Disruptive Behavior Disorders Structured Parent Interview

Transcription

1 ID Number: Interviewer: Date: Disruptive Behavior Disorders Structured Parent Interview The Disruptive Behavior Disorders Structured Parent Interview should be administered by a trained clinician with one or both parents or guardians present. The clinician should introduce each symptom and should ask parents to describe their child s typical behavior in regard to that symptom, using the situational prompts for the symptom. Based on parents responses, the clinician should rate each of the situational prompts as not a problem, mild problem, moderate problem, or severe problem according to the definitions listed below. Clinicians should record unable to determine if the situational prompt is not applicable (e.g., child does not have sibling) or if the parent cannot provide adequate information (e.g., behaviors occurring outside the home). The clinician should also determine the answers to all time-related prompts (e.g., for at least 6 months; within the last year) and should circle the appropriate response. Then, using all of the information gained from the situational prompts and time-related questions, the clinician should make a final determination regarding symptom severity and should circle the appropriate number in the Clinician Rating section below each symptom. Clinician ratings for each symptom should reflect the highest situational rating given (e.g., if a clinician rated a symptom as severe at home, moderate at school, and moderate at other places, the overall rating should be severe problem). Definitions: : The symptom is not present or is exhibited to a degree that does not differ from that of other children of similar developmental level. The presence of the symptom does not interfere with the child s or family s ability or desire to participate in typical activities. The child requires no more than routine monitoring in daily activities. Examples: The child fidgets with his hands and feet during church services at a rate that is developmentally appropriate the child occasionally blurts out an answer before her teacher has completed the question but at a rate that is similar to that of most children in the class the child is easily annoyed when he has not had an appropriate amount of sleep but not at other times. : The symptom is present to a greater degree than in other children of similar developmental level. The presence of the symptom interferes with the child s or family s ability or desire to participate in typical activities but not to a degree that causes concern to the child, his or her parents, teachers, other adults, or peers. The child requires some additional monitoring in daily activities. These difficulties in functioning are not sufficient to justify intervention from a professional. Examples: The child has more difficulty sustaining attention during homework time than other children his age but is able to complete the required work with some extra parental monitoring the child is more easily distracted than other members of her softball team but is able to participate fully without causing undue concern to her teammates, coach, or parents. : The symptom is present to a considerably greater degree than in children of similar developmental level. The presence of the symptom interferes with the child s or family s ability or desire to participate in typical activities to a degree that causes concern. The child or family is able to participate in typical activities but only with considerable effort and experiences conflict, embarrassment, or perceived disapproval by others. The child requires frequent monitoring in daily activities. These difficulties in functioning are sufficient to justify some degree of intervention from a professional. Examples: The family rarely goes to restaurants because the child deliberately annoys other diners and embarrasses his parents the child s teacher frequently sends notes to the parents regarding the child s lost homework assignments or behavior at school the child sometimes receives invitations to other children s homes but parents of those children have complained that the child refuses to comply with their house rules. : The symptom is present to a substantially greater degree than in children of similar developmental level. The presence of the symptom interferes with the child s or family s ability or desire to participate in typical activities to a degree that causes substantial concern. The child or family is 1

2 unable or unwilling to participate in typical activities due to the extreme effort that would be required, or the level of conflict, social embarrassment, or perceived disapproval that would likely be experienced. The child requires constant adult supervision to participate in daily activities. These difficulties in functioning are sufficient to justify comprehensive and sustained intervention from a professional. Examples: The child s soccer coach informs the child s parents that their child will no longer be allowed to participate due to the child s repeated temper outbursts the child is no longer invited to classmates birthday parties because he has initiated physical fights at previous activities the family is unwilling to go to dinner at a restaurant because the child deliberately annoys other people to a degree that causes significant embarrassment and perceived disapproval by others the child is removed from her usual classroom because of her disruptive behavior a full-time classroom aide is assigned to the child because he has significant difficulty sustaining attention and cannot complete his work without constant adult supervision. Summary: Level Degree of Symptom Presence Does not differ from children of similar developmental level Greater than children of similar developmental level Considerably greater than children of similar developmental level Substantially greater than children of similar developmental level Level of Concern/Interference with Daily Activities Does not interfere Interferes with daily activities but does not cause concern Interferes with daily activities and causes concern Interferes with daily activities and causes substantial concern Level of Monitoring Required No more than routine monitoring required Additional monitoring required Frequent monitoring required Constant monitoring required Level of Intervention Required pplicable Not sufficient to justify intervention Sufficient to justify some degree of intervention Sufficient to justify comprehensive and sustained intervention To make diagnoses, clinicians also must obtain symptom ratings from teachers, and measures of clinically significant impairment using a measure such as the Impairment Rating Scale completed by parents and teachers. 2

3 ATTENTION DEFICIT HYPERACTIVITY DISORDER Definition: Either (1) or (2): (1) six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: items 3, 6, 7, 12, 13, 15, 16, 17, 18 (2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: items 1, 2, 4, 5, 9, 10, 11, 19, 20 Note: items 8 & 14 were included in the DSM III-R symptom list for ADHD but are not included in DSM IV. 1. Often fidgets with hands or feet or squirms in seat (Hyp-Imp; DBD #12) at home (e.g., meals, homework, playing games) at school other (e.g., in car, restaurants, waiting rooms, Sunday school/ church/temple) 2. Often leaves seat in classroom or in other situations in which remaining seated is expected (Hyp-Imp; DBD #25) at home (e.g., meals, homework, playing games) at school other (e.g., in car, restaurants, waiting rooms, Sunday school/ church/temple) 3. Is often easily distracted by extraneous stimuli (Inatt; DBD #9) at home (e.g., meals, homework, chores, playing alone and with others, getting ready for school and/or bed) at school other (e.g., in car, restaurants, waiting rooms, Sunday school/church/temple) 3

4 4. Often has difficulty awaiting turn (Hyp-Imp; DBD #30) at home (e.g., board games, backyard baseball games) at school (e.g., class discussions, recess, lunch) other (e.g., soccer practice) 5. Often blurts out answers before questions have been completed (Hyp-Imp; DBD item #19) at home at school other (e.g., Sunday school/church/temple) 6. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) (Inatt; DBD #27) at home (e.g., homework, chores, getting ready for school and/or bed, while watching TV) at school other (e.g., while playing with a group of children, organized sports, cub scouts) 7. Often has difficulty sustaining attention in tasks or play activities (Inatt; DBD #29) at home (e.g., homework, getting ready for school and/or bed, chores, playing alone) at school other (e.g., playing with a group of children, team sports, cub scouts) 4

5 8. Often shifts from one uncompleted activity to another (DSM III-R; DBD item #21) at home (e.g., homework, getting ready for school and/or bed, chores, playing alone) at school other (e.g., playing with a group of children, team sports, cub scouts) 9. Often has difficulty playing or engaging in leisure activities quietly (Hyp-Imp; DBD item #22) at home (i.e., when playing quietly is required) at school (i.e., when playing quietly is required) other (e.g., in church/temple/meetings, in public places such as stores, theaters) 10. Often talks excessively (Hyp-Imp; DBD item #7) at home (e.g., to parents, to siblings, to peers) at school e.g., to teachers and school personnel, to peers) other (e.g., in public places such as stores, theaters) 5

6 11. Often interrupts or intrudes on others (e.g., butts into conversations or games) (Hyp-Imp; DBD item #1) at home (e.g., parents, siblings, or peers at school (e.g., teachers, peers) other (e.g., in public places or with other adults or children) 12. Often does not seem to listen when spoken to directly (Inatt; DBD item #18) at home (e.g., when spoken to by parents or siblings) at school (e.g., when spoken to by teachers or peers) other (e.g., when spoken to by coaches, scout leaders, peers in neighborhood) 13. Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) (Inatt; DBD #34) at home (e.g., clothes, toys) at school (e.g., pencils, books) other (e.g., homework or school papers between school and home; sports equipment or jacket around neighborhood) 14. Often engages in physically dangerous activities without considering possible consequences - not for the purpose of thrill-seeking (e.g., runs into street without looking) (DSM III-R; DBD item #10) at home (e.g., when playing alone, when playing with others) at school other (e.g., when playing in the neighborhood) 6

7 15. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities (Inatt; DBD item #23) at home (e.g., homework, chores) at school (e.g., schoolwork, tests) other (e.g., paper route, mowing lawn, other "odd jobs") 16. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) (Inatt; DBD #37) at home (e.g., homework, chores) at school other (e.g., team sports, cub scouts) 17. Often has difficulty organizing tasks and activities (Inatt; DBD #42) at home (e.g., homework, chores, getting ready for school or bed at school other (e.g., team sports, cub scouts, "odd jobs") 18. Is often forgetful in daily activities (Inatt; DBD item #44) at home (e.g., homework, chores, getting ready for school or bed at school other (e.g., when asked to run an errand, forgets what he/she was supposed to do; when playing with others, forgets the rules of the game) 7

8 19. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) (Hyp-Imp; DBD item #35) at home (e.g., during meals or homework time, while watching TV, when visitors are in the home) at school other (e.g., in car, restaurants, waiting rooms, stores, Sunday school/church/temple, at a friend's house) 20. Is often "on the go" or often acts as if "driven by a motor" (Hyp-Imp; DBD item #33) at home at school other (e.g., in the neighborhood, restaurants, waiting rooms, stores, Sunday school/church/temple, at a friend's house) 21. At what age did you first notice any of these problems? Did your child have trouble in kindergarten or first grade because of any of these problems? No Yes 8

9 OPPOSITIONAL DEFIANT DISORDER Definition: A pattern of negativistic, hostile, and defiant behavior lasting at least six months, during which four (or more) of the following are present: Note: Item 9 was included in the DSM III-R symptom list for ODD but is not included in DSM IV. 1. Often loses temper (DBD #28) for no apparent reason following a command from or when things don't go his or her way with parents following a command from or when things don't go his or her way with teachers when things don't go his or her way with peers when things don't go his or her way with siblings when things don't go his or her way with other adults when frustrated with himself or herself 2. Often argues with adults (DBD #3) for no apparent reason following a command from or when things don't go his or her way with parents following a command from or when things don't go his or her way with teachers when things don't go his/her way with peers when things don't go his or her way with siblings when things don't go his/her way with other adults when frustrated with himself or herself 9

10 3. Often actively defies or refuses to comply with adults' requests or rules (DBD item #17) Circle one defies mother (actively / passively) defies father (actively / passively) defies teacher (actively / passively) defies principal (actively / passively) defies unfamiliar adults (actively / passively) 4. Often deliberately annoys people (DBD #39) directed toward the teacher directed toward classmates at school directed toward parents directed toward siblings directed toward peers at home directed toward other adults directed toward peers in the neighborhood 5. Often blames others for his or her mistakes or misbehavior (DBD #15) blames peers blames siblings blames parents blames teachers 10

11 6. Is often touchy or easily annoyed by others (DBD #26) by siblings by peers by parents by teachers by other adults 7. Is often angry and resentful (DBD #24) for no apparent reason following a command from or when things don't go his or her way with parents following a command from or when things don't go his or her way with teachers when things don't go his or her way with peers when things don't go his or her way with siblings when things don't go his or her way with other adults at himself or herself when frustrated 8. Is often spiteful and vindictive (DBD #13) toward siblings toward peers toward parents toward teachers toward other adults 11

12 9. Often swears or uses obscene language (DSM III-R; DBD #14) directed toward peers directed toward siblings directed toward parents directed toward teachers directed toward other adults not directed at anyone/anything; occurring in the presence of adults not directed at anyone/anything; occurring in the presence of peers or siblings 12

13 CONDUCT DISORDER Definition: A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months: 1. Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others) (DBD #4) Estimate frequency per week to avoid blame for punishment for gain to self to boost self-esteem 2. Often initiates physical fights (DBD #5 and #20) directed toward parents directed toward other adults directed toward siblings, is usually unprovoked directed toward peers, is usually unprovoked directed toward siblings, is usually provoked directed toward peers, is usually provoked Clinician Rating toward peers: Clinician Rating toward siblings: 13

14 3. Often bullies, threatens, or intimidates others (DBD #32) Describe typical events: directed toward parents directed toward other adults directed toward siblings, is usually unprovoked directed toward peers, is usually unprovoked directed toward siblings, is usually provoked directed toward peers, is usually provoked Clinician Rating toward peers: Clinician Rating toward siblings: 4. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) (DBD #8) Briefly describe each incident (including number of times): from siblings from peers from parents from other adults 14

15 5. Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) (DBD #2) Briefly describe each incident (including number of times): 6. Has deliberately engaged in fire setting with the intention of causing serious damage (DBD #41) Briefly describe each incident (including number of times): 7. Often truant from school, beginning before age 13 years (DBD #11) Beginning at what age? Number of episodes: Briefly describe each incident: 15

16 8. Has broken into someone else's house, building, or car (DBD #43) Briefly describe each incident (including number of times): 9. Has deliberately destroyed others' property (other than by fire setting) (DBD #16) Briefly describe each incident (including number of times): property of siblings property of peers property of parents property of other adults 16

17 10. Has been physically cruel to animals (DBD #36) Briefly describe each incident (including number of times): to family pets to other animals to insects 11. Has forced someone into sexual activity (DBD #31) Briefly describe each incident (including number of times): 17

18 12. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun) (DBD #45) Briefly describe each incident (including number of times): 13. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) (DBD #40) Briefly describe each incident (including number of times): -- from siblings -- from peers -- from parents -- from other adults 18

19 14. Has been physically cruel to people (DBD #6) Briefly describe each incident (including number of times): parents other adults (describe: ) siblings peers acts of extreme physical cruelty to people (e.g., ties up and abandons victim, systematically cuts or burns a victim) 15. Often stays out at night despite parental prohibitions, beginning before age 13 years Beginning at what age? Number of episodes Briefly describe each incident: 19

20 SCORING INSTRUCTIONS FOR THE DISRUPTIVE BEHAVIOR DISORDER RATING SCALE There are two ways to determine if a child meets the criteria for DSM IV diagnoses of Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, or Conduct Disorder. The first method involves counting symptoms for each disorder using the Disruptive Behavior Disorders (DBD) rating scale. The second method involves comparing the target child's factor scores on the DBD Rating Scale to established norms. The factor scores method is preferable for diagnosis of females (e.g., using a 2 SD cutoff), as the symptom counting method often results in underdiagnosis of female children. Please note that Items 10, 14, and 21 are from DSM-III-R and are not included in the scoring for a DSM-IV diagnosis. Method 1: Counting Symptoms To determine if a child meets the symptom criteria for DSM IV diagnoses of Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, or Conduct Disorder as measured by the DBD Parent / Teacher Rating Scale, count the number of symptoms that are endorsed "pretty much" or "very much" by either parent or teacher in each of the following categories: Note that impairment and other criteria must be evaluated in addition to symptom counts. Attention-Deficit/Hyperactivity Disorder Attention-Deficit/Hyperactivity Disorder - Inattention Symptoms (items 9, 18, 23, 27, 29, 34, 37, 42, 44) 6 or more items must be endorsed as "pretty much" or "very much" to meet criteria for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type. The six items may be endorsed on the teacher DBD, the parent DBD, or can be a combination of items from both rating scales (e.g., 4 symptoms endorsed on the teacher DBD and 2 separate symptoms endorsed on the parent DBD). The same symptom should not be counted twice if it appears on both versions (parent and teacher) of the rating scale. Attention-Deficit/Hyperactivity Disorder - Hyperactivity/impulsivity Symptoms (items 1, 7, 12, 19, 22, 25, 30, 33, 35) 6 or more items must be endorsed as "pretty much" or "very much" on the parent and/or the teacher DBD to meet criteria for Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type If 6 or more items are endorsed for Attention-Deficit/Hyperactivity Disorder - inattention and 6 or more items are endorsed for Attention-Deficit/Hyperactivity Disorder - hyperactivity/impulsivity, then criteria is met for Attention-Deficit/Hyperactivity Disorder, Combined Type Some impairment from the symptoms must be present in two or more settings (e.g., school, home) Oppositional Defiant Disorder Oppositional Defiant Disorder (items 3, 13, 15, 17, 24, 26, 28, 39) A total of 4 or more items must be endorsed as "pretty much" or "very much" on either the parent or the teacher DBD to meet criteria for Oppositional Defiant Disorder Conduct Disorder Conduct Disorder - aggression to people and animals (items 6, 20, 31, 32, 36, 40, 45) Conduct Disorder - destruction of property (items 16, 41) Conduct Disorder - deceitfulness or theft (items 4, 8, 43) Conduct Disorder - serious violation of rules (items 2, 11, 38) A total of 3 or more items in any category or any combination of categories must be endorsed as "pretty much" or "very much" on either the parent or the teacher DBD to meet criteria for Conduct Disorder Method 2: Using Factor Scores Factor scores for the two ADHD and ODD dimensions for teacher ratings on the DBD are reported in Pelham, et al (1992), Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders: Journal of the American Academy of Child and Adolescent Psychiatry, 31, The factor scores for DSM IV factors are the same as for the DSM III-R factors reported in that paper. To determine how a child's scores compare to normative data, compute the average rating for the items from each factor (listed below) using the following scoring: t all = 0, Just a little = 1, Pretty Much = 2, Very much = 3. Then, using the information from the attached table of norms, determine where the child falls in relation to other children. A variety of cutoff scores can be used (e.g., 2 standard deviations above the mean). Factors Oppositional / Defiant (items 3, 13, 15, 17, 24, 26, 28, 39) Inattention (items 9, 18, 23, 27, 29, 34, 37, 42, 44) Impulsivity / Overactivity (items 1, 7, 12, 19, 22, 25, 30, 33, 35)

21 Normative Information from the DBD Rating Scale DSM IV Information: Means and Standard Deviations for Average DBD Scores for Children Rated by Teachers in Regular Classrooms ADHD-Inattention ADHD-Hyp-Imp ODD CD Grade N M (SD) M (SD) M (SD) M (SD) Boys: K (0.79) 0.61 (0.81) 0.32 (0.65) 0.29 (0.54) (0.77) 0.74 (0.79) 0.46 (0.70) 0.35 (0.58) (0.88) 0.67 (0.76) 0.51 (0.73) 0.34 (0.54) Girls: K (0.51) 0.30 (0.56) 0.13 (0.36) 0.10 (0.25) (0.64) 0.34 (0.57) 0.22 (0.57) 0.16 (0.41) (0.74) 0.35 (0.54) 0.26 (0.47) 0.17 (0.34) Percentage of Children Rated by Teachers in Regular Classrooms Reaching DSM-IV Recommended Cutoffs for Diagnosis as a Function of Level of Deviance Required Inattentive Hyp/Imp Combined ODD CD Grade N Pretty Much Very Much Pretty Much Very Much Pretty Much Very Much Pretty Much Very Much Pretty Much Very Much Boys: K Girls: K Note. The number of symptoms required were 6 of either Inattentive or Hyperactive/Impulsive for ADHD, 4 for ODD, and 3 for CD. DSM-III-R Information: Means and Standard Deviations for Average ADHD, ODD, and CD Scores for Boys Rated by Teachers in Regular Classrooms Age N ADHD ODD CD M (SD) M (SD) M (SD) (0.82) 0.46 (0.59) 0.23 (0.44) (0.76) 0.50 (0.70) 0.19 (0.36) (0.82) 0.71 (0.80) 0.27 (0.45) (0.88) 0.78 (0.89) 0.34 (0.58) Proportion of Boys Rated by Teachers in Regular Classrooms Reaching DSM-III R Recommended Cutoffs for Diagnosis as a Function of Level of Deviance Required Age N ADHD ODD CD Pretty Much Very Much Pretty Much Very Much Pretty Much Very Much Note. The number of symptoms required were 8 for ADHD, 5 for ODD, and 3 for CD. Pelham, WE, Gnagy, EM, Greenslade, KE, & Milich, R. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 31, For parent norms, see DuPaul, GJ; Anastopoulos, AD; Power, TJ; Reid, R; Ikeda, MJ; McGoey, KE. (1998). Parent ratings of attention-deficit/hyperactivity disorder symptoms: Factor structure and normative data. Journal of Psychopathology & Behavioral Assessment, 20,

22 Narrative Description of Child -- Teacher Child's Name: Teacher's Name: Date Completed: Instructions: In the space below, please describe what you see as this child's primary problems. Also, please describe how this child's problems have affected the following areas and complete the rating at the end of each: (1) his or her relationship with other children, (2) your relationship with him or her, (3) his or her academic progress, (4) your classroom in general, and (5) his or her self-esteem. Continue on a separate sheet if necessary. For the ratings, please mark an "X" on the lines at the points that you believe reflect the impact of the child's problems on this area and whether he or she needs treatment or special services for the problems. PLEASE COMPLETE BOTH SIDES OF THIS FORM. (1) How this child's problems affect his or her relationship with other children No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services Regardless of whether this child is popular or unpopular with peers, does he or she have a special, close "best friend" that he or she has kept for more than a few months? (Please circle) YES NO (2) How this child's problems affect his or her relationship with the teacher No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services Please complete reverse page

23 (3) How this child's problems affect his or her academic progress No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services (4) How this child's problems affect your classroom in general No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services (5) How this child's problems affect his or her self-esteem No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services Please mark an "X" on the following line at the point that you believe reflects the overall severity of this child's problem in functioning and overall need for treatment. No Definitely does not need treatment or special services Teacher ImpRatingScale.v2 Extreme Definitely needs treatment or special services CTADD

24 Narrative Description of Child -- Parent Child's name: Form completed by: Date completed: Instructions: In the space below, please describe what you see as your child's primary problems, both at home and at school. Also, please describe how your child's problems have affected the following areas and complete the rating at the end of each: (1) his or her relationships with playmates and brothers or sisters, (2) his or her relationship with you (and your spouse if present), (3) his or her academic progress at school, (4) his or her self-esteem, and (5) your family in general. Continue on a separate sheet if necessary For the ratings, please mark an "X" on the lines at the points that you believe reflect the impact of the child's problems on this area and whether he or she needs treatment or special services for the problems. PLEASE COMPLETE BOTH SIDES OF THIS FORM. (1) How your child's problems affect his or her relationship with playmates No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services Regardless of whether this child is popular or unpopular with peers, does he or she have a special, close "best friend" that he or she has kept for more than a few months? (Please circle) YES NO How your child's problems affect his or her relationship with brothers or sisters (If has no brothers or sisters, check here and skip to #2 ) No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services (2) How your child's problems affect his or her relationship with you (and your spouse if present) No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services

25 (3) How your child's problems affect his or her academic progress at school No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services (4) How your child's problems affect his or her self-esteem No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services (5) How your child's problems affect your family in general No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services Please mark an "X" on the following line at the point that you believe reflects the overall severity of this child's problem in functioning and overall need for treatment. No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services Parent ImpRatingv.2 CTADD

26 Scoring the Narrative Descriptions Teacher/Parent (Impairment Rating Scale) An important construct in the DSM-IV guidelines for diagnosis of childhood disorders is degree of impairment. The Narrative Description (Teacher/Parent) is a scale that we have been using for some time to measure impairment. The scales ask teachers and parents to rate the degree to which a child's problems impact his or her functioning in several key domains and the degree to which the rater believes that the child needs treatment or special services. The scale also provides spaces for parents and teachers to describe children's problems in several key domains of functioning. Our experience has been that parents, teachers, and clinicians react positively to this scale because it supplements standardized rating scales. Parents and teachers like the open-ended aspect because it is not constrained by the yes/no aspect of rating scales, and clinicians find the open-ended narratives very informative. Raters mark an X at a point on a line such as the following: No Definitely does not need treatment or special services Extreme Definitely needs treatment or special services To score the narrative, divide the line into seven equal portions and assign the numbers 0 through 6 to those portions (0 = No, 6 = Extreme ). The number that corresponds to the portion of the line in which the teacher marked an X is the number that is used to score the item. Normative data on the Impairment Rating Scale have been collected from a nondeviant elementary-aged population. In general, a mark from the midpoint to the extreme range (i.e., a score of 3 or above) defines a high proportion of children with behavior problems and indicates impairment as defined with a variety of rating scales and objective measures. Data from a clinic sample indicate that scores in the above range distinguish children referred for treatment from the nondeviant sample. Fabiano, G.A., Pelham, W.E., Gnagy, E.M., Waschbusch, D., Lahey, B.B., Chronis, A.M., & Kipp, H. The Children s Impairment Rating Scale (CIRS): Psychometric properties of an impairment rating scale for children with ADHD. Manuscript under review.

27 Means, Standard Deviations and Frequencies for Boys on the Impairment Rating Scale. 1. His or her relationship with other children: 4. How this child's problems affect your classroom in general: Grade N Mean SD 0 No Extreme Grade N Mean SD 0 Creates No Extreme K K G G G G G G G G G G All Grades All Grades His or her relationship with the teacher: 5. His or her self-esteem: Grade N Mean SD 0 No Extreme Grade N Mean SD 0 No Extreme K K G G G G G G G G G G All Grades All Grades His or her academic progress: Overall severity of this child's problem and overall need for treatment: Grade N Mean SD 0 No Extreme Grade N Mean SD 0 No Extreme K K G G G G G G G G G G All Grades All Grades Notes: N = 933 boys. Frequencies are presented as percentages of boys receiving each rating.

28 Means, Standard Deviations and Frequencies for Girls on the Impairment Rating Scale. 1. His or her relationship with other children: 4. How this child's problems affect your classroom in general: Grade N Mean SD 0 No Extreme Grade N Mean SD 0 No Extreme K K G G G G G G G G G G Average Average His or her relationship with the teacher: 5. His or her self-esteem: Grade N Mean SD 0 No Extreme Grade N Mean SD 0 No Extreme K K G G G G G G G G G G Average Average His or her academic progress: Overall severity of this child's problem and overall need for treatment: Grade N Mean SD 0 No Extreme Grade N Mean SD 0 No Extreme K K G G G G G G G G G G Average Average Note: N = 1002 girls. Frequencies are presented as percentages of girls receiving each rating.