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.

Brief Problem Checklist (BPC)

The Brief Problem Checklist (BPC) is a measure designed by Chorpita et al. (2010) to periodically assess the clinical progress of a child over the course of psychological treatment. The scale measures internalising and externalising problems found in children aged 7-13, and such feedback can be used by a clinician to track outcomes and to adjust treatment. The scale is presented in an interview format which contains twelve items, and there is both a child and caregiver version. The BPC is intended to be conducted via an over-the-phone interview at weekly intervals during treatment. The burden for families partaking in such frequent interviews is believed to be minimal, as Chorpita et al. (2010) found that on average the administration time takes less than one minute.

The measure was developed in the USA, and the normed sample was composed of American children (aged 7 -13 years old) who were offered treatment due to a range of problems that could be subsumed under the broad categories of anxiety, depression, or disruptive behaviour (Chorpita et al., 2010). The BPC interviews yield three scales; a Total Problems scale, and Internalising scale, and an Externalising scale. When answering the questions, children and care-givers are required to rate how true the 12 items are in reference to the previous week, using a 3-point Likert scale. Example items include: “I disobey my parents or people at school” (caregiver version: “disobedient at home or school”) and “I threaten to hurt people” (caregiver version: “threatens people”).

To create items for the BPC, Chorpita et al. (2010) applied factor analysis to both the Child Behaviour Checklist (CBCL) and the Youth Self-Report (YSR); two instruments which are widely used and established as evidence-based measures. Items with high factor loadings across both the CBCL and YSR were chosen, leading to the identification of 14 internalising items and 20 externalising items. Items were then selected based on their ability to maximise information pertaining to the clinical change of the client. The resultant 12 items were subjected to exploratory factor analysis using maximum likelihood estimation. A two-factor solution was drawn from the following scree plot, and the factors were extracted and subjected to promax rotation. The resultant factors corresponded to the Externalising and Internalising scales of the BPC.

To determine convergent validity the scales of the BPC were correlated with corresponding scales from the CBCL and YSR (Chorpita et al., 2010). Each BPC scale (Internalising, Externalising, and Total Problems) was highly significantly correlated to scales on both the YSR (coefficients at .61 or above) and the CBCL (coefficients at .56 or above). A longitudinal examination of BPC interview data across 6 months of treatment demonstrated that the BPC is capable of significantly predicting change in related measurements of symptomology (ie. the CBCL and YSR), providing strong evidence for its clinical utility. Test-retest coefficients across an average period of 8-9 days ranged from .72 to .79 for each of the BPC subscales. The agreement of the child and caregiver versions of the scale were examined and produced correlations ranging from .19 to .31; findings which are comparable to the literature comparing parent-child symptom agreement (Chorpita et al., 2010).

The BPC can be readily accessed online and is available for both commercial and research purposes. Due to the relatively new construction of the measure and its potential to quickly and efficiently monitor clinical change in children, the BPC holds both great practical relevance and would benefit from further psychometric testing and cross-cultural validation. No major revisions of the BPC have occurred to the author’s knowledge.

References

Chorpita, B. F., Reise, S., Weisz, J. R., Grubbs, K., Becker, K. D., Krull, J. L., & The Research Network on Youth Mental Health. (2010). Evaluation of the Brief Problem Cheklist: Child and caregiver interviews to measure clinical progress. Journal of Consulting and Clinical Psychology, 78(4), 526-536. doi: 10.1037/a0019602

BPC Links:

Child version: http://www.childfirst.ucla.edu/Brief%20Problem%20Checklist%20-%20Child.pdf Parent Version: http://www.childfirst.ucla.edu/Brief%20Problem%20Checklist%20-%20Parent.pdf

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.