Behavior Assessment System for Children, Second Edition (BASC-2) Cecil R. Reynolds, Ph.D. Distinguished Research Scientist and Professor Texas A & M University R.W. Kamphaus, Ph.D. Distinguished Research Professor and Department Head University of Georgia
Acknowledgements and Disclosure • Cecil R. Reynolds, BASC 2 senior author, Rob Altmann and Mark Daniel 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, Patrick Schniederjan of Grand Junction CO,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, Chris Stokes, Meghan VanDeventer • Alumni research team members Drs. Nancy Lett, Shayne Abelkop, Martha Petoskey and Ann Heather Cody • Some BASC Research was 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. • R. Kamphaus is co-author of the BASC 2 with a significant financial interest in the product
Categorical Diagnosis • Presence of marker symptoms or deviant signs defines the syndrome (e.g. schizotypal affect) as espoused originally by Kreapelin • Syndromes are mutually exclusive (e.g. mental retardation, autism, versus pervasive developmental disorder) but potentially comorbid (e.g. ADHD and Tourettes) • Diagnosis is dichotomous; that is one either has the disorder or not and subsyndromal psychopathology is not considered(Cantwell, D. P. (1996). Classification of child and adolescent psychopathology. Journal of Child Psychology and Psychiatry, 37, 3-12.) • Severity of symptoms in categorical systems is not measured. In other words criteria do not exist to define “severe” ADHD. • Differential diagnosis of syndromes (e.g. ADHD, CD, and ODD) remains controversial
Dimensional Diagnosis • Measures “latent traits” or “latent constructs” made up of multiple indicators (i.e. items) or behaviors (Kamphaus, 2001; Kamphaus & Frick, 2002) • Traits are distributed dimensionally in the population thus making it possible to assess “severity” or amount of the latent trait possessed. Positive or adaptive traits are of relatively greater interest • Norm referencing to a population is used to define deviance. “Subsyndromal” as well as “hypersyndromal” cases can be identified for both clinical and research purposes (Scahill et al., 1999) • Measures are well suited for assessing response to treatment or intervention because of known reliability and validity (e.g. effectiveness of medications)
Phenomenology of TRS-C Type 3 Disruptive Behavior Problems (8%) (Kamphaus, R. W., Huberty, C. J., Distefano, C., & Petoskey, M. D. (1997). A typology of teacher rated child behavior for a national U. S. sample. Journal of Abnormal Child Psychology, 25, 253-263.)
Multi-Dimensional-Multi-Method • SDH: Structured Developmental History (Some changes) • SOS: Student Observation System (No Changes, BASC POP) • TRS: Teacher Rating Scales (Some changes) • PRS: Parent Rating Scales (Some changes) • SRP: Self-Report of Personality (Some changes) • SRP-Col: Self-Report of Personality College (New) • SRP-I: Self-Report of Personality Interview (New; ages 6-7, Available in 2005) • CPRF: Child-Parent Relationship Form (New)
Additional Components • Spanish-Language SRP, SDH, and PRS forms • BASC Spanish version for Spain and Latin America now available • Spanish and English language administration CDs • Parent Feedback Forms • BASC Portable Observation Program • www.psychologicalforum.com
Changes - The Bottom Line • BASC/BASC-2 correlations are in the 80s and 90s for the TRS • BASC/BASC-2 correlations are in the 70s and 80s for the PRS • BASC/BASC-2 correlations are in the 60s and 70s for the SRP
Activities of Daily Living (PRS only) Adaptability (new to A) Aggression Anxiety Attention Problems Atypicality Conduct Problems (C, A) Depression Functional Communication Hyperactivity Leadership (C, A) Learning Problems (TRS–C, A) Social Skills Somatization Study Skills (TRS–C, A) Withdrawal BASC–2 TRS and PRS Scales
BASC–2 TRS and PRS Scales • Activities of Daily Living (PRS only) (MR PRS = 34-36; Motor PRS 36-38) • Acts in a safe manner. • Needs to be reminded to brush teeth. • Organizes chores or other tasks well. • Adaptability (new to A) (Bipolar TRS = 36, PRS = 30-36) • Adjusts well to changes in family plans. • Recovers quickly after a setback. • Aggression • Hits other children. • Seeks revenge on others.(recognition of concept of relational aggression)
BASC–2 TRS and PRS Scales • Anxiety (Somatization still key symptom of anxiety in childhood) • Is nervous. • Worries about making mistakes. • Attention Problems (sub-clinical problems may cause impairment;Scahill, L., Schwab-Stone, M., Merikangas, K. R., Leckman, J. F., Zhang, H., & Kasl, S. (1999). Psychosocial and clinical correlates of ADHD in a community sample of school-age children. J. Am. Acad. Child Adolesc. Psychiatry, 38, 976-984.) (ADHD TRS = 60-61, PRS = 64) • Listens to directions. • Pays attention. • Atypicality (preschool imaginary friends persist into early elementary school with 27% in preschool and 31% at ages 6 and 7, Taylor, M. (2004) Developmental Psychology, 40) (ASD TRS = 66-71, PRS = 75-76) • Sees things that are not there. • Acts strangely.
BASC–2 TRS and PRS Scales • Conduct Problems • Lies to get out of trouble. • Deceives others. • Depression (clinical sample PRS = 76-80, TRS = 65) • Is sad. • Seems lonely. • Functional Communication (MR TRS = 32-39, PRS = 29-31; Speech-Lang 41-38; Motor PRS 36-38; Hearing PRS 42-46) • Is unclear when presenting ideas. • Responds appropriately when asked a question. • Is able to describe feelings accurately.
BASC–2 TRS and PRS Scales • Hyperactivity (ADHD TRS = 61, PRS = 64-66; evidence of cross-cultural validity in Pineda, D.A., Aguirre, D.C., Garcia, M.A., Lopera, F.J., Palacio, L.G., & Kamphaus, R.W. (in press). Validation of Two Rating Scales for ADHD Diagnosis in Colombian Children. Pediatric Neurology.) • Cannot wait to take turn. • Acts out of control. • Leadership (C, A) (group collaboration assessed) • Gives good suggestions for solving problems. • Is good at getting people to work together. • Learning Problems (TRS–C, A) (LD TRS = 61-62) • Had reading problems. • Has trouble keeping up in class.
BASC–2 TRS and PRS Scales • Social Skills • Compliments others. • Offers help to other children. • Somatization • Has stomach problems. • Complains of being sick when nothing is wrong. • Study Skills (TRS–C, A) • Reads assigned chapters. • Tries to do well in school. • Withdrawal (ASD PRS = 72-73, TRS = 66-71) • Avoids other children. • Quickly joins group activities.
BASC–2 TRS and PRS Composite Scales • Externalizing Problems • Hyperactivity • Aggression • Conduct Problems (C/A only) • Internalizing Problems • Anxiety • Depression • Somatization
BASC–2 TRS and PRS Composite Scales • Adaptive Skills • Adaptability • Social Skills • Functional Communication • Leadership (C and A only) • Study Skills (TRS-C/A only) • Activities of Daily Living (PRS only) • School Problems (TRS–C, A) • Attention Problems • Learning Problems
BASC–2 TRS and PRS Composite Scales • Behavioral Symptoms Index (BSI) • Hyperactivity • Aggression • Depression • Attention Problems • Atypicality • Withdrawal
BASC–2 TRS and PRS Validity Indexes • F Index • Consistency Index • Number of Omitted/Unscoreable Items • Patterned Responses
BASC-2 Software • ASSIST • Unlimited use • Basic scoring and reporting • Fast, efficient item entry with optional verification • Multi-rater report comparisons • Windows 98 SE +and MAC OSX compatible • Scannable version available for Windows • Network compatible
BASC-2 Software • ASSIST Plus • Unlimited use • Advanced scoring and reporting • DSM-IV diagnostic criteria • Content scales • Extended narrative • Multi-rater report comparisons • Fast, efficient item entry with optional verification • Windows 98 SE + and MAC OSX compatible • Scannable version available for Windows • Network compatible
Terry – Mild mental retardation, ADHD combined type, clinical depression • 10 year old third grader diagnosed with MR in grade 1 • Full Scale IQ = 66, Vineland Adaptive Behavior Composite = 61 • Diagnosed as ADHD in first grade as well • Ritalin has not worked as well for the past two months as she has become more emotional • Her mother reports “I think she needs more nerve medicine”
Terry’s depression and school stress • Recent trouble getting to sleep and staying asleep • Recent crying spell at school in the lunch room • Refusing to go to school and is bullied by others • She reports, “Most of them pick on me and laugh about it.” When asked why teased she said, ”I’m too slow, and I can’t do my work.” • She said that the same boy pushes her onto the same girl’s desk every day. The girl gets angry at her and Terry feels bad the remainder of the day. • Terry says that the teasing makes her so angry that she cries • Her mother cannot manage her at home. She is disobedient and refused to help around the house. Her mother is very stressed and says, “I can’t take it any more.”
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).
BASC–2 SRP Changes • Mixed item format (T/F and MC) • Age range expansion • College-form edition • Interview format for ages 6–7 (available 2005) • New scales
Alcohol Abuse (COL) Anxiety Attention Problems (ADHD SRP-C = 58, SRP-A = 57) (Bipolar SRP-A = 61) Attitude to School (C, A) Attitude to Teachers (C, A) Atypicality Depression (Depression SRP-A = 55) Hyperactivity (ADHD SRP-C = 57, SRP-A = 56) (Bipolar SRP-A = 59) Interpersonal Relations (ASD SRP-C = 45, SRP-A = 41) (Bipolar SRP=-A = 44) Locus of Control Relations with Parents (Bipolar SRP-A = 43) School Maladjustment (COL) Self-Esteem (Depression SRP-A = 43) Self-Reliance (Bipolar SRP-A = 43) Sensation Seeking (A) Sense of Inadequacy Social Stress (ASD SRP-C = 55, SRP-A = 57) Somatization (A) (Depression SRP-A = 56) BASC–2 SRP Scales
BASC–2 SRP Composite Scales • School Problems (Formerly School Maladjustment; C, A) • Attitude to School (C, A) • Attitude to Teachers (C, A) • Sensation Seeking (A)
BASC–2 SRP Composite Scales • Internalizing Problems (Formerly Clinical Maladjustment; cluster found in US population by Kamphaus, DiStefano, & Lease, 2003, A Self-Report Typology of Behavioral Adjustment for Young Children. Psychological Assessment, 15, 17-28) • Atypicality • Locus of Control • Social Stress • Anxiety • Depression • Sense of Inadequacy • Somatization (A, COL)
BASC–2 SRP Composite Scales • Inattention/Hyperactivity Composite • Attention Problems • Hyperactivity • Personal Adjustment • Relations with Parents • Interpersonal Relations • Self-Esteem • Self-Reliance
BASC–2 SRP Composite Scales • Emotional Symptoms Index (ESI) • Social Stress • Anxiety • Depression • Sense of Inadequacy • Self-Esteem • Self-Reliance (replaces Interpersonal Relations)
BASC–2 SRP Validity Indexes • F Index • L Index (new to C level) • V Index • Consistency Index (new) • Number of Omitted/Unscoreable Items • Patterned Responding
Maleco – False Positive • Third grade boy referred for suspected ADHD with an abrupt onset of symptoms of inattention, hyperactivity and conduct problems at the beginning of second grade. He has been cited for hitting others, setting another child’s hair ablaze, running away from school, teacher defiance, cursing, and anger outbursts. He is about to be suspended from school unless his behavior improves significantly. His teachers hope that medication will improve his behavior.
Maleco - History • He is an only child who moved across country to a new school at the beginning of second grade. Up until this time he was raised by his maternal grandparents. His development was normal until the beginning of second grade and he is considered to be an intelligent child by all. He was described by his first grade teacher as exceedingly well behaved, high achieving, obedient, and curious. He has been acting out at home with anger outbursts, crying spells, setting a garage on fire, and tearing up shrubs in his mother’s yard. His mother does not think that he has any serious problems such as ADHD and is concerned about placing him on stimulant medication. He is currently receiving play therapy to help him control his behavior andemotions better.
Maleco – Cognitive Results • Composite intelligence test score of 118 • Academic achievement test scores ranging from a low of 116 in mathematics computation to a high of 128 in reading comprehension • Grades have been all As and Bs but are beginning to suffer due to refusal to complete work at school
Maleco – Self Report • Scale T-Score • Anxiety 66 • Depression 75 • Sense of Inadequacy 78 • Social Stress 73 • Atypicality 71 • Locus of Control 59 • Attitude to School 68 • Attitude to Teachers 75 • Relations with Parents 51 • Interpersonal Relations 35 • Self-Esteem 46 • Self-Reliance 36
Maleco – Critical Items • Life is getting worse and worse • Sometimes voice tell me to do bad things • No one understands me • I cannot stop myself from doing bad things • I cannot control my thoughts • Nobody ever listens to me • Other kids hate to be with me • I am always in trouble at home • Sometimes I want to hurt myself • I give up easily • Nothing goes my way
Assessment forDiagnosis and Classification (Kamphaus, R. W., & Frick, P. J. (2002). Clinical Assessment of Child and Adolescent Personality and Behavior. Needham Heights, MA: Allyn & Bacon.) • Assess core constructs/symptoms (DSM IV) and severity (rating scales) • Assess age of onset (history), developmental course (history), and multiple contexts (history, observations, and rating scales) • Rule out alternative causes (history and rating scales) • Rule in comorbidities (history, DSM IV, IDEA, and rating scales)
History SDH • Age and rapidity of symptom onset (e.g. ADHD, Pandas - pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection caused OCD; ocfoundation.org; differentiates ADHD from low birth weight, Johnson-Cramer, N.L., 1999. Assessment of school-aged children with comorbidity of attention deficit disorder and low birth weight classifications, Dissertation Abstracts Internationl, Section A: Humanities and Social Sciences, 59, 7A, 2344) • Developmental course (e.g. Episodic reading problems) • Assessment of etiology (e.g. Depression associated with Interferon therapy for cancer) • Solution focused intervention design or asking “when, or under what conditions does she or he behave well” (e.g. Prozac related relapse or Cheryl’s head banging) • Assessment of risk and resilience factors (e.g. family resemblance for depression, peer substance use or abuse, recreational strengths such as music or sports) • Available in Spanish
Principles for Interpretation • All raters possess evidence of validity • Parent/Teacher predictive validity (Verhulst, F. C., Koot, H. M., & Van der Ende, J. (1994). Differential predictive value of parents’ and teachers’ reports of children’s problem behaviors: a longitudinal study. Journal of Abnormal Child Psychology, 22, 531-546.) • Teachers accurately assess effects of medication (Conners,1956) • SRP possesses concurrent validity with peer ratings (Kamphaus, R. W., DiStefano, C. A., & Lease, A. M. (2003). A Self-Report Typology of Behavioral Adjustment for Young Children. Psychological Assessment, 15, 17-28) • Simple interpretation schemes work as well as complex schemes (Piacentini, 1991)
SRP-C Type 9, Internalizing yoked ratings(7.4% of 8-11 year olds, 47%f; low self-confidence, uncooperative, too sensitive, anxious/shy, unhappy/sad, disruptive, loses things, seems odd, unlikeable, unpopular, fewer friends)
Interpretation Step 1: Validity Congruence of findings Lie index F index Omitted items Patterned responding Consistency index Reading proficiency
Interpretation Step 3. Ratings • Identify all scales with T scores in the at-risk range • Confirm or disconfirm the importance of each with available evidence • Collect additional evidence as needed • Draw conclusions regarding classification, diagnosis, and intervention