Obsessive compulsive Archives

Yale – Brown Obsessive Compulsive Scale (Y-BOCS)

The Yale-Brown Obsessive Compulsive scale was developed by Wayne Goodman and his colleagues to rate the severity and types of symptoms that a client my have. It is important to note that the Y-BOCS is not intended to diagnose OCD but is used to rate the severity of symptoms and can be administered throughout therapy to track improvements made by the client. The Y-BOCS is administered as a semi-structured interview where the client responds to questions that are asked by the interviewer. The severity of the obsessive symptoms and compulsive symptoms are rated separately to give the practitioner an idea of what symptoms are most prominent. The semi-structured interview also allows the practitioner to ask the client any additional questions that they may feel will be helpful in treating the client. The Y-BOCS is considered to be a valid and reliable measure with strong internal consistency for the symptom checklist and severity scale. Scoring the test is straight forward and categorises the clients score to having a mild case of OCD to an extreme case of OCD.

References

https://psychcentral.com/disorders/ocd/what-causes-obsessive-compulsive-disorder-ocd/ )

https://iocdf.org/about-ocd/treatment/

https://www.ncbi.nlm.nih.gov/pubmed/20528050

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3958520/

http://www.brainphysics.com/ybocs.php

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994744/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994744/table/t1-jcnsd-8-2016-013/

http://www.novopsych.com/y-bocs.html

https://www.ncbi.nlm.nih.gov/pubmed/20528050

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3958520/

Florida Obsessive-Compulsive Inventory (FOCI)

The Florida Obsessive-Compulsive Inventory (FOCI) is a free to use measure of the number of symptoms of obsessive-compulsive disorder (OCD) present, as well as the severity of the symptoms¹. It was initially developed in 2007 by researchers at the University of Florida^{1, 2}. It was based on the Yale-Brown Obsessive-Compulsive Scale-Self Report (Y-BOCS-SR), which was considered the gold standard at the time and the only other self-report measure for OCD. However, the FOCI is a much quicker measure to use and to score, taking less than 5 minutes².

One of the primary reasons the FOCI was developed is that there were some concerns surrounding the Y-BOCS-SR’s validity due to its use of separate obsession and compulsion scales when factor analysis is conducted¹. Secondly, many of the other OCD measures that had been used by clinicians in the past were not able to measure the number and severity of symptoms in a brief manner. Thus, the FOCI was developed with the Y-BOCS in mind, was reviewed by OCD experts for reliability and relevance, and was revised in consultation with a few OCD in-patients^{1, 2}.

Psychometric Properties

Once the final FOCI was developed, its psychometric properties were measured using 113 previously diagnosed (using DSM-III-R or DSM-IV) OCD patients, who were diagnosed at least one year prior. It has been since found to have good internal consistency (α = 0.89), adequate reliability (K-R 20 = 0.83) for the SC, and is highly correlated with the Y-BOCS-SR total score (previously considered the gold standard)^{1, 2}.

In addition, internal consistency has been shown with the moderate correlations between the two parts of the measure (SC and SS, rs < 0.45). It has also shown to correlate with other measures such as the DASS and Hamilton Depression Rating Scale (depression/anxiety) and Clinical Global Impression Scale (psychopathology severity)^{1, 2}.

Scoring

The FOCI contains two parts: 1) the symptom checklist (SC) and 2) the severity scale (SS). The SC measures the number of symptoms present from a 20-item list of common symptoms that the individual will circle either “yes” for present or “no” for not present (range 0 – 20; 10 each of obsessions and compulsions). If there is more than one “yes”, the client completes the SS on the second page. They will rate the severity of their symptoms identified on the SC. The clinician adds the total and a score of 8+ indicates possible OCD traits. The clinician can also average the scores over the SS to find an overall severity The SS measures the severity of the symptoms that have been identified, as a whole, and not individual symptoms^{1, 2}.

Cultural issues

There does not appear to be any issues between gender, culture or age at this stage of research, and the measure has been adapted into a child version (C-FOCI), which has been translated into Spanish. The adult version has been translated into Thai and Chinese, and all versions developed to date have similar psychometric properties to the adult English version^{3 – 6}.

Critical analysis

While it cannot measure the severity of individual symptoms, it does measure the severity of the impact of the symptoms on the client. It cannot, for example, determine the severity of contamination concerns versus the severity of avoiding certain numbers; but it can determine the severity of time consumed on the behaviours.

One other issue with the FOCI is that there is no option to add extra symptoms to the list, and the list is not exhaustive. However, the list does include the most common obsessions and compulsions that occur in OCD clients. Because the FOCI is a self-report, it is possible that the client may indicate this in another way (such as writing their own) or, because it should be followed by a clinical interview, this can be brought to the clinicians attention on deeper analysis.

The FOCI has established, good sensitivity to change, and is therefore a great tool to use when determining the success or failure of treatment interventions over time, and there are no known issues with using the measure multiple times with the same client. Because it is quick to complete and easy to score, it is preferable to use the FOCI instead of longer assessments, such as the Y-BOCS. However, it should be noted that the English version has not been tested across clinical and non-clinical populations or clinical-OCD versus other clinical populations.

Finally, it is worth noting that there is a high correlation with the FOCI and measures of depression and anxiety. However, this is thought to be due to the high co-morbidity of these disorders.

References

Storch, E. A., Kaufman, D. A. S., Bagner, D., Merlo, L. J., Shapira, N. A., Geffken, G. R., Murphy, T. K., & Goodman, W. K. (2007). Florida Obsessive-Compulsive Inventory: Development, reliability and validity. Journal of Clinical Psychology, 63(9), 851 – 859. DOI: 10.1002/jclp.20382
Aleda, M. A., Geffken, G. R., Jacob, M. L., Goodman, W. K., & Storch, E. A. (2009). Further psychometric analysis of the Florida Obsessive-Compulsive Inventory. Journal of Anxiety Disorders, 23, 124 – 129. DOI:10.1016/j.janxdis.2008.05.001
Saipanish, R., Hiranyatheb, T., Jullagate, S., & Lotrakul, M. (2015). A study of diagnostic accuracy of the Florida Obsessive-Compulsive Inventory – Thai version (FOCI-T). BMC Psychiatry, 15, 251 – 257. DOI: 10.1186/s12888-015-0643-2
Storch, E. A., Khanna, M., Merlo, L. J., Loew, A., Franklin, M., Reid, J. M., Goodman, W. K., & Murphy, T. K. (2009). Children’s Florida Obsessive Compulsive Inventory: Psychometric properties and feasibility of a self-report measure of obsessive-compulsive symptoms in youth. Child Psychiatry & Human Development, 40, 467 – 483. DOI: 10.1007/s10578-009-0138-9
Piqueras, J. A., Rodriquez-Jimenez, T., Ortiz, A. G., Moreno, E., Lazaro, L., & Storch, E. A. (2017). Factor structure, reliability and validity of the Spanish version of the Children’s Florida Obsessive-Compulsive Inventory (C-FOCI). Child Psychiatry & Human Development, 48, 166 – 179. DOI: 10.1007/s10578-016-0661-4
Zhang, C. C., McGuire, J. F., Qiu, X., Jin, H., Li, Z., Cepeda, S., Goodman, W. K., & Storch, E. A. (2017). Florida Obsessive-Compulsive Inventory: Psychometric properties in a Chinese psychotherapy-seeking sample. Journal of Obsessive-Compulsive and Related Disorders, 12, 41 – 45. DOI: 10.1016/j.jocrd.2016.11.006

Revised Children’s Anxiety and Depression Scale (RCADS)

Description
The Revised Children’s Anxiety and Depression Scale (RCADS; Chorpita, Yim, Moffitt, Umemoto & Francis, 2000) is a 47-item self report measure which assesses the frequency of anxiety and depression symptoms in youth aged 8-18 years. The RCADS was developed in Hawaii, United States and is partly a revision of Spence’s Children’s Anxiety Scale (SCAS; 1997). The measure has a parent-version form as well as a short-form (RCADS-25; Ebesutani et al., 2012). The RCADS is composed of 6 scales, 5 of which are related to anxiety (separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive compulsive disorder) and another one related to major depressive disorder. The scales are aligned with anxiety and depression diagnosis criteria in the DSM-IV. Individuals rate their answers on a 4-point likert scale ranging from “never” to “always”. The results can be scored manually or via the scoring software created by the authors. In terms of results, T-scores greater than 65 are borderline clinically significant whereas those above 75 are clinically significant. These T-scores indicate that the individual’s responses reflect anxiety and depression-related symptoms very similar to those of individuals who meet diagnostic criteria for that particular disorder or syndrome.

Psychometrics
The RCADS has good internal consistency with Cronbach alpha values ranging from .78 for social anxiety disorder to .88 for panic disorder in a clinical population (Chorpita, Moffitt & Gray, 2005) as well as acceptable internal consistency in the general population (Chorpita et al.,2000). Furthermore, the measure has good convergent validity with similar measures such as the Revised Children’s Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1978), the Children’s Depression Inventory (CDI) and interview dimensional ratings (Chorpita et al., 2005). The RCADS also has favourable test-retest reliability for most scales with the social phobia scale being most reliable (0.80) and the obsessive compulsive disorder scale generally being the least reliable (0.65) when tested in a community sample of school children and adolescents (Chorpita et al., 2000). In terms of model fit, a study by Chorpita et al. (2005) using confirmatory factor analysis indicated an adequate model fit for a 6-factor model when compared to a 1 factor and a 2 factor model. The RCADS has been successfully validated in several countries including Australia (de Ross, Gullone & Chorpita,2002), Denmark (Esbjorn, Somhovd, Turnstedt & Reinholdt-Dunne, 2010), the Netherlands (Kosters, Chinapaw, Zwaanswijk, van der Wal & Koot, 2015) and Spain (Sandin, Valiente & Chorot, 2009) in clinical and school-based samples.

Use
The RCADS is available publicly and free of cost from www.childfirst.ucla.edu/resources.html. It can be used for both educational and professional purposes. However, if you want to use this tool for research purposes, permission is required from the authors. It’s a valuable tool for use with youth suspected of having an anxiety disorder or major depressive disorder as its scales reflect DSM-IV criteria and it’s one of the only anxiety measures that also measures depressive symptoms separately. Furthermore, the RCADS has been translated into several languages including Spanish, Chinese and French and due to its cross-cultural validations, it can be used with youth from different cultures. It should be noted that the RCADS is only standardized for grades 3 and above as T-Score conversions have not been developed for children younger than grade three. Therefore, the authors recommend using clinical judgement for interpreting raw scores for these children.

References

Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behaviour research and therapy, 43(3), 309-322.

Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behaviour research and therapy, 38(8), 835-855.

de Ross, R. L., Gullone, E., & Chorpita, B. F. (2002). The revised child anxiety and depression scale: a psychometric investigation with Australian youth. Behaviour Change, 19(02), 90-101.

Ebesutani, C., Reise, S. P., Chorpita, B. F., Ale, C., Regan, J., Young, J., … & Weisz, J. R. (2012). The Revised Child Anxiety and Depression Scale-Short Version: Scale reduction via exploratory bifactor modeling of the broad anxiety factor. Psychological Assessment, 24(4), 833.

Esbjørn, B. H., Sømhovd, M. J., Turnstedt, C., & Reinholdt-Dunne, M. L. (2012). Assessing the Revised Child Anxiety and Depression Scale (RCADS) in a national sample of Danish youth aged 8–16 years. PLoS One, 7(5), e37339.

Kösters, M. P., Chinapaw, M. J., Zwaanswijk, M., van der Wal, M. F., & Koot, H. M. (2015). Structure, reliability, and validity of the revised child anxiety and depression scale (RCADS) in a multi-ethnic urban sample of Dutch children. BMC psychiatry, 15(1), 132.

Reynolds, C. R., & Richmond, B. O. (1978). What I think and feel: A revised measure of children’s manifest anxiety. Journal of abnormal child psychology, 6(2), 271-280.

Sandín, B., Valiente, R. M., & Chorot, P. (2009). RCADS: evaluación de los síntomas de los trastornos de ansiedad y depresión en niñosy adolescentes. Revista de Psicopatología y Psicología Clínica, 14(3), 193-206.

Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour research and therapy, 36(5), 545-566.

Children’s Yale-Brown Obsessive Compulsive Scale (CYBOCS-2)

The Children’s Yale-Brown Obsessive Compulsive Scale (Goodman et al., 1989; Scahill, Riddle, Mcswiggin-Hardin, & Ort, 1997) was designed to assess OCD symptomology and severity in children (8 – 17 years of age). Since its development it was revised in 2004 (Storch et al., 2010), and a second edition is freely available. This is a semi-structured interview, clinician-rated tool. In research the tool is a primary outcome measure for clinical or behaviour treatment trials. Clinicians can use the tool to track the progress of patients. Although this was not designed to be a diagnostic tool, the symptom checklist if often employed as a diagnostic aid. Administering the tool revolves around a semi-structured interview with the patient. Depending on the age of the child, or anxiety levels, a parent may be present. The clinician and the child go through a symptom checklist identifying the most prominent symptoms, past and present (last 30 days). Then the clinician asks 10 questions (5 items regarding severity and 5 items regarding obsessions) and rates the child’s answers on a 6-point scale. An overall score is produced at the end to track progress. The scale has been show to have excellent psychometric properties. It has high internal consistency of both the severity scale (alpha = .89) and the obsession scale obsession scale (alpha = .86). The tool is freely available on Google, however when used for research purposes the author must be contacted.

References

Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., … Charney, D. S. (1989). The Yale-Brown Obsessive Compulsive Scale: I. Development, Use, and Reliability. Archives of General Psychiatry, 46(11), 1006–1011. https://doi.org/10.1001/archpsyc.1989.01810110048007

Scahill, L., Riddle, M., Mcswiggin-Hardin, M., & Ort, S. (1997). Children’s Yale-Brown obsessive compulsive scale: Reliability and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36(6), 844–852.

Storch, E. A., Rasmussen, S. A., Price, L. H., Larson, M. J., Murphy, T. K., & Goodman, W. K. (2010). Development and Psychometric Evaluation of the Yale-Brown Obsessive-Compulsive Scale-Second Edition. Psychological Assessment, 22(2), 223–232. https://doi.org/00012030-201006000-00003

Spence Children’s Anxiety Scale (SCAS)

The Spence Children’s Anxiety Scale (SCAS) developed by Spence (1998), is a self-report measure designed to assess the severity of anxiety symptoms in children relating to separation anxiety, social phobia, obsessive-compulsive disorder, panic agoraphobia, generalised anxiety and fears of physical injury. The major sample involved in the acquisition of normative data included 2,052 children, 8-12 years of age, recruited from primary schools in Brisbane, Australia. The scale was primarily developed as most child-report measures of anxiety fail to examine anxiety symptoms that relate to specific anxiety disorders, such as separation anxiety disorder. Secondly, most of the measures available are downward extensions of adult measures of anxiety and are based on the assumptions that childhood anxiety closely resembles adult anxiety (Spence, 1998).

The scale consists of 44 items which can be filled out by the child. Thirty-eight of the items reflect specific symptoms of anxiety, while 6 relate to positive, filler items to reduce negative response bias, such as, “I am the most popular amongst other kids my own age”. The scale is quick and easy to administer, taking only 10 minutes. Items are consistent with specific DSM-IV anxiety disorders. Participants are asked to rate the degree to which they experience a symptom on a 4-point frequency scale, Never, Sometimes, Often and Always. Sample items from the separation anxiety subscale include, “I worry about being away from my parents” and “I feel scared if I have to sleep on my own”. Sample items from the obsessive-compulsive subscale include, “I have to keep checking that I have done things right (like the switch is off, or the door is locked)” and “I have to do some things in just the right way to stop bad things happening” (Spence, 1998).

The total score may be computed from adding together all the subscale scores. The sub-scale scores are computed by adding the individual item scores on the set of items within that domain. Scores within one standard deviation (ie. a T-score of 10) above the mean on any dimension are regarded as being within the normal range on that dimension. A T-score of 60 is indicative of sub-clinical or elevated levels of anxiety. This justifies further investigation and confirmation of diagnostic status using clinical interview.

Confirmatory factor analysis demonstrates that the SCAS items load strongly upon the factors that they purport to measure. Internal consistency (reliability) for the total scale is extremely high (.92) confirming that the items of the scale are measuring the same construct. The internal consistency for the subscales is also acceptable, .82 (panic-agoraphobia); .70 (separation anxiety); .70 (social phobia); .60 (physical injury fears); .73 (obsessive-compulsive) and .73 (generalised anxiety). Test-retest reliability was examined in a sample of 344 children who were reassessed after 6-months after the initial data collection which showed a test-retest reliability coefficient of .60. This suggests reasonably high reliability over a 6-month period for the total score. Test-retest reliabilities were lower for the individual subscales, indicating children’s reports of anxiety symptoms tend to decrease after a six-month retest interval. The SCAS total score correlates significantly (.71) with the Revised Children’s Manifest Anxiety Scale (RCMAS).

Since the development of the SCAS a parent version (Nauta et al., 2004), a pre-school version (Spence, Rapee, McDonald, & Ingram, 2001) and an adolescent version (Spence, Barrett, & Turner, 2003) has been developed, validated and readily available. The SCAS is freely available and provides a measure of anxiety symptoms related to specific anxiety disorders. The SCAS is used in clinical contexts for both assessment and evaluation purposes. It is also used to identify children at risk of developing anxiety problems and for monitoring outcome intervention. The developers of the SCAS stipulate a diagnosis should be made with the addition of a structured clinical interview.

References

Nauta, M. H., Scholing, A., Rapee, R. M., Abbott, M., Spence, S. H., & Waters, A. (2004). A parent-report measure of children’s anxiety: psychometric properties and comparison with child-report in a clinic and normal sample. Behaviour Research and Therapy, 42(7), 813-839. doi: 10.1016/S0005-7967(03)00200-6

Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36(5), 545-566. doi: 10.1016/S0005-7967(98)00034-5

Spence, S. H., Barrett, P. M., & Turner, C. M. (2003). Psychometric properties of the Spence Children’s Anxiety Scale with young adolescents. Journal of Anxiety Disorders, 17(6), 605-625. doi: 10.1016/S0887-6185(02)00236-0

Spence, S. H., Rapee, R., McDonald, C., & Ingram, M. (2001). The structure of anxiety symptoms among preschoolers. Behaviour Research and Therapy, 39(11), 1293-1316.