Clinical Assessment of Behavior

Bruce A. Bracken, Ph.D.

The College of William and Mary
Williamsburg, VA (USA) Babrac@wm.edu

Problem Statement
 To what extent are childrens and adolescents positive (i.e., adaptive) and negative (i.e., clinical) behavior ratings a result of basic demographic conditions (e.g., age, gender, race/ethnicity)?  Are childrens behavioral ratings comparably reliable as a result of these basic demographic conditions?  What percent of the variance in childrens behavioral ratings is associated with basic demographic conditions?  To what extent do childrens behavioral ratings differ as a result of race/ethnicity and gender?

Method
 Students behaviors were rated by their mothers or fathers during the standardization of a new behavior rating scale, Clinical Assessment of Behavior (Bracken & Keith, 2004).  Students positive and negative (i.e., clinical) behaviors were compared directly (i.e., mean score comparisons) and indirectly (e.g., percent of variance accounted for by demographic variables; internal consistency estimates)

Instrument
 Clinical Assessment of Behavior (CAB; Bracken & Keith, 2004).  Third-party behavior rating scale completed by parents and teachers (Parent form used in this study)  Appropriate for children ages 2 - 18 years  Assesses Clinical behaviors (Psychopathology, sociopathy, educational exceptionalities) and Adaptive behaviors  Used as triangulating element in multi-source, multinstrument clinical assessments

Triangulation: MultiMulti-source, Multiple Context Assessment

Other Sources
- Direct Observation - Indirect Approaches (e.g., Projective Techniques) - Background Information

Behavioral and Psychosocial Adjustment

Self-Report - Self-concept - Sentence Completion Forms

Third-Party Report - CAB Parent or Teacher

- BASC, DSMD, SSRS Achenbach, Connors

CAB Assesses:
 Critical Behaviors: low-incidence behaviors that define serious psychopathology and sociopathy Psychotic experiences (e.g., hallucinations) Substance abuse Satanic worship Gang-related behaviors  Behaviors exhibited in medical and neuropsychological conditions Attention-deficit/hyperactivity disorders Learning disabilities Executive function strengths and limitations Autistic spectrum behaviors

CAB Assesses:
 Behaviors that correspond to educational exceptionalities and conditions Mental retardation Learning disabilities Gifted and talented Adaptive behaviors Social skills  Behaviors of current societal concern Aggression Anger management Bullying Conduct problems

Clinical Scales
Internalizing Behaviors Scale (INT)  Assesses behaviors directed toward self (e.g., depression, anxiety, somatization, fear)
- cries easily; is easily startled; is emotionally fragile

Externalizing Behaviors Scale (EXT)  Assesses problematic conduct directed toward others (e.g., rulebreaking behaviors, vandalism, truancy)
- insults others; is difficult to manage; ignores rules

Critical Behaviors Scale (CRI)  Assesses behaviors associated with serious psychopathology and sociopathy
- uses illegal drugs; hallucinates; expresses an unusual interest in Satan

Adaptive Scales
Social Skills Scale (SOC)  Assesses interpersonal relations with peers and adults
- listens attentively to others; is considerate of others; annoys others

Competence Scale (COM)  Focuses on ability to get needs met appropriately, learning, and cognitive and language development
- has poor judgment; is easily confused; learns new things easily

Adaptive Behaviors Scale (ADB)  Assesses developmental progress and degree of personal independence
- dresses self; reliably makes simple purchases; prepares simple meals for self

CAB Scale Structure and Number of Items

Scale Clinical Scales Internalizing Externalizing Critical Behaviors Adaptive Scales Social Skills Competence Adaptive Behaviors Total Scale CAB-PX 30 30 30 CAB-P 16 18 -CAB-T 16 18 --

30 30 20 170

18 18 -70

18 18 -70

CAB Clusters and Number of Items

Clusters Clinical Clusters Anxiety Depression Anger Aggression Bullying Conduct Problems Attention Deficit/Hyperactivity Autistic Spectrum Behaviors Learning Disability Mental Retardation Adaptive Clusters Executive Function Gifted and Talented CAB-PX 23 36 15 25 36 28 21 30 23 25 17 27 CAB-P 11 16 9 13 13 8 20 13 15 12 13 17 CAB-T 11 16 9 13 13 8 20 13 15 12 13 17

Theoretical Structure of CAB

U.S. Normative Sample

Sample Size Parent Forms - ages 2 6 - ages 7 12 - ages 13 18 Teacher Form - ages 5 6 - ages 7 12 - ages 13 18 Males 309 455 318 145 471 391 Females 291 422 319 95 288 299 Total 600 877 637 240 759 690

Race/Ethnicity (Percent Representation) Whites Blacks Hispanics 65 71% 12 17% 9 12%

Other 6 8%

Normative Sample
Education Level < 11 years 12 years 13 - 15 years 16 years > 17 years Unknown Geographic Region Midwest Northeast South West 21 25% 13 22% 35 45% 19 22% 17 22% 22 25% 36 39% 17 20% CAB-P 3.9% 23.9% 38.7% 14.6% 18.8% 0.1% CAB-T 3.2% 2.5% 11.4% 17.5% 65.2% 0.2%

CAB-PX Total Sample Internal Consistency

Scales
Internalizing Behaviors (INT) Externalizing Behaviors (EXT) Critical Behaviors (CRI) Social Skills (SOC) Competence (COM) Adaptive Behaviors (ADB)

r
.95 .97 .91 .95 .94 .92

Clusters
Anxiety (ANX) Depression (DEP) Anger (ANG) Aggression (AGG) Bullying (BUL) Conduct Problems (CP) Attention-Deficit (ADH) Autistic Spectrum (AUT) Learning Disability (LD) Mental Retardation (MR) Executive Function (EF) Gifted and Talented (GAT)

r
.93 .95 .93 .95 .97 .92 .94 .92 .92 .91 .91 .94

Total (CBI)

.98

CAB PX Stability
Scale Internalizing Externalizing Critical Behaviors Social Skills Competence Adaptive Behaviors CAB Behavioral Index CAB Clusters CAB-PX .89 .90 .77 .92 .92 .87 .94 .83 - .94

CAB Inter-rater Coefficients

Scale Internalizing Externalizing Critical Behaviors Social Skills Competence Adaptive Behaviors CAB Behavioral Index CAB Clusters
* Parent - Parent

CAB-PX* .78 .81 .41 .62 .79 .53 .82 .70 - .90

Analyses
 Estimates of total scale internal consistency by race  Estimates of percent scale variance accounted for by basic demographic variables  Scale and cluster mean score comparisons for basic demographic variables

Comparative Reliabilities by Ethnic Group, Across Age Levels

Caucasian Clinical Internalizing Externalizing Critical Behaviors Adaptive Social Skills Competence Adaptive Behavior Total Scale CBI Clusters .97 - .99 .84 - .97 .98 - .99 .85 - .97 .96 - .99 .78 - .97 .94 - .95 .96 - .97 .71 - .92 African-American .93 - .96 .96 - .97 .80 - .98 Hispanic .91 - .96 .93 - .98 .42 - .92

.92 - .96 .91 - .95 .79 - .89

.92 - .95 .92 - .95 .82 - .90

.89 - .96 .89 - .97 .84 - .89

Scale Variance Associated With Demographic Variables

Age Clinical Internalizing Externalizing Clinical Behaviors Adaptive Social Skills Competence Adaptive Behaviors Total Scale (CBI) 1.44 2.69 49.70 2.86 2.69 2.96 1.80 2.31 .03 .01 .01 .01 .67 .81 .03 .61 .35 .19 4.93 .08 2.82 .53 .59 .01 .36 .21 .42 .72 Gender Race Parent Ed

Cluster Variance Associated With Demographic Variables

Anxiety Depression Anger Aggression Bullying Attention Deficit Autistic Spectrum Learning Disability Mental Retardation Executive Function Gifted and Talented Age .00 .71 .79 1.37 .49 .90 5.15 .46 12.60 2.76 3.10 Gender .35 .40 2.07 4.45 2.34 3.84 1.72 2.19 2.86 4.16 3.46 Race .26 .37 .32 .10 .00 .03 .00 .00 .04 .00 .06 Parent Ed .22 .29 .45 .67 .58 .42 .61 .58 .77 .57 .94

Gender Differences
Main Effect for Gender by Race ANOVA
(No significant gender by race interactions)
Scales
Internalizing Behaviors (INT) Externalizing Behaviors (EXT) Critical Behaviors (CRI) Social Skills (SOC) Competence (COM) Adaptive Behaviors (ADB)

p
ns ns ns ns ns ns ns

Clusters
Anxiety (ANX) Depression (DEP) Anger (ANG) Aggression (AGG) Bullying (BUL) Conduct Problems (CP) Attention-Deficit (ADH) Autistic Spectrum (AUT) Learning Disability (LD) Mental Retardation (MR) Executive Function (EF) Gifted and Talented (GAT)

p
ns ns ns ns ns ns ns ns ns ns ns ns

Total (CBI)

Race/Ethnicity Differences*
*Main effect for Race/ethnicity, with no interactions Only INT revealed differences on post hoc analyses due to conservative nature of Scheffe Scales
Internalizing Behaviors Whites > Blacks Externalizing Behaviors Critical Behaviors Social Skills Competence Adaptive Behaviors

p
.05 ns .05 ns ns ns ns

Clusters
Anxiety (ANX) Depression (DEP) Anger (ANG) Aggression (AGG) Bullying (BUL) Conduct Problems (CP) Attention-Deficit (ADH) Autistic Spectrum (AUT) Learning Disability (LD) Mental Retardation (MR) Executive Function (EF) Gifted and Talented (GAT)

p
.05 .05 ns ns ns ns ns ns ns ns ns ns

Total (CBI)

Conclusions
 Minimal variance in clinical and adaptive behaviors due to basic demographic variables (except age in developmental conditions - - adaptive behavior)  CAB produces minimal mean score differences as a result of basic demographic variables (gender, race/ethnicity)  Behaviors assessed by the CAB, both adaptive and pathological, appear to be normally distributed within the greater population.  CAB appears to produce highly reliable assessment of the behavior of youth regardless of age, race, or gender