Reliability and validity of the work and social adjustment scale in phobic disorders

The Work and Social Adjustment Scale (WSAS) is a simple widely used 5-item measure of disability whose psychometric properties need more analysis in phobic disorders. The reliability, factor structure, validity, and sensitivity to change of the WSAS were studied in 205 phobic patients (73 agoraphobia, 62 social phobia, and 70 specific phobia) who participated in various open and randomized trials of self-exposure therapy. Internal consistency of the WSAS was excellent in all phobics pooled and in agoraphobics and social phobics separately. Principal components analysis extracted a single general factor of disability. Specific phobics gave less consistent ratings across WSAS items, suggesting that some items were less relevant to their problem. Internal consistency was marginally higher for self-ratings than clinician ratings of the WSAS. Self-ratings and clinician ratings correlated highly though patients tended to rate themselves as more disabled than clinicians did. WSAS total scores reflected differences in phobic severity and improvement with treatment. The WSAS is a valid, reliable, and change-sensitive measure of work/social and other adjustment in phobic disorders, especially in agoraphobia and social phobia.     

The children of the Lundby study as adults: A salutogenic perspective

In this study, 100 patients consecutively admitted to four child psychiatric inpatient wards in Finland were prospectively followed 12 months after discharge from short-term inpatient treatment. It turned out that 50 patients were discharged back to their previous residence and to outpatient treatment, 40 patients were admitted to long-term inpatient treatment and 10 patients were placed in some institution. The child's antisocial behaviour on admission was the strongest determinant for long-term treatment or placement at the 12 month follow-up. Other predictors of long-term treatment or placement in an institution included a high total score in teacher's behaviour ratings, being referred by a psychiatric agency and living in a semi-rural area. No statistically significant relationship was found in the child's age, gender, parents' education level or occupation, family characteristics, total life events, parent's ratings of total behaviour, total life events, parent's ratings of total behaviour, CGAS ratings by a clinician or a wide range of treatment variables.     

Assessing emotional and behavioral problems in children with intellectual disability: revisiting the factor structure of the developmental behavior checklist

The objective of the reported study was to reassess the factor structure of the Developmental Behaviour Checklist (DBC) in a large cross-cultural sample representing all levels of intellectual disability. Parent and teacher DBC ratings on a combined sample of 1536 Dutch and Australian children and adolescents (ages 3–22) with mild to profound intellectual disability were used. Principal components analyses produced five subscales: Disruptive/Antisocial, Self-Absorbed, Communication Disturbance, Anxiety, and Social Relating, explaining 43.7% of the total variance. Internal consistencies of these subscales ranged from .66 to .91. The revised factor structure of the DBC appears to be an improved and useful tool for assessing emotional and behavioral problems in children with intellectual disabilities.     

The trajectory of psychiatric disorders in young people with intellectual disabilities

OBJECTIVE: This study addresses the question of how prevalence and patterns of psychiatric disorder change from childhood to adolescence in young people with intellectual disability (ID). METHOD: A representative epidemiological sample of 582 young people with ID aged 4-19 years was surveyed in 1991-1992 and again in 1995-1996. The main measure of psychiatric disturbance was the developmental behaviour checklist (DBC), a 96 item parent/carer completed questionnaire with robust psychometric properties which provided an overall score, 6 subscale or syndrome measures of psychiatric disturbance and determined caseness. RESULTS: The findings confirmed that about 40% of young people with ID had psychiatric disorders which persisted over 4 years. Clinically significant change in symptoms with either deterioration or improvement occurred in around 14% of the sample. CONCLUSION: Psychiatric disorder is 3-4 times more prevalent in young people with ID than in the general population. Less than 10% of these young people receive specialist services for a problem which is numerically as large as schizophrenia.     

Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA)

INTRODUCTION: Assessment of the effectiveness of clinical practice requires appropriate outcome measures.Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) is a recently developed measure of outcome for use in child and adolescent mental health services (CAMHS). The aims of the present study were to evaluate sensitivity to change, face validity and clinical feasibility of HoNOSCA in a Danish field trial. METHOD: A prospective design in which HoNOSCA, Global Assessment of Psychosocial Disability (GAPD) and a clinician rated global outcome measure were completed at 15 field sites. 173 patients were rated both at initial assessment and at follow-up after three months. RESULTS: HoNOSCA demonstrated satisfactory face validity. There was a strong correlation between HoNOSCA scores and GAPD scores ( r = 0.6, P < 0.001) and a highly significant association (ANOVA (F = 25.4, P < 0.001)) between change in HoNOSCA scores and global clinical ratings of change.Mean HoNOSCA scores varied between psychiatric diagnoses. CONCLUSIONS: HoNOSCA is a sensitive and valid measure of change for children and adolescents attending CAMHS.     

Rating depressed patients: observer- vs self-assessment.

An overview of the rating scale literature reveals that the clinician now has many validated rating scales to choose from to assess his patient's condition. In general terms, it is the observer-rating scales that should be used as the principal outcome criterion in depressive disorders, both in general practice and in drug-related trials. However, self-rating scales can provide important additional information for therapy evaluation. They also provide a measure of the patient's perception of his own illness and recovery, which is not possible with observer ratings. Self-rating scales are designed for frequent use and to be sensitive to the change brought about by therapy and its time course. Observer ratings can also show sensitivity for change, and these compare well with the self-rating measures. The multimethod approach, including both observer- and self-rating scales, and covering different domains such as psychopathological symptoms, social functioning, etc. , is the preferred method for assessing patients. Using this approach, clinicians are able to build up complete profiles of their patients' illnesses and make full assessments of the efficacy of treatment and their return to normal social functioning.     

Exploring associations between self-regulatory mechanisms and neuropsychological functioning and driver behaviour after brain injury

The objective of this prospective one-year follow-up study was to explore the associations between self-regulatory mechanisms and neuropsychological tests as well as baseline and follow-up ratings of driver behaviour. The participants were a cohort of subjects with stroke and traumatic brain injury (TBI) who were found fit to drive after a multi-disciplinary driver assessment (baseline). Baseline measures included neuropsychological tests and ratings of self-regulatory mechanisms, i.e., executive functions (Behavior Rating Inventory of Executive Function–Adult Version; BRIEF-A) and impulsive personality traits (UPPS Impulsive Behavior Scale). The participants rated pre-injury driving behaviour on the Driver Behaviour Qestionnaire (DBQ) retrospectively at baseline and after one year of post-injury driving (follow-up). Better performance on neuropsychological tests was significantly associated with more post-injury DBQ Violations. The BRIEF-A main indexes were significantly associated with baseline and follow-up ratings of DBQ Mistakes and follow-up DBQ Inattention. UPPS (lack of) Perseverance was significantly associated with baseline DBQ Inattention, whereas UPPS Urgency was significantly associated with baseline DBQ Inexperience and post-injury DBQ Mistakes. There were no significant changes in DBQ ratings from baseline (pre-injury) to follow-up (post-injury). It was concluded that neuropsychological functioning and self-regulatory mechanisms are related to driver behaviour. Some aspects of driver behaviour do not necessarily change after brain injury, reflecting the influence of premorbid driving behaviour or impaired awareness of deficits on post-injury driving behaviour. Further evidence is required to predict the role of self-regulatory mechanisms on driver behaviour and crashes or near misses.     

A comparison of alternative assessments of depressive symptom severity: a pilot study

This study compared the performance of an itemized symptom self-report (Inventory of Depressive Symptomatology - Self-Report; IDS-SR), patient global ratings, and clinician global ratings with an itemized clinician-rated symptom severity measure (Inventory of Depressive Symptomatology - Clinician-Rated; IDS-C) in detecting treatment effects in patients with major depressive disorder (MDD). A total of 28 inpatients (30.8% psychotic) and 34 outpatients (17.9% psychotic) with MDD began treatment that followed the Texas medication algorithm. The clinicians completed the IDS-C and a Physician Global Rating Scale (PhGRS) at each assessment visit, while the patients completed the IDS-SR and a Patient Global Rating Scale (PtGRS). Change scores from the baseline to subsequent weeks were computed for all subjects, utilizing all four measures. The IDS-SR was a significant independent predictor of the response to treatment as compared to the two global ratings. The IDS-SR was as sensitive to change as the IDS-C. While the clinician-rated itemized symptom severity rating scale remains the standard to assess the symptomatic outcome of the treatment of MDD, a self-report of identical symptomatology may be a reasonable alternative for many patients.     

A comparison of alternative assessments of depressive symptom severity: a pilot study

This study compared the performance of an itemized symptom self-report (Inventory of Depressive Symptomatology - Self-Report; IDS-SR), patient global ratings, and clinician global ratings with an itemized clinician-rated symptom severity measure (Inventory of Depressive Symptomatology - Clinician-Rated; IDS-C) in detecting treatment effects in patients with major depressive disorder (MDD). A total of 28 inpatients (30.8% psychotic) and 34 outpatients (17.9% psychotic) with MDD began treatment that followed the Texas medication algorithm. The clinicians completed the IDS-C and a Physician Global Rating Scale (PhGRS) at each assessment visit, while the patients completed the IDS-SR and a Patient Global Rating Scale (PtGRS). Change scores from the baseline to subsequent weeks were computed for all subjects, utilizing all four measures. The IDS-SR was a significant independent predictor of the response to treatment as compared to the two global ratings. The IDS-SR was as sensitive to change as the IDS-C. While the clinician-rated itemized symptom severity rating scale remains the standard to assess the symptomatic outcome of the treatment of MDD, a self-report of identical symptomatology may be a reasonable alternative for many patients.     

Evaluation of the Illness Management and Recovery Scale in schizophrenia and schizoaffective disorder

The aim of the present study was to evaluate the psychometric properties of the parallel client and clinician versions of the Illness Management and Recovery Scale (IMRS) developed to monitor the clients' progress in the Illness Management and Recovery (IMR) program in schizophrenia. A total of 107 study participants completed assessments of the IMRS, interview-based ratings of psychiatric symptoms, self-ratings of psychiatric symptoms, perception of recovery, and quality of life. Case managers completed the clinician version of the IMRS. Both versions of the scale demonstrated satisfactory internal reliability and strong test-retest reliability. The results also indicated convergent validity with interview-based ratings of psychiatric symptoms, self-rated symptoms, perception of recovery, and quality of life for both versions of the IMRS. These findings support the utility of the IMRS as a measure of illness self-management and recovery in clients with schizophrenia.     

Parenting training in the community: linking process to outcome

This pilot study examines the effectiveness of the Parents Together Community Course(i) (a six week preventative version of the Parents Plus Early Years Programme) in reducing parent-reported behaviour problems in pre-school and school aged children. It also investigates if there is an association between process ratings on a weekly session rating form (WSRF) and client outcome. Thirty-one parents who completed the course filled out pre and post outcome measures (namely the Strengths and Difficulties Questionnaire (SDQ) and a specially designed Client defined Problem and Goals form (CPG)), and a process measure during the course of the group. It was found that 45% of children in the community sample had behavioural problems in the borderline or clinical range, and significant reductions in these problem behaviours and gains towards parent-defined goals were observed following the course. Results also showed a number of correlations between high ratings on the WSRF and positive outcome as measured by the CPG and SDQ indicating a possible link between this process measure and outcomes. This highlights the importance of early community interventions in dealing with childhood behaviour problems and the possible utility of a process measure for identifying contributing factors to change.     

Clinical relevance of cognitive scores in hepatitis C patients with advanced fibrosis

Mild neuropsychological impairment has previously been reported in chronic hepatitis C (CHC) patients. The aim of this study was to assess the presence and severity of cognitive impairment among a cohort of CHC patients with advanced fibrosis using clinician ratings compared to classification based upon statistical methods. In addition, we set out to determine the relationship between cognitive scores and functional status. Two experienced neuropsychologists provided "clinician ratings" on a battery of 10 neuropsychological tests performed in 100 randomly selected patients participating in the HALT-C clinical trial. The overall kappa between the 2 graders on level of impairment was 0.59. Clinician ratings (the gold standard) were similarly sensitive to identifying cognitive impairment as was classification based on standard scores (44% vs. 40%). Global Deficit Scores (GDS), derived from pooling standard scores, also identified 44% of patients as having mild impairment and were highly correlated with clinician ratings (r = .81 p = < 0.0001). Neither clinician ratings nor deficit scores correlated with SF-36 subscale or summary scores but did correlate with depression scores (p < .0007). In summary, clinician ratings and deficit scores identified a similar prevalence of cognitive impairment amongst CHC patients with advanced fibrosis. There was a significant correlation between cognitive impairment and self-reported depression.     

Clinician versus machine: Reliability and responsiveness of motor endpoints in Parkinson's disease

BackgroundEnhancing the reliability and responsiveness of motor assessments required to demonstrate therapeutic efficacy is a priority for Parkinson's disease (PD) clinical trials. The objective of this study is to determine the reliability and responsiveness of a portable kinematic system for quantifying PD motor deficits as compared to clinical ratings.MethodsEighteen PD patients with subthalamic nucleus deep-brain stimulation (DBS) performed three tasks for evaluating resting tremor, postural tremor, and finger-tapping speed, amplitude, and rhythm while wearing a wireless motion-sensor unit (Kinesia) on the more-affected index finger. These tasks were repeated three times with DBS turned off and at each of 10 different stimulation amplitudes chosen to yield small changes in treatment response. Each task performance was video-recorded for subsequent clinician rating in blinded, randomized order. Test–retest reliability was calculated as intraclass correlation (ICC) and sensitivity was calculated as minimal detectable change (MDC) for each DBS amplitude.ResultsICCs for Kinesia were significantly higher than those for clinician ratings of finger-tapping speed (p < 0.0001), amplitude (p < 0.0001), and rhythm (p < 0.05), but were not significantly different for evaluations of resting or postural tremor. Similarly, Kinesia scores yielded a lower MDC as compared with clinician scores across all finger-tapping subscores (p < 0.0001), but did not differ significantly for resting and postural tremor.ConclusionsThe Kinesia portable kinematic system can provide greater test–retest reliability and sensitivity to change than conventional clinical ratings for measuring bradykinesia, hypokinesia, and dysrhythmia in PD patients.     

Utility of the Time-Line Follow-Back to assess substance use among homeless adults

Assessing substance use of homeless persons is a critical task. This study examines the test-retest reliability, concurrent validity, and sensitivity to change of the Time-Line Follow-Back interview, a calendar instrument used to assess days and quantities of alcohol use and days of illicit drug use, in the multisite Collaborative Program to Prevent Homelessness (CPPH). The Time-Line Follow-Back was reliable for assessing use during the past month and the recent 6 months. Results from the Time-Line Follow-Back were correlated with other self-reports of use, with research diagnoses of substance use disorder, and with clinician ratings of severity of substance abuse. The Time-Line Follow-Back detected changes in clients with severe mental illness and in those with less severe psychiatric problems.     

Associations among measures of awareness of cognitive deficits in dementia

BackgroundAwareness of deficits is a complex phenomenon. In this study, we examined the relationships among various measures of awareness of cognitive deficits in dementia, and investigated the unique association between clinician ratings and alternative approaches to assessing awareness.MethodsParticipants included 108 patients with very mild (n = 50) or mild (n = 58) dementia. Awareness of cognitive difficulties was assessed by clinician ratings, informant ratings, patients' reports of cognitive difficulties, discrepancies between patients' and informants' reports of cognitive difficulties, and patients' perceptions of performance on neuropsychological tests. Correlational analyses were used to assess associations among these measures of awareness, and ordinal logistic regression was used to examine the unique relationship between clinician ratings of awareness and the other approaches.ResultsAll measures of awareness were significantly correlated with one another. Coefficients ranged from 0.26 to ?0.64. Patients categorized as unaware by either clinicians or informants reported fewer cognitive difficulties. Of the awareness measures evaluated, clinician ratings had the strongest correlation with measures of global cognition. In the regression analysis, only informant global ratings and patients' reports of cognitive difficulties were significantly associated with clinician ratings. The model's classification accuracy was satisfactory for patients in the “intact awareness” and “severe unawareness” categories, but not for those in the “mild unawareness” category.ConclusionsAlthough measures of awareness likely share overlapping variance, they are not interchangeable. Each potentially elucidates unique aspects of the complex phenomenon of awareness, with clinician assessment being the most suited for ambiguous cases. When clinician assessment is not feasible, informant rating (but not patient-informant discrepancy) would be a valid substitute.     

A clinically useful depression outcome scale

If the optimal delivery of mental health treatment ultimately depends on examining outcome, then precise, reliable, valid, informative, and user-friendly measurement is the key to evaluating the quality and efficiency of care in clinical practice. Self-report questionnaires are a cost-effective option because they are inexpensive in terms of professional time needed for administration, and they correlate highly with clinician ratings. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we describe the reliability and validity of the Clinically Useful Depression Outcome Scale (CUDOS). The CUDOS was designed to be brief (completed in less than 3 minutes), quickly scored (in less than 15 seconds), clinically useful (fully covering the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition symptoms of major depressive disorder and dysthymic disorder), reliable, valid, and sensitive to change. We studied the CUDOS in more than 1400 psychiatric outpatients and found that the scale had high internal consistency and test-retest reliability. The CUDOS was more highly correlated with another self-report measure of depression than with measures of anxiety, substance use problems, eating disorders, and somatization, thereby supporting the convergent and discriminant validity of the scale. The CUDOS was also highly correlated with interviewer ratings of the severity of depression, and CUDOS scores were significantly different in depressed patients with mild, moderate, and severe levels of depression. The CUDOS was a valid measure of symptom change. Finally, the CUDOS was significantly associated with a diagnosis of major depressive disorder. Thus, the results of this large validation study of the CUDOS shows that it is a reliable and valid measure of depression that is feasible to incorporate into routine clinical practice.     

Behavioural phenotype in foetal alcohol syndrome and foetal alcohol effects

A sample of 12 children (seven males, five females; mean age 6 years 7 months, SD 2 years 6 months, range 2 years 4 months to 12 years 1 month) with moderate-to-severe foetal alcohol syndrome (FAS) and another sample of 26 children (12 males, 14 females; mean age of 6 years 2 months SD 2 years 10 months, range 2 years 6 months to 12 years 8 months) with mild FAS or foetal alcohol effects (FAE) as well as a sample of 15 age- and sex-matched control children with unspecific intellectual disability were compared using the Developmental Behaviour Checklist (DBC). There were significant differences (p=0.01) between the groups on five of six subscales of the DBC with controls scoring lower on the disruptive, self-absorbed, anxiety, antisocial behaviour, and communication disturbance scales. The DBC profiles of the two foetal alcohol exposed groups did not differ from each other. It is concluded that quantitative behaviour measurement provides insights into specific behavioural phenotypes of FAS/FAE.     

Behavioural and emotional difficulties in students attending schools for children and adolescents with severe intellectual disability

Background   For several decades, researchers and clinicians have been aware of an increased prevalence of psychiatric disorder in children with intellectual disability. However, there are few research studies exploring this issue.
Methods   The parents of 123 children attending schools for children with 'severe learning difficulties' completed the Developmental Behaviour Checklist (DBC) in order to identify those children with clinically significant behavioural and emotional problems. Comparisons were made with norms for the DBC and a range of child variables were investigated as possible correlates of disorder.
Results   Some 50.4% of the children scored above the cut-off on the DBC for psychiatric disorder. The child's severity of physical disability was related most strongly to parental ratings of behavioural and emotional problems. There were also effects for the child's age and the absence of Down's syndrome.
Conclusions   The present study confirms previous research findings of a high prevalence of behavioural and emotional difficulties amongst children with intellectual disability, and identifies a number of correlates of disorder which require further investigation.     

Demand Characteristics and Quality Improvement: Who is Fooling Whom?

Since some of the data used for quality assurance purposes (i.e. rating scales) requires the active participation of clinicians, administrators use various mandates or incentives to insure its collection. However, although improving clinician compliance these measures may bias clinician responses. It is suggested that the concept of ‘demand characteristics’ originally developed by Orne to describe how non-specific aspects of the experimental setting shape what the human subject does may be applicable. For example a measure that might increase clinician compliance with completing GAF ratings on an inpatient unit might also influence the scores to make them coincide with the expectation that all patients are very ill when admitted and improved when discharged. Why such a phenomenon would be difficult to detect and what it might say about the relationship between managers and those they manage is also explored.     

Validation and Use of the Youth and Caregiver Treatment Outcome Expectations Scale (TOES) to Assess the Relationships Between Expectations, Pretreatment Characteristics, and Outcomes

This study introduces the youth and caregiver versions of the Treatment Outcome Expectations Scale (TOES) and presents the results of comprehensive psychometric analyses in a large sample of clinically-referred youth (N = 291) ages 11-18 and their caregivers (N = 268). This study also examines whether expectations are predictive of early or overall treatment change as measured by changes in youth symptom severity rated by multiple respondents (youth, caregiver, and clinician). Additionally, the relationship between treatment outcome expectations and several background, pretreatment, and clinical variables is explored. Finally, this study investigates the correspondence in outcome expectations between dyads of youth and caregivers. Results demonstrate the TOES is a psychometrically sound measure for use in this population. Findings also indicate that while higher youth outcome expectations significantly relate to higher youth-rated internalizing symptom severity at baseline, they also relate to a faster rate of reduction in internalizing symptom severity. Additionally, caregiver age and youth gender were significant predictors of youth-rated outcome expectations. Results also demonstrate a small, positive correlation between youth and caregiver ratings of outcome expectations. Implications, future directions, and limitations of the study are discussed.