 98% suggesting that the combined scale is very good for identifying children who do not have ADHD (Bard et al., 2013).
The VAS has been used with clinical and community samples of American, African American, Hispanic, Spanish and German children in rural, urban and suburban areas; with those at high and low risk of ADHD. Only small differences were found for gender, age, school grade or severity of ADHD symptoms (Wolraich et al., 2002).
Strengths:
The scale is: easy to complete and score, psychometrically sound, useful for collecting data from multiple sources and assessing academic and behaviour performance (Collett et al., 2003; Kratochvil et al., 2009). It can be used to establish baselines to measure treatment effectiveness (Kratochvil et al., 2009) and has utility to screen for comorbid disorders (Becker et al., 2012; Langberg et al., 2010). The teacher scale correlates highly with a diagnosis of ADHD (Austerman, 2015).
Weaknesses:
There is no evidence found for discriminant validity. Items are more relevant for school aged children than younger. Very low inter-rater reliability between scales and is to be used as a screening tool only.
Clinical utility:
The VAS provides a psychometrically sound method of data collection from both parents and teachers that can be used in the diagnostic process for children with ADHD.  It useful and acceptable to clinicians, readily available and provides assessment of performance and comorbid disorders (Bard et al., 2013).  It is so simple to use, a line can be drawn down the page to delineate meeting or not meeting diagnostic criteria (Molina, 2017).
Link to scale: https://www.nichq.org/resource/nichq-vanderbilt-assessment-scales

References
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.
Austerman, J. (2015). ADHD and behavioral disorders: Assessment, management, and an update from DSM-5. Cleveland Clinic Journal of Medicine, 82, S2-S7.
Bard, D.E., Wolraich, M.L., Neas, B., Doffing, M., & Beck, L. (2013). The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic parent rating scale in a community population. Journal of Developmental and Behavioral Pediatrics, 34, 72-82.
Becker, S.P., Langberg, J.M., Vaughn, A.J., & Epstein, J.N. (2012). Clinical utility of the Vanderbilt ADHD diagnostic parent rating scale comorbidity screening scales. Journal of Development and Behavioral Pediatrics, 33, 221-228.
Collett, B.R., Ohan, J.L., & Myers, K.M. (2003). Ten-year review of rating scales. V: Scales assessing attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 1015-1037.
Fields, S.A., & Hale, L.R. (2011). Psychoeducational groups for youth attention-deficit hyperactivity disorder: a family medicine pilot project. Mental Health in Family Medicine, 8, 157-165.
Kratochvil, C.J., Vaughan, B.S., Barker, A.M.., Corr, L., Wheeler, A., & Madaan, V. (2009). Review of pediatric attention deficit/hyperactivity disorder for the general psychiatrist. Psychiatric Clinics of North America, 32, 39-56.
Molina Healthcare (2017). Behavioral health provider toolkit. Retrieved from: http://www.molinahealthcare.com/providers/common/PDF/Behavioral-Health-Toolkit-for-Specialists.pdf
National Initiative for Children’s Healthcare Quality (2017). Attention Deficit Hyperactivity Disorder (ADHD) Learning Collaborative. Retrieved from: https://www.nichq.org/project/attention-deficit-hyperactivity-disorder-adhd-learning-collaborative
National Initiative for Children’s Healthcare Quality (2017). NICHQ Vanderbilt assessment scales. Retrieved from: https://www.nichq.org/project/attention-deficit-hyperactivity-disorder-adhd-learning-collaborative
Wolraich, M.L., Bard, D.E., Neas, B., Doffing, M., & Beck, L. (2013). The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic teacher rating scale in a community population. Journal of Developmental and Behavioral Pediatrics, 34, 83-93.
Wolraich, M.L., Lambert, W., Doffing, M.A., Bickman, L.B., Simmons, T., & Worley, K. (2003). Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. Journal of Pediatric Psychology, 28. 559-568.

Child Behaviour Assessment Instrument (CBAI)

Background

The Child Behaviour Assessment Instrument (CBAI) is a screening tool to identify young children at risk of behavioural problems. The CBAI was developed in Sri Lanka for use with children aged 4 – 6 years in a non-clinical environment. Carers often only present children to practitioners once behaviour reaches crisis point. The CBAI can be administered by community members to identify if professional support may be necessary. A freely available tool that eliminates the need for professional administration means assessment costs are minimised, earlier identification is more likely and subsequent interventions are more timely.

Development

Following a literature review, experts from community medicine, child psychiatry, paediatrics, child psychology and policy making used the Delphi method, to reduce 54-items to 15-items covering six domains: inattention, hyperactivity and impulsivity, aggression, impaired social interactions, abnormalities of communication and restricted, stereotyped pattern of behaviour. A convenience sample of 50 mothers of children aged 4-6 years pre-tested the instrument and amendments to enhance clarity and relevance of checklist items were made. Observable behaviours include “follows instructions of adults” and “speech is relevant to the occasion”. Raters tick if the behaviour has occurred “very often”, “sometimes” or “never” in the past 6 months and can also add other relevant information in a final open question.

Psychometric properties

A validation study used a sample of 332 children aged 4-6 years. Criterion and construct validity was found to be satisfactory. Convergent validity was tested by comparing CBAI assessment results against DSM driven clinical interviews and observations. One-way ANOVA indicated children with behavioural problems had significantly higher mean scores (21.377, p=0.001) than their counterparts (7.040). A test-retest process using a 15% subset of the sample showed satisfactory agreement between assessment times (0.851, CI95 = 0.731-0.971) indicating reliability. No cross-cultural validations were located. Back-translation (English – Sinhala) of the tool suggests research with English speaking samples is viable.

Use

The tool can be accessed via International Journal of Mental Health Systems https://ijmhs.biomedcentral.com/articles/10.1186/1752-4458-4-13 . The assessment instrument is included as a downloadable .pdf file. Permission is not required to use the instrument. Access is unrestricted access providing the original work is cited. Validation with an Australia sample in regional and remote areas is encouraged here. Limited access to support services in regional and remote Australia is an ongoing issue. A community tool such as the CBAI would support early identification in these geographical areas and minimise the risk of early problem behaviours developing into longer term issues. At the time of the study, two members of the research team (Samarakkody and McClure) were based at Monash University in Victoria, Australia (known for outstanding contributions to research) and are encouraged to consider this suggestion.

Reference

Samarakkody, D., Fernando, D., Perera, H., McCLure, R. & De Silva, H. (2010). The Child Behaviour Assessment Instrument: development and validation of a measure to screen for externalising child behavioural problems in community setting. International Journal of Mental Health Systems, 4:13. DOI: 10.1186/1752-4458-4-13

Early Childhood Behaviour Questionnaire (ECBQ)

The Early Childhood Behaviour Questionnaire (ECBQ) was designed to assess temperament in children aged between 1-3 years old. The ECBQ was designed to provide a more comprehensive and detailed assessment of temperament compared to existing measures appropriate for toddlers (Putnam, Gartstein, & Rothbart, 2006). While fine grained instruments existed to assess temperament in infants and older children, an equivalent scale did not exist for measurement of children aged 1-3. The ECBQ was designed to fill this gap (Putman, et al., 2006). Unlike previous temperament scales for toddler aged children that defined temperament solely in terms of individual differences in emotionality in early development, the ECBQ definition of temperament included reactive processes involving not only emotion, but also motor and sensory systems, as well as an emphasis on self-regulatory processes that modulate reactivity (Rothbart, Ahadi, Hershey, & Fisher, 2001).

The ECBQ consists of 201 items and 18 scales. The eighteen scales included in the ECBQ are predominantly “downward extensions” of dimensions contained on the Children’s Behavior Questionnaire (CBQ; Rothbart, et al., 2001) and “upward extensions” from the Infant Behavior Questionnaire-Revised (IBQ-R; Gartstein & Rothbart, 2003). The measure also included 3 scales (social fear, activity level and anger) from an existing measure of toddler temperament, the Toddler Behaviour Assessment Questionnaire (TBAQ; Goldsmith, 1996). The scale items ask parents to report on the frequency of specific behaviours (eg. e.g., how often did your child “sit quietly and watch,” “become sadly tearful”) in frequently occurring contexts (e.g., “When told no”) on a 7 point likert scale ranging from never to always. The measures psychometric properties were tested on two samples (preliminary and final version) from the United States, where the measure was developed.

A principal axis factor analysis revealed a consistent factor structure of the measure across the two samples (Putman, et al., 2006). A three-factor solution was extracted from the analysis. One factor was appeared to represent Negative Affectivity, with primary loadings for Discomfort, Fear, Sadness, Frustration, Soothability (negative loading), Motor Activation, Perceptual Sensitivity, and Shyness. The second factor appeared to represent Surgency/Extraversion, including primary loadings for Impulsivity, Activity Level, High-intensity Pleasure, Sociability, and Positive Anticipation. The third factor appeared to correspond to Effortful Control, and was defined primarily by loadings of Inhibitory Control, Attention Shifting, Low-intensity Pleasure, Cuddliness, and Attention Focusing (Putman, et al., 2006). The same three-factor structure has been found in the development of Russian Slobodskaya, & Kozlova, 2016) and Japanese (Sukigara, Nakagawa, & Mizuno, 2015) versions of the ECBQ.

To measure internal consistency, alpha coefficients were calculated separately for the three age groups in Sample 1 (54 alphas) and the four time points in Sample 2 (72 alphas). The alphas in Sample 2 (the final measure) were similar to those found in Sample 1; 37 were over .80, 5 were below .70, and only 1 (Impulsivity at 18 months) was below .60. Inter-rater reliability of primary and secondary caretakers found the majority of raters were consistent with one another. The most consistent agreement for primary caretakers was found for scales assessing discrete aspects of Negative Affectivity, while the lowest agreement was found for Low-intensity Pleasure, Sociability, Motor Activation, Attention Shifting, and Positive Anticipation (Putman, et al., 2006).  In terms of longitudinal stability, with the exception of the 18 to 36 month correlation for Positive Anticipation, all correlations for primary caregivers are significant at p < .01 (Putman, et al., 2006). The consistency of the findings between primary and secondary caregivers, and over two separate samples, both cross-sectional and longitudinal measurements reflect that the scale is internally valid, but additional work is required, however, to establish the concurrent, predictive, and external validity of the instrument (Putman, et al., 2006).

The authors state with the release of their questionnaires that their focus is on normal development, so the instruments are not designed for use in diagnosis of psychological or psychiatric disorders.  They remain optimistic that they may be helpful in the context of a therapeutic relationship, or in other applied settings but, this has not been empirically demonstrated and thus make no claim about the effectiveness in any other setting other than research.

The ECBQ can be downloaded from https://research.bowdoin.edu/rothbart-temperament-questionnaires/request-forms/downloads/. Permission is required, but very simple and quick request form. I received a response with a password in a number of minutes.

References

Gartstein, M., A., & Rothbart, M. K. (2003). Studying infant temperament via the Revised Infant Behavior Questionnaire. Infant Behavior and Development, 166, 1–23. Retrieved from: https://research.bowdoin.edu/rothbart-temperament-questionnaires/files/2016/09/2003-ibq-studying-infant-behavior.pdf

Goldsmith, H. H.(1996). Studying temperament via construction of the Toddler Behavior Questionnaire. Child Development, 67, 218–235.doi: 10.1111/j.1467-8624.1996.tb01730.x

Putnam, S. P., Gartstein, M. A., & Rothbart, M. K. (2006). Measurement of fine-grained aspects of toddler temperament: The early childhood behavior questionnaire. Infant Behav Dev, 29, 386-401. doi: 10.1016/j.infbeh.2006.01.004

Rothbart, M. K., Ahadi, S. A., Hershey, K. L., Fisher, P. (2001). Investigations of temperament at three to seven years: The Children’s Behavior Questionnaire. Child Development, 72, 1394–1408. doi: 10.1111/1467-8624.00355

Sukigara, M., Nakagawa, A., & Mizuno, R. (2015). Development of a japanese version of the early childhood behaviour questionnaire (ecbq) using cross-sectional and longitudinal data. SAGE Open, 5, 1-11.doi: 10.1177/2158244015590443

Slobodskaya, H., & Kozlova,E. A. (2016). Early temperament as a predictor of later personality. Personality and Individual differences, 99,127-132. doi: 10.1016/j.paid.2016.04.094