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.

Pediatric Symptom Checklist (PSC-35)

The PSC-35 was designed as a brief screening tool to assess general psychosocial dysfunction in children (Vogels, Crone, Hoekstra & Reijneveld, 2009). It was developed in the USA and is used to improve the identification of psychosocial problems in children (Vogels et al., 2009). The measure is filled out by the parent/guardian and it examines the domains of attention, externalizing, and internalizing symptoms (Massachusetts General Hospital, 2017). It is applicable for use with children between the ages of 4 and 18 and usually takes less than five minutes to administer. Scoring only takes 1 to 2 minutes.

The tool contains a total of 35 items. The items cover a broad range of emotional and behavioral problems experience by children that reflect the parent’s impression of the child’s psychosocial functioning (Jellinek et al., 1988). Responses to the items are Never, Sometimes or Often and items are scored 0, 1 and 2 respectively. The tool is scored by adding these scores together. A positive screen for children aged between 6-18 is indicated by a score of greater than 27 and a score greater than 23 for 4-5 year children. Cutoff scores indicating a clinical level of dysfunction have been derived using Receiver Operator Characteristic analyses. This involves the comparison of the performance of the PSC to other validated questionnaires and clinician assessment.

The test has been demonstrated to have a sensitivity of 0.95 with a specificity of 0.68 (Jellinek et al., 1988). Internal consistency has been shown to be particularly strong with a cronbach alpha of 0.89 (Vogels et al., 2009). Further, a Pearson’s r value of 0.81 was calculated using the Child Behaviour Checklist as a reference point (Vogels et al., 2009). This is a longer strongly validated tool that is also used to assess psychosocial problems. Given the effect size demonstrated is a large size (Cohen, 1992) this provides evidence of strong convergent validity for the PSC-35.

Given the strong evidence for the tool, other researchers have adapted the measure in to encapsulate a wider client base. A shorter 17 item version of the tool has been created and has also been translated into English, Spanish, Chinese and Japanese. There is also a pictorial version available and a version has been introduced for children over the age of 11 that allows them to respond to the item themselves.

In general, the tool is a particularly efficient and effective way of identifying potential psychosocial problems in children in early development. It is easy to administer and score for busy clinicians and it a simple tool for parents to understand.

References

Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159. DOI:10.1037/0033-2909.112.1.155

Massachusetts General Hospital. (2017). Pediatric Symptom Checklist. Retrieved from: http://www.massgeneral.org/psychiatry/services/psc_about.aspx

Jellinek, M. S., Murphy, J. M., Robinson, J., Feins, A., Lamb, & S., Fenton, T. (1988). Pediatric symptom checklist: Screening schoolage children for psychosocial dysfunction. The Journal of Pediatrics, 112, 201-209. DOI: 10.1016/S0022-3476(88)80056-8.

Vogels, A. G., Crone, M. R., Hoekstra, F., & Reijneveld, S. A. (2009). Comparing three short questionnaires to detect psychosocial dysfunction among primary school children: A randomized method. BMC Public Health, 9(1), 489-501. DOI: 10.1186/1471-2458-9-489