Observational Assessment of Preschool Disruptive Behavior, Part II: validity of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS).

OBJECTIVE: To examine the validity of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS), a new observational method for assessing preschool disruptive behavior. METHOD: A total of 327 behaviorally heterogeneous preschoolers from low-income environments comprised the validation sample. Parent and teacher reports were used to identify children with clinically significant disruptive behavior. The DB-DOS assessed observed disruptive behavior in two domains, problems in Behavioral Regulation and Anger Modulation, across three interactional contexts: Examiner Engaged, Examiner Busy, and Parent. Convergent and divergent validity of the DB-DOS were tested in relation to parent and teacher reports and independently observed behavior. Clinical validity was tested in terms of criterion and incremental validity of the DB-DOS for discriminating disruptive behavior status and impairment, concurrently and longitudinally. RESULTS: DB-DOS scores were significantly associated with reported and independently observed behavior in a theoretically meaningful fashion. Scores from both DB-DOS domains and each of the three DB-DOS contexts contributed uniquely to discrimination of disruptive behavior status, concurrently and predictively. Observed behavior on the DB-DOS also contributed incrementally to prediction of impairment over time, beyond variance explained by meeting DSM-IV disruptive behavior disorder symptom criteria based on parent/teacher report. CONCLUSIONS: The multidomain, multicontext approach of the DB-DOS is a valid method for direct assessment of preschool disruptive behavior. This approach shows promise for enhancing accurate identification of clinically significant disruptive behavior in young children and for characterizing subtypes in a manner that can directly inform etiological and intervention research.

Observational Assessment of Preschool Disruptive Behavior, Part I: reliability of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS).

OBJECTIVE: To examine the reliability of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS), a new observational method for assessing preschool disruptive behavior. METHOD: The DB-DOS is a structured clinic-based assessment designed to elicit clinically salient behaviors relevant to the diagnosis of disruptive behavior in preschoolers. Child behavior is assessed in three interactional contexts that vary by partner (parent versus examiner) and level of support provided. Twenty-one disruptive behaviors are coded within two domains: problems in Behavioral Regulation and problems in Anger Modulation. A total of 364 referred and nonreferred preschoolers participated: interrater reliability and internal consistency were assessed on a primary sample (n = 335) and test-retest reliability was assessed in a separate sample (n = 29). RESULTS: The DB-DOS demonstrated good interrater and test-retest reliability. Confirmatory factor analysis demonstrated an excellent fit of the DB-DOS multidomain model of disruptive behavior. CONCLUSIONS: The DB-DOS is a reliable observational tool for clinic-based assessment of preschool disruptive behavior. This standardized assessment method holds promise for advancing developmentally sensitive characterization of preschool psychopathology.

A guide for monitoring child development in low- and middle-income countries.

OBJECTIVE: In low- and middle-income countries, methods for clinicians to address difficulties in language, social-emotional, cognitive, behavioral, or neuromotor development during early childhood are lacking. To fill this gap, we designed, in Turkey, the Guide for Monitoring Child Development, which aims to aid clinicians in monitoring and supporting child development and the early detection and management of developmental difficulties. The Guide for Monitoring Child Development monitoring component is a practical, open-ended interview that catalyzes communication between clinicians and caregivers and obtains a portrayal of the child's development. We report on the development and psychometric properties of the Guide for Monitoring Child Development monitoring component for children aged 0 to 24 months. METHODS: We examined the ages of attainment of Guide for Monitoring Child Development milestones and internal consistency in a cross-sectional study of healthy children receiving well-child care (study 1). In 2 clinical samples, we studied the interrater reliability between medical students and a child development specialist administering the guide (study 2), as well as the concurrent validity of the guide administered during a health visit and a comprehensive developmental assessment (study 3). RESULTS: In study 1 (N = 510), item-total scale correlations ranged from 0.28 to 0.91. An age-dependent attainment pattern was seen in all of the milestones. In study 2 (N = 92), interrater reliability between medical-student pairs and between the child development specialist and students was high (kappa scores were 0.83-0.88). In study 3 (N = 79), the sensitivity, specificity, and positive and negative predictive values were 0.88, 0.93, 0.84, and 0.94, respectively. CONCLUSIONS: The Guide for Monitoring Child Development is an innovative method for monitoring child development that is designed specifically for use by health care providers in low- and middle-income countries. Studies in Turkey provide preliminary evidence for its reliability and validity.

The bed requirement inventory: a simple measure to estimate the need for a psychiatric bed.

OBJECTIVE: To develop an assessment of bed need that was as little affected by personal bias as possible. METHOD: The Bed Requirement Inventory (BRI) is an eight-point scale designed to identify the appropriate use of an acute psychiatric bed. This is completed by a member of the ward staff, usually a nurse, and takes 5 minutes to fill in. The reliability, validity and feasibility of using the scale in normal practice were tested in a one-year study, and variations in inappropriate bed use described. RESULTS: The inter-rater reliability of the scale was good (intra-class correlation coefficient = 0.63) and a comparison of the need for a psychiatric bed (comparing the BRI score with the judgement of an independent multidisciplinary group of professionals) also showed good agreement (k = 0.69), suggesting reasonable validity (although when the assessment was made by the named nurse agreement was less good). Results from a year-long survey in two West London hospitals showed that 17% of admissions were inappropriate and 32% had delayed discharge, black Caribbean patients had a significantly higher proportion (25%) of inappropriate admission than others (11%) and those referred from housing charities and hostels had a higher proportion (50%) of inappropriate bed use at some time than other groups (33%). CONCLUSIONS: The Bed Requirement Inventory is a quick and reliable method of determining the appropriate use of a psychiatric bed and could be of use in estimating local bed needs. Delayed discharge remains a serious reason for inappropriate bed use in London.

The Brief Infant-Toddler Social and Emotional Assessment: screening for social-emotional problems and delays in competence.

OBJECTIVE: To examine the reliability and validity of the 42-item Brief Infant-Toddler Social and Emotional Assessment (BITSEA), a screener for social-emotional/behavioral problems and delays in competence. METHOD: Parents in a representative healthy birth cohort of 1,237 infants aged 12 to 36 months completed the Infant-Toddler Social and Emotional Assessment (ITSEA)/BITSEA, the Child Behavior Checklist (CBCL)/1.5-5, the MacArthur Communication Developmental Inventory vocabulary checklist, and worry questions. In a subsample, independent evaluators rated infant-toddler behavior. RESULTS: Test-retest reliability was excellent and interrater agreement (mother/father and parent/child-care provider) was good. Supporting validity, BITSEA problems correlated with concurrent evaluator problem ratings and CBCL/1.5-5 scores and also predicted CBCL/1.5-5 and ITSEA problem scores one year later. BITSEA measures of competence correlated with concurrent observed competence and predicted later ITSEA competence measures. Supporting discriminant validity, only 23% of high BITSEA problem scorers had delayed vocabulary. Moreover, the combined BITSEA problem/competence cutpoints identified 85% of subclinical/clinical CBCL/1.5-5 scores, while maintaining acceptable specificity (75%). CONCLUSIONS: Findings support the BITSEA as a screener for social-emotional/behavioral problems and delays in social-emotional competence.

Use of the Global Assessment of Function scale in learning disability.

BACKGROUND: The Global Assessment of Function (GAF) scale is widely used in adult psychiatric practice and research but it has not often been used in learning disability, which is inherently more complex. AIMS: To evaluate the reliability of GAF in the assessment of learning disability. METHOD: GAF reliability was tested by simultaneous multiple rating of unselected case vignettes (n=19-25) from health professionals of different disciplines, under controlled conditions. Analysis of reliability was made with the intraclass correlation coefficient (R(1)) with separate assessments to determine rater bias and individual performance of raters. RESULTS: The results of three data-sets showed generally poor overall levels of agreement, with R(1) levels of 0.35 and 0.28 and somewhat better levels for current GAF scores (R(1)=0.49). However, a subset of raters was identified that achieved much higher levels (R(1)=0.54 to 0.74). CONCLUSIONS: The GAF, in its current format, is not reliable enough to be used in the routine assessment of learning disability. A subgroup of raters, however, have ratings that are, by current biostatistical criteria, sufficiently reliable.