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.

Swanson, Nolan, and Pelham, Version IV Scale-Teacher Form (SNAP-IV)

The SNAP-IV is a questionnaire developed in the US, initially to the standards of the DSM III, to screen for Attention Deficit Hyperactive Disorder, Oppositional Defiance Disorder, as well as overlapping symptoms of all other psychiatric disorders of childhood. It has a short and longer, more comprehensive form, which contains 90 items and includes all of the previously mentioned constructs. The short form, referred to as the MTA version, has 26 items and measures the core ADHD symptoms of impulsivity, hyperactivity, inattention, and a few ODD symptoms. While either can be used in both the clinical and research setting, the MTA version seems to be more commonly used because of its brevity and its ability to measure the core aspects of ADHD. It is designed to be filled out by either the parent or teacher of an elementary school aged child.

The most recent study on the SNAP-IV (MTA version) re-evaluated the psychometric properties of the scale. Factor analysis indicated that the SNAP-IV loads on 3 factors. This matches the framework guiding its construction. Two factors for ADHD emerged – impulsivity/hyperactivity and inattention, while the third one was for ODD. The authors compared the results of the scale with the Diagnostic Interview Schedule for Children, Parent Version (DISC-IV-P), which bases its diagnosis on the DSM-IV and explores functioning in both the home and at school. There is suitable predictive validity support for the SNAP-IV when screening for ADHD.

As for reliability, the study demonstrated that it had acceptable reliability figures. They computed for the reliability figures for the parent and teacher ratings separately, as well as producing subdomain alphas for each factor. The coefficient alpha for overall parent ratings was .94, with alphas of .90, .79, and .89 for the inattention, hyperactivity/impulsivity, and ODD subdomains, respectively. The reliability of the teacher ratings was slightly better at .97 for the overall scale, .96 for inattention, .92 for hyperactivity/impulsivity, and .96 for ODD. The report also produced Pearson correlations for the inter-rater reliability between the parent and teacher ratings for each factor. The correlations are as follows: .49 for inattention, .43 for hyperactivity/impulsivity, and .47 for ODD, and all were statistically significant (p < .001)

While the psychometrics of the SNAP-IV may be quite good, it is important to note the limitations of its norms. The researchers may have used sizable samples for their parent (n = 1,613) and teacher (n = 1,205) ratings, as well as for their validation sample (n = 266), but the norms are far more limited. They sampled in just one school district in North Florida with high poverty rates and limited diversity. Additionally, they only included white and African American children in the assessment. Interestingly, there is a Japanese and a Chinese version of the SNAP-IV, each with its own corresponding norms.

There may be valid reasons to take a conservative approach to interpreting the results of the SNAP-IV, but it still functions effectively as a relatively quick and easy screener to use.

References

Bussing, R., Fernandez, M., Harwood, M., Wei, H., Garvan, C. W., Eyberg, S. M., & Swanson, J. M. (2008). Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: Psychometric properties and normative ratings from a school district sample. Assessment, 15(3),  317-328. doi:10.1177/1073191107313888

Gau, S. S., Lin, C. H., Hu, F. C., Shang, C. Y., Swanson, J. M., Liu, Y. C., & Liu, S. K. (2009). Psychometric properties of the Chinese version of the Swanson, Nolan, and Pelham, Version IV Scale-Teacher Form. Journal of Pediatric Psychology, 34(8), 850-861. doi:10.1093/jpepsy/jsn133

Inoue, Y., Ito, K., Kita, Y., Inagaki, M., Kaga, M., & Swanson, J. M. (2014). Psychometric properties of Japanese version of the Swanson, Nolan, and Pelham, version-IV Scale-Teacher Form: a study of school children in community samples. Brain Development, 36(8), 700-706.          doi:10.1016/j.braindev.2013.09.003