Behavior Assessment System for Children (BASC)

1. Behavior Assessment System for Children (BASC) R. W. Kamphaus, Ph.D. The University of Georgia

2. Acknowledgements • Cecil R. Reynolds, BASC senior author • Mark Daniel and Rob Altmann of AGS • Co-researchers Andy Horne, Carl Huberty, and Michele Lease of UGA, Jean Baker of Michigan State, Christine DiStefano of Louisiana State University, Linda Mayes of Yale Child Study Center, David Pineda of Universidad de Antioquia • Student research team members Anne Winsor, Ellen Rowe, Jennifer Thorpe, Cheryl Hendry, Amanda Dix, Erin Dowdy, Anna Kroncke, Sangwon Kim, Robert Brown, Tracey Troutman. • Alumni research team members Drs. Nancy Lett, Shayne Abelkop, Martha Petoskey and Ann Heather Cody • Research is supported in part by grant number R306F60158 from the At-Risk Institute of the Office of Educational Research and Improvement of the United States Department of Education, to R. W. Kamphaus, J. A. Baker, & A. M. Horne.

3. Multimethod • Structured Developmental History (SDH) • Student Observation System (SOS) • Teacher Rating Scales (TRS) • Parent Rating Scales (PRS) • Self-Report of Personality

4. Objectives • Learn five assessment uses unique to history taking • Use the SOS to take a 15 minute classroom observation • Write and describe clinically significant findings for the PRS, TRS, and SRP • Explain the impact of child culture and sex on TRS and PRS results • Describe a TRS-based 7 cluster classification system of child behavioral adjustment status and its use for screening and classifying risk for school problems • Describe research findings regarding the use of the BASC as a program evaluation too. • Summarize research findings regarding the use of the BASC to classify cases of ADHD.

5. History Taking SDH • Identifying age of symptom onset (e.g. ADHD) • Developmental course (e.g. LD) • Assessment of etiology (e.g. Thyroid condition) • Treatment or intervention design (e.g. Prozac related relapse or Cheryl’s head banging) • Assessment of risk and resilience factors (e.g. family resemblance, peers, recreation) • Documentation of educational or other impairment (e.g. grades, productivity, test scores, relations with parents, school attendance)

6. Student Observation System (SOS) • Both adaptive and maladaptive behaviors are observed • Multiple methods are used including clinician rating, time sampling, and qualitative recording of classroom functional contingencies • A generous time interval is allocated for recording the results of each time sampling interval (27 seconds) • Operational definitions of behaviors and time sampling categories are included in the BASC manual • Inter-rater reliabilities for the time sampling portion are high which lends confidence that independent observers are likely to observe the same trends in child’s classroom behavior (see Lett & Kamphaus, 1997).

7. SOS • Part A - Treatment/IEP Planning; frequency, range, and disruptiveness of classroom behavior • Part B - Treatment/Program evaluation of effectiveness (track change with ADHD Monitor software) • Part C - Functional analysis of antecedents, behavior, and consequences (e.g. teacher position)

8. Adaptive Scales Response to teacher Work on school subjects Peer interaction Transition movement Behavior Problem Scales Inappropriate movement Inattention Inappropriate vocalization Somatization Repetitive motor movements Aggression Self-injurious behavior Inappropriate sexual behavior Bowel/bladder problems SOS Scales

9. Using Part B • There is typically no need to select target behaviors to observe • schedule the observation period at a time of day and, in a class, where problems are known to be of teacher or parent concern so that target behaviors can be observed. In addition, the examiner may want to also observe in a class where problems are not present • Use an observer who is already familiar to the school, or introducing himself or herself to the teacher ahead of time • Develop a timing mechanism (PDA software available April, 2003)

10. Cecilia - Age 8, Optimal Response to Ritalin

11. SOS Functional Assessment • Frequency - Part A ratings of NO, SO, or FO. Part B frequencies. • Duration - Part B ratings of percentage of time engaged in behavior. • Intensity - Part A ratings of disruptive and Part B ratings of relative frequency. • Antecedent Events - Part C teacher position and behavior. • Consequences - Part C teacher change techniques. • Ecological Analysis of Settings - Observations at various times of school day. PRS ratings. • Use three classroom observations to establish trajectory of behavior

12. TRS Details Discourage having two or more teachers complete the same form collaboratively • Norms extend to age 2 years 6 months • General, gender, and clinical norms available for TRS, PRS, SRP • When needed help teachers define a “never” response as a behavior that they have not seen or experienced • Advise teachers to rate most recent behavior • When a current teacher is not available a teacher from the past academic year may provide a good estimate (see next slide)

13. TRS Reliability and Validity • Traits that are considered stable are rated consistently by teachers over a 2 to 8 week interval (Reynolds & Kamphaus, 1992). A study of three clinical samples produced median test-retest values of .89, .91, and .82 for preschool, child, and adolescent levels. • Different teachers rate the same child similarly (Reynolds & Kamphaus, 1992). A sample of 30 children was rated by two teachers each within a few days of one another. Interrater coefficients were variable ranging from a low of .53 for social skills to .94 for learning problems. Most clinical scales had adequate reliabilities such as aggression .71, anxiety .82, attention problems .68, and learning problems. 94. • Teacher internal consistency coefficients are higher than those for either parents or adolescent self-reports (Reynolds & Kamphaus, 1992).

14. Behavior is stable as rated by different teachers: TRS-C Means, 1996-2000

15. TRS Reliability and Validity • Teacher ratings are better able to diagnose the subtypes of ADHD than classroom observations by independent observers (Lett & Kamphaus, 1997). The TRS was significantly better than the SOS at differentiating non-disabled, ADHD combined type, and ADHD combined type plus conduct problem groups with about a 70% accuracy rate. • Teacher ratings are significantly associated with adjustment to school (Baker, Kamphaus, & Horne, Project ACT Early) • Teacher ratings are predictive of adjustment six years later (Verhulst et al., 1994)

16. Well Adapted (Type 1) Average (Type 2) Disrupt Behavio Probs (Type 3) Academic Probs (Type 4) Physical Complaints and Worry (Type 5) Gen Probs Severe (Type 6) Mildly Disruptive (Type 7) Percent Cited for Physical Aggress 1 8 43 15 2 43 14 Discipline Reports for Physical Aggression by Type for ACT Early Year 3 Reported in Proportions of Sample

17. Hyperactivity (impulsivity) Aggression (verbal or physical) Conduct Problems (delinquency; 6-18 only) Anxiety (worry, nervousness) Depression (sad, unhapppy) Somatization (physical complaints) Attention Problems Learning Problems (academic problems; 6-18 only) Atypicality (hyperactivity, odd behaviors, psychoticism) Withdrawal (avoidance of social interactions) Adaptability (4-11) (adjusts easily to change) Leadership (especially interpersonal skills) Social Skills Study Skills (6-18) Patterning Consistency Fake Bad (F) TRS

18. Schwean, Burt, & Saklofske (1999) Items on the Atypicality scale of the BASC are relevant to several different interpretations…, with many describing behaviors that parallel those seen in a hyperactive-impulsive disorder (e.g., daydreams, complains about being unable to block out unwanted thoughts, stares blankly, babbles to self, sings or hums to self, rocks back and forth). Several examples will help illustrate this point. Although we typically think of inattentive children as “daydreamy”. Research has noted that one of the most common observations made by elementary school teachers about hyperactive children is that they appear to be daydreaming (Goldstein & Goldstein, 1992). Hyperactive-impulsive children are also often known to talk excessively and to hum or make odd noises (American Psychiatric Association, 1994; Barkely, 1990). Moreover, irrelevant and purposeless gross bodily movements (i.e., hyperactivity) can easily be confused with more stereotypic motor behaviors. (p. 59)

19. George - ADHD Combined TypeComorbid with MR

20. Under-diagnosis of ADHD in Children with MR • Pearson and Annan (1994) concluded,“Findings suggest that chronological age should be taken into consideration when behavior ratings are used to assess cognitively delayed children for ADHD. However, the results do not support guidelines stating that mental age must be used to determine which norms should be applied when such children are evaluated clinically.” (p. 395) • The use of mental age as a consideration in making the ADHD diagnosis for children with mental retardation may result in the denial of somatic and behavioral treatments that are known to have demonstrated efficacy (Reynolds & Kamphaus, 2002).

21. PRS Details • Audiotape administration • Spanish edition available • Norms to age 2 years 6 months • Fifth grade reading level • Mothers and fathers produce similar average raw scores • Parent feedback form available for PRS, TRS, and SRP results

22. Parent/Caregiver Ratings • Primary caregiver and/or person who knows the child’s problems best will indicate more problems • Parent ratings are also predictive of behavior problems six years later (Verhulst et al., 1994) • Parent ratings of behavior are predicted by early temperament (Nelson et al., 1999)

23. Hyperactivity Aggression Conduct Problems (6-18) Anxiety Depression Somatization Attention Problems Atypicality Withdrawal Adaptability (4-11) Leadership Social Skills Patterning Consistency Fake Bad (F) PRS

24. Lynn - ADHD Ritalin therapy at school, Mother is primary caregiver

25. SRP Details • Validity Scales include: Patterning, Consistency, Lie (L) (12-18), Fake Bad (F), Validity (V) • Third grade reading level • Spanish version available • Children and adolescents may know themselves better that parents or teachers (see next slide)

26. SRP-C Type 9, Internalizing yoked ratings (7.4% of 6-11 year olds, 47% f/53%m)

27. Depression Somatization Anxiety Atypicality Sense of Inadequacy (feels unsuccessful in school) Social Stress (tension around peers) Locus of Control (rewarded or punished by others) Sensation Seeking (12-18) (risk taking) Attitude Toward Teachers Attitude Toward School Relations with Parents Interpersonal Relations (friendships) Self-Esteem Self-Reliance (dependability) SRP - Clinical and Adaptive Scales

28. Maryann - Depression, Conduct Disorder, Cognitive Deficit • At age 17 she has history of suicide attempts, runaway behavior, STD’s, dental decay, academic failure, family dissolution, problems in foster care. She currently admits to suicidal ideation.

29. Jonathan - Depression, Polysubstance Dependence • A high school senior, he is hospitalized for a suicidal attempt. He was previously treated for addiction to alcohol at age 14. Now, at age 17, he abuses alcohol, marijuana, heroin, and other drugs.

30. SRP Facts • Child ratings are virtually uncorrelated with adult ratings • Teachers are unaware of many child problems especially those of an internalizing nature (Kamphaus & Frick, 2002) • Children with cognitive delay may be less able to respond untruthfully • Adolescents in juvenile detention are known to report high rates of psychopathology (Stowers-Wright, 2000)

31. Ratings Interpretation (Kamphaus & Frick, 2002) • All raters possess some evidence of predictive validity • Simple Scheme - All indicators of problems weighted equally (e.g. teacher and child ratings of depression weighted equally)

32. Ratings Interpretation • Identify all scales with T scores in the at-risk range (T=>60) • Confirm or disconfirm the importance of each with available evidence • Collect additional evidence as needed • Draw conclusions regarding classification, diagnosis, and intervention

33. Ratings Interpretation • 70+ Functional impairment in multiple settings, Often diagnosable condition • 60-69 Functional impairment in one or more settings, sometimes diagnosable condition • 45-59 No functional impairment or condition • <45 Notable lack of symptomatology

34. Score Range Interpretation 70+ Often acts in a hostile manner (both verbal or physical) that is threatening to others. Significant functional impairment is noted in home and school settings, and with peers. 60-69 Acts in a hostile manner (either verbal or physical or both) that is threatening to others. Functional impairment may be present in home and/or school settings, and with peers. 45-59 Displays of either verbal or physical aggression are infrequent and age appropriate. No functional impairment is present. <45 Displays of either verbal or physical aggression are extremely rare. No functional impairment is present. Aggression Scale Interpretation (Reynolds & Kamphaus, 2002)

35. BASC + IDEA • Impaired relations = Withdrawal, Atypicality, Social Stress, Interpersonal Relations, Social Skills, Relations with Parents • Inability to learn = Learning Problems • Inappropriate behavior = Atypicality, Withdrawal • Unhappiness/depression = Depression, Sense of Inadequacy • Physical symptoms/complaints = Somatization

36. Karen - Substance abuse, conduct disorder, bipolar • 14 year old female 9th grader with normal development until 1996 • Academics declined, began spending large amount of time with peers and smoking marijuana and drinking alcohol • Hx of day and residential treatment, truancy, drug paraphernalia at school • Avg IQ and achievement

37. Karen Maternal Ratings

38. Att to School 71 Att to Teach 55 Sensation 60 Atypicality 41 Locus of C 50 Somatization 39 Social Stress 38 Anxiety 47 Depression 49 Sense of In 45 Relations Par 30 Interpersonal 57 Self-Esteem 58 Self-Reliance 46 Critical - I just don’t care anymore Karen SRP

39. Stefan - Emotional Distrubance • 10 year old fifth grade child with history of poor organization, work incompletion, resistance to teacher direction, anger outbursts, low frustration tolerance • Intelligence and achievement are average except for below average scores in written expression including spelling • Chaotic family background with loss

40. Att to School 64 Att to Teach 84 Atypicality 48 Locus of C 68 Social Stress 60 Anxiety 55 Depression 68 Sense of In 78 Relations Par 10 Interpersonal 31 Self-Esteem 34 Self-Reliance 36 Critical - Sometimes I want to hurt myself Stefan SRP

41. Stefan Teacher Ratings

42. Stefan Parent Ratings

43. Effects of Culture and Sex • Cross-cultural studies have shown small mean differences between at least 13 cultural groups for the CBCL (Crijnen et al., 1997) and 4 for the BASC (Kamphaus et al., 2000) • Sex differences, in direct contrast, are large and in the same direction in all countries studied (Crijnen et al., 1997; Kamphaus et al., 2000)

44. Effects of Culture

45. Effects of Child Sex

46. Cross-Cultural Assessment Strategies • Collect test scores and ratings from parents and recent teacher from country of origin or previous U.S. school • Use three classroom observations two weeks apart to establish trajectory of behavior • Defer special education classification until child has been in school system long enough to develop linguistic competencies and friendships • Seek second opinion from psychologist with cultural knowledge to reduce tendencies toward under or over-diagnosis (Kamphaus & Frick, 2002) • Use history taking to clarify standardized test and rating scale results

47. BASC and Treatment/Outcome Evaluation (SRP/TRS/PRS) • Significant effects were shown for a therapeutic adventure program with the SRP-A (Faubel, 1998) • Effects have been shown for child cancer (Challinor, 1999; Shelby, 1999), and rheumatoid arthritis (Wutzke, 1999; Youseff, 1999)

48. BASC and Risk Assessment • A person-oriented approach may be used to identify children at risk for behavioral problems (Project ACT Early; Baker, Horne, & Kamphaus, 1996-present; Petoskey, 2000) • Typologies of behavioral adjustment are associated with important child outcomes (Baker, Kamphaus, & Horne, in press) • Types of adjustment replicate in numerous samples for differing SES and cultural groups (Pineda, et al., 199; Kamphaus et al., 2000; Kamphaus & DiStefano, in press) • Most children with significant behavior problems are not served by special education or other service delivery system (Kamphaus et al., 1997)

49. Person-Oriented Methodology • “The concepts of average child and average environment have no utility whatever for the investigation of dynamics ...An inference from the average to the particular case is …impossible” (Lewin, 1931, p. 95; cited in Richters, 1997) • Child behavior problems are dimensionally distributed in the population and much variability is associated with subsyndromal behavior problems that nevertheless produce functional impairment (Hudziak, et al., 1999; Scahill, et al., 1999; Cantwell, 1996) • “…teachers cope with a high degree of variability in their classrooms… By capturing this variability it may be possible to design interventions that ameliorate the risk of failure for some groups of children” (Speece & Cooper, 1990, p. 119)

50. TRS-C Type 1 Well-Adapted (34%) Note. 61% Female