Children Mental Disorders Detecting Instruments - Essay Example

? Psychometric Review of Children Mental Disorders Detecting Instruments Katrina Evans Adler School of Professional Psychology Mental disorder is serious phenomena that results in antisocial behavior that leads to psychopathic behavior in the latter and the general negative impact on a victim’s life. According to forensic psychology, theoretical conceptualizations of antisocial behaviors in children have changed over the past years. The most common of all instruments for measuring these disorders in children are the Oppositional Defiant Disorder (ODD) and the Conduct Disorder (CD). To cub these alarming disorders in children, generic health instruments such as the Conduct Disorder Rating Scale (CDRS) and the Oppositional Defiant Disorder Rating Scale (ODDRS) have been designed and implemented. The sole objective of this review was to examine the reliability and vadility of ODDRS and CDRS in children with Oppositional Defiant Disorder and Conduct Disorder respectively, by reviewing peer reviewed published evidence relating to forensic psychology. Keywords: Oppositional defiant disorder (ODD), Conduct Disorder (CD), children, antisocial behavior Psychometric Review of Children Mental Disorders Detecting Instruments The progression of Oppositional Defiant Disorder (ODD) to Conduct Disorder (CD) and even to Antisocial Personality Disorder can result in lifelong psychological and behavioral problems. According to a research conducted by forensic psychologists, one third of the diagnosed children had ODD, one third will later be diagnosed with CD; 40% of those diagnosed with ODD will later be diagnosed with anti-social personality disorder in adulthood (Sutton & Armando, 2008). Reliable and valid measures are needed to detect antisocial behavior at an early age so that providers can identify children who are at risk for developing lifelong mental health difficulties. Current measures in the field fail to fulfill this need as they lack strong Interrater agreement and a more reliable tool that identifies children without CD than children with CD. General Description and Purpose The Conduct Disorder Rating Scale (CDRS) and the Oppositional Defiant Disorder Rating Scale (ODDRS) generally diagnose mental disorders in children. According to American Psychiatric Association [DSM-IV-TR] (2000), these instruments diagnose defiant behaviors resulting from mental disorders that lead to antisocial behaviors and low academic performances. These disorders are described by persistent loss of temper, arguing with adults, always annoying people, restlessness, and elated moods. Current Measuring Instruments in the Field Measures for evaluating antisocial behaviors is fundamental to health care practices, besides being a research tool for due treatment and comparing disorder symptoms and severity. Conduct Disorder Rating Scale (CDRS) The Conduct Disorder Rating Scale (CDRS) measures CD in children between the ages of 5 and 12 years old (Waschbusch & Elgar, 2007). There are two versions of the CDRS, one for teachers and one for parents. The teacher version of the CDRS consists of 12 symptom items based on DSM-IV-TR criteria. Application of Conduct Disorder Rating Scale The teachers rate each symptom’s frequency with a Likert scale that ranges from 0 (never) to 4 (daily) and each symptom’s severity with a Likert scale that ranges from 0 (no problems) to 4 (very severe problems), so that data on how serious and often the child exhibit symptoms of CD can be gathered. The parent version consists of 15 symptom items that are also based on the DSM-IV-TR criteria, and uses the same Likert scales. Waschbusch and Elgar (2007) conducted two studies that investigated the reliability and validity of the CDRS. Participants of study one (N=1, 554) included 801 boys and 744 girls with an age range from 5 to 12. Teachers and parents completed the scale at two times to study test-retest reliability. Of the 1,554 students, the parents rated 470 children at time one, time two; the teachers rated 1,363 children at both time one and time two. Pearson correlations were computed to evaluate 7-month test-retest reliability. Study 2 tested the reliability and validity of the CDRS with a clinical population (N=80). Boys (n=57) and girls (n=23) ranged from 7–13 years old. Similar results from study 1 were found in study two for parental internal consistency (? = .78) and teacher internal consistency (? = .83), which provides further evidence of the stability of the scale’s internal validity. Interrater agreement was 73.8%; however, 65% of the ratings were the result of the parents and teachers agreeing that a child did not have a CD. The scale’s ability to identify students without the CD is stronger than its ability to identify students with CD. In support of the scale’s construct validity, the scale scores were moderately correlated (r = .55) with the Diagnostic Interview Schedule for Children – Version IV (DISC) that measures 31 psychiatric disorders. While the correlation suggested that the CDRS was a unique measure of the CD, the teacher version of the scale demonstrated weak interrater agreement and test-retest reliability, which diminished the validity of the scores. Scoring Protocol and Threshold Parents’ showed higher test-retest reliability (r = .81) than teacher’s (r = .55). Both parents (? = .74) and teachers (? = .74) versions of the CDRS showed moderate internal consistency (Waschbusch & Elgar, 2007). Pearson correlations showed low interrater agreement (r = .33) in terms of symptom severity, but an agreement between parents and teachers concerning if the CD was or was not present was found in 94.7% of the cases (Waschbusch & Elgar, 2007). In the second study, under the scale’s construct validity, the scale scores were moderately correlated (r = .55) with the Diagnostic Interview Schedule for Children – Version IV (DISC) that measures 31 psychiatric disorders. While the correlation suggested that the CDRS was a unique measure of the CD, the teacher version of the scale demonstrated weak interrater agreement and test-retest reliability, which diminished the validity of the scores. Interpretation The low correlation associated with the interrater agreement may be due to parents’ observation on their children in multiple contexts versus teacher observation of the children only in school. It is necessary to observe a child in multiple contexts to understand if the child’s behavior is pervasive in relation to reaction to the environment, such as school. For example, a child displays CD symptoms at school may be doing so in response to peer bullying. However, at home the child may not display those same symptoms because he/she is not concerned about bullying. In support of the scale’s test-retest reliability, seven-month correlation was .81 for parents, indicating good test-retest reliability; however, test-retest reliability was much lower for teachers at .55 (Waschbusch & Elgar, 2007). This low reliability may be as a result of teachers who have to observe multiple students. An alternate explanation is that the teacher may notice the child commit a CD behavior at one point in time, but there is no guarantee that the teacher will be present at the same time when the child repeats the behavior. Based on this information; it is recommended that the CDRS parent version be used rather than the teacher version. Future research could reveal the items on the scales of teachers and parents disagreed when identifying children with CD. Oppositional defiant disorder (ODD) The Oppositional Defiant Disorder Rating Scale (ODDRS) is a parent rating scale that measures the symptoms of ODD based on the DSM-IV-TR (Hommersen, Murray, Ohan, & Johnson, 2006). Application The eight items are rated on a Likert scale ranging from 0 (not at all) to 3 (very much). In support of the scales internal reliability, coefficient alpha for internal consistency was .92 (Hommersen et al., 2006). Interrater reliability between parents was moderate (r = .70), and the test-retest reliability for 1 year correlation was low (r = .54) (Hommersen et al., 2006). Scoring Protocol and Threshold While the scale shored the internal consistency to be high, the test-retest reliability is a concern. The one year test-retest period might be too long to establish stability given that many events are likely to occur that could change the level of ODD for a child. Future research should examine the test-retest reliability using a shorter time frame. O’Laughlin, Hackenberg, and Riccardi (2010) further examined the reliability and validity of the ODDRS. In order to administer the scale to parents and teachers, they altered the items by changing “my child” to “this child.” Similar to past research, the scale showed the internal consistency for parents to be high (? = .90) and the teachers' version of the ODDRS demonstrated high internal consistency for teachers (? = .92) (O’Laughlin, Hackenberg, & Riccardi, 2010). While parents and teachers agreed on the absence of ODD symptoms in some students (51%), their agreement with the eight item ratings when ODD symptoms were present was low (r= .11). While parents and teachers tended to agree that the child did not have ODD, their agreement when four or more symptoms were present was only 12%. Interpretation In support of the scale’s validity, the correlation between the ODDRS scores with those from the Aggression subscale of the BASC-2 were high (r = .85), indicating a good convergent validity convergent validity. O’Laughlin et al. (2010) also found that the correlations within rater between the ODDRS and BASC-2 were higher than correlations between raters, which suggested that the correlation estimates could be biased upwards because the source of information was the same. Regarding recommendations for using the scale, the original parent scale has demonstrated reliability that could recommend its use, but comparing the modified teacher and parent scales is not recommended based on low interrater agreement. The general result from this review indicates that, test-retest reliability, levels of internal consistency, and cross-informant agreement for both the parent and teacher rating are adequate. The ratings for teacher were immensely correlated with observable data in the classroom while parent rating relied solely on behavioral factors. Conclusion This study supports the internal consistency and both parent and teacher rating stability. The findings confirmed the dimension structures of two instruments as outlined in the DSM-IV. The relationship between teacher ratings and parents’ behavior observations were accurate and significant, though teacher rating correlations were stronger. The difference between the two factors can be useful for children who are clinically-referred. The CDRS rating scale apres to have acceptable reliability and validity for use in the clinical process as well as a diagnostic instrument. Future research aimed at understanding and verifying the utility and property of scale across the entire social geographic environment comprising of the entire population especially in the United States should be done. This will improve the accuracy in detecting children mental disorders. References Atkins, M.S., Licht, M. H. (2005). A Comparison of Classroom Measures and Teacher Ratings of Attention disorder. Journal of Abnormal Child Psychology, 13, 155-166 Hommersen, P., Murray, C., Ohan, J. 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