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Clinical AssessmentClinical Assessment

of Behaviorof Behavior

Bruce A. Bracken, Ph.D.The College of William and Mary

Williamsburg, VA (USA)

[email protected]


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Problem Statement

To what extent are childrens and adolescents positive

(i.e., adaptive) and negative (i.e., clinical) behavior

ratings a result ofbasic 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 behavioralratings is associated with basic demographic conditions?

To what extent do childrens behavioral ratings differ as a

result of race/ethnicity and gender?


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Method

Students behaviors were rated by their mothers orfathers

during the standardization ofa 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 ofvariance accounted for bydemographic variables; internal consistency estimates)


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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, mult-

instrument clinical assessments


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Triangulation:Triangulation:

MultiMulti--source, Multiple Contextsource, Multiple Context

AssessmentAssessment

Self-Report

-Self-concept

-Sentence Completion Forms

Third-Party Report

- CAB Parent orTeacher- BASC, DSMD, SSRS

Achenbach, Connors

Behavioral

and

Psychosocial

Adjustment

Other Sources- Direct Observation

- Indirect Approaches

(e.g., Projective Techniques)

- Background Information


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CAB Assesses:

Critical Behaviors: low-incidence behaviors that define seriouspsychopathology 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


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CAB Assesses:

Behaviors that correspond to educational exceptionalities andconditions

Mental retardation Learning disabilities Gifted and talented Adaptive behaviors Social skills

Behaviors ofcurrent societal concern Aggression Anger management Bullying Conduct problems


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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., rule-breaking behaviors, vandalism, truancy)

- insults others; is difficult to manage; ignores rules

Critical Behaviors Scale (CRI)

Assesses behaviors associated with serious psychopathology andsociopathy

- usesill

egaldrugs; ha

lluc

inates; expresses an unusua

linterest

in Satan


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Adaptive Scales

Social Skills Scale (SOC)

Assesses interpersonal relations with peers and adults

- listens attentively toothers; is considerate ofothers; annoys others

Competence Scale (COM)

Focuses on ability to get needs met appropriately, learning, andcognitive and language development

- has poo

r judgment;is eas

ily c

onfused;

learns new th

ings eas

ily

Adaptive Behaviors Scale (ADB)

Assesses developmental progress and degree of personalindependence

- dresses self; reliably makes simple purchases; prepares simple

meals for self


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CAB Scale Structure and

Number ofItems

Scale CAB-PX CAB-P CAB-T

Clinical Scales

Internalizing 30 16 16Externalizing 30 18 18

Critical Behaviors 30 -- --

Adaptive Scales

Social Skills 30 18 18Competence 30 18 18

Adaptive Behaviors 20 -- --

Total Scale 170 70 70


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CAB Clusters and

Number ofItemsClusters CAB-PX CAB-P CAB-T

Clinical Clusters

Anxiety 23 11 11Depression 36 16 16Anger 15 9 9Aggression 25 13 13Bullying 36 13 13Conduct Problems 28 8 8Attention Deficit/Hyperactivity 21 20 20

Autistic Spectrum Behaviors 30 13 13Learning Disability 23 15 15Mental Retardation 25 12 12

Adaptive ClustersExecutive Function 17 13 13Gifted and Talented 27 17 17


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Theoretical Structure

of CAB


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U.S. Normative Sample

Sample Size Males Females Total

Parent Forms

- ages 2 6 309 291 600- ages 7 12 455 422 877

- ages 13 18 318 319 637

Teacher Form- ages 5 6 145 95 240

- ages 7 12 471 288 759

- ages 13 18 391 299 690

Race/Ethnicity (Percent Representation)

Whites Blacks Hispanics Other

65 71% 12 17% 9 12% 6 8%


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Normative Sample

Education Level CAB-P CAB-T

< 11 years 3.9% 3.2%

12 years 23.9% 2.5%13 - 15 years 38.7% 11.4%16 years 14.6% 17.5%

> 17 years 18.8% 65.2%Unknown 0.1% 0.2%

Geographic Region

Midwest 21 25% 17 22%Northeast 13 22% 22 25%

South 35 45% 36 39%West 19 22% 17 20%


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CAB-PXTotal Sample

Internal ConsistencyScales r

Internalizing Behaviors(INT) .95

Externalizing Behaviors(EXT) .97

Critical Behaviors (CRI) .91

SocialSk

ills (SOC) .95

Competence (COM) .94

Adaptive Behaviors (ADB) .92

Total (CBI) .98

Clusters r

Anxiety (ANX) .93

Depression (DEP) .95

Anger (ANG) .93

Aggression (AGG) .95

Bullying (BUL) .97

Conduct Problems (CP) .92

Attentio

n-Deficit (ADH) .94

Autistic Spectrum (AUT) .92

Learning Disability (LD) .92

Mental Retardation (MR) .91

Executive Function (EF) .91

Gifted and Talented (GAT) .94


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CAB PXStability

Scale CAB-PX

Internalizing .89

Externalizing .90

Critical Behaviors .77

Social Skills .92

Competence .92

Adaptive Behaviors .87

CAB Behavioral Index .94

CAB Clusters .83 - .94


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CAB Inter-rater

Coefficients

Scale CAB-PX*

Internalizing .78

Externalizing .81

Critical Behaviors .41

Social Skills .62

Competence .79

Adaptive Behaviors .53

CAB Behavioral Index .82

CAB Clusters .70 - .90

* Parent - Parent


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AnalysesAnalyses

Estimates of total scale internal consistency by race

Esti

matesof

percent scal

ev

ari

ance acco

untedfo

r bybasic demographic variables

Scale and cluster mean score comparisons for basic

demographic variables


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Comparative Reliabilities byComparative Reliabilities by

Ethnic Group, Across Age LevelsEthnic Group, Across Age LevelsCaucasian Afr ican-American Hispanic

ClinicalInternalizing .94 - .95 .93 - .96 .91 - .96

Externalizing .96 - .97 .96 - .97 .93 - .98Critical Behaviors .71 - .92 .80 - .98 .42 - .92

AdaptiveSocial Skills .92 - .96 .92 - .95 .89 - .96

Competence .91 - .95 .92 - .95 .89 - .97Adaptive Behavior .79 - .89 .82 - .90 .84 - .89

Total ScaleCBI .97 - .99 .98 - .99 .96 - .99

Clusters .84 - .97 .85 - .97 .78 - .97


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Scale Variance Associated

With Demographic Variables

Age Gender Race Parent Ed

Clinical

Internalizing .35 .08 .59 .21Externalizing .19 2.82 .01 .42Clinical Behaviors 4.93 .53 .36 .72

Adaptive

Social Skills 1.44 2.69 .03 .67Competence 2.69 2.96 .01 .81Adaptive Behaviors 49.70 1.80 .01 .03

Total Scale (CBI) 2.86 2.31 .01 .61


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Cluster Variance Associated

With Demographic Variables

Age Gender Race Parent Ed

Anxiety .00 .35 .26 .22

Depression .71 .40 .37 .29

Anger .79 2.07 .32 .45

Aggression 1.37 4.45 .10 .67

Bullying .49 2.34 .00 .58

Attention Deficit .90 3.84 .03 .42

Autistic Spectrum 5.15 1.72 .00 .61

Learning Disability .46 2.19 .00 .58

Mental Retardation 12.60 2.86 .04 .77

Executive Function 2.76 4.16 .00 .57

Gifted and Talented 3.10 3.46 .06 .94


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Gender DifferencesM

ain Effect for Gender by Race ANOVA(No significant gender by race interactions)

nsTotal (CBI)

nsAdaptive Behaviors (ADB)

nsCompetence (COM)

nsSocial Skills (SOC)

nsCritical Behaviors (CRI)

nsExternalizing Behaviors(EXT)

nsInternalizing Behaviors(INT)

pScales

nsExecutive Function (EF)

nsGifted and Talented (GAT)

nsMental Retardation (MR)

nsLearning Disability (LD)

nsAutistic Spectrum (AUT)nsAttent

ion-De

ficit (ADH)

nsConduct Problems (CP)

nsBullying (BUL)

nsAggression (AGG)

nsAnger (ANG)

nsDepression (DEP)nsAnxiety (ANX)

pClusters


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Race/Ethnicity Differences**Main effect for Race/ethnicity, with no interactions

Only INTrevealed differences on post hoc analyses due to

conservative nature of Scheffe

nsTotal (CBI)

nsAdaptive Behaviors

nsCompetence

nsSocial Skills

.05Critical Behaviors

nsExternalizing Behaviors

.05Internalizing BehaviorsWhites > Blacks

pScales

nsExecutive Function (EF)

nsGifted and Talented (GAT)

nsMental Retardation (MR)

nsLearning Disability (LD)

nsAutistic Spectrum (AUT)nsAttent

ion-De

fici

t (ADH)

nsConduct Problems (CP)

nsBullying (BUL)

nsAggression (AGG)

nsAnger (ANG)

.05Depression (DEP)

.05Anxiety (ANX)

pClusters


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ConclusionsConclusions

Minimalvariance 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 ofbasic demographic variables (gender,

race/ethnicity)

Behaviors assessed by the CAB, both adaptive andpathological, appear to be normally distributed within the

greater population.

CAB appears to produce highly reliable assessment of

the behaviorofyouth regardless ofage, race, or gender

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