A broad-based assessment (aka a multimethod, multisource, multisetting assessment):
- Methods: direct observation, behavior rating scales, interviews, record review, sociometric assessment, self-report measures.
- Sources: child, parents, other family members, teachers, other school personnel, peer group, community-based informants.
- Settings: home, school, clinic, play, community.
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Differential diagnosis involves two steps: (1) "making a binary decision as to whether the problem is considered normal or abnormal" and (2) deciding how to classify the problem specifically (e.g., conduct disorder versus oppositional defiant disorder).
Type I error (or false-positive error): when you classify someone as having a disorder that they in fact don't have. Type II error (false-negative error): when you classify someone as being normal when they in fact have a disorder.
Different classification systems: DSM-5, classification under special education law.
An alternative to classification: behavioral dimensions approach. "The paradigm used in the behavioral dimensions approach is rooted in empirical methods of measuring behavior and complex statistical procedures that allow for the identification of behavioral clusters, which refer to clusters of highly intercorrelated behaviors." Primarily developed by Thomas Achenbach and his colleagues.
The Achenbach System of Empirically Based Assessment (ASEBA). ASEBA identifies two primary broad-band syndromes: internalizing problems (a.k.a. overcontrolled behavior) (e.g., anxiety, depression, somatic complaints, social withdrawal) and externalizing problems (a.k.a. undercontrolled behavior) (e.g., delinquent behavior, aggressive behavior, hyperactivity). ASEBA also identifies narrow-band syndromes: withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior.
"The ASEBA is arguably the most sophisticated system of child behavior assessment tools currently available, and it is certainly the most extensively researched. These tools have become widely used by practitioners in school and clinical settings and by researchers."
One problem of conducting assessments using many sources and instruments is behavioral covariation.
Multiple gating: "through a series of assessment and decision steps (gates), a large population is sequentially narrowed down to a small population of individuals who are very likely to exhibit the behavioral syndromes in question across settings and over time." The first step (or gate) consists of screening a large population...
Behavior Rating Scales
The advantage of behavior rating scales over checklists is that rating scales not only "allow the rater to indicate whether a specific symptom is present" but also "provide a means of estimating the degree to which a characteristic is present." Advantages of rating scales: (a) more inexpensive than direct behavioral observation, (b) they're "capable of providing data on low-frequency but important behaviors that might not be seen in a limited number of direct observation sessions," (c) a rating scale is "an objective assessment method that provides more reliable data than unstructured interviews or projective-expressive techniques," (d) they can be used to assess children "who cannot readily provide information about themselves," (e) they "capitalize on observations over a period of time in a child's" natural environment, (f) they "capitalize on the judgments and observations of persons who are highly familiar with the child or adolescent's behavior."
Problems with behavior rating scales: bias of response and error variance. Three types of response bias:
Types of error variance found with rating scales:
Another problem with rating scales: respondents tend to give disproportionate weight to recent events.
ASEBA, BASC, and Conners "represent some of the best constructed and widely researched instruments currently available."
Best practices: (a) a great use of rating scales is to use them as screenings; children whose rating scale scores are 1 or more standard deviations above the mean should be considered for further evaluation; this narrows down the screening pool to 16 percent of population; (b) use the aggregation principles (i.e., obtain ratings from multiple sources in multiple settings); (c) assess progress during and after interventions.
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Differential diagnosis involves two steps: (1) "making a binary decision as to whether the problem is considered normal or abnormal" and (2) deciding how to classify the problem specifically (e.g., conduct disorder versus oppositional defiant disorder).
Type I error (or false-positive error): when you classify someone as having a disorder that they in fact don't have. Type II error (false-negative error): when you classify someone as being normal when they in fact have a disorder.
Different classification systems: DSM-5, classification under special education law.
An alternative to classification: behavioral dimensions approach. "The paradigm used in the behavioral dimensions approach is rooted in empirical methods of measuring behavior and complex statistical procedures that allow for the identification of behavioral clusters, which refer to clusters of highly intercorrelated behaviors." Primarily developed by Thomas Achenbach and his colleagues.
The Achenbach System of Empirically Based Assessment (ASEBA). ASEBA identifies two primary broad-band syndromes: internalizing problems (a.k.a. overcontrolled behavior) (e.g., anxiety, depression, somatic complaints, social withdrawal) and externalizing problems (a.k.a. undercontrolled behavior) (e.g., delinquent behavior, aggressive behavior, hyperactivity). ASEBA also identifies narrow-band syndromes: withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior.
"The ASEBA is arguably the most sophisticated system of child behavior assessment tools currently available, and it is certainly the most extensively researched. These tools have become widely used by practitioners in school and clinical settings and by researchers."
One problem of conducting assessments using many sources and instruments is behavioral covariation.
Multiple gating: "through a series of assessment and decision steps (gates), a large population is sequentially narrowed down to a small population of individuals who are very likely to exhibit the behavioral syndromes in question across settings and over time." The first step (or gate) consists of screening a large population...
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Behavior Rating Scales
The advantage of behavior rating scales over checklists is that rating scales not only "allow the rater to indicate whether a specific symptom is present" but also "provide a means of estimating the degree to which a characteristic is present." Advantages of rating scales: (a) more inexpensive than direct behavioral observation, (b) they're "capable of providing data on low-frequency but important behaviors that might not be seen in a limited number of direct observation sessions," (c) a rating scale is "an objective assessment method that provides more reliable data than unstructured interviews or projective-expressive techniques," (d) they can be used to assess children "who cannot readily provide information about themselves," (e) they "capitalize on observations over a period of time in a child's" natural environment, (f) they "capitalize on the judgments and observations of persons who are highly familiar with the child or adolescent's behavior."
Problems with behavior rating scales: bias of response and error variance. Three types of response bias:
- Halo effects ("rating a student in a positive or negative manner simply because they possess some other positive or negative characteristics not pertinent to the rated item").
- Leniency or severity ("the tendency of some raters to have an overly generous or overly critical response set when rating all subjects").
- Central tendency effectives ("the proclivity or raters to select midpoint ratings and to avoid endpoints of the scale such as 'never' and 'always'")
Types of error variance found with rating scales:
- Source variance: different raters respond to statements/questions differently.
- Setting variance: what works for child in one environment might not work in other environments.
- Temporal variance: behavior often changes over time, and a respondent's ratings might change over time.
- Instrument variance: different scales often measure different hypothetical constructs.
Another problem with rating scales: respondents tend to give disproportionate weight to recent events.
ASEBA, BASC, and Conners "represent some of the best constructed and widely researched instruments currently available."
Best practices: (a) a great use of rating scales is to use them as screenings; children whose rating scale scores are 1 or more standard deviations above the mean should be considered for further evaluation; this narrows down the screening pool to 16 percent of population; (b) use the aggregation principles (i.e., obtain ratings from multiple sources in multiple settings); (c) assess progress during and after interventions.
Interviewing Techniques
It's important to observe the child during the interview, especially because children's "typically unsophisticated verbal mediation skills make it difficult for them to express directly their concerns, needs, and problems." A good interviewer is aware of the developmental stages.
Interviews with elementary-aged children "may be enhanced by: (1) relying on familiar settings and activities during the interview; (2) allowing them to use manipulatives and drawings during the interview; (3) avoiding constant eye contact (which elementary-aged children are typically not used to); and (4) providing contextual cues (such as pictures, colors, and examples) with requests for language interaction."
(1) Traditional or Unstructured Interviewing
This term "represents a broad range of clinical interviews that are relatively open-ended, less structured, and highly adaptable depending on the situation."
Gathering background information from parents/teachers:
- Medical History. Problems during pregnancy and delivery? Complications shortly after birth? Serious illnesses/high fevers or convulsions? Serious injuries or accidents? Serious illnesses in family history? Allergies or dietary problems? Current health problems or medications? Vision and hearing OK?
- Developmental history. Ages for reaching developmental milestones: crawling, talking, walking, toilet-training. Developmental delays (communication, motor, cognitive, social)? Development in comparison with siblings or peers.
- Social/emotional functioning. Temperament as an infant/toddler? Quality of attachment to caregivers as infant/toddler? Quality of relationships with parents? Quality of relationships with siblings and peers? Discipline methods: what works best, who does he or she mind the best? Behavioral problems at home or in community? Number and quality of friendships with peers. Any traumatic/disturbing experiences? Any responsibilities or chores?
- Educational progress. Initial adjustment to school? Academic progress: delayed, average, high-achieving? School grades and progress notes? Any school attendance problems? Behavioral problems at school? Quality of peer relations at school? Favorite subjects, classes, or teachers? Etracurricular activities?
- Community involvement. Belong to any organizations or clubs (e.g., Boys and Girls Club)? Organized team sports? Religious background/participation? Relationships with etended family.
Example of comprehensive formal developmental history interview: the Structured Developmental History form from the BASC-3.
Interviewing the child. Four areas to observe:
- Physical characteristics. Unusual or inappropriate attire. Height and weight in comparison to same-age peers. Obvious physical difficulties. Direct signs of possible illness. Motor coordination. Tics (vocal, facial, motor).
- Overt behavioral characteristics. Activity level. Attention span. Interaction with environment. Distractibility. Impulsivity.
- Social/emotional functioning. Range and appropriateness of affect. Mood state during interview. Reaction to praise. Reaction to frustration. Social skills with interviewer. Obvious anxiety or nervousnesss. Ease of separate from caregiver.
- Cognitive functioning. Communication skills. Overall intellectual competence, estimated. Intrapersonal insight/self-awareness. Logic of reasoning. Time and space orientation. Level of organization in activities. Apparent planning ability.
Interviewing the child. General areas of questioning:
- Intrapersonal functioning. Eating and sleeping habits. Feelings/attributions about self. Peculiar or bizarre experiences (e.g., hearing or seeing things). Emotional status (e.g., depressed, anxious, guilty, angry, happy). Clarity of thought/orientation to time and space. Insight into own thoughts and concerns. Defensiveness/blaming. Understanding of reason for interview.
- Family relationships. Quality of relationships with parents. Quality of relationships with siblings. Family routines, responsibilities, chores. Involvement with extended family members. Level of perceived support from family. Perceived conflicts within family.
- Peer relationships. Number of close friends. Preferred activities with friends. Perceived conflicts with peers. Social skills for initiating friendships. Reports of peer rejection and loneliness.
- School adjustment. Current grade, teacher, school subjects. General attitudes/feelings about school. Previous and current academic performance. Favorite or preferred subjects or teachers. Difficult or disliked subjects or teachers. Involvement in extracurricular activities. School attendance patterns. Perceived conflicts or problems at school.
- Community involvement. Involvement in clubs or youth organizations. Participation in community activities. Religious activities. Levels of mobility within community. Relationships with others in the community.
(2) Behavioral Interviewing
The primary purpose of behavioral interviewing is to understand the functions of problem behavior. Examples: The Functional Assessment Checklist for Teachers and Staff, The Functional Assessment Checklist for Students.
(3) Structured or Semistructured Diagnostic Interviewing
Most school-based practitioners will find that "the most complex and highly structured interview tools are not practical for day-to-day use. These tools require extensive training and time, and are more suited for settings such as teaching hospitals, and for purposes such as research." Examples: the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Semistructured Clinical Interview for Children and Adolescents (SCICA).
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Internalizing Problems
Observational technique used in the assessment of anxiety: Behavioral Avoidance Test (BAT) (subject observed as he/she approaches anxiety- or fear-provoking stimulus).
Kazdin "listed three general classes of behavioral codes that could be used for direct observational assessment of childhood depression":
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Internalizing Problems
Observational technique used in the assessment of anxiety: Behavioral Avoidance Test (BAT) (subject observed as he/she approaches anxiety- or fear-provoking stimulus).
Kazdin "listed three general classes of behavioral codes that could be used for direct observational assessment of childhood depression":
- Social activity: talking, playing a game, participating in a group activity.
- Solitary behavior: playing a game alone, working on an academic task, listening and watching, straightening one's room, grooming.
- Affect-related expression: smiling, frowning, arguing, complaining.
The Anxiety Dimensional Observation Scale (Anx-DOS).
Behavior rating scales should be used, but it should be noted that "many aspects of internalizing problems are not readily detectable to an external observer, even one who knows the child or adolescent relatively well." Parent reports tend to be more accurate for assessing externalizing problems, while child self-reports tend to be more accurate for assessing internalizing problems.
Self-reports should be used. Recommended: CDI, RCMAS, RCDS, RADS-2, MASC-2, TAIC,Interviewing should be done; see the Children's Depression Rating Scale (CDRS). Sociometric assessments "can screen effectively for internalizing problems in children."
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