Behavioral, Social, and Emotional

Assessment of Children and Adolescents

Generally recognized as the standard work in its field, Behavioral, Social, and Emotional
Assessment of Children and Adolescents is a comprehensive guide for conducting concept-
ually sound, culturally responsive, and ecologically oriented assessments of students’
social and emotional behavior. Written for graduate students, practitioners, and research-
ers in the fields of school psychology, child clinical psychology, and special education, it
will also be of interest to those in related disciplines. Building on the previous editions,
this fifth edition includes updated references to DSM-5 and federal standards as well as
an integrated approach to culturally competent assessment throughout the text.
In Part I, Foundations and Methods of Assessment, the author provides a general
foundation for assessment practice and outlines basic professional and ethical issues,
cultural considerations, and classification and diagnostic problems. Part II, Assessment
of Specific Problems, Competencies, and Populations, includes material on assessing
specific social–emotional behavior domains, including externalizing problems, internal-
izing problems, social skills and social–emotional strengths, and the unique needs of
young children. A chapter on school-wide screening methods was also added with this
edition. By weaving together the most recent research evidence and common application
issues in a scholarly yet practical matter, Behavioral, Social, and Emotional Assessment of
Children and Adolescents continues to be the pre-eminent foundation for assessment
courses.
Sara A. Whitcomb is Associate Professor in the College of Education at the University of
Massachusetts, Amherst, USA.
“There is no better text describing evidence-based assessment methods for students’
social and emotional behavior. The author comprehensively describes contemporary
diagnostic methods and preventative approaches, including universal social-emotional
screening. This text has broad applicability to professional programs in school, clinical,
and counseling psychology, as well as psychiatry and social work.”
—Tanya L. Eckert, Associate Professor, Psychology, Syracuse University, USA

“Behavioral, Social, and Emotional Assessment of Children and Adolescents continues to be

an indispensable resource for graduate students and practitioners. Rich information is
provided regarding the broader categories of assessment as well as specific evidence-
based tools. Updates to the book include content related to crucial practices within multi-
tiered systems of support, such as universal screening.”
—Stephen Kilgus, Assistant Professor, School Psychology Program,
University of Missouri, USA
Behavioral, Social, and
Emotional Assessment of
Children and Adolescents
Fifth Edition

Sara A. Whitcomb
Fifth edition published 2018
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2018 Taylor & Francis
The right of Sara A. Whitcomb to be identified as author of this work has
been asserted by her in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilized in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and
explanation without intent to infringe.
First edition published by Lawrence Erlbaum 1998
Fourth edition published by Routledge 2012
Library of Congress Cataloging-in-Publication Data
A catalog record for this book has been requested

ISBN: 978-1-138-81438-7 (hbk)

ISBN: 978-1-138-81439-4 (pbk)
ISBN: 978-1-315-74752-1 (ebk)

Typeset in Minion
by Keystroke, Neville Lodge, Tettenhall, Wolverhampton.
I continue to dedicate this book to my mentor, Kenneth W. Merrell, who was
the original author of this work and a pioneer in the field of behavioral, social,
and emotional assessment. I am honored to continue this work, and I wish that
I could share with him all of the exciting developments in this area.
 CONTENTS

List of figures xxi

List of tables xxiii
Preface xxvii
Acknowledgments xxix

Part I Foundations and Methods of Assessment 1

1. Foundations of Assessment 3
Theoretical Foundations of Social and Emotional Behavior 3
Social Cognitive Theory: An Integrated Orientation 5
Components of Social Cognitive Theory 5
Triadic Reciprocality: Understanding the Determinants of Behavior 6
Observational Learning: A Multiprocess Analysis 7
The Importance of Context: Ecological Systems Theory 9
Finding Your Own Theoretical Foundation 11
Philosophical Foundations of Assessment 11
Nomothetic and Idiographic: Definitions and Historical Development 12
Nomothetic and Idiographic Approaches in Practice 12
The Empirical Approach to Assessment 13
Understanding and Clarifying Assessment Referrals 14
Assessment as a Problem-Solving Process 15
A Model for Assessment as a Problem-Solving Process 16
Phase I: Identification and Clarification 17
Phase II: Data Collection 17
Phase III: Analysis 17
Phase IV: Solution and Evaluation 18
Designing a Multimethod, Multisource, Multisetting Assessment 18
Response to Intervention (RtI): A Public Health Approach to Assessment
and Intervention 20

vii
viii s Contents

Legal and Ethical Issues in Assessment 22

The Basis for Legal Constraints on Assessment 22
Specific Assessment Practices Affected by Ethics and Law 23
Informed Consent 23
The Validity of Assessment Procedures 25
The Right to Privacy/Confidentiality 26
Some Concluding Comments on Legal and Ethical Issues 27
Criteria for Inclusion of Assessment Methods and Instruments 28
Conclusions 28
Review and Application Questions 30

2. Social–Emotional Assessment and Cultural Diversity 31

Test and Assessment Bias in Professional Practice 33
Test and Assessment Bias 33
Professional Ethics and Culturally Appropriate Assessment 34
Professional Practice 37
Acculturation and Identity Development 38
Factors That Influence Acculturation 39
Determining Acculturation and Cultural Orientation 40
Development of Racial/Cultural Identity 40
Stage 1: Conformity 41
Stage 2: Dissonance and Appreciating 41
Stage 3: Resistance and Immersion 42
Stage 4: Introspection 42
Stage 5: Integrative Awareness 42
Problems with Categories and Group Emphasis 43
Cultural Diversity in the United States: Description of Major
Racial/Ethnic Groups 44
African Americans 45
Asian Americans 47
Hispanic Americans 48
Native Americans 49
Some General Characteristics of the Majority Culture 51
Assessment Methods and Cultural Diversity: Special Considerations 52
Behavioral Observation 53
Behavior Rating Scales 54
Interviewing 56
Learn About the Interviewees’ Culture 57
Learn About the Interviewees’ Language 58
Establish Rapport 58
Identify Stereotypes 58
Promote Clear Communication 58
Identify Family Needs 58
Identify Attitudes toward Health and Illness 58
Recognize the Extent of Acculturation 59
Accept the Interviewees’ Perspectives 59
 Contents s ix

Sociometric Techniques 59
Self-Report Instruments 60
Projective–Expressive Techniques 62
Recommendations for Culturally Competent Assessment 63
Conclusions 65
Review and Application Questions 67

3. Assessment and Classification 69

Why Classify? 70
Differential Diagnosis and Classification Error 70
Current Classification Systems 71
The DSM System 71
Assumptions and Structure of the DSM 71
Using the DSM System in Assessment 73
Improvements to and Changes in the DSM 74
Classification under Special Education Law 76
General Assessment Guidelines in the IDEIA 76
The IDEIA Definition of “Emotionally Disturbed” 77
The “Emotionally Disturbed” versus “Socially Maladjusted” Issue 79
State Adaptations of the Federal Definition 80
New Directions 81
Behavioral Dimensions: An Alternative Approach to Classification 82
Behavioral Dimensions and the Achenbach System of Empirically
Based Assessment (ASEBA) System 82
Example of Behavioral Dimensions Approaches to Specific Classes
of Behavior 83
Additional Comments on the Behavioral Dimensions Approach 84
Multiple Gating Approaches to Assessment and Classification 85
Community- and Clinic-Based Multiple-Gating Procedure 86
SSBD: A School-Based Multiple-Gating Procedure 87
SARS: Classification of Behavioral Problems Using Existing School Records 89
Concluding Comments on Assessment and Classification 89
Conclusions 91
Review and Application Questions 93

4. Direct Behavioral Observation 95

Behavioral Observation: Basic Principles and Concepts 95
Direct Behavioral Observation and Ecological Assessment 96
General Methods of Behavioral Observation 97
Naturalistic Observation 97
Analogue Observation 98
Self-Monitoring 99
Observational Coding Procedures 100
Event Recording 101
Interval Recording 103
Whole-Interval or Partial-Interval Recording? 103
Time-Sample Recording 105
x s Contents

Duration and Latency Recording 105

Duration Recording 106
Latency Recording 106
Examples of Observational Coding Systems 106
School-Based Observation Systems 107
The Direct Observation Form (DOF) 107
Behavioral Observation of Students in Schools (BOSS) 108
The Behavior Coding System (BCS) 108
Home-Based Observation Systems 109
Social Interaction Coding System (SICS) 109
Family Interaction Code (FIC) 109
Clinic-Based Observation Systems 109
The Coders Impression Measure (CI) 109
Child’s Game/Parent’s Game 110
The Teacher Behavior Code (TBC) 111
Technology Advances in Behavioral Observation 111
BehaviorSnap 111
BOSS 112
!Observe 112
iObserve 112
Reliability and Validity Issues in Direct Behavioral Observation 112
Defining the Observation Domain 113
Observer Training and Reliability 114
Use of Social Comparison Data 114
Observer Reactivity 115
Situational Specificity 116
Inappropriate Recording Techniques 116
Biased Expectations and Outside Influence 117
Behavioral Observation and Functional Behavior Assessment 119
How Many Observations Are Needed? 121
Direct Behavioral Observation and Decision Making 122
Conclusions 123
Review and Application Questions 124
Scenarios 125

5. Behavior Rating Scales 127

Characteristics of Behavior Rating Scales 127
Definitions and Foundations 127
Rating Scales Versus Checklists 128
Advantages of Behavior Rating Scales 128
Problems Associated with Using Behavior Rating Scales 129
Measurement and Technical Issues 131
Review of Selected General-Purpose Behavior Rating Scales and Systems 133
ASEBA: Child Behavior Checklist and Teacher’s Report Form for
Ages 6 to 18 133
Description 134
Scoring System and Scale Structure 134
 Contents s xi

Development and Standardization 135

Psychometric Properties 136
Additional Comments 137
Behavior Assessment System for Children, Third Edition 138
Description 139
Scoring System and Scale Structure 140
Development and Standardization 141
Psychometric Properties 141
Additional Comments 142
The Conners Rating Scales, Conners Rating Scales–Revised, the
Conners 3, and the Conners Comprehensive Behavior Rating Scales 143
The Conners Rating Scales–Revised (1997) 144
Description of the Conners 3 145
Scoring System and Scale Structure in the Conners 3 146
Development and Standardization of the Conners 3 146
Psychometric Properties 147
The Conners Comprehensive Behavior Rating Scales (CBRS) 148
Additional Comments 148
Best Practices in Using Behavior Rating Scales 149
Behavior Rating Scales and Decision Making 150
Conclusions 152
Review and Application Questions 153

6. Interviewing Techniques 155

The Role of Interviews in Assessing Children and Adolescents 156
Developmental Issues in Interviewing 157
Preschool-Age and Primary-Age Children 158
Elementary-Age Children 160
Adolescents 161
Factors That May Affect the Quality of the Interview 163
The Interpersonal Context 163
The Ethnocultural Context 164
The Behavioral Context 165
The Truth Context: Dealing with Lying 166
The Physical Context 167
Selecting an Appropriate Interview Method 168
Traditional Interviewing Techniques 169
Gathering Relevant Background Information from Parents and
Teachers 169
Developing the Interview with Children and Adolescents 171
Areas for Observation 171
Areas for Questioning 171
Behavioral Interviewing 172
Implementing Behavioral Interviews with Parents and Teachers 174
Problem Identification Interview 175
Problem Analysis Interview 176
Implementing Behavioral Interviews with Children and Adolescents 177
xii s Contents

Structured and Semistructured Interview Tools 179

Schedule for Affective Disorders and Schizophrenia, School-Age Children 179
The Semistructured Clinical Interview for Children and Adolescents 180
Concluding Comments on Formal Interview Schedules 182
Clinical Interviewing and Suicidal Ideation or Behavior 182
Facts Regarding Suicidal Behavior among Children and Adolescents 182
Recommendations for Clinical Interviewing 184
Thinking about Suicide 185
Suicide Plan 185
Means and Preparations for Suicide 185
Intended Place or Setting 186
Immediate Protective Action 186
Suicidal Safety Planning 186
Interviews and Decision Making 187
Conclusions 188
Review and Application Questions 189

7. Sociometric Techniques 191

Sociometrics: Importance, History, and Empirical Base 191
Why Assess Social Status? 192
Historical Development of Sociometric Assessment 193
Validity of Sociometric Assessment 194
Dimensions of Social Status 194
Technical Adequacy of Sociometric Procedures 195
Predictive Validity of Sociometric Assessment 195
Overview of Sociometric Assessment Procedures 196
Peer Nomination Procedures 197
Peer Rating Procedures 199
Sociometric Ranking Procedures 201
Alternative Sociometric Procedures 202
Picture Sociometrics 202
Class Play 204
“Guess Who” Measures 204
Ethical Concerns in Using Sociometric Procedures 205
Sociometric Procedures and Decision Making 208
Conclusions 209
Review and Application Questions 210

8. Self-Report Assessment 213

Foundations of Self-Report Assessment 214
Historical Foundations of Personality Testing 214
Psychometric Foundations of Objective Test Construction 215
Three Approaches to Developing Objective Self-Report Tests 217
Rational–Theoretical Approach 217
Factor Analytic Approach 217
The Empirical Criterion Keying Approach 218
Response Bias and Error Variance 219
 Contents s xiii

Reviews of Selected General-Purpose Self-Report Tests 220

The Adolescent Psychopathology Scale (APS) 221
Description 221
Technical Characteristics 222
The APS Short Form 223
Evaluation 223
The Behavior Assessment System for Children, Third Edition:
Child and Adolescent Self-Reports 223
Description 223
Technical Characteristics 225
Evaluation 225
The Minnesota Multiphasic Personality Inventory–Adolescent
Version and Restructured Form (MMPI-A, MMPI-A-RF) 226
Description 226
Technical Characteristics 227
The Minnesota Multiphasic Personality Inventory–Adolescent–
Restructured Form (MMPI-A-RF) 228
Evaluation 229
The Conners 3 Self-Report 229
Description 229
Technical Characteristics 230
Evaluation 230
The Conners 3 Comprehensive Behavior Ratings Scale Self-Report
(CBRS-SR) 230
Description 230
Technical Characteristics 231
Evaluation 231
The Youth Self-Report (YSR) 231
Description 231
Technical Characteristics 232
Evaluation 232
Self-Report Tests and Decision Making 233
Conclusions 234
Review and Application Questions 235

9. Projective–Expressive Assessment Techniques 237

Projective Assessment: An Introduction 238
Thematic Approaches 240
The Thematic Apperception Test (TAT) 241
The Children’s Apperception Test (CAT) 243
The Roberts Apperception Test for Children (RATC) 243
Reliability and Validity 245
Concluding Comments on Thematic Approaches 245
Drawing Techniques 246
The Draw-A-Person Technique (DAP) 247
Administration, Scoring, and Interpretation 247
Reliability and Validity 250
xiv s Contents

Additional Comments 251

The Kinetic Family Drawing Technique (KFD) 252
Administration, Scoring, and Interpretation 253
Reliability and Validity 254
Kinetic School Drawing 255
Additional Comments 256
The Bender-Gestalt Test (BGT) as a Measure of Social–Emotional Status 256
Administration, Scoring, and Interpretation 257
Reliability and Validity 259
Additional Comments 260
Concluding Comments on Drawing Techniques 260
Sentence Completion Tasks 261
Administration, Scoring, and Interpretation 263
Reliability and Validity 263
The Hart Sentence Completion Test (HSCT) for Children 264
The Washington University Sentence Completion Test 264
Concluding Comments on Sentence Completion Tasks 265
Best Practices 265
Conclusions 267
Review and Application Questions 268

Part II Assessment of Specific Problems, Competencies, and

Populations 271

10. Assessing Externalizing Problems 273

Externalizing Disorders: An Overview 273
The Behavioral Dimensions Approach to Classifying Externalizing
Disorders 274
Undersocialized Aggressive Conduct Disorder 274
Socialized Aggressive Conduct Disorder 274
Attention Deficit Hyperactivity Disorder (ADHD) 275
The DSM Approach to Classifying Externalizing Disorders 276
Attention Deficit Hyperactivity Disorder (ADHD) 276
Conduct Disorder 278
Oppositional Defiant Disorder (ODD) 281
Intermittent Explosive Disorder 282
Subdimensions of Externalizing Problems: Classification Studies 282
Prevalence, Development, and Prognosis of Externalizing Disorders 284
Prevalence 284
Comorbidity 284
Etiology and Development 285
Developmental Course and Prognosis 286
Methods of Assessing Externalizing Problems 288
Behavioral Observation 288
The Dyadic Parent–Child Interaction Coding System (DPICS) 289
Behavior Rating Scales 291
Narrow-Band Rating Scales for Attention Deficit Hyperactivity Disorders 291
 Contents s xv

The ADHD Rating Scale-5 (ADHD-5) 292

The Attention Deficit Disorders Evaluation Scales (ADDES-4) 293
The Conners 3 ADHD Index (Conners 3AI) 294
The Behavior Rating Inventory of Executive Function, Second
Edition (BRIEF-2) 294
Interviewing Techniques 295
Sociometric Techniques 298
Self-Report Instruments 299
The Jesness Inventory–Revised (JI-R) 300
Linking Assessment to Intervention 302
Conclusions 303
Review and Application Questions 304

11. Assessing Internalizing Problems 305

Internalizing Problems: An Overview 305
Behavioral Dimensions Classification 306
The DSM Classification 306
Prevalence 307
Gender Issues in Prevalence 308
Symptoms of Major Internalizing Disorders: Depression, Anxiety, and
Related Problems 308
Depression 309
Depression as a Symptom 309
Depression as a Syndrome 309
Depression as a Disorder 310
Causal Factors 312
Anxiety 312
Causal Factors 314
Related Internalizing Disorders 315
Social Withdrawal 315
Somatic Problems 315
Fears and Phobias 316
Other Problems 316
Implications of Internalizing Disorders 317
Positive and Negative Affectivity: A Model for Understanding
Internalizing Problems 317
Internalizing Problems and Self-Concept 318
Methods of Assessing Internalizing Problems 320
Behavioral Observation 321
Functional Assessment and Internalizing Problems 323
Behavior Rating Scales 323
Interviewing 324
Sociometric Techniques 325
Narrow-Band Self-Report Instruments 326
The Children’s Depression Inventory (CDI) and the Children’s
Depression Inventory–2 (CDI-2) 327
xvi s Contents

The Revised Children’s Manifest Anxiety Scale (RCMAS) and the

Revised Children’s Manifest Anxiety Scale, Second Edition
(RCMAS-2) 329
The Reynolds Child Depression Scale (RCDS) and the Reynolds
Child Depression Scale, Second Edition (RCDS-2) 330
The Reynolds Adolescent Depression Scale, Second Edition
(RADS-2) 331
The Multidimensional Anxiety Scale for Children, Second Edition
(MASC-2) 332
The State-Trait Anxiety Inventory for Children (STAIC) 332
Concluding Comments on Internalizing Symptoms Self-Report
Measures 333
Self-Report Instruments for Assessing Multidimensional Self-Concept 334
The Multidimensional Self-Concept Scale (MSCS) 334
The Self-Description Questionnaire I (SDQ-I) 335
The Self-Description Questionnaire II (SDQ-II) 335
The Self-Perception Profile for Children (SPPC) 336
The Self-Perception Profile for Adolescents (SPPA) 337
Linking Assessment to Intervention 338
Conclusions 339
Review and Application Questions 340

12. Assessing Other Behavioral, Social, and Emotional Problems 343

Classification and Taxonomy 344
Behavioral Dimensions Classification 344
The DSM Classification 345
Autism Spectrum Disorder 345
Description 347
Autism Spectrum Disorder 347
Asperger’s Disorder 350
Rett’s Disorder 351
Childhood Disintegrative Disorder 351
Assessment 352
The Autism Diagnostic Observation Schedule (ADOS) 352
The Autism Diagnostic Interview (ADI) 353
The Childhood Autism Rating Scale, Second Edition (CARS-2) 354
The Gilliam Autism Rating Scale, Third Edition (GARS-3) 355
The Assessment of Basic Learning and Language Skills-Revised
(ABLLS-R) 355
Schizoid Disorders 356
Description 356
Assessment 358
TIC Disorders 358
Description of Tourette’s Disorder/Tourette Syndrome 359
Assessment 359
Schizophrenia Spectrum and Other Psychotic Disorders 360
Description 360
 Contents s xvii

Assessment 363
Behavioral Observation 363
Behavior Rating Scales 363
Clinical Interviews 364
Sociometric Techniques 365
Self-Report Instruments 365
Eating Disorders 366
Description 367
Anorexia Nervosa 367
Bulimia Nervosa 368
Binge Eating Disorder 368
Assessment 369
Linking Assessment to Intervention 369
Conclusions 371
Review and Application Questions 374

13. Assessing Social Skills and Social–Emotional Strengths 375

Social Competence: A Complex Construct 375
Adaptive Behavior 376
Social Skills 376
Peer Relations 377
Theoretical Model 377
Dimensions of Social Skills 378
The Importance of Social (and Emotional) Skills 381
Methods of Assessing Social and Emotional Skills 382
Direct Behavioral Observation 382
The Student Interaction in Specific Settings Tool (SISS) 383
The Peer Social Behavior Code 383
The Target/Peer Interaction Code 385
Comments on Direct Observation of Child Social Behavior 386
Behavior Rating Scales 387
The Social Skills Improvement System (SSIS)—Parent and Teacher
Forms 387
The School Social Behavior Scales, Second Edition (SSBS-2)/Home
and Community Social Behavior Scales (HCSBS) 389
The Social Emotional Assets and Resilience Scales—Teacher and
Parent Reports (SEARS-T, SEARS-P) 393
The Devereux Student Strengths Assessment (DESSA) 394
Interviewing Techniques 395
Sociometric Approaches 397
Assessment with Self-Reports 399
The Social Skills Improvement System—Student Forms 399
The Social Emotional Assets and Resilience Scales—Child and
Adolescent Forms (SEARS-C, SEARS-A) 400
Linking Assessment to Intervention 401
Conclusions 403
Reviews and Application Questions 405
xviii s Contents

14. Assessing Social and Emotional Behavior of Young Children 407

An Alternative Diagnostic Classification System 408
Methods for Assessing Young Children 411
Direct Behavioral Observation 412
Example: Early Screen Project (ESP) Social Behavior Observations 412
Behavior Rating Scales 413
The Ages and Stages Questionnaires: Social–Emotional, Second
Edition (ASQ:SE-2) 414
The Social Emotional Assessment Measure (SEAM) 415
The Devereux Early Childhood Assessments (DECA) 415
The Behavior Assessment System for Children, Third Edition (BASC-3) 416
The Early Childhood Rating Forms of the ASEBA System 417
The Preschool and Kindergarten Behavior Scales, Second Edition
(PKBS-2) 419
The Social Skills Improvement System (SSIS) 421
Interviewing Techniques 422
Sociometric Approaches 424
Self-Report Tests 425
The Pictorial Scale of Perceived Competence and Acceptance for
Young Children 426
The Berkeley Puppet Interview (BPI) 427
Best Practices 428
Conclusions 429
Review and Application Questions 431

15. Universal Screening in Schools (with Kayla Gordon) 433

Context for Universal Social–Emotional Screening 433
Social–Emotional Screening 434
School-Wide Screening Measures 435
The Systematic Screening for Behavior Disorders, Second Edition
(SSBD-2) 435
Behaviors Targeted 437
Technical Adequacy 438
Feasibility 439
The Student Risk Screening Scale—Internalizing and Externalizing
(SRSS-IE) 439
Behaviors Targeted 439
Technical Adequacy 440
Feasibility 440
The Strengths and Difficulties Questionnaire (SDQ) 440
Behaviors Targeted 440
Technical Adequacy 441
Feasibility 441
The Social, Academic, and Emotional Behavior Risk Screener (SAEBRS) 441
Behaviors Targeted 441
Technical Adequacy 442
Feasibility 442
 Contents s xix

The Behavior Intervention Monitoring Assessment System (BIMAS) 442

Behaviors Targeted 442
Technical Adequacy 443
Feasibility 443
The BIMAS Flex 443
The Behavioral Assessment System for Children, Third Edition:
Behavioral and Emotional Screening System (BASC-3: BESS) 444
Behaviors Targeted 444
Technical Adequacy 444
Feasibility 444
The BASC-3 Flex Monitor 445
The Social Skills Improvement System—Performance Screening
Guide (SSIS-PSG) 445
Behaviors Targeted 445
Technical Adequacy 446
Feasibility 446
Additional Promising Tool 446
Strengths and Importance of School-Wide Screening 447
Implementation Challenges Associated with School-Wide Screening 447
Conclusions 449
Review and Application Questions 449

References 451
Index 497
 FIGURES

1.1 An outline of Bandura’s (1986) theory of triadic reciprocality 6

1.2 Components of Bronfenbrenner’s (1977, 1989) ecological systems theory 10
1.3 A model for multimethod, multisource, multisetting assessment practice 19
1.4 A public health approach, “triangle of support” model for students with
behavioral and emotional problems 21
3.1 Diagram of a clinic-based multiple-gating procedure used to identify
youths at risk for delinquency 87
3.2 Diagram of the multiple gating stages of the Systematic Screening for
Behavior Disorders 88
4.1 An example of behavioral observation data that were collected using an
event recording procedure and the A–B–C (antecedent–behavior–
consequence) technique 102
4.2 An example of an interval-based coding system used to collect social
observation data. This particular form was used for a playground-based
observation of a referred student, using the partial-interval method,
and focusing on social interaction and aggressive behavior 104
5.1 An example of a “frequency of behavior” alternative rating scale format 132
5.2 Diagram of scales and their relationship structure from the cross-informant
scales of the CBCL/6–18 and TRF/6–18 of the ASEBA system 136
7.1 An example of an item-by-peer matrix for a peer nomination procedure
that includes positive and negative items 198
7.2 An example of a sociogram plotted for a group of 15 elementary-age boys
who were asked to select the two boys in the classroom with whom they
would most like to be friends 198
7.3 A sample peer rating assessment form 200
7.4 Instructions for rank-ordering students with internalizing social–
emotional problems, from stage 1 of the SSBD multiple gating system.
A rank-ordering procedure for externalizing problems is also included
in stage 1 203

xxi
xxii s Figures

9.1 A human figure drawing produced by a five-year-old girl, using

standard DAP directions 248
9.2 A Kinetic Family Drawing produced by an eight-year-old boy 253
9.3 Bender-Gestalt Test designs produced by an 11-year-old boy 258
10.1 Forehand and McMahon’s (1981) Problem Guidesheet, a tool for
conducting behavioral interviews to assess child conduct problems 296
13.1 Outline of a proposed theoretical model of the relationships among
the constructs of adaptive behavior, social competence, social skills,
and peer relationships 378
13.2 Peer Social Behavior Recording Form 384
13.3 Peer Social Behavior Observation Summary Sheet 385
13.4 Scale A (Social Competence) of the School Social Behavior Scales 390
13.5 Scale B (Antisocial Behavior) of the School Social Behavior Scales 391
14.1 Social Skills Examples from the Preschool and Kindergarten Behavior
Scales, Second Edition 420
14.2 Problem Behavior Examples from the Preschool and Kindergarten
Behavior Scales, Second Edition 420
15.1 Diagram of the multiple gating stages of the Systematic Screening for
Behavior Disorders 436
15.2 Instructions for rank-ordering students with internalizing social–
emotional problems, from stage 1 of the SSBD multiple gating system.
A rank-ordering procedure for externalizing problems is also included
in stage 1 437
 TABLES

1.1 A model for assessment as a problem-solving process 16

2.1 Stages of minority racial/cultural development 41
2.2 Nine recommendations by Sattler (1998) for effective interviewing of
racial/ethnic minority children and their families 57
2.3 General recommendations for culturally competent practice in behavioral,
social, and emotional assessment of children and youth 64
3.1 Overview of the DSM-5 72
3.2 DSM-5 sample chapter: Neurodevelopmental disorders 73
3.3 Example of criteria for a DSM-5 diagnostic category: Oppositional
Defiant Disorder 313.81 (F91.3) 75
3.4 Cross-informant syndrome categories used in the Achenbach System
of Empirically Based Assessment 83
3.5 Overview of dimensional subtypes of delinquent behavior merging the
findings of Achenbach (1982a) and Quay (1975) 84
4.1 Guide to four basic observational coding procedures 100
4.2 Characteristics of eight selected general-purpose observational coding
systems 107
4.3 Some potential threats to the validity of behavioral observations 118
5.1 Example of differences between checklist and rating scale formats for
assessing child behavior problems 128
5.2 Types of error variance found with behavior rating scales 130
5.3 Composites and scales of the child and adolescent forms of the Teacher
Rating Scales (TRS) and Parent Rating Scales (PRS) of the Behavior
Assessment System for Children, Third Edition 139
6.1 Developmentally sensitive interviewing: Considerations and suggestions 158
6.2 Generalized between-group communication style differences among
major ethnic groups in the United States: Some aspects of overt activity
and nonverbal and verbal communication 165

xxiii
xxiv s Tables

6.3 Recommended areas of questions for gathering background information 170

6.4 Important child characteristics to observe during interviews 172
6.5 General areas of questioning for child/adolescent interviews 173
6.6 Specific purposes of behavioral interviewing 174
7.1 Descriptions of four nonaverage child and adolescent social status 194
8.1 Adolescent psychopathology scale, listed by area and scales 222
8.2 Composites and scales of the child and adolescent versions of the
self-report form of the Behavior Assessment System for Children,
Third Edition 224
8.3 Basic and content scales of the MMPI-A 228
9.1 Summary of 38 emotional indicators for human figure drawings from
the Koppitz (1968) Scoring and Interpretation System 250
9.2 20 sample stems typical of the content of sentence completion tasks
advocated for use with older children and adolescents 262
10.1 Major characteristics of three domains of externalizing behavior
disorders derived from Quay’s (1986a) classic literature review 275
10.2 Diagnostic criteria for Attention Deficit Hyperactivity Disorder
from DSM-5 277
10.3 DSM-5 diagnostic criteria for Conduct Disorder 279
10.4 DSM-5 diagnostic criteria for Oppositional Defiant Disorder 281
10.5 Scale structure of the Jesness Inventory–Revised 301
11.1 Major characteristics of two dimensions of internalizing problems
identified through Quay’s (1986a) Review of Multivariate
Classification Studies 306
11.2 Major diagnostic categories of internalizing disorders from DSM-5 307
11.3 DSM-5 diagnostic criteria for Major Depressive Episode 310
11.4 Diagnostic criteria for Generalized Anxiety Disorder from the DSM-5 314
11.5 Self-report instruments for assessing internalizing problems and
self-concept: Summary of instruments reviewed in Chapter 11, listed
in order of review 327
12.1 Major behavioral characteristics of two types of severe behavioral
syndromes identified through Quay’s (1986a) analysis 345
12.2 Some major diagnostic areas and categories from DSM-5 that
constitute severe, low base rate, or less differentiated types of
behavioral, social, and emotional disorders among children and
adolescents 346
12.3 Some major characteristics and associated features of four primary
pervasive developmental disorders that were in the DSM-IV 347
12.4 Diagnostic criteria for Autism Spectrum from the DSM-5 348
12.5 Major characteristics and associated features of Tourette’s Disorder 359
12.6 Behavioral, emotional, and cognitive symptoms associated with
schizophrenia and related psychotic disorders in children 362
12.7 Major characteristics and associated features of the primary eating
disorders 367
13.1 The five most common dimensions of social skills, developed from
a review and analysis by Caldarella and Merrell (1997) 379
 Tables s xxv

13.2 Summary of standardized assessment instruments for measuring

social skills and peer relations 402
14.1 Multiaxial organization of the Diagnostic Classification: 0–3, Revised
(DC: 0–3R) 410
14.2 Categories and examples of antisocial and nonsocial behavior from
the Social Observations of the Early Screening Project 413
 PREFACE

The science and practice of psychological and educational assessment of children and
adolescents continue to evolve and have experienced some major recent advancements.
New innovations and developments continue to emerge, sometimes at a rapid rate that
surpasses the ability of the field to keep pace with them. At the same time, psychological
and educational assessment practices with youth have continued to be mired in some of
the same traps, impasses, and controversies that have existed for years. For some, under-
standing social–emotional and behavioral assessment as a process aimed at targeting
children’s instructional needs versus diagnosing pathology is still somewhat of a foreign
concept. One only needs to consider briefly the reliance some place on assessment
methods and techniques that are substantially lacking in empirical support, a lack of
sensitivity of many current assessment practices to important group and individual
differences, and the gross misuse of assessment technology for inappropriate purposes to
understand that the field still has a continuous journey ahead.
That said, this book is my effort to continue to understand current innovation in
social–emotional and behavioral assessment, so that I can continue the work that Ken
Merrell began to help elevate the practice of psychological and educational assessment
of children and adolescents, to increasingly higher professional standards and a solid
evidence-based foundation. This book was developed to provide a comprehensive
foundation and guide for conducting comprehensive assessments of child and adolescent
social–emotional behavior in a practical, defensible, empirically sound, and culturally
appropriate manner. It was written as a graduate-level training textbook and as a
professional reference book. It is specifically relevant to the fields of school psychology,
clinical child psychology, and special education. Professionals in related fields, who
work with children and adolescents with behavioral, social, and emotional problems
(e.g., counseling, social work, and child psychiatry), may also find it useful.
While the fifth edition continues to share similar theoretical grounding and the chapter
structure of the previous editions, this book represents a major revision that is my attempt
to share some of the rapid advances in the field, while also maintaining the compre-
hensive review of fundamental assessment features. Relevant chapters have been aligned

xxvii
xxviii s Preface

to the DSM-5 diagnostic categories, which was a significant undertaking. Aligning with
the DSM-5 was particularly challenging, given that many assessment measures and
interview tools have yet to be updated. Several measures, however, have been updated,
and I did my best to include them. For example, in Chapters 5, 8, and 15, I have provided
an extensive review of the recently released BASC-3 assessment and intervention system.
In Chapter 13, Assessing Social Skills and Social–Emotional Strengths, I have included more
strength-oriented measures, as this is an area that seems to be expanding. As much as
possible, I have provided information on the integration of technology into the assess-
ment process. So many structured behavioral observation tools are now available for
cellphones and computers, for example, that I have incorporated a review of just a few
that are fairly inexpensive and easy to use. Additionally, administration and analysis
of behavioral assessment data have become so much more efficient with management
systems like Pearson’s Q-Global, that I referenced how to find such systems as much as
possible.
Finally, in my preparation of this book and my current applied work in schools, I get
perhaps most excited about the role that social–emotional and behavioral assessment has
begun to play within multi-tiered systems of support (MTSS) and Responsiveness-to-
Intervention models (RtI). MTSS, a prevention-focused approach to instruction and
assessment, is finally gaining traction in schools. I work with many schools as they develop
their tiered systems of support related to social–emotional behavior. I’m always thrilled
when schools are placing as much importance on teaching behavior as they do on
academics. In addition to building the understanding that behavior and social–emotional
skills can and should be taught, school professionals have also grasped onto the idea of
universal screening methods. Screening a school of children for social–emotional risk
enables school professionals to work together to identify appropriate, preventative
instructional targets as well as “catch” students, who may benefit from more support, before
they spiral into crisis. That said, I decided to add a chapter to this edition focused entirely
on universal screening in schools. This chapter provides a review of several screening tools
from the perspective of behaviors targeted, technical adequacy information provided, and
feasibility or usability. In addition, I have included content related to how a school might
attempt to successfully “roll out” a new universal screening method over time.
The chapters are divided into two major sections. Part I, Foundations and Methods of
Assessment, includes nine chapters that provide a general foundation for assessment
practice. These chapters include coverage of basic professional and ethical issues, cultural
considerations, classification and diagnostic problems, and comprehensive introductions
to six primary assessment methods: behavioral observation, behavior rating scales,
clinical interviewing, sociometric techniques, self-report instruments, and projective–
expressive techniques. Part II, Assessment of Specific Problems, Competencies, and
Populations, includes five chapters or applications for assessing specific social–emotional
behavior domains, including externalizing problems, internalizing problems, other prob-
lems, social skills and social–emotional strengths, and the unique needs of young chil-
dren. The book finishes with the new chapter on universal screening. Together, these two
parts provide a framework for a model of assessment that is practical, flexible, sensitive
to specific needs, and empirically sound. To the greatest extent possible, this book weaves
together the most recent research evidence and common application issues in a scholarly
yet practical manner. It is intended to complement professional training and not to act
as a substitute for it.
 ACKNOWLEDGMENTS

First, I would like to thank Ken Merrell for mentoring me, sharing his knowledge with
me, and giving me this opportunity. As I continue authorship on this book, I often find
myself wondering, “What would Ken have thought about this?” I miss not being able
to share this process with him, but I am forever grateful for this learning experience.
Additionally, I would like to acknowledge Daniel Schwartz and Rebecca Novack, editors
at Routledge Publishers, for their patience, support and continued enthusiasm for Ken’s
work and for their confidence in my ability to write this new edition on my own. I would
also like to acknowledge the Routledge production staff, particularly Matthew Friberg, for
their careful work and help throughout the process. I look forward to working with
Routledge on a sixth edition of this book in the future.
I am very fortunate to have been trained in the University of Oregon’s College of
Education and School Psychology Program. It was there that I truly realized my profes-
sional aspirations with the support of the esteemed faculty. I would like to acknowledge
those who have supported this work at my current academic home, the University of
Massachusetts in Amherst. I would not have been able to get this done without Kayla
Gordon, who co-authored Chapter 15 with me and helped to keep me on track. I would
like to recognize all of my graduate students that read chapters and gave feedback. I am
lucky to be part of a supportive community.
My understanding of behavioral, social, and emotional assessment has also been
shaped by my practical experiences with children in school and home environments.
As much as possible, I try to get into schools so that I can informally and formally observe,
rate, and hypothesize about behavior. I am so appreciative for the many experiences with
the children I have had the chance to meet.
Most importantly, I want to thank my family for their support. Stuart, who always
brings me coffee; Jack, who always has an encouraging word; Caeli, who always has a
smile and a hug; and Buster, who reminds me to get outside and take a break.
Sara A. Whitcomb

xxix
 Part I
FOUNDATIONS AND
METHODS OF ASSESSMENT
 1
FOUNDATIONS OF ASSESSMENT

This chapter introduces important issues in social–emotional assessment, provides a

foundation for understanding the design and flow of subsequent chapters, and overview
of the current state of the art in best assessment practices. The chapter begins with an
exploration of how theory guides practice, using social cognitive theory and ecological
systems theories as preferred models, and then describes some of the philosophical
foundations on which present-day assessment practices are built. A discussion of the
referral process is then provided, with specific emphasis on how referral processes are
tied to spheres within human ecological systems, and how referrals should shape the
approach to assessment. Assessment is conceptualized and proposed as a comprehensive
problem-solving process. The preferred way for conducting assessments of behavioral,
social, and emotional problems is through the use of an aggregated multimethod, multi-
source, multisetting design, which is ideally implemented through an approach involving
services for all individuals within a population. The “triangle of support” model from the
field of public health is seen as an ideal way to consider allocating screening and assess-
ment services to produce the maximum impact within limited resources. A discussion
of pertinent legal and ethical issues in assessment follows, and specific recommendations
for legal and ethical assessment practices are provided. The chapter ends with a brief
discussion of what criteria were used for including specific assessment techniques and
instruments within the book. Essentially, this chapter serves as an introduction and guide
for understanding the overall goals and the larger picture of the entire book.

THEORETICAL FOUNDATIONS OF SOCIAL AND

EMOTIONAL BEHAVIOR
Is theory essential for practice? More specifically, can one conduct reliable and valid
assessments of youngsters with behavioral, social, and emotional problems without being
firmly grounded in a theoretical orientation to how these problems develop, progress,
and change? Well, one might administer some tests and interpret the results under this
scenario. But is this type of approach the most desirable? Probably, it is not. Without a
solid theoretical background and orientation, the assessor is relegated to the somewhat
paraprofessional role of a technician or tester. No matter how skilled, he or she may never
fully integrate the assessment findings to the youngster’s past, and future, with an adequate
degree of continuity or unity. Additionally, developing a solid theoretical understanding
of the origins of behavioral, social, and emotional problems may have important
implications when it is time to link assessment results to a useful intervention plan.

3
4 s Foundations and Methods of Assessment

This book was designed with a specific theoretical foundation of human behavior
in mind: social learning or social cognitive theory. In addition, this book includes a
strong emphasis on ecological or environmental aspects of behavior, and thus also has
a strong emphasis on social-ecological theory. Before delving into an exploration of these
two theoretical models, this section first provides a brief discussion of some other
approaches to conceptualizing human behavior and how theory shapes practice. Then,
in more detail, we explore social cognitive theory and its related aspects, and introduce
the notion of social ecological theory.
To say that there is a traditional theory of human behavior, or even a small handful of
these theories, in modern psychology, is misleading. Although psychodynamic and behav-
ioral theories were strong and distinct unitary forces in the early days of psychology, neither
one of these schools of thought, similar to most other ways of conceptualizing human
behavior, is currently considered a unitary force, as they have matured, and to some extent,
have split into divergent schools of thought, if not factions, that have a common lineage.
Let us take behaviorism as an example in more detail. In the modern world of behav-
iorism, there are divergent schools of thought that take significantly different approaches
and yet still fall under the umbrella of behaviorism. The “true believers” in behaviorism
are probably those who claim the strongest legacy to Skinner, Watson and Raynor, and
Thorndike. This contingent of behaviorism is perhaps best exemplified by those who are
active practitioners of experimental and applied behavior analysis, which can be traced
directly to B. F. Skinner and his brilliant and voluminous work that spanned a 60-year
period from 1930 to 1990, making him unquestionably the most influential American
psychologist. To summarize applied behavior analysis or the work of Skinner in a few
short sentences is presumptuous to say the least. With this caveat in place, however,
behavior analysis is grounded in the notion that behaviour is shaped by the antecedents
that precede it and the consequences that follow. This notion is key to understanding,
predicting, and changing behaviour. A more recent school of thought within the behavioral
world is a diverse group of ideas for understanding and changing behavior that center
around the term cognitive behavior therapy. This loose-knit faction does claim some legacy
to Skinner’s work, considering that overt emitted behaviors, consequences, and the
environment are important. The emphasis on internal cognitive processes and mediat-
ing events that links most theories in cognitive behavioral therapy is a clear departure,
however, from the framework advocated by Skinner and his colleagues. In fact, throughout
his career, Skinner repeatedly criticized “mentalistic” approaches to learning and behavior.
In his later years, Skinner became particularly vocal in this regard. His mid-1980s article
titled “The Shame of American Education” (B. F. Skinner, 1984) included an angry and
disappointed indictment of the American educational system for failing to adopt scienti-
fically based learning and management procedures and focusing instead on mentalistic
or cognitive constructs that could not be easily defined or measured. In his last public
address, shortly before his death in 1990, after receiving an award for his lifetime of
scientific contributions, Skinner presented a keynote address at a meeting of the American
Psychological Association (APA), in which he thoroughly lambasted “cognitive science,”
portraying it as a misguided attempt to explain human behavior through studying under-
lying mental processes, which is a throwback to mentalism and turn-of-the-century
introspectionism. In addition to receiving four standing ovations during his sometimes
dramatic address, Skinner also shocked many in his audience by referring derisively to
cognitive science as “the creationism of psychology” (APA, 1990).
 Foundations of Assessment s 5

The point to be made by this brief discussion of the evolution of modern behaviorism
is that the traditional theoretical schools of thought that are discussed in general
psychology textbooks have evolved tremendously over the years, often branching into
smaller groups that share common backgrounds. This same process is true for other
traditional theoretical schools of thought, such as psychodynamic theory, the neuro-
biological model, and the humanistic movement. The philosophical basis of each of these
areas has evolved tremendously over the years, and there is no longer just a small and
powerful handful of theoretical schools with which a practitioner may be aligned.
Clinicians and researchers today are much more likely to consider themselves “eclectic”
in their theoretical approach to human behavior than to align themselves with one school
of thought. These present circumstances have had a dual effect: on one hand, the decreas-
ing amount of dogmatism has paved the way for acceptance of new and influential
theories, but on the other hand, the current generation of clinicians is perhaps less likely
to place a great deal of thought to their theoretical orientation, which could lead to an
unanchored approach to assessment and treatment.

Social Cognitive Theory: An Integrated Orientation

Social cognitive theory, a primary underlying orientation in this book, is a sophisticated
and complex theory that takes into account not only the multiple causes of behavioral,
social, and emotional problems, but also the reciprocal nature of the relationship between
causes and effects. This theory is not overviewed in order to proselytize the nonbeliever—
it is not a philosophy of life and does not have to carry any metaphysical implications.
Although you should understand that it is the framework embedded within this book,
social cognitive theory is proposed as a solid foundation for assessment of children and
adolescents because it takes into account many potential factors contributing to the
assessment problems; it is flexible; and in its fullest form, it has strong implications for
linking assessment data to intervention planning.

Components of Social Cognitive Theory Social cognitive theory and the related concepts
of triadic reciprocality and observational learning are based on the work of Albert Bandura
(e.g., 1977, 1978, 1986). Most people who have studied psychology and related fields at
the graduate level are familiar with Bandura’s famous work on social learning processes
in aggression. These processes were demonstrated in the famous “Bobo Doll” experi-
ments wherein the effects of models and perceived consequences were found to have a
tremendous impact on aggressive and prosocial behavior in school-age and preschool-
age children. These particular demonstrations of social cognitive theory do not tell the
full story and do not account for the entire complexity of the process. Although it is
impossible to detail social cognitive theory completely in a portion of one book chapter
(for a comprehensive account, see Bandura’s 1986 book, Social Foundations of Thought
and Action), it is useful to review its major components. As stated by Bandura (1986),
social cognitive theory holds that:

[People] are neither driven by inner forces nor automatically shaped and controlled
by external stimuli. Rather, human functioning is explained in terms of a model of
triadic reciprocality in which behavior, cognitive and other personal factors, and
environmental events all operate as determinants of each other.
(p. 18)
6 s Foundations and Methods of Assessment

The nature of people is explained in terms of five basic human capabilities: symbolizing
capability, forethought capability, vicarious capability, self-regulatory capability, and self-
reflective capability.
Symbolizing capability involves the use of various symbols, including language, as a
means of altering and adapting to different environments. The use of symbols allows
communication with others, even at distant times or places. Forethought capability
consists of the anticipation of likely consequences of behavior and is demonstrated by
intentional and purposive actions that are future oriented. Vicarious capability is entailed
by the fact that not all learning must result from direct experience, but can occur through
the observation of other people’s behaviors and the consequences that follow them.
Self-regulatory capability affects the development of our own internal standards and self-
evaluative reactions to our behavior—discrepancies between our internal standards and
our actual behaviors govern our future behavior. Self-reflective capability involves self-
consciousness, or the uniquely human ability that enables us to think about and evaluate
our own thought processes. Together, these five fundamental human capabilities form the
basis for our vast human potential and help explain the inner workings that result in our
behavioral output.

Triadic Reciprocality: Understanding the Determinants of Behavior The social cognitive

viewpoint supports a conception of the causes of human behavior being due to reciprocal
determinism. The idea behind reciprocal determinism is that the causes behind one’s
behavior become influenced and shaped by the behavior itself. Specifically, the type of
reciprocal determinism favored by social cognitive theory is known as triadic reciprocality
(Bandura, 1977, 1978). This view contends that behavior, environmental influences, and
various personal factors (e.g., cognition, temperament, biology) all work together in an
interactive manner and have the effect of acting as determinants of each other. Bandura’s
theory of triadic reciprocality is illustrated in Figure 1.1.
Triadic reciprocality in social cognitive theory can be exemplified in practical terms
through an example of the interaction process between parents and a newborn child.
Take a scenario where the infant happens to have an irritable or difficult temperament,
which is present from birth and is probably biological in nature. The infant’s irritable
temperament is an example of a personal factor. Because this particular infant tends to
cry frequently and in a most distressing tone, is highly demanding, and sleeps for only
short periods of time (behavioral factors), an environment is created in which constant

Behavior

Person Environment

Figure 1.1 An outline of Bandura’s (1986) theory of triadic reciprocality

 Foundations of Assessment s 7

demands, noise, and limited opportunities for sleep interact with the personal factors of
the parents to help shape their own behavior and characteristics in the direction of their
being constantly tired, more irritable than normal, anxious, frustrated, and perhaps over
time, somewhat depressed. The behavior of the parents continues to shape the environ-
ment of the infant, and the infant’s behavior continues to shape the environment of the
parents, which in turn affects their personal characteristics. If the infant persists in being
highly irritable and demanding, and the parents tend to reinforce these demands with
immediate attention in an attempt to terminate their child’s difficult behavior, the child’s
irritable and demanding personal characteristics will probably become strengthened
and persist over time. If the parents learn to deal with their child in a quiet and relaxed
manner, the child’s demanding irritability may be reduced, and the behavioral demands
in the environment may change.
Bandura’s early view of the social cognitive and triadic reciprocality models is quite
consistent with the most sophisticated contemporary models in the field of developmental
psychopathology, namely the interactional and the transformational models of develop-
ment of maladaptive behavior in children (M. Lewis, 2000). Although triadic reciprocality
and the interactional and transformational models are much too complex to do justice
to within a section of a book chapter, they can be reduced into two points on family
influences relative to child behavior problems that are highly salient for conducting assess-
ments of behavioral, social, and emotional problems: “(1) children have effects on adults
that are equal to adults’ effects on children, and (2) family interactions are understand-
able only when reciprocal influences of parent and children on each other are taken
into account” (Kauffman, 1989, p. 165). Kauffman’s work on this topic predated the
most recent models by nearly a decade and was described as a transactional–interactional
model of the development of child behavior disorders. Likewise, some of the seminal
research and writing on this topic was developed by Patterson and his associates at the
Oregon Social Learning Center (e.g., Patterson, 1982; Patterson, Reid, & Dishion, 1992),
who wrote extensively on the phenomena of reciprocal influences in developmental
psychopathology, particularly antisocial behavior. Their numerous investigations into
the topic for nearly three decades have linked the development and maintenance of child
behavioral and emotional problems to coercive, reciprocal interactions within families.
It takes only a small leap from these examples of parent–child interactions to understand
that human behavior is shaped through complex, mutually influential interactions,
whether it is in the home, school, workplace, or community.
In completing our discussion of triadic reciprocality, it is useful to understand that the
three parts of the triad (personal, behavioral, and environmental factors) are thought
to make differing contributions at various points in time. As Bandura (1986) noted,
“Reciprocality does not mean symmetry in the strength of the bidirectional influences . . .
[and] the triadic factors do not operate in the manner of a simultaneous holistic inter-
action” (pp. 24–25). In other words, there are times when an environmental factor may
become the strongest influence in the reciprocal interaction, and at other times, personal
factors of behavior may become pre-eminent. The important thing to consider is that
each factor may influence and shape the other two in some way.

Observational Learning: A Multiprocess Analysis To conclude this excursion into social

cognitive theory, it is worthwhile to take a brief look at the process of observational
learning. As outlined by Bandura (1977, 1986), observational learning is a model for
8 s Foundations and Methods of Assessment

understanding the learning process in a social context, which is fully compatible with
social cognitive theory and triadic reciprocality. Individuals who have only a superficial
knowledge of observational learning might consider it to be equivalent to simple modeling
or mimicking of behavior, but it is far more comprehensive than such comparisons would
suggest. As Bandura (1986) stated, “Most human behavior is learned by observation
through modeling . . . [but] in skill acquisition, modeling is more accurately represented
as rule learning rather than mimicry” (pp. 47–48).
What are the elements that guide the process of rule learning? Bandura (1986) outlined
five different types of effects that are said to guide the process of modeling. Observational
learning effects include new behaviors, cognitive skills, and standards of judgment that
are acquired through directly observing others. These effects are thought to be stronger
when the behavior observed is novel or unique. Inhibitory and disinhibitory effects
determine how likely it is that a newly learned behavior will be demonstrated. It is more
likely that a newly learned behavior will be performed if a person believes that a positive
outcome will result, and less likely if it is perceived that a negative outcome will result.
Our perception of what is likely or not likely to happen following our behaviors either
inhibits or disinhibits us from performing those behaviors. Response facilitation effects
involve the actions of others as social prompts for us to engage in behaviors we have
learned. Peer pressure, or encouragement, is an example of how a child is prompted to
engage in certain social behaviors. Environmental enhancement effects encompass the
physical circumstances of the environment we have observed in that it will result in
our performing a behavior in a certain way. For example, a child who has observed two
other children fighting on the playground where one child “wins” the fight by throwing
a handful of dirt and gravel into the face of the other might engage in the same behavior
if confronted with a similar conflict situation, primarily because this child observed that
the behavior was successful in the short term. Finally, arousal effects involve the level
of emotional intensity, or arousal, that is elicited in observers. When emotional arousal
is heightened, the form or intensity of ongoing behaviors can be altered; interactions
that might normally result in an argument might result in a physical altercation in an
environment of intense emotional arousal. In sum, these five modeling effects can serve
to instruct, inhibit or disinhibit, facilitate, and enhance the behaviors we engage in,
whether they are prosocial, neutral, or antisocial in nature.
Observational learning also involves four related cognitive processes that help deter-
mine how effectively we are able to learn through observation. According to Bandura
(1986), these four processes work as follows:

1. Attentional processes. Learning will occur through the observational process only if
adequate attention is focused on the event. Humans do not give their attention
equally to all stimuli—we are more focused and attentive if the behavior is novel or
if we consider the model to have high status.
2. Retention processes. Retention processes involve the encoding of the event or
behavior we have observed into our memory. Two major memory systems are likely
to be involved in retention processes: imaginal and verbal.
3. Production processes. This subprocess pertains to our ability to perform the behaviors
we have observed and retained. In this sense, our motor abilities are often involved
and may limit our ability to enact the behavior we have learned. Although virtually
all basketball aficionados would pay careful attention to, and be able to retain, a
 Foundations of Assessment s 9

memory representation of one of basketball phenom LeBron James’s patented

moves to the hoop, few could actually produce the behavior.
4. Motivational processes. In social cognitive theory, there is a differentiation between
learning and performance, as we tend not to enact everything we learn. Whether we
are motivated to enact a newly learned behavior depends mainly on the incentives
we believe are involved. Incentives can be either internal or external and can be
direct, vicarious, or self-produced.

The Importance of Context: Ecological Systems Theory

Social cognitive theory provides a sophisticated model for understanding the development
of human behavior, particularly the development of behavioral, emotional, and social
problems. Like any other theory, social cognitive theory provides a way of considering and
understanding a phenomenon, but it is not and should not be considered all-encompassing.
No single theory can account for all scientific truth. For these reasons, and because I view
the importance of social contexts or environments as extremely critical in children’s
developmental and learning processes, I advocate within this book an additional theory
for framing children’s behavioral, social, and emotional problems: the late psychologist
Uri Bronfenbrenner’s (1977, 1979, 1989) ecological systems theory.
Bronfenbrenner’s ecological systems theory is not a general theory of human behavior
in the same way that behavioral and psychodynamic theories are. Rather, this theory
provides a detailed framework for viewing and understanding the importance of social
systems and contexts in which humans develop and behaviors are learned and exhibited.
Social cognitive theory also includes a strong emphasis on the environment in shaping
the behavior and the person, but does not detail specific aspects of social environment in
a way that may be generalized across settings. For this reason, ecological systems theory
is a highly useful adjunct to social cognitive theory in providing a foundation on which
to understand the development of children’s social–emotional behavior, and to frame
referrals for assessment and intervention.
Originally conceptualized as an ecological theory of child development, Bronfenbrenner’s
model quickly became influential in psychology and human development, and its influence
then spread to the fields of education, family studies, and even business, as it became
adapted and increasingly known as ecological systems theory. The premise underlying this
theory and model is that every child exists within multiple social ecologies or systems,
and that each of these systems may play a key role in the child’s development. Figure 1.2
provides an illustration of major components of the model, which consists of a series of
four embedded circles, each representing a sphere of influence or social ecology.
At the center of the model is the microsystem, which includes the individual child, as
well as his or her immediate environments. The home environment, school environ-
ment, and the immediate neighborhood in which the child resides are usually considered
the most immediate or proximal systems in the child’s life. Moving out from the child’s
immediate environments into broader ecological systems, the mesosystem aspect of
Bronfenbrenner’s model accounts for reciprocal interactions among components of the
microsystem. For example, when a child’s teacher contacts his or her parent regarding
concern over a behavioral or emotional problem and the parent then responds back to
the teacher or school team, a mesosystem interaction has taken place. Similarly, the home
environment and immediate neighborhood in which the child lives may often interact
in a mesosystem manner as the child attempts to make friends, as other children in the
10 s Foundations and Methods of Assessment

Figure 1.2 Components of Bronfenbrenner’s (1977, 1989) ecological systems theory

neighborhood seek out interactions with the child, and as a parent takes steps to promote
desirable interactions and to protect the child from negative or potentially dangerous
interactions. The exosystem aspect of ecological systems theory makes up the third level
of the model and moves out from interactions within aspects of the child’s immediate
environment to include the social context in which these immediate environments
operate. For example, the broader school system outside of the child’s own classroom,
the type of community in which the child’s family lives, a parent’s workplace, and the
extended family system of relatives who do not live with the child’s immediate family all
could be considered to be part of the exosystem. These exosystem components shape the
more immediate aspects of the child’s environment in many direct and subtle ways. For
example, a child whose family lives in a highly religious community will be exposed to
certain norms, values, and behavioral expectations that will differ somewhat from those
of a family living in a highly secularized community. Likewise, a child raised in a general
community culture where violence and gang activity is normative will be impacted at an
exosystem level in a much different way than a child who is raised in a safe and peaceful
environment.
Finally, the fourth level of the model is referred to as the macrosystem. The outermost
layer of the circle reflects the broad cultural context in which the exosystem, mesosystem,
and microsystem operate. The general values, beliefs, customs, laws, and resources of the
society or nation in which the child lives influence the child’s development indirectly.
This process occurs by shaping the ways that the more inner systems function, as well
as the priorities and values that are promoted within these systems. For example, a child
living within the United States not only will receive some basic training in traditional
aspects of American citizenship and democracy in school and in the community, but also
will likely be exposed to the normative values of individualism, consumerism, pursuit of
self-interests, justice, and perhaps even hedonism through exposure to popular culture,
media, and the other broad influences that stem from the macrosystem.
Because all children exist within multiple social contexts and because requests for
assessment and intervention for children with behavioral, social, and emotional concerns
all stem from one or more of these contexts, ecological systems theory is an invaluable
contribution. When considered in conjunction with social cognitive theory, this ecological
systems theory adds to the foundation for understanding child and adolescent behavior,
 Foundations of Assessment s 11

and it is considered throughout this volume as the process of assessment of behavioral,

social, and emotional problems.

Finding Your Own Theoretical Foundation

In sum, although there are many competing theories on the development of human
behavioral, social, and emotional problems, social cognitive theory, ecological systems
theory, and related contemporary models of developmental psychopathology have
many advantages for conceptualizing and assessing child and adolescent behavioral and
emotional problems. These theories are especially emphasized in this book. Social cogni-
tive theory and ecological systems theory offer sophisticated and relevant frameworks
for conceptualizing the referral problems and treatment issues in assessing children and
adolescents. Although it is not necessary to adopt these theories (or any other theoretical
approach) wholesale in order to conduct technically adequate assessments, using the
approaches that are a foundation for this book will provide a basis for understanding
and will allow for better conceptualization of referral problems and for dealing with the
assessment–intervention process in a cohesive manner.
The intent of this section has been to illustrate the importance of having a solid
theoretical foundation for assessment. It has been my experience that the integrated
development of theory and philosophy as a foundation for assessing and treating human
behavior is increasingly being ignored or minimized in graduate training programs
in professional psychology and related mental health fields. The generic umbrella of
“eclecticism” in selecting treatment techniques has some merit but is often used as a
substitute for putting any serious thought into the development of a personal and
professional framework for conceptualizing child and adolescent social and emotional
behavior. What many graduate students and professionals do not fully comprehend
is that the move toward pragmatic eclecticism in selecting appropriate treatment
modalities—which may be appropriate in many instances—does not replace having a
solid theoretical foundation for conceptualizing how problems begin in the first place.
Without an underpinning theoretical framework for conceptualizing behavior, the
professional who conducts the assessment moves out of the scientist–practitioner mode
and relegates his or her conduct to the role of technician.
Social cognitive theory, ecological systems theory, and the compatible interactional
and transformational models of developmental psychopathology constitute my personal
choice of theoretical foundations and are emphasized throughout this book. Despite the
value and appeal of these theories for professionals conducting child and adolescent
assessments, it is understood that they will not fit equally as well with all professionals.
Readers are strongly encouraged to think seriously about their own views on human
behavior and to adopt and develop an appropriate and congruent underlying theoretical
framework to guide their practice. The benefits of taking such a step are many.

PHILOSOPHICAL FOUNDATIONS OF ASSESSMENT

Not only is it desirable to approach the assessment process firmly grounded in theory,
but it is also important to understand the philosophical foundations on which assessment
practices are conducted. One philosophical issue that is important to understand, to
become truly educated in psychological and educational assessment, is the difference
12 s Foundations and Methods of Assessment

between nomothetic and idiographic approaches to scientific inquiry, how these constructs
have been adopted into assessment, and how the convergence of the two approaches in
assessment is increasingly being viewed as desirable. Many professionals who specialize
in assessment have heard these terms, but few have gone beyond a cursory discussion to
acquire an understanding of how they came to be and have influenced assessment. This
section provides a brief excursion into the meaning of this issue and ends with a discussion
of the empirical approach to assessment, a more modern conceptualization of inquiry in
this area.

Nomothetic and Idiographic: Definitions and Historical Development

The issue and controversy regarding nomothetic and idiographic approaches to inquiry
were examined in detail in two key articles in a special issue on this topic of Theory and
Psychology Journal (Lamiell, 1998; Mos, 1998). The two seemingly dichotomous terms
were first introduced by the German philosopher of science Wilhelm Windelband in
1894, as an attempt to define the differences between two seemingly opposite methods of
scientific inquiry, during an era when the use of statistical methods and data aggregation
was increasingly supplanting traditional methods of inquiry. According to Windelband,
the nomothetic approach to inquiry (sometimes referred to as nomological) involved the
development of general scientific laws through finding similarities among phenomena:
the abstract, the universal, and the general. The idiographic approach to inquiry was
viewed as the opposite of the nomothetic approach. Windelband’s view of idiographic
inquiry was that it was concerned with identifying the uniqueness of a phenomenon: the
concrete, the individual, and the unique.
Beginning in the early twentieth century, Windelband’s nomothetic–idiographic
dichotomy was extremely influential in shaping and articulating methods of epistem-
ology or inquiry in numerous scientific fields. Psychology was no exception. In practice,
the use of statistical aggregration, psychometrics, population means, and prediction
through general trend analysis became associated with the nomothetic approach to
psychology, whereas the use of single case design, ecological analysis, qualitative and
informal description, and case studies became associated with the idiographic approach
to psychology. The issue was popularized and became the point of much discussion in
psychology with the publication of Paul Meehl’s (1954) book, Clinical versus Statistical
Prediction. In this book, Meehl argued that clinical judgment (which he viewed as idio-
graphic) was a poor substitute for quantitative or actuarial prediction based on objective
data (which he viewed as nomothetic). According to Barnett and Zucker (1990), nomo-
thetic approaches to assessment focus on actuarial and quantitative data, objective tests,
and statistical prediction. Idiographic assessment in the social–emotional behavior
domain focuses more on individual and qualitative data, projective tests, and clinical
judgment. In the behavioral assessment domain, the use of single-subject data collection
and research designs is often considered to be idiographic in nature.

Nomothetic and Idiographic Approaches in Practice

The conflicting opinions that have fomented controversy over the years regarding
nomothetic versus idiographic approaches to assessment are unfortunate because they
tend to mask two important issues. First, when Windelband introduced the terms in
1894, he was positing them as diverging ways to approach scientific inquiry in general and
was not superimposing them on the fields of psychological and educational assessment,
 Foundations of Assessment s 13

which for all intents and purposes did not yet exist in its present form. It was many years
later that these terms were connected to assessment. Much of the flack regarding
nomothetic versus idiographic assessment is a product of the two terms being adapted
beyond their original scope and intent (Lamiell, 1998; Mos, 1998). It might be argued
that pitting the two approaches against each other in terms of which is “right” is an
arbitrary act that fails to grasp the rich historical context in the philosophy of science and
epistemology from which these notions originated.
In reality, most clinicians who practice assessment of children in educational and
psychological service settings comingle the nomothetic and idiographic approaches to
inquiry on a routine basis, without giving the matter a second thought. Consider a child
who is referred to a child study team in a school setting because of concerns regarding
his or her behavioral and emotional adjustment. In the comprehensive social–emotional
assessment that is ultimately conducted, the team uses a combination of direct behavioral
observation, behavior rating scales, interviews, and self-report instruments to gather
information. Because the focus is on the unique individual needs of the child, it could be
viewed as idiographic. In conducting the observation, the specific and unique behaviors
of the child within particular environmental contexts are recorded, which might be
viewed as idiographic, but the child’s behavior is contrasted with that of social comparison
peers, seeking some normative generalizations in a nomothetic manner. The behavior
rating scales and self-report instruments involve normative comparisons of the child’s
obtained scores with those of standardization samples, and T scores and percentile ranks
are calculated, which is a nomothetic procedure. The team also carefully looks at the
specific items from these instruments, inspecting them qualitatively to seek further
understanding of the child, without respect to the normative aspects of such consideration.
This approach is certainly idiographic in nature. Skilled and theoretically astute assess-
ment professionals routinely seek to understand children’s behavioral and emotional
functioning using both means of inquiry to satisfy unique questions. There is typically
no need to break into opposing camps on this issue, which in my view reflects a short-
sighted lack of understanding of the philosophy of science and the maturation of
psychological and educational assessment.

The Empirical Approach to Assessment

A construct that has been articulated in recent years within the area of psychological
evaluation and measurement is the “empirical approach” to assessment, sometimes
referred to as empirically based assessment. Similar to our discussion on nomothetic and
idiographic approaches to assessment, it is useful to consider this term further because of
its increasing influence. It might be argued that the empirical approach to assessment
is most consistent with nomothetic rather than idiographic inquiry, but from a historical
perspective this single alignment is questionable, and empirically based assessment is
compatible with the idiographic approach.
The term empirical originates from the Greek word empeiria, which refers to experi-
ence (Achenbach, McConaughy, & Howell, 1987). Empirical data are based on experience
or observations and can be proved or disproved through direct experimentation or
observation. In Achenbach, McConaughy, and Howell’s conceptualization of empirical
assessment, this approach “follows psychometric principles, including the use of stand-
ardized procedures, multiple aggregated items, normative-developmental reference
groups, and the establishment of reliability and validity” (p. 16). In this book, empirically
14 s Foundations and Methods of Assessment

based assessment is a major focus because it is defensible, replicable, and, when used
correctly, holds to high standards of scientific inquiry. Although the scope of this book is
broad, particular emphasis is placed on using assessment methods and procedures that
are more direct and objective in nature, and compatible with the notion of empirically
based assessment.

UNDERSTANDING AND CLARIFYING ASSESSMENT REFERRALS

Any professional with experience in assessing children would agree that referrals for
assessment come in a wide variety of dimensions. Sometimes the pervasive nature of the
problems leading to the referral make one contemplate why the referral did not happen
earlier. At other times, the character of the stated referral issue seems so benign as to
make one consider if there was truly a need for it in the first place. What these disparate
examples illustrate is that in order to conduct a sound assessment, the reasons for referral
and circumstances leading up to the point of referral first must be carefully analyzed and
explored.
Almost every child, at some time, will exhibit behavioral, social, or emotional problems
that are serious enough to cause some concern for their parents or teachers, but only a
few of these problems will ultimately result in a referral for assessment or treatment.
What are the factors that result in behavioral, social, or emotional problems being taken
to the point of referral?
In contrast to adult mental health clients, who are typically self-referred, children and
adolescents are usually referred for assessment by someone else, such as a parent or teacher.
It is common for referred children and adolescents not to recognize or admit that their
perceived problems exist and not to understand fully why the assessment is happening in
the first place. Knoff (1986) suggested that referrals for social, emotional, or behavioral
assessment are often “the result of a perceived discrepancy between the referred child’s
behaviors, attitudes, or interpersonal interactions . . . and some more optimal level desired
and defined by the referral source” (p. 4). The basis of these discrepancies is thought to
stem from differing perspectives that define the referral source’s idea of what constitutes
acceptable and unacceptable social–emotional behavior. As we see herein, this notion is
very consistent with the notion of ecological systems.
Knoff (1986) postulated three specific perspectives that influence referral decisions
and that have direct parallels within ecological systems theory. They include the socio-
cultural perspective, the community subgroup perspective, and the setting-specific perspective.
These three perspectives are as relevant today as when they were first proposed. The socio-
cultural perspective involves the broad environment within a community: generalized
precepts regarding what constitutes acceptable and unacceptable ways of behaving that
are pervasive at most levels within a given community or society. This notion is akin to
the ecological systems concept of a macrosystem. A child or adolescent who is referred
because of a discrepancy related to this perspective would likely be exhibiting behaviors
that are in opposition to overall societal standards. Community subgroup perspectives
are shaped by smaller groups within a community—religious organizations, neighbor-
hoods, and specific cultural or ethnic groups. This notion is akin to the ecological systems
concept of an exosystem. Referrals that are related to discrepancies from this perspective
may involve behaviors or attitudes that are unacceptable within one subgroup but may be
 Foundations of Assessment s 15

acceptable within another. For example, adolescents who listen to musical forms of expres-
sion that are lyrically violent in content—such as some forms of rap, heavy metal, or
punk—may adopt attitudes based on these forms of expression that may cause consider-
able concern within some community subgroups but go almost unnoticed within others.
The setting-specific perspective involves social behavioral norms that are distinctive to
individual settings, such as specific families and classrooms; what is tolerated as normal,
by some parents or teachers, may be totally unacceptable to others. The setting-specific
perspective is closely akin to the ecological systems notion of a microsystem.
The essential point to consider in analyzing referrals from these various perspectives
or ecological systems is that all three are interdependent. One cannot focus singly on
a given perspective without taking into account the others. A child who comes from a
family background in which there is open disrespect or contempt for a general societal
standard, such as law and order, may reject typically accepted standards of behavior in the
school or community, while maintaining solidarity with the standards set within his or
her family. In contrast, a child whose family has recently immigrated from a distant part
of the world might adopt typical values of his or her new host culture that create dissension
within the family but are hardly cause for notice within the school or larger community.
It becomes the job of the clinician to examine the reasons for referral carefully and
how these reasons relate to the three basic perspectives. In some cases, referrals may need
to be refused as being improper, or at least carefully considered and discussed before
proceeding. In other cases, the referral may need to result in a complete assessment to
determine to what extent behavioral, social, or emotional problems are present.

ASSESSMENT AS A PROBLEM-SOLVING PROCESS

Given that assessment is one of the primary activities of many psychologists and other
education/mental health practitioners, it is surprising that until recently so little attention
has been paid to identifying and clarifying the purposes of assessment. There are
many specific potential purposes, such as problem clarification, diagnosis, classification,
intervention planning, and intervention evaluation. Despite the wide array of complex
purposes associated with assessment, some practitioners and administrators continue
to view assessment as being synonymous with testing. In reality, these two activities are
related but are not necessarily the same. Testing is the process of administering and
scoring tests, whether simple or complex. Within the most narrow interpretation of
the process, testing can become a means and an end, a nearly self-contained activity.
Assessment is clearly superordinate to testing. Assessment, in the broad view, is a process
whereby information is gathered regarding a specific problem or issue. This information-
gathering process may also involve testing, but not out of necessity. A crucial aspect of
the broad view of assessment is that it is a means to an end, rather than an end itself.
Ideally the end result of assessment is to gather information that may be used to help
solve specific problems.
A few attempts have been made to develop models of assessment as a problem-solving
process. Sloves, Docherty, and Schneider (1979) proposed a scientific problem-solving
model of psychological assessment that consisted of three basic elements: a six-step
problem-solving process, levels of organizational action, and methods. The purpose of
this model was to help differentiate the practice of psychological assessment, as a process
16 s Foundations and Methods of Assessment

of problem solving, from testing, as one set of methods for problem solving. In a similar
vein, Nezu (1993) delineated a conceptual model of assessment based on a problem-
solving framework, whereby the clinician is considered the problem solver, and the
problem to be solved is the discrepancy between the client’s current state and desired state.
Both of these model-building attempts are laudable, as are other attempts to promote
assessment as a broad problem-solving process. Yet the reality of the situation is that none
of these models fully integrates the assessment of social and emotional behavior of
children and adolescents into a comprehensive problem-solving process.

A Model for Assessment as a Problem-Solving Process

It is my view that school psychologists, clinical child and adolescent psychologists,
and professionals in related disciplines, should approach their respective roles as data-
oriented problem solvers. For an important historical perspective of this concept of
data-oriented problem solving, see Gray (1963), and for more current perspectives, see
Deno (1995), Merrell, Ervin, and Gimpel (2006), Walser (2009), Sugai & Horner (2009),
and Horner et al. (2015). Given the importance of viewing assessment as part of a broad
problem-solving process and the lack of an adequate theoretical model for viewing social–
emotional assessment in this regard, I have proposed a four-phase model of assessment as a
problem-solving process. Rather than composing a general problem-solving model, Merrell
developed this model (which is illustrated in Table 1.1) to be specifically relevant to the
problems inherent in assessing social and emotional behavior of children and adolescents.
This model is broad enough in its scope, however, that it can easily accommodate other
applications of assessment. This model is based on the premise that within four basic

Table 1.1 A model for assessment as a problem-solving process

Phase I: Identification and clarification

Who is the client (or who are the clients)?
From the client’s perspective, what is the problem?
What is the intended purpose of the assessment?
Phase II: Data collection
What information is needed?
What assessment methods, procedures, and tests will best provide this information?
Which of the potential means of gathering information are most appropriate for this specific client,
problem, and situation?
Phase III: Analysis
Does the assessment information confirm the problem?
What other information do the assessment data provide regarding the problem?
How can the assessment information be used to answer specific referral questions?
What are the factors that appear to contribute to the problem?
Is there any missing assessment information that is needed to help analyze this problem?
If so, how can it be obtained?
Phase IV: Solution and evaluation
Based on all the available information, what should be the target for intervention? What behaviors
should be increased/decreased?
What appear to be the most appropriate types of intervention?
What resources are available to implement the intervention?
Which means of assessment can be used to collect data continuously during intervention?
Which means of assessment can be used to evaluate the effectiveness of the solution?
 Foundations of Assessment s 17

phases of assessment, a series of essential questions can guide assessment practice into
appropriate actions so that assessment truly becomes an integral part of an overall process
of data-oriented problem solving. It is congruent with Deno’s position that assessment
practices have an important role to play in a comprehensive problem-solving orientation
to service delivery, which includes three basic elements: formulating the problem,
generating and selecting potential solutions, and testing the selected alternatives.

Phase I: Identification and Clarification The first phase is identification and clarification.
In this phase, it is crucial to answer some basic questions that will lead to articulating
clearly the purpose of assessment. First, it is essential to identify who the client is. In
reality, this identification is often complex. We all would agree that the referred child or
adolescent is the client, but it also is likely the referral agent, such as a parent or teacher, is
the client as well, given that the person has a specific interest in the outcome of the assess-
ment. Determining who is the client is sometimes a challenging task, given that there may
be multiple interests involved, and that the specific source and setting of the referral may
dictate who is the primary client. Second, it is crucial to delineate clearly what the problem
is from the client’s perspective. Sometimes the perceived problem is anything but straight-
forward, and there may be multiple problems from the client’s perspective. Third, the
clinician must identify what is the intended purpose or purposes of the assessment.
It is possible that there will be more than one purpose, such as diagnosing the problem,
determining eligibility for specific services, and helping to develop a plan of intervention.

Phase II: Data Collection The second phase of the model is where the assessment data
are gathered. Rather than mindlessly gathering information through administration of a
standard battery of procedures that is the same for everyone, the data-oriented problem
solver will let the purposes of the assessment and the characteristics of the client and
problem guide the selection of assessment procedures. First, it is essential to identify
clearly what information is needed. Second, one should determine which assessment
methods, procedures, and tests will best provide the needed information. Third, after
some basic decisions have been made regarding what information is needed, the clinician
should analyze carefully the specific nature of the client, problem, and situation, to deter-
mine whether some means of information gathering may be more appropriate than
others. For example, if the main referral issue is inattentive and hyperactive behavior
problems, it would make sense to select a behavior rating scale for completion by parents
or teachers specifically designed to evaluate the characteristics of attention deficit hyper-
activity disorder (ADHD). In some cases, there also may be evidence of co-occurring
conduct problems, such as aggressive and antisocial behavior. In the latter situation, a
broad-band externalizing behavior problem rating scale would be a better choice than
a scale designed solely to evaluate ADHD characteristics.

Phase III: Analysis In the third phase of the process, the obtained assessment data are
analyzed in detail. Some of the questions that may be most useful in guiding this process
involve whether the data confirm the problem or what other information the data provide
regarding the problem, how the data can be used to answer specific referral questions,
what other factors seem to be contributing to the problem, and what, if any, assessment
data are missing. If there is necessary assessment information that is missing, the clinician
also must ask if this information can be obtained and, if so, how.
18 s Foundations and Methods of Assessment

Phase IV: Solution and Evaluation The final phase of assessment as a problem-solving
process is perhaps the most difficult—using the obtained assessment information to
develop a solution to the problem and, ultimately, to evaluate the effectiveness of
the solution. First, the main targets for intervention should be selected, based on all the
available information that has been obtained. Second, the most appropriate types of
intervention for these targets should be identified, as should the potential resources for
implementing such intervention. These second and third questions in the phase should
guide the development of a specific intervention plan. The fourth and fifth questions in
the phase are often overlooked but should be considered essential if assessment will
truly result in problem solving. When an intervention plan has been developed, it is also
essential to consider how data can be collected continuously during the intervention to
help determine whether the desired effect is occurring. This type of continuous data
collection is closely linked to the process of formative evaluation, or making decisions
that will guide instruction or treatment practices on an ongoing basis. Finally, it is often
appropriate to use assessment procedures to assist in summative evaluation, to determine
whether or not the intervention has produced the desired changes after it has been
implemented.
This proposed model represents a practical, common-sense approach to assessment
as a broad process for solving problems. Other models, including models developed
individually by clinicians to serve their own purposes, may have the same effect. Regardless
of which specific questions are asked or what specific theoretical approach is used to
guide the assessment, readers of this book are urged to approach assessment from a broad
perspective that is a means to an end, rather than a simple testing perspective where the
means becomes an end, or where the end purpose is never clearly defined.

DESIGNING A MULTIMETHOD, MULTISOURCE, MULTISETTING

ASSESSMENT
Since about 1980, there have been significant advances in the research and technology base
for conducting assessments with children and adolescents. One of the major develop-
ments has been the articulation of a model for a broad-based assessment design. The
essential feature of this model is that by using various assessment methods with different
informants or sources and in several settings, the amount of error variance in the assess-
ment is reduced, and the result becomes a comprehensive representation of the referred
child or adolescent’s behavioral, social, and emotional functioning. This type of broad-
based assessment design has been referred to by various names, including multisetting–
multisource–multi-instrument assessment (R. P. Martin, 1988; R. P. Martin, Hooper,
& Snow, 1986) and multiaxial empirically based assessment (Achenbach et al., 1987).
Although there are some differences between the way these different models have been
articulated, the crucial feature of obtaining assessment data on an individual by using
many different instruments, methods, sources, informants, and settings remains the
same.
To represent the type of broad-based assessment that was just described, I prefer the
term multimethod, multisource, multisetting assessment, particularly when considering
the domain of behavioral, social, and emotional assessment of children and adolescents.
Figure 1.3 is a graphic representation of the model.
As an example of how a multimethod, multisource, multisetting assessment might be
conducted in actual practice, let’s look at the hypothetical case of a child who is referred
to a clinic setting because of a variety of behavioral and emotional problems. In terms of
 Foundations of Assessment s 19

Components of Assessment

Methods Sources Settings

Direct Observation The Child or Home
Adolescent Client
Behavior Rating Scales School
Parents
Interviews Other Family Members Clinic
Teachers
Records Reviews Other School Personnel Play
The Peer Group
Sociometric Assessment Community
Community-Based
Self-Report Measures Informants

Figure 1.3 A model for multimethod, multisource, multisetting assessment practice

method, it probably would be desirable to include behavioral observation, interviews,

rating scales, and self-report instruments as part of the assessment. Within each method,
a variety of instruments or specific techniques should be used when possible. In the event
that the child was experiencing social adjustment problems and there was easy access
to a social group (i.e., school or playground) for assessment, it also might be desirable
under some circumstances to gather sociometric assessment data. In terms of source, it
would be necessary to gather assessment data from the client and his or her parents at a
minimum, and if possible, it would be desirable to include other relevant sources who
know the child, well as informants. These other sources might include school personnel,
other family members, and community-based individuals such as clergy and youth group
leaders. In terms of setting, clinic, home, and school, would be included in an optimal
assessment and, when feasible, community-based and play settings.
In reality, it is often difficult to include all of the possible relevant sources and settings,
and it is sometimes a problem even to include more than a couple of methods. The main
point to consider in this regard is that as the assessment becomes more diverse and
broad-based, an aggregated picture of the child’s behavioral, social, and emotional func-
tioning is obtained. Such an assessment design is considered to be a best practice that has
the possibility of reducing error variance and providing a more comprehensive picture
of the child.
Some caution is warranted in considering the possibilities and advantages of an aggre-
gated multimethod, multisource, multisetting assessment. Although the vast majority of
current professional thinking purports that such a design is a best practice and the most
sophisticated way of implementing the assessment, there has historically been some
divergence of opinion here, primarily stemming from research that was conducted in
the 1980s, among experts in the field of child and adolescent psychopathology (e.g.,
Arkes, 1981; Loeber, Dishion, & Patterson, 1984; Reid, Baldwin, Patterson, & Dishion,
1988; Wiggins, 1981). Some of these researchers presented persuasive arguments that in
specific cases, aggregated multiple assessment data may increase error variance because
of covariation among different assessment sources and the inability of clinicians to aggre-
gate effectively assessment data that are contradictory. This argument is compelling and
interesting and is, at least partially, the impetus behind efforts that advocate sequential
or multiple gating approaches to assessment, which are reviewed in Chapters 3 and 14.
20 s Foundations and Methods of Assessment

Even some experts who advocate the aggregated multiple assessment model (e.g.,
Achenbach & Edelbrock, 1984) have acknowledged this possibility.
So, in light of these contradictory arguments, what is the best clinical practice? The
position advocated throughout this book is that the informed and judicious use of an
aggregated multiple assessment model is almost always the best practice for general
social–emotional assessment of children and adolescents. Clinicians and researchers
need to be informed, however, of the potential liabilities of their assessment design. In the
meantime, additional empirical evidence on this assessment issue would be helpful in
assisting those in the child and adolescent assessment field articulate a state-of-the-art
assessment model. Because most of these contradictory arguments on assessment design
are theory based, but not yet empirically validated, being aware of positions and their
possibilities seems to be a prudent step at the present time.

RESPONSE TO INTERVENTION (RTI): A PUBLIC HEALTH APPROACH

TO ASSESSMENT AND INTERVENTION
During the past decade there has been much interest in adapting models that were
originally developed within the field of public health into the realm of education and
mental health services for children and adolescents. The general idea behind the public
health approach is that the delivery of services should be carefully planned so that all
individuals within a population receive some benefit, not just those who have intense
needs (Costello & Angold, 2000; Merrell & Buchanan, 2006). Such an approach presumes
that there will always be a need to deliver intensive, individualized services to those
individuals with intense needs, but by planning for prevention and early intervention
services to those individuals with lower levels of current need, latent and emerging
problems may be prevented or diminished, thus reducing the percentage of individuals
who develop intense or serious problems. This approach is well worth considering in
planning for social–emotional assessment and intervention services.
The best known adaptation of the public health approach into educational and
children’s mental health services is the “triangle of support” model (e.g., T. J. Lewis &
Sugai, 1999; Walker et al., 1996), which is presented in Figure 1.4 with adaptations to
illustrate how a comprehensive service system might work when focused on school-based
services for children and youth with behavioral and emotional problems.
This figure is well-aligned with Response to Intervention (RtI) models that profession-
als are currently using to address school-based academic assessment and support (Fuchs
& Fuchs, 1986). At the bottom of the triangle is the Universal level of support, which
includes universal screening, prevention efforts, well-articulated schoolwide discipline
practices, and a system of effective behavioral support that extends to all students within
a school. Assessment at this level consists of brief screening practices that are designed
to narrow a population into “good suspects” rather than provide an in-depth evaluation
of individual characteristics. The roughly 80% of students in a typical school who do not
exhibit significant behavioral or emotional problems will benefit from basic instruction
and management strategies, as will those who exhibit more significant challenges. Effective
services at the Universal level will have the result of decreasing the number of students at
the more intense support levels, and will provide a basis for healthy behavioral, social, and
emotional adjustment among all students. The bottom of the triangle is associated with
 Foundations of Assessment s 21

In~ated Support Intervention

Assessment Indicated Individualized
5% Tertiary Interventions
Comprehensive Indi vidual Assess ment
Prevention Assessment-Based
High-Risk Multi- Method , Source, an d Setting Design
Students Individual Student Services
Protect ive and Risk Factors, Individual, Family,
with Intense Special Education/lEP
,and Com mun ity Characterist ics Wraparound Service System
Problems

Targeted Support'
Brief Funct ional Assessment
15% School Records Review Targeted Specialized
Secondary Interventions
Behavior Rating Scales
Students At Risk Prevention Classrooms and Groups
for Negative Behavioral and Specialized Skills Training
Emotional Outcomes Mentoring
Increased Support

Un iversal Screenin g
Universal Support Teacher Nomination
Brief Screening Tools
Universal Interventions
80%
Primary School-Wide (behavior support)
Students Who Do Not Exhibit Prevention Prevention Curricu la
Significant Behavioral or Emotional Problem~
Social Skills Training
Positive School Climate

Figure 1.4 A public health approach, “triangle of support” model for students with behavioral and emotional problems

the public health notion of Primary Prevention, or maintaining health and preventing the
development of problem symptoms.
The middle of the triangle details Targeted support, which is aimed at the approxi-
mately 15% of students in a typical school who are considered to be “at risk” for negative
behavioral or emotional outcomes, and who will likely benefit from being identified
using more specific assessment procedures, which would enable them to be the focus
of prevention and early intervention strategies delivered in groups or classrooms.
Assessment at the Targeted level might consist of brief functional assessments, school
records reviews, and behavior rating scales—relatively low-intensity procedures that can
yield some useful information about individual students who are considered to be at risk
for developing intensive problems. Assessments at this level are also used to monitor the
progress of students receiving targeted intervention support. The middle of the triangle
reflects the public health notion of Secondary Prevention, where the goal is to prevent
developing problems from worsening into intense needs or disorders.
The top of the triangle focuses on Indicated support and reflects the estimated 5%
of students within a typical school who are at very high risk in terms of behavioral and
emotional functioning. These students should be carefully identified through compre-
hensive individual assessment and provided with intensive, individualized interventions.
For some of these high-risk students, special education services under the emotionally
disturbed, autism, or Other Health Impaired classification categories of Individuals with
Disabilities Education Improvement Act (IDEIA) will be appropriate. Students at the
22 s Foundations and Methods of Assessment

“top of the triangle” should be provided with a range of services and progress monitoring
well beyond that which students at the lower levels of support require. Within public
health terminology, individuals who exhibit such intense needs are served within a
Tertiary Prevention framework, where the goal is rehabilitation or reduction of current
levels of problems.
Figure 1.4 indicates the basic notions of the triangle model and also illustrates how
screening and assessment activities might be tied to each level of the triangle, and
how primary, secondary, and tertiary prevention activities and progress-monitoring
activities might be put into place following initial screening and assessment. Education
and mental health professionals are urged to consider this public health approach as a
viable way of planning for assessment and intervention services so that the percentage
of a population with intense problems is kept to a minimum, and so that systems of
service are put into place to prevent most children and youth from developing notable
behavioral and emotional problems in the first place. In an era when the percentage of
children and youth who are considered to be at risk is increasing, and where availability
of specialized mental health and educational services is remaining static or shrinking,
using the public health approach makes sense on many levels.

LEGAL AND ETHICAL ISSUES IN ASSESSMENT

Although a truly comprehensive overview of the legal and ethical issues in assessment is
beyond the scope of this book (for more complete discussions of the topic, see DeMers,
1986; Jacob, Decker, & Hartshorne, 2011; Messick, 1988), it is useful to take a brief look
at some of these issues that are particularly relevant for assessment of behavioral, social,
and emotional problems. By definition, legal issues involve aspects of assessment that are
affected by either constitutional or statutory constraints. Ethical issues do not always
involve legal constraints, but rather what is considered to be “right” professional practice,
as dictated by the codes for ethical conduct developed by professional organizations,
such as the American Psychological Association (APA), National Association of School
Psychologists (NASP), and American Counseling Association (ACA). Although it is
sometimes possible to separate law from ethics, in reality, the two areas are intertwined.
Legal constraints affecting assessment practices often have been developed from the basis
of professional practice codes, and these codes of ethics for professionals typically take
into account important legal constraints that affect the profession.

The Basis for Legal Constraints on Assessment

According to DeMers (1986), there are two basic ways that testing and assessment
practices can be affected by the law. The first means of jurisdiction involves constitutional
protections to citizens. In this regard, the equal protection and due process clauses from
the 14th Amendment to the U.S. Constitution are the areas most likely to constrain
assessment practices, particularly if the individual conducting the assessment is employed
by the “state” (e.g., public school districts, corrections agencies, hospitals, clinics). The
14th Amendment “was created to prevent state governments from trespassing on
the rights of individual citizens” (Jacob et al., 2011, p. 29). The equal protection clause of
this amendment forbids the state to treat, in a different manner, the persons who are
similarly situated, unless there is a justifiable reason. Examples of assessment practices
 Foundations of Assessment s 23

that would violate the equal protection clause are those that result in members of a
specific gender or racial/ethnic group receiving inferior assessment, classification, or
treatment services (i.e., the use of an assessment procedure that was systematically biased
against a particular group). The due process clause of the 14th Amendment was designed
to prevent “the government from denying life, liberty, or property without (1) a legitimate
reason, and (2) providing some meaningful and impartial forum to prevent arbitrary
deprivations of those protected interests” (DeMers, 1986, p. 37). Property and liberty
interests have been defined broadly through many U.S. Supreme Court decisions—the
concept of liberty is now thought to encompass rights to privacy, personal security, and
reputation. In the assessment process, many activities potentially could infringe on liberty
rights, including the actual conducting of the assessment and the writing and maintaining
of confidential assessment reports.
The second way that assessment practices can be affected by law involves various
statutory provisions that may be invoked at the state and federal levels. These types of
legal constraints typically do not directly involve constitutional provisions but consist
of the passage of specific laws by legislative bodies that are considered to be useful in
governing professional practices. At the state level, laws for licensing of professional
psychologists and other service providers usually contain specific regulations pertaining
to who can provide services, how privileged information and confidentiality must be
handled, and to what extent clients must be informed of the procedures they might
become involved in. Another example of state-level law that affects assessment practices
would be school law, in which specific procedures and safeguards governing consent
for assessment and release of assessment records are often included. At the federal level,
assessment practices in school settings may be affected by the IDEIA, the Family
Educational Rights and Privacy Act (FERPA), and the Every Student Succeeds Act (ESSA).
The IDEIA and FERPA both contain provisions relating to parental access to student
records and release of records to third parties. The IDEIA also contains provisions for
selection of appropriate assessment instruments and procedures. ESSA does not include
extensive provisions governing the specifics of social–emotional assessment practices,
but does require that school districts employ “school-based mental health services pro-
viders” and “specialized instructional support personnel” who are involved in assess-
ment. Further, ESSA requires that states report data on the status of school climate and
bullying in annual reports, and that in addition to academic performance indicators,
states include another indicator of school quality (e.g., school climate, student engage-
ment) as part of its accountability plan (NASP, 2016).

Specific Assessment Practices Affected by Ethics and Law

To be more specific about how social–emotional assessment practices can be affected
by legal and ethical constraints, we can identify three distinctive areas that have been
addressed in this realm: informed consent, validity of assessment procedures, and right to
privacy/confidentiality. These areas are discussed in this section, with specific comments
regarding assessment practices with children and adolescents.

Informed Consent The area of informed consent is broadly construed to mean that
before any assessment services are conducted, the client (and/or parent or guardian,
in the case of a minor) must receive a sufficient explanation of the purpose and nature
of the procedures that will be done and the risks involved, if any, and must give their
24 s Foundations and Methods of Assessment

express consent for participation. Informed-consent regulations are a major feature of

the due-process stipulations in the IDEIA. Within the regulations of IDEIA, there are
three components: knowledge (parents are to be given a complete explanation of the
purposes and procedures of the assessment), voluntariness (consent is willfully granted
and not obtained through coercion or misrepresentation), and competence (parents
must be legally competent to give consent, which is usually assumed by school officials).
Even when psychologists or other professionals are engaging in assessment activities
outside the scope of the IDEIA, there are similar ethical expectations for using informed-
consent procedures, as indicated by the APA’s Ethical Principles of Psychologists and
Code of Conduct (APA, 2010) and the NASP’s Principles for Professional Ethics (NASP,
2010).
For many years, the concept of informed consent, as applied to children and adolescents
in the United States, was relatively straightforward and uncomplicated; it traditionally
has been assumed that parents or guardians were the ultimate holders of the informed-
consent right and that the child or adolescent played a secondary role in this process,
if any at all. In recent years, evolving ethics and values in society and some new legal and
philosophical concepts have begun to put a new spin on how informed-consent issues
should be handled with minors. Legally speaking, the right of informed consent still
belongs to parents or guardians of minors, especially when considering service delivery
under specific systems and laws, such as the IDEIA. In legal circles, however, the
static nature of informed consent for children and adolescents has been increasingly
challenged by a gradually evolving concept that is sometimes referred to as the mature-
minor doctrine. The basis of this doctrine is that decisions regarding competence and
consent should be made on the basis of cognitive capacity (and perhaps emotional
maturity) and not age (Hesson, Bakal, & Dobson, 1993; Shields & Johnson, 1992). An
adolescent who is intellectually advanced and possesses reasonable emotional maturity
might be allowed in some circumstances to provide his or her own informed consent,
even without prior parent notification. The most likely situations in which adolescents
may give informed consent are when they voluntarily seek mental health treatment,
which does not necessarily fall within the realm of IDEIA and parental rights to informed
consent. This concept is still evolving, however, and is certainly at odds with several
sectors of society that are seeking to increase parental empowerment in decisions
regarding their children. Until the mature-minor concept becomes widely recognized and
better defined, practitioners should be cautious in thinking about using it, but should at
least be aware of it and should attempt to stay abreast of informed-consent laws in their
own state and with federal laws.
An additional evolving legal–ethical concept involving children and adolescents in
mental health research and services is the assent doctrine. Simply stated, this concept
embodies the idea that researchers and practitioners should, in addition to obtaining
appropriate parental consent, allow the child or adolescent to have a voice in whether or
not he or she will be involved as a research participant or as the recipient of professional
services (Levine, 1995; Powell & Vacha-Haase, 1994; Range & Cotton, 1995). For example,
if this concept were implemented fully, the child or adolescent for whom research or
services are targeted would have the opportunity to agree to or decline such participation,
whether or not he or she has been legally emancipated. This concept is complicated and
potentially thorny. Although most persons probably would agree that a mature minor
should be able to voluntarily decline or agree to participate in a research study, the point
 Foundations of Assessment s 25

at which one is considered mature enough for self-determination is unclear. Additionally,

there are serious potential problems involved when moving assent from the realm
of research to the realm of service delivery. If a child or adolescent provides his or her
assent for treatment, he or she will likely feel more empowered and positive about the
process. But what about refusal of assent? Should a 14-year-old with severe mental health
problems—who has been referred by his or her parents for assessment and possible
diagnosis and treatment—be allowed to refuse the assessment? According to the NASP
Principles for Professional Ethics (2010), school psychologists should make every effort to
inform students of his/her treatment, but they may continue with service delivery without
student assent if treatment is deemed to be beneficial or required by law. These are
difficult but important issues. As the concept of assent continues to evolve, practitioners
and researchers should strive to stay current with laws in their own state or province and
stay aware of the current Zeitgeist involving this issue.
Given that many schools are beginning to embrace the idea of prevention and institute-
tiered systems of assessment and intervention, further questions regarding when it is
necessary to obtain parent consent have surfaced. According to NASP’s ethical principles
(NASP, 2010), school psychologists do not need to obtain consent when they are con-
ducting observations or consulting with a teacher or an instructional support team on
a child’s behavior, as long as proposed strategies and interventions fall within the purview
of the classroom teacher’s role. Furthermore, the principles state that as schools move
toward using systematic, universal mental health screening to identify children at risk,
it is important, and ethically sound, to ensure that parents are informed of the process
and that they have the right to exclude their children from this process at any time. Again,
this is an evolving concept in the field and staying current with ethical codes and laws
is critical.

The Validity of Assessment Procedures Regarding the legal and ethical aspects of the
validity of assessment procedures, there is substantial agreement and an overlap between
the provisions of the IDEIA and the ethical/conduct codes of APA and NASP. Some of the
conditions stated in the public law and in the professional codes include:

1. Tests must be validated for the specific purposes for which they are being used.
2. Tests must have adequate technical (psychometric) properties.
3. Obsolete assessment results should not be used.
4. Assessment procedures must be administered only by persons with specific and
adequate training.

Although there have been many criticisms of the technical aspects of many social–
emotional assessment instruments (particularly those in the personality and projective–
expressive technique realm) (Gregory, 2000; Salvia & Ysseldyke, 2004), in contrast to
their counterpart instruments in the domain of cognitive assessment, there have been few
legal complaints stemming from the use of inadequate measures in the social–emotional
domain (DeMers, 1986). Education and mental health professions, and society at large,
generally have been much less vocally critical of social–emotional assessment procedures
compared with intellectual and academic achievement tests, despite the fact that the latter
category of tests tends to be better researched and possess higher levels of reliability and
validity. Whatever the reason for this relative lack of controversy, the potential for future
26 s Foundations and Methods of Assessment

litigation regarding social–emotional assessment procedures appears to be great, and

practitioners and researchers are advised to stay current on changing laws and ethics
codes regarding validity of assessment procedures.

The Right to Privacy/Confidentiality The third area involves the broad domain of what is
most commonly referred to as the right to privacy, but also includes the concept of confi-
dentiality. In this area, procedures and principles have been outlined not only by the
IDEIA, APA, and NASP standards, but also by FERPA, numerous state statutes, and court
decisions related to the right to privacy inferred from, or carved out of, the 14th Amendment
to the U.S. Constitution. Within the general area of right to privacy, some key components
relating to assessment practices include:

1. Clients (and the parents of minor clients) are provided access to their records and
assessment results.
2. Assessment results are not released to third parties without the express consent of
the client (or parents of a minor client).
3. Communications between the professional and client are regarded as confidential
unless the client has voluntarily waived his or her right to confidentiality or the
information obtained in the professional relationship reveals a clear and imminent
danger to the client or to other persons (the “duty to warn” principle). Additionally,
each U.S. state and Canadian province has laws mandating that reasonable
evidence or suspicions of child abuse be reported to the proper legal authority.
Within the context of information obtained during a social–emotional assess-
ment, such information would constitute an instance where confidentiality must
be breached.

Given the various provisions and exceptions to the laws and ethical codes, clinicians must
be careful about the way that promises of confidentiality are stated to their child and
adolescent clients. It has been argued that mental health professionals have a primary
obligation to respect the wishes expressed by a mature minor in relation to the provision
of counseling services, including confidentiality. Given the uncertainties and evolving
nature of the mature-minor doctrine, however, and given the legal status of children and
adolescents, confidentiality of communication does not exist in a strict sense because
parents have a right to be informed of what information is obtained in most situations
(DeMers, 1986; Jacob et al., 2011), and there are certain legal exceptions to the rule. This
statement is particularly true when service provision is under the blanket of specific
federal and state laws that mandate parents’ ultimate right to information. Clinicians
should avoid making unrealistic promises to their child or adolescent clients that what
they say will be kept in strict confidence and instead should help them understand the
limits of confidentiality, giving them the power to participate in the process as fully
informed as possible.
An additional area to consider regarding privacy and confidentiality is that there has
been a long-standing concern among psychologists that using personality assessment
instruments, and presumably other social–emotional measures, may result in unjustifiable
encroachment of privacy rights (Jacob et al., 2011; Messick, 1965). Within this line of
reasoning, the argument is that because they are designed to obtain highly private,
personal information, some personality or social–emotional assessment methods may
 Foundations of Assessment s 27

routinely violate privacy rights. This concern, although important, is difficult to define
and articulate clearly and would obviously lead to difficult distinctions among various
assessment instruments (i.e., which are justifiable and which are not). In practice,
adhering to the three component areas outlined in this section and always acting to “do
no harm” will reduce the likelihood of invading privacy rights within the context of
assessing social and emotional behavior.

Some Concluding Comments on Legal and Ethical Issues

As was stated earlier, the type of assessment instruments that have most often been the
targets of legal action are intellectual ability and academic achievement tests rather
than social–emotional behavior measures. There is a peculiar irony to this imbalance of
legal action. Tests of intellectual ability, as a whole, tend to have better psychometric
properties and a more extensive research base than do most behavioral–emotional
assessment instruments. When projective personality measures are included, the
difference in psychometric quality becomes even more pronounced (Gregory, 2000;
Salvia & Ysseldyke, 2004). A possible reason for behavioral–emotional or personality
measures not being legally targeted as extensively as intellectual tests was articulated
by DeMers (1986), who suggested that there is a limited legal basis for complaints
against these types of measures. They have seldom been found to discriminate system-
atically against particular groups and are most often administered in the context of
voluntary work by private citizens, rather than as an action of the state. Although the
potential legal entanglements of social–emotional assessment remain high—particularly
when assessing students for the purpose of determining if they qualify for special
education services as “emotionally disturbed”—these measures are probably not likely to
be targeted for action until their use is found systematically to bias opportunities for
specific groups of people.
A final interesting point to think about in regard to legal and ethical issues is that they
can and do change over time. The codes of ethical practice adopted by professional
organizations tend to be influenced by changes in social thought, and statutory regulation
at the state level tends to be influenced by changes in the ethical codes of professional
organizations. An example of such changing social thought is the mature-minor and
assent concepts discussed previously in this section, which for all practical purposes did
not exist until only a few years ago. These concepts have begun to evolve as society has
begun to consider seriously the notion of self-determination for children and adolescents.
Another example of changing legal and ethical standards is that until the mid-1970s,
both the American Psychiatric Association and the American Psychological Association
officially viewed homosexuality as a form of mental illness. Today, neither organization
views homosexuality in this manner, and there is considerable controversy regarding
whether it is even ethical for therapists to work with clients who desire to change their
sexual orientation (i.e., reparative therapy). This shift in direction over a 40-year period
has mirrored changing social trends that have become more accepting of LGBTQ as
an alternative lifestyle (Corey, Corey, & Callanan, 1997). A similar shift regarding social
and organization attitudes toward individuals who are considered to have Gender
Dysphoria (a current psychiatric diagnostic term) also appears to be a future possibility.
In terms of social–emotional assessment practices, it is difficult to predict how legal and
ethical constraints will change over time, but it is likely, if not given, that such changes
will occur.
28 s Foundations and Methods of Assessment

CRITERIA FOR INCLUSION OF ASSESSMENT METHODS

AND INSTRUMENTS
Throughout this book, six general assessment methods are emphasized: direct behavioral
observation, interviewing techniques, behavior rating scales, sociometric approaches,
self-report procedures, and projective-assessment techniques (with a special emphasis
on cautions and psychometric problems that are usually inherent in this method). With
this fifth edition, I have incorporated a new chapter on school-wide screening efforts
(Chapter 15). Given that there are many more specific procedures and instruments within
each of the several general methods of interest than can be included in any book, the
guidelines for including them within this text reflect the following principles:

1. Any procedure or instrument that is advocated or discussed at length must have met
at least minimal standards for technical adequacy (i.e., must have sufficient research
behind it showing psychometric properties and clinical utility).
2. Any procedure or instrument included must have a high degree of “usability” for
the clinician. In other words, any techniques or tests requiring an extensive amount
of specialized equipment or training to the point that it is overly burdensome for
clinicians to use day-to-day were not included, regardless of the technical properties.
3. In the case of standardized, norm-referenced instruments (such as behavior rating
scales and self-report tests) to be included in this text, these instruments must
(1) include reasonably large and representative normative populations, and (2) be
easily available (i.e., commercially published or easily accessible within the public
domain). This third criterion is in addition to the first two being met.

In some cases, the number of possible instruments or techniques that meet the inclu-
sion criteria are well in excess of the capacity for all to be included within one book. Some
assessment methods, such as using norm-referenced behavior rating scales and self-report
instruments, have experienced a proliferation of new and technically sound tools in recent
years, making it virtually impossible to catalog fully and describe the various tools avail-
able within a book of this type. Instruments or specific approaches that are representative
of each general domain were included as examples of what is available and are not held
out as being the only tools available or the absolute best of what are available.

CONCLUSIONS
Assessment (or at least testing) may be conducted with minimal thought regarding a
theoretical foundation for social and emotional behavior, but such practice is discour-
aged because it relegates the assessment professional to the role of a technician. Numerous
theories regarding human behavior and personality have influenced psychology,
education, and related fields, ranging from behaviorism to psychodynamic theory to
humanistic theory. Social cognitive theory, stemming from the work of Bandura, is
proposed as a foundation for much of this book and is briefly overviewed. Bronfenbrenner’s
ecological systems theory is also reviewed and promoted as a way of taking human
environments into consideration when conducting assessments. Professionals are urged
to integrate theory into their assessment practices, regardless of whether they adopt the
orientation of this book or select a competing theory to guide their work.
 Foundations of Assessment s 29

Theoretical foundations of social and emotional assessment often have emphasized

the differences between nomothetic and idiographic approaches to scientific inquiry.
Applying these two approaches to the field of social and emotional assessment as a
dichotomous and mutually exclusive paradigm ignores the philosophical and scientific
bases of these terms, however, as well as the way that assessment is conducted in the real
world. Empirically defensible and scientifically sound approaches to child assessment are
emphasized throughout this book, without regard to their placement along the idiographic–
nomothetic continuum.
Referrals for assessment of child and adolescent social–emotional behavior often occur
because of a discrepancy between the child’s or adolescent’s current level of functioning
and an optimal level of functioning desired by the referral source. Such discrepancies may
be from standards desired by society in general, by community subgroups, or by specific
families or teachers. These perspectives represent distinct spheres within the ecological
systems model. It is crucial to recognize these perspectives of the referral source when
proceeding with assessment referrals.
Although previous attempts have been made to integrate assessment into an overall
process of problem solving, surprisingly little attention has been paid to this area. All too
often, assessment practitioners tend to view assessment as a means and an end, rather than
as one part of an overall process, and administrative practices in many school districts and
mental health agencies tend to reinforce this limited view. A four-phase model of assessment
as a problem-solving process is proposed. This model includes various practical questions
within the phases of identification and clarification, data collection, analysis, and solution
and evaluation.
A multimethod, multisource, multisetting model of assessment design is emphasized
as best practice throughout this book. This type of assessment design is aimed to overcome
error variance associated with specific types of assessment practices by building an
aggregated assessment design to the greatest extent that is feasible. By including multiple
methods of assessment and various sources of data, and by basing the assessment on more
than one setting, the limitations of any one type of assessment may be overcome, and a
broad-based picture of the social–emotional behavior of the referred child or adolescent
is likely to be obtained.
Given that the percentage of children and youth who are considered to be at risk
for developing behavioral and emotional problems continues to increase, while the avail-
ability of specialized educational and mental health services to support these youth has
remained constant or shrunk, new ways of thinking about assessment and intervention
services are needed. The public health approach and well-known triangle of support
model is recommended as a way of planning for services for all children and adolescents
within a given school or community population. Using such an approach will help
to identify procedures and goals for screening and assessment, and will help link screen-
ing and assessment to appropriate intervention services at the primary, secondary, and
tertiary levels of prevention.
There are numerous legal and ethical constraints on assessing children, based on spe-
cific statutes or administrative laws of individual states, federal laws affecting educational
practice, certain provisions of the U.S. Constitution, and the ethics code of various
professional organizations. Specifically the areas of informed consent, validity of assess-
ment procedures, and right to privacy/confidentiality are involved with legal and ethical
constraints when assessing social and emotional behavior of children and adolescents.
30 s Foundations and Methods of Assessment

Legal and ethical constraints regarding assessment and related professional practices are
constantly in a state of change, based on the changing values of society. Professionals are
advised to keep current on changes that may affect their assessment practices.

REVIEW AND APPLICATION QUESTIONS

1. Compare and contrast social cognitive theory with any other prevailing theory of social–
emotional behavior (e.g., behavioral, psychodynamic, humanistic). When it comes to using
either theory as a foundation for conducting and reporting an assessment, what are the
limitations and advantages of each?
2. After considering the limitations and advantages of a variety of theoretical orientations to
social–emotional behavior, reflect upon your experiences with assessment thus far (e.g.,
textbook readings, lecture information, observing supervisors, direct assessment), consider
the theory you find most compelling and most likely to apply to assessment, and argue your
perspective regarding why this orientation is a valid approach to childhood assessment.
3. What are the three components of triadic reciprocity within social cognitive theory, and
how do they affect each other?
4. What are some ways that assessing social and emotional behavior of children and
adolescents can be done as part of a comprehensive process of problem solving?
5. Identify the three major components of informed consent. How might they need to be
addressed before conducting a child or adolescent assessment?
6. With respect to the legal and ethical mandates for using assessment procedures that have
adequate validity, what types of instruments or procedures commonly used for social–
emotional assessment might be problematic?
7. Regarding confidentiality between the clinician and child or adolescent clients, what are
some reasonable statements that could be made to help a child or adolescent understand
the limits and ramifications of confidentiality when an assessment is being conducted?
8. Define the terms nomothetic and idiographic as they relate to scientific inquiry in general
and social–emotional assessment of children and adolescents in particular.
9. For social–emotional assessment of children and adolescents, what are some potential
components within a broad-based multimethod, multisource, multisetting assessment
design?
10. A 14-year-old student who has been receiving special education services as “emotionally
disturbed” since grade 2 enters the records office of the school and, in a highly emotional
and agitated state, demands to see her permanent behavioral file. This file includes several
psychological, social work, and psychiatric reports, all of which contain some sensitive
information about the student and her family. What is an appropriate way to deal with this
situation, maintaining a balance between what is legal and what is in the best interests of
the student?
11. A 16-year-old boy is participating in a diagnostic interview with a psychologist in a
community mental health center. He was referred to the center by his parents because of
their concerns regarding serious depression. During the interview, the boy talks about
being jealous and angry with a former girlfriend who broke up with him, and he seems
almost obsessed with his anger toward her. At one point in the interview, he angrily states
that “if she makes me look like a fool one more time, I’ll kill her!” Based on ethical and
legal best practices, what is an appropriate way to handle this situation?
 2
SOCIAL–EMOTIONAL ASSESSMENT
AND CULTURAL DIVERSITY

The topic of psychological and educational assessment and cultural diversity has received
a great deal of professional and public attention. Some well-known court cases in the
1970s and 1980s, most notably Larry P. v. Riles and Diana v. State Board of Education
(both in California) and Guadalupe v. Tempe Elementary School District (Arizona), placed
the issue of cultural validity of standardized assessment instruments in the forefront
of professional practice. These cases resulted in calls for change (and, in some cases, legal
mandates for change) in special education assessment practices with racial/ethnic-
minority youth. During the 1990s, a widespread flurry of professional and public attention
accompanied Hernstein and Murray’s (1994) book The Bell Curve: Intelligence and Class
Structure in American Life, which addressed the issue of racial/ethnic differences and
possible bias on IQ and achievement tests. These few examples, among many, provide
some evidence that the issue of cultural diversity in assessment is complex and has
become a serious concern. This concern has stimulated the field to take action in research
and practice, as evidenced by numerous books and chapters on the topic (e.g., Castillo,
Quintana, & Zamarripa, 2000a, 2000b; Dana, 2000a, 2000b, 2005; Hambleton & Kang Lee,
2013; Kohn, Scorcia, & Esquivel, 2012; Martines, 2008; Rhodes, Ochoa, & Ortiz, 2005;
Suzuki, Ponterotto, & Meller, 2001).
Professional, public, and legal attention on this topic has been focused almost exclu-
sively within the domain of cognitive assessment, as is stated in Chapter 1. By compari-
son, far less attention has been paid to the issue of cultural diversity and behavioral,
social, and emotional assessment, and most of this attention has been on assessment with
adults rather than children. For whatever reason, the assessment establishment and
the public have accepted much of the reasoning on behavioral, social, and emotional
assessment across cultures rather uncritically. This statement should not be inferred to
mean that there are no critics of these practices. On the contrary, a handful of writers have
decried the ongoing state of affairs regarding assessment and cultural diversity, including
the social–emotional domain. About 20 years ago, Dana (1996), a scholar in the area of
multicultural applications of psychological assessment, stated:

With few exceptions the psychological tests used in the United States have been
designed by Europeans or North Americans and embody a Eurocentric worldview
and derivative psychometric technology. Comparisons among ranked individuals or
groups expose human differences within a format of psychological judgment using
Anglo American normative standards. Standard tests of intelligence, personality,
and psychopathology are often assumed to be genuine etics, or culture-general in

31
32 s Foundations and Methods of Assessment

application. In fact, most of these tests are culture-specific or emic measures

designed for Anglo Americans, but have been construed as imposed etic measures,
or pseudo etics, because the equivalence with different cultural groups has not been
demonstrated.
(p. 477, italics added for emphasis)

More recently, Carjuzza and Ruff (2010) reflected on the increased diversification of U.S.
schools and urged educators to question the cultural responsiveness of their overall
pedagogical practices, including assessment:

Recognition of the relevance of non-Western knowledge calls into question the

tacit assumptions contained within Western standards. These assumptions need
to be identified and questioned to facilitate culturally competent instructional
assessment. Questioning academic practices is tantamount to acknowledging the
lack of neutrality in academic rationality and from this recognition assessment
standards can be renegotiated to facilitate cultural equity.
(p. 75)

These strong statements raise many concerns regarding assessment practices with
children and youth of diverse cultural backgrounds. Statements such as these also raise
many questions, such as:

s 3HOULD WE ASSUME THAT STANDARDIZED NORM REFERENCED TESTS THAT ARE BASED ON
representative normative samples that approximate the general U.S. population are
not appropriate for use with individuals from racial/ethnic-minority groups?
s )STHEUSEOFLOCALNORMSMOREAPPROPRIATETHANTHEUSEOFNATIONALREPRESENTATIVE
norms for the assessment of minority children and adolescents who live in areas
where their own racial/ethnic group is the majority?
s !RESTANDARDIZEDNORM REFERENCEDASSESSMENTPROCEDURESMOREORLESSBIASEDTHAN
qualitative or unstructured assessment procedures, such as projective techniques and
unstructured interviews, for members of racial/ethnic-minority groups?
s !RETHEASSUMPTIONSREGARDINGTESTBIASTHATAREBASEDONINTELLECTUALANDACADEMIC
achievement measures appropriately inferred for measures of behavioral, social, and
emotional functioning?

These are difficult questions, and as shown throughout this chapter, the answers are
equally difficult. In many cases, the questions are equivocal or even impossible to answer
fully given the relative paucity of empirical evidence in this area. Even the most ardent
voices in the area of multicultural assessment acknowledge that the scientific basis of best
practice in this area is lacking and that developing best practice is more art than science
(Dana, 1998, 2005).
This chapter explores issues of cultural diversity within the framework of behavioral,
social, and emotional assessment of children and adolescents. At present, this topic
involves questions and issues that simply have not been addressed and answered suffi-
ciently in most cases. This chapter raises awareness regarding some thorny assessment
issues that may take several more years of empirical study to be addressed adequately. In
comparison with the voluminous evidence and opinion that has accumulated regarding
 Social–Emotional Assessment and Cultural Diversity s 33

cultural diversity within the framework of intellectual/academic assessment, much less is

known in this area regarding personality or behavior assessment (Dana, 1998, 2000a,
2000b, 2005; Hood & Johnson, 1997). Added to this problem is a widely held assumption
that, in general, knowledge regarding assessment of children tends to lag behind in
comparison with the empirical evidence regarding adult-focused assessment practices.
This chapter begins with a discussion of test and assessment bias in professional
practice and the role that organizational standards play in shaping multicultural assess-
ment practices. Next, some concepts related to acculturation, and racial/cultural identity
development are presented, including theorized stages of identity development. With
some cautions in place regarding potential problems that result from overemphasizing
between-group differences (e.g., stereotyping and divisiveness between groups), some
general demographic information, and psychosocial characteristics of the major racial/
ethnic groups in the United States are presented. Special considerations for culturally
competent assessment of social–emotional behavior within each of the major assess-
ment methods are reviewed, with an emphasis on the known problems and solutions
regarding each method. The chapter ends with the presentation of 11 recommendations
for culturally competent assessment practice.

TEST AND ASSESSMENT BIAS IN PROFESSIONAL PRACTICE

This section focuses on some specific aspects of assessment theory and practice that are
highly related to the area of cultural diversity, including theory of test and assessment
bias, examination of current professional standards related to culturally appropriate
assessment practices, and an overview of current practices and future directions in this
area among professionals.

Test and Assessment Bias

The terms test bias and assessment bias have been used in various ways in the professional
literature. Some discussions of these concepts refer to them in terms of inappropriate
uses of assessment instruments, whereas other discussions couch definitions of bias in
terms of the properties of the instrument or procedure. In reality, both situations may
cause bias. Although there is no universal definition of test or assessment bias, we can
consider a psychological or educational assessment instrument or procedure to be biased
if it “differentiates between members of various groups on basis other than the charac-
teristic being measured” (Brown, 1983, p. 224). In operational terms, such bias is said to
exist if “its content, procedures or use result in a systematic advantage or disadvantage
to members of certain groups over other groups and if the basis of this differentiation is
irrelevant to the test purpose” (Brown, 1983, p. 224). Behavioral, social, or emotional
assessment instruments or procedures would be considered biased if their use resulted in
systematic and improper diagnosis, classification, or service provision for a specific group
of children or adolescents (i.e., based on race/ethnicity).
Because most discussions of test or assessment bias are usually in relation to cognitive
tests (i.e., IQ and academic achievement or aptitude tests), many of the traditional methods
of showing that a test is acceptably unbiased may be problematic when assessment of
social–emotional behavior is considered. There are some major differences between cogni-
tive and social–emotional tests that make across-the-board methodological comparisons
34 s Foundations and Methods of Assessment

difficult. Virtually all cognitive tests have a correct or “right” answer, are scored in a dichoto-
mous manner (yes/no, correct/incorrect), and result in distributions of scores that
closely approximate a normal bell-shaped curve. Conversely, standardized instruments
designed to assess social–emotional behavior almost never have a “right” answer and often
are scored along a gradient, such as a 4-point scale. In contrast to cognitive tests, distribu-
tions of scores of social–emotional instruments are seldom (if ever) normal, but tend to be
skewed toward a lack of symptoms or problems in the normal population.
Viewing assessment bias as a yes/no or all-or-nothing proposition is faulty reasoning.
Because assessment bias may include the properties of an instrument and the manner in
which it is used, it would be incorrect to state unequivocally that a specific assessment
tool was absolutely free of any biasing characteristics. Even if the internal properties of
an instrument, such as the items, score norms, and sub-scale structure, were shown to
be equivalent for various racial/ethnic groups, the instrument still could be used in a
manner that may be inappropriate for individuals with particular types of background
characteristics. The goal for valid assessment of children’s social–emotional behavior
should be to implement it in a culturally appropriate manner and to reduce threats of
assessment bias.

Professional Ethics and Culturally Appropriate Assessment

Since about the 1980s, there has been increased emphasis within the ethical codes and
standards of professional organizations regarding cultural diversity, cultural differences,
and cultural appropriateness of assessment materials and intervention techniques. These
various ethical standards tend to serve as minimal guidelines. That is, they provide some
general statements regarding expectations for appropriate professional practice, but they
usually do not go beyond that level of specificity. The most influential professional organ-
izations, that represent individuals who are involved with psychological and educational
assessment, have shown an interest in advocating for culturally appropriate assessment
practices but in most cases have not prescribed specific models or best practices.
The most recent revision of the Ethical Principles of Psychologists and Code of Conduct
of the American Psychological Association (APA, 2010) is an extension of the prior
revisions of the code (which took place in 1993 and 2002), placing increased emphasis
and importance on culturally sensitive practice. For example, in general Principle D:
Justice and Principle E: Respect for People’s Rights and Dignity include statements regarding
valuing sensitivity to human diversity and cultural differences, and ensuring that biases
do not negatively impact practice. Ethical Standard 2.01, Boundaries of Competence,
establishes that psychologists are expected to become culturally competent:

Where scientific or professional knowledge in the discipline of psychology estab-

lishes that an understanding of factors associated with age, gender, gender identity,
race, ethnicity, culture, national origin, religion, sexual orientation, disability,
language, or socioeconomic status is essential for effective implementation of their
services or research, psychologists have or obtain the training, experience, consulta-
tion, or supervision necessary to ensure the competence of their services, or they
make appropriate referrals.

In addition, Standard 9.06, Interpreting Assessment Results, focuses on taking into account
cultural and linguistic factors when interpreting assessment data:
 Social–Emotional Assessment and Cultural Diversity s 35

When interpreting assessment results, including automated interpretations,

psychologists take into account the purpose of the assessment as well as the various
test factors, test-taking abilities, and other characteristics of the person being
assessed, such as situational, personal, linguistic, and cultural differences, that might
affect psychologists’ judgments or reduce the accuracy of their interpretations. They
indicate any significant limitations of their interpretations.

The National Association of School Psychologists’ (NASP) Principles for Professional

Ethics were most recently updated in 2010. This document includes several global
guidelines and specific standards related to culturally appropriate assessment practice.
For example, Principle 1.3, related to Fairness and Justice, states:

In their words and actions, school psychologists promote fairness and justice. They
use their expertise to cultivate school climates that are safe and welcoming to all
persons regardless of actual or perceived characteristics including race, ethnicity,
color, religion, ancestry, national origin, immigration status, socioeconomic status,
primary language, gender, sexual orientation, gender identity, gender expression,
disability, or any other distinguishing characteristics.
(NASP, 2010, p. 5)

Under the principle that is specific to Competence, several specific examples address
issues of diversity. For example,

Standard II.1.2: Practitioners are obligated to pursue knowledge and understanding

of the diverse cultural, linguistic, and experiential backgrounds of students, families,
and other clients. When knowledge and understanding of diversity characteristics
are essential to ensure competent assessment, intervention or consultation, school
psychologists have or obtain the training or supervision necessary to provide
effective services, or they make appropriate referrals.
(NASP, 2010, p. 6)

A final example, in regards to Responsible Assessment and Intervention Practices,

Standard II.3.5: School psychologists conduct valid and fair assessments. They
actively pursue knowledge of the student’s disabilities and developmental, cultural,
linguistic, and experiential background and then select, administer, and interpret
assessment instruments and procedures in light of those characteristics.
(NASP, 2010, p. 9)

The jointly produced Standards for Educational and Psychological Testing, a combined
effort in 2014 of the American Educational Research Association (AERA), American
Psychological Association (APA), and National Council on Measurement in Education
(NCME), is a highly influential document among educational and psychological testing
experts. Similar to the ethical codes of APA and NASP, the Standards include specific
statements regarding culturally appropriate methods of administering and interpreting
standardized assessment instruments. In contrast to the two ethical codes, the Standards
also include specific details regarding instrument development, and many of these are
36 s Foundations and Methods of Assessment

specific to cultural diversity. Section 3 of the Standards includes four clusters that organize
specific Standards 3.1 through 3.20, titled Fairness in Testing, and deals specifically with
varying views on fairness in assessment bias, and fairness in selection and prediction.
These clusters include:

1. Test Design, Development, Administration, and Scoring Procedures That

Minimize Barriers to Valid Score Interpretations for the Widest Possible Range
of Individuals and Relevant Subgroups.
2. Validity of Test Score Interpretations for Intended Uses for the Intended Examinee
Population.
3. Accommodations to Remove Construct-Irrelevant Barriers and Support Valid
Interpretations of Scores for Their Intended Uses.
4. Safeguards Against Inappropriate Score Interpretations for Intended Uses.
(Standards for Educational and Psychological Testing, p. 63)

One example of the Standards that is most relevant for the topic of assessment and
cultural diversity includes:

When credible evidence indicates that test scores may differ in meaning for
relevant subgroups in the intended examinee population, test developers
and/or users are responsible for examining the evidence for validity of score
interpretations for intended uses for individuals from those subgroups. What
constitutes a significant difference in subgroup scores and what actions are
taken in response to such differences may be defined by applicable laws.
(Standard 3.6, p. 65)

Regarding Standard 3.6, it is important to consider that significant group-based

differences in test scores are not the problem here. It is bias, or differences in group
scores that are not meaningfully related to the test construct, that should be eliminated.
Consider that with social–emotional assessment instruments, some forms of group
differences are expected and contribute to the validity of the assessment tool. For example,
given that the research literature is clear regarding gender differences in attention deficit
hyperactivity disorder (ADHD) (with boys outnumbering girls by a ratio from 3:1 to 9:1),
elimination of all items that show evidence of significant gender differences would render
the test useless. Likewise, there are many other psychological and educational constructs
in which there might be expected differences based on actual differences in functioning
related to gender, culture, or race/ethnicity.
Another sample standard that pertains to fairness in testing, particularly as it applies
to sharing data about diverse subgroups is Standard 3.17.

When aggregate scores are publicly reported for relevant subgroups—for example,
males and females, individuals of differing socioeconomic status, individuals
differing by race/ethnicity, individuals with different sexual orientations, indi-
viduals with diverse linguistic and cultural backgrounds, individuals with disabilities,
young children or older adults—test users are responsible for providing evidence
of comparability and for including cautionary statements whenever credible
 Social–Emotional Assessment and Cultural Diversity s 37

research or theory indicates that test scores may not have comparable meaning
across subgroups.
(Standard 3.17, p. 71)

This standard is becoming more relevant in the social–emotional and behavioral

assessment domain, as school professionals are being asked to screen large samples
of students for risk, and share results of screening efforts “publicly” with other profes-
sionals and families as a part of a school-wide effort to identify risk for problems early.
Further, many schools are beginning to use these types of data to examine how their
practices may reflect explicit or implicit bias against particular groups of individuals.
For example, in many schools I currently work with, teachers are being asked to rate the
social–emotional behaviors of all students in their classes, using a brief screening method.
These data are then analyzed and often aggregated in different ways (i.e., by subgroup)
to best understand how teachers perceive student behavior and to identify relevant
intervention targets.
In sum, various professional organizations and associations, that have interests in
psychological and educational assessment, have made cultural aspects of assessment
specific targets of their standards to varying degrees of specificity. Additionally, over
the years, these documents have shifted to expand definitions of “diversity” to be more
inclusive of the multiple ways in which individuals are diverse (e.g., gender, learning
differences) rather than focus on cultural and linguistic diversity exclusively. Although
some of the changes that have been evidenced in the various revisions of these codes in
recent years have focused attention on cultural-sensitivity issues, some writers (e.g.,
Dana, 1994, 2005) have argued that the changes have not gone far enough and that the
standards still avoid areas that remain controversial. In reality, these guidelines provide
only a framework for professionals and do not detail highly specific suggestions for pro-
fessional practice. It is anticipated that future revisions to these and similar standards will
continue to include an increased focus on all forms of diversity, including applications
in assessment.

Professional Practice
According to Dana (1995, 2005), there are three major deficiencies in standard psycho-
logical assessment practice that result in culturally inappropriate assessment. These
deficiencies include test construction, test administration, and interpretation. In Dana’s
view, test construction may lead to cultural bias because the development of traditional
assessment instruments has been based on a psychometric paradigm that may result in
culture-specific tests that are appropriate only for individuals within a European American
cultural context. Essentially, these types of development practices may create a “one size
fits all” assessment instrument that simply is not appropriate for many individuals. In
addition, traditional methods of standardized test administration tend to be impersonal
and may cause individuals, who are not comfortable with the examiner or situation, to
respond in ways that do not reflect their true characteristics. Traditional methods of test
interpretation that are rigid and based on culturocentric views of human behavior may
result in “overpathologization” of individuals who are not part of the dominant culture
or, in other words, characterize them as being “more disturbed than in fact they are”
(Dana, 1995, p. 63). It is obvious that to the extent these problems may exist, they violate
the spirit and letter of the various professional standards that have been established
38 s Foundations and Methods of Assessment

regarding culturally appropriate assessment. It also is clear that although change in this
area has been slow to emerge, it will continue, perhaps with increased speed.
The future of culturally appropriate assessment, according to Dana, will be development,
administration, and interpretation procedures that expand the concept of individual
differences to include gender and culture, and require increased competence of assess-
ment professionals. “Multicultural assessment adheres to an ethical mandate for moving
beyond cultural sensitivity toward cultural competence” (2005, p. 7). He maintains that
this future will be in the direction of social constructivism, or constructing specific
methods of assessment and interpretation that are flexible and appropriate within a
given context for a given individual and where meaning or interpretation is derived in
an individualized and unique context. The relationship between examiner and subject will
take on a new importance in such an assessment model. Although from an objective or
empirical perspective, it is highly arguable that social constructivist approaches will solve
the challenges related to assessment across cultural groups, this notion is interesting.
However, Dana’s position does not reduce the responsibility of assessment professionals
to become well trained in psychometric procedures, as he contends that “multicultural
assessment is dependent to an even greater extent than standard assessment on adequate
psychometric knowledge for selection of relevant tests and methods” (2005, p. 9).
Some fairly recent models for conceptualizing and implementing assessment in a
culturally appropriate manner consistent with Dana’s recommendations have been
articulated. One example is responsive assessment (Henning-Stout, 1994; Kea, Campbell-
Whatley, & Bratton, 2003; Lezak, 2002; Sullivan, 2010). Responsive assessment is perhaps
best characterized as a way of implementing assessment rather than a type of assessment.
The traditional mystique surrounding formal psychological testing and the authority
position of the professional conducting the assessment are supplanted by a broader view
of assessment as a process. In this process, the examiner works with the client and other
individuals who have an interest in the outcome of the assessment (i.e., parents, teachers)
to design and implement an assessment that is authentic, culturally acceptable, and
appropriately focused on the issues of concern. The participants in this process are
referred to as stakeholders, reflecting the more egalitarian nature of the relationships
of those involved and emphasizing accountability of the examiner. It is certain that
other models for implementing psychological and educational assessment in a culturally
appropriate manner will continue to emerge during the next decade and that the
sociocultural aspects of assessment will play a role of increasing importance.

ACCULTURATION AND IDENTITY DEVELOPMENT

When dealing with the issue of cultural diversity and educational/mental health service
delivery, it is crucial to understand that among individuals of all racial/ethnic-minority
groups, there is a wide variation in terms of their orientation toward the traditional char-
acteristics of their racial/ethnic group, assimilation into the majority or dominant culture,
and their own racial/ethnic identity. Acculturation is defined as “the process of cultural
change that occurs in individuals when their own culture and another culture meet; it
leads individuals to adopt elements of another culture, such as values and social behaviors”
(Sattler, 2008, p. 138). Furthermore, Rhodes et al. (2005) discussed this construct with
respect to how standardized assessment measures are developed, stating:
 Social–Emotional Assessment and Cultural Diversity s 39

Acquisition of the cultural content of the dominant society is known as acculturation.

The process of acquiring culture (i.e., acculturation) is developmentally invariant,
predictable, and easily measured. As with other developmental patterns, the simpler,
commoner elements of culture are learned first, and the more complex elements are
learned later. Standardized tests are based directly on this principle, known as the
“assumption of comparability.
(p. 155)

When an individual who is a member of a minority group begins to examine and

understand the differences between their group and the majority group, the process of
acculturation is inevitable to some extent. The outcome of this process varies widely,
however. The actual process of acculturation may include what Sattler (2008) terms as
traditionalism, transitional period, marginality, assimilation, and biculturalism. Although
acculturation is most often associated with racial/ethnic group identity, it is not limited
to this domain. For example, individuals who are members of an obscure religious group
that is viewed with disdain by the dominant secular culture because of their separateness
and unique practices may go through a similar process, as may individuals who identify
as transgender or those who do not have a heterosexual orientation. According to Dana
(2005), one of the aspects of acculturation that is often ignored is cultural differences in
belief systems, which may include an overall worldview, as well as specific beliefs regarding
mind–body relationships, values, spirituality/religion, health and illness, locus of control
and responsibility, and notions of individualism versus collectivism.

Factors That Influence Acculturation

In 1985, Kumabe, Nishida, and Hepworth identified several factors that may influence
whether individuals from racial/ethnic-minority groups maintain or depart from the
traditional cultural practices of their group or allow these traditional practices to coexist
with new practices adopted from the majority group. The six primary factors within this
model include:

s HISTORYOFMIGRATIONEXPERIENCEIEWHETHERITWASFREELYCHOSENORCOERCED 
s DISTANCEPHYSICALANDPSYCHOLOGICAL FROMTHECOUNTRYOFORIGINANDINDIGENOUS
culture;
s PLACEOFRESIDENCEANDSOCIOECONOMICSTATUS
s TYPE OF NEIGHBORHOOD IN THE RESETTLEMENT COUNTRY IE WHETHER THERE ARE OTHERS
close by who share the same racial/ethnic ties);
s CLOSENESSOFTIESWITHIMMEDIATEANDEXTENDEDFAMILYAND
s UNIQUENESSOFLANGUAGEANDCUSTOMSFROMTHEHOMELAND

Since the time of this Kumabe et al.’s (1985) publication, many other researchers and
scholars have taken interest in the topic of acculturation and have identified other key
variables that play a role in one’s experience. For example, Tartakovsky (2012) noted that
an individual’s perceived control over life matters could affect acculturation. For example,
individuals with an ability to master a new language, with social support, with financial
support, and limited experiences with discrimination may be able to acculturate easier
than those without these supports. Further, individuals’ plans for returning to their home
after a period in another country may reduce the levels acculturation.
40 s Foundations and Methods of Assessment

Whether an individual from a racial/ethnic-minority group maintains strong cultural

ties to that group may depend on several important variables, and clinicians cannot
presume to understand the degree of acculturation or cultural assimilation without first
attempting to investigate it.

Determining Acculturation and Cultural Orientation

In conducting psychoeducational assessments with children, youth, and their families,
there may be times when it is essential to determine, as accurately as possible, their level
of acculturation and cultural orientation. In some cases, such information may have a
direct bearing on how valid the assessment results may be considered. In other cases,
acculturation information will be essential for translating assessment data into culturally
appropriate intervention plans. There is no universal method of determining accultur-
ation or cultural orientation. Dana (2005) has reviewed several instruments or research
tools that have been developed for determining acculturation or cultural orientation
of individuals from specific racial/ethnic-minority groups. These instruments often
provide information on the traditional culture and the level of acquisition of values
of the dominant society. Most tools focus on a particular target group and address
behavioral outcomes of respondents, rather than psychological outcomes (Celenk &
Van de Vijver, 2011). These tools have been developed primarily for use with adults and
older adolescents, however. In most cases, it is unclear how effectively they might be used
with children and adolescents, although it is reasonable to assume that they at least could
be adapted to provide a general framework.
In the absence of common child-oriented standardized tools for determining accultur-
ation and cultural orientation of youths from various racial/ethnic-minority groups,
there are other practices that should be considered. Simple information gathering before
the assessment is one possibility. The examiner could review existing records carefully
and consult with teachers, parents, and other referral sources regarding such issues as
language proficiency and preference, typical social behavior, involvement and participation
in customs of the traditional culture, and apparent comfort with adults from other racial/
ethnic groups. Another possibility is to attempt to ascertain this information directly
from the child or adolescent client during the process of assessment. Admittedly, this
latter possibility is difficult in some cases. A racial/ethnic-minority youth who is primarily
oriented toward his or her traditional culture may not be comfortable with an examiner
who is a member of the majority group, and in the absence of a strong relationship
of trust that has been formed between the professional and the client, the obtained data
are clearly suspect (Dana, 2008). Special care and perhaps extra time should be devoted
to the process of building trust, forming rapport, and generally establishing familiarity
between the persons who are of strongly differing cultural backgrounds if useful assess-
ment data are to be gathered. Readers are referred to the previous references by Dana for
more information regarding the process of determining acculturation and obtaining
valid assessment data with diverse groups of clients.

Development of Racial/Cultural Identity

As has been stated previously in this section, an individual’s level of acculturation in his
or her traditional culture is likely to depend on many factors, and the general level of
acculturation is likely to have an important bearing on how effective traditional methods
 Social–Emotional Assessment and Cultural Diversity s 41

Table 2.1 Stages of minority racial/cultural development

Stage Characteristics

1. Conformity Depreciating attitude toward self and others of same minority group; discriminatory
attitude toward other minority groups; appreciating attitude toward dominant group
2. Dissonance Conflict between depreciating and appreciating attitudes toward self, others of same
minority group, other minority groups, and dominant group
3. Resistance/ Appreciating attitude toward self and others of same minority group; conflict between
immersion empathetic and culturocentric feelings toward other minority groups; depreciating
attitude toward dominant group
4. Introspection Concern with basis of self-appreciation and unequivocal nature of appreciation toward
others of same minority group; concern with culturocentric views toward members of
other minority groups; concern with basis of depreciation of dominant group
5. Integrative Appreciating attitude toward self, others of same minority group, and other minority
awareness groups; selective appreciation for dominant group
Source: Based on previous work by Atkinson, Morten, & Sue (1989), and Sue & Sue (1990, 1999, 2008).

of assessment will be with the individual. Related to these concepts is the idea of racial or
cultural identity development.
In this sense, identity is defined as a sense of belonging to one’s racial/ethnic group
and how this sense of belonging influences behavior, thought, and affect. Sue and Sue
(1990, 1999, 2008) have articulated the emerging evidence and thought regarding racial/
cultural identity development among minority group members. Based on a wide variety
of research and writing in this area, a general consensus has emerged that such identity
development tends to follow a distinct set of stages. These include conformity (Stage 1),
dissonance and appreciating (Stage 2), resistance and immersion (Stage 3), introspection
(Stage 4), and integrative awareness (Stage 5). These stages are discussed briefly in this
section and presented in summary form in Table 2.1.

Stage 1: Conformity During Stage 1, individuals accept and value the characteristics
of the dominant culture as being the norm and prefer these values over the traditional
values espoused by their own group. Individuals at this stage of development take
on a self-depreciating attitude, often viewing their own group with disdain. According
to Sue and Sue (2008), the conformity stage “represents, perhaps, the most damning
indictment of White racism” (p. 244). Individuals at this stage may be immersed in self-
hatred, suffer from low self-esteem, and uncritically adopt the values and views of the
dominant culture.

Stage 2: Dissonance and Appreciating During Stage 2, an individual begins to feel

discomfort or dissonance regarding some of the beliefs he or she has adopted. For
example, “A Latino individual who may feel ashamed of his cultural upbringing may
encounter another Latino who seems proud of his/her cultural heritage” (Sue & Sue,
2008, p. 246). This tends to be a gradual process. Conflict begins to emerge between self-
depreciation and group depreciation and appreciation. The individual also may begin to
have doubts regarding his or her uncritical valuation and acceptance of the dominant
culture.
42 s Foundations and Methods of Assessment

Stage 3: Resistance and Immersion In Stage 3, the individual rejects the values and views
of the dominant culture and begins to immerse him or herself in the minority views of
his or her own culture. At this point, the attitude toward the majority group becomes
negative and depreciating, whereas attitudes toward those of other minority groups begin
to become conflicted between feelings of culturocentrism and shared empathy for their
differing minority experience. According to Sue and Sue (2008), the three most common
feelings that characterize this stage are guilt, shame, and anger. The anger may be directed
outwardly with great force to combat racism and oppression.

Stage 4: Introspection As an individual moves into Stage 4, he or she may begin to

question the basis and nature of their unequivocal appreciation and acceptance of his or
her own group values and the basis for the unanimous rejection of the majority group.
Attitudes toward other minorities may reflect concern with ethnocentrism as a basis
for forming judgments. As Sue and Sue (2008) stated, “The resistance and immersion
stage tends to be a reaction against the dominant culture and is not proactive in allowing
the individual to use all energies to discover who or what he or she is” (p. 250). The need
for more realistic self-definition and discovery emerges.

Stage 5: Integrative Awareness Individuals who move into Stage 5 have resolved many
of their previous conflicts. They now have adopted an attitude that focuses on self-
appreciation, group appreciation, appreciation of other minority groups, and selective
appreciation of the dominant culture. Their own culture no longer is viewed as being in
conflict with the dominant culture. Summed up by Sue and Sue (2008):

There is now the belief that there are acceptable and unacceptable aspects in all
cultures, and that it is very important for the person to be able to examine and
accept or reject those aspects of a culture that are not seen as desirable.
(p. 251)

This stage theory of racial/cultural identity, as discussed by Sue and Sue (2008) and
others (e.g., Atkinson, Morten, & Sue, 1989), has highly relevant implications for working
with children and adolescents. First, like most social–emotional stage theories of develop-
ment, not all individuals progress neatly through the various stages, and some individuals
never proceed past a given stage. Second, it seems to be linked to some extent to cogni-
tive and social–emotional development. It would be highly unlikely or impossible for
children or adolescents to have moved through all of the stages because of their limited
life experiences and their developing capabilities. Individuals from majority or dominant
cultures also may develop racial/cultural attitudes through a similar process, although
the characteristics of each stage differ from those presented herein. Essentially, a person
in this situation who moves through these stages of identity development progresses from
a highly ethnocentric worldview to the development of a nonracist identity. An example
of a poignant personal account of how an individual may move through the various
stages of racial/cultural identity development is found in The Autobiography of Malcolm
X (A. Haley, 1996), which vividly tells the story of how a historically prominent African
American man moved from an attitude of self-hatred to militant anger to eventual
acceptance of the limitations of his previous views shortly before his untimely death.
 Social–Emotional Assessment and Cultural Diversity s 43

PROBLEMS WITH CATEGORIES AND GROUP EMPHASIS

One of the major issues in regard to understanding appropriate assessment practices for
individuals from specific cultural backgrounds (i.e., similar race/ethnicity) is the develop-
ment and use of appropriate language and schemas (categories) to describe groups of
people. Regarding race and ethnicity, there is no single definition of these terms that is
generally agreed on, and it is common for researchers and practitioners to refer to ethnic-
ity, culture, and race in an interchangeable manner when identifying and categorizing
individuals by these background characteristics (Watt & Norton, 2004). The term race
usually is used to imply some observable physical characteristic that is common to a
group, such as skin and eye color, hair type, and facial features. Ethnicity is the term com-
monly used to describe characteristics that may be less externally observable, such as a
common group cultural history, language, country of origin, or religion.
The terms race and ethnicity have been under fire in recent years, as has the practice
of emphasizing separateness of uniqueness or individuals from specific groups. There are
times when these terms and practices can be politically charged. For example, regional
allotment of federal government funds is affected by changes in racial category distribu-
tion, and district realignment for voting purposes may be affected (Okazaki & Sue, 1995).
Many Americans do not fit neatly into simple categories, making categorical models
problematic. For example, monoracial categorization excludes biracial and multi-racial
groups (Robinson-Wood, 2016). During preliminary planning for the national census
for 2000, the U.S. Bureau of the Census briefly considered the possibility of creating a new
multiracial category to add to the existing traditional categories, an idea that created tre-
mendous controversy (Eddings, 1997) and that ultimately was rejected (although it later
was determined that individuals could check more than one racial category to describe
themselves and that the category of “Asian or Pacific Islander” would be separated into
two distinct categories). For the 2010 U.S. Census, the Census Bureau also included the
category of “Some Other Race” for those who did not identify with any of the listed
categories.
In this chapter, the hybrid term race/ethnicity is used to describe our major focus on
cultural diversity. This term, like all the other categories and labels used to describe groups
of people, is imperfect and potentially problematic. For example, take the case of two
American children, one who traces his ancestry to Vietnam (his family emigrated to the
United States in the 1980s) and the other who traces her ancestry to China (her ancestors
emigrated to the United States in the late 1800s). The U.S. Bureau of the Census currently
would classify both of these children as “Asian,” and a professional research study in
which they participated might refer to them in the written report both as Asian American
participants. The cultural characteristics they share in common may be truly minimal,
however, and in some respects, they might each share more background characteristics
with individuals from other groups than with each other.
A related problem in this area is that emphasizing specific group membership tends
to place a strong emphasis on differences among persons from various racial/ethnic
groups and may in some cases unduly overemphasize such differences. There is an under-
standable rationale for the practice of describing or trying to understand individuals
based on their racial/ethnic background characteristics because this practice is based
on the assumption that “such shared cultural-psychological characteristics are related to
personality or psychopathology” (Okazaki & Sue, 1995, p. 368). It is easy for this type of
44 s Foundations and Methods of Assessment

grouping emphasis ultimately to distort a simple truth regarding human behavior. With
few exceptions, variation within groups is always greater than variation between groups.
Let us assume that a norm-referenced self-report test of personality and behavior prob-
lems for adolescents, when scrutinized statistically, shows evidence that racial/ethnic
Group X tends to have higher scores than racial/ethnic Group Y on a subscale measuring
emotional distress. Let us also assume that these differences are small but still signi-
ficantly different from a statistical standpoint. A focus on the score differences between
the two groups might lead to the assumption that members of Group X tend to be in
continual emotional turmoil and that perhaps this is a defining characteristic of Group
X. Conversely, a critic of norm-referenced testing might argue that the self-report instru-
ment is not appropriate for (or even biased against) members of Group X. Both of these
assumptions could mask the truth of the matter: that there is substantially more variation
in self-reported emotional distress among persons within each group than there is
between the two groups. This issue has been analyzed from a legal context by Richard
Thompson Ford, an African American law professor at Stanford University, whose book
Racial Culture: A Critique (2005) makes an argument against the common presumption
that social categories such as race, ethnicity, gender, and sexuality are defined by distinc-
tive cultural practices. Ford argues against law reform proposals that would attempt to
apply civil rights protections to “cultural difference,” and focuses on the adverse effects
of multicultural rhetoric and multicultural rights on individuals who are supposed
to benefit from them. Such practices, Ford argues, result in a “difference discourse” that
forces minority groups to accept the very stereotypes they may be trying to oppose. In
sum, it seems that although emphasis on, and sensitivity to, differences in racial/ethnic
groups is necessary and important, too much emphasis may result in distortion of fairly
small differences among groups and ultimately lead to stereotyping based on group
membership (Sue & Sue, 2008).

CULTURAL DIVERSITY IN THE UNITED STATES: DESCRIPTION

OF MAJOR RACIAL/ETHNIC GROUPS
With the cautions in place regarding the impact of acculturation and moderator variables
on racial/ethnic identity, and the potential problems and controversies regarding
emphasis on shared group identity and characteristics, this section provides some
basic information regarding the major racial/ethnic groups in the United States as they
typically are defined. This information includes a focus on population characteristics,
including specific issues that may be highly relevant to behavioral, social, and emotional
assessment of children and youth.
When considering this information, it is important to recognize that the population
distribution statistics for children differ from the statistics for adults or the general
population. For example, the 2010 U.S. Census reported that for the general U.S. population,
approximately 72% were White (including White Hispanics), and the remaining 28% were
members of racial/ethnic-minority groups (13% Black or African American, 5% Asian,
0.9% American Indian/Alaska Native, 0.2% Native Hawaiian/Pacific Islander, 6% Some
Other Race alone, and Multi-Racial 3%). When individuals younger than age 18 are
considered, however, it is clear that there is a larger percentage of individuals who are
members of racial/ethnic-minority groups. The population estimates by age group and
 Social–Emotional Assessment and Cultural Diversity s 45

race indicate that 46.5% of children and adolescents younger than age 18, are racial or
ethnic minorities and that all of the growth in percentages of youth in the last ten years are
attributable to racial and ethnic minorities (Frey, 2011). These estimates also indicate
that the child and adolescent population in the United States is more racially/ethnically
diverse than the adult population, reflecting such factors as a younger mean age for several
racial/ethnic-minority groups and higher birth rates and age-related immigration patterns
in some instances.
Another fact to consider in the interpretation of basic information presented on ethnic
groups is that the U.S. demographic makeup is changing rapidly. Population estimates for
the near future predict increasing ethnic diversity and a gradual but continuous dimin-
ishment of the percentage of Americans who are in the current racial/ethnic-majority
group White/non-Hispanic. Although the most recent population estimates show that
about 70% of all Americans are in the White/non-Hispanic group, this percentage is
expected to shrink to a slight majority (barely over half) by the year 2050 (Rosenblatt,
1996). Embedded in this estimate is the projection that Hispanics, who recently became
the largest ethnic minority group in the United States, will compose nearly one fourth
of the entire U.S. population by the year 2050. It is important to consider the dynamic
nature of the American population. In every region of the nation, the population will
reflect increasing racial/ethnic diversity in the next few decades. In border states such as
California, Arizona, Texas, and Florida, these changes have already made a dramatic
impact in education and youth services, and such changes are rapidly spreading to other
states.
A final note before discussing each specific racial/ethnic group. First, this is a limited
overview that necessarily focuses on only a few key characteristics and at the same time
ignores other important characteristics. Readers desiring a more in-depth description
of specific racial/ethnic group characteristics should refer to other sources. Second,
although it has been stated explicitly and implied previously in this chapter, it is worth
repeating: Psychological characteristics associated with specific groups are generalities
based on group research. They do not apply to all members, or even most members, of
particular groups.

African Americans
African Americans (or Blacks, as the U.S. Census Bureau describes this category) include
individuals in the United States who trace their ancestry to the continent of Africa,
specifically to native African groups of dark skin color (e.g., as opposed to White South
Africans, who trace their African ancestry to European colonists). The 2010 U.S. Census
reported that about 13% of the general population was African American, which was the
largest racial minority group. This percentage is expected to increase to 16.2% by 2050,
although it is not expected to constitute the largest racial/ethnic-minority population
at that time because the Hispanic population is expected to grow at a substantially faster
rate (Aponte & Crouch, 1995). Most African Americans live in the southeastern United
States (55%), followed by the Midwest (18%), Northeast (17%), and West (10%) (U.S.
Bureau of the Census, 2011b).
Although African Americans may include recent immigrants from the African
continent who have left their native nations by choice for various personal, political, or
economic reasons (or the descendants of individuals who did likewise), this situation is
not the most typical. By far, this category includes most individuals whose ancestors were
46 s Foundations and Methods of Assessment

removed from their African homelands through coercive and violent means, primarily by
Europeans, through what has been referred to as the African Diaspora: the slave trade that
flourished in the colonies and states (and other parts of the Western hemisphere) from
the 1600s through the mid-1800s. The collective identity and experience of most African
Americans is intertwined with the most divisive issue in the nation’s history, which was
arguably the major factor in the bloody Civil War in the 1860s. For many Americans, the
continuing problem of race relations is primarily viewed as a White/Black issue, owing
to the tremendous and continuing ramifications from our nation’s past, including the
history of institutionalized racism.
Some of the major behavioral, social, and emotional considerations regarding African
American youth has been discussed by Robinson-Wood (2016). One important charac-
teristic is the emphasis and prestige placed on strong verbal and language skills, especially
assertive and emotionally expressive communication. Many Black children and adoles-
cents (particularly those who live in urban poverty areas) may speak a variation of stand-
ard English that has been referred to as Black English or Ebonics, which may be used
to varying degrees and in various situations, depending on the acculturation of the
individual and their connection to the majority culture. Some basic examples of Black
English include the use of “do” instead of the standard English use of “does”; omitting “is”
and “are” from sentences; and reversing the /s/ and /k/ sounds that appear in that order
in Standard English usage, such as pronouncing the word ask as “aks.” Although the
uninitiated interviewer from another culture may mistakenly view the use of Black
English as an indication of poor language development, in reality, it is a complex linguis-
tic system that has its roots in the oral language traditions of West African languages.
In terms of affect, “black [youth] typically are described as expressive, lively, and extro-
verted” (Sattler, 1998, p. 283). African American youth have been shown to have similar
levels of positive self-concept as White youth but may value such attributes as verbal
skills, assertion, and athletic ability at a higher level. Regarding family life, African
American families are more likely than White families to be headed by a woman, but
typical family structures are likely to be similar among the groups. A significant issue for
many Black youth (particularly those who live in low-income urban areas) is the low
value that is often placed on success and achievement in the school setting by their peers.
Many Black youth, particularly those who live in urban poverty centers, may feel alien-
ated from the educational system and believe that it is futile for them to try to succeed in
it, particularly since these youth are twice as likely than White youth to experience
suspension, expulsion, and corporal punishment in school settings (Murray & Zvoch,
2011). Interpersonally, Black adolescents are known for often forming close associations
with same-sex peers. Such close associations may provide a stronger sense of social
identity, but also can result in pressure to participate in antisocial activities (i.e., through
gang membership) in areas where such groups are common. Although the history of
institutionalized racism, cultural appropriation, and lack of opportunities many African
Americans have experienced has produced a strong resiliency in some, it has resulted in
numerous problems for many African American adolescents, including pressure for par-
ticipation in gang activities; feelings of rage, futility, and hopelessness; and, particularly
among Black adolescent boys, heightened probabilities for death through homicide, and
a dramatic overrepresentation in the criminal justice system.
Given some of these unique characteristics and significant challenges common to
many African American adolescents, it is crucial to note the faulty thinking that may
 Social–Emotional Assessment and Cultural Diversity s 47

result from placing too much emphasis on between-group differences and within-group
commonality. Although it is important to note the unique characteristics, shared history,
and specific challenges faced by many African Americans, it also is important to recognize
that there is a growing percentage of African Americans who are middle class, who are
highly educated, and who face a different set of circumstances. Pattillo-McCoy (1999a,
1999b, 2000), a sociologist who has researched the topic of the growing middle class in
the Black community, has noted that this group is often ignored or overlooked in favor
of focusing on stereotypes. She has shown that the research on African Americans is
dominated by the study of concentrated urban poverty, even though most African
Americans are not poor, even fewer live in extremely poor neighborhoods, and there is a
rising percentage of upwardly mobile individuals and families. In addition, in writings
such as her critically acclaimed book Black Picket Fences (1999a), she argued that a
monolithic focus on African Americans is counterproductive. Assessment professionals
who work with African American children and adolescents, regardless of their own racial/
ethnic background, should take into consideration the within-group diversity among
African Americans and understand that Black youth from middle class and highly
educated families may have their own unique strengths and challenges.

Asian Americans
Asian Americans comprise a rapidly growing racial/ethnic-minority population in the
United States. In the 1990 census, 3.0% of the U.S. population was listed as Asian, and that
percentage grew to 3.8% in the 2000 Census. The 2010 Census data indicate that the Asian
population was the fastest growing racial minority in the last ten years (U.S. Census
Bureau, 2011a). The absolute numbers and relative percentages of Asian Americans are
expected to grow during the next several decades, and this group is expected to comprise
10.7% of the general U.S. population by the year 2050 (Aponte & Crouch, 1995), primarily
because of continual immigration to the United States from Asian and Pacific Rim nations.
The largest concentrations of Asian Americans are in the West and Pacific Northwest
regions of the United States.
Asian Americans constitute an extremely diverse group. Most individuals within
this general category trace their ancestral heritage to such varied places as China, Japan,
Korea, the Philippines, and several Southeast Asian nations, such as Laos, Cambodia, and
Vietnam. Sue and Sue (2008) noted that there are at least 40 distinct subgroups of Asian
Americans, each with differing languages, customs, religions, levels of acculturation,
and historical reasons for immigration to the United States. Some of these subgroups are
recent arrivals to the United States, whereas others have been in the nation for several
generations. Many Asian Americans are faced with special challenges, such as English-
language competency issues. There is a bimodal distribution of wealth among Asian
Americans, with some having achieved great economic success and a large proportion
(primarily those of recent Southeast Asian descent) living below the economic poverty
level (Sue & Sue, 2008). This notion is attested to by the fact that in the 1990 census, Asian
Americans had the highest median family income of any racial/ethnic group, including
Whites, but had a higher percentage of families and individuals living at or below the
poverty level than Whites. As a group, Asian Americans tend to do well on standardized
educational achievement tests, particularly in mathematics and the physical sciences,
and they tend to be proportionately overrepresented at prestigious institutions of higher
education, such as the University of California at Berkeley and the Massachusetts Institute
48 s Foundations and Methods of Assessment

of Technology. High-profile indicators such as these mask the fact that there is also a
substantial percentage of Asian Americans who do not enjoy such notable educational
success, because of poverty, discrimination, and significant language barriers (Sue &
Sue, 2008).
Although Asian Americans constitute a truly diverse group, there are certain psycho-
social characteristics that tend to be associated with the larger group, perhaps because
of some common experiences and the heritage of an “Eastern” worldview. One notable
characteristic among Asian Americans is respect for the customs and traditions of their
forebears and extended family. Asian Americans tend to be more socially and politically
conservative than members of other racial/ethnic-minority groups, often resisting
change, stressing a high achievement orientation, and avoiding offending others. They
may be perceived by some members of other racial/ethnic groups as emotionally restrained
because they may not show emotion in overt ways. Asian cultures tend to encourage
interdependency and a group orientation and to discourage individualism and an auto-
nomous orientation. Asian American adolescents may experience conflicts regarding
opposing pressures of assimilation into mainstream American culture and maintaining
traditional family and cultural expectations. Many of these adolescents feel pressure
to conform to stereotypes of being a “model minority,” high educational achievers, and
focused on mathematics and the physical sciences. Asian Americans tend to underuse
mental health services (Sue & Sue, 1990, 1999, 2008) and may be uncomfortable with
mental health service systems that are based on a Eurocentric tradition.

Hispanic Americans
The U.S. Bureau of the Census does not include Hispanic as a racial category. It is
considered to be a category of ethnicity that primarily reflects descent from Spanish-
speaking countries and culture regions in South and Central America and the Caribbean,
Mexico, and the southwestern United States (Aponte & Crouch, 1995). In some cases,
Hispanic Americans (or Latinos, an increasingly preferred term) may speak French or
Portuguese. Obviously, this is a diverse racial/ethnic group. Most Hispanic Americans
define themselves as White in the census racial category, but a sizable proportion define
themselves as Black or as “Some Other Race.” Hispanic Americans represented over half
of the growth in ethnic minorities according to the 2010 Census data. Hispanics constituted
9% of the general U.S. population in the 1990 census and 11.9% of the population in the
2000 census, and now constitute 16% of the population. Hispanics became the largest
ethnic minority group in the United States shortly after the 2000 census. Aponte and
Crouch (1995) reviewed data projections that Hispanics would compose about 20% of the
U.S. population by 2050, but in view of the recent rapid growth of this group that has
surpassed previous projections, it is feasible that the 2050 percentage could be at least
25%, if not higher. Although population patterns are constantly shifting, in the 1990s
and early 2000s, the largest percentage of Hispanic Americans lived in the West (41%),
followed by the South (36%), Northeast (14%), and Midwest (9%) (U.S. Bureau of the
Census, 2011b). The greatest numbers of Hispanic Americans are in three states: California,
Texas, and Florida.
Although Hispanics constitute an eclectic and diverse ethnic group, most of this group
(60%) are of Mexican ancestry, and perhaps the most significant unifying background
characteristic among all Hispanics is the historical (or present) connection to the Spanish
language and ultimately Spanish (and Portuguese) exploration and colonization in the
 Social–Emotional Assessment and Cultural Diversity s 49

Western hemisphere. Another significant historical commonality among Hispanic people

is the influence of the Roman Catholic religion. Lee and Richardson (cited in Sattler, 1998,
p. 291) stated, “Hispanic culture developed as a result of the fusion of Spanish culture
(brought to the Americas by missionaries and conquistadors) with American Indian and
African (the result of the slave trade) cultures.” The culture reflected in this ethnic heritage
is eclectic. Historically, the nuclear and extended family and the dominance of fathers and
other men, along with a family-centered and home-centered role for women, has played
an important role in shaping Hispanic cultural characteristics (Rivers & Morrow, 1995).
Group identity seems to be more important to most Hispanics than to most non-Hispanic
Whites, with the extended family taking priority over the individual in many cases.
According to Sattler (1998), most Hispanic Americans tend to place a high value on
human relationships, identify strongly with their families, and feel comfortable with open
displays of affection and emotion.
Because Hispanic American youth are a heterogeneous group, the characteristics that
should be especially considered in forming a behavioral, social, or emotional perspective
are varied. One characteristic that will be important for a sizable number of Hispanic
American youth is language. Youth whose families have emigrated recently to the
United States may speak only or primarily Spanish. Non-Spanish-speaking educators and
clinicians who work with them are faced with a significant challenge, even if an interpreter
is available. Children with this language background who are placed in schools where
there is little support for their primary language (i.e., where there are no bilingual or
English language learner programs) will feel frustrated and likely will suffer academic
problems as they struggle to immerse themselves in a new culture and acquire a new
language, particularly if English is not spoken in their homes. Many children in this
situation naturally would want to withdraw from an environment that is perceived as
being unsupportive of their individual communication needs. A related issue for some
Hispanic youth may be acculturative stress, or difficulties that emerge when trying to
assimilate into the dominant culture while still trying to honor the traditions and
expectations of their families. Such difficulties, however, may include increased conflict
within the family, which may typically be a source of support (Lorenzo-Blanco, Unger,
Baezconde-Garbanati, Ritt-Olson, & Soto, 2012). There is the possibility of resistance to
treatment recommendations that emanate from an Anglo perspective. Also according to
Sattler, more traditional Hispanic families may have a mistrust for special education
programs because they may feel such programs are inappropriate for their child, who
may receive special treatment or sympathy for a disability. Instead, parents in this situation
may want practical answers to their questions, such as wanting to know how long it will
take for the child to overcome the disability. On the other hand, Kuperminc, Darnell, and
Alvarez-Jimenez (2008), found that parental involvement in schools increased Latino
student academic achievement and improved teachers’ expectations for students. People
with a traditional Hispanic orientation may underuse mental health services, but when
involved with such services may feel more comfortable with a practical, solution-focused
approach to service delivery.

Native Americans
Native Americans include individuals who trace their ancestry to the aboriginal
inhabitants of the North American continent (i.e., those who lived in North America
before European migration). The U.S. Bureau of the Census category for this group also
50 s Foundations and Methods of Assessment

includes the terms Eskimo and Aleut. Native Americans comprise a broad category of
people, including hundreds of federally recognized tribal groups and several tribal
nations. This is the smallest racial/ethnic group within the United States, composing less
than 1% of the general population. Although there are many federally recognized tribes
(500), only a few have substantial populations. The 1990 census listed only seven tribes
that have more than 50,000 members, including (beginning with the largest group),
Cherokee, Navajo, Chippewa, Sioux, Choctaw, Pueblo, and Apache (U.S. Bureau of the
Census, 1993). Although population predictions for the next 50 years project that Native
Americans will still be the smallest racial/ethnic-minority group in the United States by
2050, the absolute numbers are projected to increase, as will the relative percentage of the
population, from the current 0.9% to 1.2% by 2050 (Aponte & Crouch, 1995).
Although Native Americans are a diverse people in many respects, certain similar hall-
mark characteristics have been associated with the various tribal groups. The common
ethnic background that ties Native Americans together is considered to be a product
of shared historical experiences, political ideologies, and worldviews, rather than
cultural similarities (Aponte & Crouch, 1995) because there are many differing tribal
languages and cultural customs. A major defining shared historical experience among
Native Americans is oppression by the U.S. government (as an instrument of the broader
American citizenry) through appropriation of their ancestral homelands, forced reloca-
tion of their ancestors to reservation areas, and continual violation of treaties. Beginning
with the first permanent European settlements on the East Coast and ending with the
Atlantic to Pacific borders produced through the “manifest destiny” of the dominant
culture, the percentage of Native Americans as a proportion of the general population
steadily declined for many years. A shared experience of many Native Americans is poverty,
and family structures of Native Americans often include a broad extended family rather
than a primary emphasis on the nuclear family. Similar to Asian Americans, traditional
Native Americans place a stronger respect for older individuals, some of whom may hold
particularly venerated positions of respect as tribal Elders. In contrast to the traditions of
most European cultures, traditional Native Americans foster a belief in harmony with,
rather than mastery over, nature. For many Native Americans, cultural religious beliefs (as
opposed to formally theocratic religions) are a highly important aspect of their worldview,
with traditional religions emphasizing a reverence for the forces of nature, mysticism,
spirituality, and mythology.
Almost half of all Native Americans live in the West, with another third living in the
South. The remaining population is spread throughout the Midwest and Northeast.
About 35% of Native Americans live on reservations or tribal lands or villages.
Certain psychosocial characteristics have been associated with Native Americans and
may be especially true of those who are more traditional as opposed to assimilated within
the majority culture. Understanding some of these characteristics may be essential for
conducting effective assessments of Native American children and adolescents. Traditional
Native American parents are much more likely than Anglos to use noncoercive and
noninterfering methods of parenting (i.e., letting children develop freely), which may be
interpreted wrongly by professionals who are not familiar with the culture. Although
individuality is respected among traditional Native Americans, there is clearly more of a
group orientation as opposed to an individualistic orientation, and modesty and humil-
ity are valued characteristics. Many traditional Native American children may be uncom-
fortable being recognized for individual achievements. Traditional Native Americans
 Social–Emotional Assessment and Cultural Diversity s 51

tend to have a less rigid, more flexible view of time than most other racial/ethnic groups,
viewing it in terms of natural processes and internal feelings rather than a mechanical
clock time. Particularly in high-poverty reservation areas, alcohol and drug abuse is a
serious problem among Native American adolescents, as is hopelessness and suicide
(Rivers & Morrow, 1995). Native American adolescents have the highest suicide rate of
any racial/ethnic group, which is almost twice as high as that of Whites, the second most
suicide-prone group, and alcoholism and drug abuse account for about 50% of Native
American deaths (Sattler, 2008). Clinicians who work with Native American adolescents
should consider these possible issues carefully and should become educated regarding
the specific cultural practices and expectations associated with the specific tribal
groups whom they serve. It also is important to recognize that there are tremendously
varying degrees of acculturation among Native Americans, and the traditional patterns
expressed in this section do not reflect the characteristics of a substantial number of
Native Americans.

Some General Characteristics of the Majority Culture

Many discussions of cultural diversity in the education and mental health fields do
not address cultural characteristics of the White/Caucasian majority group and instead
focus only on characteristics of racial/ethnic-minority groups. The implied assumptions
regarding this type of approach are that readers are already familiar with the essential facts
and characteristics of the majority group, or that such information is not pertinent to
becoming a culturally competent practitioner. In our view, such an approach simply leads
to further perpetuation of incorrect notions regarding cultural diversity. One problem
with not including the majority White group in discussions of professional practice and
cultural diversity is that it perpetuates a notion that the current Caucasian/White majority
culture within the United States is the normative or typical standard rather than a cultural
variant. The reality here is that whereas Whites currently constitute more than two thirds
of the population in the United States, they do not constitute a majority of the world’s
overall population, and even within the United States, the proportion of non-Hispanic
Whites is now expected to diminish steadily to become a minority (less than 50%) of the
U.S. population by about 2050. Another problem with majority-omitting discussions
on diversity is that it may foster a belief among members of the current majority culture
that they are not ethnic, that they do not have a culture, and that only groups who
are variant from this normative perspective should be discussed in examinations of
diversity. I contend that such conscious omissions only foster further ethnocentrism
by members of the majority group and that this issue is important for a brief discussion
in this section.
One of the problems in defining and discussing the White racial/ethnic majority in
the United States is that so many terms are applied to it, and the terminology is at times
misleading. For example, the U.S. Bureau of the Census uses the category White, non-
Hispanic to classify the current majority group, but other terms that are commonly
applied include Caucasian (a racial classification used by anthropologists and ethno-
biologists), European American, Anglo, and a host of lesser known terms. Most discus-
sions of the White racial group within the United States are focused on individuals who
trace their ancestry to European nations. There is substantial variation in culture and
ethnicity among a group so broadly defined. A descendent of the first permanent
European settlers to North America several hundred years ago may feel that they have
52 s Foundations and Methods of Assessment

little in common with a modern-day immigrant from Russia or Lithuania, other than the
color of their skin. Added to this problem is the fact that there are many individuals in
the United States who technically are considered to be White by the census bureau but
whose cultural background varies dramatically from that of a stereotypical White Anglo-
Saxon Protestant, such as individuals who trace their ancestral heritage to the Arabic and
primarily Muslim nations of the Middle East.
Although the people of various European/Caucasian ethnic and cultural groups
generally are referred to as comprising a monolithic majority group, not all groups who
fit within this constellation historically have been treated this way. Irish immigrants to
the United States in the mid-1800s were the objects of substantial discrimination and
hostility, as were later immigrants from eastern and southern Europe. Immigrants to the
United States from almost all parts of the world and at almost all points in time have faced
hostility from the dominant culture. In reality, White or European American immigrants
to the United States, although they may face substantial challenges, have had an easier
time fitting in within the dominant culture than have Asian Americans, African Americans,
Hispanics, and Native Americans because of such issues as skin color and historically
shared cultural heritage.
With all the caveats in place, there are certain psychosocial or cultural characteristics
that tend to be considered uniquely European in nature and have been used to describe
the White majority group in the United States. Individuals in this group, although they
may be diverse, tend to share a Western worldview and value system (Corey et al., 1997).
Some major characteristics of this worldview include an emphasis on individualism and
fulfillment of individual needs, a nuclear family structure, competitiveness, an orientation
toward the future, assertiveness, independence, emphasis on youth, nonconformity and
individual freedom, mastery over the environment, and individual responsibility. People
who hold this value system often go to great lengths to try to gain control over their cir-
cumstances and destiny and may not be able to relate well to persons whose worldview
and value system emphasize fate or who believe that individual efforts will have little
influence on the outcome of a situation. Whites of European ancestry are less likely than
Asian Americans and Native Americans to defer personal decisions to the views and
needs of the extended family group or elders and instead tend to focus on self-fulfillment
as a means of achieving satisfaction or happiness. As is true in the case of all racial/ethnic
groups discussed in this chapter, these characteristics may differentiate the group from
other groups, but there is likely to be more substantial variation in these areas among
individuals within the dominant culture. White readers of this book who question whether
the characteristics presented in this section are representative of them should consider
carefully how essential it is to not stereotype individuals from other racial/ethnic groups
but to use the available information on cultural generalities as a basis for understanding
rather than labeling the individual.

ASSESSMENT METHODS AND CULTURAL DIVERSITY: SPECIAL

CONSIDERATIONS
This section includes separate discussions of the six methods of assessment that are
presented in this book, with an emphasis on what is known regarding the multicultural
applications of each method. Each method is associated with certain problems for
 Social–Emotional Assessment and Cultural Diversity s 53

culturally competent assessment, although substantial progress has been made with some
of these methods.

Behavioral Observation
Because there is such a wide variation in potential techniques for direct behavioral
observation, the cultural validity of these techniques presumably also may vary widely.
The primary advantages of behavioral observation as an assessment method, as detailed
in Chapter 3, include the potential of strong experimental validation and replicability,
the wide flexibility, and the strong potential ecological validity of assessing behavior
within the context of behavior–environment relationships. If the assessor appropriately
takes into account the cultural background characteristics of an individual child in
designing the observational coding system and interpreting the obtained data, direct
behavioral observation may be an excellent choice for culturally appropriate assessment
of social–emotional behavior.
There are some potential threats to the validity of direct behavioral observation that
may have a significant impact on the cultural appropriateness of this method. Of the
potential threats to validity of behavioral observations that are discussed in Chapter 3,
the following threats have specific ramifications for culturally appropriate assessment:
lack of social comparison data, observer reactivity, and situational specificity of behavior.
Regarding the social comparison problem, failure to compare the observed behavior of a
target child appropriately with that of their peers may result in interpretations that are
not based on a normative perspective, and deviancy of behavior may be underestimated
or overestimated. When observing a child or adolescent who is a member of a racial/
ethnic-minority group within a given environment, social comparisons of behavior
should be made with other children of their group and children who are in the majority
group if possible. Such inclusiveness in defining the social comparison targets may help
to differentiate between maladaptive behavior and behavior that simply differs from the
norm. In regard to observer reactivity, if the person conducting the observation stands
out in some obvious way from the students in the classroom, it is more likely that the
students will react behaviorally to the presence of the observer and that the observational
data that are obtained may be distorted. If an African American observer went into a
classroom in a tribal school on a remote and rural reservation area in the West to collect
data, he or she most likely would stand out significantly to the children, simply because
of the lack of experience of most of these children with African Americans. Likewise,
a White observer entering a school that is composed primarily of African American
students and teachers in a similar situation may be likely to create reactivity. To minimize
the effects of such reactivity, observers who are in a situation where they stand out as
unique should take extra time for settling in and having an adjustment period before
beginning the formal observation. With regard to the situational specificity of behavior
phenomena, observers should consider carefully that children who are in a substantial
racial/ethnic-minority situation in classroom or clinic observation settings may behave
differently in those environments than they would in environments with which they were
more familiar and comfortable. The culturally valid behavioral assessment will include
observational data from a variety of normal environments to the greatest extent possible.
Although these cautions and recommendations are based on sound theory and make
good sense, it is important to recognize that there is little empirical evidence regarding
the effects of race/ethnicity or other cultural variables on the validity of direct behavioral
54 s Foundations and Methods of Assessment

observation. The few studies that have been conducted in this area (e.g., Harvey et al.,
2009; Lethermon et al., 1984; Lethermon, Williamson, Moody, & Wozniak, 1986; Turner,
Beidel, Herson, & Bellack, 1984) have indicated that in certain situations, there may be an
interaction between the race/ethnicity condition of the observer and the target subjects,
and in some circumstances, this interaction may result in biased observational data. It
also has been stated, however, that appropriate training of observers may reduce such bias
(Lethermon et al., 1986). The recommendations regarding appropriate training and
support of observers that are provided in Chapter 3 seem to have special relevance to the
topic of culturally valid assessment practices.

Behavior Rating Scales

Because behavior rating scales typically are standardized norm-referenced assessment
tools, their validity for use with diverse cultural groups for which they are intended may
be ascertained to some extent through the information available in the test manual. In
other words, the developers of such instruments should follow specific procedures for
item development and accumulation of validity evidence if they desire to make a claim
that the instrument is valid for use across groups with differing characteristics along some
major demographic domain. For example, the Standards for Educational and Psychological
Testing (AERA, APA, & NCME, 2014) recommends that test developers should carefully
examine the appropriateness of the item content for intended target groups, that groups
for which the test is intended should be represented adequately in normative samples,
and in certain cases, that research regarding similarity or differences among specific
groups should be shown. It is recommended that potential users of behavior rating
scales and other standardized norm-referenced social–emotional behavior instruments
should scrutinize carefully the contents of the technical manual before deciding to use the
instrument with racial/ethnic-minority youth.
One of the ongoing debates (for which there is little empirical evidence) regarding
culturally appropriate uses of standardized norm-referenced instruments, such as behav-
ior rating scales, is in regard to the desirable proportion of representativeness of various
racial/ethnic groups within the norm group and whether local norms are better than
national norms. In other words, does the assumption of comparability discussed by Rhodes
et al. (2005), and mentioned earlier in this chapter, hold true in specific situations, or
does it fail? The standard practice in educational and psychological test development
in more recent years has been to ensure that the norm sample of the instrument parallels
the characteristics of the general population for which it is intended, to the greatest extent
possible. In other words, a test developer who intends the completed instrument to be
used generally with children and adolescents in the United States should attempt to
develop a norm sample that closely parallels the racial/ethnic, gender, and socioeconomic
status characteristics of the general population from the most recent census. In reality,
this practice, although laudable and challenging, does not provide evidence of cultural
validity a priori, and some experts have criticized the practice because minority groups
still comprise a minority within the norm sample against which their scores are to be
compared. For illustration purposes, based on the 2010 census, slightly less than 1% of the
population in the United States are Native Americans. Using the standard practice of
instrument development, representation of Native Americans in about 1% of the norm
sample for the test should satisfy the general standard of equivalency. However, 1% is still
a very small proportion, even when it represents the general percentage of a specific
 Social–Emotional Assessment and Cultural Diversity s 55

subgroup within a general group. In this example, assuming there is a total norming sample
of 1,000 for a specific measure—a respectable figure—it would require only ten Native
American youth to make the sample of Native Americans in the norming population pro-
portional to the actual percent in the U.S. population. Such a simplistic application of
proportionality raises many questions. For example, if our ten Native American youth in
the norming sample are all members of the Yakima tribe in the Pacific Northwest,
should we assume that Native American youth in general have been sampled, or is there
some concern regarding generalizing the statistical representation to other subgroups,
such as the Ojibwa tribe in the northern Midwest? Along this same line of reasoning, it
has been proposed that a small representation, even if it is in proportion to the percentage
of the group within the total population, might be presumed to result in test bias (e.g.,
Harrington, 1988).
What can be made of the opposing arguments regarding proportionality in norming?
The scant evidence that is available on normative representation within standardized
tests may indicate that proportional representation, or even minority overrepresentation
within the norm group, may have little impact on the ability of the test to predict behavior
or performance in a valid manner, as long as adequate sampling procedures are used
in the construction of the norm group, and the content of the test items is relatively free
of cultural bias to begin with (Fan, Wilson, & Kapes, 1996). The Fan et al. study used
varying proportions (0%, 5%, 10%, 30%, and 60%) of differing ethnic groups (White,
African American, Hispanic, Asian American) in a tightly controlled standardization
experiment and found that there was no systematic bias against any of the groups when
they were in the not represented or underrepresented conditions. Fan et al. referred to the
notion of proportional representation or overrepresentation of racial/ethnic-minority
groups as a best practice as the “standardization fallacy.” This interesting study did not
target specifically assessment of social–emotional behavior, and a replication using this
performance domain would be useful. It is one of the few tightly controlled studies,
however, to address the issue of representation of specific racial/ethnic groups within
standardization groups, and racial/ethnic differences on scores of standardized social–
emotional behavioral measures tend to be less than differences on cognitive measures.
Based on the results of this study, it seems that the most important aspects of develop-
ing assessment instruments that have wide cultural applicability and validity are the
actual content development procedures (to eliminate biasing items) and the use of good
sampling methods for construction of the norm group. Other instrument develop-
ment procedures may also be useful for showing appropriateness with differing racial/
ethnic groups, such as conducting specific comparisons with subsamples of various
racial/ethnic groups regarding such characteristics as mean score equivalency, internal-
consistency properties, and factor structure.
Relatively few studies have been conducted regarding culturally appropriate develop-
ment and use of behavior rating scales across diverse racial/ethnic groups. In reporting
research on a national normative sample for the original Child Behavior Checklist
(CBCL), Achenbach and Edelbrock (1979, 1981) noted that the effects of race/ethnicity
were minimal if socioeconomic status was used as a controlling covariant. The most
recent CBCL (Achenbach, 2001a), however, has been studied with children from
30 or more societies and data suggest that the proposed factor structure fits these inter-
national samples well (Rescorla et al., 2007; Rescorla et al., 2011). Other studies using
socioeconomic status as a covariant with the normative samples included the School
56 s Foundations and Methods of Assessment

Social Behavior Scales (SSBS) (Merrell, 1993a, 1993b, 2002b) and the Preschool and
Kindergarten Behavior Scales (PKBS) (Merrell, 1994, 1996a, 2002a). Differences in levels
of problem behavior scores across racial/ethnic groups may be associated more strongly
with variables such as family income and education level than with race/ethnicity.
Developers of behavior rating scales and other standardized assessment instruments
should ensure appropriate stratification based not only on race/ethnicity, but also on
geographical representation and socioeconomic status. Although the actual effects of
proportional underrepresentation or overrepresentation of various racial/ethnic groups
within general norm samples are still unclear, test developers also would be wise to ensure
that the various groups receive adequate representation in the standardization sample.

Interviewing
The area of clinical interviewing is especially important when considering cultural diver-
sity and social–emotional assessment. Interviewing may involve some of the strongest
potential barriers to effective cross-cultural assessment, but also is perhaps the most
modifiable and flexible social–emotional assessment method, offering great promise
in this regard for clinicians who acquire the skills for culturally sensitive interviewing
(Hughes & Baker, 1990; Sattler, 2008).
Little attention has been given to the topic of making clinical interviews with children
more culturally appropriate. Nevertheless, it is clear that attention to this area is needed.
In commenting on culturally competent assessment practices in the United States,
Dana (1996) noted that the traditional information-gathering styles of many assessment
professionals of the White majority may pose substantial obstacles for effective assessment.
He stated:

Anglo American assessors have been influenced by medical model service-delivery

requirements for compliance with a matter-of-fact, somewhat impersonal style that
puts business first and discourages a more personal relationship during the service
delivery or later. As a result, many Anglo American assessors expect clients to have
an immediate task orientation including cooperation and responsiveness to the
test materials. . . . However, most traditional persons cannot respond comfortably
to assessment tasks if the assessor uses a social etiquette that is uncomfortable,
intrusive, frustrating, or alienating.
(p. 475)

Certainly, conducting clinical interviews in this manner with children in general would
be a problem, but it may be substantially more problematic if the child is a member of a
racial/ethnic-minority group and has a traditional orientation. So, given what is known
regarding traditional clinical interviewing practices and cultural differences among
the U.S. population, what should be done to approach this problem? A detailed approach
for conducting culturally sensitive interviews, including interviews with parents, was
proposed by Rhodes et al. (2005), in a separate chapter on interviewing in their excellent
book Assessing Culturally and Linguistically Diverse Students. Although too detailed to
justly summarize in this section, the recommendations by Rhodes and colleagues for
successful interviewing in cross-cultural situations include a strong emphasis on prior
preparation for the interview with respect to linguistic and acculturation issues and can
be summarized by the following steps in their recommended process:
 Social–Emotional Assessment and Cultural Diversity s 57

s PREPARINGFORTHEINTERVIEW
s ISSUESTOCONSIDERBEFORECONDUCTINGTHEINTERVIEW
s SELECTINGANINTERVIEWFORMAT
s DETERMININGTHERELEVANCYOFQUESTIONS
s ASKINGDIFlCULTQUESTIONS
s DETERMININGWHOSHOULDBEINVOLVEDINTHEINTERVIEW
s WHATTODOIFTHEPARENTISNTAVAILABLEFORAFACE TO FACEINTERVIEW
s LIMITATIONSOFCONDUCTINGTHEINTERVIEWBYTELEPHONE
s NECESSARYCONDITIONSFORASUCCESSFULINTERVIEW
s CONSIDERATIONOFCULTURALFACTORS
s WHATTODOAFTERTHEINTERVIEW

In a similar vein, a cohesive and detailed set of suggestions for culturally competent
interviewing of ethnic-minority children (particularly children who are traditional rather
than bicultural or marginal in their acculturation) has been offered by Sattler (1998), who
made nine recommendations, which are detailed in Table 2.2.

Table 2.2 Nine recommendations by Sattler (1998) for effective interviewing of racial/ethnic minority children and their families

Recommendation Comments

Learn about the Active efforts to learn about cultural issues such as ethnic identification,
interviewee’s culture traditional practices and customs, attitudes toward childrearing and education
Learn about the Should occur before the interview; if the child/family is not comfortable
interviewee’s language speaking the language of the interviewer, arrangements should be made for a
different interviewer or an interpreter
Establish rapport Encouragement of the child/family’s participation, interest, and cooperation;
use diplomacy and tact, and avoid being disrespectful
Identify stereotypes Inward examination by interviewer regarding their own beliefs, prejudices, and
stereotypes regarding the racial/ethnic group of the child/family; consider that
these expectations may not be accurate
Clear communication Avoid use of jargon, slang, technical language, and statements with double
meanings; use courtesy and respect in communications; if needed, modify the
interview format
Identify family needs Determine material, physical, and psychosocial needs of child and family, and
consider community resources to meet these needs; may be especially
important for recent immigrants or families living in poverty
Identify attitudes toward What are beliefs regarding illness, healing, traditional rituals, and religious
health and illness customs? What drugs and folk remedies is child using?
Recognize the extent of Determine level of acculturation within traditional group and assimilation into
acculturation dominant group; for recent immigrants, determine level of functioning before
leaving homeland and level of acculturation stress
Accept the interviewee’s Active efforts by interviewer to accept beliefs and attitudes they may not share,
perspectives coupled with recognition that problems may not be due to minority status

Learn About the Interviewees’ Culture This recommendation would include efforts by
the interviewer directed at learning about such factors as family ethnic identification,
cultural patterns related to parenting practices, specific family attitudes regarding
58 s Foundations and Methods of Assessment

childrearing, the education and the occupational background of the parents, and the
ethnic community with which they may identify themselves. Attempts to learn about
the culture should be tempered with the realization that your information may be
only partially correct. “Recognize your ignorance about some details of the family’s
culture . . . if you are not a member of the ethnic group, you may be viewed as a stranger”
(Sattler, 1998, p. 313). It also is recommended that the interviewer be frank with the
family regarding the lack of knowledge he or she may have regarding their cultural
background.

Learn About the Interviewees’ Language Attempts to learn about the language of the
interviewee and family would include a determination of their preferred language (before
the interview) and familiarity with English. This background information is essential in
determining if an interpreter is needed for the interview, assuming that there is not
another potential interviewer who speaks the language of the family.

Establish Rapport The larger the cultural background differences between the interviewer
and the client (and their family), the more time may be needed to establish adequate
rapport. Sattler (1998) recommended that the interviewer should “make every effort
to encourage the child’s and family’s motivation and interest” and “take the time to enlist
the child’s and family’s cooperation” (p. 315). Diplomacy, tact, and respect are crucial
characteristics of attempts to establish good rapport.

Identify Stereotypes This process is focused on an inward examination by the interviewer

regarding his or her own preconceived notions, prejudices, and stereotypes regarding
the racial/ethnic group of the child and their family. Assumptions should not be made
immediately that the family is traditionally acculturated into the known cultural charac-
teristics of their racial/ethnic group. “Ask them about these matters as needed” (Sattler,
1998, p. 315).

Promote Clear Communication If the child and the family are not bicultural or well
assimilated into the culture of the interviewer, specific attempts should be made to ensure
that communication is enhanced. Avoidance of technical jargon, slang expressions,
unusual idioms, or statements with dual meanings may be necessary. If these ethnic-
group differences begin to hamper the interview, the interviewer should try actively to
monitor his or her behavior and use other approaches. “Be flexible, and use innovative
interviewing strategies tailored to the needs of the family’s ethnic group” (Sattler, 1998,
p. 316).

Identify Family Needs Particularly if the child and the family are recent immigrants to
the United States or if they live in poverty, the interviewer should attempt to ascertain
whether they have obvious material, physical, or psychosocial needs and what can be
done to connect them with appropriate community resources.

Identify Attitudes toward Health and Illness If the child and the family are traditionally
oriented to their ethnic culture, they may have concepts of illness, healing, rituals, and
religious beliefs that are unfamiliar to the interviewer and most people within the public
school system. In making active attempts to learn about their attitudes and beliefs in this
 Social–Emotional Assessment and Cultural Diversity s 59

area, the interviewer should try to understand the child’s and family’s expectations
regarding professional treatment and ascertain what prescription drugs, over-the-counter
drugs, folk remedies, and illicit drugs the child may be taking.

Recognize the Extent of Acculturation As has been stated many times throughout this
chapter, there is tremendous variation among individuals and families regarding how
acculturated they are within their racial/ethnic culture and their knowledge and orienta-
tion to the dominant culture. If the child and family are recent immigrants to the United
States, it is recommended that the interviewer attempt to assess their level of functioning
before leaving their homeland and to determine how they are coping with the stresses
associated with the process of acculturation.

Accept the Interviewee’s Perspectives The interviewer should make a substantial effort to
accept the cultural perspectives of the interviewee and his or her family. This is an ideal
rather than a technique and in some cases may be difficult to achieve. This process may
be the most difficult aspect of culturally competent assessment and intervention. It
involves the willingness of the interviewer to accept perspectives he or she may not share
or with which he or she may feel uncomfortable. At the same time, efforts need to be
made to achieve a balance between understanding any behavioral, social, and emotional
problems within the cultural context and avoiding attributing all individual and family
problems to the cultural background and minority group status.
Any competent assessment professional who thoughtfully attempts to implement
these suggestions will find that his or her cultural sensitivity in clinical interviewing is
enhanced. In some cases, these efforts will not be enough to achieve the desired goal,
however. Willingness to conduct more than one interview also may be necessary, and
honesty and reliability in communication likely will enhance the trust between the inter-
viewer and the client. “Improved intercultural communication will ultimately depend
on changes in the socio political system. Until our society eliminates racism and discrim-
ination, there will always be vestiges of suspicion and mistrust between people of different
ethnicities” (Sattler, 1998, p. 317).

Sociometric Techniques
Although sociometric techniques are most likely to be used as assessment tools for research
purposes rather than for everyday clinical practice, there is a small but coherent body
of evidence indicating that they may be associated with strong racial/ethnic effects. Any
professional contemplating the use of sociometrics with a diverse group of children
should consider this issue carefully and be aware of potential bias. The primary consistent
finding in this area is that similarity provides a strong basis for positive peer nominations
and ratings. This issue is discussed in Chapter 7 with respect to gender similarity, which
has been shown in scores of studies to influence sociometric results of friendship patterns.
In other words, boys are more likely to rate or nominate other boys using positive criteria,
and girls are more likely to select other girls in this manner. A smaller but also compelling
collection of research in this area also has emerged regarding race/ethnicity as a sociometric
prediction variable.
A study by Singleton and Asher (1977) explored social interaction patterns among
Black and White third-grade students in integrated schools. In this study, race (and sex)
was found to be a significant determinant of positive sociometric ratings for play and
60 s Foundations and Methods of Assessment

work. Black children were substantially more likely to select other Black children as the
people with whom they would most like to play or work, and White children were equally
likely to select White children in this regard. This study, which was conducted shortly
after the initiation of court-mandated school integration in many areas of the United
States, was timely but did not explore the issue in more detail. The generalities of Singleton
and Asher’s study were replicated in a later study by Clark and Dewry (1985), who found
the same type of racial/ethnic preferences using a more controlled methodology.
More recent sociometric investigations have verified the notion that similarity, whether
it be in gender, race/ethnicity, socioeconomic status, or social behavior patterns, provides
a strong basis for friendships (Graham & Cohen, 1997; Kupersmidt, DeRosier, & Patterson,
1995). Some of these studies have pushed the issue further, however, and have provided
some more specific answers to the question of racial/ethnic similarity in sociometric
assessment. Kistner, Metzler, Gatlin, and Risi (1993) examined peer preferences and per-
ceptions among African American and White children in classrooms where there were
clear majority patterns (i.e., classrooms where there was a dominance of African American
children and classrooms where there was a dominance of White children). Their findings
put a different twist on the issue of similarity in sociometric assessment, showing that
being in a minority situation, regardless of your racial/ethnic group, was associated with
higher rates of peer rejection for girls but not for boys. Another finding from this study
was that peer preferences may be influenced by cultural dominance. In other words, a child
who is in the racial/ethnic minority in a given classroom (regardless of what race he or she
is) is likely to rate children of the dominant group more positively than he or she would if
he or she were in the majority and the members of the other group were in the minority.
Another study that found an interesting race/ethnicity and gender interaction effect in
sociometric assessment was conducted by Kistner and Gatlin (1989). These researchers
studied positive and negative nominations of White and Black children, some of whom
had learning disabilities, but most of whom did not have disabilities. Predictably, there was
a racial/ethnic (and gender) effect for positive nominations, where children were more
likely to identify as friends those children with whom they felt they had the most similarity.
Effects for negative nominations also were identified, however. Children of both racial/
ethnic groups were more likely to reject children of the opposite gender and racial/ethnic
group. Similar results can even be found in preschool settings, suggesting that these
patterns of behavior begin early (Park, 2011).
These studies all have a common theme, showing that race/ethnicity is likely to be a
significant factor not only in friendship patterns, but also in patterns of peer rejection.
The racial/ethnic make up of the class also seems to be an added factor to consider in
sociometric data collection (Jackson, Barth, Powell, & Lochman, 2006). For researchers
or clinicians using sociometric techniques, there is an obvious practical implication.
Children whose racial/ethnic group comprises a small percentage of the overall classroom
may be overidentified as socially neglected or rejected, and faulty interpretations might
be reached if these cultural variables are not considered fully. It would be advisable to
include sociometrics of racial/ethnic-minority youth only within the context of a com-
prehensive assessment design that overcomes the limitations of reliance on one method.

Self-Report Instruments
In comparison with most areas of behavioral, social, and emotional assessment, a
relatively larger body of evidence has accumulated regarding the use of self-report
 Social–Emotional Assessment and Cultural Diversity s 61

instruments with ethnic-minority populations. Because there has been little research and
development work with child populations and self-report assessment until the past
decade, most of what is known regarding multicultural applications in this area has come
from research with adults. We can use the accumulated knowledge and thinking from the
adult population, however, as a basis for developing some general guidelines for assess-
ment practices with children and youth. In general, self-report assessment is an area in
which caution should be used for the selection, administration, and interpretation of
assessment instruments with members of racial/ethnic-minority groups, particularly
those who have a traditional cultural identity and are not highly acculturated within the
mainstream majority culture.
The most widely used self-report instrument in existence is clearly the Minnesota
Multiphasic Personality Inventory (MMPI) and its recent successors the MMPI-2 and
MMPI-A. Several reviews of the use of the MMPI with members of racial/ethnic-minority
groups (e.g., Dana, 1993, 1995, 2005; Greene, 1987; Hoffman, Dana, & Bolton, 1987) have
indicated that there are clear patterns of profile differences with these groups compared
with the general instrument norms. Specifically, research has shown that members of
racial/ethnic-minority groups, regardless of their clinical status, are more likely than
members of the dominant culture in the United States to respond to MMPI items in ways
that may result in elevated scores on some of the validity and clinical scales. In Dana’s
1995 review, he noted that African Americans are likely to receive high scores on scales F,
6, and 8 as a process of becoming Afro-centric; Hispanic Americans tend to exhibit similar
patterns of score elevations on these scales as a result of traditional cultural orientation;
and Native Americans are more likely than majority group members to show elevations
on scales F, 4, and 8, regardless of their diagnostic status. Less is known regarding the
use of the MMPI with Asian Americans, although some studies have shown that they are
likely to receive elevated clinical profiles in comparison with the majority-dominated
standardization group. Dana’s more recent (2005) review of the MMPI instruments
contends that this system can be used effectively with culturally diverse individuals so
long as appropriate adaptations are implemented but provides many cautions.
Given that there is no a priori reason to believe that members of racial/ethnic-minority
groups should respond to a broad-band self-report measure such as the MMPI measures
in ways that show more psychopathology than exists among the majority culture, the
history of such differences raises serious questions and concerns. Because the large major-
ity of the cross-cultural MMPI research has been with populations who responded to the
MMPI or MMPI-2 rather than the MMPI-A, there is additional reason for caution when
using this test with racial/ethnic-minority youth. Dana (1995) suggested that the MMPI
“should be used only when the assessee has been demonstrated to be comparable to the
standardization population on demographic variables, including world view as measured
by moderator variables, and speaks English as a first language” (p. 66). In other words,
use of the MMPI (and presumably the MMPI-A) with racial/ethnic-minority clients
who are traditional in their orientation is not recommended. Although the MMPI-A
norms are more racially/ethnically diverse than the norms for the original MMPI, the body
of evidence regarding response profiles among racial/ethnic-minority youth is still in the
formative stage, and it is prudent to assume that caution is warranted.
The MMPI is a relatively unique type of self-report measure, using empirical criterion
keying in the construction of the subscales, using items that are not particularly specific to
behavioral, social, or emotional problems (e.g., “I believe in law enforcement,” “I like
62 s Foundations and Methods of Assessment

collecting flowers and growing houseplants,” or “I would like to be a nurse”), and employing
a forced-choice true/false response format. It may be possible that there are some
peculiarities associated with the format and structure of the MMPI that make it particularly
prone to the racial/ethnic bias in terms of the profile patterns that are produced.
Aside from the implications of research on the MMPI, relatively little is known
regarding cross-cultural applications of self-report assessment, but some new evidence
with the newer generation self-report instruments for children and adolescents is
beginning to emerge. Two studies using the Internalizing Symptoms Scale for Children
(ISSC) showed that this instrument produces levels of total and subscale scores with
African American children (Sanders, 1996) and Native American youth (M. S. Williams,
1997) that are comparable to those of the general normative sample, even with minority
children who are from low-socioeconomic-status homes. Information in the technical
manual for the Personality Inventory for Youth (PIY) indicates that the overall score
levels and profile patterns of racial/ethnic-minority subsamples tend to be similar to
those of the general norm population. Some of the research on narrow-band self-report
instruments such as the Children’s Depression Inventory, Second Edition and Revised
Children’s Manifest Anxiety Scale, Second Edition (both of which are discussed in
Chapter 11) has included large samples of racial/ethnic-minority youth and not shown
any substantial biasing effects for race/ethnicity. These studies and a few similar studies
with other self-report measures are more encouraging from a cultural-validity perspective
than the cross-cultural research with the MMPI and provide some hope that future efforts
might show definitively that the new generation of child and adolescent self-report
measures is appropriate for use with children from varying racial/ethnic backgrounds.

Projective–Expressive Techniques
The general category of projective–expressive assessment techniques, including thematic
approaches, drawing techniques, and sentence completion tasks, continues to be used
widely for social–emotional assessment of children adolescents. Although the use of these
techniques for diagnostic purposes remains a hotbed of controversy, and the associated
limitations and problems have been convincingly documented, they are used widely for
cross-cultural applications. A comprehensive review of the professional journal articles
available on CD-ROM databases such as PSYCH LIT using the key words projective testing
quickly reveals that projective–expressive techniques are used widely in research and
clinical applications of child assessment throughout the world.
Despite their worldwide popularity, less is known regarding appropriate cross-cultural
applications of projective techniques among members of racial/ethnic-minority groups
in the United States, particularly where children are concerned. There are also differing
perspectives and arguments regarding the appropriateness of traditional projective–
expressive techniques in American cross-cultural applications. Hood and Johnson (1997)
argued that “projective techniques are personality instruments that undoubtedly have less
value as assessment tools for minority clients” (p. 309) because they are based on upper-
middle-class majority-group perspectives. Dana (1993, 1995, 2005) has taken the stance
that drawing, thematic, sentence completion, storytelling, and other projective–expressive
techniques have considerable promise as assessment tools with members of racial/ethnic-
minority groups and has provided numerous references for culture-specific applications
of such techniques. Dana’s generally supportive statements regarding cross-cultural
applications of projectives are tempered, however, with his numerous other comments
 Social–Emotional Assessment and Cultural Diversity s 63

criticizing the Eurocentric theoretical bases on which most of the interpretation systems
are built, particularly psychodynamic theory, as not being relevant for interpretation of
the products produced in projective–expressive assessments by members of cultural-
minority groups, particularly those who are traditional in their acculturation. Instead,
Dana has suggested that such techniques be adapted specifically for use with particular
racial/ethnic groups through using a constructivist approach to understanding their own
cultural norms and values. For example, rather than using the traditional Thematic
Apperception Test with Native Americans, he suggests it might be more appropriate to
use “tribe-specific picture stimulus cards,” and for appropriate interpretation of the
responses, “assessors should be familiar with the history, customs, ethnography, fiction,
and published life histories of individuals for any tribe whose members are assessed using
picture story techniques” (Dana, 1995, p. 67). Similar suggestions are made for adaptations
of other projective–expressive techniques for use with racial/ethnic-minority group
members, such as using human figure drawings in a general manner, but avoiding existing
scoring systems, and using sentence completion tasks developed in the native language of
the client.
It is my opinion that projective–expressive techniques have some merit for cross-
cultural assessment of children and adolescents because they are nonthreatening, because
they may offer a glimpse of the worldview of the client, and because they may provide a
basis for relationship and trust enhancement between the evaluator and the child,
something that may be especially challenging when strong cultural differences are present.
The primary use of projectives for this purpose should be focused on observing and
building a relationship with the child and not on making diagnostic inferences using the
traditional interpretation techniques. For example, some traditional psychodynamic-
based interpretations of drawing techniques often postulate that drawings of trees devoid
of leaves may indicate emotional barrenness and that smoke rising out of chimneys of
houses may indicate turmoil or conflict within the home. As questionable (if not naive)
as such interpretation paradigms are in general, they may be particularly offensive when
applied cross-culturally. Would it be unusual for a traditional Navajo youth whose family
lives in a hogan, and whose primary heat source is wood fuel, to draw smoke arising from
the dwelling? It may be reasonable to assert that projective–expressive techniques have
some potentially useful cross-cultural applications, but that extra precautions should
be in place for such use, to avoid inappropriate and culturally offensive interpretation
and overpathologization. And of course, any cross-cultural application of projective–
expressive techniques, in our view, should be tempered further by the overwhelming
evidence that such measures tend to have poor stability, and appear to be highly dependent
on the context, situation, or recent past of the examinee.

RECOMMENDATIONS FOR CULTURALLY COMPETENT ASSESSMENT

This chapter on assessment and cultural diversity has included a wide variety of topic
areas, discussions of problems in current assessment practices, and suggestions for specific
types of culturally competent social–emotional assessment practices. Emphasis on cultural
diversity within educational and psychological assessment is a relatively recent major
focus, and this important topic has been neglected to a great extent in the past. It should
be understood that much of our current empirical knowledge and practical applications
64 s Foundations and Methods of Assessment

Table 2.3 General recommendations for culturally competent practice in behavioral, social, and emotional assessment of children
and youth

s / BTAINSUFlCIENTBACKGROUNDINFORMATIONBEFOREPLANNINGANDCONDUCTINGASSESSMENT
s # ULTURALBACKGROUNDINFORMATIONSHOULDINCLUDEESTIMATESOFACCULTURATIONANDCOMFORTWITHTHE
majority language and dominant culture
s 5 SEACOMPREHENSIVEASSESSMENTDESIGNMULTIMETHODMULTISOURCEMULTISETTING TOOVERCOMETHE
culturally limiting factors of any one method
s % XAMINENEWSTANDARDIZEDINSTRUMENTSFOREVIDENCEOFMULTICULTURALAPPLICATIONS
s 2 EMAINmEXIBLEINTHEDESIGNANDIMPLEMENTATIONOFTHEASSESSMENTMAKINGINNOVATIONSAND
modifications as needed
s h 7HENINDOUBTCONSULTv
s 3 TRIVEFORHONESTYANDOPENCOMMUNICATIONREGARDINGCULTURALISSUESWITHTHECLIENTANDHISORHER
family
s 0 RESENTFEEDBACKONASSESSMENTRESULTSWITHINACULTURALLYACCEPTABLEFRAMEWORK
s 3 TRIVEFORSENSITIZATIONTOANDAWARENESSOFWITHIN GROUPANDBETWEEN GROUPCULTURALDIFFERENCES
s 2 ESEARCHANDDEVELOPMENTWORKINASSESSMENTSHOULDEMPHASIZEGENERALMULTICULTURALAPPLICATIONSAND
specialized techniques for specific populations
s % DUCATORSANDMENTALHEALTHPROFESSIONALSSHOULDINTROSPECTIVELYEXAMINETHEIROWNCULTURAL
background, values, beliefs, and ethnocultural assumptions

of this knowledge is provisional. Much of what we currently know and do regarding

multicultural applications of assessment is not well documented, and this area seems to
be undergoing constant change. It seems likely that there will be important developments
in this area in the near future, including substantial experimental innovation.
To conclude this chapter, the yield of information regarding best practices or practical
applications for culturally competent behavioral social and emotional assessment of
children and youth can be summarized in the following 11 points, which are listed for
additional reference in Table 2.3:

1. Assessment professionals should obtain as much information as possible regarding

the cultural background characteristics and orientation of the child or adolescent
to be assessed, before conducting the assessment, and use this information in
developing a tentative plan for the assessment. This issue is particularly important
when the examiner is part of the majority culture and the client is not.
2. Cultural background information regarding children and adolescents to be assessed
(and their families) always should include some appropriate estimation of their
approximate level of acculturation and their comfort with the majority language
and dominant culture.
3. Use of a comprehensive assessment design, such as the multimethod, multisource,
multisetting model presented in Chapter 1, will help to create an ecologically valid
and culturally appropriate social–emotional assessment. The cultural limitations
of any one method, instrument, or technique can be curbed through the use of
such a broad-based design.
4. In their selection of standardized assessment instruments (i.e., behavior rating
scales, structured interviews, and self-report instruments), culturally competent
professionals should carefully examine the technical manuals for evidence of
appropriate multicultural applications, in addition to the general characteristics
(e.g., reliability and validity) that are traditionally valued.
 Social–Emotional Assessment and Cultural Diversity s 65

5. Flexibility should be a key component of culturally appropriate assessment practice.

If a given instrument or technique that was administered as part of the original
assessment design proves to be obviously inappropriate for a given client, it should
be abandoned or discarded. If assessment methods or techniques that were not part
of the original design are seen to be valuable in a given situation, they should be
adopted.
6. The professional adage “when in doubt, consult” should be particularly adhered to
when moving into the realm of cross-cultural or multicultural assessment and
intervention services. If one does not know the right answer or direction in a given
situation, one should not be afraid to consult with someone one trusts.
7. Honesty and open communication with clients (and their families) who are from
different ethnocultural backgrounds is especially important. If an examiner is
unsure about a particular custom, belief, or issue that he or she thinks may be part
of his or her client’s worldview, he or she should respectfully and appropriately ask
about it.
8. Assessment results feedback should be presented within a culturally acceptable
framework (i.e., aimed toward the specific beliefs of the child’s family regarding
health, illness, and treatment) so that the results will be more likely to be used to
develop appropriate intervention plans.
9. Sensitization to, and awareness of, multicultural within-group and between-group
differences can help to create a greater awareness of cultural differences and
ultimately may lead to more culturally appropriate assessments.
10. Researchers and other developers of assessment instruments should attempt to the
greatest extent possible to make new methods, techniques, and instruments as
culturally general as possible and to develop and validate specialized techniques
that are designed to meet the needs of unusually specific cultural situations.
11. If they have not previously or recently done so, psychologists and educators of
all backgrounds are urged to examine their own values, beliefs, ethnocultural
background and assumptions, and general worldview, on a continual basis. This
type of introspective self-examination is likely to lead to greater awareness of the
strengths and barriers that one’s background brings to assessment and treatment
situations.

CONCLUSIONS
The topic of cultural diversity within psychological and educational assessment has
received increasing professional and public attention. This increased emphasis has been
spurred on primarily by legal decisions and well-known public controversies regarding IQ
and educational aptitude testing, but also by a changing consciousness within American
culture regarding the importance of culture and race/ethnicity in public and private life.
There is an increasing consensus among assessment experts and policymakers that our
current assessment practices have not gone far enough in promoting equity and utility
across various ethnocultural groups.
Test bias and assessment bias are terms that reflect the properties and the uses of
assessment instruments and methods. An instrument or technique is considered to
have an unacceptable level of bias when it results in one group being systematically
66 s Foundations and Methods of Assessment

disadvantaged or shows group differences based on characteristics other than what are
purported to be measured. Although the area of behavioral, social, and emotional
assessment has not been scrutinized or criticized in this regard as much as cognitive-
ability testing, bias in assessment is still a major concern. Organizations that represent
professionals who are concerned with psychological and educational assessment have
developed various codes and standards for appropriate practice and ethical behavior.
Some of these standards have been revised to include a greater emphasis on the cultural
validity of practices, although some have argued that these changes have not gone far
enough. There seem to be several problems with the current state of affairs regarding
multicultural applications or assessing social–emotional behavior, and efforts have been
directed at developing new models and paradigms for culturally appropriate assessment
practice.
Acculturation is defined as a process of individual change that occurs when two cultures
meet. This process varies widely among individuals and groups and includes such factors
as retention of traditions and customs of the native culture and adoption of new customs
and values that are part of the new culture. The process of acculturation can be stressful
for members of racial/ethnic-minority groups, and the actual types of stresses and out-
comes vary as a function of the particular circumstances. Although specific instruments
have been developed for determining the level of acculturation of members of particular
minority groups, most of these instruments have been aimed at adults rather than youth.
The process of determining the level of acculturation may involve such factors as
language preferences, adherence to traditional customs, and level of comfort with the new
culture. It has been proposed that members of various racial/ethnic groups, including
members of the dominant group, may go through various stages of racial/cultural
development. Understanding these stages and the process of movement between stages
can help professionals understand better the unique characteristics of their clients.
Although increased emphasis on the characteristics of various racial/ethnocultural
groups has many potential benefits, there are some possible problems that also must
be considered. One negative outcome may be the stereotyping of individuals from
specific groups based on a few facts known regarding general characteristics of that group.
It is crucial to recognize that within-group differences almost always are greater than
between-group differences and that each racial/ethnocultural group contains individuals
of widely varying characteristics. In addition to inaccurate stereotyping, another possible
ramification of not considering this fact is polarization and divisiveness among various
groups.
The 2010 U.S. Census indicated that slightly more than two thirds of the general
population are members of the White/Caucasian majority group, with the other major
racial/ethnic groups, in order of current size, including African Americans, Hispanic
Americans, Asian Americans, and Native Americans. The population of children and
adolescents is more diverse than the general population in the United States because of
group differences in immigration patterns and birth rates. All demographic projections
indicate that the White/Caucasian majority group will continue to shrink in its current
proportion of the population and may comprise a slight minority (slightly less than 50%)
of the general population by 2050 if present trends continue. All racial/ethnic-minority
groups are projected to increase in terms of their absolute numbers of percentages within
the general population during this time frame, however. Each of the five major racial/
ethnic groups is diverse in its own right but has been associated with specific psychosocial
 Social–Emotional Assessment and Cultural Diversity s 67

characteristics that may hold true for many group members. Clinicians should become
aware of these general characteristics but at the same time recognize that there is a wide
variation among individuals within groups.
Each of the six assessment methods emphasized in this book has specific difficulties
regarding multicultural applications, but there have been some encouraging develop-
ments for culturally competent assessments with each of these methods. Clinicians
and researchers should become aware of the problems and limitations associated with
multicultural applications of each method and develop assessment plans accordingly.
Certain recommended best practices for assessing social–emotional behavior within a
culturally competent framework have been provided to form the basis of clinical and
research practices. These recommendations include obtaining sufficient cultural back-
ground information on clients before the assessment, using a comprehensive assessment
model, selecting instruments and procedures based on their demonstrated multicultural
applications, remaining flexible and innovative in the implementation of the assessment,
consulting with colleagues as needed, striving for honest communication with clients
and their families, presenting assessment results feedback within a culturally acceptable
framework, striving for sensitivity to within-group and between-group differences,
developing new techniques that will be effective cross-culturally and for specific cultural
applications, and introspectively examining one’s own belief and value system.

REVIEW AND APPLICATION QUESTIONS

1. Operationally define the term test bias (or assessment bias) as it relates to behavioral,
social, and emotional assessment.
2. Characterize the current status of professional standards and ethical codes for culturally
competent assessment. In your view, are the current standards adequate?
3. What have been the major criticisms of current professional practices in educational and
psychological assessment, with regard to cultural diversity?
4. Focusing on cultural diversity and assessment practices inevitably leads to a focus on
some of the notable characteristics of specific racial/ethnic groups and subgroups within
the larger groups. What are some of the potential problems that may occur from making
generalizations regarding specific groups?
5. Characterize the projected demographic trends in racial/ethnic diversity in the United
States between the present time and the year 2050.
6. For each of the six general methods of assessment that are covered in this chapter, what
are some of the major advantages and possible problems for multicultural applications?
7. Operationally define the term acculturation.
8. Regarding the proposed stages of racial/cultural identity development, what are some of
the similarities and differences in the progression through stages for members of racial/
ethnic-minority groups as opposed to members of the majority culture?
9. A 10-year-old Hispanic female is referred to you by the school referral team. The student
emmigrated from Honduras two years ago and lives with her parents and younger brother.
The team is concerned about . . . Using the recommendations for culturally competent
practice (see Table 2.3), discuss and outline how you will go about an assessment.
 3
ASSESSMENT AND CLASSIFICATION

One of the traditional purposes of assessing social and emotional behavior is to determine
an appropriate diagnosis or classification. The term diagnosis historically is linked with
the medical model of psychological disorders, whereas the term classification is used more
in education and by behaviorally oriented researchers. Both terms imply a common
element of categorizing and codifying an observable phenomenon based on an existing
taxonomy or scheme. Without arguing over conceptual or definitional differences between
the two terms, both are subsumed under the more generic term, classification, in this
chapter. Both terms are related to the notion of taxonomy, which comes from the Greek
verb tassein, meaning “to classify,” and nomos, meaning “law, science.” In the sciences,
taxonomic structures are often hierarchical in nature, meaning they classify phenomena
from the most important to the least important feature. Taxonomies may also include
network relationships, which are nonhierarchical. Most people who have completed a
middle-school- or high-school-level biology course are familiar with the taxonomic
system used to classify living things according to their domain, kingdom, phylum, class,
order, family, genus, and species.
There has been extensive debate within the behavioral sciences regarding the useful-
ness and current validity of the processes of classification and taxonomy. The traditional
view of classification is that the behavioral sciences, like the natural sciences, should
develop and use classification taxonomies to create order, to provide a common ground
for clinicians and researchers to use in describing problems or strengths, to help
predict the future course of behavior, and ideally, to recommend an intervention plan.
However, the state of the behavioral sciences is still far from being at the point where
these goals for classification are being met, or where there are universally accepted
taxonomic classification systems that hold up under tough scrutiny (Gresham & Gansle,
1992; McBurnett, 1996). The problems with traditional classification systems have led
to great dissatisfaction by many behaviorally oriented practitioners and researchers.
It is important to recognize, however, that during the past decade or two, there have been
encouraging improvements in the reliability and usefulness of traditional systems of
classification (Kauffman, 2000; Power & DuPaul, 1996).
This chapter discusses several important issues regarding the role of classification
in assessment. First, a rationale for conducting classification activities is proposed,
which is followed by a discussion of differential diagnosis and classification error. Most
of the chapter is devoted to descriptions of current classification systems. Three major
classification systems are overviewed, including the Diagnostic and Statistical Manual for
Mental Disorders (DSM) system, the special education classification system from federal

69
70 s Foundations and Methods of Assessment

law, and the emerging behavioral dimensions approach. Following the presentation of
current classification systems, the chapter includes a brief overview of multiple-gating
approaches, which represent relatively new developments in systematic assessment and
selection for classification and treatment. The chapter concludes with a brief discussion
of some additional issues relating to the assessment–classification process.

WHY CLASSIFY?
There is no doubt that current classification systems in psychology, psychiatry, and edu-
cation are imperfect. Yet, despite their present flawed state, there is wisdom in the notion
that disregarding or abandoning our current systems because of their imperfections may
be throwing out the proverbial baby with the bath water. There are some solid pragmatic
reasons why classification is often necessary and useful as part of the assessment process.
The following four examples are reasons why doing a formal classification as part of an
evaluation is often important:

1. Classification can provide some common ground of understanding for different

professionals working with the same client.
2. Classification can provide access to needed services for clients.
3. Educational and health service institutions often require classification to remunerate
the client or service providers for services.
4. In the absence of an entirely reliable and valid classification taxonomy for behavioral
and emotional problems, continuing to work with and refine present systems is a
step in the right direction toward developing improved systems.

Although it is true that there are many problems with current classification systems
and that they are often used and implemented cynically, I propose that abandoning the use
of classification simply because the state of the art is currently marginal is short-sighted.
“Giving up all uses of classification is tantamount to abandoning the scientific study of
social and behavioral difficulties. Indeed, we need labels for problems to communicate
about them” (Kauffman, 1997, p. 158). Thus, the primary purposes of this chapter are to
orient the reader to the more common classification systems that are used as part of the
assessment process, and to provide a rational argument for how current classification
systems can be best used in assessment.

DIFFERENTIAL DIAGNOSIS AND CLASSIFICATION ERROR

The term differential diagnosis is often used in psychiatric and psychological literature, but
it is often misunderstood and misused. The process of differentially diagnosing or classi-
fying a behavioral, social, or emotional problem essentially involves two steps: (1) making
a binary decision as to whether the problem is considered normal or abnormal in nature;
and (2) reaching a decision regarding how to classify the problem specifically (e.g., conduct
disorder versus oppositional defiant disorder (ODD); specific learning disability versus
emotional disturbance). This differential process is often difficult because it is considered
to be one of the most technically demanding aspects of the assessment process. It is also
critical for understanding the topography and functionality of symptoms (First, 2013).
 Assessment and Classification s 71

Given the imperfect nature of current classification systems, it is inevitable that some
errors will be found in many differential diagnostic and classification decisions. Two
types of errors are of particular interest for clinicians making classification decisions.
A false-positive error (also called a Type I error) occurs when an individual is classified as
having a particular disorder, but in fact does not. A false-negative error (also called a Type
II error) occurs when an individual is classified as being “normal” or not having a specific
disability or disorder, when he or she in fact does.
Which type of error is worse? The answer to this question depends on what type
of classification decision one is making and what the potential consequences are for
making such errors. When conducting initial screening (e.g., to identify children who are
in the early stages of developing behavioral, social, or emotional problems), the primary
goal is to narrow down from a large group of individuals who may be good suspects, then
to look at the narrowed population in more detail. For a screening process, it would be
preferable to make a false-positive error rather than a false-negative error because the
problem of overselection can be corrected at a later point, but underselection may result
in a child, who is in need of help, going for an additional long period of time without
receiving it. If you are making a decision as to whether or not an individual has a psychotic
disorder, making a false-positive error sets up a potentially high-stakes situation in which
the client is improperly labeled, has a good chance of being stigmatized for a long period
of time, and may even end up being the recipient of a treatment that is not needed and
may have negative side effects, such as the prescription of antipsychotic medications that
have significant side effects.
In general, it is recommended that the higher the risks and consequences are in a
differential diagnosis and classification decision, the more conservative the approach to
making the decision should be. In cases in which a great deal of adverse consequences is
a potential, a clinician should even go so far as to take a disconfirmatory approach, which
involves approaching the classification decision with the hypothesis that the disorder or
disability under question is not present and rejecting that premise only when the evidence
to the contrary clearly overwhelms the initial working hypothesis.

CURRENT CLASSIFICATION SYSTEMS

Three different classification systems for arranging behavioral, social, and emotional
problems of childhood and adolescence are described in this section. First, the psychiatric-
based DSM system, which is widely used by mental health professionals, is overviewed.
Then the classification categories and definitions based on special education law are
discussed. Finally, a relatively recent and promising approach to classification of behavioral,
social, and emotional problems, the behavioral dimensions method, is introduced.

The DSM System

Assumptions and Structure of the DSM Without question, the most widely used system
for classification of behavioral, social, and emotional problems in North America—and
possibly in the world—is the psychiatric-based DSM. The most recent revision of the
DSM was released in 2013. This fifth revision is referred to as the DSM-5 (American
Psychiatric Association, 2013) and represents over ten years of research and development
72 s Foundations and Methods of Assessment

that included an overhaul of the text-revised version of the fourth edition (DSM-IV-TR)
(American Psychiatric Association, 2000).
The first edition of the DSM was published in 1952 and, like subsequent editions, was
based on a medical model of behavioral and emotional problems, which views such
disturbances as mental disease. The most traditional underlying assumption of this model
is that behavioral and emotional problems reside within the individual, although this
assumption has been tempered to a great extent in more recent years by the influence of
behavioral psychology, which provides an alternative framework for viewing problems as
a product of eliciting and reinforcing stimuli within a person’s environment.
Prior versions of the DSM used a multiaxial approach to classification. That is, indi-
viduals were classified according to five different dimensions or axes, rather than as
simply experiencing a given problem. The first axis referred to clinical disorders, and the
second referred to personality disorders and intellectual disabilities. The other three axes
referred to general medical conditions, psychosocial and environmental problems, and
level of adaptive functioning. Within Axes I (clinical disorders) and II (personality dis-
orders and mental retardation), several of the disorders within the classification system
were not relevant to children and adolescents, whereas other disorders were specific to
the developmental years or are at least considered to be first evident during childhood
or adolescence.
Table 3.1 provides a brief overview of the clusters of current chapters of the DSM-5,
which is a significantly different organization from other versions. Documentation of
disorders in the DSM-5 is no longer organized by the multiaxial structure seen in other
versions; instead symptoms of disorders are described with required documentation for
severity and client functioning. Table 3.2 specifies the specific chapters within one cluster
as an example. The DSM-5 no longer has a separate chapter on disorders that are first

Table 3.1 Overview of the DSM-5

Neurodevelopmental disorders
Schizophrenia spectrum and other psychotic disorders
Bipolar and related disorders
Depressive disorders
Anxiety disorders
Obsessive–compulsive and related disorders
Trauma- and stressor-related disorders
Dissociative disorders
Somatic symptom and related disorders
Feeding and eating disorders
Elimination disorders
Sleep–wake disorders
Sexual dysfunctions
Gender dysphoria
Disruptive, impulse control, and conduct disorders
Substance related and addictive disorders
Neurocognitive disorders
Personality disorders
Paraphilic disorders
Other mental disorders
Medication-induced movement disorders and other adverse effects of medication
Other conditions that may be a focus of clinical attention
 Assessment and Classification s 73

Table 3.2 DSM-5 sample chapter: Neurodevelopmental disorders

Neurodevelopmental disorders
Intellectual Disabilities: Mild, Moderate, Severe, Profound, Global Developmental Delay, Unspecified
Intellectual Disability
Communication Disorders: Language Disorder, Speech Sound Disorder, Child–Onset Fluency Disorder
(Stuttering), Social (Pragmatic) Communication Disorder, Unspecified Communication Disorder
Autism Spectrum Disorder: Autism Spectrum Disorder
Attention Deficit/Hyperactivity Disorder: Attention Deficit/Hyperactivity Disorder (Combined presentation,
Predominantly inattentive presentation, Predominantly hyperactive/presentation), Other Specified
Attention Deficit/Hyperactivity Disorder, Unspecified Attention Deficit/Hyperactivity Disorder
Specific Learning Disorder
Motor Disorders: Developmental Coordination Disorder, Stereotypic Movement Disorder, Tic Disorders,
Other Specified Tic Disorder, Unspecified Tic Disorder
Other Neurodevelopmental Disorders: Other Specified Neurodevelopmental Disorder, Unspecified
Neurodevelopmental Disorder

diagnosed in childhood or adolescence; rather, particular disorders may include notes

or specifiers pertinent to presentation of symptoms in children. This was a purposeful
change to create more of a lifespan approach to the description of clinical problems.
Further, additional notes are included that encourage professionals to recognize cultural
manifestations of certain symptomology.
In the mid-1980s, many professionals within the early childhood field began to vocalize
concern that the DSM system did not adequately attend to developmental manifestations
of clinically concerning behaviors. This spurred the development of the Diagnostic
Classification of Mental Health Disorders of Infancy and Early Childhood (DC: 0–3) by a
task force convened by ZERO TO THREE (1994). The DC: 0–3R (ZERO TO THREE,
2005) is the current version of the manual, which follows a multi-axial format similar to
the DSM-IV system, and is often used in conjunction with the DSM-IV to comprehen-
sively classify childhood disorders. The DC: 0–5 is in development and is due to be
available in 2017.

Using the DSM System in Assessment Virtually any type of moderate to severe behavioral
or emotional problems that might be experienced by a child or adolescent is potentially
DSM-5 diagnosable under one of the many categories available. The all-inclusive nature
of this system is both an advantage and a problem. The advantage lies in a clinician being
able to use the system to classify a broad range of problems, to provide a common frame-
work of understanding with other professionals, and to have possible implications for
treatment (although this third point is arguable).
A problem with the all-inclusive nature of the system is that clinicians using it may end
up making classification decisions (and, potentially, intervention recommendations) that
are outside of their areas of professional expertise. For example, how many psychiatrists
have sufficient training and experience with reading, writing, and arithmetic problems?
How many psychologists or clinical social workers have any special training or expertise in
diagnosing and treating speech and language problems? The broad, all-inclusive nature of
the DSM system, along with potential problems of unreliability between different raters,
does present some potential difficulties when using the system in assessment.
74 s Foundations and Methods of Assessment

Another quandary that the DSM system poses is that the specific criteria for each
category of disorder are not tied to specific assessment techniques, and the classification
categories are not clearly linked to common intervention techniques. The responsibility
for selecting and using specific assessment techniques or instruments, and eventually
developing an appropriate intervention plan, is fully on the shoulders of the clinician or
team conducting the assessment. The DSM does provide, however, relatively objective
criteria for clinicians to follow in making a classification decision, and one of the major
improvements of the DSM-5 was to make these criteria even more objective and thus
more reliable.
Consider the diagnostic criteria for DSM-5 code 313.81 (F91.3), Oppositional Defiant
Disorder, a type of problem classification that is not uncommon in children and adoles-
cents who have been referred for psychological or other mental health services. The
diagnostic criteria specify a clear time element (the condition must have lasted at least
six months) and a list of behavioral conditions (in which at least four of nine specified
conditions must be present). The criteria also list severity conditions that include
consideration of the number of times per week symptoms are observed and the number
of settings in which symptoms are observed. The classification criteria do have, at a
minimum, face value of objectivity. Nevertheless, when viewing the complete criteria for
Oppositional Defiant Disorder shown in Table 3.3, it becomes clear that classification
decision-making also involves a fair amount of subjectivity. For example, what does the
“often” in “often loses temper” mean—once a week, once a day, or several times a day?
How easy is it in certain cases to determine if the “deliberately” in “often deliberately
annoys people” is indeed deliberate?
Obviously the DSM system of classification, although it is the most widely used system,
has inherent in it many potential pitfalls that clinicians need to be aware of, but if used
judiciously, it can help the clinician achieve many of the goals and necessities of assessment.

Improvements to and Changes in the DSM Each subsequent edition of the DSM has
contained various, sometimes substantial, changes in content and format. Presumably,
these changes involve improvements to the system. One of the primary purposes of the
change to the last few editions of the DSM was to develop more consistency with the World
Health Organization’s ICD-10 health classification system, which was published in 1992.
Presumably, this type of change would make the DSM system more useful outside of North
America. During the development of the DSM-IV, it was reported that the threshold for
adding new categories under this revision was higher than in previous revisions of the
DSM (Spitzer, 1991), an attempt to produce a relatively conservative document that would
integrate changes from the DSM-III-R only when it was necessary to ensure consistency
with the ICD-10 or to integrate new findings. The classification codes in the DSM-5 include
codes from previous versions of the DSM as well as codes from the ICD system. In 2014,
all clinicians were expected to begin using the ICD codes for diagnosis and billing. This
represents a major step in terms of aligning North America with the rest of the world.
Earlier in this section, some of the problems of the DSM system relating to assessment
and classification were discussed, and to be sure, there has been no shortage of criticisms
of the use of the DSM system, particularly when used with children and in school settings
(Gresham & Gansle, 1992; McBurnett, 1996). There has been optimism, however, that the
changes in the DSM system over the years have resulted in a more reliable and valid
classification system and have been a significant step toward reducing or eliminating
 Assessment and Classification s 75

Table 3.3 Example of criteria for a DSM-5 diagnostic category: Oppositional Defiant Disorder 313.81 (F91.3)

A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least

six months as evidenced by at least four symptoms from any of the following categories, and exhibited
during interaction with at least one individual who is not a sibling.
Angry/Irritable Mood
1. Often loses temper
2. Is often touchy or easily annoyed
3. Is often angry and resentful
Argumentative/Defiant Behavior
4. Often argues with authority figures, or for children and adolescents, with adults
5. Often actively defies or refuses to comply with requests from authority figures or with rules
6. Often deliberately annoys others
7. Often blames others for his or her mistakes or misbehavior
Vindictiveness
8. Has been spiteful or vindictive at least twice within the last six months
9. Often argues with adults
10. Often actively defies or refuses to comply with adult requests or rules
Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that is
within normal limits from a behavior that is symptomatic. For children younger than five years, the
behavior should occur on most days for a period of at least six months unless otherwise noted
(Criterion A8). For individuals five years or older, the behavior should occur at least once per week for
at least six months, unless otherwise noted (Criterion A8). While these frequency criteria provide
guidance on a minimum level of frequency to define symptoms, other factors should also be
considered, such as whether the frequency and intensity of the behaviors are outside a range that is
normative for the individual’s developmental level, gender, and culture.
B. The disturbance in behavior is associated with distress in the individual or others in his or her
immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on the
social, educational, occupational, or other impairment areas of functioning.
C. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or
bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder.
Specify current severity:
Mild: Symptoms are confined to only one setting
Moderate: Some symptoms are present in at least two settings
Severe: Some symptoms are present in three or more settings
Note: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (Copyright
© 2013) American Psychiatric Association.

some of the problems associated with earlier versions of the manual. The continuing
refinements in the DSM system appear to be positive steps in improving the empirical
integrity of this influential system (Waldman & Lillenfeld, 1995). The DSM-5, released
in 2013, had been in development since about 2000 and is a result of continued commit-
ment to empirically supported diagnostic criteria. In fact, the National Institute of Mental
Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute
on Alcoholism and Alcohol Abuse (NIAAA) granted 1.1 million dollars to support
implementation of research planning conferences that aimed to share current research
and build research agendas that would support changes in diagnostic criteria published
in the DSM. Particular areas that this edition aims to address are diagnostic categories
that are sensitive to the developmental progression of particular disorders across different
ages and genders and a better system to acknowledge the dimensionality of particular
76 s Foundations and Methods of Assessment

disorders (Regier, Narrow, Kuhl, & Kupfer, 2009). Given some of the encouraging develop-
ments in the DSM system during the last 20 or more years, the possibilities for the long-
term refinement of a scientifically sound taxonomy of human behavioral and emotional
disorders appears to be improving, and the ultimate goal of a scientifically precise and
reliable classification system appears to be within closer reach.

Classification under Special Education Law

Although the DSM system is the most commonly used classification structure for behav-
ioral, social, and emotional problems within the mental health professions, professional
practice in these areas is governed by an additional definition and classification structure
within the public educational systems of the United States. In 1975, the U.S. Congress
passed the Education for All Handicapped Children Act (also referred to as P. L. 94–142) as
a result of “constitutionally based challenges to the exclusion of handicapped children”
(Rothstein, 1990, p. xxiii). Now after four decades of existence, the federal law has had a
profound impact on assessment and classification practices within school settings. This
law, which since 2004 has been referred to as the Individuals with Disabilities Education
Improvement Act (IDEIA), is designed to ensure the provision of a free and appropriate
public education and related educational services to all children and adolescents with dis-
abilities. As part of the IDEIA, specific classification criteria for disability conditions have
been adopted, and specific guidelines for assessment have been enacted. It is beyond the
scope of this book to provide a comprehensive understanding of the IDEIA, but it is impor-
tant for school-based and community-based practitioners to have a basic understanding of
how the IDEIA affects assessment and classification. This section provides a basic outline
of the assessment and classification procedures of the IDEIA that are pertinent to assessing
behavioral, social, and emotional problems. A specific emphasis is placed on the classification
category “emotionally disturbed” because it is the area most pertinent to this topic.

General Assessment Guidelines in the IDEIA Before a student with a disability can receive
special education services under the auspices of the IDEIA, he or she first must be identi-
fied as having a disability, and this process typically involves the use of formal assessment
practices. Within the IDEIA itself and through many court decisions that have been
reached over the years, certain assessment requirements and safeguards have been put into
place. Nine of these requirements and procedures that are most pertinent to our general
topic are briefly listed as follows:

1. Parent consent must be obtained before the assessment is conducted.

2. When the school district requests that an evaluation be done, it is paid for at public
expense.
3. Tests must be valid for the purpose for which they are being used.
4. No single assessment procedure may be used as the sole criterion for classification
or program eligibility.
5. The assessment procedures must be culturally and racially appropriate; the child
must be tested in his or her native language or mode of communication unless it is
infeasible.
6. The evaluation is conducted by a multidisciplinary team (MDT) or group of
individuals, including at least one team member who is knowledgeable about the
child’s specific area of disability.
 Assessment and Classification s 77

7. The student is assessed in all areas pertinent to the suspected disability.

8. To be eligible for special education, students must meet criteria for a particular
disability and demonstrate a need for specialized instruction.
9. The identified student’s program must be reviewed annually, and the child must
be reevaluated at least once every three years (although this reevaluation does not
have to involve formal assessment, unless it is suspected that the child’s disability
condition has changed).

These nine examples from the IDEIA are deceptively simple and straightforward. It is
easy to understand what the intent of the law is, but often difficult to implement. As an
example, let’s look at guideline number 5. It is common for clinicians who are from the
majority Anglo culture to conduct an assessment with ethnic minorities who have been
raised in cultural conditions much different from those of the majority culture and
for whom English is not their primary language. Given that few, if any, clinicians have a
proficient command of all the potential languages that might be needed to meet this
requirement, their first inclination when approached with cases like these may be not to
take on the case. Yet, there is a competing pressure that makes it difficult to refer a prob-
lematic case. Particularly in isolated rural areas, the assessment professional in question
may be the only person available at the time with technical training in educational and
psychological assessment, and there may be no prospect of a qualified professional who
is also bilingual. In a situation like this, the examiner is faced with a variety of ethical,
technical, and legal dilemmas, of which the solution is often complex (for good discussions
of best practices in considering cultural and linguistic factors, see Burr, Haas, & Ferriere,
2015; Nuttall, DeLeon, & Valle, 1990; Rhodes et al., 2005).
Another good example of how these nine guidelines are easy to understand, but
complex to implement, can be demonstrated by considering guideline number 3, that
test procedures must be valid for the purpose for which they are being used. How many
of the assessment instruments used by an examiner in attempting to determine whether
or not a child is emotionally disturbed have been validated for that specific purpose?
Many procedures typically used for this purpose may have good psychometric properties
and general evidence of validity, but may not have been adequately validated for that
specific use. Given the questionable level of reliability and validity evidence of most
projective techniques, it is doubtful that most, if any, would hold up under the scrutiny
of a due process hearing or court decision, particularly if they were used as the primary
basis for decision making.
Guideline number 6 should be of special interest to clinicians working in nonschool
mental health settings. The law is clear in stating that the school MDT has the ultimate
responsibility for conducting the evaluation and determining program eligibility; it is not
appropriate for one person to make a unilateral decision, even though one person may
have conducted most of the evaluation. Some professionals working in medical clinics,
community mental health centers, or private practices may be unaware of this requirement,
much to the consternation of school personnel when they receive a psychological report
that states a child is eligible for special education services as emotionally disturbed, before
the child has even been made a focus of concern by the school MDT.

The IDEIA Definition of “Emotionally Disturbed” In looking at all of the IDEIA’s

potential special education service categories, the category “emotional disturbance”
78 s Foundations and Methods of Assessment

(ED, as it is commonly described) is most relevant to the practice of clinical assessment

of social and emotional behavior. It is true that such problems often occur concomitantly
with other disability conditions, but it is the ED category that most specifically addresses
disturbances of behavior, social adjustment, and emotion.
Students who are classified as ED receive the same federal protections as students with
other disability conditions (right to a free and appropriate public education and related
services) and are potentially provided with a “cascade” of placement and service, ranging
from regular classroom placement with the assistance of a behavioral consultant to
full-time placement in a residential treatment center. The specific type of placement and
service a student with ED is entitled to receive varies depending on the nature and severity
of the disability and what the student requires to benefit educationally.
In developing the rules and regulations for implementing the original Education of
the Handicapped Act (P.L. 94–142), the U.S. Congress adopted the following definition
(which has since been revised to remove the term autism, which is now a category on its
own). This definition was an adaptation of an earlier proposed definition developed by
Eli Bower (1981), based on his widely influential research with youth engaging in delin-
quent and disturbing behaviors in California in the 1950s and 1960s, under the auspices
of the California Youth Authority. The adaptation of Bower’s definition that was originally
embraced in the federal law is as follows:

(Seriously) emotionally disturbed is defined as follows:

(i) the term means a condition exhibiting one or more of the following characteristics
over a long period of time and to a marked degree, which adversely affects
educational performance:
(A) An inability to learn which cannot be explained by intellectual, sensory, or
health factors;
(B) An inability to build or maintain satisfactory interpersonal relationships
with peers and teachers;
(C) Inappropriate types of behavior or feelings under normal circumstances;
(D) A general, pervasive mood of unhappiness or depression, or,
(E) A tendency to develop physical symptoms or fears associated with personal
or school problems.
(ii) The term includes children who are schizophrenic or autistic. The term does not
include children who are socially maladjusted, unless it is determined that they
are also (seriously) emotionally disturbed.

Note that the term seriously appears in parentheses before “emotionally disturbed.”
The law originally passed by Congress and the resulting regulations that integrated
Bower’s definition referred to this category as “seriously emotionally disturbed.” The 1997
reauthorization of the IDEA resulted in the word seriously being dropped from the title
(Dwyer & Stanhope, 1997), but otherwise retained the same essential definition of the
term that has been in use for more than 20 years.
A careful reading of the federal ED definition shows that using these criteria to make
a classification decision is a process, similar to using the DSM criteria, that is at least
superficially objective, but also involves a great deal of subjectivity. For example, what is
a “long period of time” over which the problems must have occurred? Is six weeks too
 Assessment and Classification s 79

little time to be considered “a long period”? Is one year too much time? How about the
phrase “to a marked degree”? What kind of objective criteria can a clinician use to
determine how marked the degree of a problem is? The definition of ED from the federal
law, like many of the DSM diagnostic criteria, carries with it some problems of inter-
pretation and implementation and requires the clinician and members of the MDT to use
a fair amount of professional judgment.

The “Emotionally Disturbed” versus “Socially Maladjusted” Issue One of the continuing
controversies surrounding the federal definition of ED stems from a brief statement
in part ii of the definition: that the term does not include children who are socially
maladjusted unless it is determined that they are also emotionally disturbed. What exactly
does this statement mean, and what are its ramifications? Although the IDEIA does
include the term socially maladjusted (SM) within the definition of ED, no operational
definition of SM is provided in the law. Traditionally, the term social maladjustment has
been used to indicate a pattern of behavioral problems that are thought to be willful, goal
oriented, and possibly reinforced as part of one’s immediate social reference group—a
gang member being encouraged by his or her peers to attack a member of a rival gang,
for example. The volitional nature of the antisocial behavior engaged in is often linked
with social maladjustment, as characterized by Kelly’s (1989) statement: “The term
socially maladjusted encompasses . . . most individuals described as ‘conduct disordered’
who demonstrate knowledge of appropriate family, social, and/or school rules and choose
not to conform to them” (p. 3, italics added for emphasis). Another traditional feature of
the way social maladjustment has been conceptualized is that it is antisocial in nature, as
typified by the type of behaviors exhibited in the DSM-5 diagnostic categories Conduct
Disorder (CD) and Antisocial Personality Disorder (APD).
Because students identified as ED cannot be expelled easily from school, and because
considering a student with severe behavioral problems as SM provides a “loophole” for
not providing special education services to them, there has been a great deal of professional
interest in this topic since the federal law was enacted. Although earlier studies of state
special education regulations indicated that more than half of all states had ignored, or
chosen not to deal with, the social maladjustment issue in their state definitions of ED
(Mack, 1985), later surveys have shown that a majority of state definitions include the
social maladjustment exclusionary clause or some other form of exclusion (Skiba, Grizzle,
& Minke, 1994), and there is no evidence from the past two decades that this trend has
reversed. In fact, more recent treatments of this topic, such as a special issue of Psychology
in the Schools (Vol. 41, Issue 8, 2004), and further articles by Cloth et al. (2013), and
Sullivan and Sadeh (2014), devoted to the SM versus ED issue, provide ample evidence
that the controversy still rages.
Although the federal ED definition provides no guidelines on how to identify social
maladjustment, many professionals in education, psychology, and law have developed
suggested classification procedures. A common approach, stemming from a legalistic
interpretation of the DSM system, is characterized by the opinions of attorney Jane
Slenkovitch during the 1980s and 1990s (1983, 1992a, 1992b), who contended that a DSM
diagnosis of Conduct Disorder should be equated with social maladjustment and could
legitimately serve to disqualify students from being identified as ED. There also have been
continuing attempts to develop psychometric instruments that are purported to be able
to distinguish ED from social maladjustment.
80 s Foundations and Methods of Assessment

In view of the great interest in this particular aspect of the ED definition, it is interesting
to note that the term socially maladjusted was never a part of Bower’s original definition
and that he is on record as being opposed to the inclusion of the term into the federal
definition as he considers it unworkable (Bower, 1982). There have been other compelling
arguments made for eliminating the social maladjustment clause from the federal ED
definition (Council for Children with Behavioral Disorders (CCBD), 1991; C. M. Nelson,
Rutherford, Center, & Walker, 1991; Skiba, 1992). In one article, Merrell and Walker (2004)
argued that the current ED definition, including the SM exclusionary clause, is untenable
and advocated for a general emotional or behavioral disorders approach to definition in
which the empirically supported internalizing and externalizing behavioral dimensions
system serves as the basis for classification and eligibility determination. There is no evi-
dence, however, that this change, or any similar changes, will occur any time soon, given
that the 1997 reauthorization of the IDEA retained the social maladjustment exclusion,
despite extensive efforts by professional groups such as the CCBD and a national educa-
tion and mental health coalition of practitioners to urge Congress to adopt a different
definition (CCBD, 1991; Forness & Kavale, 2002; Forness & Knitzer, 1992), and that there
were no extensive lobbying efforts in this vein prior to the 2004 reauthorization of the law.
In fact, it appears that energy from previous years that was aimed at developing a more
defensible definition of ED has dissolved, and that the ED/BD field is failing to achieve its
promise (Walker, Zeller, Close, Webber, & Gresham, 1999). It will be interesting to see if
there is movement on this issue with the anticipated reauthorization of IDEIA in the next
few years.
For now, professionals conducting school-related assessments of children and adoles-
cents with behavioral, social, and emotional problems should be aware that there are no
psychometrically valid and defensible assessment procedures that can be used to make
the ED versus SM distinction. Clinicians and program administrators who are forced
to deal with this issue must walk a perpetual fine line between empirically validated pro-
fessional practices and the necessity of making pragmatic decisions based on policies
and resource constraints. The final addendum in the current federal definition does
allow students who are considered to be socially maladjusted to receive special education
services if it is determined that they are also emotionally disturbed, but the interpretation
of this particular statement has been problematic, and the statement itself may be con-
strued as using circular logic. In commenting on this and related statements years ago in
federal definition discussion of social maladjustment, Kauffman (1997) remarked that
“the final addendum regarding social maladjustment is incomprehensible” (p. 28).

State Adaptations of the Federal Definition In practice, the IDEIA is carried out by each
of the states, who are given a fair amount of leeway in adapting and implementing specific
aspects of the rules and regulations. Not all states have adopted this classification category
by the emotionally disturbed title or its predecessor seriously emotionally disturbed. Given
that these terms tend to elicit images of psychiatric hospitals and highly disturbing
behaviors, many individuals believe the term is pejorative at best, and some states
have adopted this part of the IDEIA by using other terms, such as seriously behaviorally
disabled, behavior disordered, or emotionally impaired. There is also some variation among
states in terms of specific assessment procedures that are to be used in making a
classification of ED. Several states require documentation of appropriate intervention
plans being implemented with a student before ED classification. Other states require
 Assessment and Classification s 81

specific assessment procedures, such as direct behavioral observation or rating scales, and
some states require an evaluation from a psychiatrist or other medical doctor before
allowing classification.
Regarding the differences among labels used to describe and implement ED from state
to state, it has long been argued that terms such as behaviorally disordered are less stigma-
tizing and more accurate as a definitional term than emotionally disturbed (Feldman,
Kinnison, Jay, & Harth, 1983; Merrell & Walker, 2004; Walker, 1982). Also, there seems
to be a preference among professionals in the field of special education for the term
emotionally or behaviorally disordered, which is seen as being less stigmatizing and more
inclusive (Kauffman, 2000). Nevertheless, widely varying terms and practices continue to
be the norm.

New Directions There is widespread agreement among leaders in the field that the
education of children with emotional and behavioral disorders under the IDEIA has
failed to achieve its promise (Merrell & Walker, 2004; Walker, Nishioka, Zeller, Severson,
& Feil, 2000; Walker et al., 1999). Despite more than three decades of intensive effort, less
than 1% of children nationally are provided with special education services under the
federal law in this area, whereas the evidence overwhelmingly indicates that we should be
identifying and serving in the range of 3% to 5% of students who are in need of intensive,
individualized services for behavioral and mental health problems. In addition, students
with emotional and behavioral disorders have the highest rate of school dropout of any
special education group and tend to fare poorly in general after the conclusion of their
school experience.
Although there are numerous reasons for this sad state of affairs, one of them is clearly
the problem of definition and classification and how it relates to assessment and identifi-
cation. To this end, Hill Walker, a longtime leader and pioneer in this field, has for several
years been advocating a change in the special education definition and classification
systems for students with emotional and behavioral disorders:

I think that the bipolar externalizing–internalizing classification scheme . . . is the

best system for use in accounting for school-related disorders. Externalizing refers
to acting-out problems that involve excess behavior that is problematic. Disorders
such as aggression, disruption, oppositional behavior, noncompliance, and negativ-
ism are illustrative of “externalizing” disorders. In contrast, internalizing refers to
insufficient amounts of behavior that often involve skill deficits. Examples of inter-
nalizing disorders are depression, social isolation and neglect, phobias, anxiety, and
immaturity. . . . I believe educators would be well served in adopting this type of
bipolar classification scheme in dealing with school-related emotional or behavioral
disorders.
(Walker, cited in Kauffman, 1997, p. 163)

More information on the dimensional externalizing–internalizing approach to classi-

fication is presented in the next section of this chapter and in subsequent chapters. We
enthusiastically endorse the notion of shifting the current special education definition
and classification system for students with emotional and behavioral disorders toward
an externalizing–internalizing disorder framework (Merrell & Walker, 2004). Such a
definition and classification system is empirically sound, easily understood, has a common
82 s Foundations and Methods of Assessment

sense appeal, and is likely to be less stigmatizing than the current system. In addition, it
is important to consider that the current system, which has systemic problems of
underidentification and underservice in general, is particularly problematic when it
comes to identifying students with internalizing disorders (e.g., depression, anxiety, social
withdrawal), who tend to be overlooked altogether (Merrell, 2001). One result of a move
toward the dimensional system of special education classification may be to increase the
visibility of and focus on students with internalizing problems.

Behavioral Dimensions: An Alternative Approach to Classification

In addition to the DSM and special education classification systems, a third type of classi-
fication system shows considerable promise as an empirically sound way of classifying
behavioral, social, and emotional problems that are exhibited by children and adolescents.
This method has been referred to by various terms but is specifically referred to as the
behavioral dimensions approach in this book. The paradigm used in the behavioral
dimensions approach is rooted in empirical methods of measuring behavior and complex
statistical procedures that allow for the identification of behavioral clusters, which refer
to clusters of highly intercorrelated behaviors. The statistical techniques that are most
important in identifying intercorrelated behavioral syndromes are factor analysis, cluster
analysis, and structural equation modeling. The use of these techniques in the behavioral
dimensions approach to classification became prominent between the late 1960s
and early 1980s, mainly through the pioneering work of Thomas Achenbach and his
colleagues (Achenbach, 1982a, 1982b; Achenbach & Edelbrock, 1981, 1983, 1984), Herbert
Quay and his colleagues (Quay, 1975, 1977, 1986a; Quay & Peterson, 1967, 1987), and
other behavioral scientists (e.g., Brown & Barlow, 2009). These researchers have developed
and refined behavioral dimensions approaches to classify behavioral problems through
the use of sophisticated rating scales with empirically derived factor structures, and with the
goal of understanding the dimensionality and co-occurrence of clinical disorders, which
often gets lost when using categorical, diagnostic tools, such as the DSM.

Behavioral Dimensions and the Achenbach System of Empirically Based Assessment

(ASEBA) System Through the development of parent and teacher rating forms of the
Child Behavior Checklist (CBCL) (Achenbach & Edelbrock, 1981, 1984, 1991; Achenbach
& Rescorla, 2001), Achenbach and his colleagues originally used factor analytic studies
to identify two general classification areas within the behavior dimensions approach. The
first general classification scheme is referred to as broad-band syndromes, which indicates
the existence of large general behavioral clusters accounting for many types of related
behavioral problems. The two primary broad-band syndromes include internalizing
problems, which relate to overcontrolled behavior, and externalizing problems, which relate
to undercontrolled behavior. Examples of internalizing problems include anxiety, depres-
sion, somatic or physical complaints, and social withdrawal. Examples of externalizing
problems include delinquent behavior, aggressive behavior, and hyperactivity.
The second general classification scheme in Achenbach’s system is referred to as
narrow-band syndromes, which are smaller behavioral clusters indicating more specific
types of behavior, social, or emotional problems. The narrow-band syndromes used in
the most recent version of Achenbach’s system, which is referred to now as the Achenbach
System of Empirically Based Assessment (ASEBA), include Withdrawn, Somatic Complaints,
 Assessment and Classification s 83

Anxious/Depressed, Social Problems, Thought Problems, Attention Problems, Delinquent

Behavior, and Aggressive Behavior
The ASEBA system includes a variety of different rating and report forms, and these are
discussed more specifically in subsequent chapters. Earlier versions of the instruments in
this system used different narrow-band syndromes for different age and gender break-
downs, which were based on separate factor analytic studies, but the most current versions
use the same “cross-informant” syndromes for each youth assessment instrument for
ages six to 18, regardless of gender and age range. The ASEBA is arguably the most sophis-
ticated system of child behavior assessment tools currently available, and it is certainly the
most extensively researched. These tools have become widely used by practitioners in
school and clinical settings and by researchers. Table 3.4 shows the division of broad-band
and narrow-band problem “cross-informant” syndromes used in the ASEBA system of
instruments for school-age children and youth.

Example of Behavioral Dimensions Approaches to Specific Classes of Behavior The

behavioral dimensions systems advocated by Achenbach and Quay conceptualize
dimensions of behavior problems in a global sense, by attempting to define and validate
overall classes of behavioral, social, and emotional problems. Some additional work by
these researchers has shown, however, that a behavioral dimensions approach to smaller
and more discrete classes of behavior is also possible. Using the specific class of delinquent
behavior as an example, both researchers (Achenbach, 1982a, 1982b; Quay, 1975, 1986a)
identified subtypes of delinquent behavior, using the same general behavioral dimensions
methodology that has been overviewed.
Achenbach (1982a) identified three dimensions of subtypes of delinquent activity:
(1) socialized-subcultural (low IQ and socioeconomic status, bad companions, gang activ-
ities, maintaining social status through illegal behavior); (2) unsocialized–psychopathic
(aggressive, assaultive, irritable, defiant, insensitive, feeling persecuted); and (3) neurotic–
disturbed (overly sensitive, shy, worried, unhappy). Likewise, Quay’s (1975) dimensional
findings on delinquent behavior are similar to those of Achenbach’s, often using the same
labels and terminology. One minor difference between the two dimensional approaches is
that Quay suggested the existence of a fourth category—inadequate–immature (passivity,
dependence, tendency toward daydreaming). Because these dimensional classification

Table 3.4 Cross-informant syndrome categories used in the Achenbach System of Empirically Based Assessment

Broad-band syndromes Narrow-band syndromes DSM-5 oriented scales Narrow-band

syndromes

Internalizing problems Aggressive behavior Depressive problems Aggressive behavior

Externalizing problems Anxious/depressed Anxiety problems Anxious/depressed
Total problems Attention problems Somatic problems Attention problems
Rule-breaking behavior Attention Deficit/ Rule-breaking behavior
Hyperactivity
Social problems Oppositional defiant Social problems
problems
Somatic complaints Conduct problems Somatic complaints
Thought problems Thought problems
Withdrawn/depressed Withdrawn/depressed
84 s Foundations and Methods of Assessment

Table 3.5 Overview of dimensional subtypes of delinquent behavior merging the findings of Achenbach (1982a) and Quay (1975)

Dimensional subtype Behavioral description

Socialized–Subcultural Peer-oriented, group or gang activities, delinquent value orientation,

lower in IQ and socioeconomic status, and experiencing less parental
rejection than other subtypes
Unsocialized–Psychopathic Unbridled aggression, assaultive, hostile, defiant, explosive, insensitive to
feelings of others, impulsive, thrill-seeking, responding poorly to praise or
punishment, feel persecuted
Neurotic–Disturbed Anxiety, guilt, overly sensitive, social withdrawal, worrying, unhappy
Inadequate–Immature Highly dependent, passive, tendency toward daydreaming

systems for delinquency subtypes are so similar, they are presented in an integrated
manner by four major categories in Table 3.5.
The purpose of presenting this overview of dimensional approaches to subtypes of
delinquent behavior is to illustrate not only how the behavioral dimensions approach to
classification extends to not just the overall conceptualization of behavior into several
broad classes, but also how it can be used within each dimensional class of behavior.
One can assume that other general classes of behavioral, emotional, or social problems
also can be developed further into dimensional subtypes.
These empirically derived findings are intriguing and suggest that the behavioral
dimensions approach to classification may also be useful in developing classification
systems at a less global and more micro level. In this specific case, we should note that there
have been more recent efforts to create subtypes within the narrow band of delinquent–
aggressive behavior or conduct disorders, such as the work of Frick and colleagues
(e.g., Frick, 1998; Frick & Ellis, 1999), but it was the work of Achenbach, Quay, and their
colleagues who pioneered this approach.

Additional Comments on the Behavioral Dimensions Approach Something to consider

when looking at the examples of behavioral dimensions clusters is that the names or titles
of the specific dimensions are developed subjectively by the researchers involved which
can be misleading if one takes them too literally. When a researcher, through factor
analytic or confirmatory studies, identifies the existence of specific behavioral clusters,
the researcher develops a name for the factor based on the types of specific behaviors
in the cluster. Sometimes the cluster can be labeled in a way that directly indicates what
the specific behaviors involved are. For example, one might label a cluster of behaviors
that includes “threatens others,” “physically fights,” “argues,” and related behaviors as
“aggressiveness,” which seems to make good clinical sense. Some clusters of behaviors
may fit together well in a statistical sense, but coming up with an equally descriptive label
for the cluster can be problematic. For example, one of the narrow-band clusters in
the ASEBA system is Thought Problems. Intuitively, one might think at first glance that
high scores on this cluster may indicate the presence of schizophrenia or other types of
psychoses, but this is seldom the case. Some of the actual behaviors found in this cluster
include “can’t get his/her mind off certain thoughts,” “strange ideas,” and “stares blankly.”
Although these characteristics might be commonly seen in severely thought-disordered
or psychotic individuals, they also may occur with frequency in individuals with lesser
 Assessment and Classification s 85

problems. Likewise, researchers sometimes change the names of identified narrow-band

clusters because of this concern and because of unease regarding stigmatizing children.
For example, the Rule-Breaking Behavior narrow-band cluster of the ASEBA system was
previously labeled as Delinquent Behavior. In a strict sense, the more recent label is more
accurate and less stigmatizing because not all rule-breaking behaviors indicated by the
items in the cluster involve illegal activity. Clinicians and researchers using assessment
and classification systems based on behavioral dimensions always need to look at the
specific endorsed behaviors or items in a cluster to make decisions, rather than strictly
going by the label or name a behavioral cluster has been given.

MULTIPLE GATING APPROACHES TO ASSESSMENT AND

CLASSIFICATION
In Chapter 1, a model for using multiple sources of assessment data obtained from
multiple sources and in multiple settings was introduced as a “best practice” in assessing
behavioral, social, and emotional problems. The advantages of this multiaxial model were
presented, and there is little doubt that its use is preferable from a clinical and a research
standpoint to using single-source assessments. Yet, despite the obvious advantages it
presents, there are also some potential obstacles. One of the problems in conducting
assessments using many sources and instruments is the problem of behavioral covaria-
tion. If many different sources of information are used in an assessment, a diverse, if not
contradictory, portrait of a child’s behavioral, social, and emotional status may be
obtained. This picture may present a serious problem for data interpretation because it
has been posited that many clinicians, perhaps most of them, are not efficient or skilled
at effectively aggregating the multiple data sources and detecting covariation across the
instruments (Achenbach & Edelbrock, 1984; Reid et al., 1988). Another problem that
may become amplified with a multisource, multisetting, and multi-instrument assess-
ment design is that the detection of a class of target behavior or a specific syndrome
that has a low base rate is difficult. If multiple data sources are not used in a sequential
and methodical fashion, the amount of error in classification may possibly be increased
because of the behavioral covariation problem. These are thorny problems for which
there are no simple solutions.
New developments in assessment technology are showing some promise in reducing
the types of assessment problems that have just been described. One of the most innova-
tive developments in assessment and classification has been the development and refine-
ment of a model for sequentially obtaining multiple sources of behavioral, social, and
emotional assessment data, then systematically using this information to make screening
and classification decisions. This assessment model has come to be known as multiple
gating. It is based on the sequential assessment strategy first introduced by Cronbach and
Gleser (1965) for applications in personnel selection. Multiple gating in the assessment
and classification of child and adolescent psychopathology was first formally articulated
and presented by research scientists at the Oregon Social Learning Center (Loeber et al.,
1984; Reid et al., 1988).
The basis of multiple gating is that through a series of assessment and decision steps
(gates), a large population is sequentially narrowed down to a small population of
individuals who are very likely to exhibit the behavioral syndromes in question across
86 s Foundations and Methods of Assessment

settings and over time. The first step (or gate) generally consists of screening a large
population of interest using time-effective and cost-effective measures such as rating scales
or teacher ranking procedures for the behavioral syndrome of interest (e.g., antisocial
behavior, aggression, hyperactivity, internalizing problems). These screening data are then
used to narrow down the larger population to a more reasonable number, by allowing only
those whose scores or rankings are at a specified level (e.g., over the 50th percentile) to pass
through the first gate and on to the second. The initial criteria are established in a fairly
liberal fashion, so as to result in many false-positive errors (identification of individuals
who do not exhibit in a serious manner the behavioral syndrome in question), but few
or no false-negative errors (failure to identify individuals who should be identified).
The next gate in the sequence might be additional low-cost data that are obtained across
different situations, for example, using lengthier rating scales completed by persons who
know the identified persons in different settings. A cutoff criterion is established to deter-
mine which individuals will pass through the second gate. Those who pass through the
second gate (their numbers should be fairly small at this point) are then assessed using
more time-intensive procedures, such as structured interviews with parents and behavioral
observations at home and/or school. The final gates also contain established decision rules
for passing through, and individuals who do pass through the final points are considered
almost certainly to exhibit the behavioral syndrome of interest to a serious degree. These
individuals are then referred for additional assessment, final classification, and, potentially,
a program of intervention or treatment. The final classification does not have to be a DSM
or special education category but could consist of any formal operational definition of
specific problem areas of interest.
Two examples of published multiple-gating procedures are presented to illustrate the
potential uses and steps involved. The first example is a community-based or clinic-based
multiple-gating procedure first developed at the Oregon Social Learning Center to identify
youths at risk for antisocial and delinquent behavior. The second example is a school-
based multiple-gating procedure to identify students with severe behavioral problems.

Community- and Clinic-Based Multiple-Gating Procedure

Many risk factors and behavioral variables have been found to correlate with the specific
antisocial behaviors associated with delinquent status among youths. Loeber and Dishion
(1983) ranked these etiological variables in terms of their predictive power and noted that
the composite measures of parental family management techniques, early childhood
conduct problems, poor academic performance, and parental criminality or antisocial
behavior were the most powerful predictors. They attempted to apply this predictive
information to a sequential multiple-gating procedure using data from 102 boys aged
12 to 16 years (Loeber et al., 1984). The result was a three-stage screening procedure that
showed evidence of a high correct classification rate and was significantly less expensive
than traditional methods of screening and assessment. The steps of this multiple-gating
procedure are illustrated in Figure 3.1.
Gate 1 in the procedure consisted of teacher ratings obtained for each boy in the study.
These ratings were conducted using a brief 11-item scale that required the teachers to rate
the boys on academic competency and social–behavioral characteristics at school. Boys
whose ratings were at the 47th percentile or higher (N = 55) were selected to be screened
at Gate 2. The second gate consisted of telephone interviews with the parents of the
remaining 55 boys. There were at least five interviews with each family, wherein questions
 Assessment and Classification s 87

Reject Accept Reject Accept Reject Accept

Gate 1 Gate 2 Gate 3

(Teachers) (Mothers)
Family-Management
Rating Scales Telephone
Practices Interview
Interviews

At-Risk
Sample

Figure 3.1 Diagram of a clinic-based multiple-gating procedure used to identify youths at risk for delinquency
Source: Adapted from Loeber, Dishion, and Patterson (1984). Copied with permission from SAGE Publications.

regarding family organization, the whereabouts of the target child, and the occurrence of
problem behaviors within a 24-hour period were asked. A risk score for this procedure
was established, and boys scoring above the 47th percentile (N = 30) were moved on
to the final gate. This final step, Gate 3, involved structured interviews with the parents
and the target children. The content of the interviews was focused on family management
procedures, such as the parental monitoring of child activities, parental discipline
practices, and perceived disobedience of the target boys. A risk score for the procedure
was developed, and boys whose scores were at the 47th percentile or higher (N = 16) were
passed through this final gate. These boys were found to have an extremely low false-
positive error rate when follow-up data on involvement by all participants in delinquent
activities were pursued. The researchers concluded that this study provided strong
initial evidence for the use of multiple gating in classification, both from empirical and
from cost-effectiveness standpoints. Since the publication of the Loeber et al. (1984)
study, researchers at the Oregon Social Learning Center have continued to refine the use
of multiple-gating assessment procedures in additional investigations. A revised multiple-
gating model has been articulated by Reid et al. (1988), and this general model has been
adopted in several research studies by other researchers and has influenced the assessment
and service delivery models in some settings.

SSBD: A School-Based Multiple-Gating Procedure

Beginning in the mid-1980s, attempts were made to use multiple gating in the development
of reliable and cost-effective screening procedures to identify students with serious
behavioral disorders in school settings. The initial development of these procedures was
based on methodology modeled after the findings of researchers at the Oregon Social
Learning Center (Loeber et al., 1984; Reid et al., 1988). The rationale for the development
of a school-based model was the desirability of identifying severe behavioral problems at
early grade levels and being able to provide appropriate interventions in the early stages of
developmental psychopathology rather than waiting until problems become extremely
serious and resistant to alteration. The researchers involved in the early stages of this effort
had noted that formal assessment and identification of students with severe behavioral
disorders usually did not occur until about the middle school years, but a review of these
students’ behavioral records often found strong evidence for the existence of severe
problems as early as kindergarten or first grade (H. Severson, personal communication,
August 18, 1992).
88 s Foundations and Methods of Assessment

The result of these efforts was the development of a multiple-gating procedure that
showed strong evidence of several forms of reliability and validity and was found to have
high classification accuracy in screening students with severe behavioral problems (Todis,
Severson, & Walker, 1990; Walker, Severson et al., 1988, 1990). This multiple-gating system
has since been revised and commercially published as the Systematic Screening for
Behavior Disorders (SSBD) (Walker & Severson, 1992; Walker, Severson, & Feil, 2014).
The SSBD is a three-gate system that includes teacher screening (using a rank-ordering
procedure) of students with internalizing and externalizing behavioral problems (Gate 1),
teacher ratings of critical behavioral problems (Gate 2), and direct behavioral observation
of students who have passed the first two processes (Gate 3). The observational procedure
used in Gate 3 includes academic behavior in the classroom and social behavior on the
playground. The end result of the SSBD system is that students who are passed through
all three gates become the focus of prereferral interventions and are potentially referred
to the child study teams for formal assessment and special education classification. Figure
3.2 provides a diagram of the gates and procedures in the SSBD.

Stage 1
Teacher Ranking

on Externalizing and Internalizing Behavior Criteria

Universal 3 highest ranked students

Screening oass to Stage 2
withSSBD

Screening Time:
-45 minutes per
classroom Stage 2
Teacher Ratings

on Critical Events and Combined Frequency Indexes

Plus Aggressive Behavior and Social Interaction Scales
(Prek-K only)

Students who meet criteria

pass to Stage 3 or go directly
- 0 intervention and/or referral.

(Optional) (Optional)

Stage 3 Stage 3
Observation School Archival
Codes Records Search

Intervention and/or Referral

Figure 3.2 Diagram of the multiple gating stages of the Systematic Screening for Behavior Disorders
Source: From Systematic Screening for Behavior Disorders, Second Edition, by H. M. Walker, H. Severson, and E. Feil (2014).
Eugene, OR: Pacific Northwest Publishing. Reprinted with Permission.
 Assessment and Classification s 89

The complete SSBD package includes procedural, training, and technical manuals;
normative data; recommendations for behavioral interventions; complete forms and
protocols; and a video for training in the observational system. These materials are now
also available online. It is a unique and exemplary system that shows some of the best
possibilities of how school-based assessment and subsequent individualized support and/
or special education classification of students with severe behavioral and emotional
problems can be accomplished.

SARS: Classification of Behavioral Problems Using Existing School Records

A fourth level of the SSBD, the School Archival Records Search (SARS) (Walker, Block-
Pedego, Todis, & Severson, 1991) is also available. The SARS may be used as a fourth level
in the multiple-gating SSBD system, or it may be used as a stand-alone tool. The SARS
was designed to provide a systematic means of coding and quantifying existing school
discipline records for the purpose of identifying students who may have externalizing or
internalizing behavioral or emotional problems, and who may benefit from prevention
or intervention programs. The SARS includes a four-page data entry form that provides
spaces to enter information on students gleaned from existing school records in the
following 11 areas: demographics, attendance, achievement test scores, number of grade
retentions, academic and behavioral referrals, special education services, placement
outside of regular classrooms, receipt of Chapter 1 academic services, frequency of refer-
rals out of school, negative narrative comments (specified individually) from school dis-
cipline records, and disciplinary contacts outside of the classroom for the current school
year. The SARS also includes a two-page Student Profile Form, which is used to code, in a
more refined manner, much of the information obtained in the record form. The SARS
manual provides instructions for converting this coded information into z scores and
factor scores and suggested cutoffs for scores that are considered to indicate risk status in
the following domains: Disruptive, Needs Assistance, and Low Achievement. The SARS
scoring procedures and cutoffs are based on a regional sample of school records reviews
from more than 300 students in Oregon.
Because the SARS is such a unique assessment tool, it is difficult to compare it with
existing measures or traditional methods, and it should be evaluated on its own terms
rather than by using traditional evaluation schemes. The information regarding the sta-
bility and effectiveness of the SARS presented in the technical manual and in subsequent
published studies (Lane, Carter, Pierson, & Glaeser, 2006; Sugai, Sprague, Horner, &
Walker, 2000; Tobin & Sugai, 1999; Tobin, Sugai, & Colvin, 1996) is impressive. The accu-
mulated evidence indicates that the SARS provides a nonobtrusive means of gathering
information from existing records that is highly predictive of existing behavioral risk
categories and future behavior problems. It is a useful addition to the SSBD system and
warrants use as a stand-alone tool. Because of increased concern regarding the failure of
school personnel to pay close enough attention to existing indications of severe behavio-
ral and emotional problems of students, tools such as the SARS designed to integrate and
quantify school behavior files systematically are an important innovation in the field.

CONCLUDING COMMENTS ON ASSESSMENT AND CLASSIFICATION

Attempts have been made in this chapter to delineate suitable reasons for making
diagnostic and classification decisions an important part of the assessment process, and
90 s Foundations and Methods of Assessment

to provide an overview of three major systems of classification: the DSM, special education
service categories, and the emerging behavioral dimensions approach. In addition, it has
been argued that there is scientific value using, and continuing to refine, our existing
taxonomic classification systems. An important additional question to consider is: How
do classification activities help link assessment to the process of intervention? Although
attempts have been made to impress the reader with the necessity and advantages of
conducting classification activities during the assessment process, the answer to this
question is not yet as hopeful as we would like it to be. At present, the evidence support-
ing the treatment validity (usefulness in developing intervention or treatment plans) of
current classification schemes is neither abundant nor compelling.
Although classification systems and activities serve several appropriate purposes,
being able to take a given classification category and translate that automatically into
a set intervention is seldom possible. Classifying human behavior is inherently easier
than changing it. Because of the wide degree of individuality and variation in the biology,
behavior, and temperament that humans exhibit, and in the conditions under which
these characteristics are manifest, developing effective interventions for behavioral, social,
and emotional problems requires a tremendous understanding of behavior–environment
relationships and a great deal of clinical sensitivity on the part of interventionists. It
remains an extraordinary challenge to the emerging generation of researchers and prac-
titioners to develop classification systems that not only reliably codify a wide array of
human characteristics, but also provide information that might translate directly into
valid treatment planning.
On a somewhat more optimistic note, behaviorally oriented research scientists Scotti,
Morris, McNeil, and Hawkins (1996) began a compelling argument for maintaining
certain aspects of current categorical systems of classification and augmenting them
with functional approaches to assessment when moving to treatment planning. These
authors acknowledged that categorical classification systems that are limited to structural
assessment of problems based on form (rather than function) of the concern are limited
with respect to assisting intervention planning, but certain diagnostic systems may
assist in delineating the typical duration and developmental course of specific clusters of
related behavioral problems. For example, if we know that a child meets diagnostic crite-
ria for the two DSM disorders Attention Deficit/Hyperactivity Disorder (ADHD) and
Oppositional Defiant Disorder (ODD), we also know that they are at a higher risk than
the general population for the development of Conduct Disorder (CD), which carries
with it serious risks. This diagnostic information may help guide the assessment process
toward the identification of protective and risk factors to target in an intervention plan.
According to Scotti et al. (1996), assessment could take the form of a funnel approach that
begins with a more traditional, structural assessment and moves to a more functional
process as treatment planning increasingly becomes the focus.
Whether such a system and process offers a useful alternative to current categorically
based systems remains an empirical question worthy of further research efforts. From the
standpoint of problem solving, these systems seem worthy of exploration and careful
evaluation. In addition, the use of multiple-gating procedures in assessment and classifi-
cation is one development that shows promise in conducting systematic screening
and assessment procedures that can be connected to various classification systems and
subsequent programs of intervention.
 Assessment and Classification s 91

On a final note related to classification are some thoughts related to the problem of
classification or identification in relation to the stigmatizing effects that these processes
may have on children and youth. Earlier in this chapter, a case was made for the practical
and scientific importance of continuing to use and improve our systems for classifying
human behavior. It is clear, however, that many professionals in the education and mental
health fields do not share this view and would like to rid the field altogether of the use
of diagnostic labels because of the stigmatizing effects such labels may have. Although
there may be risks of stigmatization involved in appropriate diagnosis and classification
practices, it is important to recognize that elimination of scientifically based systems
of diagnosis and classification would not eliminate the stigmatization of children and
youth with behavioral, social, and emotional problems: “Much worse than accurate
diagnoses are the other labels that are applied to these children . . . bad, unmotivated,
dysfunctional, criminal, lazy, space-cadet, weird, etc.” (Jensen, 2000, p. 2). Most human
societies have a long tradition of stigmatizing individuals who have significant mental
health and behavior problems (Kauffman, 2000). Eliminating labels and diagnostic
categories might help reduce the discomfort that some professionals feel when they are
presenting results to parents and teachers or making recommendations, but it would do
little to reduce the stigma for children who are perceived as being different because of
their behavior. Perhaps a better approach is to work toward improving current systems
of diagnosis and classification, demanding that diagnoses be data-driven, and educating
others regarding misconceptions and biases that lead to more difficulties for children
who are already dealing with significant challenges in their lives.

CONCLUSIONS
Classification of behavioral, social, and emotional problems continues to be an important
aspect of the overall assessment process. Although current psychological/psychiatric
classification systems are imperfect, classification continues to be an important function
because it can provide some common ground of understanding for professionals, and help
provide access to services and remuneration for clients. Continuing to work with and
refine present systems is a step in the right direction toward developing improved systems.
Refining and improving our classifications that describe behaviors based on their form
rather than their function is also consistent with the classification and taxonomic approaches
that have typified the natural sciences for generations.
Differential diagnosis is a two-step process that involves making a decision regarding
whether a problem is considered normal or abnormal and then reaching a decision
regarding how to classify the problem. In making classification decisions, there are two
major types of errors. A false-positive error involves making a determination that an
individual has a particular disorder when in reality he or she does not, whereas a false-
negative error involves failure to diagnose an individual with a particular condition or
disorder that he or she in fact has. The stakes involved in making particular decisions
determine which type of error is less onerous. The higher the risks and consequences are
in a differential diagnosis and classification decision, the more conservative the approach
to making the decision should be.
The DSM system, currently in its fifth edition, is the most widely used psychological/
psychiatric classification system in North America, and possibly the world. Historically,
92 s Foundations and Methods of Assessment

it has been based on the medical model, wherein emotional and behavioral disorders are
viewed as manifestations of an underlying disease process residing within the individual.
In more recent editions, the medical model outlook of the DSM has been tempered
somewhat by the influence of behavioral psychology, and more attention is now given
to the situational and environmental factors in diagnosing many types of disorders.
Although the DSM system has been rightly criticized in the past for problems of
unreliability and lack of treatment validity, there have been substantial improvements
with the most recent editions. Continued future attention to behavior–environment
relationships and the developmental and contextual aspects of behavioral and emotional
problems will be useful in making the DSM system more sensitive and effective.
Within the public education system in the United States, the IDEIA has substantial
implications for assessment and classification of children and adolescents. Of particular
interest to assessing social and emotional behavior in school settings is the IDEIA special
education eligibility category “emotionally disturbed.” The definitional criteria for this
category are broad enough to allow for classification of children with a variety of challeng-
ing social–emotional behaviors. One of the continuing controversies regarding the IDEIA
definition of ED is the so-called social maladjustment exclusion clause, which, similar to
the definition of ED, has come under intense criticism but has not been changed by
Congress, despite intensive lobbying efforts prior to the 1997 reauthorization. Efforts
to move toward a general emotional–behavioral disorder definition that utilizes the behav-
ioral dimensions (externalizing–internalizing) approach to identifying youth with emo-
tional and behavioral disorders in school settings through the federal special education
law hold promise.
A more recent approach to classification of child and adolescent social–emotional
problems is what has been referred to as the behavioral dimensions approach. This
approach, typified by the pioneering work of Achenbach and Quay, relies on sophisticated
statistical models to derive empirically clusters or syndromes of child behavior.
A promising and innovative approach to assessment and classification of social–
emotional problems of children and adolescents is school-wide and multiple gating.
By using a sequential series of systematic and increasingly time-consuming screening
procedures, multiple-gating methods allow for narrowing a large population down to a
small group of candidates who are likely to exhibit behavioral and emotional problems
to the point of needing further assessment and intervention. Multiple-gating approaches
have been developed and validated for use in community and school settings. Although
this methodology is time-consuming, multiple gating and sequential assessment theoret-
ically may reduce error variance associated with using aggregated multiple assessment
sources. Such efforts are promising and, with future refinements and improvements, may
be utilized on a wide scale in providing universal screening of children and youth similar
to what is advocated in the public health approach to disease prevention and health pro-
motion. Despite the substantial improvements in classification systems for emotional
and behavioral disorders of children and adolescents, many challenges remain. Perhaps
the foremost challenge in this area is development of classification systems and categories
that not only are reliable and scientifically taxonomic, but also have strong treatment
validity. Although traditional classification systems may be useful as a starting point
in developing intervention plans, by providing some general information about the
structure of the problem, the function of the problem is also an essential element to be
addressed in developing effective interventions.
 Assessment and Classification s 93

REVIEW AND APPLICATION QUESTIONS

1. What are the primary purposes of classifying emotional and behavioral disorders of children
and adolescents?
2. Define the term differential diagnosis, illustrating how it is used in the assessment and
classification process.
3. Give examples of how false-positive and false-negative classification errors might occur in
assessing behavioral, social, and emotional problems. Is one type of error less damaging
than the other?
4. The DSM classification system has been widely criticized over the years but continues to
be refined and is without question the pre-eminent classification system in North America.
List the major positive and useful aspects of the DSM that have helped expand its
influence.
5. What are some of the continuing problems with the DSM approach to classification?
Reflect upon clinical cases you have discussed, observed, or conducted assessment, and
consider the specific ways in which a DSM approach to classification has been helpful to
the individual, as well as potentially harmful.
6. How defensible do you believe it is to restrict special education service eligibility as
emotionally disturbed to students who are not “socially maladjusted”?
7. What are the assumptions and procedures behind the behavioral dimensions approach to
classification, and how do they differ from those of other classification methods?
8. Two multiple-gating procedures for assessment and classification were described in this
chapter. Identify the potential problems involved with instituting and using a multiple-
gating procedure, and determine what steps could be taken to reduce these problems.
9. Using a multiple-gating procedure not only requires time and personnel to conduct the
process, its results increase the likelihood that more referrals for assessment will be made
to the multidisciplinary team. Assume your school or agency were considering starting a
multiple-gating assessment procedure, discuss information you would present to support
initiating a multiple-gating approach, its development, and maintenance.
10. One of the criticisms of classification and labeling systems for human behavioral and
emotional problems is that they have little or no utility in development interventions or
treatments. How much do you agree with this assertion?
11. Is limited intervention utility a big enough problem to justify moving away from classification
taxonomies and into noncategorical service/eligibility systems?
 4
DIRECT BEHAVIORAL OBSERVATION

This chapter provides a detailed introduction to the principles, specific uses, and problems
of direct behavioral observation as a child assessment tool. This assessment technique is
one of the primary tools of many clinicians and researchers who are involved in the
assessment of behavioral, social, and emotional problems of children and adolescents,
and it holds a prominent position as being one of the most empirically sound of these
assessment techniques. In fact, behavioral observation is among the most frequently
used assessment methods and may be the most commonly employed method among
school psychologists (Wilson & Reschly, 1996). However, it is important for even the most
ardent advocates of behavioral observation (including us) to recognize that this method
of assessment does include several key challenges, and potential problems. Furthermore,
there are major differences between anecdotal observation of behavior and systematic
observational methods (e.g., Volpe & McConaughy, 2005), which cause us to contend that
not all observational tools are equally useful and valid. This chapter first provides an
overview of the basic principles and concepts of behavioral observation, then takes a
detailed look at the general methods and typical coding procedures of behavioral
observation. After the general foundations and methods of direct behavioral observation
have been described, a review of several formal observational coding systems is provided.
These systems were selected for inclusion in this chapter based on their general-purpose
design and their utility in conducting assessments in school, home, and clinic settings.
The chapter includes an analysis of some of the major problems and issues in behavioral
observation. Issues ranging from the problem of observer reactivity to situational speci-
ficity of behavior are covered, and specific suggestions for overcoming these problems
and limitations of behavioral observation are provided. The exploration of direct
behavioral observation concludes with a discussion of how direct behavioral observation
can be useful in making various decisions that are related to the assessment process.

BEHAVIORAL OBSERVATION: BASIC PRINCIPLES AND CONCEPTS

Direct observation of behavior is one of the cornerstone tools for the assessment of
behavioral, social, and emotional problems exhibited by children and adolescents.
Whether the observation involves formal behavioral recording in naturalistic settings,
or whether it is done informally as part of other measurement strategies, behavioral
observation provides the clinician with one of the most direct and objective assessment
tools available. Direct behavioral observation is a procedure in which observers develop

95
96 s Foundations and Methods of Assessment

operational definitions of the targeted behaviors of interest, observe the subjects, and
systematically record their behaviors. Behavioral observation has the advantage of being
linked to the development of interventions in a relatively straightforward manner.
The roots of behavioral observation are grounded firmly in behavioral psychology, as
advocated by Watson, Skinner, and others. Since about the 1970s, there have been increased
efforts at integrating behaviorism and direct observation into broader models of concep-
tualizing human behavior. To that end, direct observation has been found to be compatible
with social learning theory (Bandura, 1977, 1978; Patterson, 1969), applied behavior anal-
ysis (Baer, 1982), and cognitive-behavior therapy (Meichenbaum & Cameron, 1982). Even
an approach to treatment as different from behaviorism as Rogers’s (1951) client-centered
therapy relies on clinical observation by the therapist as an important part of understand-
ing and treating the problems of the client, even though it is not as systematic as a solidly
grounded behaviorist would prefer.
Keller (1986) noted that the unifying factor of various behavioral approaches appears
to be “their derivation from experimentally established procedures and principles”
(p. 355). As such, most methods of behavioral observation, and specifically those methods
and techniques covered in this chapter, have a strong emphasis on sound empirical
methodology and a high degree of treatment validity. Alessi (1988) noted that one of the
crucial characteristics of observation methods for emotional and behavioral problems
is that they permit a functional analysis of behavior and as such are intrinsically linked
to the valid interpretation of assessment data and the development of systematic inter-
vention plans. Direct behavioral observation methods are particularly suited to assessing
the behavior of individuals as opposed to groups, although groups of individuals may be
involved, because these methods are particularly adept at taking into account the unique
context and the repertoire of responses exhibited by individuals (Alberto & Troutman,
2012; L. K. Miller, 1996; C. H. Skinner, Dittmer, & Howell, 2000; Sulzer-Azaroff & Mayer,
1991).

DIRECT BEHAVIORAL OBSERVATION AND ECOLOGICAL

ASSESSMENT
Perhaps the foremost advantage of direct behavioral observation is that it allows the
observer to gather functional information regarding not just individual behavior, but
how this behavior exists as part of an interactive environment. This advantage of behav-
ioral observation is particularly relevant to the theories of human behavior that were
detailed in Chapter 1, namely social cognitive theory and the “triadic reciprocality” way
of analyzing behavioral development and the ecological systems model of child behavior
within varying contexts. Since the 1970s, substantial efforts by behavioral scientists have
demonstrated that behavior is best understood, and predicted, when one takes into
account the natural support systems within the environment that elicit and maintain the
behavior because “those [behaviors] that run counter to natural support systems are less
likely to prevail for very long” (Sulzer-Azaroff & Mayer, 1991, p. 46).
Take the case of an elementary-age student who exhibits aggressive and antisocial
behavior in the various settings at school. A superficial observation of this student’s
behavior would merely define when, where, and how the problem behavior is occurring.
In contrast, a systematic direct behavioral observation that takes into account the
 Direct Behavioral Observation s 97

surrounding environment or ecology in which these behaviors exist, is more likely to

provide information on conditions that elicit and maintain the problem behaviors, such
as interactions between teachers and peers, the physical aspects of the classroom, or
particular activities or individuals. A skilled clinician can use this type of information not
only to describe and classify the behavior in detail, but also to develop intervention plans
that may have a good chance of succeeding.
The notion of examining environmental antecedents and consequences of behavior
and the ecological system in which behavior occurs, has existed for many years and has
been continually refined. An influential article by Rogers-Warren (1984) more than
20 years ago referred to this notion as “ecobehavioral assessment,” and the term ecological
assessment also has been employed to reflect this notion. In the 1990s and later, this notion
was infused with new energy through the proliferation of research and writing on the
topic of functional behavior assessment (FBA) (Haynes & O’Brien, 1990; Horner, 1994;
McComas & Mace, 2000; Reep, 1994; Vollmer & Northrup, 1996; T. S. Watson & Steege,
2003). FBA is discussed later in this chapter. In sum, researchers and practitioners who
use direct behavioral observation should always consider that behavior does not occur
“in a vacuum”; examining environmental relationships within the entire behavioral
ecology should be a standard practice if the observation is meant to result in anything
more useful than simple description of behavior.

GENERAL METHODS OF BEHAVIORAL OBSERVATION

Although there are many specific techniques and systems for observing and coding
behaviors within direct observation, most can be subsumed in the three general categories
of naturalistic observation, analogue observation, and self-monitoring. This section illustrates
the main characteristics and uses of each of these three general methods.

Naturalistic Observation
The most direct way to assess child and adolescent behavior in most cases is through
naturalistic observation in the setting in which the behavior typically occurs (Jackson,
2015; C. H. Skinner, Rhymer, & McDaniel, 2000; Whitley, Kite, & Adams, 2012). The essen-
tial elements of naturalistic observation were outlined by Jones, Reid, and Patterson (1979)
more than 30 years ago, and include: (1) observation and recording of behaviors at the
time of occurrence in their natural setting; (2) the use of trained, objective observers; and
(3) a behavioral description system that requires only a minimal amount of inference
by the observers–coders. Naturalistic observation differs from the other two general
methods of observation in that there is a premium on obtaining observational data in
typical, day-to-day situations, with strong efforts to minimize any obtrusiveness or re-
activity caused by the presence of an observer. Analogue or self-monitoring methods require
more inference than naturalistic observation in determining whether observed behaviors
are representative of what actually occurs in the subject’s day-to-day environment.
What type of observational settings can be considered to be naturalistic? Perhaps more
than any other setting, school-based assessments offer many opportunities for naturalistic
observation. Whether the observation takes place in the classroom, on the playground,
during recess, in the cafeteria, in the halls between classes, or even on the school bus, the
school environment has great potential for unobtrusive data collection in situations that
98 s Foundations and Methods of Assessment

are encountered by children and adolescents on a regular basis. For younger children who
are not yet in school, other possibilities for naturalistic observation settings are day-care
centers and play groups.
The home setting also offers opportunities for naturalistic observation but on a more
limited basis. Observing a child interacting with his or her family in the home environment
has the potential for being an excellent means of gathering data, but there are significant
obstacles that must be overcome: the increased probability of obtrusiveness and reactivity
and the physical circumstances of the home. Because most families are not used to having
strangers enter their home and watch their ongoing activities, it is a given that they
will behave differently under these conditions; most likely, they will make an effort to
minimize the occurrence of any maladaptive or coercive behaviors by putting their “best
foot forward.” The design of most American houses and apartments, with the resulting
lifestyles that are shaped, also creates considerable challenges for conducting observation.
Many houses and apartments are sufficiently large and compartmentalized so that family
members can distance themselves from each other (and from an observer) with relative
ease by going into different parts of the home. In their pioneering efforts to develop valid
home-based observation systems, investigators at the Oregon Social Learning Center
(OSLC) (Reid, 1982; Reid et al., 1988) worked extensively on the problems of conducting
effective naturalistic observations in home settings and developed methods of minimizing
reactivity and physical barriers with their coding systems. A typical in-home observation
by OSLC researchers is structured so that family members agree to stay in a common
area of the home and do some activity together (other than watching television, which
is considered too passive an activity to elicit sufficient family interaction) during the
observation period. In a sense, conducting a home observation in this manner is contrived
and is akin to analogue observation, but it still allows for highly effective observation and
coding of family interactions in the home setting (Patterson, Ray, Shaw, & Cobb, 1969).
More recently, the use of structured observation tasks in the homes has been linked to the
development of contextually relevant, family-based interventions (Dishion & Stormshak,
2007). These observation tasks are often videotaped and then later used to give families
feedback about the strengths and barriers in their interactions with one another (Smith,
Dishion, Moore, Shaw, & Wilson, 2013). This direct feedback may not only help families
to engage in intervention supports, but it also can help to reduce negative perceptions
caregivers have about their children’s behavior.

Analogue Observation
Unlike naturalistic observation methods, which are designed to capture behavior as and
where it normally occurs, analogue observation methods are designed to simulate the
conditions of the natural environment and to provide a highly structured and controlled
setting in which behaviors of concern are likely to be observed (Hintze, Stoner, & Bull,
2000). Analogue assessment is considered to be an indirect measurement procedure
that reflects “how an individual might behave in a real life situation” (p. 56). Analogue
observation might occur in a clinic or a research laboratory, but the specific environment
developed for the observation is structured to simulate everyday situations in the natural
environment. In many cases, the participants in analogue observation might be requested
to role play or engage in the observation activity in a specific way. Examples of situations
that have been developed for analogue observation include parent–child interactions,
family problem-solving approaches, and children’s task orientation.
 Direct Behavioral Observation s 99

Analogue observation carries with it problems and obstacles. Compared with natural-
istic observation, more inference is required in drawing conclusions about behavior
and its generalization outside of the clinic or laboratory setting, and many questions are
likely to arise concerning the validity of the observational data. Analogue observation
offers enough advantages, however, that clinicians who conduct child and adolescent
assessments are advised to become competent in its use. One of the chief advantages
of the analogue method is that the observer can exert much greater control over the
environment than with naturalistic observation, increasing the opportunities for eliciting
important, but low-frequency, behaviors. For example, if one of the stated referral prob-
lems is noncompliance to teacher or parent directions, the observer can create many
analogue situations in which the participants must react to directions. A related advant-
age that the control aspect of analogue observation offers is that extraneous stimuli—
those things that are inconsequential to or detract from the behavior in question—can
be reduced or eliminated. Overall, the analogue method offers many advantages and
possibilities, if the observer considers its limitations.
One of the most important aspects of conducting an analogue observation is to
structure the observational conditions so that they closely resemble those of the settings
in which the problems are most likely to occur. By doing this, similarity in stimuli and
responses between the two settings is maintained, and the observation is more likely to be
conducive to the behavior in question. For example, if the assessment goal is to obtain
observational data of interactions between a mother and her child, it would be important
to have them engage in activities that they are likely to be doing at home, role play, or work
with materials that they are likely to use at home. By carefully structuring the conditions
of the analogue observation, the similarity between the natural environment is increased,
and the resulting validity and usefulness of the observation data are enhanced.

Self-Monitoring
A third general method of observing behavior is self-monitoring. The essential feature of
self-monitoring is that the participant or target child is trained in observing and recording
his or her own behavior. The advantages of self-monitoring include its relatively low cost
and efficiency, its utility in the measurement of covert or private events such as thoughts
and subtle physiological changes, and its lack of intrusiveness (Cole, Marder, & McCann,
2000; Shapiro & Cole, 1994).
There are many drawbacks to self-monitoring, of which the reliability and validity of
the self-monitored observations stand as major concerns (Gravina & Olson, 2009; Keller,
1986; R. O. Nelson & Hayes, 1986). It is difficult enough to train impartial observers–
coders in the reliable use of observation technology, and when the observation is extended
to include self-scrutiny by the participant (particularly with children), the implementation
problems are likely to be increased. These potential reliability and validity problems can
be decreased through specific procedures, including: (1) providing a sufficient amount
of training to the subject; (2) using systematic and formal observation forms; (3) using
self-monitoring procedures that require a minimum of time and energy by the subject;
(4) conducting occasional reliability checks with the subject; and (5) reinforcing the
subject for conducting accurate observations. Training should also include sufficient
practice opportunities, so that the child is clear on when and how to self-monitor.
Self-monitoring tends to be used to a much greater extent in behavioral treatment
programs than as part of a multimethod, multisource, multisetting assessment and, as
100 s Foundations and Methods of Assessment

such, is not addressed in any more detail in this book. For a more complete discussion of
the use of self-monitoring procedures, readers are referred to works by Alberto and
Troutman (2012), Cole et al. (2000), Cooper, Heron, and Heward (1987, 2007), Shapiro
and Cole (1994), Sulzer-Azaroff and Mayer (1991), and the Journal of Applied Behavior
Analysis. The first five sources are prominent texts that include many school-based
applications of self-monitoring in assessment and treatment, whereas the last-mentioned
source is the most prestigious scholarly journal related to applied behavior analysis and
has included a large number and variety of articles over the years that detail many different
uses of self-monitoring.

OBSERVATIONAL CODING PROCEDURES

Now that we have analyzed the general methods of behavioral observation, it is useful to
look at the specific ways that behavioral observation data may be recorded or coded.
As many as seven different observational coding procedures and useful combinations of
procedures have been identified (Sulzer-Azaroff & Mayer, 1991), but in this chapter, the
number of recording categories has been collapsed into four general types, which are
illustrated as follows. A brief summary of these four observational coding procedures is
found in Table 4.1. Note that for years observational coding was documented via paper
and pencil formats. Although this is still a common mode of documentation, computer

Table 4.1 Guide to four basic observational coding procedures

Coding procedure Definition Example Advantages and

disadvantages

Event recording Recording the number of Number of times A: Can be used to

times a specific behavior students leave their determine antecedents and
occurs during the length of seats consequences of behavior
an observational period D: Not useful with
behaviors that occur
frequently
Interval recording Dividing the observational Number of intervals in A: Good choice for
period into intervals, and which student is out of behaviors that occur at a
recording specified behaviors seat at any point moderate but steady rate
that occur at any time during (partial interval) or D: Requires complete
the interval (partial interval) during entire time attention of observer
or during the entire interval (whole interval)
(whole interval)
Time-sample Dividing observational Number of intervals in A: Requires only one
recording period into intervals, and which student is out of observation per interval
recording if specific behavior seat at exact point of D: May miss some
occurs momentarily at interval important low-frequency
interval behaviors
Duration/latency Recording how long a How long students are A: Simple to do with a
recording particular behavior lasts out of seat (duration); stopwatch or wall clock
(duration), or how long how long students are D: Difficult for behaviors
from the end of one out of seat after the without a clear beginning
behavior to the beginning teacher tells them to or end
of another (latency) return to seat (latency)
 Direct Behavioral Observation s 101

software (e.g., iBAA or Behavioral Assessment Application available through iTunes and
compatible with MacIntosh products) is consistently being developed and tested to make
the input and analysis of behavioral observation data a more efficient process.

Event Recording
Event recording (also known as frequency recording) is a measure or count of how many
times specified target behaviors occur during the length of the observational period. Event
recording is best suited for use with behaviors that meet three criteria. The first criterion
is that the behaviors should have a clear beginning and end. Within the behavioral domains
of physical aggression or asking for help, it is normally quite simple to determine starting
and stopping points, but with behaviors such as making noise, this task becomes more
difficult. The second criterion is that behaviors should last approximately the same amount
of time each time they occur. If the observer is recording a class of behaviors that vary con-
siderably in time from occurrence to occurrence, another recording technique, such as
duration recording, should be used. Because event recording yields a simple tally of how
many times the behaviors occurred, it is not useful for gauging such aspects of behavior
as intensity or length. The third criterion is that the behaviors should not occur so frequently
that it becomes difficult to separate each occurrence. For example, if an observer was using
event recording to measure self-stimulation behavior (e.g., hair twirling, rocking, or lip
rubbing) of a child with severe disabilities, and these behaviors were occurring every few
seconds, the event-recording procedure would become too cumbersome. Regarding this
third criterion, the observer must make a decision if the frequency of the behavior is so
high that event recording would be difficult to implement.
Certain techniques can be used with event recording to maximize its usefulness as an
observational recording procedure. One way that the utility of event recording can be
increased is to record events sequentially, or in the exact order in which they occur. By
developing a sequential analysis of observed events, behaviors can be categorized accord-
ing to antecedents and consequences, a task that may be helpful in better understanding the
function of behavior and in developing intervention plans. A useful way of transcribing
event recording into an analysis of behavioral antecedents and consequences is through
the use of an A–B–C (antecedent–behavior–consequence) evaluation narrative, which
follows these steps:
1. Divide a sheet of paper into three columns, one each for antecedents, behaviors, and
consequences.
2. List the specific behaviors that were recorded in the middle column (behaviors).
3. Note what events or behaviors preceded the recorded behaviors (antecedents) in
the left column and what events or behaviors followed the recorded behaviors
(consequences) in the right column.
Using this A–B–C procedure requires some flexibility in the observation system—in
some cases a targeted behavior that was recorded in the B column also will appear in the
A column as an antecedent to another important behavior or event. The payoff of using
this technique will come in the form of an ecologically sensitive observational recording
system that has strong implications for treatment. An example of using the A–B–C
breakdown sheet with event recording is provided in Figure 4.1.
The advantage of using a basic A–B–C breakdown sheet with event recording in
observations (or with behavioral interviews) is that it allows one to develop a testable
102 s Foundations and Methods of Assessment

A-B-C Event Recording Sheet

Antecedent Behavior Consequence

Teacher asks students to 5 does not take out Teacher reprimands 5

take out their workbooks workbook, talks to
neighbor

Teacher reprimands 5 5 removes workbook from Teacher focuses attention

desk away from 5

5 raises hand to ask Teacher works with

question another student

5 continues to raise hand Teacher responds to 5's

question

Teacher responds to 5's 5 puts head down on

question desktop

5 puts head down on 5 begins to tap leg againsl Neighbor tells 5 to be

desktop desk quiet

Neighbor tells 5 to be 5 tells neighbor, "shut up" Teacher tells 5, "get back
quiet to work"

Teacher tells 5, "get back 5 puts book in desk, Teacher again tells 5 to
to work" places arms and head on get back to work
desktop

Teacher again tells 5 to 5 pounds hand on desk Teacher tells 5 to go to

get back to work and swears at teacher time-out chair in back of
room

Teacher tells 5 to go to 5 kicks chair and goes to

time-out chair in back of time-out chair
room

Figure 4.1 An example of behavioral observation data that were collected using an event recording procedure and the A–B–C
(antecedent–behavior–consequence) technique

hypothesis regarding the presumed functions that the problem behaviors may serve,
which can then be evaluated and potentially used in developing an intervention (Crone
& Horner, 2003).
Another way that the use of event recording can be fine-tuned to yield more useful
data is to report the events in different ways, depending on the length of the observ-
ation period. Barton and Ascione (1984) suggested three length-based ways of reporting
data:

1. If each observation period is of the same length, report the actual frequency with
which each event occurred.
2. If the observation periods differ in length, the data should be reported by rates of
occurrence, or the number of responses divided by the time period in which the
observations took place.
3. Behavioral events that are supposed to follow specific cues (such as compliance with
directions from the teacher) should be reported as a percentage of opportunities
that the behavior occurred, as in three compliances for five commands.
 Direct Behavioral Observation s 103

Event recording in its most basic form is relatively easy to use, but by using some of these
modifications, the observer will be able to make the observation more insightful and
useful.

Interval Recording
The essential characteristics of interval recording involve: (1) selecting a time period
for the length of the observation; (2) dividing the observational period into a number of
equal intervals; and (3) recording whether the specified target behaviors occur during
each interval. Interval recording is considered to be a good choice for use with behaviors
that occur at a moderate but steady rate but is not as useful for behaviors that occur with
relatively low frequency. It does not provide an exact count of behaviors but is a good
choice for use with behaviors that occur on a frequent basis. An example of a typical
interval-based observation would be a 30-minute observation period divided into
90 equal intervals of 20 seconds each.
Interval recording requires the complete attention of the observer and can be difficult to
implement if the intervals are too short, the total observation time is too long, or the
number of behaviors that are targeted for observation are too great. Interval recording
may also be challenging with respect to obtaining high levels of interobserver reliability,
and doing so may require extensive supervised training. In typical practice, an observ-
ational period is less than one hour long (20 to 30 minutes is typical in school-based
practice), and the intervals are no more than 30 seconds long. The most simple form of
interval recording involves using the procedure with one targeted behavior and recording
a plus (+) or minus (–) in boxes that have been drawn for each interval to indicate whether
the target behavior occurred. If the intervals are short, or if the number of behaviors that
are targeted for observation are so many that it creates difficulty in making an accurate
recording, brief recording intervals can be placed between each observation interval
(Alberto & Troutman, 1998). For example, an observer might use ten-second intervals for
the observation but place a five-second scoring interval between each observation inter-
val, giving him or her the time to record accurately the behaviors and prepare for the next
interval.

Whole-Interval or Partial-Interval Recording? Interval recording can be divided into two

general types: whole-interval recording and partial-interval recording. With whole-
interval recording, the behavior being coded must be observed during the entire interval
in order to be recorded. The whole-interval method is a good choice if the behaviors
being coded are continuous (such as on-task behavior) and the intervals are short to
medium in length (Shapiro & Skinner, 1990). With partial-interval recording, the observer
codes the target behavior in question if it occurs at any time during the interval; when a
specific behavior has been coded, it is no longer necessary to monitor that behavior until
the next interval begins. The partial-interval method is a good choice for recording
behaviors without a clear beginning and end and that happen with such a high frequency
that they are hard to count (Shapiro & Skinner, 1990). Figure 4.2 provides an example of
a behavioral observation coding sheet used to code observations of social behavior in a
playground setting, for a referred student, using the partial-interval method. Both types
of interval recording, whole or partial, procedures may result in error.
Whole-interval recording tends to underestimate the behavior, whereas partial-
interval recording tends to overestimate the behavior (Salvia & Hughes, 1990; Salvia &
104 s Foundations and Methods of Assessment

Playground Social Behavior Recording Form

Name and Grade: Justin T., Grade 4 Date: October 17

Location: Central School Playground Activity: Morning Recess
Observer: Chris Thompson Start/Stop Time: 10:05-10: 18 A.M.
Interval Lengthffype: 20 seconds, partial interval

Interval PA VA INT ISO Interval PA VA INT ISO

1 X 21 X
2 X 22 X
3 X 23 X
4 X 24 X
5 X 25 X
6 X 26 X
7 X 27 X
8 X 28 X
9 X 29 X
10 X 30 X
11 X 31 X
12 X 32 X
13 X 33 X
14 X 34 X
15 X 35 X
16 X 36 X
17 X 37 X
18 X 38 X
19 X 39 X
20 X 40 X

Coding Key:
PA = Physically Aggressive VA = Verbally Aggressive
INT = Appropriate Social Interaction ISO = Socially Isolated

Figure 4.2 An example of an interval-based coding system used to collect social observation data. This particular form was used
for a playground-based observation of a referred student, using the partial-interval method, and focusing on social interaction and
aggressive behavior

Ysseldyke, 2004). Which is the better of these two methods of interval recording? It
depends on the behaviors being observed and the purposes for which the observation is
being conducted.
A final consideration of interval recording is that to use it effectively, special timing
devices may be necessary. If the observation intervals are long enough, and if the number
of targeted behaviors is limited, it is possible to get by with the use of a phone or a digital
watch with second timers. As the length of the time intervals decrease, or as the numbers
of behaviors targeted for observation increase, using a typical watch with a second timer
becomes increasingly frustrating (if not maddening), and the reliability and validity of
 Direct Behavioral Observation s 105

the observation inevitably suffer as a result. Another option for the technologically savvy
user would be to use programs such as GarageBand (MacIntosh application) to record
audio cues onto an iPod at desired intervals, so that one doesn’t have to visually keep track
of intervals while simultaneously observing behavior.

Time-Sample Recording
Time-sample recording is similar to interval recording in that the observation period is
divided into intervals of time. The essential difference between the two procedures is that
with time sampling, behavior is observed only momentarily at the prespecified intervals.
An additional difference between the two procedures is that with interval recording, the
observation intervals are generally divided into equal units, whereas it is not unusual to
divide the intervals randomly or in unequal units with time-sample recording. As with
interval recording, time-sample recording is most useful for observing behaviors that
occur at a moderate but steady rate.
Time-sample recording can be illustrated using assessment of on-task academic
behavior as an example. The observation might occur during a 20-minute period of
academic instruction that has been divided into 20 intervals of 1 minute each. As each
minute ends, the observer records whether the target child was on-task. In this example,
the time units were divided into equal intervals. These intervals do not need to be equal,
however, and even could be generated randomly. If the intervals used in time-sample
recording are short or highly variable, the type of electronic timing devices mentioned in
the discussion of interval recording would be useful. Some innovative researchers and
clinicians have developed electronic timing devices that randomly generate audible tones
at varying time intervals.
A major advantage of time-sample recording procedures is that they require only one
observation per interval and are less subject to the very real problems of getting “off-track”
that are easily encountered with interval recording. If the intervals are large enough, the
time-sampling method may free up the observer to engage in other activities. For example,
a teacher could still go about directing an instructional activity while conducting an
observation using time-sample recording, provided that the intervals are large enough
and the recording is simple. The major advantage of time-sample recording is closely
related to its most glaring drawback. Because time-sample recording allows for recording
of behavior that occurs only occasionally, an observer may end up not recording many
important behaviors, and conclusions may be reached based on sketchy or incomplete
information (C. H. Skinner, et al., 2000). The longer the interval used with time-sample
recording, the less accurate the data; as the interval increases, the sample of behavior
decreases. Reaching an appropriate balance between the length of the interval needed and
the necessity of freeing up the observer for other activities is the most reasonable way to
use time-sample recording.

Duration and Latency Recording

Event recording, interval recording, and time-sample recording all have the similarity of
focusing on obtaining exact or approximate counts of targeted behaviors that occur
during a given time frame. Two additional techniques, duration and latency recording,
differ from the first three because their focus is primarily on the temporal aspects of the
targeted behaviors rather than on how often the behaviors occur. Duration and latency
recording are best used with behaviors that have a discrete beginning and end and last for
106 s Foundations and Methods of Assessment

at least a few seconds each time they occur. Common examples of these behaviors include
out-of-seat behavior, self-stimulating or stereotypic behavior, and tantrumming.

Duration Recording In duration recording, the observer attempts to gauge the amount of
time that a target child engages in a specific behavior. In other words, the most critical
aspect of the observation is how long the behavior lasts. For school-based assessment, a
good example of how duration recording might be used is provided by the observation of
out-of-seat behavior. If a student leaves his or her workspace during an instructional
activity to wander around the classroom, it may be useful to know how long the out-of-
seat behavior lasts. There is a big difference between a student who gets out of his or her
seat three times during a 30-minute observation, who is still academically engaged for
most of the period, and a student whose out-of-seat behavior occurs only once during the
observation but who stays out-of-seat for most of the period. For clinic-based assessment,
a good example of the use of duration recording is provided by observation of child
temper tantrums. The parent of a six year old who engages in temper tantrums two to
three times per week but whose tantrums last for 20 minutes or longer can provide the
clinician with valuable information by measuring the length of the tantrums. As a
practical matter, a treatment that reduces the average number of tantrums from three
per week down to two per week might be less valuable than a treatment that does not
change the average number of tantrums but reduces their duration to no more than five
minutes each.

Latency Recording In latency recording, the observer attempts to gauge the amount of
time from the end of one behavior to the beginning of another. The most critical aspect
of the observation is how long it takes for the behavior to begin. A typical example of
how latency recording could be used comes from observation of a child referred for
noncompliant behavior. In this case, it might be important to observe how long it takes
from the parent or teacher request for action to the enactment of the noncompliant
behavior. Treatment progress could be gauged through seeing a consistent trend of a
decreased amount of time between the request and the compliance.

EXAMPLES OF OBSERVATIONAL CODING SYSTEMS

This section provides overviews of several observational coding systems that are relatively
general in orientation and focused primarily on social–emotional behaviors. Observational
coding systems that are useful for highly specific purposes, such as the measurement of
hyperactivity or social withdrawal, are reviewed in Chapters 9 to 13. Volpe, DiPerna,
Hintze, and Shapiro (2005) conducted an excellent review of observational coding systems.
This review includes some of the same coding systems described in this book, but also
includes others that are focused more on academic behavior rather than general social–
emotional behavior. The eight observational coding systems described in this section,
which are summarized in Table 4.2, are divided into three types—school based, home
based, and clinic based—with a few representative coding systems selected for each cate-
gory. With the exception of the Direct Observation Form (DOF) of Achenbach’s ASEBA
system, these observation coding systems are not commercially published products. Most
of these coding systems were originally reported in professional journals as one part of the
 Direct Behavioral Observation s 107

Table 4.2 Characteristics of eight selected general-purpose observational coding systems

Code name Setting Measures Uses

Direct Observation School 96-item rating scale, event Internalizing and externalizing
Form recording, interval recording behavior problems and
on-task behavior
Behavior Coding System School eight categories, interval Coercive and aggressive
recording behavior
Social Interaction Home 12 categories, continuous General social–behavioral
Scoring System event recording problems
Family Interaction Code Home 29 categories, interval Aversive family behavior
recording
Child’s Game and Clinic seven parent behavior and Child noncompliance,
Parent’s Game three child behavior behavior problems during
categories, coded in interactions with parent
30-second intervals
Teacher Behavior Code Clinic/Home nine categories, interval- Change in parent teaching
based “teaching trials” behavior following training
Behavioral Observation School momentary time sampling, Academic engagement and
of Students in Schools interval recording off-task behaviors
Coders Impression Clinic 59-item rating scale and Parents’ use of discipline, skill
Measure six-item addendum encouragement, problem-
solving, positive involvement,
and monitoring

research methodology employed in a study, and in some cases, these systems have become
popular among other researchers and clinicians. To obtain complete information on most
of these observational systems, readers need to locate the reference cited with them and
may benefit from conducting a computer-assisted literature search using the name of the
observational system as a keyword. These observational coding systems are included to
provide illustrative examples. Although these systems are not being advocated as the “best
of ” coding systems available, they were selected because of their innovative designs and
sound empirical base. You might also notice that each of these coding systems has been
around for several years. They have stood the test of time and are among the more widely
cited observational coding systems that have been developed.

School-Based Observation Systems

The Direct Observation Form (DOF) The Direct Observation Form (DOF) was developed
by Achenbach (1986, 2009) and his colleagues as the child observational component
of the ASEBA. It was developed specifically for use in classrooms and in other group
activities. The DOF, in contrast to many observational coding systems, is at least partially
based on rating scale technology because it includes 96 items rated on a 4-point scale
following a ten-minute observation period. The rating scale items are completed based
only on what was observed during the observation period and not on a rater’s general
knowledge of a target child. In addition to the rating format, the DOF merges the use of
event recording and time-sample recording. The event-recording aspect of the DOF is
108 s Foundations and Methods of Assessment

included by having the observer write a narrative description of the child’s behavior
as it occurs during the observation period. The time-sampling aspect of the DOF is
included by having the observer record whether the subject was on-task at the end of each
1-minute interval.
Another characteristic of the DOF that sets it apart from most other observational
coding systems is that it is a norm-referenced instrument—a norm group of 287 non-
referred children aged five to 14 was used as the basis for comparing individual observ-
ation scores. The norm-group data also were used to develop a factor structure for the
96 rating items on the DOF, which, in addition to a total-problems score, includes inter-
nalizing and externalizing scores, consistent with the other measures in the CBCL system.
Six additional narrow-band factor scores also are available through the use of an optional
computer-scored profile.
The DOF, like the other components of the ASEBA system, is a thoroughly researched
instrument that represents an empirically sound approach to assessment of behavior
problems. It is easy to use and, unlike many other systematic observation systems, requires
only a modest amount of training. The recommended observation and scoring procedure
for the DOF allow for the obtaining of social comparison data with two observed control
children on the checklist and on-task ratings. The psychometric properties of the DOF are
good to excellent, with acceptable levels of inter-rater reliability and discriminant validity
(Achenbach, 2001b; McConaughy, Achenbach, & Gent, 1988). The DOF is a good choice
for group-based observations in which serious behavioral or emotional problems are
likely to be observed in short time periods. It is not particularly useful for observing
children or adolescents in individual or solitary situations and is not a good choice for
assessing low-frequency behaviors that are unlikely to occur within a ten-minute period.

Behavioral Observation of Students in Schools (BOSS) The Behavioral Observation

of Students in Schools (BOSS) coding system (Shapiro, 2003, 2011, 2013) was designed
to measure the academic engagement and off task behaviors of target students. The BOSS
uses momentary time-sampling to measure whether an observed student is actively
engaged, passively engaged, or not engaged in instruction. Additionally, observers use a
partial interval recording system to determine different types of off-task behaviors.
Student behaviors could be coded as off-task motor (OFT-M), off-task verbal (OFT-V),
and off-task passive (OFT-P). OFT-M includes behaviors that are not associated with
the academic task at hand and may include pencil tapping, random page turning, rolling
on the carpet, etc. OFT-V includes verbal behaviors that are not permitted in class, such
as whistling, talking to a peer, etc. OFT-P behaviors may be slightly more difficult to code
and include passive behaviors such as staring out the window. Observers record the
type of instruction being observed and collect peer comparison data during every fifth
interval of observation. The BOSS is a user-friendly system that enables observers to
gather useful information about student engagement. It is a familiar tool to many, who
collect behavioral observation data.

The Behavior Coding System (BCS) Developed by Harris and Reid (1981), the Behavior
Coding System (BCS) was designed to measure patterns of coercive behavior and
aggression in classroom and playground settings. The BCS uses an interval-recording
system with eight behavioral categories. The coding system of the BCS is easy enough
to use so that para-professionals or trained undergraduate students could be effective
 Direct Behavioral Observation s 109

observers. The reported psychometric properties of the BCS are strong, with interobserver
agreement at 93% in classroom settings and 86% on playground settings. Harris and
Reid also reported satisfactory consistency in behavioral categories across different
settings. An interesting aspect of the BCS is that it not only provides a general observational
measure of aggressive and coercive behaviors, but also provides data on the stability of
these behaviors across different settings. As such, the BCS might be effective in helping
to determine whether aggressive behavior problems are setting specific or whether they
appear to generalize across settings.

Home-Based Observation Systems

Social Interaction Coding System (SICS) Designed to assess family interaction behaviors
along various dimensions and on general classifications, the Social Interaction Coding
System (SICS) (Weinrott & Jones, 1984) provides an interesting and useful format
for conducting home-based observations. The SICS uses a continuous event-recording
procedure wherein 12 different behavioral categories are targeted. The methodology
employed in field testing the SICS was unique; the reliability of the coding system was
studied using covert and overt observation techniques. In both cases, the reliability of the
SICS proved to be adequate to good, although it was higher for overt observations (0.91)
than for covert observations (0.73). While this is an interesting measure, there are fewer
references in the literature mentioning its use, making it hard to know the extent to which
this system is actually used.

Family Interaction Code (FIC) Another observational recording system developed by

Weinrott and Jones (1984) for home-based observation and discussed in the same research
report as the SICS, is the Family Interaction Code (FIC). Although the FIC was field tested
along the same dimensions as the SICS (overt versus covert observations), its focus is
different, and its design and use vary considerably. The FIC uses a six-second interval-
recording system wherein 29 different behavioral categories are targeted. As such, the
complexity and difficulty of use of the FIC is great, and it should be used by experienced
trained observers. The general area measured through the FIC is family interactions, with
its specific focus being aversive family behaviors. Similar to the SICS, the reliability level
was higher on the FIC for overt (0.87), rather than covert (0.69) observations.

Clinic-Based Observation Systems

The Coders Impression Measure (CI) The Coders Impression Measure (CI) (DeGarmo,
Patterson, & Forgatch, 2004) was developed to measure family interactions and parenting
practices. This measure stems from a body of research in which Patterson (1982) and his
colleagues developed the notion of coercive family practices, those that encourage the
development and maintenance of antisocial behaviors by consistent and increasingly
adverse interactions between parents and children. This research has expanded to include
a related intervention approach, Parent Management Training Oregon (PMTO) (Forgatch
& DeGarmo, 2002), which focuses on giving parents the skills to improve their positive
parenting practices. Central to PMTO is the CI, which has enabled researchers and
clinicians the opportunity to observe parenting behaviors. The CI globally measures
parents’ use of discipline, skill encouragement, problem-solving, positive involvement, and
110 s Foundations and Methods of Assessment

monitoring. Coders observe videotaped interactions between parents and children that
occurred in a clinic or research facility. These interactions are prompted through specific
tasks, such as a play task, during which a parent is asked to follow a child’s lead in playing
a game; a clean up task, in which parents are to encourage the child to clean up a game or
toys; a problem-solving task in which families are encouraged to remember a recent
problem that occurred in the family and discuss ways in which the problem could have
been solved. The coders rate parents’ behaviors on a Likert scale, and reliability estimates
have ranged between 0.67 and 0.94 in previous studies (Forgatch, DeGarmo, & Beldavs,
2005). More recently, researchers (Stora, Hagtvet, & Heyerdahl, 2013) utilized general-
izability theory to better understand the reliability between data collectors, observers
and sources of measurement error on the CI. This is important to consider as sometimes
the data collection is conducted by clinicians/researchers who are different from those
that code videos. In this study, it was found that coders that analyzed all families from
data collected, versus different coders for each family, yielded different reliability
estimates; with a higher (and likely inflated) generalizability estimate for coders that
analyzed all families.

Child’s Game/Parent’s Game An innovative coding procedure useful for observing

parent–child interactions in clinic settings was developed by Forehand and his colleagues
(Forehand & McMahon, 1981; Forehand et al., 1978). This coding system has not been
formally named but is referred to herein as the Child’s Game/Parent’s Game because
of its tasks and focus. The setting that is recommended for use of this observational
coding system is a sound-wired clinic playroom that has a supply of toys and is equipped
with a one-way window, from which an observer codes parent–child interactions from
an adjoining room. Alternatively, observations could be videotaped and coded at a later
time. Parent–child pairs are observed in two different situations that may last five or ten
minutes each. The first situation is referred to as the Child’s Game, which is an unstructured
or free-play setting in which the child chooses the activity and rules. The second situation
is the Parent’s Game, in which the parent is instructed to choose an activity and rules. The
Parent’s Game is a situation in which the parent delivers commands to the child.
For both games, parent and child behaviors are coded using frequency counts in
30-second intervals. The only exception is inappropriate behavior, which is coded as
occurring or not occurring during each interval. Six parent behavioral domains are
coded, including rewards, attends, questions, commands, warnings, and time out. Three
child behavioral domains are coded, including compliance, noncompliance, and inappro-
priate behavior. These codes are later summarized into rate per minute of various parent
behaviors and percentages of child behaviors to various parent commands. An additional
summary statistic includes the percentage of parental attention that was contingent on
child compliance.
Several studies have shown the Child’s Game/Parent’s Game coding system to have
adequate technical properties, including an average interobserver agreement rate of 75%
(Forehand & Peed, 1979), strong stability over time (Peed, Roberts, & Forehand, 1977),
sensitivity to treatment effects (McMahon & Forehand, 1984), and discriminant validity
for differentiation of clinic-referred and non-referred children (Griest, Forehand, Wells,
& McMahon, 1980). In sum, this clinic-based observational coding system is relatively
easy to implement, requires a small amount of parent and child time, is unobtrusive, and
seems to be a reliable and valid method of conducting behavioral assessment.
 Direct Behavioral Observation s 111

The Teacher Behavior Code (TBC) Unlike other observation systems reviewed in this
chapter, the focus of the Teacher Behavior Code (TBC) (Weitz, 1981) is on the parent or
caregiver, rather than the child. Specifically, the TBC was designed to be used in assessing
the amount of change in “teaching behavior” by parents who have participated in a
parent-training program. Although developed specifically for use with parents of children
with developmental disabilities, there is no reason why the TBC could not be used as a
measure for parents of children with different types of problems. The TBC was selected
for review in this chapter for a pragmatic reason; in the clinical treatment of children
with behavioral, social, or emotional problems, the parent is often the mediator or initial
target of treatment. As such, it is important to have a measurement technique to assess
the parent’s responsiveness to consultation or parent training, rather than focusing on
only the resulting child behavior.
The TBC can be used in home and clinic settings and includes nine targeted behavioral
categories that are recorded using an interval measurement system during “teaching
trials.” The TBC can be used by trained graduate students, and perhaps even trained
paraprofessionals, and by experienced observers. The reported technical properties of
the TBC are adequate to good, with an average interobserver agreement of 87% and a
range across categories from 69% to 98%. The TBC is a unique observation system that
is worthwhile for consideration by clinicians or researchers who provide consultation or
training to parents and who desire a formal system for assessing the level of change in
parent’s behaviors.

TECHNOLOGY ADVANCES IN BEHAVIORAL OBSERVATION

With the onslaught of laptops, tablets, and smartphones in our workplaces, it is essential
that we begin to develop an understanding of how technology can be applied to behav-
ioral observation. Cohen and Rozenblat (2015) call researchers and practitioners to con-
sider this particular aspect of behavioral assessment and review some of the advantages
and disadvantages of incorporating technology into applied behavior analysis, with a
specific focus on data collection (i.e., direct observation). With a smartphone, for example,
observers can collect a large sample of behavioral data efficiently. Observers can quickly
observe changes over time with repeated measurement and can compute interobserver
agreement easily, without having to rely on an arduous paper and pencil method. Further,
observational codes that are programmed into an application in advance may make it
easier to observe multiple topographies of behavior at the same time and may make
observation of multiple behaviors more reliable. On the other hand, utilizing new techno-
logy applications may take practice to reliably code behaviors, and software may be
subject to viruses and glitches. This section includes examples of behavioral observation
codes, primarily used in schools, which highlight some of the rapid advances in techno-
logy that we have seen over the last few years. While there are a number of technology
applications available, we have chosen to share four that may be used to observe students
in school settings.

BehaviorSnap
BehaviorSnap (BehaviorSnap 2016, Version 2.3.1) is an application developed by
SuperPsyched LLC and can be downloaded on Apple Products and Android products
112 s Foundations and Methods of Assessment

for $9.99. This download enables users to make up to 12 observations before being
prompted to choose a subscription plan. BehaviorSnap represents four separate tools in
one application, which enables interval recording, ABC data collection, duration record-
ing, frequency recording, and peer comparison data collection. This application can be
used to help professionals target concerning behaviors, understand relevant antecedents
and consequences, and collect ongoing data to monitor behavioral progress. Data collected
can be downloaded into a csv file on a computer, which then can easily be summarized and
incorporated into behavioral assessment reports.

BOSS (Behavioral Observation of Students in Schools)

The BOSS (Behavioral Observation of Students in Schools 2015, Version 1.2.0) is an
application available on iTunes and Google Play for $29.99. It is a tool published by
Pearson and developed by the late Dr. Edward Shapiro. This tool mirrors the paper and
pencil version and allows observers to set the duration of the observation session
and then track off-task (motor, verbal, passive) and student engagement (active, passive)
through momentary and partial-interval time sampling. Data are compiled and graphed
and can be emailed to the observer for future use.

!Observe
!Observe (Psychsoft 2015, Version 2.0.1) is an application available on iTunes and Android
products for $9.99 and is available in 16 languages. There is also an !ObserveLite available
for free with some reduced functionality of !Observe. This application allows observers to
record data on one behavior or a class of behaviors. It records duration of behavior and
analyzes data in terms of average duration of behavior and rates per minute. Data are saved
and can easily be transferred right into Dropbox for later review. !Observe allows for peer
comparison data to be taken as well.

iObserve
iObserve (2016, Version 1.4.3) is available from iTunes and Android stores for $64.99.
This tool is appropriate for educators as well as persons in other professions in which
behavioral observations are required (e.g., coaches, inspectors). This tool enables users to
develop their own observational criteria and can also utilize audio and video functions.
Users can also timestamp the observation, review the observation with students/teachers
being observed, and then save the data.

RELIABILITY AND VALIDITY ISSUES IN DIRECT BEHAVIORAL

OBSERVATION
Despite the strong empirical support and practical utility of using behavioral observation
as a primary means of assessment, there are many potential limitations, problems,
and cautions that should be kept in mind. Although there have been some significant
developments in methodology and technology for child behavior observation during the
past two decades, there are still many challenges and unanswered questions regarding
this assessment method. It is important to consider that the jury is still out regarding how
well traditional psychometric principles apply to direct behavioral observation methods
(Hintze, 2005). Even the strongest advocates of observational assessment concede that the
 Direct Behavioral Observation s 113

accuracy, validity, and reliability of behavioral observation data are often not adequately
established, and there are various potential threats to the integrity of observational data
(Briesch, Chafouleas, & Riley-Tillman, 2010; Hintze, 2005; C. H. Skinner, Dittmer, &
Howell, 2000; C. H. Skinner, Rhymer, & McDaniel, 2000; Sulzer-Azaroff & Mayer, 1991). In
this vein, it is worthwhile to consider that practitioners who develop observational codes
should identify a “bottom line” of reliability, validity, and overall quality of their observ-
ational systems and seek to keep above this line in conducting observational assessment.
It may be helpful to consider the seven “essential quality indicators” that have been
proposed by Hintze (2005) with respect to direct observation methods, which include
internal-consistency reliability, test–retest reliability, interobserver agreement, content validity,
concurrent and convergent validity, predictive validity, and sensitivity to change. Observational
systems that meet all of these quality indicators should certainly be the end goal, but it is
important to realize that many practitioners may be using systems that are lacking in one
or more areas. This section addresses some of the issues surrounding the use of behavioral
observation that are potentially problematic, with a particular emphasis on issues that may
impact reliability and validity of observational assessment data.

Defining the Observation Domain

One of the first tasks in developing an observational coding system or in using an existing
system is defining what types of behaviors are important to target in the observation and
then developing appropriate operational definitions for those behaviors. In defining
behaviors to target, the domain of behavior can be viewed as a continuum, with broadly
defined behaviors on one end and narrowly defined behaviors on the other end. Although
defining each behavioral domain in a highly narrow manner may seem to make empirical
sense, it may be impractical when it comes time to conduct the observation. For example,
if aggressive behavior is of particular importance in an observational assessment, and
the general category of “aggressiveness” is broken down into 15 different subcategories of
behavior, the observational coding system will probably be cumbersome and of little use
for all but the most esoteric scientific purposes. Conversely, defining a behavioral domain
too broadly might increase the ease of coding by the observer but will tend to reduce
the validity and reliability of the observational system (Epps, 1985; Skinner, Rhymer, &
McDaniel, 2000). Using the example of the general category of aggressive behavior, it is
easy to see how two behaviors that are qualitatively different might be coded in the same
way if the domain of “aggressiveness” is defined too broadly. Arguing with and physically
attacking another person are generally considered to be forms of aggression, but coding
them as the same may not be particularly helpful for the assessment or for intervention
planning.
To reduce the potential problems associated with defining the behavioral domain to be
observed, care should be taken to ensure that the observational coding categories are
defined neither too broadly nor too narrowly; the scope of the behavioral definition should
be linked to the specific purposes of the observation, and treatment implications should be
considered in creating definitions if the purpose of the assessment is to evaluate a problem
and develop an appropriate intervention. If the observational domain must be defined
broadly, the validity of the assessment can be increased by employing multiple measures. The
use of multiple measures allows for the measurement of a broad range of behaviors, while
avoiding the practice of equating behaviors that are related but still qualitatively different
(Kent & Foster, 1977).
114 s Foundations and Methods of Assessment

Observer Training and Reliability

One of the universes of generalization in behavioral assessment in Cone’s (1978) classic
and widely influential conceptualization of a Behavioral Assessment Grid is referred to
as scorer generalization. This term indicates that behavioral assessment data may vary
because of differences between persons who score or code the data. When the observ-
ational system has been developed or selected, it is imperative that the individuals who
actually will be conducting the observations are properly trained, so that the resulting
observational data are reliable and valid. Failure to train observers properly in the use of
specific coding systems and procedures may result in behavioral assessment data that are
of questionable use.
After the observers are trained properly in the reliable use of an observational coding
system, there is still potential for scorer generalization problems. It was shown years ago
that over time there is a tendency for observers to depart gradually from their original
definitions of how to score or code particular behaviors (e.g., Kent, O’Leary, Diament,
& Deitz, 1974), a phenomenon that is referred to as observer drift. This phenomenon is
just one element of the generalizability challenges that are inherent in direct behavioral
observation (Hintze, 2005; Hintze & Matthews, 2004). As is the case for observations
carried out by observers who are poorly trained in the first place, a great deal of observer
drift will produce observational data that are of questionable utility. To reduce the ten-
dency of different observers to “drift” from original definitions of behavior, it is suggested
that retraining or reliability checks of observers be conducted from time to time (Kazdin,
1981; Reid, 1982). Common procedures that might be used in observer retraining might
include: (1) periodic group meetings; (2) conducting observations on actual sets of events
(“live” or using videotaped situations); (3) calculating the rate of interobserver agree-
ment (agreements divided by agreements plus disagreements); (4) discussing points of
disagreement and coming to common decision rules; and (5) practicing until an accept-
able criterion of reliability is reached. A simple procedure for calculating interobserver
agreement, expressed as a formula, is:

number of agreements
number of agreements + number of disagreements

Although the problem of observer drift can be dealt with through the steps that have
been noted, these steps are seldom possible for practitioners who work independently.
Clinicians who employ direct-observation procedures in assessment who work under more
solitary conditions can overcome this disadvantage in several ways. Enlisting the assistance
of a colleague to act as a reliability check is one possibility. Other possibilities include doing
an occasional self-check on observational reliability by videotaping observational situations,
and striving to keep aware of new information pertinent to the observational
techniques that are being used.

Use of Social Comparison Data

During the observational process, the target of the assessment is generally a specific child
or adolescent who has been referred because of academic or behavioral concerns.
Naturally the observation should focus on that particular individual. If the observation
does not also include the use of social comparison data, however, the results may lead to
inappropriate conclusions about the nature and severity of problems, and the validity of
 Direct Behavioral Observation s 115

the observation might be jeopardized. The use of social comparison data is important to
determine whether the problem behaviors exhibited by a particular subject deviate
significantly from those of his or her peers who are in similar situations (Skinner, Rhymer,
& McDaniel, 2000). In practice, obtaining social comparison data can be a simple part
of the observation. The observer might randomly pick two or three non-referred subjects
in the same setting and alternate the observation between the referred subject and the
social comparison subjects on a rotating basis. The social comparison data obtained from
rotating the alternate observation intervals may be considered to represent the behavior
of a “typical” peer in a situation similar to the target subject’s.
Alessi and Kaye (1983) suggested that obtaining observational social comparison data
from the referred person’s peer group may serve as a basis for identifying individuals
whose behavioral problems are severe enough to warrant intervention. This suggestion is
still a good starting point for practice. An important factor to keep in mind in obtaining
social comparison data is the type of setting in which the behavior was observed. For
example, if the assessment was conducted in a school setting in which the referred student
was placed in regular education and special education classroom settings, it would be
important to obtain social comparison data in both settings because the behavioral norms
in the two settings might vary considerably (Walker, 1982). Reaching an inappropriate
conclusion on the basis of observational data without social comparison information
could threaten the overall validity of the observational system.

Observer Reactivity
Anyone with experience in observing child and adolescent behavior in naturalistic
settings can attest that the presence of an observer may influence the behavior of the
subjects, a problem that is referred to as observer reactivity. Often with uncanny percep-
tiveness, children seem to understand and react to the presence of a “stranger” in the
observational setting, sometimes with amusing results. In my own experiences conduct-
ing behavioral observations in classroom settings, the target subject, on several occasions,
has walked directly over to me and said something to the effect of “you’re here to watch
me, aren’t you?” Other examples of children being aware of the presence of an observer
are more subtle but equally illustrative of the reactivity problem. For example, it is
common for a particular child who is not the target of the observation to spend a good
deal of time during the observational period staring at the observer, asking questions like
“what are you doing here,” and even showing off or trying to impress or gain the attention
of the observer. These examples illustrate the fact that obtrusiveness by the observer can
cause a change in subject performance, simply as a result of the presence of a new person
in the environment (Kazdin, 1981; Skinner, Dittmer, & Howell, 2000).
In situations in which there is a high degree of obtrusiveness in the observation, it is
unwise to interpret the observational data without taking into account possible reactivity
effects. In cases in which the presence of the observer has created significant reactivity,
the data should be used with extreme caution, and attempts should be made to gather
observational data that is more valid, if possible. As with other threats to observational
validity, the use of data obtained under conditions of significant observer reactivity might
result in reaching unwarranted conclusions.
Several steps may be taken to reduce the potential effects of observer reactivity. One
possibility is to select observational settings in which the presence of the observer does
not create an unusual circumstance. For example, observations in playground settings
116 s Foundations and Methods of Assessment

can be done in a way so that the targeted subjects might not even be aware of the presence
of the observer, whereas observations in the home setting are likely to result in signi-
ficant reactivity—the more private the observation setting, the more likely that observer
reactivity will become a factor. In classroom observation situations, where the observation
is usually considered to be naturalistic in character, the fact that subjects are being
observed doing routine tasks is by itself a factor in reducing reactivity. Other commonsense
measures can be employed to reduce the potential reactivity in classroom observations,
such as (1) entering the classroom at the end of a recess period or other activity rather
than during the middle of instructional time, (2) conducting the observation in an
inconspicuous location such as the back of the room, (3) avoiding any unnecessary
use of observational equipment that might attract the attention of the students, and
(4) observing informally for a short period in order for the students to adjust to the
observer’s presence before the formal observation is conducted (Merrell, 1989).

Situational Specificity
The concept of situational specificity of behavior is central to assessment from the behav-
ioral perspective and has certain implications for conducting behavioral observations.
In the formative years of modern behavioral observation methodology development,
Kazdin (1979, 1981, 1982) wrote extensively on this topic and regarded the essence of
situational specificity as behavior exhibited by an individual in one particular setting that
may or may not parallel their behavior in other settings. In other words, the ecological
differences and varied stimulus control between settings may create specific conditions for
behavior. For example, a student might behave differently in two different classrooms in
which he or she is placed. Classroom rules, teacher expectations and management style,
composition of students, and physical circumstances of the two classrooms might vary
considerably, creating differences in the overall ecology of the classrooms that elicit, shape,
and maintain behaviors in a different manner.
The idea of situational specificity of behavior has been supported by findings from
several research projects. Wahler (1975) found that child behavior tends to “cluster”
between school and home settings. Even when deviant or antisocial behaviors are present
in the school and the home setting, the specific types of deviant behavior tend to differ.
Stokes, Baer, and Jackson (1974) found that subject responses tended to be specific to the
presence of individual experimenters and observers. The important point from both of
these studies is that changes in setting were found to lead to different behavior patterns,
indicating that generalization of behavior needs to be programmed into assessment and
intervention strategies (Baer, Wolf, & Risley, 1968).
The problems related to situational specificity occur during behavioral observation
assessment under two conditions: (1) when generalized inferences are drawn based on
behaviors observed in specific settings; and (2) when the observer selects a setting for the
observation that is inappropriate and does not adequately represent the behavioral
responses exhibited in other settings. Both of these problems can be minimized when
observations occur in multiple settings and when caution is used in making behavioral
inferences based on what was observed in only one setting.

Inappropriate Recording Techniques

Earlier in this chapter, four general observation coding procedures were discussed—event,
interval, time-sample, and duration or latency recording. Some authors (e.g., Barton &
 Direct Behavioral Observation s 117

Ascione, 1984) have suggested that there are six or more distinct categories of recording
techniques. Whether or not one collapses or expands the categories of recording procedures,
observation data can be recorded using at least four and possibly more procedures.
In addition to looking at specific recording procedures, behaviors can be categorized
according to the dimensions under which they occur, which tend to correlate with spe-
cific recording techniques of choice. Alberto and Troutman (1998, 2003) identified six
specific dimensions under which behaviors may occur, including (1) rate, (2) duration,
(3) latency, (4) topography, (5) force, and (6) locus. The various dimensions under
which behavior occurs might be expressed differently than these six categories, but the
overall concept is still the same: Behaviors occur under several dimensions. There is also
a general similarity between systems for recording behavior and systems for explaining
behavior, which leads to the conclusion that a specific category of behavior is probably
best chronicled through the use of a related recording system.
A potential threat to the validity of an observation may occur when the observer chooses
a system for recording the behavior that is incongruent with that behavior. Low-frequency,
but important behavioral occurrences, are normally best recorded using event recording
techniques. Use of interval or time-sampling techniques probably would result in these
behaviors not even being recorded. The dimension under which the behavior occurs and
the recording system must mesh to a reasonable degree, or inappropriate conclusions may
be reached.

Biased Expectations and Outside Influence

An additional potential threat to the validity of data obtained through direct behavioral
observation may occur as a result of the observer, or someone who might influence the
observer, expecting behavior to occur or change in a specific manner. Little has been
written on this potential problem, but it nevertheless should be considered as a real threat.
There is a humorous (but all too real) adage regarding biased expectations in behavioral
science research and in life in general: “I wouldn’t have seen it if I hadn’t believed it.” An
observer who expects to see a target child engaging in aggressive behavior is more likely
to record the behavior as being aggressive, even if the observational coding system
used is quite objective. In this scenario, subtle biases in perceptions may occur wherein
behavior that is a borderline or questionable fit with a particular coding category may
be coded in that direction because the observer believes it should fit. One of my former
students related to me an example of the subtle way in which this problem emerges.
Having been asked to conduct an observation of a fourth-grade student in a general-
education classroom setting, the observer (my former student) had been primed by the
teacher and parent that the target student had serious problems with off-task behavior,
inattentiveness, over-activity, and the like. Having never before met the target child, the
observer asked the teacher to point him out from the back of the room, in a nonintrusive
way. The observer conducted a 30-minute observation, and noted many instances of off-
task and impulsive behavior. However, a later discussion with the teacher caused the
observer to realize, in great embarrassment, that he had been observing the wrong student.
The target child was actually one row of desks up from the child he had actually observed!
Another situation that may lead to biased results in observational data is when a
researcher, supervisor, or some other person with a vested interest in the outcome of
the observational assessment communicates to observers his or her satisfaction, dis-
appointment, or annoyance with the content of behavioral observation data or his or her
118 s Foundations and Methods of Assessment

expectations regarding the child’s behavior. In making plans for an observer to come into
the classroom to assess a particular child, a teacher might make a comment such as “Karen
is always off-task at least two or three times as much as other students in my class,” with
an empathic emphasis on “always.” Or a supervisor might mention to the observer that
the referral source for a specific case “almost always exaggerates how bad a problem is,”
setting up a situation in which the observer may feel pressure to not observe and code
substantial problem behavior. This type of communication may set up a situation in
which the observer feels some pressure to satisfy the stated expectations, which in turn
might subtly bias the way that observed behavior is coded.
This particular threat to validity has no simple solutions. About the only actions that
can be taken to reduce this threat are for the observer to make overt efforts to maintain
their objectivity, to be scrupulously precise in the way they objectively code behavioral
data, and to resist pressures toward a specified given outcome.
In sum, although there are several potential threats to the reliability and validity of
systems for observing behavior directly, there are also many potential solutions. The
major threats to validity, their potential consequences, and some possible solutions are
presented in brief in Table 4.3.
Becoming aware of what problems might be encountered as part of direct behavioral
observation and taking the appropriate preventative steps greatly enhance the usefulness
of the obtained behavioral assessment data.

Table 4.3 Some potential threats to the validity of behavioral observations

Problem Potential consequences Possible solutions

Poorly defined Observational recording system is Carefully define and select

observational domains either too cumbersome or too vague behaviors to be observed based
on assessment problem and
intervention goals
Unreliability of observers Observers drift from original Provide high-quality initial
definitions; inter-rater reliability training; conduct periodic
decreases reliability checks and retraining
Lack of social comparison Interpretations of behavior are not Include typical or randomly
data based on a normative perspective; selected subjects in the same
deviancy may be under- or setting for behavioral comparison
overestimated
Observer reactivity Subject behavior is influenced by the Select and participate in
presence of the observer observational settings in a discrete,
unobtrusive manner
Situational specificity of Interpretations of observational data Conduct observations in multiple
behavior may not represent the larger picture settings; don’t overgeneralize from
limited data
Inappropriate recording Behaviors are not adequately depicted; Select recording systems carefully
techniques inappropriate conclusions are reached to match the behavioral domain
Biased expectations of the Borderline behaviors may be Resist pressure to confirm
observer systematically coded in a biased expectations of persons with
manner vested interests; remain
scrupulously objective in
coding behavior
 Direct Behavioral Observation s 119

BEHAVIORAL OBSERVATION AND FUNCTIONAL BEHAVIOR

ASSESSMENT
In the 1990s, there was a strong general increase in attention to the notion of using func-
tional behavioral assessment procedures to identify behavior and academic problems of
children and youth and to link these problems to effective interventions. This increased
interest has been particularly evident in the fields of special education and school
psychology, primarily because of new requirements for assessment practice that were
added to the IDEA as part of the 1997 congressional reauthorization (P.L. 105–17) of
the law. The language in this reauthorization of the IDEA required that FBA be con-
ducted for students engaging in behaviors that interfere with the educational process.
In practice, the FBA requirement means that school personnel must conduct preinter-
vention assessments of the functional relationships between a student’s behavior and
the suspected causes of that behavior. Following the FBA process, school personnel
must develop intervention plans based on the obtained information (J. A. Miller, Tansy,
& Hughes, 1998).
It is important to recognize that the actual process of FBA was not defined in P.L.
105–17. As a result, there has been confusion and frustration among practitioners
and researchers concerned with child misbehavior regarding what FBA is and how it
should be used within the overall processes of assessment and intervention. Because of
the increased prominence of FBA over the past decade and its obvious relationship
to direct behavioral observation, this section is included to provide some context to the
issue. This section is necessarily brief and is not intended to be a comprehensive treat-
ment of FBA or how direct behavioral observation fits into the process. Readers who
desire additional information on this topic are referred to the following excellent works
on FBA: Crone, Hawken, and Horner (2015), Horner (1994), Horner and Carr (1997),
McComas and Mace (2000), O’Neill, Albin, Storey, Horner, & Sprague (2014), and Steege
and Watson (2003).
FBA procedures may have been developed initially as a way of linking assessment to
intervention with individuals having severe disabilities. As progress was made with FBA
technology, however, its potential applications became more broad. The basis for FBA is
relatively straightforward, although certain types of implementation may require a great
deal of time and expertise in using the tools of applied behavior analysis. In its most
simple description, functional assessment is merely a way of assessing problems to identify
the particular functions of these problems. In other words, it is assumed that most problem
behaviors serve some kind of a purpose in the child’s or adolescent’s world and that
these purposes sometimes may maintain the problems. FBA also seeks to determine
relationships between the problem behaviors or characteristics and any environmental
antecedents that may elicit or bring forth the problems. The primary goal of FBA is to
develop hypotheses about probable functions that the problem behaviors serve and to
test these hypotheses by implementing an intervention. The experimental manipulation
and evaluation of the treatment hypotheses is a separate phase or process and is referred
to as functional analysis rather than functional assessment (McComas & Mace, 2000; J. A.
Miller et al., 1998). Common functions of problem behavior include, but are not limited
to, escape or avoidance of unpleasant or difficult tasks, social attention, self-stimulation,
and access to desired items or activities. Although these common possible functions
of problem behavior are frequently noted in discussions on this topic, it is important to
120 s Foundations and Methods of Assessment

recognize that for some complex behavior problems, the functions those behaviors serve
may be very challenging to identify.
Because FBA focuses on obtaining assessment information that is as direct as possible,
direct behavioral observation is usually a natural part of the process. Typically, the obser-
vation of behavior will occur in a naturalistic setting such as the school, but clinic-based
analogue observation also has been shown to be an effective method in FBA. During the
assessment process, careful attention is paid to the antecedents, the consequences, and the
general environmental context of the targeted problem behavior. J. A. Miller et al. (1998)
suggested that in practice, the first phase of FBA (description of the problem) should focus
on the following aspects:

s SETTINGSINWHICHTHEBEHAVIOROCCURS
s FREQUENCYOFTHEBEHAVIOR
s INTENSITYOFTHEBEHAVIOREGCONSEQUENCESOFTHEBEHAVIORFORTHESTUDENTPEERS
and immediate surrounding environment);
s DURATIONOFTHEBEHAVIORHOWLONGTHEBEHAVIORLASTSATAGIVENTIMEHOWMANYDAYS
in a row it is observed);
s PREVIOUSINTERVENTIONSATTEMPTED
s EDUCATIONALIMPACTOFTHEPROBLEMBEHAVIOR

Although it may be possible to obtain information on these aspects of the behavior using
methods other than direct observation (e.g., through interviews or rating scales), there
are many advantages to using direct behavioral observation.
After the initial assessment data are gathered during the description process, the next
phase (function) is to use the information to form hypotheses regarding the presumed
functions of the behavior and to use these hypotheses to guide intervention planning.
This phase is potentially difficult because in some circumstances there are no apparent
explanations for the function of the behavior, and in other circumstances, there may be
many competing explanations. Consider the potential functions that aggressive behavior
may serve. Engaging in aggressive behavior toward peers may involve certain payoffs
(reinforcement), such as getting what one wants. The inevitable attention that a child
receives for engaging in aggressive behavior, even if it is negative attention, may serve
as a reinforcing function. There also may be cognitive or affective contributions to the
aggressive behavior. A youth may be depressed, which increases his or her irritability and
helps to set up a chain of events that make aggressive interactions more likely. He or she
may have distorted cognitions (e.g., inaccurate attributions of the intentions of others),
which also may serve to increase the probability of aggressive behavior. There may be
issues such as communication needs, frustration with the educational curriculum or
expectations, physiological or constitutional issues, family issues, modeling, and more
that may help to explain when the problem behavior is more or less likely to occur. In this
process, the most plausible functions are identified based on the hypotheses that have
been generated. These identified functions serve as the basis for an intervention plan.
Ideally the intervention should be monitored carefully so that additional decisions
may be data based. Although it is possible that the FBA process may end here, a complete
or comprehensive FBA also should include a functional analysis phase, wherein the
hypotheses that have been generated are evaluated empirically and fine-tuned as they are
implemented. FBA and functional analysis are related concepts but not the same and not
interchangeable.
 Direct Behavioral Observation s 121

In sum, FBA is an increasingly important process for guiding assessment and inter-
vention of problem behaviors, and it is particularly relevant to working with students in
school settings, where its use is mandated in some instances. Although FBA procedures
do not rely on a single behavioral assessment method, direct behavioral observation has
a potential role to play that is extremely important. The processes and coding systems
related to naturalistic and analogue observation of behavior, which were described
previously in this chapter, may be especially useful in successful implementation of FBA.

HOW MANY OBSERVATIONS ARE NEEDED?

An additional consideration regarding direct behavioral observations is the increasingly
asked question, “How many observations are needed to get a reliable assessment of child
behavior?” This question was not even considered a significant issue two decades ago,
but a small number of research studies have indicated that it is a potentially serious issue
with extensive implications for practice. With other primary methods of assessment—
particularly with behavior rating scales, sociometrics, self-report instruments—the typical
practice is to conduct the assessment at one time to gather a snapshot of the behavioral
data. Although the issue of repeated assessments with these methods does raise some
occasional questions regarding technical issues, best practice in the field overwhelmingly
convinces practitioners and researchers to conduct one assessment with each tool or
method and leave it at that. The same thinking has been true in most regards with direct
behavioral observation, although with less certainty. It is typical practice for a school-
based assessment professional to conduct one classroom or playground observation of a
referred or identified child, and use the results from the single observation session to
provide a snapshot of behavior in the naturalistic setting.
Given that naturalistic observation of behavior is known to be impacted by situational
specificity or unique setting characteristics, some practitioners and researchers—
including me—have argued that multiple observations, and observations across settings,
may be a wise step. In fact, previous discussion in this chapter, as well as the recommen-
dations found in Table 4.3, argue in favor of multiple observations, especially observa-
tions across multiple settings. But what of the issue of observations within a single setting?
Is more than one observation within a single setting a requirement for obtaining reliable
observational assessment data? Increasingly, there is evidence supporting this notion.
An intriguing study by Doll and Elliott (1994) found that with preschool-age children
observed in a free-play setting, at least five observations over time were required in order
to reliably represent the behavior of individual children. Because this study was con-
ducted in a free-play setting, and because it has been presumed that the behavior of
younger children is particularly sensitive to changes in environment, it has been unclear
whether these results are applicable to older children who are observed in academic
settings. Interestingly, a more recent study by Hintze and Mathews (2004) dealt directly
with this question and produced intriguing results. Conducting observations of on-task/
off-task behavior during instructional time with individual students in a general-
education fifth-grade classroom (two observations a day for ten school days), these
researchers applied generalizability (G) theory to the data in an attempt to explain indi-
vidual variance in behavior and to evaluate reliability of these observational data. It was
determined that adequate levels of reliability of behavior could not be achieved even with
122 s Foundations and Methods of Assessment

a very straightforward on-task/off-task behavior definition. Follow-up analyses indicated

that “for adequate levels of reliability to be assumed, participants would have had to
be observed four times per day for four school weeks” (Hintze & Matthews, 2004,
pp. 266–267).
Without question, it is simply not feasible for practitioners to devote such extensive
amounts of time as may be needed to obtain reliable data within a specific setting with
a particular child. Although these two studies with relatively small numbers of subjects
are far from definitive, in tandem they raise a serious question and argue in support of
the notion of the multimethod, multisource, multisetting assessment design that was
introduced in Chapter 1. As Hintze and Mathews (2004) stated, “Clearly, systematic
direct observation—although an important part of behavior assessment—cannot be
used in isolation and must be combined with other forms of assessment (e.g., interviews,
informant reports) in the decision-making process” (p. 268).

DIRECT BEHAVIORAL OBSERVATION AND DECISION MAKING

As has been stated several times in this chapter, the most important and powerful
contribution that direct behavioral observation assessment methods can make to psycho-
educational decision-making processes is in the area of intervention and treatment
planning. Essentially, this use of assessment data places it within the context of a problem-
solving process (Skinner, Rhymer, & McDaniel, 2000). Because behavioral observation
has the capability, if done with great care, of being an ecologically valid assessment
method, fewer inferences and intervening steps are potentially needed in translating the
observational data to intervention planning because of the functional type of data that
result from such an observation. Given that observation data may be capable of not only
pinpointing specific problem behaviors, but also gauging the antecedent stimuli and
controlling consequences of these behaviors, this assessment method can provide a great
deal of information relevant to modifying the environment for the purpose of behavioral
change.
Various forms of direct observation can be used within system-wide behavioral
response to intervention (RtI) efforts. In terms of screening and assessment decisions,
direct behavioral observation is potentially useful, but it may be too costly (in terms of
professional time) to use on a large scale with several individuals. For example, observ-
ational data obtained during the course of a formal assessment may provide clues
that further types of assessment are warranted, but using direct observation during the
initial stages of a large-scale screening typically would be unmanageable and too costly.
Direct observation could feasibly be used as a screening tool if the unit of analysis is
larger, such as an observation of a classroom or recess period. During the initial screening
stages of assessment for individuals, however, a quicker method, such as behavior rating
scales, is desirable.
In making individual diagnosis or classification decisions, behavioral observations
may provide useful information but probably will be insufficient alone. Two problems are
likely to emerge if observational data are used exclusively in making diagnostic decisions:

1. Child behavior tends to be variable across situations and time, and an observational
picture of child behavior may be incomplete.
 Direct Behavioral Observation s 123

2. To be used most effectively in making reliable diagnostic decisions, direct behavioral

observation would need to occur in several settings and over several time periods,
which could be an expensive and difficult proposition.

Situational specificity of behavior appears to be an increasingly important issue with

respect to direct behavioral observation.
For making placement decisions with children and adolescents, observational data are
often necessary. In implementing the IDEIA, several states have required that direct behav-
ioral observations must be conducted before placing a student in a more restrictive edu-
cational setting. For making placement decisions that involve psychiatric hospitalization
or residential treatment facilities, few (if any) credible institutions would consent to such
placements without having a staff member or associate first obtain a direct assessment of
the referred child’s behavior through observation.
Direct observation may be appropriate for progress monitoring behaviors targeted
for intervention, but conducting regular, lengthy, systematic direct observations may not
be the best use of staff time. Direct behavior ratings (DBRs) can serve as a more efficient
method for progress monitoring behaviors targeted for intervention across contexts
(Christ, Riley-Tillman, & Chafouleas, 2009). DBRs are viewed as a hybrid between system-
atic direct observation and indirect behavior ratings (see Chapter 5 for more information
on behavior rating scales). These ratings are direct in that regular direct observations of
behaviors in context are taken. DBRs target specific behaviors (e.g., academic engagement,
disruption), and they require an adult (or sometimes the child) to rate the observed behav-
ior at a particular moment in time (e.g., morning, math class). This method is promising
in terms of its utility. It does not require substantial staff time but it aims to provide objec-
tive behavioral data that can both aid in monitoring intervention effectiveness and serve
as a communication tool between school and home environments (Chafouleas, Riley-
Tillman, & Christ, 2009).

CONCLUSIONS
Direct behavioral observation is one of the key assessment tools of scientifically minded
clinicians and researchers. Grounded in the tradition of behavioral psychology, parti-
cularly the work of B. F. Skinner and the field of applied behavior analysis, direct
behavioral observation is potentially useful in many situations, without respect to the
theoretical orientation of the observer.
Perhaps the greatest advantage of direct behavioral observation is the fact that it can be
highly functional or, in other words, be used to identify important antecedent stimuli and
controlling consequences of behavior. In the hands of a skilled and theoretically grounded
observer, direct observation data can be used to help in planning and implementing
interventions. Essentially, high-quality direct behavioral observation assessment can be
“ecobehavioral assessment.”
There are three major types of direct behavioral observation: naturalistic observation,
analogue observation, and self-monitoring observation. Naturalistic observation, or
observing subjects in their natural environment and using an objective and impartial
coding procedure, is the preferred method for most purposes. Analogue observation, or
simulating the circumstances of the natural environment within a laboratory or clinic,
124 s Foundations and Methods of Assessment

has some advantages for research and may be used when naturalistic observation is not
possible. Self-monitoring observation is a process whereby the subject is trained to
monitor and record his or her own behavior. Self-monitoring has the advantage of being
strongly linked to intervention and may serve to change behavior in, and of, itself. It is
difficult to maintain reliability and objectivity over time with self-monitoring, however.
Several types of coding systems have been developed for use in direct behavioral
observation. In this chapter, these types of coding systems were circumscribed into four
general areas: event recording, interval recording, time-sample recording, and duration
and latency recording. Each of these types of coding systems is useful for different purposes,
and the choice of a specific system should be guided by the characteristics of the behavior
under observation.
Six formal observation coding systems were reviewed in some detail. These six systems
are representative of the variety found in direct behavioral observation and show how
specific observational systems may be developed for specific purposes. In contrast to
some other types of assessment methods, most direct behavioral observation systems are
not commercially produced or norm referenced. They tend to be developed for specific
purposes and settings. Skilled clinicians may develop their own observational systems to
address the specific problems and situations they encounter.
Although, at its best, direct behavioral observation is highly ecologically valid and func-
tional, several potential threats to the validity of observational data must be considered.
These threats include poorly defined observational data, unreliability of observers, lack
of social comparison data, observer reactivity within observation settings, situational
specificity of behavior, use of inappropriate recording techniques, and biased observer
expectations. Specific practices may be employed to reduce these various threats to obser-
vational validity. Perhaps the most important practice in reducing threats to observational
validity is simply to consider these various threats when planning and implementing the
observation and taking specific steps to counter problems as they arise.
FBA has emerged as an important process in behavioral assessment and intervention
for children and adolescents in school settings, particularly when problem behaviors are
extremely challenging and disrupt the educational process. FBA is an approach to integrat-
ing assessment with intervention and not a separate assessment method. Rather, FBA relies
on various assessment methods to help describe objectively the problem behavior and its
presumed functions, and to assist in forming hypotheses regarding functions that may
be useful in developing interventions. Direct behavioral observation has an obvious
natural role in conducting FBA and should be considered one of the first-line assessment
methods to use.
Direct behavioral observation data may be used in various ways in making decisions
regarding the delivery of psychological or educational services. Perhaps the greatest
advantage of direct observation in this regard is use of ecologically valid and functional
information for intervention planning and implementation. Direct observation proce-
dures are typically so time-consuming and costly that they are best used in the later stages
of the classification process. In doing so, it is crucial to consider the potential problems of
situational specificity of behavior and unreliability of behavior over time, and the increas-
ingly important notion that several observations may be required in order to reliably
represent child behavior.
 Direct Behavioral Observation s 125

REVIEW AND APPLICATION QUESTIONS

1. Define the term ecobehavioral assessment. What practices should be considered
and implemented in behavioral observation to make the resulting data functional and
ecologically valid?
2. Three types of general observational procedures were outlined: naturalistic observation,
analogue observation, and self-monitoring. For each of these three types, describe an
appropriate and inappropriate situation for using it.
3. Define functional behavior assessment (FBA) and describe how direct observation of
behavior may serve as an important foundation of FBA.
4. What are some of the most potentially useful ways that direct behavioral observation data
may be used in decision making? Conversely, in what situations will direct behavioral
observation data be less useful in decision making?
5. The issue of the number of observations required to reliably represent child behavior is
increasingly being raised. Given the current state of knowledge regarding this issue, what
is the recommended best practice in using direct behavioral observation data in decision
making?
6. Measuring behavior through observation requires operational definitions of target behaviors
that are neither too broad, nor too narrow. Consider the following common behavioral
terms and brainstorm how you would define each to increase the likelihood that an
accurate and useful measurement will be taken:
t
XJUIESBXO
t
EFQSFTTFE
t
IZQFSBDUJWF
t
JOBUUFOUJWF
t
SFMVDUBOU
PS
BWPJEBOU
t
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PG
DPOUSPM
t
JNQVMTJWF
7. You are leading a research project whereby observational data must be collected in an
elementary school classroom. You are interested in measuring “student engagement” and
have determined four aspects of this concept to measure. Eventually you would like to
publish your study in a peer-refereed journal and you know that the editor will look for the
use of an inter-rater observer procedure in your study. Describe how you will protect against
observer drift, while utilizing an inter-rater observer procedure.
8. You are a psychologist working in a community mental health clinic, seeing clients for
50-minute sessions. A ten-year-old child is brought to an initial appointment by his mother,
who reports the child chronically “back talks” and is frequently noncompliant. After speaking
with the child, along with the mother, you note that he has answered all of your questions
in a polite and thoughtful manner. Which observational phenomenon might this behavioral
discrepancy represent and what observational methods could you consider to measure the
behaviors of concern?
9. Perhaps the best way to integrate one’s understanding of the best uses of various types of
observational and coding procedures is to work on cases requiring the development
of various methods and procedures. For each of the five scenarios listed below, do the
following:
t
4FMFDU
BOE
TQFDJGZ
POF
TFUUJOH
UIBU
XPVME
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DPOEVDUJOH
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NJOVUF

observation.
126 s Foundations and Methods of Assessment

t
4FMFDU
XIBU
ZPV
DPOTJEFS
UP
CF
UIF
NPTU
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PCTFSWBUJPO
NFUIPE
OBUVSBMJTUJD

analogue, or self-monitoring observation).
t
4FMFDU
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ZPV
DPOTJEFS
UP
CF
UIF
NPTU
BQQSPQSJBUF
DPEJOH
QSPDFEVSF
FWFOU
JOUFSWBM

time-sample, duration and latency recording).
t
1SPWJEF
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SBUJPOBMF
PS
KVTUJmDBUJPO
GPS
UIF
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BOE
QSPDFEVSFT
ZPV
TFMFDU
$POTJEFS

threats to validity and how you would address these.
t
-JTU
XIBU
CFIBWJPS T

ZPV
XPVME
TQFDJmDBMMZ
UBSHFU
GPS
PCTFSWBUJPO

Scenarios
t
0CTFSWBUJPO
PG
B
QSJNBSZHSBEF
TUVEFOU
XIP
XBT
SFGFSSFE
CFDBVTF
PG
GSFRVFOU
PGGUBTL

behavior, difficulty “staying put,” and problems completing academic work.
t
0CTFSWBUJPO
PG
B
GPVSZFBSPME
DIJME
XIP
XBT
SFGFSSFE
CFDBVTF
PG
TFWFSF
TPDJBM
XJUI
drawal, significant interpersonal communication problems, and stereotypic self-stimulating
behavior (rocking, twirling, and hand flapping). The child attends a developmental preschool
three hours per day.
t
0CTFSWBUJPO
PG
BO
BEPMFTDFOU
XIP
XBT
SFGFSSFE
CFDBVTF
PG
TFMGSFQPSUFE
EFQSFTTJPO
5IJT

client has made two suicide gestures or attempts in the past six months (cutting wrists,
ingesting a bottle of aspirin).
t
0CTFSWBUJPO
PG
B
OJOUIHSBEF
TUVEFOU
XIP
XBT
SFGFSSFE
CFDBVTF
PG
TFWFSF
BDUJOHPVU
BOE

aggressive behavior at school, including attacking other students and throwing chairs or
other objects. These types of behaviors are reported to occur an average of three to five
times per week.
t
0CTFSWBUJPO
PG
B
mGUIHSBEF
TUVEFOU
XIP
XBT
SFGFSSFE
CFDBVTF
PG
QFFS
SFMBUJPOTIJQ

problems, including teasing classmates, difficulty making friends, and being rejected by
other students.
 5
BEHAVIOR RATING SCALES

The popularity and use of behavior rating scales as a method of assessing behavioral,
social, and emotional problems and competencies of children and adolescents has
increased dramatically since about the mid-1980s. Behavior rating scales are now employed
frequently as a primary component of an assessment battery, as a key means of obtaining
information on a child or adolescent before implementing an intervention, and as a tool
for monitoring the effectiveness of interventions and programs. As behavior rating scales
have become more widely used, there have been numerous advances in research on rating
scale technology that have strengthened the desirability of using this form of assessment
(Elliott, Busse, & Gresham, 1993; Merrell, 2000a, 2000b).
The purpose of this chapter is to acquaint readers with the theoretical, technical, and
applied aspects of using behavior rating scales as a method for assessing behavioral,
social, and emotional concerns of children and adolescents. First, a brief discussion of the
nature and characteristics of rating scales is presented. Sections on advantages and problems
of rating scales and some of the measurement and technical issues involved in rating
scale technology follow to assist readers in developing a broader understanding of some
important measurement issues. After the initial foundation-laying part of the chapter,
reviews and discussions of some of the most widely used general-purpose problem behavior
rating scales for children and adolescents are provided. Next, some recommended practices
in using rating scales are presented. The chapter ends with a discussion of the use of
behavior ratings in making various decisions related to the assessment process.

CHARACTERISTICS OF BEHAVIOR RATING SCALES

Definitions and Foundations

Behavior rating scales provide a standardized format for the development of summary
judgments regarding a child’s or adolescent’s behavioral characteristics by an informant
who knows the child or adolescent well. The informant is usually a parent or teacher, but
other individuals who are familiar with the child or adolescent might legitimately be a
source for behavior rating scale data, including work supervisors, classroom aides, day-
care providers, temporary surrogate parents, and extended family members.
As an assessment methodology, behavior rating scales are less direct than behavioral
observation or structured behavioral interviewing because they measure perceptions of
specified behaviors rather than provide a first-hand measure or direct observation of the
existence of the behavior. Rating scales are an objective method, however, and yield more

127
128 s Foundations and Methods of Assessment

reliable data than either unstructured clinical interviewing or projective–expressive

techniques (R. P. Martin et al., 1986; Merrell, 2000a). As behavior rating scales began to
be more widely used during the late 1970s, they typically were viewed with suspicion and
used as a “last resort” by behaviorally oriented clinicians (Cone & Hawkins, 1977), but as
the research base and technological refinements in rating scales became more advanced,
there was a concurrent increase in their acceptance among researchers and clinicians.

Rating Scales Versus Checklists It is useful to differentiate rating scale from a related term
checklist. A checklist format for identifying behavioral problems or competencies lists a
number of behavioral descriptors, and if the rater perceives the symptom to be present,
he or she simply “checks” the item. After completing the checklist, the number of checked
items is summed. Checklists are thus considered to be additive in nature, because the
obtained score is a simple additive summation of all the checked items. Rating scales, like
checklists, allow the rater to indicate whether a specific symptom is present or absent.
However, rating scales also provide a means of estimating the degree to which a character-
istic is present. A common 3-point rating system (there are many variations of this) allows
the rater to score a specific behavior descriptor from 0 to 2, with 0 indicating the symptom
is “never” present, 1 indicating the symptom is “sometimes” present, and 2 indicating the
symptom is “frequently” present. Because rating scales allow the rater to weight the spec-
ified symptoms differentially, and each weighting corresponds with a specific symbolic
numerical value and frequency or intensity description, rating scales are said to be alge-
braic in nature. Conners and Werry (1979) defined rating scales as an “algebraic summa-
tion, over variable periods of time and numbers of social situations, of many discrete
observations” (p. 341). In general, the algebraic format provided by rating scales is pre-
ferred to the additive format provided by checklists because it allows for more precise
measurement and differentiation of behavioral frequency or intensity (Merrell, 2000a,
2000b). The differences between the additive nature of a checklist format and the alge-
braic character of a rating scale format are illustrated by the sample items in Table 5.1.
A wider range of possible scores and variance is possible using the algebraic rating
scale format as opposed to the less sophisticated checklist format, which seems to have
continually lost favor over time.

Table 5.1 Example of differences between checklist and rating scale formats for assessing child behavior problems

Behavioral descriptor Checklist Format Rating Scale Format

1. Is noticeably sad or depressed Y N 0 1 2

2. Feels hopeless about his or her problems Y N 0 1 2
3. Wants to be left alone Y N 0 1 2
4. Has had a change in eating or sleeping habits Y N 0 1 2
5. Is irritable or disagreeable Y N 0 1 2
Note: Key to checklist format: Y = symptom is present; N = symptom is not present.
Key to rating scale format: 0 = never occurs; 1 = sometimes or to some degree occurs; 2 = frequently or to a great degree
occurs.

Advantages of Behavior Rating Scales

The widespread popularity of using behavior rating scales is not incidental—they offer
many advantages for clinicians and researchers conducting child and adolescent
 Behavior Rating Scales s 129

assessments. The main advantages of behavior rating scales are summarized in the
following six points:

1. In comparison with direct behavioral observation, behavior rating scales are less
expensive in terms of professional time involved and amount of training required
to use the assessment system.
2. Behavior rating scales are capable of providing data on low-frequency but important
behaviors that might not be seen in a limited number of direct observation sessions.
An example is violent and assaultive behavior. In most cases, these types of behavior
do not occur on a constant or consistent schedule, so they might be missed within
the constraints of conducting two brief observations. Nonetheless, it is extremely
important to know about them.
3. As mentioned earlier, behavior rating scales are an objective assessment method
that provides more reliable data than unstructured interviews or projective–
expressive techniques.
4. Behavior rating scales can be used to assess children and adolescents who cannot
readily provide information about themselves. Consider the difficulty in obtaining
valid assessment data on an adolescent who is in a secure unit in a psychiatric hospital
or juvenile detention center, and who is unavailable or unwilling to be assessed
through interviews and self-reports.
5. Rating scales capitalize on observations over a period of time in a child’s or
adolescent’s “natural” environments (i.e., school or home settings).
6. Rating scales capitalize on the judgments and observations of persons who are
highly familiar with the child or adolescent’s behavior, such as parents or teachers,
and are considered to be “expert” informants.

With these six advantages of using rating scales illustrated, it is easy to see why they
are so widely used: they get at the “big picture” of the assessment problem in a short
amount of time, at moderate cost, and with a good deal of technical precision and
practical utility.

Problems Associated with Using Behavior Rating Scales

Despite the several advantages behavior rating scales offer, there are some problems or
disadvantages. The most sophisticated rating scales can help provide objective, reliable,
and socially valid information on broad and narrow dimensions of behavioral, social, and
emotional problems. The nature of rating scale technology contains several potential
flaws, however, which are important to understand. At the onset of discussing problems
associated with behavior rating scales, it is useful to remember that by their nature (i.e.,
assessing perceptions of problems), rating scales are capable of providing a portrait of a
general idea or conception of behavior, but they do not provide actual observational data,
even though their technical characteristics allow for actuarial prediction of behavior.
More than two decades ago, R. P. Martin et al. (1986) categorized the measurement
problems of behavior rating scales into two classes: bias of response and error variance.
These classes still represent an excellent way to understand some of the measurement
challenges associated with rating scales.
Bias of response refers to the way that informants completing the rating scales
potentially may create additional error by the way they use the scales. There are three
130 s Foundations and Methods of Assessment

Table 5.2 Types of error variance found with behavior rating scales

Type of error variance Examples

Source variance Various types of response bias; different raters may have different ways of
responding to the rating format
Setting variance Related to situational specificity of behavior; eliciting and reinforcing variables
present in one environment (e.g., Classroom 1) may not be present in a closely
related environment (e.g., Classroom 2)
Temporal variance Behavior is likely to change over time, and an informant’s approach to the
rating scale task may change over time
Instrument variance Different rating scales may be measuring different hypothetical constructs;
there is a continuum of continuity (ranging from close to disparate) between
constructs measured by different scales

specific types of response bias, including: (1) halo effects (rating a student in a positive or
negative manner simply because they possess some other positive or negative character-
istic not pertinent to the rated item); (2) leniency or severity (the tendency of some raters
to have an overly generous or overly critical response set when rating all subjects); and
(3) central tendency effects (the proclivity of raters to select midpoint ratings and to avoid
endpoints of the scale such as “never” and “always”).
Error variance is related closely to, and often overlaps with, response bias as a form
of rating scale measurement problems but provides a more general representation of
some of the problems encountered with this form of assessment. Four types of variance
that may create error in the obtained results of a rating scale assessment are outlined in
Table 5.2.
These types of variance are summarized as follows: Source variance refers to the
subjectivity of the raters and any of the idiosyncratic ways that they complete the rating
scales. Setting variance occurs as a result of the situational specificity of behavior (Kazdin,
1979), given that humans tend to behave differently in different environments because
of the unique eliciting and reinforcing properties present. Temporal variance refers to the
tendency of behavior ratings to be only moderately consistent over time—partly as a
result of changes in the observed behavior over time, and partly as a result of changes in
the rater’s approach to the rating task over time. Finally, instrument variance refers to the
fact that different rating scales measure often related but slightly differing hypothetical
constructs (e.g., aggressive behavior versus delinquent behavior), and a severe problem
behavior score on one scale may be compared with only a moderate problem behavior
score on a differing rating scale for the same person. Another problem that creates instru-
ment variance is the fact that each rating scale uses different normative populations with
which to make score comparisons, and if the norm populations are not stratified and
selected in the same general manner, similar score levels on two different rating scales
may not mean the same thing.
Although there are several problems inherent in using behavior rating scales, there are
also effective ways of minimizing those problems. Notwithstanding the argument that in
some cases it might increase error variance, the aggregation principle is particularly
important to understand and implement in using behavior rating scales, and we consider
this principle in some detail in the “best practices” later in this chapter.
 Behavior Rating Scales s 131

Measurement and Technical Issues

So far I have reviewed some of the uses, advantages, and disadvantages of using behavior
rating scales. This section provides a brief overview of some of the measurement and
technical issues that can affect the psychometric properties of rating scales. One of the
measurement characteristics of rating scales that can produce variation in the reliability
and validity of a measure is the time element involved in making the rating. This is related
to, but not the same as, the issue of temporal variance, which was already discussed.
According to Worthen, Borg, and White (1993), there is a tendency for recent events and
behavior to be given disproportionate weight when a rater completes a rating scale. This
idea is based on the notion that it is easier to remember behavioral, social, and emotional
characteristics during the previous two-week period than during the previous two-month
period. Rating scales differ as to the time period on which the ratings are supposed to be
based. For example, some rating scales specify that the rater should complete the rating
items based on the observation of the child over the previous six-month period, whereas
some other scales have a shorter time period (say, one month), and some scales do not
indicate a time period. A related measurement issue raised by Worthen et al. (1993) is that
it is easier for raters to remember unusual behavior than ordinary behavior. Typical
uneventful behaviors may be assigned less proportional weight during the rating than
novel, unusual, or highly distinctive behaviors.
Another measurement and technical variable that may affect the psychometric
properties of rating scales is the construction of the rating format. The two rating formats
that seem to be the most common for child behavior rating scales are 3-point and 5-point
scales. An alternative scaling system that appears in some behavior rating scales is
a 4-point scale, which reflects the middle ground between the two typical formats, but
lacks an exact midpoint. These two or three typical formats are all capable of providing a
reasonable and technically sound basis for behavior ratings, and there is no convincing
evidence that one of these formats is necessarily better than the other.
Typically, each numerical value in the rating format is keyed or anchored to a descriptor
(e.g., 0 = never, 1 = sometimes, 2 = frequently). As a rule, more accurate ratings are
obtained when there is a tangible and understandable definition for each quality level.
In terms of deciding how many rating points or levels of rating are appropriate in con-
structing a rating scale, Worthen et al. (1993) suggested that a common error in scale
construction is to use too many levels; the higher the level of inference needed in making
the rating, the more difficult it becomes to discriminate reliably among the rating levels.
A good convention is for scale developers to use the fewest rating levels needed to make
the rating discrimination and for scale consumers to avoid rating scales that include an
extremely high number of inference points. It also is important to review carefully the
descriptors or anchor points in a rating format to ensure that they are clear and meaningful
before adopting a new behavior rating scale.
An interesting issue related to scaling of behavior rating formats is the wording of the
descriptions or anchors that are connected to each potential rating item. In the examples
that have already been provided for the most typical rating formats, the descriptors
or anchors are usually somewhat generic and slightly subjective (e.g., 0 = never, 1 =
sometimes, 2 = frequently). This traditional rating scale anchoring format has held up
well over time and has not proven to present any insurmountable technical problems.
Some alternatives to the traditional rating scale formatting have begun to emerge, in
which the anchors to specified numerical rating points are very specifically connected to
132 s Foundations and Methods of Assessment

the estimated frequency of specified behaviors. Although this emerging alternative format
does not have a particular appellation at this time, I like to refer to it as the frequency of
behavior format. Holland, Gimpel, and Merrell, (1998, 2001) experimented with this
format in the development of the ADHD Symptoms Rating Scale (ADHD-SRS), which is
discussed in Chapter 10 and ultimately decided to use it in lieu of the traditional rating
scale format. The specific frequency of behavior rating points and anchors from the
ADHD-SRS are illustrated in Figure 5.1. In this illustration, we used a 5-point rating scale,
ranging from 0 = “behavior does not occur/no knowledge of behavior” to 4 = “behavior
occurs one to several times an hour.” The main difference between this frequency of
behavior rating format and traditional rating scale formats is that the anchors and rating
points are tied to very specific time periods, such as months, weeks, days, and hours. In
developing this format, they hypothesized that such an anchoring system might result
in higher reliability and precision in ratings. The actual pilot-testing research in which
they asked teachers and parents to complete child ratings using both formats, and then
rate their preference for each, resulted in some interesting and unexpected findings. With
respect to reliability and precision of ratings, they found that the two formats were both
solid and essentially identical, negating their hypothesis that the frequency of behavior
format would result in better precision and consistency. With respect to rater preferences,
they found that there was a small but meaningful overall preference of teachers and
parents for the frequency of behavior format over the traditional format. Given the
essential similarity of the two rating formats with respect to the psychometric properties
of the ratings, they opted to go with the frequency of behavior format, concluding that
the higher preference for it among raters was a potentially important aspect of user
acceptability and social validity. At that time, there had been no other studies of this
ratings format scaling phenomenon, and this issue continues to represent a potentially
important area for future investigations.
A final technical characteristic to consider regarding rating scales includes their
directions for use. Some scales provide highly detailed instructions for completing the
ratings, such as which persons should use the rating scale, the time period involved,
and how to approach and interpret the items. Other scales may provide a minimum of
directions or clarifications. It is recommended that users of behavior rating scales select
instruments that provide clear and tangible directions for conducting the rating and

Directions: Read each item carefully and decide how often you think this child has
demonstrated these behaviors in the past 3 months. Circle the number that best
describes your choice. Please complete all items.

Behavior Does Behavior Behavior Behavior Behavior

Not Occur/No Occurs One Occurs One to Occurs One to Occurs One
Knowledge of to Several Several limes Several limes to Several
Behavior limes a Month a Week a Day limes an Hour

0 2 2 3 4

Figure 5.1 An example of a “frequency of behavior” alternative rating scale format

Source: Reproduced by special permission from the ADHD Symptoms Rating Scale (ADHD SRS) by Melissa Lea Holland, Ph.D.,
Gretchen A. Gimpel, Ph.D., Kenneth W. Merrell, Ph.D., Copyright 2001 by Wide Range, Inc.
 Behavior Rating Scales s 133

decision rules for interpreting blurred distinctions (Gronlund & Linn, 1999). In sum, the
characteristics of rating scale technology that make behavior rating scales appealing also
may negatively affect the consistency and utility of the measure. As with any type of
measurement and evaluation system, consumers of behavior rating scales are advised to
evaluate a potential instrument based on the important technical characteristics.

REVIEW OF SELECTED GENERAL-PURPOSE BEHAVIOR RATING

SCALES AND SYSTEMS
Now that the technical foundation for understanding the technology, uses, and problems
of rating scales has been covered, I take an in-depth look at a few selected behavior rating
scale systems that are widely available and frequently employed as child assessment tools
in school and clinic settings. The instruments or systems that have been selected for
review and discussion include two rating scales from the Achenbach System of Empirically
Based Assessment; the Behavior Assessment System for Children, Third Edition; and the
Conners Rating Scale system. Besides the fact that these three systems are frequently used
and widely available, they have been selected for inclusion because they are general-
purpose behavior rating scale systems. That is, they provide parent and teacher rating
forms to measure a variety of behavioral, social, and emotional problems. In many cases,
these systems also include scales and subscales that measure adaptive competencies
in addition to problem behaviors. Another reason these instruments have been singled
out for inclusion as examples in this chapter is that they represent some of the best
constructed and widely researched instruments currently available. Finally, these three
systems can be completed by either parents or teachers and are useful in a variety of
assessment and treatment settings.
Several other general problem behavior scales are available but not reviewed in this
chapter because of space limitations and my own judgment regarding which scales or
systems are most influential. The lack of a descriptive review in this book should not be
interpreted as a condemnation of any assessment tool. In addition to the scales reviewed
in this chapter, there is an ever-increasing array of general-purpose behavior rating scales
available that are useful, have adequate or good technical properties, and are used on a
wide-scale basis in assessing children and adolescents. Several other behavior rating scales
have been developed for more specific purposes, such as assessing social skills, hyperac-
tivity, depression, anxiety, antisocial behavior, and school-based behaviors, that could be
referred to as specific-purpose or narrow-band instruments. Many of these instruments
are reviewed and discussed in subsequent chapters of this book, when assessment of
specific problems or constructs is discussed.

ASEBA: Child Behavior Checklist and Teacher’s Report Form for Ages 6 to 18
Among the most sophisticated, well-researched, and technically sound general-purpose
problem behavior rating scales are those incorporated into the Achenbach System of
Empirically Based Assessment (ASEBA). This collection of instruments incorporates
several rating scales, self-report forms, interview schedules, and observation forms for
children, adolescents, and adults. Several of these instruments—particularly those for use
with school-age children and youth—use a common cross-informant system of similar
subscales and items. Two of the instruments in this system, the Child Behavior Checklist
134 s Foundations and Methods of Assessment

for Ages 6 to 18 (CBCL/6–18) (Achenbach, 2001a), and the Teacher’s Report Form for
Ages 6 to 19 (TRF/6–18) (Achenbach, 2001c), are conceptually similar and are reviewed
herein. These two instruments are in many ways the historical core of the ASEBA system.
Although the CBCL/6–18 and TRF/6–18 have different names and normative groups,
the items and format are quite similar. In combination, these instruments are clearly the
most widely researched parent and teacher behavior rating scales in existence for use
with schoolchildren. In fact, there have been more than 8,000 publications from more
than 100 cultures written by about 15,000 authors, and translations of the ASEBA tools
have been made in over 90 languages to date. Without question, this volume of research
dwarfs that of any similar assessment system. More than any other measures, the ASEBA
child behavior rating scales have been the driving force behind the increased interest and
acceptance of behavior rating scales and the advances in technical adequacy that have
occurred since the late 1970s. The 2001 revisions of these two rating scales reflect minor
content changes and new norming samples from the previous versions (Achenbach,
1991a, 1991b). A new user’s guide and technical manual (Achenbach, 2001b) provides
research documentation and user information for both rating scales. In addition to the
updated materials released in 2001, the Multicultural Supplement to the Manual for the
ASEBA School-Age Forms and Profiles was made available (Achenbach & Rescorla, 2007).
This module provides users with norms for children in countries other than the United
States. It also enables scores to be calculated in the following new scales: Obsessive-
Compulsive Problems, Posttraumatic Stress Problems, and Sluggish Cognitive Tempo.
The release of the DSM-5 also required developers to update the DSM-Oriented Scales.
This update was taken seriously and included having a number of experts from 30 societies
rate the extent to which items were not consistent, somewhat consistent, or very consistent
with DSM-5 criteria that had changed. The Anxiety Problems and Somatic Problems scales
were revised so that they are comprised of items most relevant to DSM-5 (Achenbach,
2013). The ASEBA rating scales for use with young children are discussed in Chapter 13,
and the Youth Self-Report version of the system is described in Chapter 7 and in other
places in this book.

Description The CBCL/6–18 and TRF/6–18 both include 120 problem items: 118 items
that reflect specific behavioral and emotional problems, and two items that are used for
open-ended description of rater’s concerns regarding the child’s or adolescent’s behavior.
These items are rated on a 3-point scale, where 0 = Not True, 1 = Somewhat or Sometimes
True, or 2 = Very True or Often True format. The 120 items on the two checklists have a
high degree of continuity, with 93 items the same across the scales, and the remainder of
the items more specific to the home or school settings. Downward extensions of both
of these measures have been developed for use with younger children and are discussed
in Chapter 13. In addition to the problem behavior rating scales on the CBCL/6–18 and
TRF/6–18, both instruments contain sections wherein the informant provides inform-
ation on the adaptive behavioral competencies of the subject. On the CBCL/6–18, this
section includes 20 items where the parents provide information on their child’s activities,
social relations, and school performance. On the TRF/6–18, the competency items include
sections for academic performance and adaptive functioning.

Scoring System and Scale Structure Raw scores for the CBCL/6–18 and TRF/6–18 are
converted to broad-band and narrow-band scores that are based on a T score system
 Behavior Rating Scales s 135

(a normalized distribution with a mean of approximately 50 and standard deviation of

10), and that are grouped according to gender and age level (six to 11, 12 to 18). Both
rating scales can be hand-scored using the test manual and appropriate versions of the
hand-scoring profiles, which include scoring keys for the internalizing/externalizing
total scores, plus the various subscales scores, and a graph to plot the scores. The hand-
scoring process is somewhat tedious, taking at least 15 minutes for an experienced scorer
and longer for a scorer who is not familiar with the system. Available hand-scoring
templates make this job quicker and easier, however, and a computerized scoring
program (ASEBA-PC software) or web-based scoring system (ASEBA-WEB) on the
publisher’s website are available at additional cost. These latter two scoring methods
provide convenient and easy-to-read printouts of score profiles. For ASEBA users who
use the CBCL/6–18 and TRF/6–18 on more than an occasional basis, it is well worth
purchasing the Assessment Data Manager (ADM) computerized scoring programs.
For both instruments, three different broad-band problem behavior scores are
obtained. The first two are referred to as Internalizing and Externalizing and are based on
the behavioral dimensions breakdown of overcontrolled and undercontrolled behavior
that were discussed in detail in Chapter 3. The third broad-band score is a total problems
score, which is based on a raw score to T score conversion of the total ratings of the
120 problem behavior items. The total problems score is not obtained by merely combin-
ing the Internalizing and Externalizing scores because there are several rating items on
each instrument that do not fit into either of two broad-band categories but are included
in the total score. The CBCL/6–18 and TRF/6–18 scoring systems also provide T score
conversions of the data from the competence portions of the instruments, which were
discussed previously.
In terms of narrow-band or subscale scores, the CBCL/6–18 and TRF/6–18 score
profiles both provide a score breakdown into eight common subscale or syndrome scores,
which are empirically derived configurations of items. These eight “cross-informant
syndromes” include the internalizing area scales of Anxious/Depressed, Withdrawn/
Depressed, and Somatic Problems; the externalizing area scales Rule-Breaking Behavior
and Aggressive Behavior; and three scales that are considered “other” problems (not
specifically internalizing or externalizing): Social Problems, Thought Problems, and
Attention Problems.
This broad-band and narrow-band configuration, which is consistent across the
school-age measures of the ASEBA, are shown in Figure 5.2 in their hierarchical relation-
ship structure. Like the 1991 version, the 2001 versions of the CBCL and TRF behavior
profiles are based on different norms for boys and girls and by age group. The names of
the narrow-band syndromes are constant, however, and the general item content within
these syndrome scores is similar. For the narrow-band and broad-band scale scores
of these measures, clinical cutoff points have been established, based on empirically
validated criteria. In addition to the basic narrow-band and broad-band scales, the 2001
versions of both instruments include six optional DSM-oriented scales: Affective
Problems, Anxiety Problem, Somatic Problem, Attention Deficit/Hyperactivity Problem,
Oppositional Defiant Problem, and Conduct Problems. These DSM-oriented scales were
added to the 2001 versions to enhance consistency with the DSM diagnostic criteria, and
to aid in initial decision making regarding possible classifications to consider.
Development and Standardization The 2001 edition of the CBCL/6–18 includes a large
new nationwide normative sample of 1,753 nonreferred child and adolescent cases,
136 s Foundations and Methods of Assessment

Total Problems

Internalizing Externalizing

Social
AnxiouS! Problems
Rule-Breaking
Depressed Behavior

Withdrawn/ Aggressive
Depressed Thought Behavior
Problems

Somatic
Complaints

Attention
Problems

Figure 5.2 Diagram of scales and their relationship structure from the cross-informant scales of the CBCL/6–18 and TRF/6–18 of
the ASEBA system

with 4,994 additional clinically referred cases used for construction of the narrow-
band and DSM-oriented subscales, and establishment of clinical cutoff criteria. The test
developers report that the normative standardization sample is representative of the
48 contiguous U.S. states for socioeconomic status, ethnicity, geographic region, and
urban–suburban–rural residence patterns. The 2001 TRF/6–18 norming sample is based
on ratings of 2,319 nonreferred students, with 4,437 additional cases of referred students
used for establishing the subscale structure and developing clinical cutoff criteria. Like the
CBCL/6–18, the TRF/6–18 norming sample is based on a broad sample that is generally
representative of the larger U.S. population in several respects.

Psychometric Properties The psychometric properties of the two ASEBA child behavior
rating forms are reported in the test manual and in hundreds of externally published
research reports. Given that the 2001 revisions of these instruments are relatively slight
in terms of item content and that the rating format remains the same as previous versions,
the huge body of accumulated evidence from previous versions of the scales should be
counted as supporting the reliability and validity of the current measures. In general,
the psychometric properties of the current versions of the CBCL and TRF, as well as
previous versions, range from adequate to excellent. In terms of test–retest reliability,
most of the obtained reliabilities for the CBCL/6–18, taken at one-week intervals, are in
the 0.80 to mid-0.90 range and are still quite good at three-, six-, and 18-month intervals
(mean reliabilities ranging from the 0.40s to 0.70s at 18 months). On the TRF/6–18, the
median test–retest reliability has been reported at 0.90 for seven-day intervals, and at 0.84
for 15-day intervals. The median TRF test–retest correlation at two months has been
reported as 0.74 and at four months, 0.68. These data suggest that ratings from both the
CBCL and TRF rating scales can be quite stable over short to moderately long periods.
Inter-rater reliabilities (between parents) on previous versions of the CBCL and TRF
have been reported in many studies and were in part the topic of a highly influential
article by Achenbach et al. (1987) on cross-informant reliability of scores within the
 Behavior Rating Scales s 137

ASEBA system. Median correlation across scales of the two forms has been reported at
0.66. On previous versions of the TRF, inter-rater reliabilities between teachers and
teacher aides on combined age samples have ranged from 0.42 to 0.72. Although lower
than the test–retest reliabilities, the inter-rater agreement is still adequate. On a related
note, Achenbach et al.’s (1987) meta-analytic study examined cross-informant correlations
in ratings of child/adolescent behavioral and emotional problems and discussed in detail
the problem of situational specificity in interpreting rating scale data. Based on the data
from this study, average cross-informant correlations across all forms of the ASEBA were
found to be closer to the 0.30 range.
Various forms of test validity on the CBCL/6–18 and TRF/6–18 and previous versions
of these scales have been inferred through years of extensive research, and are cataloged
in a staggering array of published studies. Through demonstration of sensitivity to theo-
retically based group differences, strong construct validity has been inferred for each
instrument. The scales have been shown to distinguish accurately among clinical and
normal samples and among various clinical subgroups. The convergent construct validity
for both scales has been demonstrated through significant correlations between the scales
and other widely used behavior rating scales. The factor analytic evidence regarding the
validity of the eight-subscale cross-informant syndrome structure is presented in impres-
sive detail in the test manual and has been replicated externally with independent samples
for the CBCL (Dedrick, 1997) and the TRF (deGroot, Koot, & Verhulst, 1996).

Additional Comments Given the current focus on responsiveness to intervention (RtI),

the Brief Problem Monitor (BPM) (Achenbach, McConaughy, Ivanova, & Rescorla,
2011) has also recently been made available. This measure is intended to monitor the
behavioral progress of children exposed to intervention. Items parallel those from
the CBCL/6–18, TRF, and Youth Self Report (YSR) and the 18–19 items can be quickly
completed by parents (BPM-P), teachers (BPM-T), and children aged 11 and older
(BPM-Y). Norms are based on gender, age and rater, and users can calculate scores based
on Internalizing, Attention Problems, Externalizing, and Total Problems scales. This
measure was developed based on Item Response Theory and has demonstrated technical
adequacy (Chorpita et al., 2010).
The CBCL/6–18 and TRF/6–18, the most widely used ASEBA tools, have a great deal of
clinical utility, given that they provide general and specific information on the nature and
extent of a subject’s rated behavioral, social, and emotional problems. Used in combination
with parents and teachers, these rating scales have been shown to be powerful predictors
of present and future emotional and behavioral disorders of children and adolescents
(Verhulst, Koot, & van der Ende, 1994). It has been the opinion of several reviewers (e.g.,
Christenson, 1990; Elliott & Busse, 1990; Myers & Winters, 2002) that the ASEBA system
is a highly useful clinical tool for assessing child psychopathology.
Despite their enormous popularity and unparalleled research base, the CBCL/6–18
and TRF/6–18 are more useful for some types of assessment purposes and problems than
others and are not necessarily the best choice for routine assessment situations. Many of
the behavioral symptoms on the checklists are quite psychiatric or clinical in nature (e.g.,
hearing voices, bowel and bladder problems, handling one’s own sex parts in public) and
certainly have a great deal of relevance in assessing childhood psychopathology. However,
many of these more severe low-rate behavioral descriptions on the scales are not seen on
a day-to-day basis in most children who have behavioral or emotional concerns, and
138 s Foundations and Methods of Assessment

some teachers and parents tend to find certain ASEBA items irrelevant for the children
they are rating, if not offensive. In addition to limited sensitivity of these instruments
to identify less serious problems, other weaknesses of the ASEBA cross-informant
system for school-age children and youths have been pointed out, including limited
(and perhaps misleading) assessment of social competence, possible bias in interpreting
data regarding physical symptoms, and difficulties raised by combining data across
informants (Drotar, Stein, & Perrin, 1995). Although Achenbach’s empirically based assess-
ment and classification system is without question the most widely researched child
rating scale currently available for assessing substantial childhood psychopathology
and has become a sort of de facto “gold standard” in this regard, and despite the fact that
it has much to commend it as a rating scale for social skills and routine behavioral prob-
lems in home and school settings, it may not be the best choice. However, for assessing
significant psychopathology or severe behavioral and emotional problems of children
and adolescents from a cross-informant perspective, the school-age tools of the ASEBA
system are without peer.

Behavior Assessment System for Children, Third Edition

The Behavior Assessment System for Children, Third Edition (BASC-3) (C. R. Reynolds
& Kamphaus, 2015) is, as the title implies, a comprehensive system for assessing child and
adolescent behavior. Over the last 20 years, the BASC system has continued to improve
with each edition (see Reynolds & Kamphaus, 1992, 2004, 2015) and has been expanded.
The BASC-3 system can be considered a family of assessments and intervention materials
designed to assess and support the emotions and behaviors of children and adolescents.
It takes a multi-dimensional, multi-method, multi-informant approach to best under-
standing the behavioral concerns of young people. The current edition includes a large
age span (two to 25) and is aligned to DSM-5 criteria and can also be used to understand
disability under IDEIA. Included in the BASC-3 are parent and teacher rating scales for
preschool-age children (two to five years old), children (six to 11 years old), and adoles-
cents (12 to 21 years old). These behavior rating scales are separately normed and unique
across age range and informant versions but still share a common conceptual and prac-
tical framework and have many items in common across versions. Also included in the
overall BASC-3 are comprehensive self-report forms (SRP) for children (aged six to seven
and eight to 11), adolescents (aged 12–21), and college-age young adults (aged 18–25), a
structured developmental history form (Structured Developmental History; SDH), and
a student observation system (Student Observation System; SOS). There is a parenting
questionnaire (Parenting Relationship Questionnaire; PRQ) as well as an intervention
(Behavior Intervention Guide) and prevention guide (Behavioral and Emotional Skill-
Building Guide). Finally, there is an updated screening system (Behavior & Emotional
Screening System; BESS) associated with the BASC-3 and a system developed that enables
progress monitoring (FLEX Monitor). These tools are all available by paper and pencil
or Q-Global/Digital, a web-based assessment and intervention management system. The
preschool versions of the BASC-3 are discussed in Chapter 14, and the self-report forms
are discussed in Chapter 8. The screening and progress monitoring system is reviewed
in Chapter 9. In this chapter, an overview is provided of the parent (PRS) and teacher
(TRS) versions of the child and adolescent rating forms. Table 5.3 includes a breakdown
of the TRS and PRS rating forms for children and adolescents by composites and scales
and by number of rating items in each form.
 Behavior Rating Scales s 139

Table 5.3 Composites and scales of the child and adolescent forms of the Teacher Rating Scales (TRS) and Parent Rating Scales
(PRS) of the Behavior Assessment System for Children, Third Edition

Composites and scales TRS-C TRS-A PRS-C PRS-A

Composite
Adaptive Skills × × × ×
Behavioral Symptoms Index × × × ×
Externalizing Problems × × × ×
Internalizing Problems × × × ×
School Problems × × – –
Primary
Adaptability × × × ×
Activities of Daily Living – – × ×
Aggression × × × ×
Anxiety × × × ×
Attention Problems × × × ×
Atypicality × × × ×
Conduct Problems × × × ×
Depression × × × ×
Functional Communication × × × ×
Hyperactivity × × × ×
Leadership × × × ×
Learning Problems × × – –
Social Skills × × × ×
Somatization × × × ×
Study Skills × × – –
Withdrawal × × × ×
Content
Anger Control × × × ×
Bullying × × × ×
Developmental Social Disorders × × × ×
Emotional Self-Control × × × ×
Executive Functioning × × × ×
Negative Emotionality × × × ×
Resiliency × × × ×
Clinical Index
ADHD Probability Index × × × ×
Autism Probability Index × × × ×
EBD Probability Index × × × ×
Functional Impairment Index × × × ×
Executive Functioning Index
Attentional Control Index × × × ×
Behavioral Control Index × × × ×
Emotional Control Index × × × ×
Overall Executive Functioning Index × × × ×
Problem Solving Index × × × ×
× × × ×

Description The BASC-3 behavior rating scales are comprehensive instruments, designed
to assess a variety of problem behaviors, school problems, and adaptive skills. These
updated scales include approximately 32% new items, many added to reflect Developmental
Social Disorder and Executing Functioning concerns (Psimas, 2015). The parent and
140 s Foundations and Methods of Assessment

teacher rating forms for school-age children and adolescents include the PRS-C (parent
rating scale for ages six to 11), PRS-A (parent rating scale for ages 12–21), TRS-C (teacher
rating scale for ages six to 11), and TRS-A (teacher rating scale for ages 12–21). These
instruments are relatively long in terms of number of items, ranging from 139 to 160 items.
Both instruments are available in English- and Spanish-language versions. The items are
rated by circling adjacent letters indicating how frequently each behavior is perceived to
occur, based on N = Never, S = Sometimes, O = Often, and A = Almost Always. The basic
hand-scored form is self-scoring and easy to use. After the rating is completed, the examiner
tears off the top perforated edge and separates the forms, which reveals an item-scoring
page and a summary page with score profiles. Norm tables in the test manual are consulted
for appropriate raw score conversions by rating form and age and gender of the child.
A comprehensive web-based administration and scoring program (Q-Global) is also
available, which can be used as a hybrid option for paper and pencil administration
with digital scoring and reporting. This requires input of individual item responses and
basic information about the respondent and child/adolescent, and which provides not
only T score and percentile rank conversions of raw scores, but detailed information
regarding score profile patterns, clinical significance of scores, and other useful interpretive
information. Users can also opt to use a completely digital format in which administration,
scoring, and reporting is all completed online.

Scoring System and Scale Structure Raw scores on BASC-3 rating scales are converted
to T scores (based on a mean score of 50 and standard deviation of ten). Examiners
may use any of several possible norming groups, including general, sex-specific,
combined-sex clinical, ADHD, and learning disabilities. T scores for clinical scales are
converted to five possible classification levels, ranging from Very Low (T scores of ≤ 30)
to Clinically Significant (T scores of ≥ 70). Other classification levels include Low, Average,
and At Risk.
In addition to the clinical and adaptive scales, the BASC-2 rating scales contain several
validity indexes, which are designed to detect unusable, excessively negative, or excessively
positive responses made by a teacher or parent.
The empirically derived scale structure of the BASC rating scales is relatively complex,
consisting of composite and scale scores. Table 5.3 shows the specific composite and scale
structure of the TRS and PRS forms, by age level. The composite scales are primarily
focused on emotional and behavior problems, but also include adaptive skills and com-
petencies. The clinical scale structures of the TRS and PRS are mostly similar. The primary
difference in this regard is found in competency areas that are more specific to the
school or home setting. The TRS includes three scales not found on the PRS, including
Attention Problems, Learning Problems, and Study Skills, whereas the PRS includes
an Activities of Daily Living scale that is not found on the TRS, and covers item content
related to the parent’s rating of their child’s daily activities and routine. The composite
scores of the BASC-3 are divided into four main areas of content and scale coverage—
Adaptive Skills, the Behavioral Symptoms Index (a sort of a composite problem total
score that includes critical emotional and behavioral problem symptom scales),
Externalizing Problems, and Internalizing Problems. The School Problems composite is
found only on the TRS version of the system. The content scales for both the TRS and
PRS include Anger Control, Bullying, Developmental Social Disorders, Emotional Self-
Control, Executing Functioning, Negative Emotionality, and Resiliency. New within the
 Behavior Rating Scales s 141

BASC-3 are clinical probability indexes that allow users to understand ADHD Probability,
Emotional Behavior Disorder Probability, Autism Probability, Functional Impairment,
and General Clinical Probability. Additionally, research by Garcia-Barerra, Karr, and
Kamphaus (2013) supported the incorporation of a new executive functioning index in
the TRS and PRS. These indexes include the Problem Solving Index, Attentional Control
Index, Behavioral Control Index, and Emotional Control Index.

Development and Standardization Extensive development procedures for the BASC-3

rating scales are detailed in the test manual. An initial item pool was developed based on
the original BASC and BASC-2 as well as from information obtained through surveys
of teachers, parents, and students. The Spanish forms were developed at the same time as
the English forms. Experts reviewed the proposed items and gave feedback to researchers,
which helped in rewording and dropping unnecessary items. Final item selection was
determined empirically through basic factorial analysis and covariance structure analysis
to determine appropriate item fit within their intended domain. Readability analyses and
bias analyses also were conducted during the item development phase.
The various components of the BASC-3 system include extensive and well-stratified
norm samples that are models of painstaking detail. The norming samples for the BASC-3
were gathered from April 2013 to November 2014 from testing sites in 44 states. The
numbers of participants used in norming the entire system include more than 9,000, a
mind-boggling figure by any standard. The TRS norms are based on a sample of 1,700 at
all levels, whereas the PRS norms are based on an across-age sample of 1,800. The samples
for the general norms were matched to the 2013 U.S. Census data, and were controlled
for sex, race/ethnicity, geographic region, socioeconomic status, and inclusion of special
populations. Although the numbers of participants in the clinical norming samples vary
somewhat (TRS or PRS), they are high and acceptably stratified by nearly any standard,
and are among the very best of any child assessment instrument.

Psychometric Properties The BASC-3 includes a detailed and comprehensive description

of evidence of the psychometric properties of the various parts of the system. Given that
the BASC-3 is a revision of the original BASC and BASC-2 and that the three versions are
mostly similar, much of the accumulated evidence regarding psychometric properties of
the first editions should also be considered in evaluating the BASC-3. Researchers have
been interested in establishing internal consistency, temporal stability, inter-rater reliabil-
ity and convergent validity of the BASC-3. Internal consistency reliability (coefficient
alpha) estimates for the PRS-C, PRS-A, TRS-C, and TRS-A are impressive, ranging from
0.92 to 0.98 for the composites, and from 0.78 to 0.96 for the scale scores, and 0.83 to 0.96
for clinical indexes (e.g., ADHD Probability Index). Short-term and moderate-term test–
retest coefficients were calculated for the TRS and PRS forms. The resulting temporal
stability indexes are adequate to good, with values ranging from 0.77 to 0.94 for the com-
posites, 0.76 to 0.93 for scale scores, and 0.82 to 0.93 for the clinical indexes. In general,
longer retest intervals produced lower coefficients, which is typical for behavior rating
scales and other social–emotional assessment tools.
Several inter-rater reliability studies of the BASC and BASC-2 have been conducted.
As should be expected, cross-informant reliability of these rating scales varies consider-
ably, depending on specific rater and setting pairs that were analyzed. As has already been
noted, considerable variability of behavior rating scale scores across raters and settings is
142 s Foundations and Methods of Assessment

a known phenomenon and is attributable to both source and setting variance. Inter-rater
reliability coefficients reported in the BASC-3 manual range from 0.47 to 0.84 for the
TRS, and from 0.58 to 0.87 for the PRS, with some individual scale coefficients showing
considerably lower cross-informant stability, and some producing higher coefficients.
These values are generally consistent with the expected ranges for cross-informant com-
parisons reported by Achenbach et al. (1987) in their highly influential review. A review
of the first edition of the BASC by Merenda (1996), although generally positive, was
critical of the test–retest and inter-rater reliability of the measures within the system. It
is my opinion, however, that Merenda’s review did not adequately take into account the
overall evidence regarding source and setting variance and expected reliability perfor-
mance with behavior rating scales. Both of these areas of reliability for the BASC, BASC-2,
and BASC-3 child and adolescent forms are in the expected range or higher compared
with other widely researched behavior rating scales and taking into account the yield of
evidence regarding cross-informant and cross-setting reliability of third-party ratings.
Validity evidence from a variety of studies is presented in the BASC-3 manual, which
bolsters the evidence that was first presented in the original BASC and BASC-2 manuals
and the external published research evidence that has accrued on the BASC since it was
first published. The complex factorial structure for the scales was based on strong empir-
ical evidence derived from extensive covariance structure analyses, and the empirically
derived scale structure appears to be quite robust. Studies reported in the BASC-3 test
manual showing correlations between the TRS and PRS with several other behavior
rating scales (including the original BASC scales from the ASEBA system, and scales from
the Conners 3) provide evidence of convergent and discriminant construct validity, as do
studies regarding inter-correlation of scales and composites of the various TRS and PRS
forms. BASC-3 profiles of various clinical groups (e.g., ADHD, learning disabilities, etc.),
when compared with the normative mean scores, provide strong evidence of the con-
struct validity of the TRS and PRS through demonstrating sensitivity and discriminating
power to theory-based group differences. Again, the validity evidence presented in the
BASC-3 manual should be considered as building on the basic foundation of evidence
that had accrued for the original BASC and BASC-2 (which included several externally
published studies), as the two versions are more similar than different.

Additional Comments As with the ASEBA system, the BASC-3 has also been expanded
significantly to include a number of new assessment and intervention options. A screen-
ing tool entitled the Behavioral and Emotional Screening System (BESS), (Kamphaus &
Reynolds, 2007) and a progress monitoring tool called the Flex Monitor (C. R. Reynolds
& Kamphaus, 2016) will be described in more detail in Chapter 9. As was mentioned
earlier, the BASC-3 system has also incorporated another scale, the Parenting Relationship
Questionnaire (C. R. Reynolds & Kamphaus, 2015). This brief measure is intended to
provide key insight into the parent or caregivers’ perceptions of their relationship with
their child, which serves to complement the PRS. The PRQ takes about ten to 15 minutes
to complete and is appropriate for children aged two to 18. It includes Attachment,
Communication, Discipline Practices, Involvement, Parenting Confidence, Satisfaction
With School, and Relational Frustration subscales.
The BASC-3 Intervention Guide & Materials (BASC-3 Intervention) (Vannest,
Reynolds, & Kamphaus, 2015) is a book that contains more than 70 interventions that
aim to decrease the behavioral challenges derived from the BASC-3 assessment tools.
 Behavior Rating Scales s 143

This book includes theoretical information, practical strategies, fidelity documentation

checklists, and even parent/caregiver tip sheets related to the 11 categories of suggested
intervention (i.e., academic problems, adaptability, aggression, anxiety, attention prob-
lems, conduct problems, depression, functional communication, hyperactivity, leader-
ship/social skills, and somatization). Additionally, there is a prevention-oriented guide,
the BASC-3 Behavioral and Emotional Skill-Building Guide, that includes skill-building
lessons and activities for groups or classrooms of students. These intervention and pre-
vention-oriented packages reflect genuine movement toward connecting behavioral
assessment data to relevant and functional clinical strategies.
Although some other components of the BASC-3 system are not as strong as the
TRS-C, TRS-A, PRS-C, PRS-A, and the BESS rating scales, overall, the system is impressive,
and there is little room for significant criticism. These instruments were developed
with the latest and most state-of-the-art standards and technology, have an impressive
empirical research base, and are practical, if not easy to use. They represent the best of the
newer generation of behavior rating scales. The original BASC was positively reviewed in
the professional literature (e.g., R. Flanagan, 1995; Sandoval & Echandia, 1994), and the
BASC-2 has been widely used. One of the few drawbacks of the BASC-2 rating scales was
their extensive length (as many as 160 items), which may make these instruments difficult
to use for routine screening work and a poor choice for frequent progress monitoring,
which requires a much briefer measure. Routine screening and progress monitoring
may require the use of shorter measures. The BASC-3 assessments have added even more
items; however, developers clearly have attempted to address these limitations with the
creation of screening, progress monitoring, and even intervention tools. For a thorough
and comprehensive system of behavior rating scales, the BASC-3 is representative of the
best of what is currently available. From the mid-1990s to the publication of the BASC-2
in 2004 and now the publication of the BASC-3, the original BASC had become extremely
popular for use in schools, through a combination of design quality, user-friendly features,
and aggressive marketing by the publisher. There is no doubt that the BASC-3 will
continue and perhaps increase the widespread popularity of the system.

The Conners Rating Scales, Conners Rating Scales–Revised, the Conners 3,

and the Conners Comprehensive Behavior Rating Scales
The Conners Rating Scales (Conners, 1990, 1997, 2008a) are referred to as a system
because they form a set of several behavior rating scales for use by parents and teachers
that share many common items and are conceptually similar. The original scales vary in
length from 28 to 93 items. Several versions of these scales have been in use since the
1960s (Conners, 1969), and were originally developed by the author, Keith Conners, as a
means of providing standardized objective behavioral assessment data for children with
hyperactivity, attention problems, and related behavioral concerns. Research on the
Conners scales has been widely reported in the literature over the years—several hundred
studies involving these scales have been published. The scales also have found wide
acceptance among clinicians. Although a broad range of behavioral, social, and emotional
problem descriptions is included in the scales, they have been touted primarily as a
measure for assessing attentional problems and hyperactivity, and historically they have
been among the most widely used scales for that purpose. It was not until 1990 that the
scales became widely commercially available and that a manual was published that
integrated the description, use, and scoring of the four scales into one source.
144 s Foundations and Methods of Assessment

In 1997, a revised, expanded, and completely restandardized version of Conners Rating

Scales was published. This revision was considered to be a comprehensive behavior
assessment system because it contained numerous parent and teacher rating scales and
an adolescent self-report scale. The revised Conners scales were designed ultimately to
replace the original Conners scales. The publisher, Multi-Health Systems, is no longer
publishing and selling the 1997 versions of the scales, but is promoting the most recent
version, The Conners 3 (2008a) and The Conners Comprehensive Behavior Rating Scales
(2008b). This review focuses extensively on The Conners 3, the most widely used version,
and concludes with a description of the Conners Comprehensive Behavior Rating Scales.
However, I also believe that a review of the previous version is important for giving
readers context for the changes that occurred in 2008.

The Conners Rating Scales–Revised (1997) The Conners Rating Scales–Revised (CRS-R)
(Conners, 1997) was a comprehensive revision and expansion of the original Conners
scales. The CRS-R was designed as a comprehensive assessment system because it contains
six main scales and five brief auxiliary scales, including adolescent self-report scales.
In terms of general problem behavior rating scales, this discussion focuses on long and
short forms of the Conners Parent Rating Scale–Revised (CPRS-R:L, 80 items, and CPRS-
R:S, 27 items) and long and short forms of the Conners Teacher Rating Scale–Revised
(CTRS-R:L, 59 items, and CTRS-R:S, 28 items). These instruments all are designed for
assessment of children and adolescents aged three to 17.
The revised Conners scales were similar in many respects to their predecessors (the
CTRS-39, CTRS-28, CPRS-48, and CPRS-93). Even though there is much similarity in
item overlap between the original and revised rating scales, some items were added or
deleted to make the revised scales specifically compatible with the DSM-IV diagnostic
criteria for ADHD. The rationally derived subscale structure of the revised Conners
scales also differed somewhat from that of the predecessor instruments. Specifically, in
addition to the general subscales, the long-form scales contained the ten-item Conners
Global Index (formerly referred to as the Hyperactivity Index), a 12-item ADHD index,
and an 18-item DSM-IV Symptom Scale for ADHD. The Global Index was more recently
specifically touted as a brief measure of psychopathology that would be useful for
screening or progress monitoring. These ten items are embedded into the long-form
rating scales and were available on a separate short scale for screening use. The ADHD
index included critical items that were considered to be important in determining the
existence of ADHD. The DSM-IV Symptoms Subscales, however, were used specifically
in determining whether ADHD characteristics fall into the Inattentive or Hyperactive–
Impulsive subtypes from DSM-IV. The ADHD and DSM-IV scales on the longer versions
of the Conners scales were packaged separately as a specific ADHD assessment instru-
ment, which is reviewed in Chapter 10. The long and short scales of the revised Conners
system included the same 4-point rating format and the same T score/percentile rank
score conversion format that were used with the original versions. Separate scoring
norms were provided for boys and girls in three-year age span increments for the
three to 17-year age range. Scoring of these instruments was accomplished by using the
Quick Score hand-scoring forms provided or, with an additional cost, using computer-
assisted administration scoring software or the publisher’s online administration and
scoring system. The CRS-R scales were available in English, Spanish, and French Canadian
languages.
 Behavior Rating Scales s 145

The standardization sample for the CRS-R system was very large, with more than 8,000
normative cases in aggregate and about 2,000 to 4,000 for the specific rating scales
reviewed in this section. The normative sample was well stratified, including extensive
samples from the United States and Canada. Extensive data were provided in the technical
manual regarding gender and racial/ethnic breakdowns of the various samples and the
effects of gender and ethnicity on CRS-R scores. Internal consistency reliability for all
CRS-R scales was adequate to excellent. For example, the internal consistency coefficients
for the CPRS-R:L subscales ranged from 0.73 to 0.94. The scales with lower reliability
coefficients tended to be the scales with fewer items. Test–retest reliability at six- to eight-
week intervals for the CPRS-R:L and CTRS-R:L had been shown to range from 0.47 to
0.88 for the various subscales. Extensive factorial validity evidence (including confirmatory
factor analyses) for the CRS-R scales was presented in the technical manual. Additional
validity evidence for the CRS-R scales was presented in the form of extensive convergent
and divergent validity coefficients among various scales within the system and correlations
with scores from the Children’s Depression Inventory. Given that the CRS-R was based
heavily on the already extensively researched original Conners rating scales, it is assumed
that the developers did not consider it as essential to gather as extensive validity evidence
as would be needed with a totally new system of instrumentation. Although it probably
can be assumed that much of the existing validity evidence for the original Conners scales
may have translated reasonably well to the revised scales, there is always a need to conduct
a full range of reliability and validity studies.
In sum, the rating scales within the revised Conners system, which was available for
over a decade, showed considerable utility. Reviews of these scales have been generally
positive (e.g., Collett, Ohan, & Myers, 2003; Hess, 2001; Knoff, 2001; S. M. Snyder, Drozd,
& Xenakis, 2004), despite some concerns noted regarding insufficient details in some
aspects of the test manual and a paucity of externally published validity evidence. The
extensive norming sample was impressive, as was the integration of DSM-IV criteria for
ADHD into subscales on the long forms. These instruments were particularly useful in
assessing children who have attention problems and hyperactivity, but they had broader
applications as well. As Conners (1997) stated:

The main use of the Conners Rating Scales–Revised will be for the assessment of
ADHD. However, the CRS-R can have a much broader scope, as they also contain
subscales for the assessment of family problems, emotional problems, anger control
problems, and anxiety problems.
(p. 5)

Description of The Conners 3 Similar to the CRS-R, The Conners third edition is a
comprehensive, multi-informant system that can aid in the assessment of ADHD and
other externalizing problems such as Oppositional Defiant Disorder (ODD) and Conduct
Disorder (CD) (Conners, 2008a). The Conners 3 represents a major revision of the CRS-R
and includes many added features. This system was specifically aligned to diagnostic
criteria included in the DSM-IV-TR and can also be linked to eligibility categories
included in IDEIA 2004. While this tool was originally aligned with the DSM-IV-TR,
the developer also carefully reviewed the items while considering changes reflected
in the DSM-5 and updated the scoring and DSM symptom scales to reflect alignment
with the DSM-5 (Conners, 2014). The Conners 3 includes items that help to identify the
146 s Foundations and Methods of Assessment

extent to which behaviors impair one’s functioning at home and in peer relationships.
There are items that screen for depression and anxiety, as well as critical items that
reflect severe behaviors in need of immediate attention. This system also includes validity
scales that help to identify if the rater is answering in an overly positive, negative or
inconsistent way.
The Conners 3 includes parent, teacher, and self-report forms that can be used for
children aged six to 18. There are full-length forms including 99–110 items, a subset of
items that constitute short forms including 41–45 items, and two ten-item index forms.
The Conners 3 AI (ADHD Index) is a brief tool that can be used to screen for ADHD
and the The Conners 3GI (Global Index) can be used to progress monitor treatment.
These indices are embedded as subscales within the full-length forms as well.

Scoring System and Scale Structure in the Conners 3 Raw scores are converted to subscale
scores using a T score distribution (i.e., mean scores of 50 and standard deviations of 10)
for all scales in the Conners system. Total scores are typically not obtained and used with
the Conners scales and are not part of the published scoring systems, although some
investigators and clinicians have used a total score in their work. The basic factor structure
and content scales of the Conners 3 have been adjusted and include A. Inattention, B.
Hyperactivity/Impulsivity, C. Learning Problems, D. Executive Functioning, E. Defiance/
Aggression, and F. Peer/Family Relations. DSM-IV-TR Symptom Scale scores are also
derived to help identify symptoms of ADHD, ODD, and CD.
The rating scales in the Conners system are scored easily and converted to standardized
subscale scores based on gender and age-level breakdowns, using an innovative two-sided
“Quickscore” format that requires minimal time and reduces the chance of committing
scoring errors. Online and software-based administration and scoring programs for the
Conners scales are also available from the publisher. The computer programs provide not
only administration and scoring possibilities, but also the generation of brief interpretive
summary paragraphs related to individual score configurations and levels.

Development and Standardization of the Conners 3 The development of the first version
of the Conners Rating Scales was started during the 1960s by clinicians at Johns Hopkins
Hospital in Baltimore, Maryland. These clinicians, who were implementing and research-
ing psychopharmacological and psychotherapeutic interventions in children, developed
a set of rating scale items that were used informally and qualitatively to obtain further
information from teachers. In discussing how the scales progressed from this earlier
informal prototype to the standardized versions, Conners (1990) stated:

When I compared data from normal children and clinical cases, it was clear that
they differed on several different dimensions, not just in the number of total
symptoms. Factor analysis confirmed that existence of stable clusters of items, . . .
having much more clinical interest than a simple catalogue of problems.
(p. vi)

Research on this first standard version of the scales was published by Conners in 1969,
and this version was essentially the same as the CTRS-39. The Conners 3, in conjunction
with the Conners Comprehensive Behavior Rating Scale and the Conners Early Childhood
(EC) (Conners, 2009), however, represents an extensive update that occurred over the
 Behavior Rating Scales s 147

course of four years. The overarching goals of this update were: (1) to refine the CRS-R
so that it is more ADHD-specific; (2) to create a separate tool that comprehensively
addresses the social–emotional and behavioral issues experienced by children (CBRS);
(3) to create a tool specific to early childhood; (4) to align items with current classification
and diagnostic schemes; (5) to provide links between assessment and intervention; and
(6) to update norms and technical properties.
The development of the Conners 3 occurred in three phases. After initial item develop-
ment, pilot studies and normative studies were conducted and included a representative
sample of over 7,000 children. Exploratory and confirmatory factor analyses were con-
ducted and determined necessary items for inclusion/exclusion and the factor structure
outlined above.
The Conners 3 Global Index (3CGI) consists of the same ten items that have been
validated over the years; these items are included in the Conners 3 full-length forms, and
provide measures of restlessness/impulsiveness and emotional lability. These items can be
used as a stand-alone tool and Conners suggests they be used to monitor treatment
effectiveness. The Conners 3 ADHD Index (3AI) was newly revised and also consists of ten
items and has been found to distinguish samples with ADHD from samples without ADHD.
Based on responses given by the normative sample, Positive Impression, Negative
Impression, and Inconsistency Indices were created. For the Positive (PI) and Negative
Impression (NI) Validity scales, each of the items was analyzed and if less than 10% of the
sample answered an item with a particular response choice, the item was given a score
of 1 rather than a 0. Completed forms resulting in raw scores of 5–6 (4–6 for PI self-
reports) should be analyzed with caution, as bias is likely a factor. The Inconsistency
Index was developed slightly differently and involved analyzing items with the highest
intercorrelations.
Anxiety and Depression screener items were chosen from the newly developed Conners
Behavior Rating Scale. Based on information gathered from item-total correlations,
representative items were chosen to screen children for symptoms of depression and
anxiety. Critical items were identified through analysis of the normative data. These items
suggested severe, concerning behaviors that would highlight a need for immediate
attention/intervention. Finally, short forms were developed that are highly correlated with
the full-length Conners 3 forms. These short forms include the PI and VI Validity scales,
but they do not include the DSM-IV-TR Symptoms Scales, The Anxiety and Depression
Screener items, the critical behavior items, the 3GI, the 3AI, or the Inconsistency Index.

Psychometric Properties Cronbach’s alpha coefficients were used to assess the internal
consistency of the parent, teacher, and self-report content scales and DSM-IV-TR symptom
scales. Mean alphas across informants and scales ranged from 0.85 to 0.94. Mean alphas
across informants for the validity scales were lower and ranged from 0.56 to 0.72. Mean
test–retest coefficients were derived after a two to four week interval from the three types
of informants and the content and DSM-IV-TR scales ranged from 0.76 to 0.89. Overall,
the reliability information suggests that the internal consistency of items is high and the
reliability of responses over time is relatively stable.
Evidence for several forms of validity for the various Conners scales has accumulated
in many published research reports over the years. Several studies have documented the
efficacy of the Conners scales in differentiating between distinct diagnostic groups—
hyperactive and normal children (King & Young, 1982), learning disabled and regular
148 s Foundations and Methods of Assessment

education students (Merrell, 1990), boys referred to juvenile court and a normal control
group (L. Berg, Butler, Hullin, Smith, & Tyler, 1978), and behavior disordered and non-
special education students (Margalit, 1983). CTRS-39 ratings of children at age seven
have been shown to be highly predictive of diagnoses of hyperactivity three years later, at
age ten (Gillberg & Gillberg, 1983). Finally, the convergent construct validity of various
versions of the Conners scales has been demonstrated through several studies that found
significant correlations between them and other instruments, such as the Child Behavior
Checklist (Edelbrock, Greenbaum, & Conover, 1985), the Behavior and Temperament
Survey (Sandoval, 1981), the Behavior Problem Checklist (Campbell & Steinert, 1978),
the School Behavior Survey, and the School Social Behavior Scales (Merrell, 1993a). Most
of the validity studies cited have involved the use of the CTRS-39, and less is known about
the properties of the CPRS-48. An annotated bibliography of more than 450 studies using
the Conners rating scales was assembled by the publisher over a decade ago (Wainwright
& MHS Staff, 1996), providing extensive documentation evidence for the many reliability
and validity studies that have been conducted prior to the publication of the most recent
version of the scales.
Similar to the earlier versions of the Conners system, the Conners 3 has begun to
accumulate a range of validity evidence. In addition to the factorial validity that helped
to determine the factor structure of the items, convergent validity has been established
based on moderate to strong correlations between the Conners 3 and the CRS-R, BASC-2,
the ASEBA, and the Behavior Rating Inventory of Executive Function (BRIEF). The
Conners 3 has been found to discriminate between clinical and typically developing
populations as well.

The Conners Comprehensive Behavior Rating Scale (CBRS) The Conners CBRS (Conners,
2008b) is a rating scale that aims to assess a wide range of childhood problems. This
system also includes a parent form, a teacher form, and a self-report form for children aged
six to 18 years. There are between 179–204 items across the forms. Scores are generated
according to either DSM-IV-TR or DSM-5 Symptom Scales, Empirical Scales, Rational
Scales, and Validity Scales. DSM symptoms addressed are those pertaining to ADHD,
CD, ODD, Major Depressive Disorder, Manic Episode, Generalized Anxiety Disorder,
Separation Anxiety Disorder, Social Phobia, Obsessive-Compulsive Disorder, Autistic
Disorder, and Asperger’s Disorder. Items associated with the Empirical Scales are
associated with Emotional Distress, Aggressive Behaviors, Academic Difficulties,
Hyperactivity, Hyperactivity/Impulsivity, Separation Fears, Social Problems, Perfectionistic
and Compulsive Behaviors. The Validity Scales are similar to those seen in the Conners 3
and pertain to Positive Impression, Negative Impression, and Inconsistency Indices. The
Rational Scales are unique to the CBRS and help to identify students who might have
the potential to commit violent acts or who suffer from physical symptoms. There are also
critical items that help to identify concerning behaviors pertaining to bullying, enuresis,
encopresis, panic, phobia, trichotillomania, trauma, etc. Finally, a Clinical Index is included
and consists of 25 items that can be used to monitor treatment programming. As with
the Conners 3, this measure was normed on a large sample. Reliability coefficients were
moderate to strong and adequate convergent and divergent validity was established.

Additional Comments The CTRS-39, CPRS-48, Conners 3, and Conners CBRS have
been and continue to be widely used in clinical practice and have been tested in various
 Behavior Rating Scales s 149

ways in many published studies. There is no question that the CTRS-39 is the particular
version of the Conners scales for which there is the most externally published empirical
evidence. Less has been demonstrated about the other Conners scales. There is a good
deal of overlap between the different scales that comprise the Conners system, however,
which should lend at least a substantial degree of “face validity” to the versions of the
scales that have not been researched as extensively.
The 1990 publication of an integrated manual and standard scoring systems for the
Conners scales filled a large void in the understanding and use of these instruments and
resulted in their increased clinical use and paved the way for the 1997 and 2008 revisions.
Because the short forms of the Conners 3, the CTRS-39 and CPRS-48 are relatively
brief instruments (half as many or fewer items than the other scales reviewed in this
chapter), they are an excellent choice for conducting initial screenings, but it is important
that they be supplemented with other evaluation methods in conducting comprehensive
clinical assessments. The Conners 3 and Conners CBRS represent an important step for
the Conners scales. They contain information that is relevant to this particular time in the
world of social and emotional assessment (e.g., alignment with IDEIA 2004, subscales
pertaining to bullying) and they include carefully constructed scales that can serve as an
incredibly useful component of a comprehensive evaluation process. The large sample
used to update norms and the structure of the assessment forms was a critical step forward
for this behavior rating system.

BEST PRACTICES IN USING BEHAVIOR RATING SCALES

This chapter has included an overview of the uses, advantages, and cautions of behavior
rating scales and reviews of several of the most widely used, commercially published
general-purpose problem behavior rating scales. To use behavior rating scales effectively
requires more than just a cursory understanding of their characteristics. Thus, three “best
practices” are suggested for using rating scales in a useful manner.
The first suggestion is to use rating scales routinely for early screening. Effective screening
practices involve being able to systematically and accurately identify children who are in
the early stages of developing behavioral, social, or emotional problems. The identified
subjects are evaluated more carefully to determine whether their problems warrant
special program eligibility and intervention services. The purpose of screening for social–
emotional problems is usually for secondary prevention, which is preventing the existing
problem from becoming worse (Kauffman, 2000). Screening for early intervention is one
of the best uses of behavior rating scales, given that they cover a wide variety of important
behaviors and take little time to administer and score. For general screening purposes, it is
recommended that children or adolescents whose rating scale scores are 1 or more standard
deviations above instrument normative means in terms of problem behavior excesses be
identified for consideration of further evaluation. This practice narrows the screening pool
down to approximately 16% of the overall population, and this selected group can be
evaluated more comprehensively.
The second suggestion is to use the “aggregation principle.” This principle involves
obtaining ratings from a variety of sources, each of which might present a slightly different
picture. When using rating scales for purposes other than routine screening, obtaining
aggregated rating scale data is recommended to reduce bias of response and variance
150 s Foundations and Methods of Assessment

problems in the assessment. In practice, using aggregated measures means obtaining

rating evaluations from different raters in different settings and using more than one type
of rating scale to accomplish this (Merrell, 2000a, 2000b).
A final suggestion is to use behavior rating scales to assess progress during and after
interventions. It has been demonstrated that continuous assessment and monitoring of
student progress after the initial assessment and intervention is important in successful
implementation of behavioral interventions (Kerr & Nelson, 1989). Progress toward
behavioral intervention goals can be assessed easily on a weekly or biweekly schedule
using appropriate rating scales. Full-length behavior rating scales may be too long and
time-consuming for teachers or parents to complete on a repetitive basis. For this reason,
clinicians and researchers might consider identifying selected items from the rating scales,
for which the initial ratings were high, and which are congruent with the intervention
goals, and creating a very brief rating tool (ten to 15 items) based on these items, solely
for the purpose of gauging perceptions of change and progress. In addition to identifying
specific items that are aligned with individualized intervention goals, researchers have
also become committed to developing technically adequate short forms of existing
rating scales that can serve as general outcome measures of behavior change (Gresham
et al., 2010; Volpe & Gadow, 2010). Although behavior rating scales may not be the best
measurement choice for daily assessment data (unless they are shortened considerably),
there are many other simple ways of assessing progress daily, such as using Direct Behavior
Ratings (Chafouleas et al., 2009), performance records or brief observational data.
Additional assessment after the intervention also can be a useful process. The main reason
for follow-up assessment is to determine how well the intervention effects have been
maintained over time (e.g., after three months) and how well the behavioral changes have
generalized to other settings (e.g., the home setting and other classrooms). In practice, a
follow-up assessment might involve having teachers and parents complete behavior
rating scales on a child after a specified time has elapsed following the student’s
participation in a social skills training program. The data obtained from this follow-up
assessment may be used to determine whether follow-up interventions seem appro-
priate and may be useful in developing future intervention programs if it is determined
that social–behavioral gains are not being maintained over time or generalized across
specific settings.

BEHAVIOR RATING SCALES AND DECISION MAKING

One of the major advances in the development and use of behavior rating scales over
the past two to three decades is considered to be the effective use of such scales in decision
making regarding children and adolescents (Elliott et al., 1993; Merrell, 2000a, 2000b).
There are several potential ways that behavior rating scales may be used in decision
making. Perhaps their most natural use involves decisions regarding screening and
additional assessment. Behavior rating scales are an excellent choice for use in either
individual or large-group screenings because they tend to be quick and easy to administer,
and if the screening criteria are set low enough, they result in few false-negative errors
(failure to identify children and adolescents who do meet behavioral criteria). For making
decisions regarding additional assessment that may need to occur, behavior rating scales
are capable of identifying specific dimensions or behavioral clusters that may need to be
 Behavior Rating Scales s 151

investigated in more detail. The multiple-gating systems described in Chapter 2 use rating
scales as one of the important first steps in narrowing down a large population to a
smaller population of potentially at-risk individuals before additional assessment
methods are used. In actual screening practice, behavior rating scales completed by
parents or teachers would be either the first or the second gate in the assessment process
and would be followed by more time-intensive measures, such as direct behavioral
observation and interviewing.
Although behavior rating scales should never be used alone for making classification
or placement decisions, they are capable of providing some valuable information in
this regard. Given the development of the behavioral dimensions approach to classifica-
tion, and the application of sophisticated multivariate statistical techniques to rating
scales, rating scales may be used to isolate specific dimensions of problem behaviors that
would be useful in making classification decisions, particularly if used across raters and
settings. Several state education agencies have recommended or required that local
education agency personnel use behavior rating scales in systematic or prescribed ways
in the identification of students for special education services under certain classification
categories.
Behavior rating scales are increasingly being considered useful for making inter-
vention planning decisions (Elliott et al., 1993; Merrell, 2000a). Primarily because they
are quite effective at identifying specific areas of behavioral deficits or excesses a child or
adolescent may exhibit, behavior rating scales may be used effectively in a general way for
intervention planning. In terms of methods for effectively linking assessment results to
intervention planning, data obtained through the use of behavior rating scales seem
to line up most effectively with two specific intervention linkage strategies described by
Shapiro (1996). The first of these strategies is referred to as the Keystone Behavior Strategy,
which was described originally by Nelson and Hayes (1986). This strategy involves
identification of a group or cluster of responses that appear to be linked to a particular
disorder, then selecting interventions that are known to be functionally linked to impact-
ing that particular problem or disorder. For example, if Child Behavior Checklist scores
on a referred adolescent consistently showed him or her to have behavioral excesses in
a cluster of items related to aggressive behavior and antisocial conduct problems, it would
be logical to select one of the several contingency management interventions that have
been found to be effective in altering this group of behaviors with antisocial–aggressive
adolescents. Another potentially useful strategy in this regard that was discussed by
Shapiro (1996) is referred to as the Template-Matching Strategy, originally described by
Cone and Hoier (1986) and Hoier and Cone (1987). This strategy involves comparing
objective behavioral data (i.e., rating scale data) on referred children with similar data
obtained on children who have high functioning levels of the desired social–behavioral
competencies. The areas of largest discrepancy between the two sets of data would become
the prime targets for intervention. For example, suppose that BASC-3 ratings on a referred
child were compared with those obtained from behaviorally high-functioning children,
and the largest discrepancy area included items related to attention problems and off-task
behavior. Appropriate behavioral strategies for increasing on-task and attentive behavior
would be the obvious intervention choices.
In addition to these particular decision-making uses for behavior rating scales, it is
important to consider their use in monitoring and modifying interventions that have
been put in place. Behavior rating scales are an excellent choice for summative evaluation
152 s Foundations and Methods of Assessment

of intervention efficacy; if modified appropriately (i.e., using shortened versions), they

may also be useful for monitoring intervention progress on a weekly (and perhaps
daily) basis.

CONCLUSIONS
Behavior rating scales have become an increasingly prominent assessment method
for measuring child and adolescent behavior. Particularly since the late 1970s and early
1980s, technical advances with behavior rating scales have enhanced their popularity
and prominence considerably. Rating scales provide a structured format for making
summary evaluative judgments regarding perceptions of child or adolescent behavior.
Behavior rating scales do not measure behavior per se, but measure perceptions of behav-
ior. The evidence regarding the validity of behavior rating scales in predicting behavior
is extensive and impressive, however. The earlier generation of rating scales tended to use
simple additive checklist formats. Beginning in the 1980s, use of an algebraic style rating
scale became the standard, allowing for more precision in measurement of degree and
intensity of behavior.
Child behavior rating scales offer many advantages for researchers and practitioners.
Among these advantages are the low cost; efficiency; increased reliability and validity in
comparison with other methods of assessment; opportunity for assessment input from
parents, teachers, and other important social informants; and possibility of obtaining
assessment data on individuals who are not in a position to be observed directly or to
provide high-quality self-report information. Rating scales are not without their dis-
advantages, however. Foremost among the limitations and disadvantages of rating scales
are various types of error variance (source, setting, and instrument variance) and response
bias from raters, such as halo effects, leniency or severity effects, or central tendency
effects. Many of these limitations and problems associated with behavior rating scales can
be dealt with effectively by using rating scales as one part of a comprehensive assessment
design and by obtaining aggregated ratings across sources, instruments, and settings.
Careful attention to the technical aspects of measurement in designing rating scales can
also reduce potential problems.
Several widely used, commercially published general-purpose problem behavior rating
scales were reviewed and discussed. These instruments—including the Child Behavior
Checklist/6–18 and Teacher’s Report Form/6–18 from the Achenbach System of Empirically
Based Assessment (ASEBA); the Behavior Assessment System for Children, Third Edition;
and Conners Rating Scales—represent some of the best of what is currently available.
Many other technically sound and clinically useful behavior rating scales that are not as
widely known as these measures have been developed for various purposes. The CBCL/6–
18 and TRF/6–18 of the ASEBA system are by far the most extensively researched of any
child behavior rating scales. The validity of these measures has been well documented
and they are useful for many purposes. They have been criticized, however, for not being
as useful for routine behavioral concerns as they are for severe psychopathology. The
Behavior Assessment System for Children, which recently was published in a third edition,
is representative of a new generation of behavior rating scales linked to a compre-
hensive assessment system. The BASC-3 rating scales offer numerous advantages, and have
become extremely popular among school-based clinicians. They are technically sound and
 Behavior Rating Scales s 153

potentially useful for varied research and clinical purposes. The various forms and ver-
sions of the Conners Rating Scales have been extensively researched and used clinically for
nearly three decades. Although the reputation of these instruments was built largely
through research and clinical applications with children who have ADHD characteristics,
they are considered to have broader applications for assessing emotional and behavioral
problems. The 1997 and 2008 revisions to the Conners scales have included several positive
changes while building on the solid empirical tradition of the previous versions.
Three best practices in using behavior rating scales were recommended. First, behavior
rating scales should be used extensively for screening and early identification purposes.
Second, the aggregation principle of gathering rating scale data from multiple informants
across multiple settings is encouraged to provide a comprehensive portrait of perceptions
of child behavior. Third, the use of rating scales to monitor progress during and after
interventions is encouraged to provide empirical evidence of the efficacy (or lack thereof)
of planned interventions and to help guide formative changes in such interventions.
Behavior rating scales are potentially useful in clinical and education decision making,
in several respects. Examples of the types of decisions that may be aided through the use
of behavior rating scales include screening and assessment, classification and placement,
and intervention decisions. Regarding intervention decisions, there appears to be an
increasing acceptance of the usefulness of behavior rating scales for this purpose. Use of
specific intervention linkage strategies, such as the Keystone Behavior Strategy and the
Template Matching Strategy, may be helpful in making effective links between behavior
rating scale data and subsequent intervention decisions.

REVIEW AND APPLICATION QUESTIONS

1. Describe the major differences between behavior rating scales and behavior checklists.
What is considered to be the major advantage of using rating scales instead of checklists?
2. For each of the four types of error variance described in this chapter, describe at least one
practical way to implement the assessment to minimize or overcome potential error.
3. Assume that the same behavior rating scale has been completed on the same child by
three different teachers, but the obtained scores from the three sources are considerably
different. What are some potentially effective ways of interpreting this pattern of data?
4. The Child Behavior Checklist and Teacher’s Report Form comprise the most widely and
well-researched combination of child behavior rating scales. They are probably not a good
choice for some purposes, however. In what situations, or with what problems, would it be
more advantageous to use a different rating scale?
5. Behavior rating scales may not be as effective for assessing internalizing problems (e.g.,
anxiety, depression, and somatic problems) as for externalizing problems, (e.g., aggressive
behavior, hyperactivity, and conduct problems). What are some reasons for this difference
in rating scale utility across symptom domains?
6. Why is test–retest and inter-rater reliability of internalizing problem subscales of behavior
rating scales typically lower than for externalizing problem subscales?
7. What are some ways that item-level data on behavior rating scales could be used to
establish and monitor Individualized Education Program (IEP) goals? Provide some
specific examples.
8. For screening purposes, a cutoff point on behavior rating scales of 1 standard deviation or
higher is recommended. If two separate rating scales are used for screening, and they
154 s Foundations and Methods of Assessment

produce differing results (one meets screening criteria, one does not), how can a screening
decision be made, and what are the risks and advantages of making yes/no decisions?
9. What is the Template-Matching Strategy, and how might it best be implemented using
data obtained through behavior rating scales?
10. Consider and describe 2 assessment questions that may be answered by the BASC-3.
11. Consider the following assessment questions and associated settings and choose the
behavior rating scale/s that could provide the best data and discuss the rationale for your
choice:
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psychologist because of concerns with daydreaming, poor work completion, nail-biting,
and clearing his throat with high frequency that it is distracting to other students.
There is no history of prior evaluations.
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mother at a community healthcare clinic. The girl was referred by her pediatrician
because of frequent daytime urinary accidents, outbursts, and noncompliant behavior.
Following the intake, the psychologist recommends an assessment and a few follow-up
therapy sessions.
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in private practice, following years of “underachievement” and diminished interest in
schoolwork. They are concerned that their son will not be admitted to college, although
he has always “flown under the radar” and his teachers have not voiced any concerns
this school year.
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intensity of acts of bullying on middle-school campuses and their effects on identified
victims over time.
 6
INTERVIEWING TECHNIQUES

Whether one is meeting informally with the teacher of a referred student, conducting a
problem identification interview with a parent, or undertaking a diagnostic interview
with a child or adolescent, interviewing is a widely used and valuable assessment method.
The popularity of interviewing is due to the many advantages it offers to clinicians.
Some surveys have indicated that interviewing is the most commonly used assessment
method among clinical psychologists (Watkins, Campbell, Nieberding, & Hallmark,
1995), and it is certainly one of the most popular assessment methods in other areas of
professional psychology as well. This chapter provides a broad overview of interviewing
children and adolescents, including problem identification and developmental history
interviewing with the parents of children and adolescents. The chapter also makes spe-
cific recommendations for procedures and techniques that may be useful in conducting
effective interviews.
The type of interviewing emphasized in this chapter has been termed clinical inter-
viewing, or the child clinical interview. These terms encompass a broad range of interview
techniques. For additional clarification of this terminology and the types of techniques
encompassed by it, readers are referred to McConaughy’s (2013) excellent treatment of
this topic. To help understand the essential features of this sort of interviewing, it is
important to recognize that the term clinical in this case refers to a purpose rather than
a place. Clinical interviewing is conducted in a variety of settings: schools, hospitals,
homes, detention centers, and clinics. The purpose reflected in the word clinical is to
gather specific information regarding behavioral, social, and emotional functioning,
particularly regarding deficits or problems in functioning that may be occurring in any
of these areas. McConaughy (2000a) noted that “clinical assessment interviews usually
cover specific content areas . . . and are limited to one or two sessions” (p. 170). In contrast
to other methods of assessment that may be used for these same purposes, clinical inter-
viewing is unique in its emphasis on direct face-to-face contact and interpersonal com-
munication between the clinician and the client. As such, it places some unique demands
on the clinician. As Sattler stated in his text on interviewing children and their families:

Clinical assessment interviewing is a critical part of the assessment process. And

even more than other assessment techniques, it places a premium on your personal
skills, such as your ability to communicate effectively and your ability to establish a
meaningful relationship.
(1998, p. 3)

155
156 s Foundations and Methods of Assessment

This chapter begins with a discussion of the role of the interview as an assessment
method, including sections on developmental issues in interviewing, factors or contexts
that affect overall interview quality, and how to select specific interview methods for
specific purposes. Much of this chapter is devoted to discussions of three types of inter-
views: the traditional or unstructured interview, behavioral interviewing, and structured
or semistructured diagnostic interviews. Because the clinical interview is the most useful
assessment technique for working with children and adolescents who are suicidal, a spe-
cific section is devoted to this topic. Before the summary and review questions, the chapter
concludes with a brief discussion of how interviews can be used in decision-making
processes.

THE ROLE OF INTERVIEWS IN ASSESSING CHILDREN

AND ADOLESCENTS
There is no question that as an assessment method, clinical interviewing holds a place
of prominence in psychology, psychiatry, social work, and counseling. This venerated
attitude toward the interview process has been perpetuated in popular media and has
strongly shaped the beliefs of the public. Public beliefs and attitudes regarding clinical
interviewing are often shaped (with help from popular media) to the point of distorting
and nearly mystifying what is actually done and accomplished in the interview process.
Many psychologists and psychiatrists have experienced this unwarranted public elevation
of the interview process and the supposed diagnostic powers possessed by clinicians,
sometimes to the point of absurdity. Even when conducting such mundane business as
standing in line at the supermarket, getting a haircut, or having a major appliance
serviced, when clinicians are queried by strangers as to what their occupation is, the
answer frequently draws responses such as “Are you analyzing me now?” or “Oh no, you’ll
figure out what all my problems are by talking to me!” An honest reply to such questions
is usually disappointing to the professional and those inquiring about their skills. Both
would like to believe that the clinician’s prowess in interpersonal communications allows
him or her more insight (if not prescience) than is usually the case.
If the process of clinical interviewing is not a mystical conduit to the inner life of the
person being interviewed, then what is it? Essentially, interviewing is structured commu-
nication, mainly verbal, but nonverbal as well. Martin (1988) noted that an interview
resembles a conversation but differs from day-to-day conversation in that it: (1) is pur-
poseful; (2) is usually “controlled” by the interviewer through the initiating of interchanges
and the posing of questions; and (3) has unity, progression, and thematic continuity.
In other words, clinical interviews should have direction and structure and are driven by
specific goals related to obtaining relevant information and using it to make decisions.
Putting a practical spin on the definition of interviewing, La Greca (1990, p. 4) notes
that, “Interviews are critical for obtaining information, appreciating children’s unique
perspectives, and establishing rapport.”
Interviews come in several forms, ranging from unstructured “stream of consciousness”
exchanges to formalized and highly structured interview schedules used for exploring
specific problem areas. Although the purposes, underlying theories, and level of structure
among different types of interviews may vary, all forms of clinical interviewing share
some commonalities and have specific advantages compared with other assessment
 Interviewing Techniques s 157

methods. Perhaps the most salient advantage of interviewing as an assessment method is

the flexibility it provides. Throughout the course of an interview, the clinician has the
opportunity to shorten or lengthen it, to change direction when needed, and to focus on
specific aspects of the client’s thought, behavior, or emotion that emerge as being most
important at the time. With other methods of assessment, this type of flexibility is rarely,
if ever, possible. Another advantage of clinical interviewing is that it provides the clinician
with the opportunity to observe the client directly under structured conditions. Client
characteristics such as social skills, verbal ability, insight, defensiveness, and willingness
to cooperate can all be assessed to a degree throughout the course of an interview. When
interviewing children, the observational advantage of the interview process is particularly
important because their limited experiences and typically unsophisticated verbal medi-
ation skills make it difficult for them to express directly their concerns, needs, and
problems. In cases in which the client is not available or otherwise incapable of providing
high-quality information in an interview context (a typical concern with young children),
interviews can be conducted with individuals who know them well, such as parents or
teachers. Finally, the process of interviewing can be an important bridge in the therapeutic
process. In contrast to any other method of assessment, clinical interviewing provides
the opportunity to establish rapport, trust, and security with clients, all of which may be
crucial to the eventual implementation of an intervention plan.
Similar to other methods of assessment, clinical interviewing does have its flaws or
weaknesses. It is wrong to think of clinical interviewing, or any other assessment method
for that matter, as the “gold standard” of assessment (McConaughy, 2013). Perhaps the
most easily criticized feature of interviewing is that the flexible, nonstandardized nature
of many interviews, which also is considered to be an advantage, may lead to unreliability
or inconsistency over time and between interviewers. Another potential problem with
interviewing is that to be effective, it requires a great deal of training and experience. In
addition, there are some important limitations in clinical interviewing related to distor-
tion and bias. Clinicians and clients may have personal biases that may result in selective
or faulty recall of information, lack of attention to important details, and subtle cues from
the clinician that may lead clients to distort the information they provide (Sattler, 1998).
Finally, clinicians need to be vigilant regarding the possibility of deliberate distortion or
lying on the part of the child or adolescent who is being interviewed. Distortion or lying
by the interviewee may occur for a variety of reasons and is common (McConaughy, 2013).

DEVELOPMENTAL ISSUES IN INTERVIEWING

The process of interviewing children or adolescents differs from interviewing adults.
Although the basic tasks of interviewing children versus adults may have some superficial
similarity, a qualitatively different approach is required to obtain a useful and informative
verbal report. As children develop and mature in their physical, cognitive, and social–
emotional functioning, their ability to respond to the tasks required of them in an interview
format likewise changes. To interview children and adolescents in an effective manner,
interviewers must have knowledge of some of the basic aspects of these developmental
issues. This section provides a general discussion of some basic developmental issues that
may affect the interview process, some of which are summarized in Table 6.1. For a more
complete discussion of developmentally sensitive interviewing, readers are referred to
158 s Foundations and Methods of Assessment

Table 6.1 Developmentally sensitive interviewing: Considerations and suggestions

Developmental considerations

Developmental Cognitive Social–emotional Suggested practices

period functioning functioning

Early childhood May be confused by Actions may be 1. Use combination of open and
appearance–reality considered right or closed questions
distinctions; memory wrong based on 2. Don’t attempt to maintain total
not fully developed; consequences; limited control of interview
some difficulty ability to describe range 3. Reduce complexity of questions
understanding of emotions; learns to 4. Use toys, props, manipulatives
perspective of others initiate tasks; some 5. Establish familiarity and
difficulty in self-control rapport
Middle Increased capability May view right or wrong 1. Avoid abstract
childhood for verbal based on rules and social 2. Rely on familiar settings and
communication; conventions; industry activities
simple logic attained; versus inferiority struggle 3. Avoid constant eye contact
mastery of increasing based on how well new 4. Provide contextual cues
cognitive challenges challenges are mastered; (pictures, examples) and
peer group becomes request language interaction
increasingly important 5. Physical props in context may
be useful
Adolescence Ability for abstract May develop 1. Consider the possibility of
reasoning and formal postconventional moral emotional lability and stress
logic usually reasoning; possibility of 2. Avoid making judgments based
emerges; systematic identity confusion and solely on adult norms
problem solving experimentation; high 3. Show respect
usually begins emotional intensity and
lability not unusual; peer
group tends to become
extremely important

book chapters by Bierman (1983) and Hughes and Baker (1990) that are specifically
devoted to this topic.

Preschool-Age and Primary-Age Children

Young children tend to be particularly difficult to interview and pose what is perhaps the
greatest challenge to the interviewer. As Bierman noted:

Young children are able to describe their thoughts and feelings, but they require
specialized interview techniques to do so. Moreover, characteristics of conceptual
organization and information processing associated with cognitive and linguistic
development result in a phenomenological world for the young child that is
qualitatively different from the adult’s world. Clinicians who are unfamiliar with the
thought processes associated with various developmental levels are likely to find
children’s reasoning extremely difficult to follow or comprehend. To conduct effective
child interviews, clinicians must acquire an understanding of the characteristics of
developing social–cognitive processes, and they must make some major adjustments
in their interviewing techniques and strategies.
(1983, pp. 218–219)
 Interviewing Techniques s 159

One of the pioneers in the field of child development, the late Jean Piaget (1896–1980),
developed an incredibly influential stage theory of child development. Although some
of the explicit assumptions of Piaget’s theory have been shown over time to underestimate
the cognitive abilities of children, the general framework is still an interesting approach
that may be potentially useful—if used with caution—in considering developmental
aspects of children and adolescents that might impact their abilities to be an effective
interview informant. In Piagetian terms, children between the ages of about two and
seven are in the preoperational stage of cognitive development, which is characterized by
the child’s being able to represent things with words and images, but still quite lacking
in logical reasoning abilities (Piaget, 1983). Many (and perhaps most) children in this
age range may be confused by distinctions between reality and appearance, find it easier
to follow positive instructions (“hold the blocks carefully”) than negative ones (“don’t
drop the blocks”), and may have difficulty understanding the viewpoint or experience
of another person. Piaget referred to this latter tendency as egocentrism, meaning that
many young children have difficulty viewing situations from anything but their own
experience or perspective. Children in this developmental stage may have difficulty recall-
ing specific information accurately because they are still developing complex memory
retrieval strategies (McNamee, 1989). Many preoperational children may focus on just
one feature of a problem, neglecting other important aspects, a tendency referred to in
Piagetian terms as centration. They may exhibit difficulty understanding that actions
can be reversed. These cognitive aspects of early childhood may lead many young children
to provide incomplete accounts of past events and make them particularly susceptible to
acquiescing to “leading” questions from an interviewer, such as “does your mom get really
mad at you?” (Saywitz & Snyder, 1996).
To many young children, behavioral actions are considered to be right or wrong
depending on their consequences (“stealing is wrong because you get put into jail”).
Kohlberg (1969) referred to this type of moral reasoning as being at a preconventional
level. In terms of emotional development, most younger children may experience a wide
range of emotions and affect but typically can describe these experiences only along a
limited number of verbal dimensions (i.e., happy or sad, good or bad, mean or nice)
because their abilities to verbally express what they are experiencing are still developing.
As was indicated previously, some of the formerly absolutist aspects of developmental
stage theories with young children—not only with Piaget’s theory but with Kohlberg’s
theory—have been questioned and disputed. Hughes and Baker (1990) reviewed several
studies from the 1970s and 1980s demonstrating that the apparent cognitive limitations
of young children are often artifacts of the way they are questioned or the way that tasks
are presented to them. It is now known that young children are capable of producing
higher quality self-report information than was previously considered to be possible
(Measelle, John, Ablow, Cowan, & Cowan, 2005). It has been demonstrated that many
young children are highly capable of engaging in prosocial or altruistic behavior (e.g.,
Eisenberg et al., 1999; Zahn-Waxler & Radke-Yarrow, 1982), and that they can be empa-
thetic toward others (e.g., Strayer & Roberts, 2004; Zahn-Waxler, Radke-Yarrow, Wagner,
& Chapman, 1992).
The chances of obtaining high-quality interview information from young children
are increased if they are comfortable in the interview situation and are questioned by
an interviewer who understands cognitive development and appropriately modifies
interview tasks for them (Gelman & Baillageon, 1983). It has been shown that providing
160 s Foundations and Methods of Assessment

specific training regarding how to recall and elaborate on details may be important for
obtaining a more accurate interview with younger children (Dorado & Saywitz, 2001).
Because social–emotional assessment in early childhood poses many singular challenges
and requires a high level of specific skills, this topic is treated separately in this book.
Specific techniques and recommendations for increasing the quality of interviews with
young children are presented in Chapter 13.

Elementary-Age Children
As children move from the preschool and primary years into the elementary years, their
capabilities for verbal communication tend to increase dramatically. Although conduct-
ing an effective interview with elementary-age children is a challenging endeavor that
requires special understanding and methodology, the probability of obtaining high-
quality interview information is substantially better than it is with younger children.
In developmental terms, elementary-age children tend to be in what Piaget (1983)
referred to as the concrete operations stage of cognitive development, which extends from
roughly seven to 11 years. Children at this developmental stage are typically able to use
simple logic, but generally can perform mental operations only on images of tangible
objects and actual events. During the concrete operations stage, many principles are
mastered that were formerly elusive to children while they were younger. The notions
that actions can be reversed, the ability to recognize that a change in appearance may not
necessarily reflect a change in substance or volume, and an increasing ability to see the
“big picture” rather than just one aspect of an event or object are among the characteristic
cognitive changes that are evidenced in elementary-age children. Elementary-age children
typically learn to develop simple hierarchical classification abilities but still may not have
the ability to use formal logic or abstract reasoning, at least beyond a very limited basis.
For example, a child at this stage of development may understand that anger is an emotion
and that acting out is a behavior, but he or she may not necessarily have much insight into
the connection between the two areas.
Elementary-age children are challenged by the task of learning to function socially
beyond the family into a broader social realm, a developmental stage that Erikson (1963)
referred to as industry versus inferiority. If they are able to master these new social chal-
lenges, elementary-age children develop a strong sense of self-competence. Lack of such
mastery may lead, however, to feelings of low self-esteem and poor self-efficacy.
Most elementary-age children learn to make moral decisions in a more complex
way than they did during the preschool and early primary grade years. Kohlberg (1969)
suggested that most children in this age range reach conventional morality, wherein
rules and social conventions are viewed as absolute guidelines for judging actions. For
example, although a preschool-age child might respond to the statement “Why is it wrong
to steal?” by stating something like “Because you will get in trouble” (a consequence-based
explanation), a typical elementary-age child might respond by saying “Because it is against
the school rules,” an example of compliance with social conventions. Of course, Kohlberg’s
theory of moral reasoning is not a universally accepted convention, and there have been
criticisms of it, but many aspects of this stage theory seem to hold up well for the typical
elementary-age child.
Effective interviewing of elementary-age children can be facilitated greatly by using
specific methods and techniques that are developmentally appropriate for this age level.
Establishment of adequate rapport and familiarity with the child before the actual
 Interviewing Techniques s 161

assessment has been found to be a crucial variable in influencing the amount and quality
of responses presented in standardized assessment situations (Fuchs & Fuchs, 1986;
McConaughy, 2013). Although elementary-age children generally have developed a
reasonable mastery of language, the interviewer should avoid the use of abstract or
symbolic questions, which probably would confuse the child (McConaughy, 2000a, 2013).
Hughes and Baker (1990) suggested that interviews with elementary-age children may
be enhanced by: (1) relying on familiar settings and activities during the interview;
(2) allowing them to use manipulatives and drawings during the interview; (3) avoiding
constant eye contact (which elementary-age children typically are not used to); and
(4) providing contextual cues (such as pictures, colors, and examples) with requests for
language interaction. Use of physical materials and familiar contexts in interviewing
children has been empirically studied. Priestley and Pipe (1997) found that the use of toys
and other physical props in interviews with children may facilitate their accurate accounts
of events they have experienced, particularly when many props are provided and the
physical similarity of these objects is similar to what was experienced in the actual event.
Use of toys, props, and other physical materials is likely to enhance the quality of interviews
with preschool-age, primary-age, and elementary-age children.

Adolescents
By the time adolescence has been reached, which is typically around 12 to 14 years of age,
children are usually capable of participating in an interactive interview situation to a
much greater extent than are younger children. In some ways, the interview task becomes
similar to that of interviewing an adult. Clinicians who assume, however, that inter-
viewing adolescents is the same as interviewing adults risk reaching invalid conclusions
or obtaining low-quality information, because of their lack of sensitivity to the unique
developmental aspects of adolescence. It is much better to approach interviews with ado-
lescents from the perspective that adolescence is a unique developmental stage that brings
forth numerous unique circumstances, challenges, and tasks.
In terms of Piaget’s stage theory, most individuals move toward the formal operations
level of cognitive development at about age 12 (Piaget, 1983). This stage is characterized
by the increasing ability to use formal logic and to apply mental operations to both
abstract and concrete objects. Many adolescents tend to become more systematic in
their problem-solving efforts, rather than using quick trial-and-error methods for attack-
ing problems. It is important to consider that some individuals (i.e., individuals with
impaired cognitive functioning or developmental disabilities) do not reach this advanced
stage of cognitive functioning; there is no guarantee that because an interviewee is
17 years old, he or she will be able to think abstractly and logically. It is worth considering
screening the youth’s academic and intellectual history before the clinical interview.
During adolescence, many persons may reach what Kohlberg (1969) referred to as
postconventional moral reasoning, a stage at which actions are more likely to be judged
based on individual principles of conscience rather than potential consequences or social
conventions. Some adolescents (particularly older adolescents) may make decisions
regarding what is considered right or wrong behavior based on abstract internalized ideals,
rather than conventional guidelines, such as school or family rules, or fear of consequences.
Although there is not a great deal of empirical evidence regarding how many adolescents
make decisions in postconventional terms, it can be generalized that this stage is more
likely to be reached toward the end of adolescence, and many individuals do not reach this
162 s Foundations and Methods of Assessment

stage of moral reasoning development at all. In practical terms, an example of a postcon-

ventional response to the question “Why is stealing wrong?” might be “Because stealing
violates the personal property rights of other people.” Related to the area of moral reason-
ing, adolescence is a time when many individuals experience personal shifts in their
values and beliefs, a developmental issue that sometimes may lead to significant stress in
relationships with parents (Dusek, 1996).
Since the time of the industrial revolution in Western industrialized societies, promi-
nent thinkers as disparate as the European philosopher Jean Jacques Rousseau and
the pioneering American psychologist G. Stanley Hall have characterized emotional
development during adolescence as a period of “storm and stress” because of the chal-
lenging adaptations that must be made. In his theory of psychosocial development,
Erikson (1963) characterized adolescence as a time of identity versus confusion crisis, in
which young persons struggle to find themselves and may experience a wide variation
in emotional intensity. Teachers and clinicians who work frequently with adolescents
(and those who are or have been parents of teens) usually agree with these assessments of
age-related emotional stress. The empirical evidence regarding adolescence as a period of
emotional storm and stress has been characterized, however, as being mixed or less than
convincing (Dusek, 1996). One of the unfortunate aspects of adolescence in the United
States is that compared with childhood, it is accompanied by substantial increases in
suicidal ideation and suicide attempts (Dusek, 1996). As of 2014, suicide constituted the
secondary cause of death for adolescents (Centers for Disease Control and Prevention,
2014). This evidence is often cited to characterize adolescence as a time of emotional
difficulty. It is important to consider that even with this age-related increase, however,
adolescent suicide rates are still low compared with older age groups (Weiten, 2000).
Although it is still empirically unclear whether adolescence constitutes a developmental
period of unique emotional turbulence, most parents of current, or former teens, are
likely to conclude that the notion of emotional turbulence is indeed a key characteristic
of adolescence, even for well-adjusted youths. Clinicians who interview adolescents should
consider that adolescence is a time of many challenges and changes and be sensitive to and
aware of these issues.
Conducting interviews with adolescents can be a rewarding experience. It is usually
more authentic and less constrained or frustrating than interviewing younger children.
Nevertheless, clinicians must consider the unique developmental aspects of adolescence
to elicit useful interview information and to make sound inferences. Although many
adolescents may be adult-like in their approach to the clinical interview and may enjoy
the unique one-on-one attention that comes from this process, others may find the
process annoying, intimidating, or upsetting. It is not unusual for troubled adolescents
to become uncooperative or disengaged during an interview situation.
It is important to consider the possibility of intensely variable emotionality with
adolescent interviewees. Although most Diagnostic and Statistical Manual of Mental
Disorders, fifth edition (DSM-5) diagnostic categories may apply to adolescents and
adults, clinicians still should exert extra care and caution in making significant inferences
with adolescents. Any diagnoses of severe affective or behavioral problems should
be tempered by the understanding of normal adolescent development, and adult stand-
ards of behavior and emotionality should not be exclusively applied. There is evidence
that making decisions on an adolescent’s social and emotional behavior in the same
manner that is done with adults may lead to faulty conclusions. Archer (2005) noted that
 Interviewing Techniques s 163

about 25% of adolescent participants responded to the original Minnesota Multiphasic

Personality Inventory (MMPI) in a manner that would be suggestive of psychotic behav-
ior when strictly interpreted according to adult norms. Regardless of whether one sub-
scribes to the notion that adolescence is by its nature an emotionally difficult and variable
period, this type of evidence compels us to consider adolescence as a time of unique
challenges and adaptation.

FACTORS THAT MAY AFFECT THE QUALITY OF THE INTERVIEW

Knowledge of child development and methods of making interviews developmentally
appropriate do not by themselves result in effective and useful interviews with children
or adolescents. In addition to developmental issues and interview format, there are many
other factors that may contribute to the overall quality of the interview. Several of these
factors are discussed in this section.

The Interpersonal Context

Whether the interview is with a child, parent, or teacher, the interpersonal relationship
established before and during the course of the interview may significantly affect the
extent and quality of client’s self-report data. One of the key tenets of humanistic
psychology (particularly person-centered theory) is that the development of a positive
relationship between the interviewer and the client is crucial to the quality of client self-
disclosure and the effectiveness of counseling. Three core relationship conditions are
considered essential: (1) empathy, or accurate understanding of the client’s concerns;
(2) respect, or positive regard for the client; and (3) genuineness, which can be described
as congruence between the interviewer’s verbal and nonverbal messages toward the client
(Rogers, Gendlin, Kiesler, & Truax, 1967). Although these interpersonal considerations
were first described and used within the context of person-centered therapy, they have
value for other forms of interviewing and therapy as well.
Cormier, Cormier, and Cormier (1997) elaborated further on the relationship-building
aspect of the interview and suggested that expertness, attractiveness, and trustworthiness
are additional characteristics that enhance the interpersonal context of communication.
Expertness is related to the client’s perception of how competent the interviewer is,
with an emphasis on characteristics of interviewer competence that are immediately
evident to a client. Attractiveness goes far beyond the client’s perception of the inter-
viewer’s physical characteristics and includes such attributes as friendliness, likability, and
similarity to the client. Trustworthiness includes the interviewer’s reputation for honesty;
the congruence of the interviewer’s nonverbal behaviors; and the amount of accuracy,
openness, and confidentiality that is evident during the interview process. Clinicians who
successfully incorporate these interpersonal characteristics and behaviors into their
interviewing methods are likely to increase the value of their interviews with clients.
Children may have a different perspective than adults on what interpersonal qualities
make a good and trusted interviewer. For example, take the concept of expertness.
Although many adults might be swayed toward positive appraisal of a clinician who
comes across as a highly knowledgeable expert, these same characteristics would not
impress children as much, and in some cases may even hinder communication. Thompson
and Rudolph (1992) stated that “adults are often too aggressive in trying to initiate
164 s Foundations and Methods of Assessment

conversations with children” (p. 33). Although some adults might respond well to a
clinician who seems confident and eager to engage in conversation, this same behavior
may be intimidating to many children. Likewise, consider how our perceptions of what
constitutes expertness relate to professional dress standards. In American culture, a
clinician who is dressed in relatively formal business-type attire might impress many
adults as being groomed like a professional, but it is highly doubtful that the same effect
would result with many children and adolescents, who might view the professional as
being stiff, detached, and unapproachable. In attempting to develop an appropriate and
effective interpersonal context for clinical interviews with children, a clinician should
always consider these and other potential differences between children and adults and
place a premium on helping the child client feel comfortable and safe.

The Ethnocultural Context

The United States is a uniquely diverse nation racially, ethnically, and culturally, and all
demographic indicators point to this diversity increasing steadily over the next several
decades. During the most recent major census, the U.S. Census Bureau (2010) found
that the proportion of Americans who are White, non-Hispanic (sometimes referred to
as European American) had shrunk to about 72% of the total population. Census updates
have indicated that this percentage has continued to decline during the first decade of the
twenty-first century, and that the percentage of Americans who are considered to be of
European American ancestry is currently about 64%. It has been estimated that the per-
centage of Americans who are considered to be White, non-Hispanic will shrink to slightly
over 50% by 2050 and that growth in the population of Hispanic Americans and Asian
Americans will account for most of this ethnic or racial population shift (Rosenblatt,
1996). Given that American culture is increasingly pluralistic with respect to race, ethnic-
ity, and culture, and given that one’s cultural background may play an important role in
interpersonal communication style, it is crucial for clinicians to consider cultural factors
that may affect clinical interviewing.
In discussing information about differences between racial, ethnic, or cultural groups,
it is important to consider that much of the information we have on group differences is
based on generalizations from studies of groups. There are always individuals who do not
fit the “typical” group characteristics. Caution is essential to avoid stereotypical over-
generalizations of group differences. I stress that the literature on group differences,
whether based on gender or race/ethnicity, must be used with great care and caution
because generalizing a characteristic from a group-based study, even if done with good
intentions, may function as a way of stereotyping individuals and further exaggerating
differences in how we categorize and classify individuals.
Two dimensions of the clinical interview that may have immediate cultural relevance
include the degree of eye contact and the amount of physical distance between the inter-
viewer and the client. Sue and Sue (2008) noted that White Americans make eye contact
with the speaker about 80% of the time but tend to avoid eye contact about 50% of the
time when speaking to others. This general trend has also been noted by Vasquez-Nuttall
and colleagues (2003) and is in contrast to the eye contact patterns of many African
Americans, who as a group tend to make greater eye contact when speaking and less
frequent eye contact when listening. Native Americans as a group are more likely to use
indirect eye contact patterns when speaking or listening, whereas Asian Americans and
 Interviewing Techniques s 165

Table 6.2 Generalized between-group communication style differences among major ethnic groups in the United States: Some
aspects of overt activity and nonverbal and verbal communication

Native Americans Asian Americans and Whites African Americans

Latinos

1 Speak softly/slower 1 Speak softly 1 Speak loud/fast to 1 Speak with affect

control
2 Indirect gaze when 2 Avoidance of eye contact 2 Greater eye contact 2 Direct eye contact
listening or speaking when listening or when listening (prolonged) when
speaking to high-status speaking, but less
persons when listening
3 Interject less, seldom 3 Similar rules 3 Head nods, 3 Interrupt (turn-
offer encouraging nonverbal markers taking) when can
communication
4 Delayed auditory 4 Mild delay 4 Quick responding 4 Quicker responding
(silence)
5 Manner of expression 5 Low-keyed, indirect 5 Objective, 5 Affective, emotional,
low-key, indirect task-oriented interpersonal
Source: From Counseling the Culturally Different (3rd ed.), by D. W. Sue & D. Sue, 1999, New York: John Wiley & Sons,
Inc. Reprinted by permission of John Wiley & Sons, Inc.

Hispanics, as groups, are more likely to avoid eye contact altogether when speaking to
persons whom they perceive to have high status.
In terms of comfortable physical proximity or distance between persons, Sue and Sue
(2008) and Vasquez-Nutall and colleagues (2003) also noted that there may be important
cultural differences. For Latino Americans, Africans, African Americans, Indonesians,
South Americans, Arabs, and French, a much closer physical stance between communi-
cators than most White/Anglo clinicians are comfortable with is normal. Degree of eye
contact and physical proximity between interviewee and interviewer may be variables
that can affect greatly the overall quality of the interview. Some culturally based aspects
of interpersonal communication styles among U.S. cultural groups are reflected in the
information presented in Table 6.2. Additionally, because cultural diversity is such a
crucial issue in conducting effective social–emotional assessments, the topic is dealt with
separately in Chapter 2.

The Behavioral Context

Some specific interviewer behaviors are likely to enhance or detract from the amount
and quality of interview information that is obtained from a client during a clinical
interview. Whether the interview has a structured or unstructured format, there is some
evidence that by preparing the client and instructing him or her in desirable ways
of responding, the interviewer will increase the amount, quality, and accuracy of self-
disclosure by the client (Gross, 1984; Saywitz & Snyder, 1996). At the beginning of an
interview with the parent of a referred child, the clinician might say something like
“When you tell me about problems you are having with Sari, I would like you to be very
specific—tell me exactly what she does that you see as a problem, how it affects you, and
what you generally do about it.” Advance instructions such as this appear to pose no
danger of leading the client. Rather, this practice may help the clients to frame their
166 s Foundations and Methods of Assessment

responses in a way that is more objective, direct, and potentially linked to understanding
antecedents and consequences of behavior.
Another interviewer behavior that may increase the quality of the interview is the use
of reinforcement. With children and adults, the selective use of praise or appreciative
statements has the effect of increasing the amount and quality of subsequent self-
disclosure (Gross, 1984). A clinician who is interviewing a child about how the divorce of
his or her parents has affected him might say something like the following:

Steffen, you did a great job of telling me what it was like for you when your mom
and dad got divorced. I know that was a hard thing for you to talk about, but you
were able to tell how you feel about it in a way that really helped me to understand
things. The more you can tell me about how you feel and what has happened to you,
the better I can understand you and help you.

Other forms of reinforcement may also be effective with younger children. Edible
primary reinforcers, such as raisins, nuts, or small pieces of candy, are one possibility,
although they should be used with parent permission and with caution to avoid satiation
effects and to avoid having the reinforcers take center stage during the interview. As an
alternative to edible reinforcers, stickers are often popular with children, as are tokens
that can be exchanged for small rewards after the interview.
Finally, the type of questioning used is another important interviewer behavior. The
use of closed questions (those that can be answered with a one-word response) should
be avoided except when specific information is needed. A barrage of closed questions
from an interviewer may leave the client feeling as though he or she is being interrogated.
With adults, adolescents, and older children, the use of open-ended questions (e.g., “Tell
me about what you like to do with your friends”) is generally preferred over closed
questions (e.g., “Do you like to play with your friends?”). In general, any question that
can be answered with a “yes” or “no” response is a closed question. There are exceptions
to the convention of avoiding closed questions. With young children, it is generally most
useful to use a combination of open and closed questions (Hughes & Baker, 1990). It also
has been recommended that interspersing open questions with probes provides an
effective means for obtaining interview information with children and adolescents
(McConaughy, 2000a; 2005).

The Truth Context: Dealing with Lying

Any experienced clinician knows that whether interviewing children or adults, some
aspects of what the client tells you may not be historically or objectively accurate. One
possible explanation for this phenomenon is that the client may not understand the
question or may be confused regarding what is wanted. Another possible explanation
is that the client does indeed understand what the clinician is getting at with his or her
question, but deliberately distorts or falsifies his or her response in order to spin it in the
manner that he or she wishes to convey. McConaughy (2013) noted that a surprisingly
high percentage of children and adolescents are perceived by their parents or teachers
as having lied in the recent past and that the percentages of youths who are perceived as
having lied are higher for mental health or special education samples than for non-
referred samples. In terms of children and adolescents own self-reports of whether they
have lied in the recent past, the percentage of non-referred youths who affirm doing so
 Interviewing Techniques s 167

ranged from 24% to 29% and the percentage of referred youths who endorsed having lied
ranged from 43% to 52% (Achenbach & Rescorla, 2001). Of course, these figures raise an
interesting conundrum: If respondents are known to have a reasonably high propensity
to lie, then how much should we trust their self-report of lying?
Given that child or adolescent clients may sometimes respond to the interviewer’s
request for information in ways that appear to demonstrate lying or falsification, some
commonsense practices should be considered. First, the interviewer should try to avoid
questions that come across as inflammatory or pejorative and, thus, may be more likely
to elicit a defensive or self-protective response from the client. Questions such as,
“How often do you steal from other kids at school?” or “When was the last time you took
illegal drugs?” both fall into this inflammatory or pejorative category. Without question,
a clinician can get at this same information in a way that is more subtle, less combative,
and more apt to eventually lead to accurate interview responses. Second, interviewers
should tread carefully in situations where it appears the client is lying. Sometimes in
an interview situation, the client may respond to the clinician’s questions in a way that
is obviously untrue. Should you confront the child or adolescent directly about this
apparent lying? McConaughy (2013) thinks not, suggesting “Confronting children
directly about suspected lies or exaggerations . . . is likely to be counterproductive, because
it may lead them to tell more lies to save face or to defend themselves against accusations
or punishments” (p. 30). Instead, it may be more effective to either skip that situation
and come back to it later after more trust and rapport is built or approach the child or
adolescent in a way that is less threatening, such as “Maybe you could tell me some more
about that . . . you said you never steal, but your file has all these office referrals for
stealing. Sometimes these questions can be really confusing or hard to answer. What do
you think?”

The Physical Context

A final aspect of the interview that should be considered is the physical context of the
interview setting and the physical or topographical aspects of communication. I have
already discussed the degree of eye contact, which involves the physical context and
the ethnocultural context. Related to degree of eye contact is physical proximity between
clinician and client. With children, this issue may be particularly important. It is widely
held that children prefer to talk to adults at the same eye level as they are, and it has
been recommended that to increase their comfort during an interview, children should
be allowed in most cases to control the distance between them and the interviewer
(Thompson & Rudolph, 1992). Clinicians are encouraged to allow the child to determine
how close he or she wants to sit to the interviewer in most situations and to be willing
to sit lower to the ground to avoid intimidation of the child. With younger children,
and children who are not comfortable in formal assessment situations, this advice may
become especially crucial. Of course, there will be occasions when a child or adolescent
client from a specific cultural background is not comfortable with these generally prefer-
able arrangements. Clinicians should strive to be sensitive to such individual differences
and should always strive to do what is best or most effective for their clients, rather than
following rules rigidly, no matter how generally true those rules seem.
An additional aspect of the physical context is the seating arrangement for the clinical
interview, or how to arrange tables, chairs, and desks for optimal comfort and effectiveness.
Although no empirical evidence has been reported regarding this issue, clinicians who are
168 s Foundations and Methods of Assessment

experienced in counseling children tend to agree that having a barrier such as a desk
between the clinician and a child client tends to make the child see the clinician as an
authority figure, which in some cases may inhibit communication. Also, having the
clinician and child client seated directly across from each other with no physical barrier
between them is seen as being problematic because it can be too intimidating for the
child. Regarding appropriate seating arrangements for counseling and interviewing with
children, Thompson and Rudolph recommended that the preferred arrangement is to:

Use the corner of a desk or table as an optional barrier for the child, allowing them
to retreat behind the desk or table corner or to move out around the corner when
he or she feels comfortable doing so.
(1992, p. 33).

These general guidelines may be useful as a starting point, but the optimal interview
situation may vary from child to child and situation to situation. Clinicians are encouraged
to pay complete attention to the comfort and level of disclosure of their client and to make
modifications to the physical setup or interview technique as needed. Essentially, what
works is what is best in any given situation, and that will certainly vary.

SELECTING AN APPROPRIATE INTERVIEW METHOD

In this chapter, clinical interviewing methods are divided into three general categories:
traditional interview techniques, behavioral interviews, and structured or semistructured
interviews. It is possible to divide or categorize interview methods into more classifications,
but this three-part division provides a useful grouping into general methods that typically
might be used in most clinical interviews.
The particular choice of the interview method depends on several factors, including:
(1) the theoretical orientation of the clinician; (2) the level of training and experience
the clinician has in conducting interviews; and (3) the overall goals and specific objectives
for the interview. The clinician’s theoretical orientation influences the choice of interview
methods in that his or her personal beliefs and biases may limit the level of comfort he or
she has in using different methods. For instance, a clinician who has a strong behavioral
orientation may not be comfortable using a traditional, open-ended interview format
with a client, perceiving that the type of information obtained will be of little use in
identifying key elements and sequences of problem behaviors and in developing an
intervention. Conversely, a psychodynamic-oriented or humanistic-oriented clinician
may perceive that some highly structured diagnostic interview schedules are rigid and
confining.
The clinician’s level of training and experience may affect choice of methods. Being
able to conduct a traditional, open-ended interview effectively and without a great deal of
preimposed structure requires a significant amount of clinical expertise, which is gained
only through training and more experience. Conducting an effective behavioral interview
requires a solid grounding in behavioral theory, if the results are to be useful in identify-
ing factors that elicit and maintain problem behaviors and subsequently developing an
intervention plan. Some of the structured and semistructured interview schedules that are
available require a high degree of specific training in that particular system, although some
 Interviewing Techniques s 169

of these schedules can be used easily and effectively by paraprofessionals and laypersons
with a minimal amount of training.
In addition to the clinician’s theoretical orientation and level of training, the choice of
interview techniques is also shaped by the specific purposes for conducting the interview.
Traditional interview formats are useful when there is a premium on obtaining historical
information and in establishing rapport with the client within the arrangement of a less
formal, client-focused interview. Behavioral methods of interviewing are particularly
useful when the pre-eminent goal is to conduct a functional behavior assessment or to
develop an immediate intervention wherein the crucial behavioral variables can be identi-
fied and modified. If diagnostic or classification purposes are paramount for the interview,
many of the semistructured or structured interview schedules are considered to be a good
choice, particularly if the purpose is psychiatric diagnoses via the DSM system.

TRADITIONAL INTERVIEWING TECHNIQUES

What is referred to in this chapter as traditional interviewing is not really a specific format
or type of interview. Rather, this term represents the broad range of clinical interviews
that are relatively open-ended, less structured, and highly adaptable depending on the
situation. Traditional interviewing techniques may include a wide range of specific types
of approaches to interviewing, such as psychodynamic, case history, and psychosocial
status. Within this discussion of traditional clinical interviewing techniques, two areas are
covered that are relevant to virtually any type of interview: (1) gathering background
information from parents and teachers; and (2) methods of developing the interview
with child or adolescent clients.

Gathering Relevant Background Information from Parents and Teachers

In addition to identifying specific problems and developing intervention plans, both of
which are covered in the Behavioral Interviewing section of this chapter, one of the main
purposes for interviewing the parent or teacher of a referred child is to obtain a report of
relevant background information. Why should background information be obtained?
Although one could make an argument for using only information that is current and
linked directly to the presenting problem, such an approach is short-sighted. By carefully
reviewing important historical information, clues sometimes are provided to the causes
of, and potential solutions to, child behavior or emotional problems. It is important to
think of children, their parents, and their teachers as existing within a complex ecological
network, such as Bronfenbrenner’s ecological systems model that was introduced in
Chapter 1. The more information clinicians have about how this network functions,
the more effective they may be in developing and implementing solutions to problems.
An additional advantage of obtaining comprehensive background information is that it
can help to provide links to seemingly unrelated problems. For example, some behavioral
or physical side effects of medications a child is taking may be misunderstood unless the
clinician is aware that the medication is being taken in the first place. Another benefit of
interviewing parents or teachers is that it creates an opportunity to build trust and rapport
with them, which is a crucial ingredient when it is time to implement interventions.
What type of background information should be obtained? The answer to this question
depends to some extent on the nature of the presenting problems, but there are some
170 s Foundations and Methods of Assessment

standard areas that typically are explored in the process. Table 6.3 includes five general
areas of inquiry, each with some specific recommended areas of questioning. The general
areas include medical history, developmental history, social–emotional functioning,
educational progress, and community involvement. This format is not all-inclusive; other
general areas and specific questions can be identified as the need arises. It is also important
to consider that the five general areas of inquiry presented here are not equally appli-
cable to all adults with whom the clinician may be conducting an interview. Specific

Table 6.3 Recommended areas of questions for gathering background information

Medical history
Problems during pregnancy and delivery?
Complications shortly after birth?
Serious illnesses/high fevers or convulsions?
Serious injuries or accidents?
Serious illnesses in family history?
Allergies or dietary problems?
Current health problems or medications?
Vision and hearing OK?
Developmental history
Ages for reaching developmental milestones: crawling, talking, walking,
toilet-training
Developmental delays (communication, motor, cognitive, social)?
Development in comparison with siblings or peers
Social–emotional functioning
Temperament as an infant/toddler
Quality of attachment to caregivers as infant/toddler
Quality of relationships with parents
Quality of relationships with siblings and peers
Discipline methods: what works best, who does he or she mind the best?
Behavioral problems at home or in community?
Number and quality of friendships with peers
Any traumatic/disturbing experiences?
Any responsibilities or chores?
Who provides after-school care?
Educational progress
Initial adjustment to school
Academic progress: delayed, average, high-achieving?
School grades and progress notes
Any school attendance problems?
Behavioral problems at school?
Quality of peer relations at school
Favorite subjects, classes, or teachers
Extracurricular activities
Community involvement
Belong to any organizations or clubs (e.g., Boys and Girls Club)?
Organized team sports?
Part-time job? (for adolescents)
Religious background/participation in church activities or spiritual practices
Relationships with extended family
 Interviewing Techniques s 171

medical and developmental history may not be known to a foster caregiver or a teacher.
Likewise, when interviewing a teacher, the focus on educational performance would be
the major area of discussion.
A wide array of forms has been developed and is in use for obtaining developmental
history information. These forms range from being self-produced to commercially pro-
duced, brief to long, informal to formal. An example of a comprehensive formal develop-
mental history interview form that has been published commercially is the Structured
Developmental History form from the Behavioral Assessment System for Children, Third
Edition (C.R. Reynolds & Kamphaus, 2015). This form is a multipage tool that covers
everything from prenatal history to family health history to adaptive skills of the child.
In some cases, extensive and lengthy interview forms such as these may be useful. In other
instances, it may be more desirable to conduct a brief and informal interview regarding
background issues. The presenting problems and purpose of the interview should drive
the format for obtaining background information.

Developing the Interview with Children and Adolescents

Interviewing a child or adolescent provides an opportunity for two important elements
of the assessment: (1) directly observing behavior under structured conditions; and
(2) obtaining self-report information regarding the interviewee’s concerns, problems,
goals, and hopes. The interview also provides an opportunity to develop rapport with the
child or adolescent, which may prove to be especially important if the interviewer will also
be functioning in an important role with the client after the completion of the assessment.

Areas for Observation Although the specific aspects of client behavior that are most
important for the interviewer to observe depend to a great extent on the purpose of the
interview and the nature of the presenting problems, there are four general areas that
almost always are useful to target: (1) physical characteristics; (2) overt behavioral
characteristics; (3) social–emotional functioning; and (4) cognitive functioning. Table 6.4
includes a more complete breakdown of child characteristics to observe within each of
these four general areas. In some cases, the clinician may need to add to or subtract from
this list, depending on the specifics of the interview.
Many clinicians who routinely conduct interviews as part of a broader assessment find
it useful to make notes of the important characteristics that were observed during the
interview so that they can be detailed in the report at a later time. Note taking should not
take center stage during an interview, however, as it is likely to distract from the flow of
communication and the establishment of good rapport with the child or adolescent.

Areas for Questioning As we have already discussed, the traditional child interview is
amenable to some specific types of interviewing. We have also discussed the use of ques-
tioning strategies (e.g., open versus closed questions) and developmental considerations
that must be considered when conducting clinical interviews with children and adoles-
cents. Although traditional interview techniques for specific purposes and problems and
with specific ages of clients vary to some extent, there are still some commonalities
and some general areas of questioning that remain constant. Table 6.5 lists five general
areas that are usually important to target when interviewing children or adolescents:
(1) intrapersonal functioning; (2) family relationships; (3) peer relationships; (4) school
adjustment; and (5) community involvement. Within each of these areas, some specific
172 s Foundations and Methods of Assessment

Table 6.4 Important child characteristics to observe during interviews

Physical characteristics
Unusual or inappropriate attire
Gang-related attire
Height and weight in comparison to same-age peers
Obvious physical difficulties
Direct signs of possible illness
Motor coordination
Tics (vocal, facial, motor)
Overt behavioral characteristics
Activity level
Attention span
Interaction with environment
Distractibility
Impulsivity
Social–emotional functioning
Range and appropriateness of affect
Mood state during interview
Reaction to praise
Reaction to frustration
Social skills with interviewer
Obvious anxiety or nervousness
Ease of separation from caregiver (for young children)
Cognitive functioning
Communication skills
Overall intellectual competence, estimated
Intrapersonal insight/self-awareness
Logic of reasoning
Time and space orientation
Level of organization in activities
Apparent planning ability

areas for recommended questioning are provided, which can be increased or decreased
as needed. When conducting traditional open-ended interviews, many clinicians find it
useful to develop the interview and make notes according to a breakdown such as that
shown in Table 6.5. This allows for a degree of structure and a logical progression in the
interview while still leaving it flexible and open-ended.

BEHAVIORAL INTERVIEWING
Behavioral interviewing differs from traditional interview methods in the level of structure
imposed by the interviewer and the purposes for conducting the interview. The roots of
behavioral interviewing are found in behavioral psychology. As noted by Gross (1984)
nearly four decades ago, it is still true that “the primary objective of behavioral assess-
ment is to obtain descriptive information about problem behavior and the conditions
maintaining it” (p. 62). The behavioral interview is viewed as a specific type of behavioral
assessment, with the same objectives as other behaviorally oriented assessment methods.
The clinician who conducts a behavioral interview is interested in pinpointing the problem
 Interviewing Techniques s 173

Table 6.5 General areas of questioning for child/adolescent interviews

Intrapersonal functioning
Eating and sleeping habits
Feelings/attributions about self
Peculiar or bizarre experiences (e.g., hearing or seeing things)
Emotional status (e.g., depressed, anxious, guilty, angry, happy)
Clarity of thought/orientation to time and space
Insight into own thoughts and concerns
Defensiveness/blaming
Understanding of reason for interview
Family relationships
Quality of relationships with parents
Quality of relationships with siblings
Family routines, responsibilities, chores
Involvement with extended family members
Level of perceived support from family
Perceived conflicts within family
Peer relationships
Number of close friends
Preferred activities with friends
Perceived conflicts with peers
Social skills for initiating friendships
Reports of peer rejection and loneliness
School adjustment
Current grade, teacher, school subjects
General attitudes/feelings about school
Previous and current academic performance
Favorite or preferred subjects or teachers
Difficult or disliked subjects or teachers
Involvement in extracurricular activities
School attendance patterns
Perceived conflicts or problems at school
Community involvement
Involvement in clubs or youth organizations
Participation in community activities
Church attendance/religious or spiritual activities
Level of mobility within community
Part-time jobs (for adolescents)
Relationships with other individuals in the community

behaviors and identifying variables that may have controlling or maintaining effects on
those behaviors. In other words, behavioral interviewing may be focused to a great extent
on understanding functions of behaviors. As such, the behavioral interview requires a
relatively high degree of structure by the interviewer for the primary goals to be met.
Because of the unique strengths and structure of behavioral interviewing, it is often an
essential element in conducting a functional assessment of behavior, which is discussed in
more detail in Chapter 4.
Several models of behavioral interviewing have been proposed, and each of them has
a different level of emphasis of such variables as cognitive and verbal competency of the
174 s Foundations and Methods of Assessment

Table 6.6 Specific purposes of behavioral interviewing

1. Gather information about client concerns and goals

2. Identify factors that elicit and/or maintain problem behaviors
3. Obtain relevant historical/background information
4. Identify potential reinforcers within client’s environment
5. Assess mediation potential of the client
6. Educate client regarding behavioral principles and the particular problem situation
7. Obtain informed consent from the parent/guardian of child or adolescent client (and obtain assent from
the child or adolescent client)
8. Communicate about the goals and procedures of assessment and intervention

client, other within-client variables, analysis of the environment, and historical inform-
ation. What these differing models of behavioral interviewing seem to have in common
is their emphasis on description and clarification of the problem behaviors and the
identification of antecedent stimuli and consequences of those behaviors.
Along these lines, Haynes and Wilson (1979) identified the essential elements of the
behavioral interview as an organized interaction between the subject or a mediator and
the behavioral interviewer for eight specific purposes ranging from gathering inform-
ation about client concerns to communicating specifically about the procedures and
goals of the assessment and any subsequent intervention. With the addition of some
modifications provided by me, the eight specific purposes of behavioral interviewing
originally outlined by Haynes and Wilson are listed in Table 6.6.
As a clinical interviewing technique, the behavioral method offers several advantages
over other forms of assessment, including other interview techniques. Behavioral inter-
viewing has been touted as an economical method of obtaining behavioral information
(Wahler & Cormier, 1970), especially compared with direct observation. Given that inter-
views may be conducted with an informant who is familiar with the client, behavioral
interviewing offers flexibility in the event that the child or adolescent client is not directly
available to observe or interview or is not capable of providing detailed information.
Another advantage of behavioral interviewing is that when conducted directly with
the client, it allows the clinician to observe directly various social behaviors and commu-
nication skills of the client, which may be useful in developing intervention strategies.
Additionally, conducting a comprehensive behavioral interview with a mediator (i.e.,
parent or teacher) allows the clinician to assess how receptive the mediator might be to
the idea of implementing an intervention and to what specific types of intervention the
mediator might be amenable (Gresham & Davis, 1988). Finally, in comparison with such
behavioral assessment techniques as direct observation and rating scales, interviewing is
flexible enough to allow the clinician the opportunity to expand or narrow the scope of
the assessment, depending on what areas emerge as specific problems.

Implementing Behavioral Interviews with Parents and Teachers

When the client is a child or adolescent, it is almost always necessary and desirable to
interview the parents as part of the initial assessment, and it is important to interview a
teacher as well. “The interviewing of parents and teachers, in addition to the children
themselves, has long been a standard component in assessing the behavior problems of
children and adolescents” (Busse & Beaver, 2000, p. 235). Interviewing the parents or
 Interviewing Techniques s 175

teacher of the referred child or adolescent can be an extremely important part of the
assessment for several reasons: (1) they are a potential rich source of behavioral data
because of their daily observations of the child’s behavior in naturalistic settings; (2) they
may be able to provide information on the child’s behavior that is not available to the
interviewer through other methods of assessment; and (3) because they often function as
mediators in the intervention process, it is crucial to obtain their report and assess their
ability to implement an intervention. Although conducting behavioral interviews of
parents and teachers has been treated as a separate topic, the processes involved have
much in common and are discussed together in this chapter.
Conceptualizing the behavioral interview process as part of an overall behavioral con-
sultation model for working with parents and teachers, Gresham and Davis (1988) and
Busse and Beaver (2000) identified three different types of behavioral interviews that
might occur: (1) the problem identification interview; (2) the problem analysis interview;
and (3) the problem evaluation or treatment evaluation interview. Because the problem
or treatment evaluation interview phase is designed to be implemented after the imple-
mentation of an intervention, it is beyond the scope of this text. This chapter deals with
only the first two types of behavioral interviews. Although it is possible to treat problem
identification and problem analysis together, they are discussed individually, for purposes
of conceptual clarity.

Problem Identification Interview Identification of the problem is considered to be the

most important phase in the consultation process because it defines what will be focused
on, and how the problem will be envisioned (Busse & Beaver, 2000; Gresham & Davis,
1988). In beginning the problem identification interview, a clinician typically starts by
obtaining demographic information and asking general questions about the child (“What
concerns do you have about your child?”) but soon begins to probe into more specifics and
in more depth (“How often does this student engage in aggressive behavior?”). The main
idea is for the interviewer to assess the variety of problems reported, identify the problems
that are of most concern, and obtain specific behavioral information relating to those
problems.
Gresham and Davis (1988) identified six major objectives for the problem identification
interview, as follows:

1. specification of the problem to be solved in consultation;

2. elicitation of an objective description of the target behavior;
3. identification of environmental conditions surrounding the target behavior;
4. estimation of the frequency, intensity, and duration of the problem behavior;
5. agreement on the type of data collection procedures that will be used and who will
collect the data;
6. setting a date for the next interview, which will be a problem analysis interview.

In addition to identifying and gathering specific information on the problem behavior

exhibited by the child or adolescent, Gross (1984) suggested that it is important to obtain
information on the child’s behavioral assets. By specifically asking the parents or teacher
what behavior is desired in place of the problem behavior, the interviewer can work on
assessing whether the child or adolescent has that behavior within his or her repertoire.
Additionally, spending some time focusing on strengths and assets can also serve to help
176 s Foundations and Methods of Assessment

the adult interviewees, who are often frustrated by the child’s behavior, to cognitively shift
toward a more positive outlook. Another example of gathering information on behavioral
assets involves the interview focusing on what things the child or adolescent finds parti-
cularly enjoyable or rewarding. This information could be used later in developing a
menu of potential reinforcers.
There are several specific interview protocols that have been developed and adhere
to the objectives laid out by Gresham & Davis (1988). Many are free and available
online. One example is The Functional Assessment Checklist for Teachers and Staff (March
et al., 2000).

Problem Analysis Interview Ideally, problem analysis occurs after a problem identifica-
tion interview, which sets the stage for an appropriate plan for obtaining baseline data.
Gresham and Davis (1988) identified four objectives for the problem analysis interview,
as follows:

1. Validation or confirmation of the problem through an examination of the baseline

data. If the problem is confirmed, this step also would include determining any
discrepancies between the child’s existing performance and what is desired.
2. Analysis of conditions surrounding the behavior. In other words, what are the
antecedents, sequences, and consequences that affect the behavior, and what are
the potential functions of the behavior?
3. Design of an intervention plan to alter the identified problem behavior. This
objective includes developing general approaches and precise plans for how the
interventions will be implemented.
4. Setting a date for the problem evaluation interview, assuming that an appropriate
intervention plan has been developed and agreed upon.

It is often difficult to divide the problem identification and problem analysis aspects
of the behavioral interview into two separate interview sessions, with the parent or
teacher agreeing to gather appropriate baseline data between sessions. In practice, there
are often strong time pressures, and needs, to develop interventions immediately that
make it necessary to combine both aspects of the behavioral interview into one extended
session. By doing this, however, there usually is no opportunity for the gathering of
baseline data, and the clinician needs to rely on the verbal report of the client and rating
scale data, then work on gathering progress data as the intervention is implemented and
modified. The following interchange of dialogue between a therapist and the parent of a
six-year-old boy illustrates how the elements of a problem identification interview and
a problem analysis interview can be merged into one session:

Therapist: You’ve told me about several problems that are happening with Marcus.
Which behavior do you see as being the biggest problem?
Parent: The temper tantrums.
Therapist: Tell me, specifically, what Marcus does when he is having a tantrum.
Parent: It usually starts out with screaming and yelling and sometimes crying. He’ll call
me names, make threats, and if it is a really bad one, he might kick the walls, push over
furniture and lamps, and even try to kick me or hit me or someone else in the family.
Therapist: What kinds of things are usually going on just before Marcus behaves like this?
 Interviewing Techniques s 177

Parent: It’s usually when he wants something that I won’t let him have or do, or when he
has been in an argument with his older brother.
Therapist: And where does it usually happen?
Parent: Always at home, and usually inside the house.
Therapist: Is it more likely to happen at particular times?
Parent: Well, most of the time it’s at night.
Therapist: And how long do these tantrums usually last?
Parent: Oh, maybe 10 or 20 minutes, but a really bad one might go on longer.
Therapist: Tell me what kinds of things you do, both just before the tantrums happen,
and then during or after them, as a way to stop them.
Parent: It seems like when the arguments start that happen before the tantrums, I am
usually tired or in a bad mood, and I might be kind of short with him. But not always.
Once it gets started, it all depends on the situation and how I am feeling—it seems like
if I’m worn-out and irritated, I yell back at him and sometimes even try to hold him
still, or something like that. If I’m not so stressed, I might try and send him to the other
room or just sit down and try to listen to him.
Therapist: And what seems to work best?
Parent: Well, it does seem like the thing that works best is to not let the argument get so
bad, like try and distract him by getting him to do something else, or to sit down calmly
and listen to him. But I usually only do that when I’m not tired or stressed. Once it gets
going, I know that the worst thing I can do is to get into it with him, but sometimes
I don’t really care. It seems like moving him into his room for a few minutes until he
settles down works better than that.

The dialogue in this interchange shows how an interviewer/therapist can ask specific
questions to pinpoint the greatest problem and determine its intensity, duration, locus,
and environmental variables that might be eliciting or maintaining it. If conducting a
functional behavioral assessment or developing an intervention plan is an important part
of the behavioral interview, these techniques are necessary.

Implementing Behavioral Interviews with Children and Adolescents

Because behavioral interviewing techniques are associated strongly with the behavioral
consultation model of problem identification and treatment, there is a definite emphasis
on conducting the interview with parents and teachers, who ultimately serve as mediators
in the intervention process. In many cases, however, the child or adolescent also can
become an important participant in the behavioral interview process. As a general rule, the
younger the child, the more difficult it is to obtain useful behavioral data in an interview,
and the more important other behavioral assessment sources will be (e.g., parent inter-
views, direct observations, rating scales). Although interviews with young children may
lead to the establishment of rapport and to the clinician being able to observe directly their
social behavior, interviews with children younger than six years old typically provide little
in the way of content information.
As children become older and more sophisticated in their use of verbal mediation
skills, the likelihood increases that they will be able to provide valuable descriptive
information in the behavioral interview process. When conducting a behavioral interview
with a child who is capable of providing detailed information, it is important to move
carefully from a general to a more specific level of questioning. The interview might start
178 s Foundations and Methods of Assessment

out with some general questions about why the client thinks he or she is being interviewed
and might be an opportunity for the child to talk about his or her interests, but ultimately
it should lead to specific probes of suspected problem behavior (e.g., “Tell me what
usually happens before you get into fights”). As is true in the case of interviewing parents
or teachers, it is important to ask questions pertaining to the child or adolescent’s
behavioral assets. Obtaining their perspective on what positive and appropriate behaviors
they can do and what their strongest likes and dislikes are may be important when it is
time to construct an intervention plan. For some students with limited communication
skills, it may also be useful to conduct a more structured preference assessment as part of
the interview process. Such assessments are available on www.interventioncentral.org
and are useful when asking a child to point to or identify potential activities or tangible
items that they prefer and that might be helpful reinforcers to use within an intervention
plan (Wright, 2002). Furthermore, an example of a structured behavioral interview
protocol to be used with older children and adolescents is The Functional Assessment
Checklist for Students (March et al., 2000).
The following example illustrates some of the elements of conducting a semistruc-
tured behavioral interview directly with the child client. In this case, the client is an
11-year-old girl who has been referred for peer-relationship problems, and the clinician
is a school psychologist, who is conducting a formal assessment:

Psychologist: Zoey, tell me what happens when you get into fights with the other girls
you told me about.
Zoey: Well, on Friday I got into a bad fight with Monica and Janeece. It was during recess,
and I knew they were talking about me behind my back. I walked up to them and told
them to just shut up.
Psychologist: You said you knew they were talking about you. Why did you think that?
Zoey: I could see them talking, while they were walking away from me, and they were
looking at me.
Psychologist: So you figured they were talking about you, even though you couldn’t hear
what they were saying. What happened next?
Zoey: Well, Janeece told me to shut up, so I said, “You got issues.” She called me a bitch, so
I pushed her away, then Monica hit me and we started to really fight. The recess
supervisor sent me to the principal’s office, and I told her that I wasn’t the one who
started it, but she never believed me.
Psychologist: Do these kind of fights usually happen during recess?
Zoey: Mostly. But sometimes during lunch and once while I was waiting for the bus.
Psychologist: But not during class?
Zoey: No really, ’cause the teachers won’t let me sit by kids who bother me all the time,
and my homeroom teacher has my desk away from them. The teacher is usually there
to stop it right away.

Similar to the previous example, this excerpt illustrates how the clinician can ask specific
questions regarding the circumstances and the location of specific problem areas. Such
information may prove to be invaluable in conducting a functional behavioral assessment
or in developing an intervention plan.
An additional consideration of involving a child or adolescent in a behavioral-oriented
interview is that it may be useful to conduct a brief joint interview with the adult and
 Interviewing Techniques s 179

child. Particularly in the case of clinic-based assessments of child behavior problems,

observing the parent and child together can provide the clinician with a rich source of
direct observation data. Being able to observe the extent and quality of parent–child
interactions and how they react to each other in positive and negative situations affords
the opportunity for a valuable merging of behavioral interviewing and direct behavioral
observation.

STRUCTURED AND SEMISTRUCTURED INTERVIEW TOOLS

Since about the 1970s, there have been several prominent efforts aimed at developing
highly structured and standardized interview schedules for use with children and adoles-
cents. Many of these structured or semistructured clinical interview instruments (or
schedules, or protocols, as they sometimes are called) originally were designed for use in
psychiatric settings or for epidemiology research, but they may be useful in other settings
and for other purposes. These tools differ from other interview techniques because
they are highly scripted, structured, and have specific purposes, such as assisting in
making DSM diagnoses (McConaughy, 2000b, 2005, 2013). Frankly, most practitioners—
especially school-based practitioners—will probably find that the most complex and
highly structured interview tools are not practical for day-to-day use. These tools usually
require extensive training and time, and are more suited for settings such as teaching
hospitals, and for purposes such as research. Further, with the release of the DSM-5,
many of the most frequently used clinical interview tools have yet to be adapted to
reflect changes in diagnostic criteria, symptoms, symptom duration, and added specifiers
(Leffler, Riebel, & Hughes, 2015). However, a good practitioner should be aware of what
is available in this area, even if he or she does not use these tools, and some of the emerg-
ing semistructured interview tools may be useful in school-based practice. Two interview
schedules that are representative of what is currently available are reviewed in some
detail, and some comments on additional interview schedules that are available follow
these reviews.

Schedule for Affective Disorders and Schizophrenia, School-Age Children

Also referred to as the Kiddie-SADS or K-SADS, the Schedule for Affective Disorders and
Schizophrenia (SADS) for School-Age Children (Puig-Antich & Chambers, 1978) is a
semistructured psychiatric diagnostic interview for children and adolescents in the six- to
17-year age range. It was developed as a downward extension of the SADS (Endicott &
Spitzer, 1978). Although the title of this instrument implies that it is for the purpose of
assessing affective and psychotic disorders, the K-SADS is a broad-based interview
that has been used for eliciting information on a wide range of emotional and behavior
problems, then classifying these problems according to DSM diagnostic criteria. The
K-SADS has undergone extensive research and revision. The differences among previous
versions have been described in detail by Ambrosini (2000).
At least three forms of the K-SADS have been developed. The Present Episode version
(K-SADS-PE) was designed for use in assessing current or present (within the past year)
episodes of psychopathology. The Epidemiologic version (K-SADS-E) was designed for
use in assessing psychopathology that has occurred over the course of the subject’s entire
life. The Present and Lifetime version (K-SADS-PL) was updated in 2009 by Axelson,
180 s Foundations and Methods of Assessment

Birmaher, Zelazny, Kaufman, and Gill. This version integrates some components of the
other two versions and includes many improvements, such as improved probes and
anchor points, diagnosis-specific impairment ratings, DSM-IV-TR diagnostic classi-
fication linkage, and a wider variety of disorder screening capabilities. For example,
extensive attention is given to bipolar disorders and pervasive developmental disorders.
This review focuses on elements of the K-SADS that are common to all versions or are
specific to the K-SADS-PL, given that it is a more recent version.
The K-SADS should be used only by experienced interviewers who have received
specific training. The format is fairly complex and requires a degree of sophisticated judg-
ment. All versions of the K-SADS first include a parent interview, then an interview of the
child or adolescent. Each interview takes approximately one hour (or longer), so one must
plan on two to three hours for the entire interview process. The interviews include a com-
bination of unstructured or open-ended questions, and questions regarding highly spe-
cific symptoms, which are scored on a rating scale. The K-SADS allows for skipping certain
areas of questioning that are not relevant for the particular client. In addition to providing
specific open-ended and structured interview questions, the K-SADS provides a format
for rating the overall behavioral characteristics and performance of the subject.
Data reported by Chambers et al. (1985) indicate that the K-SADS-PE has moderate
test–retest reliability with parents and children over a 72-hour period (average = 0.54
across symptom categories), and adequate inter-rater reliability (.86 for parent interviews
and 0.89 for child interviews) across symptom categories. A study of the validity of the
K-SADS-E by Orvaschel, Puig-Antich, Chambers, Tabrizi, and Johnson (1982) compared
K-SADS-E diagnoses of 17 subjects who were previously diagnosed using an earlier version
of the K-SADS and found that 16 of the 17 subjects received the same diagnosis. More
recent evidence on the K-SADS-PL indicates that it has good concurrent validity with
diagnostic classification and standard self-report measures and has excellent test–retest
reliability (Ambrosini, 2000; Kaufman, Birmaher, Brent, & Rao, 1997). In general, the
evidence regarding the K-SADS indicates that it has adequate to good reliability and
validity, and it has been recommended as one of the better structured interview schedules
for use with children and adolescents (Hodges, 1993). To be better aligned with the DSM-5,
the K-SADS does require some significant edits across particular diagnoses. For example,
some diagnoses, such as Autism Spectrum Disorders, will require updates to symptom
items, while Conduct Disorders will require updates to specifiers, since “with limited
prosocial emotions” has been added to reflect behavior consistent with callous/unemotional
traits (Leffler et al., 2015). The K-SADS may be a good choice for use in some situations in
which DSM diagnostic criteria are important.

The Semistructured Clinical Interview for Children and Adolescents

The Semistructured Clinical Interview for Children and Adolescents (SCICA)
(McConaughy & Achenbach, 2001), a more recently developed interview instrument
than the three tools discussed previously, is part of the ASEBA. The SCICA, which is
described in some detail by McConaughy (2000a, 2000b, 2005, 2013), is a more recent
addition to the ASEBA system and has undergone some fairly recent revisions that make
it a promising clinical and research tool. In contrast to the other diagnostic interview
schedules described in this chapter, which are designed to be used primarily as “stand-
alone” tools, the SCICA is intended to be used as one component of a comprehensive
assessment design, preferably with other parts of the ASEBA.
 Interviewing Techniques s 181

The SCICA is designed for use with children and adolescents aged six to 18. The
method of administration and scoring within the SCICA is novel in comparison with
the other structured and semistructured interview tools reviewed in this section. The
interviewer conducts an open-ended interview of the child or adolescent, with questions
in nine major areas, ranging from questions about activities, school, and job to questions
about self-perception and feelings. Then, the interviewer evaluates the behavior of the
interviewee using a standardized 120-item Observation Form and also evaluates the self-
report content of the interview, using a 125-item Self-Report. The observation and
self-report ratings are made using a 4-point scale, ranging from 0 (no occurrence of the
problem) to 3 (definite occurrence with severe intensity of more than three minutes
duration). Many of the SCICA items have direct or somewhat similar counterpart items
on the CBCL and TRS components of the ASEBA system. A training videotape is available
to assist users of the SCICA in learning scoring procedures.
Interviewer ratings on the SCICA are converted to T scores and percentile ranks using a
standardized profile of problem scales. Five empirically based syndrome scales are used in
deriving scores for problems observed by the interviewer: Anxious, Withdrawn/Depressed,
Language/Motor Problems, Attention Problems, and Self-Control Problems. In addition,
three syndrome scales are used in driving scores for the problems reported by the child or
adolescent during the interview process: Anxious/Depressed, Aggressive/Rule-Breaking,
and Somatic Complaints (for ages 12 to 18 only). Factor analysis of SCICA was used to
produce an internalizing and externalizing broad-band grouping of score clusters, and
there are also six optional scales that may be used to help cluster items into scores derived
from DSM-IV diagnostic categories: Affective Problems, Anxiety Problems, Somatic
Problems, Attention-Deficit/Hyperactivity Problems, Oppositional Defiant Problems, and
Conduct Problems. Like other elements of the ASEBA system, the SCICA may be scored
using hand-scoring profiles or by use of a computer software scoring program. Scores are
aggregated by the six to 11 and 12 to 18 age groupings. Score distributions of both typical
and clinic-referred youths were used by the authors to develop clinical cutoff scores.
Prior to the publication of the 2001 second edition of the SCICA, the senior author
of this tool noted, “Although the SCICA does not have the extensive research base of the
structured and semistructured diagnostic interviews, findings to date support its relia-
bility and validity for multimethod assessment of children’s problems” (McConaughy,
2000b, p. 343). Norms for the SCICA were derived from 686 children referred to a clinic
setting and adequate test–retest reliability estimates were achieved (mean r across scales
= 0.78). Some new research findings have been compiled since the 2001 revision,
although it is fair to say that the amount of evidence for the SCICA is still limited and
does not equal what is available for the three older structured interview systems that
were reviewed previously. That said, the SCICA is recommended as an innovative
semi-structured interview tool for use with children and adolescents. Although training
is required for effective use of the SCICA, it is not as complicated as some other stand-
ardized interview systems, and clinicians who are already familiar with the other com-
ponents of the ASEBA system should have little problem learning it, especially if the
training videotape is used. One of the primary advantages of the SCICA is its connection
to the ASEBA system, and the common platform for deriving scores from interview
items, which is part of this connection. Future research may help to further establish the
SCICA, but it presently appears to have sufficient technical integrity, user-friendliness,
and usefulness to warrant its use as part of a multimethod assessment.
182 s Foundations and Methods of Assessment

Concluding Comments on Formal Interview Schedules

As was stated earlier, these two interview schedules do not represent the entire domain
of semistructured and highly structured interview tools that are available for use with
children and adolescents. The National Institute of Mental Health Diagnostic Interview
Schedule for Children (DISC-IV) (Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000)
is a widely known structured interview schedule for use in assessing child and adolescent
behavioral emotional problems, and it has been through several revisions over the years.
Other structured interview schedules that have been reported in the child psychiatry and
psychology literature include the Interview Schedule for Children and Adolescents (ISCA)
(Sherrill & Kovacs, 2000), the Mental Health Assessment Form (MHAF) (Kestenbaum
& Bird, 1978), and the Children’s Interview for Psychiatric Syndromes (ChIPS) (Weller,
Weller, Rooney, & Fristad, 1999). The two interview schedules reviewed in this chapter
were featured because of factors such as availability, amount and quality of psychometric
data, ease of use, and general purpose design.
Formal structured and semistructured interview schedules are an important develop-
ment in the area of child and adolescent assessment, particularly in the arenas of psychia-
try and mental health. For the most part, they represent high-quality attempts to integrate
a stronger empirical base into the process of clinical interviewing. These tools appear
to be particularly useful for assisting in generating DSM diagnoses, but many need revi-
sions to be more consistent with DSM-5, and they are decidedly less useful for day-to-day
assessment of child problem behaviors in school settings.

CLINICAL INTERVIEWING AND SUICIDAL IDEATION OR BEHAVIOR

Suicide is one of the most disturbing phenomena faced by mental health professionals. It
is particularly troubling when a person who makes a suicide attempt is a child or adolescent.
Many individuals simply cannot understand why a young person—someone with “his or
her whole life ahead of them”—would even consider the possibility of taking his or her
own life. To most individuals, suicide is an intensely irrational act. The evidence regarding
suicide convinces us that it cannot be dismissed, however, and that children, especially
adolescents, are not immune to it. Because suicide attempts and completions by children
and adolescents seem to be increasing in the United States, and because clinical interviewing
is the most widely used and direct method of assessing suicidal ideation (thinking about
suicide) and potential suicidal behavior (specific behaviors aimed at suicide), this section
is included. First, some facts regarding suicidal ideation and suicidal behavior among
young people are provided. Second, recommendations for conducting clinical interviews
with children and adolescents who may be suicidal are offered. This treatment of clinical
interviewing and suicide is necessarily brief. Readers who desire a more in-depth treatment
of the topic are referred to chapters by Brock and Sandoval (1997), McConaughy (2013),
and Sattler (1998); books by Berman and Jobes (1991), Davis and Sandoval (1991),
Erbacher, Singer, and Poland (2015) and D. N. Miller (2011); and articles by Peach and
Reddick (1991) and Shaffer, Garland, Gould, Fisher, and Trautman (1988).

Facts Regarding Suicidal Behavior among Children and Adolescents

When we discuss statistics concerning suicide among young persons, it is important to
recognize that there are many problems with the data, including the fact that most of the
 Interviewing Techniques s 183

available data are a few years old, and that the data are in some cases contradictory. Many
(perhaps most) suicide attempts go unreported, and many suicides are misinterpreted or
reported as accidents. The available evidence does indicate, however, that suicide among
children and adolescents is a significant problem in U.S. society. It appears that the rate
of suicide among young people in the United States has increased since the 1990s.
Statistics for younger children are virtually nonexistent. For elementary-age and middle
school-age children (ages ten to 14), Curtin, Warner, and Hedegaard (2016) reported a
suicide rate of 0.5 per 100,000 for females and 1.9 per 100,000 rate for males in 1990,
compared to a 2014 female suicide rate of 1.5 per 100,000 and male suicide rate of 2.6 per
100,000. For ages 15–24, this report included a female suicide rate of 3.0 per 100,000 and
a male rate of 16.8 per 100,000 in 1990. This is compared to 2014, when the female rate
was 4.6 per 100,000 and 18.2 per 100,000 for males. Although these rates are not as high
as the suicide rates for any adult age group in the United States, they are troubling, not
only because of their mere existence, but also because of their continually increasing
trend. More recent data from the Centers for Disease Control (2006) indicates that the
increasing rates of youth suicide in the U.S. appear to have leveled off or even diminished
since the 1990s, but they are still much higher than in the 1960s and 1970s, and the
problem is considered to be unacceptable.
Although suicidal ideation and suicidal behavior potentially may affect young persons
from virtually any demographic, there are clear demographic trends regarding who is
more likely to make and complete suicide attempts. Regarding gender, girls are more likely
than boys to make suicide attempts, but boys are more likely than girls to complete suicide
attempts. Among adolescents of all racial/ethnic groups, girls were about twice as likely as
boys to make a suicide attempt, but boys were about four times as likely as girls to die by
suicide (Centers for Disease Control, 2006). There are some substantial group differences
regarding race and ethnicity. According to the 2012 Statistical Abstract of the United
States from the U.S. Census Bureau, non-Hispanic/White males account for 21.9 per
100,000 suicides, and Native American/Alaska Native males account for 18.1 per 100,000
suicides. Further, LGBTQ are perhaps at most risk as 1 in 3 youth attempt suicide.
There are additional, numerous risk factors that may increase vulnerability among
young people to suicidal ideation and behavior. Although these risk factors are complex
and in many cases interactive, some of the major ones are thought to be the following:

s PSYCHOLOGICALDISORDERSPARTICULARLYDEPRESSIONANDCONDUCTDISORDER
s SUBSTANCEABUSE
s FAMILYHISTORYOFSUICIDE
s FAMILYHISTORYOFSIGNIlCANTMEDICALANDPSYCHIATRICILLNESS
s CHRONICANDDEBILITATINGILLNESS
s FEELINGSOFHOPELESSNESS
s SEVERELIFESTRESSESPECIALLYINVOLVINGPERCEIVEDLOSSES

These risk factors, when they exist in isolation, may be relatively weak predictors of
suicide; however, they may have an interactive effect on each other. In other words, the
presence of additional risk factors may increase vulnerability to suicide in more of a
multiplicative than additive manner.
Experts on child and adolescent suicide have noted that although suicide attempts may
occur suddenly after a single traumatic stressor, they usually are preceded by a number
184 s Foundations and Methods of Assessment

of signals or warning signs that may predict the suicide attempt (McConaughy, 2013).
Although it is crucial to recognize that such warning signs may be numerous, complex,
and weakly predictive in individual situations, they nevertheless should be scrutinized
carefully. Some of the most commonly identified suicide warning signs include the
following:

s SUICIDENOTES
s SUICIDETHREATSSUICIDALSTATEMENTSBOTHDIRECTANDINDIRECT
s PREOCCUPATIONWITHDEATHANDRELATEDTHEMES
s ROMANTICIZINGANDGLORIFYINGDEATH
s MAKINGlNALARRANGEMENTSEGSAYINGGOODBYEGIVINGPOSSESSIONSAWAY 
s FEELINGSOFHELPLESSNESSANDHOPELESSNESS
s WITHDRAWALFROMFAMILYANDFRIENDS
s LOSSOFINTERESTINACTIVITIESTHATWEREPREVIOUSLYIMPORTANT
s HEAVYUSEANDABUSEOFDRUGSINCLUDINGALCOHOL
s MARKEDCHANGESINTEMPERAMENTANDORBEHAVIOR

There is some overlap between the list of risk factors and the list of warning signs.
Some characteristics or behaviors seem to serve both purposes. Most children and
adolescents who become suicidal are not likely to be observed by persons who are highly
familiar with the warning signs of suicide. It is more realistic to think that the persons
most likely to observe suicide warning signs will be parents, friends, and teachers.
Professional education and outreach activities regarding warning signs are imperative.

Recommendations for Clinical Interviewing

While sometimes controversial, many schools have begun to consider implementation
of school-based suicide prevention screening and programming (Hamilton & Klimes-
Dougan, 2015; Lazear, Roggenbaum, & Blasé, 2012; Schilling, Aseltine, & James, 2016).
This work requires building school professionals’ capacity to understand and notice
student behaviors that may suggest risk as well as planned responses to students’ self-
reports of suicide risk. Although some good tools for screening for suicidal tendencies
among adolescents have been developed, such as W. M. Reynolds’ (1987) Suicidal Ideation
Questionnaire, most clinicians use a more traditional interview format for such assess-
ment. If this is the case, it is crucial that particular questions be asked and that particular
areas of content be included in the interview. There should be some strands of evidence
within the overall assessment or the content of the interview that first alert the interviewer
that the client may be suicidal. Questions regarding the client’s affect, level of engagement
in activities, substance abuse, changes in routines and behavior, and especially feelings of
helplessness and hopelessness may serve to drive hypotheses regarding potential suicidal
characteristics. These areas of questioning may be part of a standard clinical interview but
may be formed by analysis of other assessment data, such as self-report tests and behavior
rating scales. Prior conversations with parents and teachers also may provide information
that may help focus the content of the interview toward suicide assessment.
When the clinician has enough evidence to justify some concern or suspicion regarding
the client’s potential suicidal ideation or behavior, it is crucial simply to “jump right in”
and conduct a suicide assessment interview. A common mistake that is made by inexperi-
enced clinicians is that clients will be too hesitant to respond to questions regarding suicide
 Interviewing Techniques s 185

or that they may become extremely upset if such questions are asked. In reality, the inex-
perienced clinician may be the one who is more likely to feel uncomfortable or upset by
such questioning. On a personal note to back up this assertion, consider Merrell’s own
experience teaching an assessment class while in the process of revising this text for a pre-
vious edition. During the lecture and discussion on interviewing potentially suicidal
youths, the class included an activity where graduate students in the class conducted prac-
tice interviews by following carefully scripted scenarios. The discussion following this
activity was revealing and actually carried into the next week. Graduate students who had
little or no prior experience interviewing suicidal clients were in several cases very upset
by the scripted practice scenarios, and it was necessary for Merrell to spend a considerable
amount of time debriefing after the exercise, following up with students individually, and
discussing the issue of conducting this activity in real practice. While this may seem time
consuming and perhaps uncomfortable, it is important to have the opportunity to practice
such skills and to think through potential scenarios prior to engaging in this work in the
“real world.”
The experience of most clinicians who work with emotionally and behaviorally
troubled children and adolescents is that they are relatively candid regarding suicidal
thought and action and may be willing to discuss it because of their ambivalent feelings
or desire to receive help. If there are reasonable concerns, the clinician should initiate
a suicide assessment interview and take all statements regarding suicidal ideation and
thought seriously. If there are no valid reasons for such concern, this will become mani-
fest quickly enough during such an interview, and the clinician can move on to a more
relevant topic.
There are many ways that suicide assessment questions may be asked, and these need
to be modified depending on the developmental characteristics of the client. Certain
areas of questioning are deemed crucial, however, in conducting a suicide assessment
interview.

Thinking about Suicide The first area of questioning is to ask the child or adolescent if he
or she has been thinking about killing himself or herself. For younger and less cognitively
sophisticated clients, this area of questioning may need to be modified because the concept
of death may be difficult for them to comprehend fully. In such cases, questions such as
“Have you been thinking about wanting to be dead?” or “Do you sometimes wish you
could make yourself be dead?” might be appropriate.

Suicide Plan If there is sufficient evidence that the client has been having suicidal thoughts,
it is crucial to ascertain whether a particular plan for suicide is in place. Questions such
as “Do you have a plan?” “Have you thought about how you might kill yourself?” or “Do
you have specific ideas about how you might kill yourself?” may be useful in this regard.
Clinicians should be particularly aware of how concrete or detailed such plans are. It is
generally agreed that the more specific or detailed the plan, the more the individual has
thought about suicide.

Means and Preparations for Suicide If the client indicates that he or she has a plan, the
next area of questioning should be aimed at determining if the client actually has
the means at hand (or specific preparations) to carry out such a plan. Questions such as
“Do you have the means to carry out your plan, with you now, at school, or at home?”
186 s Foundations and Methods of Assessment

might be used. If the plan is specific and, for example, involves a gun, the clinician simply
should ask the child or adolescent, “Do you have a gun?” or “Is there somewhere you can
get a gun?” At this point, it is crucial to become very specific. Clinicians should find out
exactly where the lethal means are (e.g., “in my dad’s gun cabinet in the basement”).

Intended Place or Setting Assuming a suicide plan is in place, the clinician should ask
where the client intends to commit the act. Such specificity in questioning has resulted
in a prevented suicide on many occasions. It also may be helpful to ask whether the client
has written a suicide note and, if so, what it says and where it is. A statement or question
such as “You told me that you were seriously thinking about killing yourself, and that you
would probably do it with the sleeping pills in your mother’s medicine cabinet. Have
you thought about where you might take the pills?”

Immediate Protective Action If one has proceeded through a suicide assessment interview
and becomes convinced that the client has been seriously considering the possibility
of killing himself or herself, ethics, law, and professional practice dictate that there is
responsibility to take further action to support and protect the client. In the most serious
cases, in which it is apparent that the client is clearly intent on killing himself or herself
and has a plan and lethal means in place, immediate and direct action must be taken.
First, the clinician should never leave a suicidal client alone in an unsecured setting, even for
a short time. Second, clinicians should follow whatever protocol or policy is in place
for such emergencies at their place of practice. Regarding this issue, Sattler (1998) stated,
“If you decide there is a risk of imminent danger, notify the parents immediately, ask
them to come to your office to get their child, and advise them to hospitalize their child”
(p. 441). All U.S. states have provisions within licensing and certification laws regarding
protecting clients from harming themselves. The clinician must be aware of the laws and
policies in his or her area and be prepared to follow them in such emergency situations.
In most areas, law enforcement officers may be called for assistance in situations in which
there is clearly imminent danger and there is no reasonable means to get the in-danger
person to the proper evaluation and treatment facility (i.e., the parents are not available
or are not willing to provide assistance).

Suicidal Safety Planning Assuming that the clinician ascertains that a child or adolescent
client has been thinking seriously about suicide, but there is no evidence of imminent
danger, another set of supportive and protective actions is called for. Clinicians often elicit
a promise or contract from the client that he or she will not engage in a suicide attempt
or any related harmful behavior and that he or she will call the clinician (or their counselor/
therapist) if he or she begins to think seriously about it. Such contracts may be in formal
written form or in the form of a verbal agreement. While clinicians often engage in this
contract process, it has actually not been found to be effective (Matarazzo, Homaifar,
& Wortzel, 2014). Instead, clinicians are encouraged to engage in more of a supportive
safety planning process in which they help clients to identify their own warning signs;
to build coping strategies; to consider social environments or people that might help
them be distracted from feelings of distress; to identify people who can help; and to learn
about who to call and where to go during a crisis (Matarazzo et al., 2014). In situations
in which there is clear risk but no apparent immediate danger, it is important to discuss
what resources the client may have to help him or her through this difficult time. Is there
 Interviewing Techniques s 187

someone or something that would stop the client from making a suicide attempt? Is
there someone with whom they are comfortable talking about their feelings? Have they
talked to family or friends about their feelings? These types of questions help to set the
stage for getting the client to think in terms of available support and appropriate courses
of action to take when he or she is distressed.
Even if the child or adolescent client does not seem to be imminently dangerous to
himself or herself, it is still recommended in most cases that the parents be called and
asked to visit with the clinician. Although the clinician may have made an agreement
with the client that their conversations would be held in confidence, danger of suicide
is always considered an exception to confidentiality rules, and prudent clinicians make
sure their clients understand this fact (and related exceptions to confidentiality) up front.
The discussion with the parents should be frank and should assist in determining what
support and resources the family is capable of providing and educating them regarding
appropriate actions to take. Most parents in such a situation are fearful and upset and
may need substantial confidence and support. Finally, it is crucial for clinicians to consult
with other professionals (especially their supervisor) regarding suicidal clients and to
determine jointly an appropriate course of action, such as follow-up plans or making a
referral. The burden of clinical interviewing with a suicidal child or adolescent is simply
too great to carry alone, and in this case, the old adage “when in doubt, consult” is
particularly important.
In sum, clinical interviewing of children and adolescents who may be suicidal is a
special circumstance and requires specific interviewing behavior and follow-up actions.
Regardless of the setting in which they work, it is essential that clinicians who work with
emotionally and behaviorally troubled youth become familiar with best practices for
interviewing suicidal clients and that they establish and follow a practice or agency
protocol for dealing with such situations. On a final note, be aware that this kind of work
can be very taxing on the professional, and there are many ways for it to go wrong, even
if all the proper steps have been followed. It may be useful to agree to not be exceptional at
this difficult work.

INTERVIEWS AND DECISION MAKING

How useful are interviews when it comes to decision making? They can range from
moderately useful to extremely useful, depending on the specific decision-making
process. For making additional assessment decisions, interviewing can provide excellent
information regarding specific additional areas that need to be assessed. During the
process of interviewing, additional information may surface that will persuade the inter-
viewer of the necessity for observation or other objective assessment in specific areas.
Interview information can be important for diagnosis and classification decision making,
although it seldom should be used alone. For special education classification, it is essen-
tial that decisions not be made based on a single assessment method. For making DSM
diagnostic decisions, the interview normally serves as an important aspect, perhaps a
keystone of a comprehensive assessment, although in some cases, DSM diagnoses can be
made based on interview data alone. In making placement decisions, interview data can
provide necessary clues and be used to support inferences drawn from additional
information sources, but data alone are seldom sufficient to make the decision. One of
188 s Foundations and Methods of Assessment

the best uses of information obtained through interviews is for intervention or treatment
decisions. If the interviews were structured carefully to identify specific problems and the
environmental conditions eliciting and maintaining those problems (e.g., behavioral
interviewing), there may be obvious implications for developing an intervention plan or
at least for conducting a functional behavior assessment. In the case of developing pre-
vention or intervention responses for suicidal youth, interviewing is likely the single best
source of information.

CONCLUSIONS
Interviewing holds a place of prominence as an assessment method among mental health
professionals. Even among the lay public, interview assessments by specially trained
professionals are accorded high status and may even be the object of unrealistically high
expectations. Although interviews appear simply to be special cases of a conversation,
they are in fact much more complex in that they are goal-oriented and the interviewer
attempts to shape or lead the direction of the conversation to fulfill specific information-
gathering purposes. There are several methods of interviewing, ranging from being
loose to tight in structure. Interviews have many advantages. They have disadvantages as
well, however, and foremost among these disadvantages is the well-known problem of
unreliability across interviewers.
Effective clinical interviewing of children and adolescents absolutely requires the
clinician to have knowledge of developmental issues and to use this knowledge to inform
the interviewing technique. Each of the three major developmental stages of early
childhood, middle childhood, and adolescence includes major cognitive developmental
milestones and changes and challenges in social–emotional functioning. Regardless of the
chronological age of the child or adolescent client, it is essential to ascertain quickly his or
her functioning in the various developmental areas and to build the interview format and
activities based on developmentally appropriate expectations and tasks.
Several key factors may affect the overall quality of the interview. Perhaps most crucial
among these factors is the interpersonal context, or the relationship that is established
between the interviewer and the interviewee. One’s culture may decidedly shape the inter-
personal communication style and characteristics, and clinicians must show appropriate
understanding of, and sensitivity to, race, ethnicity, and other cultural variables that may
be important in establishing effective communication. Behavior of the client during an
interview may be shaped by the clinician to optimize the validity of the interview through
making specific requests and through modeling appropriate ways of responding. The
physical context of the interview is an important factor in affecting interview quality.
Clinicians should arrange and modify the physical circumstances of the interview setting
to make the child or adolescent feel comfortable, safe, and secure.
Traditional interviewing techniques tend to be relatively unstructured and highly
flexible and are probably the most commonly used of any of the interviewing techniques.
In conducting traditional unstructured interviews, clinicians should strive to obtain
appropriate relevant historical and developmental information from parents, develop
the interview in a manner that meets their goals for interviewing, and carefully observe
certain key behaviors of the interviewee. Traditionally, there are several specific areas of
questioning that are useful to focus on in conducting clinical interviews.
 Interviewing Techniques s 189

Behavioral interviewing tends to be more structured than traditional interviewing

and is aimed clearly at identifying crucial events and behaviors that elicit, shape, or
maintain the presenting social–emotional problems. Behavioral interviews tend to involve
parents and teachers in a consultation model of service delivery. Behavioral interviews may
provide an important foundation for conducting a functional behavior assessment.
Various models have been presented for conducting behavioral consultation interviews,
but most are oriented toward identifying and analyzing the problem in behavioral terms
and, most importantly, identifying possible intervention agents and factors to change
problem behaviors.
Several structured interview schedules have been developed for use with children
and adolescents. These structured interview schedules, such as the K-SADS and SCICA,
in most cases tend to be scripted and time-consuming and require extensive inter-
viewer training. In their better manifestations, such structured interview schedules
can yield high reliability across interviewers, however, something that is notoriously
difficult with less structured interview methods. Also, some of these structured interview
methods, particularly the K-SADS, have been shown to have good diagnostic validity
from a DSM diagnostic perspective. Some emerging interview tools, such as the SCICA,
show a great deal of promise as alternatives to the traditional structured diagnostic
schedules.
For assessing children and adolescents who may be suicidal, clinical interviewing is
the pre-eminent method and offers many advantages over other methods, such as rating
scales, self-report tests, and direct behavioral observation. Suicide among children and
adolescents appears to be a significant phenomenon in U.S. society. It is essential that
clinicians who work with troubled children and adolescents become knowledgeable in
conducting a suicide assessment interview. Such an interview requires specific areas of
direct questioning to ascertain if the individual may be suicidal, if he or she has a specific
plan and lethal means in place, and what supports may be available to individuals to
help them cope with suicidal feelings and thoughts. Ethically, there are specific obligations
that professionals assume when interviewing a suicidal child or adolescent, specifically, the
duty to protect. In the most serious cases, immediate protective action must be taken,
which in some cases involves immediate hospitalization or asking for the assistance of law
enforcement officers. In cases in which the threat of danger to the self seems less clear and
imminent but is still probable, other precautionary and follow-up measures should be
taken. When dealing with suicidal children and adolescents, it is often necessary to break
the confidentiality of the communication and to notify other persons, particularly the
child’s parents. Working with suicidal clients is too great of a burden for one professional
to deal with in isolation. Discussing suicidal cases with a supervisor is a given, and practices
and agencies should have clear guidelines in place for such situations. Even for clinicians
in solo private practices, it is crucial to consult with trusted colleagues regarding the
appropriate course of action: “When in doubt, consult.”

REVIEW AND APPLICATION QUESTIONS

1. Regarding physical circumstances of clinical interviews with children, what is the
recommended optimal furniture and space setup to facilitate comfort and communication?
2. Several typical interpersonal communication styles and behaviors related to the racial
or ethnic background of individuals were described in this chapter. How well do such
190 s Foundations and Methods of Assessment

generalities predict individual behavior, and what are some problems related to overgen-
eralizing such inferences regarding group differences?
3. Regarding cognitive development of children and adolescents, how should our knowledge
of developmental stages shape specific interviewing practices with preschool-age and
primary-age children, with elementary-age children, and with adolescents?
4. Regarding social–emotional development of children and adolescents, how should our
knowledge of developmental stages shape specific interviewing practices with preschool-
age and primary-age children, with elementary-age children, and with adolescents?
5. What are some practical ways that behavioral interviewing might be useful in identifying
possible functions of behavior and in developing future intervention plans?
6. For what purposes are structured and semistructured clinical interview schedules such as
the K-SADS and SCICA most appropriate?
7. When should a statement by a child or adolescent regarding suicide be taken seriously?
8. If one is concerned that an interviewee may be suicidal, what are the most essential areas
of questioning to pursue?
9. What prior preparations are recommended for breaking confidentiality between clinicians
and minor clients in the case of suicidal ideation or behavior?
 7
SOCIOMETRIC TECHNIQUES

Sociometric techniques include a variety of procedures used within social groups to

measure such related constructs as social status, popularity, peer acceptance or rejection,
and reputation. Sociometric techniques are not new; in fact, they have been used in
educational–clinical practice and research since the 1930s. Several important research
efforts in this area occurred between the 1960s and 1980s. These landmark studies
(e.g., Cowen, Pederson, Babigan, Izzo, & Trost, 1973; Dodge, Coie, & Brakke, 1982; Roff,
1961) emphasized the importance of social functioning in childhood and underscored the
importance of clinicians who work with children having a basic knowledge of sociometric
assessment methods, regardless of whether they use these techniques on a regular basis.
This chapter begins with a discussion of the conceptual and historical foundations of
sociometric assessment and some information about the validity of sociometrics for
various clinical and research purposes. The largest section of the chapter is devoted to
detailed overviews of four general types of sociometric methods: peer nominations, peer
ratings, sociometric rankings, and alternative sociometric procedures. General and specific
aspects of assessment using these four approaches are discussed, and numerous examples
are presented. Following the overview of specific sociometric assessment techniques, some
ethical and pragmatic issues regarding sociometric assessment are explored. The chapter
ends with a discussion on how sociometric assessment can be used best in making various
types of clinical and educational decisions.

SOCIOMETRICS: IMPORTANCE, HISTORY, AND EMPIRICAL BASE

Sociometric assessment procedures involve gathering information directly from within
a peer group (usually in a classroom setting) concerning the social dynamics of that
group. The key ingredient of sociometric assessment is that data on various aspects of
social status of persons within the peer group are obtained directly from its members,
rather than through observations or ratings by impartial outside evaluators. These pro-
cedures allow the assessor to tap directly into the ongoing social dynamics of a group, an
obvious advantage because there are many aspects of social relationships within a group
that are not easily discernible to the casual observer (Merrell & Gimpel, 1998; Worthen
et al., 1993).
Sociometric assessment provides an avenue for measuring constructs such as level
of popularity; peer acceptance or rejection status; and attribution of specific positive
and negative characteristics such as leadership ability, athletic or academic prowess,

191
192 s Foundations and Methods of Assessment

aggressiveness, and social awkwardness. In contrast to many other assessment methods,

sociometric procedures are not usually norm-referenced, standardized, or commercially
published. Instead, they tend to consist of different variations of a few relatively simple
methods originally developed for use by researchers but capable of being translated into
school or clinical practice.

Why Assess Social Status?

In 1917, C. R. Beery, a prominent educator, published a series of books titled Practical
Child Training. In this series, Beery offered some practical advice to mothers who had
children with few friends and difficulty approaching peers. Beery suggested that mothers
could help these children by facilitating opportunities for peer interaction, such as a
picnic that would include their children’s classmates. He noted that these types of activities
would help children to “have a royal good time” and further suggested that if a child
shows fear in approaching other children, the mother should “not scold or make any
scene, but simply appear to pay no attention to him” (cited in Asher & Parker, 1989, p. 5).
Although advice to parents may now take a different form in contemporary contexts, this
anecdote demonstrates that concern regarding the quality of children’s social interactions
with peers has been of academic and practical importance for many years.
As we see herein, the study of social status is important because peer relationship
problems during childhood may have a potentially large and lasting impact on later
adjustment in life, whether positive or negative. How extensive are peer relationship prob-
lems during childhood? Based on a classic study by Hymel and Asher (1977), wherein
typical elementary-age children were asked to nominate their three best friends, Asher
(1990) provided a conservative estimate that about 10% of all children experience signif-
icant peer relationship difficulties. This estimate is based on Hymel and Asher’s finding
that about 10% of the children in the study were not named as anybody’s best friend.
Asher (1990) noted that if the criterion of reciprocal friendship nominations is used,
the estimated percentage of children with peer relationship problems is substantially
higher. We can make a conservative estimate that at least 10% of all school-age children
experience notable problems in developing friendships and in gaining social acceptance.
Given the poor long-term prognosis that may follow many of these children, this figure is
alarming.
The study and assessment of children’s social status is also important because of the
positive developmental purposes that children’s friendships serve. Fine (1981) noted that
children’s friendships serve an important purpose by making a significant contribution
to the development of their overall interactional competence. In other words, through the
processes that friendship building requires and refines, children not only learn to interact
effectively with their friends, but also develop social-interactional skills that may general-
ize to many other situations and persons. Fine specifically identified three functions of
preadolescent friendships that contribute to general interactional competence. First,
friendships provide a staging area for behavior. Friendships are situated in social environ-
ments that have implications for the acquisition of interactional competencies. Second,
friendships are cultural institutions, and as such they provide didactic training. Third, friend-
ships provide a context for the growth of the child’s social self, a context within which
he or she can learn the appropriate self-image to project in social situations (p. 49).
Understanding some of these dynamics regarding the positive developmental aspects of
children’s friendships allows us to understand better why peer relationship problems in
 Sociometric Techniques s 193

childhood can be so detrimental. Essentially the development of positive peer relation-

ships via friendship making is a crucial aspect of a child’s overall cognitive and social
development.

Historical Development of Sociometric Assessment

The use of sociometric assessment procedures dates back to the 1930s, with the first
clinical and research uses of these techniques being conducted by educators and socio-
logists. One of the first published works on sociometry was a highly influential book
by Moreno (1934), ominously titled Who Shall Survive? The earliest attempts to use
sociometric assessments were experimental and novel, but by the late 1930s and early
1940s, reports of the systematic use of sociometry began appearing in scholarly journals.
The journal Sociometry began publication in the 1930s and included a mix of articles
showing applications of sociometric techniques in educational practice and sociological
research. Several research reports using sociometric assessment were published in the
Journal of Educational Psychology in the early 1940s, as exemplified through articles by
Bonney (1943) and Young and Cooper (1944).
By the 1950s, the state of sociometric assessment had advanced considerably, and
many books were published on the topic (e.g., Cunningham, 1951; Laughlin, 1954; Taba,
Brady, Robinson, & Vickery, 1951). During this period, and probably through the early to
mid-1960s, sociometric procedures were used commonly as a means of measuring social
adjustment in public school settings, in what can now be viewed as a kind of “golden
age” of sociometry. Starting in about the mid-1960s, the use of sociometrics as a typical
school-based assessment procedure appears to have declined. Possible reasons for the
declining clinical or practical use of sociometrics may include the advancement of other
forms of assessment (specifically behavior rating scales and objective self-report measures),
emerging new ethical and legal standards regarding informed consent and assent, public
and professional concerns that sociometric assessment may have some negative effects
on some children, and the increasingly stringent nature of ethical guidelines for research
and human subjects institutional review boards. Although concerns do exist about the
potential negative effects of sociometric assessment, these concerns have not necessarily
been substantiated through research. The ethical–professional concerns associated with
sociometric assessment are discussed later.
Although sociometric techniques are still used widely by researchers in the fields of
child development, education, sociology, and psychology, their use as a standard method
for assessing social adjustment problems in schools appears to be less than it was in the
1970s and 1980s. Surveys of school psychologists during the 1980s (Goh & Fuller, 1983),
1990s (Hutton, Dubes, & Muir, 1992), and 2000s (Shapiro & Heick, 2004) indicated that
sociometric procedures were used so seldom by practitioners that they did not even
appear on tables of survey results.
One area in which sociometry has begun to gain momentum in education, however, is
in use of statistical packages that support Social Network Analysis (SNA) methodology to
“map” relationships within an organization (e.g., school, classroom). SNA is different from
typical sociometric techniques that aim to better understand attributes of individuals (e.g.,
students) and how individuals are separated based on attributes. SNA, rather, is predicated
on understanding shared attributes and relational ties between individuals to understand
social influence, diffusion of ideas, and achievement of outcomes (Grunspan, Wiggins,
& Goodreau, 2014). Whether there will be increased use of sociometric assessment in the
194 s Foundations and Methods of Assessment

future remains to be seen, but it is doubtful that sociometry, used to understand attributes
and clinical concerns, will regain the level of popularity that it had during its heyday in the
1940s and 1950s, if for no other reason than because of the advent and refinement of so
many other competing assessment procedures that were not available at that time, coupled
with the challenges of obtaining informed consent and assent on a groupwide basis.

Validity of Sociometric Assessment

Dimensions of Social Status According to Landau and Milich (1990), early researchers in
the use of sociometrics tended to view social status in a fairly unidimensional manner.
More recent efforts in this area have led investigators to conclude, however, that the
construct of social status is complex and multidimensional. In a landmark study, Coie,
Dodge, and Coppotelli (1982) used peer preference questions in a sociometric technique
with a large number (N = 5,537) of elementary-age and middle school-age children
and analyzed the obtained data to develop five different social-status groups: popular,
rejected, average, neglected, and controversial. An analysis of characteristics of the
students indicated that although there was some overlap between categories, each category
had some distinct features. Popular children were those who were rated by peers as being
cooperative, having leadership ability, and engaging in little disruptive behavior. Rejected
children were rated as frequently fighting and being disruptive and not being cooper-
ative or having leadership traits. Neglected children were those who were largely ignored
by other children and were seen as being socially unresponsive. The fourth nonaverage
group, controversial children, tended to exhibit features of the popular and the rejected
group, being considered disruptive and aggressive, but also as being assertive leaders. This
widely cited and influential conceptualization of social-status ratings shows how complex
social dynamics within peer groups can be and indicates that sociometric procedures can
provide complex and compelling social assessment data.
Table 7.1 presents the four nonaverage groups from the Coie et al. (1982) study, with
a listing of the social–behavioral characteristics pertinent for each group. In viewing this
conceptualization of children’s social-status groupings, it is important to recognize that
this system is not without criticism.
Because Coie et al.’s system has been so widely influential, it has been adopted by
researchers for various purposes in several investigations. Not all of these studies have

Table 7.1 Descriptions of four nonaverage child and adolescent social status

Group Sociometric findings and social–behavior characteristics

Popular Receive the most positive and fewest negative nominations; described by peers in
prosocial terms and perceived as leaders
Rejected Receive the most negative nominations; described by peers as being disruptive and likely
to fight; perceived as having poor leadership skills and being uncooperative
Neglected Receive few positive or negative peer nominations; described by peers as being shy and
unassertive; perceived as having poor social skills
Controversial Have characteristics similar to popular and rejected groups; described by peers as being
active and assertive leaders, but also perceived as being disruptive, demanding, and
frequently not liked
Note: Based on research by Coie, Dodge, and Coppotelli (1982).
 Sociometric Techniques s 195

produced results supportive of the classification system. Gresham and Stuart (1992)
found that the categories in the Coie et al. system (particularly the Controversial category)
were relatively unstable over a one-year interval and produced high reclassification errors.
Foster, Bell-Dolan, and Berler (1986) maintained that the Coie et al. classification system
produced subject selection bias and overlapped poorly with teacher nomination and
assessment methods. These two studies do not negate the usefulness of the classification
system but should serve to promote careful consideration and caution in its use.

Technical Adequacy of Sociometric Procedures The technical and psychometric aspects

of various sociometric procedures have been investigated in numerous studies. In general,
the yield of this research has shown favorable evidence of the technical adequacy of
sociometrics, leading the authors of one comprehensive review of sociometrics to state,
“We find clear evidence of the importance and utility of sociometrics” (McConnell &
Odom, 1986, p. 275). Temporal stability of sociometric assessments has been shown to
be relatively high at short-term and long-term stability periods (Hartup, 1983; Jiang &
Cillessen, 2005; Roff, Sells, & Golden, 1972). Landau and Milich (1990) reviewed several
studies of inter-rater correspondence in sociometric procedures and noted moderate to
high levels of correspondence between raters. There is one interesting and peculiar finding
in this regard, however: a gender difference on social convergence in ratings wherein
boys and girls tend to attribute more positive attributes to members of their own sex and more
negative attributes to members of the opposite sex. A methodologically sophisticated study
on this topic by Hayden-Thomson, Rubin, and Hymel (1987) went a step beyond simply
identifying the fact that boys and girls tend to provide more positive nominations and
ratings to each other than to members of the opposite sex. In this study, gender biases in
children’s sociometric preferences were examined developmentally. The authors used a
two-study cross-sectional design to obtain rating scale data from 195 girls and 191 boys
in kindergarten through third grade and 91 girls and 88 boys in third grade through
sixth grade. As expected, the results indicated that children at each grade level rated their
classmates of the opposite sex significantly lower than same-sex peers. A significant linear
trend for these gender biases was found, however, wherein the negative gender biases of
boys and girls increased with age. This trend was particularly evident at the early grade
levels. The generally strong inter-rater correspondence in sociometric assessment may not
generalize well when cross-gender data are considered, particularly as children move from
early childhood to intermediate elementary grades.
The role that context plays in understanding the stability of sociometric preferences has
also recently been studied. Martin (2011) published an article in which he had surveyed
the sociometric preferences of 522 students from the island of Tenerife. Surveys required
students to state their most and least preferred classmates in academic settings and in
leisure (recess) settings. About 50% of students’ ratings changed depending on context.
Ratings included children identified as preferred, rejected, ignored, controversial, and
unclassified. Students rated as rejected had the most stable scores across settings while
students rated as controversial in one setting were those that were most likely to receive a
different rating in another setting.

Predictive Validity of Sociometric Assessment Predictive validity, or ability to predict

future social outcomes of sociometric assessment procedures, has been established
through several widely cited studies. Cowen et al. (1973) used the Class Play peer assessment
196 s Foundations and Methods of Assessment

procedure in their longitudinal study of 537 children who were tested in three different
cohorts in either the first grade or the third grade. The children who were nominated
more frequently for negative roles in the Class Play assessment were more likely to receive
psychiatric services as adults, based on their names appearing on registers of psychiatric
services.
Roff (1961) conducted a prospective study of 164 boys who were referred to child
guidance clinics and who later served in one of the branches of the U.S. military. On the
basis of a review of the participants’ case histories as children and their adult service
records, those who were reported to have poor peer adjustment were significantly more
likely to receive bad-conduct discharges from the military than the children who were
reported to have good peer relations. Approximately half of the subjects in this study
ultimately received bad-conduct discharges. Another widely cited and highly influential
study by Roff and his colleagues (Roff & Sells, 1968; Roff et al., 1972) used a longitudinal
design in studying various social–behavioral characteristics of approximately 40,000
children who were enrolled in grades 3 through 6 in public schools in Minnesota and
Texas. The sociometric assessment data for this study included peer nominations and
teacher ratings. When records of delinquency were evaluated four years after the comple-
tion of the sociometric assessments, it was found that low-rated children were significantly
more likely to appear on rosters of juvenile offenders in the corrections system. These
classic studies from the watershed era of sociometric assessment indicate that important
future social outcomes are associated strongly with sociometric assessment information
obtained during childhood and adolescence.
Sociometric status also has been shown to be a significant factor in predicting school
dropout patterns. Ullman (1957) studied peer and teacher sociometric ratings of students
in 11 ninth-grade classes and found that positive sociometric ratings were predictive of
being named on honor rolls at graduation, whereas negative sociometric ratings were
predictive of the students’ dropping out of school before graduation.
In sum, although sociometric assessment procedures tend not to be standardized or
commercially published, like many other forms of assessment, they nevertheless have
been shown to have favorable technical properties and should be viewed as a potentially
useful method of assessing peer relations and social status. Understanding social networks
could be incredibly helpful when planning targeted interventions aiming to support
individual behavioral change or the overall dynamic of a group or classroom.

OVERVIEW OF SOCIOMETRIC ASSESSMENT PROCEDURES

Because most sociometric assessment procedures are nonstandardized and have a
considerable amount of overlap with each other, it is difficult to divide them into distinct
categories. There are some distinctive similarities and differences among various methods,
however, that make a general categorization possible. This section provides an overview
of some commonly used sociometric procedures based on a division into four common
categories: (1) peer nomination procedures; (2) peer rating procedures; (3) sociometric
ranking procedures; and (4) alternative sociometric procedures. In some cases, these
categories involve general descriptions common to many methods within the category.
In other cases, the categorical description is unique to a specific procedure.
 Sociometric Techniques s 197

Peer Nomination Procedures

The oldest and most widely used sociometric approach, and the basis for most other types
of sociometric measures, is the nomination method, originally introduced by Moreno
(1934). The essential characteristic of the peer nomination technique is that students are
asked to nominate or name classmates they prefer according to specific positive criteria.
This approach typically involves the students’ naming one or more classmates with whom
they would most like to study, play, work on a class project, or engage in some other
positive way. For children with sufficient reading and writing ability, peer nomination
procedures can be administered by an item-by-peer matrix or a questionnaire wherein
they fill in names of classmates on blank lines following questions.
The item-by-peer matrix consists of having the names of all children in the class across
the top of the page and the social interaction items listed vertically on the left side of the
page. The students are instructed to put an X under the names of the other students to
whom they think the item applies (e.g., “Which student would you most like to have as
your best friend?”). Use of a questionnaire format accomplishes essentially the same thing
(e.g., “Write the names of three students in your class that you would most like to have as
your friends” followed by three numbered blank lines). Scoring of peer nominations
typically is done by totaling the number of nominations that each child receives.
Worthen et al. (1993) suggested that the results of positive peer nomination procedures
can be classified and interpreted according to a frequently used set of criteria. Stars are
individuals who are frequently chosen. Isolates are individuals who are never chosen in the
process. Neglectees are those who receive only a few nominations. The results also can be
plotted graphically using a sociogram, which shows the patterns of choice for each student
and helps to identify not only frequently and never nominated students, but also cliques
or small groups. A mutual choice occurs when an individual is chosen by the same student
that he or she selected. A cross-sex choice occurs when a boy chooses a girl or a girl chooses
a boy. A clique is identified by finding a small group of students who choose each other
and make few or no choices outside of that group. Cleavage is when two or more groups
within the class or social unit are identified who never choose someone from the other
groups. Using these scoring and classification criteria, one can see easily how a procedure
as deceptively simple as the peer nomination method can yield information that is striking
and complex. Figure 7.1 is an example of an anonymous item-by-peer matrix that could
be used in a peer nomination assessment in a classroom setting and includes positive and
negative items. Figure 7.2 is an example of a sociogram that was plotted based on a positive
nomination procedure used with 15 elementary-age boys who were asked to select two
boys with whom they would most like to be friends.
Although the peer nomination technique as described involves the use of positive
items indicative of high social status, many researchers and some practitioners have used
variations of this method by employing negative nominations, using items created to
identify students who are socially rejected by peers (e.g., “Who would you least like to play
with?” or “Who would you never want to be friends with?”). Negative nominations are
scored and interpreted in a variety of ways, including finding specific patterns of social
rejection within a group and identifying rejected students who receive a large number of
negative nominations.
Scores of research studies have indicated that negative nominations may be a powerful
predictor of later negative outcomes. When used in conjunction with positive nominations,
198 s Foundations and Methods of Assessment

PLEASE LIST THE NAME OF YOUR TEACHER

WHAT GRADE ARE YOU IN?

I AM A (circle one): BOY/GIRL

DIRECTIONS: We are interested in finding out how well children are able to notice the behavior of other children. Please
help us by answering some questions about the other children in your class. Follow along as the questions
are read out loud, and try to answer each question the best you can. For each question, you will be asked
to pick one student that you think the question is most like, and then put an X in the box under their name
for that question. Remember, there are no right or wrong answers, and the way you answer these
questions will not affect your grade. Your classmates and your teacher will not know how you answered
the questions. If you don't understand what to do, or need help, please raise your hand.

TIna Jan Cal Ole Ken Tim Kim Sari Jon TIa Kyle Sue Erin Pat I Eli
Who would you most like to be best friends with?
Who is angry or mad a lot?

Who would you like to invite over to your home?

Who gets in fights?

Who gets along well with the teacher?

Who is in trouble a lot?

Figure 7.1 An example of an item-by-peer matrix for a peer nomination procedure that includes positive and negative items

Lupe

Allen John

Richard

Steven Cory

Glen
Austin
Juan Daniel

Tru Justin

Ben Jason

Calvin

Figure 7.2 An example of a sociogram plotted for a group of 15 elementary-age boys who were asked to select the two boys in
the classroom with whom they would most like to be friends
 Sociometric Techniques s 199

negative nominations can provide more detailed information about the subtle dynamics
of social status within a group, as exemplified by Coie et al.’s (1982) division of social
status into five different groups.

Peer Rating Procedures

The use of peer ratings, also referred to as the roster rating method, constitutes a form of
sociometric assessment that is conceptually and psychometrically quite different from
peer nominations. In the peer rating procedure, the children within a group are asked to
respond to a sociometric question for each child in the group. A typical procedure for
implementing the peer rating method involves providing each member of a group with
a roster that has the names of all other group members and a list of sociometric questions,
then rating each member of the group on each question using a 5-point scale (Connolly,
1983). For younger children, a variation of the 5-point scale is often used, which consists
of a series of three or five faces ranging from frowning to smiling that are anchored to
different scale values. Using this method, the children are asked to circle one of the faces
in lieu of a numerical rating (Asher, Singleton, Tinsley, & Hymel, 1979). A sample peer
rating assessment form is shown in Figure 7.3. This particular example shows a rating
scale format for peer rating that might be used with children in grades 3 to 6.
Psychometrically and statistically, peer rating methods vary considerably from peer
nomination methods. Each child’s score is based on an average of all the ratings he or she
receives. Because each child is rated by all of his or her classmates, a broader picture of the
child’s social status is obtained. Compared with peer nomination methods, ratings are
more stable within a group and are affected less by the size of the group (Connolly, 1983).
In general, peer ratings tend to yield higher reliability/stability coefficients than do nom-
ination methods (McConnell & Odom, 1986), and with younger children, the increase in
score stability with rating methods is particularly noticeable (Asher et al., 1979). Another
measurement characteristic of peer ratings is that they tend to provide distributions
that are less skewed than distributions provided by some other forms of sociometric
assessment (Hops & Lewin, 1984).
In addition to having measurement qualities that differ from peer nomination proce-
dures, peer rating methods differ conceptually and may measure a somewhat different
construct. Peer ratings are thought to produce a measure of average likability, whereas peer
nominations are thought to produce a measure of popularity. Although likability and
popularity have obvious similarities, there are some subtle yet important differences
between these constructs. For example, using the peer rating method, a child might receive
scores that indicate an average amount of likability, yet it is possible that he or she might
not receive any positive nominations. In this case, if the sociometric interpretation were
based on the peer nomination data alone, the child might be considered to be socially
isolated or neglected, which might not be the case. There is a relatively large degree of
measurement overlap between these procedures; Oden and Asher (1977) reported a cor-
relation of 0.63 between the two measures. In another study (Asher & Hymel, 1981) of
23 children who received no positive nominations, 11 received high positive ratings from
their peers.
By combining the nomination and rating procedures in conducting a sociometric
assessment, the obtained sociometric data may be more powerful in differentiating
popular/likeable and unpopular/unliked children than would be single-source data
(Asher & Renshaw, 1981). Another advantage of using peer rating procedures is that they
200 s Foundations and Methods of Assessment

Rating Form

Please List the Name of Your Teacher:

What Grade Are You In?

I AM A (circle one): BOY / GIRL

DIRECTIONS: We are interested in finding out how much the students in your class would like to work
with each other or play with each other. For each student on this list, circle one of the numbers to show
how much you would like to play with them and circle one of the numbers to show how much you would
like to work with them. This is what the numbers mean:

1= NOT AT ALL (I definitely would not want to work or play with this person)
2= NOT VERY MUCH (I don't think I would want to work or play with this person)
3= DON'T CARE (It really wouldn't matter to me if I played with this person or not)
4= SORT OF (I think I would like to work or play with this person)
5= VERY MUCH (I definitely would like to work or play with this person)

Your teacher and the other students in the class will not know how you answered. There are no right or
wrong answers, and the way you fill this form out will not affect your grade. If you have any questions,
or if you need help, raise your hand.

NAME WORK WITH? PLAY WITH?

1.. 2 2 3 4 5 2 2 3 4 5
2.. 2 2 3 4 5 2 2 3 4 5
3 .. 2 2 3 4 5 2 2 3 4 5
4 .. 2 2 3 4 5 2 2 3 4 5
5 .. 2 2 3 4 5 2 2 3 4 5
6.. 2 2 3 4 5 2 2 3 4 5
7.. 2 2 3 4 5 2 2 3 4 5
8 .. 2 2 3 4 5 2 2 3 4 5
9.. 2 2 3 4 5 2 2 3 4 5
10. 2 2 3 4 5 2 2 3 4 5

Figure 7.3 A sample peer rating assessment form

can provide information regarding positive and negative social status without the use of
negative questions; this can be done by wording questions positively or neutrally and
looking at the distribution of scores. This advantage may be particularly important when
one is attempting to obtain consent from parents or program administrators who are
uncomfortable with the use of negative nomination methods.
In contrast to traditional sociometric procedures, sociometric instruments have
been developed to assess specific social indices related to classrooms. A promising and
alternative instrument for collecting sociometric data to assess the management needs
of a classroom is what Doll, Zucker, and Brehm titled “ClassMaps” (2004). ClassMaps is
a student survey modeled after sociometric rating procedures in which students rate
classroom conditions and characteristics of their classmates that are related to academic
 Sociometric Techniques s 201

engagement. Doll and colleagues make the argument that students can reliably and
accurately gauge relationships within their classroom, thus providing evidence that
students are a good resource for accurately describing their classroom’s resilience.
In order to assess classroom resilience through a sociometric strategy, the authors
developed a 55-question survey addressing six resilience characteristics: academic effi-
cacy, academic self-determination, behavioral self-control, teacher–student relationships,
peer relationships, and home–school relationships. All individual student ratings are
aggregated to capture a general impression of classroom beliefs. Results of studies in
elementary schools (Doll, Spies, LeClair, Kurien, & Foley, 2010) and middle schools (Doll,
Spies, Champion, Guerrero, Dooley, & Turner, 2010) indicated that the survey’s technical
adequacy is fairly robust and consistent with the survey’s conceptual framework. All
in all, ClassMaps provides a cost-effective sociometric method to assess classroom resil-
iency, and, interestingly, combines both student perceptions of relationship dynamics
and classroom context (Doll et al., 2004).

Sociometric Ranking Procedures

In contrast to the peer nomination and peer rating procedures that have just been reviewed,
sociometric ranking procedures are designed to provide information on child social status
and peer relations through data contributed by adults rather than peers. In most instances
of sociometric ranking procedures that have been reported in the literature, the informant
is a teacher and the peer group consists of same-grade classmates. It would also be possible,
however, to implement sociometric ranking assessment procedures in nonschool settings,
such as group homes, residential or day treatment programs, and perhaps clinic-based
therapy groups.
Because the object of sociometric assessment is to obtain information on status and
relations within a peer group, what advantage is there in going outside of the peer group
to an adult informant to collect these data? Connolly (1983) noted that when using the
peer group as a source of information, one must assume that children are capable of
making accurate social distinctions. With typical children who are elementary age or
older, this assumption seems to be valid. With younger children and perhaps with older
children who have moderate to severe intellectual or social–emotional disabilities,
however, the completion of sociometric tasks may be difficult and may result in lower
reliability. Using teachers as sociometric informants may increase reliability in some
instances (Foster et al., 1986; Hagborg, 1994). Another reason for employing teachers as
sociometric informants is that they tend to be expert objective observers of child behavior
and understand the social dynamics within their classroom. Additionally, educators are
often understandably hesitant to commit blocks of academic time for nonacademic
student tasks and might be more willing to provide sociometric ranking data themselves
rather than have their students spend instructional time on it.
There are two general ways in which sociometric rankings can be completed by
classroom teachers. The first method involves the teacher rank-ordering every student in
the classroom according to some sociometric criteria, such as popularity with classmates
or positive interactions with peers. Previous studies that have employed this type of
ranking procedure have shown that the obtained data tend to be highly reliable and may
correlate better with independent ratings and observations of child social behavior than
do peer nominations or ratings (Connolly & Doyle, 1981; Greenwood, Walker, Todis, &
Hops, 1979). When the object of interest is negative social interactions or peer rejection,
202 s Foundations and Methods of Assessment

teacher rankings have been found to correlate with independent ratings and observations
of child behavior to a lower degree than negative peer nominations (Connolly, 1983).
A related method for obtaining teacher sociometric rankings involves first determining
which students in a classroom fit a given social–behavioral description, then rank-ordering
the students according to the severity or strength of how they fit those criteria. Using this
method of ranking, not all students in a classroom are ranked, only those who are found
to meet a given criterion. An example of this method of selective rank-ordering is found
in Stage 1 of Walker and Severson’s (1992, 2014) Systematic Screening for Behavior
Disorders (SSBD), a multiple-gating screening and assessment procedure that was
discussed in Chapter 3. This rank-ordering procedure involves teachers selecting ten
students in their classrooms whose behaviors most closely match an objective description
of internalizing behavior problems, then rank-ordering the students according to the
severity of their symptoms. Examples from the description of internalizing problems
include not talking with other children; being shy, timid, or unassertive; not participating
in games and activities; and being unresponsive to social initiations by others. Following
the rank-ordering along the internalizing dimension, a separate rank-ordering procedure
is conducted in a similar manner for students who exhibit externalizing social–behavioral
problems. Examples from the description of externalizing problems include arguing,
forcing the submission of others, disturbing others, and stealing. The instructions for
rank-ordering students with internalizing behavior problems are presented in Figure 7.4.
Research reported in the SSBD technical manual indicates that the Stage 1 rank-
ordering procedures have adequate to strong inter-rater agreement between teachers and
classroom aides (0.89 to 0.94 for the externalizing dimension and 0.82 to 0.90 for the
internalizing dimension) and good test–retest reliability at ten to 30-day intervals (0.81 to
0.88 for the externalizing dimension and 0.74 to 0.79 for the internalizing dimension). The
Stage 1 ranking procedure of the SSBD has also been found to have a strong degree of
sensitivity in discriminating students with behavioral disorders from peers with normal
levels of problem behaviors.

Alternative Sociometric Procedures

In addition to peer nominations, peer ratings, and sociometric rankings, other sociometric
procedures have been developed that may have some similarities with one or more of these
categories but are unique in many ways. Three of these alternative sociometric assess-
ment procedures are reviewed in this section: picture sociometrics, the Class Play, and
“guess who” techniques.

Picture Sociometrics Picture sociometric procedures involve individually presenting to

each child in a classroom an arbitrary assortment of photographs of each child in the class,
then asking the child to answer a series of questions by pointing to or selecting a photograph
of a peer. This method is an adaptation of other peer nomination methods and is useful
for work with preliterate subjects. Landau and Milich (1990) stated that it is the preferred
method for preschool-age children through second-grade students. Examples of questions
that have been used with this technique include “Whom do you like to play with the most?”
and “Who is your best friend?” and “Who is the best student in your class?” As with most
other sociometric techniques, specific questions can be developed on the basis of the
clinical or research questions, and these questions can be produced to indicate either social
acceptance or social rejection.
 Sociometric Techniques s 203

Stage 1 Screening for Internalizing Students

Rank Ordering on Internalizing Dimensions

Step 1. Carefully study the definition of internalizing behavior below and then review your class roster.

Internalizing refers to all behaviour problems that are directed inwardly (Le., away from the external
social environment) and that represent problems with self. Internalizing behavior problems are
often self-imposed and frequently involve behavioral deficits and patterns of social avoidance.
Non-examples of internalizing behavior problems would be all forms of social behavior that
demonstrate social involvement with peers and that facilitate normal or expected social development.

Examples Include: Non-Examples Include:

• Having low or restricted activity levels • Initiating social interactions with peers
• Not talking with other children • Having conversations
• Being shy, timid, and/or unassertive • Playing with others, having normal rates or
• Avoiding or withdrawing from social situations levels of social contact with peers
• Preferring to play or spend time alone • Displaying positive social behaviour toward
• Acting in a fearful manner others
• Not participating in games and activites • Participating in games and activities
• Being unresponsive to social initiations by other • Resolving peer conflicts in an appropriate
• Not standing up for one's self manner
• Appearing depressed • Joining in with others

Step 2. In Column One, enter the five students whose characteristic behavior patterns most closely match
the internalizing behavior definition.

Step 3. In Column Two, rank order students you have listed in Column One according to the degree or
extent to which each displays internalizing behavior. The student who exhibits internalizing behavior to the
greatest degree in ranked first and so on until all five students are rank ordered. The three highest ranked
students will be rated on Stage 2 measures.

Column One Column Two

List Internalizers Rank Order Internalizers
Student and/or ID No. Student and/or ID No.

Figure 7.4 Instructions for rank-ordering students with internalizing social–emotional problems, from stage 1 of the SSBD
multiple gating system. A rank-ordering procedure for externalizing problems is also included in stage 1
Source: From Systematic Screening for Behavior Disorders, Second Edition, by H. M. Walker, H. Severson, and E. Feil (2014).
Eugene, OR: Pacific Northwest Publishing. Reprinted with Permission.

The original picture sociometric technique and minor variations of it are scored on
the basis of totaling the number of times each child was nominated by classmates in
questions indicating positive social status. Using this scoring scheme, rejected or neglected
children would have significantly lower scores than accepted children with higher social
status. Variations in scoring procedure would be needed if there were any significant
deviations in administration method from the original study by McAndless and Marshall
(1957). Questions that reflect positive (e.g., “Whom do you most like to do schoolwork
with?”) and negative (e.g., “Whom are you afraid to be around on the playground?”)
social status could be mixed, and the scoring system could be divided into positive and
negative status categories.
The use of picture sociometrics was first reported by McAndless and Marshall (1957)
and has been used in many other published studies. The psychometric properties of
204 s Foundations and Methods of Assessment

picture sociometric techniques have been shown to be quite good, with relatively high
inter-rater reliability, high short-term test–retest reliability, and adequate long-term test–
retest reliability (Landau & Milich, 1990; Shin, Kim, Goetz, & Vaughn, 2014). Validity of
the picture sociometric method has been shown by producing significant discrimin-
ations between groups of aggressive, aggressive–withdrawn, and normal boys (Milich &
Landau, 1984). With young children, picture sociometrics have been shown to produce
more effective discriminations of social status than information provided by teachers,
particularly when negative ratings or nominations are involved. In this day of easy digital
photography, it may be easier to physically prepare for picture sociometrics than was
true in the past, but researchers and practitioners should consult appropriate admin-
istrators to first determine whether active parental consent is needed prior to taking such
photographs of children.

Class Play The Class Play procedure first was used and described by Bower (1969), then
was revised further by Masten, Morrison, and Pelligrini (1985). It is a frequently used
sociometric technique that has been employed in several large-scale investigations,
including the classic 11- to 13-year follow-up study of elementary-age children by Cowen
et al. (1973). The basis of this procedure is that children are asked to assign their peers to
various roles (usually positive and negative roles) in an imaginary play. The original Class
Play described by Bower included positive (e.g., “someone who will wait his or her turn”)
and negative (e.g., “someone who is too bossy”) roles but consisted of a scoring procedure
wherein only a single score (negative peer reputation) was derived, which was done by
calculating the number of negative roles given to a child and dividing that by the total
number of roles given to the child. Large percentages are supposed to indicate a high
degree of peer rejection, whereas low percentages are meant to indicate that the child has
higher social status. As is the case with most sociometric approaches, the specification of
roles in the Class Play procedure (and the method of scoring) can be manipulated by the
clinician or researcher to suit specific assessment goals. The scoring system advocated by
Bower has been criticized as being flawed (Landau & Milich, 1990).
The use of Class Play sociometric procedures is attractive for two reasons other than
the measurement capabilities it may have. One advantage is that children seem to enjoy
participating in make-believe plays and casting their peers into the various roles. The
second advantage is that teachers and administrators seem to view this type of procedure
more positively or at least with less suspicion than some other sociometric methods, and
as such, it is more likely to be supported and approved than some other approaches.
Masten et al. (1985) suggested that because of the diversity of roles needed in a play, this
procedure would reduce any probability of disapproving labels on children with high
negative scores by other children in the rating/casting process.

“Guess Who” Measures The “guess who” technique is a sociometric approach wherein
brief descriptive statements are provided to students and they are then asked to write
down names of a few other students (usually three or fewer) who they think best fit the
descriptions. For example, the students might be asked to respond to descriptions
such as “Guess who is often in trouble,” “Guess who does the best job on schoolwork,”
“Guess who no one knows very well,” or “Guess who is often angry at other children.” The
descriptions can be provided to the students verbally or in written format. The content
of the “guess who” items can be made up by the teacher, clinician, or researcher on the
 Sociometric Techniques s 205

basis of specific characteristics they are interested in identifying. Scoring of these types
of measures is done by making simple frequency counts of each question/description.
More elaborate scoring methods are possible, such as grouping descriptions into
categories of similar content (e.g., antisocial behaviors, helping characteristics, peer
popularity) and obtaining frequency counts within each broader category.
An example of a “guess who” measure that has been used with a large number of
students and has been investigated carefully is the Revised PRIME Guess Who Measure,
which was developed for use in Project PRIME, a large-scale investigation of students with
disabilities who had been integrated into regular education classrooms for part of their
instructional day (Kauffman, Semmell, & Agard, 1974). The original instrument consisted
of 29 questions/descriptions and was administered to more than 13,000 students in grades
3 through 5. Factor analytic procedures conducted on the instrument divided the items
into four major factors, labeled disruptive, bright, dull, and well-behaved. A revised scale
including 20 items (the five items contributing the most to each factor) was developed by
Veldman and Sheffield (1979), who reported reliability coefficients ranging from 0.56 to
0.77 for each factor score and developed a satisfactory concurrent validity procedure for
the instrument by correlating the instrument items with teacher ratings along similar
dimensions.
In sum, the “guess who” technique is flexible, easy to administer, and easy to score; has
been used in a large number of studies and projects; and has been found to have satisfactory
technical properties. Clinicians and investigators desiring an adaptable, easy-to-administer
sociometric measure may find “guess who” techniques to be a useful choice in assessment
instrumentation.

ETHICAL CONCERNS IN USING SOCIOMETRIC PROCEDURES

Sociometric assessment approaches have a great deal of appeal to clinicians and researchers
and have a long history of use in psychology, sociology, and education. These approaches
are not without controversy, however. Many sociometric methods involve negative
ranking or nomination procedures or having children single out peers based on negative
characteristics. Largely because of the use of these negative nomination procedures,
parents, teachers, and administrators may be hesitant or alarmed at the possibility of their
children participating in sociometric assessments, for fear that some children may be
singled out by peers and ostracized further because of the procedure. The use of negative
criteria is the most controversial aspect of sociometric assessment (McConnell & Odom,
1986). The gist of this controversy is that there seems to be a common concern that
children will compare their responses after the assessment to find out which children
were singled out for negative nominations and that this process will end up in increased
isolation or social exile for the children who were commonly perceived in negative
terms. We are personally familiar with several separate research projects that had to
undergo major methodological modifications or be stopped altogether because of threats
by parents and some educators to “shut down the study” because of outrage over the use
of negative peer ranking or nomination procedures.
Although concerns regarding negative effects from sociometric assessment are under-
standable, such concerns have never been substantiated through empirical evidence.
Landau and Milich (1990) noted that several large-scale longitudinal investigations with
206 s Foundations and Methods of Assessment

at-risk children have been conducted wherein sociometric procedures have been employed
(e.g., Pekarik, Prinz, Liebert, Weintraub, & Neale, 1976; Serbin, Lyons, Marchessault,
Schwartzman, & Ledingham, 1987) with no reports of negative consequences to the par-
ticipants. An ambitious and intriguing investigation by Hayvren and Hymel (1984) found
that there were no observable negative consequences within peer groups immediately
after the use of sociometric assessment procedures. This study was conducted with a
population of preschool-age children, however, and it is unclear whether the same results
would generalize to elementary-age or secondary-age schoolchildren.
More recently, an ambitious study was conducted by Mayeux, Underwood, and
Risser (2007) to gauge children’s long-term reactions to participating in sociometric
assessment. In this study, 91 third-grade students were included in a sociometric assess-
ment procedure. 15 weeks following the assessment period, students were interviewed
about their experiences during and following assessment. In general, researchers found
that children were not upset by the assessment procedure. They reported enjoying the
experience and they did not feel as though their friends treated them differently following
the assessment.
Mayeux et al.’s study is similar to that conducted by Iverson and Iverson (1996). In this
study, 82 children in the fifth grade completed a positive and negative peer nomination
procedure during the last week of the school year. After summer vacation, 45 of the par-
ticipants (who were by then in the sixth grade) were interviewed individually to assess
their reactions to the sociometric procedures. One-third of the participants indicated that
they had discussed the measures with their peers, despite specific instructions that they
were not to do so. The participants stated that they enjoyed participating in the socio-
metric procedure, however, particularly the positive nomination procedure. Because the
original nomination procedure was used to assign participants to social status groups
based on the five-category breakdown of average, controversial, neglected, popular, and
rejected by Coie et al. (1982), the participants’ responses were analyzed by group.
No evidence of reactions indicating any harm to any of the participants was found.
The research which has specifically examined possible negative effects of sociometric
techniques on participants (including additional studies by Bell-Dolan, Foster, and
Christopher, 1992, and Bell-Dolan, Foster, and Sikora, 1989) has grown to the point where
the body of evidence can be examined as a whole, rather than relying solely on individual
studies. In commenting on the yield of research in this area, Hoza and colleagues stated:

[Sociometric] procedures must be done while protecting the confidentiality of the

target individual and addressing concerns about the effects of the measurement
procedure on the peer group. We find it important that numerous studies now
document the lack of ill effects of administering sociometric procedures on the peer
group . . . yet misconceptions and logistical constraints remain as impediments.
(2005, p. 412, italics added for emphasis)

Given the combined evidence in this area to date, two things can be surmised. First, it
seems likely that a substantial number of children who participate in sociometric
procedures, perhaps one-third or more of participants, will discuss their choices with
peers, even if they are instructed not to do so. Second, despite the reasonable possibility
of children comparing their responses, there is no empirical evidence that negative
nomination or rating procedures are harmful to individuals who participate in the
 Sociometric Techniques s 207

assessment. In fact, there are several studies that have examined this issue specifically, and
in no cases were ill effects identified. Concerns regarding the use of sociometrics may
be reduced through not using negative criteria, but such a course of action may reduce
the utility of sociometric assessment. Before deciding to do away entirely with the use
of any negative criteria in sociometric assessment, the following quote from McConnell
and Odom (1986) should be considered: “Because the efficiency of peer nomination
assessments will decrease markedly when negative nominations are not used, it is
imperative that they be included in the assessment process” (p. 233).
Whether or not concerns about the effects of sociometric assessment are founded,
clinicians and researchers desiring to use sociometric approaches are advised to pick care-
fully the most appropriate method for their purposes, communicate closely and carefully
with their constituent groups, and educate those involved on the purposes and procedures
involved. Landau and Milich (1990) suggested that the use of positive nomination proce-
dures or peer ratings instead of negative nomination procedures may be necessary (but
not optimal) when working with systems or individuals who are suspicious of the use of
sociometrics. In the meantime, additional research on any potential peer effects of socio-
metric measurement involving negative ranking or nomination would be extremely useful.
In addition to the potential ethical concerns and administrative difficulty in conducting
sociometric assessments, there is a practical consideration that may create a significant
challenge. Because the basis of sociometric assessment is that data are gathered from
within an existing social group, it is necessary that the entire group (or most of the group)
participate in the assessment, not just a few individual members of the group. In other
words, if a clinician or researcher plans to conduct a sociometric assessment of children
within a specific classroom, he or she needs to plan on including all of the children in the
classroom in the assessment. If even a few children are left out of the assessment, some
important or even vital data may be lost. The challenge here is that specific parental
consent generally is required for each child who is to participate in the assessment. If the
targeted classroom included 25 students, parental permission would need to be secured
from parents or guardians of each of the students for full participation in the assessment.
Clinicians, researchers, or teachers who have never been faced with the challenge of
obtaining so many parental consent forms simultaneously may be surprised at how
difficult and time-consuming a task it may be. Two potential problems may occur in this
regard. First, for various reasons, some parents simply may refuse permission for their
child to participate in the assessment, which is certainly their right. Second, some parents
(usually a greater number than the first category) simply ignore the permission slips and
do not sign and return them as requested. My own experience with this second issue is
that a phone call, note, or other prompt to the parents usually results in some additional
permissions being granted, but the process may be time-consuming, and even then, some
parents simply will not follow through.
The reality is that in many or most cases of attempting to conduct sociometric assess-
ment with large social groups of children, it may be difficult to ensure that the entire group
will end up being able to participate. This situation raises the obvious question: “How
many data are enough?” A novel study of this issue by Hamilton, Fuchs, Fuchs, and Roberts
(2000) indicated that a minimum of 80% participation by children and classroom settings
may be required for the obtained data to be reliable. Based on this study, participation rates
of less than 80% are likely to result in unreliable information and threaten the overall
validity of the assessment. Although this particular study is the only one of its kind to date,
208 s Foundations and Methods of Assessment

it employed sound methodology and should be considered a benchmark of sorts until new
evidence accrues to convince us otherwise.

SOCIOMETRIC PROCEDURES AND DECISION MAKING

Perhaps the best use of sociometric assessment is in making decisions about screening
and assessment. As a screening tool, various sociometric approaches can help quickly
identify individuals who might be at heightened risk for developing social–behavioral
problems. As part of a comprehensive assessment system, sociometric methods can help
to confirm or disprove hypotheses about peer relationship problems or other social risk
factors that have been developed through the use of other assessment methods.
Sociometric assessment may have some use as a means to identify individuals who
might benefit from special social skills interventions, but if used for this purpose, it would
be important to augment the sociometric approaches with other objective assessment
methods. It also would be important to word the sociometric assessment questions or
instructions carefully to match the type of intervention that is intended. For example, if a
school counselor or psychologist were attempting to identify potential participants for an
anger control group, a peer nomination question such as “List five students who lose their
tempers” might be useful in conjunction with other selection data. For making specific
intervention decisions, it is difficult to see how sociometric data would be very useful. It
has been suggested by some researchers that a clear link between sociometric assessment
and social–behavioral intervention is not clearly founded (Foster et al., 1986; Gresham &
Stuart, 1992; Hagborg, 1994).
An intriguing potential use of sociometric assessment data is for grouping students
together in classroom settings for maximizing cooperation and providing appropriate
modeling. For example, a student who lacks social skills and comes out as socially neglected
in a sociometric assessment might be paired strategically with another student with strong
social competence and who is identified in the sociometric assessment as being well liked
and accepting. Such a pairing might result in the socially neglected student being exposed
to a positive social model and a potential source of social support. Likewise, a teacher who
is assigned to teach an intact group of students but who does not yet know these students
well might use a sociometric assessment to ensure that seat assignments and work group
pairings include an appropriate mix of students and that students at heightened risk for
engaging in negative social behavior (e.g., rejected and controversial students) are not
clustered together.
Further, with increased use of SNA statistical packages, sociometric assessment and
analysis could be used to better understand how social networks change (or remain
stable) over time. Longitudinal SNA could serve to better understand the extent to which
school-wide or class-wide behavioral intervention and prevention approaches impact
social networks. For example, Sentse, Kiuru, Veenstra, & Salmivalli (2014) used SNA to
understand the bullying behavior of adolescent social networks. They assessed students at
three points in the school year, some of whom were provided with the Finnish KiVA bully
prevention program and others who served as controls. Researchers found that students
were less likely to like peers who engaged in a high level of bullying behavior, and that
peers liked others with similar levels of bullying behavior (i.e., low levels). Interestingly,
they also found no changes in peer ratings between intervention and control groups,
 Sociometric Techniques s 209

suggesting that consideration may need to be given on how to best implement prevention
efforts in secondary schools, where students are more mobile, and class climate initiatives
may need to look different from those implemented in intact elementary classroom
settings.
For making diagnosis/classification or placement decisions, sociometric assessment
procedures seem to be less useful. These types of decisions tend to require objective
information on whether an individual meets specific criteria. The only possible use of
sociometrics in this regard would be as a means of confirming or disproving other data
used in determining whether the criteria have been met.
In sum, sociometric assessment, similar to other forms of assessment used to gauge
emotional and behavioral problems, is more relevant for certain types of decision-making
processes. The decision-making process that seems to be most relevant to sociometric
assessment is screening and assessment decision making. Sociometric assessment also
may have some relevance when used, in conjunction with other forms of assessment,
for making general decisions about interventions for peer relationship problems, but the
current link in this regard is questionable.

CONCLUSIONS
Sociometric assessment comprises a collection of related measurement techniques that
allow for the gathering of social information from within an intact peer group, such as
students within a classroom. Social status, popularity, social acceptance or rejection, and
average likability are the most common constructs that are assessed with sociometrics.
Sociometrics is a potentially important assessment method because the constructs that are
measured are important and highly predictive of future social and emotional outcomes.
Sociometric assessment has a rich history within developmental psychology, education,
and sociology and became widely used by the 1950s and 1960s. The use of sociometrics
seems to have declined since that era, however, perhaps partly because of the increasing
availability of other social assessment methods and partly because of increasing difficulty
in obtaining acceptance and approval for using sociometrics.
The empirical base for sociometrics is generally quite solid. Numerous studies have
been conducted over the years that have documented the reliability and validity of various
sociometric procedures. Perhaps the most compelling of these studies supporting the use
of sociometrics were the classic studies conducted by Cowen, Roff, Ullman, and their
respective colleagues. These studies showed in a persuasive way that sociometric assessment
not only is capable of having sound technical adequacy, but, more importantly, is also
strongly predictive of important future social–emotional outcomes. Some studies have
been conducted that have highlighted the shortcomings of sociometric assessment, but it
has held up surprisingly well to some fairly intense scrutiny.
The peer nomination procedure is the oldest sociometric technique and provides the
basis for most other sociometric techniques. Peer nominations involve presenting
children with a series of positive and negative statements or questions—such as “Whom
would you most like to play or work with?” or “Whom are you afraid to be around?”—
and asking them to nominate someone from their peer group who they think best fits
the specific question. In addition to the peer nomination procedure, other common
sociometric techniques include peer rating scales and sociometric ranking procedures.
210 s Foundations and Methods of Assessment

These methods vary in terms of how they best tap underlying constructs and their
technical or psychometric properties. Additional alternative sociometric techniques, such
as picture sociometrics, “guess who” techniques, and the Class Play, have been developed
for use with specific populations and problems.
Since the 1970s and 1980s, there has been increasing concern regarding the ethics of
using sociometric techniques for assessment of children. Prompted primarily by concerns
regarding the use of negative criteria and the fear of children comparing their responses
and then further ostracizing rejected or neglected children, many institutional review
boards and school administrators have been reluctant to approve projects involving
sociometric assessment. As a result, many practitioners or researchers do not view
sociometry as a viable method or they compromise by removing all negative criteria,
which has the effect of reducing the power and efficiency of sociometric assessment.
These concerns are understandable but simply are not founded on empirical evidence.
None of the several studies that have attempted to investigate negative effects resulting
from participation in sociometric assessment have identified any short-term or long-
term negative consequences for participants. If informed consent and full participation
is not obtained for all or most of the members of a group, the validity of the sociometric
assessment data may be questionable. To date, the best benchmark for a minimal level
of participation for reliable and valid data is the 80% figure suggested by Hamilton et al.
(2000).
Perhaps the best use of sociometric assessment to assist in psychoeducational decision
making is for making decisions regarding additional screening and assessment.
Sociometrics have been shown to have substantial accuracy in identifying at-risk children
and adolescents who may be in need of additional assessment or intervention services.
With increased use of statistical packages utilizing SNA, we may find an increased use of
sociometry to understand networks and relationships among students, teachers, and
teaming structures within organizations.

REVIEW AND APPLICATION QUESTIONS

1. What are some advantages of obtaining peer-referenced sociometric assessment data
rather than relying solely on teacher ratings or observations of social interaction patterns?
2. Briefly describe some of the evidence attesting to the predictive validity of sociometric
assessment.
3. Compare and contrast peer ranking and peer rating procedures. Under what circumstances
might each procedure be best used?
4. Describe two ways of using positive nomination procedures. Under what circumstances
might each procedure be best used?
5. What are some ways of implementing sociometric assessment procedures with children
who cannot yet read or write?
6. Develop a list of five different “guess who” questions that you might use to help select the
three students in a third-grade classroom who are most likely to benefit from participation
in a social-skills training group wherein friendship-making and peer interaction skills will
be stressed.
7. The use of negative peer nomination procedures and other negative criteria in sociometrics
has generated a great deal of controversy. Regarding this issue, respond to the following
 Sociometric Techniques s 211

questions: (1) What are some of the possible negative outcomes of using negative
nomination procedures? (2) What evidence exists attesting to the negative effects of these
procedures? (3) What are some potential alternatives to negative nominations?
8. There may be practical and ethical challenges to obtaining informed consent for full group
participation in a sociometric assessment. What is the recommended minimal percentage
of group participation for sociometric assessment to be reliable and valid, and what
are the risks of proceeding with the assessment if less than this level of participation is
reached?
 8
SELF-REPORT ASSESSMENT

This chapter addresses the development and use of a broad category of assessment
instruments that are referred to herein as objective self-report tests, or simply self-report
tests. This assessment category is linked inextricably to the field of personality assess-
ment. Some assessment texts define self-report assessment separately from personality
assessment, whereas other texts include additional categories of assessment methods in
this vein. For this book, a decision was made to refer to this general category of assessment
instruments as self-report tests because the term is descriptive of the type of activity the
assessment involves and because many (if not most) of the self-report tests reviewed in
this chapter and in later chapters are not designed to measure the broad construct of
personality, but to assess specific aspects of social and emotional characteristics and
behavior based on the child or adolescent’s own perceptions.
Self-report assessment is conceptualized and viewed differently by various authors and
researchers. For example, Eckert and colleagues (Eckert, Dunn, Codding, & Guiney, 2000;
Eckert, Dunn, Guiney, & Codding, 2000) have described self-report assessment tools as
“rating scale measures” and positioned them as being conceptually similar to behavior
rating scales, with the primary difference between the two forms of assessment being the
informant. Differences of opinion exist regarding how direct and objective self-report
assessment is as a general method, with some authors considering it to be a direct form
or process of assessment (Witt, Cavell, Heffer, Carey, & Martens, 1988) and other authors
considering it to be an indirect form (Cone, 1978). Differences of opinion aside, it is
important to view objective self-report assessment of children and adolescents as an
increasingly prominent method that can play an important role and provide unique and
valuable information as part of a broad-based assessment design.
This chapter provides a framework for understanding and using self-report assessment.
The chapter begins with a broad examination of the important foundations of self-report
assessment, including historical and psychometric considerations. Most of the chapter is
dedicated to evaluative reviews and discussion of several self-report assessment instru-
ments designed for use with children and adolescents. These instruments differ from
the types of self-report measures that are reviewed in Chapters 10 to 13 because they are
omnibus or general purpose assessment instruments designed for measuring overall
personal adjustment and psychopathology. Conversely, the self-report instruments
discussed in later chapters include instruments developed for assessing specific constructs,
such as ADHD, depression, anxiety, social competence, and self-concept. The chapter ends
with a discussion on how data from self-report tests can be used in making decisions
regarding screening and assessment, classification, and intervention.

213
214 s Foundations and Methods of Assessment

FOUNDATIONS OF SELF-REPORT ASSESSMENT

To best appreciate the uses of self-report tests in assessing behavioral, social, and emotional
problems, it is first necessary to develop a general understanding of them. This section
presents a historical and psychometric overview of the basis of objective self-report
assessment. First, a brief historical account of the personality testing movement is
presented, followed by some basic definitions and discussion of objective measurement.
Then, information specific to methods of objective test construction and some associated
measurement problems are presented.

Historical Foundations of Personality Testing

As was mentioned previously, self-report assessment is linked closely to, if not an integral
part of, the field of personality assessment. As noted by McReynolds (1986), interest
in personality assessment is older than the field of psychology. Primitive attempts to
measure personality have been identified in antiquity, as exemplified by the work of some
of the ancient Greek philosophers. Hippocrates originated the theory that one’s personality
or persona is based on four separate temperaments (sanguine, choleric, melancholic,
phlegmatic). Galen expanded on Hippocrates’ theory by positing that each temperament
was related to one of four bodily fluids or humors: blood, mucus, black bile, or yellow bile.
These notions of temperaments and the four humors survived for well over 1,000 years
and were prevalent in Europe throughout the Middle Ages and well into the beginnings
of the modern era. The idea of “blood letting” to treat certain maladies stemmed from the
humoral notion of personality. Later, the eighteenth-century German philosopher
Immanual Kant wrote extensively on the four temperament types and developed an axis
to evaluate each type based on the feeling and activity.
The first formal efforts connected to assessing personality structure in the modern
era were found in free-association techniques, such as those developed by Freud and Jung
in their psychoanalytic work and Kraepelin’s (1892) use of the technique in studying
physiological effects of hunger, fatigue, and drugs (cited in Anastasi & Urbina, 1997). As
advances in the study of personality continued in the early 1900s, there was more of a
distinction between projective methods (such as the Rorschach test, apperception tests,
and drawing tests) and objective methods of personality assessment, the latter of which are
the focus of the remainder of this discussion.
Anastasi (1988) and Anastasi and Urbina (1997) noted that the prototype of the
modern personality/self-report inventory was the Personal Data Sheet, which was
developed by Woodworth during World War I as a test to screen men with serious emo-
tional problems from military service. By the late 1920s and early 1930s, many objective
personality questionnaires, surveys, and inventories had been developed for research and
clinical purposes. Many of these early efforts did not meet the current criteria for being
considered objective self-report measures, but they were objective in the sense that they
incorporated methods that were distinctly different from associative and projective
techniques. By the late 1930s and early 1940s, advances in personality theory, psychometric
theory, and statistical analysis set the stage for major advances in objective personality
assessment. In the first edition of his enormously influential book, Essentials of Psychological
Testing, Cronbach (1949) noted that the publication of Berneuter’s Personality Inventory
in the 1930s resulted in an instrument that was based on four personality traits and was
 Self-Report Assessment s 215

used widely in clinical and other applied settings. This assessment instrument became the
prototype for many later objective self-report measures. The most notable of these later
measures was the MMPI, which was first published in 1943 and which subsequently has
been revised and updated. The MMPI was the first widely used instrument to use the
sophisticated empirical criterion keying method of construction, a technique on which
many later tests were constructed.
During the 1950s, 1960s, and 1970s, there were many challenges to the validity of tradi-
tional personality assessment. Some of these challenges arose from the increasing influence
of behaviorism in graduate psychology training, which challenged many of the assump-
tions of personality assessment. The growth of humanistic psychology in the 1950s and
1960s also posed some challenges to traditional personality assessment because many
humanistic practitioners considered personality assessment to be impersonal, mechanistic,
and invasive. Some of the challenges to personality assessment during this era arose from
the fact that many of the assessment instruments that were commonly used had poor
psychometric/technical qualities and limited evidence of validity. During the 1970s, 1980s,
and 1990s, the field of personality assessment underwent many changes but has not seen
its demise, as some predicted. In fact, there has been a resurgence of interest in personality
assessment since the 1980s (Anastasi & Urbina, 1997; Swann & Seyle, 2005). Currently,
numerous professional organizations and scholarly journals are devoted specifically to
the assessment of personality or social–emotional behavior. Some of the reasons for the
apparent modern revitalization of personality assessment include: (1) increasing eclectic-
ism among practitioners and researchers; (2) a decline in dogmatism and parochialism
in specific schools or fields of psychology; and (3) the development and refinement of
sophisticated mathematical models and statistical techniques for studying personality
and developing self-report instruments. Regarding the relatively recent improvements in
technical sophistication and research regarding personality assessment, Anastasi and
Urbina stated:

The 1990s have witnessed a resurgence of research that faced up to the complexities
of personality assessment and sought innovative solutions to these long-standing
problems. The period is characterized by significant theoretical and method-
ological advances. The earlier critiques of personality measurement undoubtedly
had a salutary effect and in part stimulated the subsequent development in this
area of psychometrics. We must, however, guard against the danger that, in the
zeal to eradicate fallacious thinking, sound and useful concepts may also be lost.
The occasional proposal that diagnostic personality testing and trait concepts be
completely discarded, for example, indicates an unnecessarily narrow definition of
both terms.
(1997, p. 385)

Psychometric Foundations of Objective Test Construction

In Chapter 1, the notion of direct and objective assessment was introduced, and it has
been touched on briefly in subsequent chapters. These concepts have not been addressed
in detail at this point, however. Because the focus of this chapter is on objective self-report
tests rather than projective–expressive techniques, it is appropriate and necessary to
discuss objective assessment more fully in this section.
216 s Foundations and Methods of Assessment

R. P. Martin (1988) proposed that there are four essential characteristics or criteria that
must be present for an assessment instrument to be considered an objective test. These
are listed as follows:

1. There must be individual differences in the responses of persons to the test stimuli,
and these differences must be sufficiently consistent over time, across test items, and
in different assessment situations.
2. The measurement must involve the comparison of one person’s responses with those
of other individuals, and the items must be presented to different persons in a
consistent manner.
3. The assessment device must include normative data so that individual scores can be
assigned a place on a scale for purposes of comparison against a larger group of
persons.
4. The test responses must be shown to be related to other meaningful behavior. In
other words, the measurement must be shown to be useful in predicting behavior.
This criterion is referred to as the validity requirement.

By this definition, an objective self-report test is one in which the targets or participants
respond to various items or questions about their own social–emotional behavior in a
standardized manner, wherein their responses are compared with those of a normative
group, and evidence is provided as to the psychometric properties (reliability and validity)
of the measure. R. P. Martin’s (1988) four criteria and the subsequent summation of these
key points show that the assessment methods discussed in previous chapters (behavioral
observation, rating scales, interviewing, and sociometric measures) are not usually consid-
ered to be objective self-report measures in the most strict sense of the term, although they
sometimes meet several of the essential characteristics. To these four characteristics, it is
useful to add a brief definition of how self-report responses are scored using objective
procedures: Each possible response on an item is associated with a predetermined score,
and there is no room (or very little room) for inference or individual judgment in the
scoring process.
With regard to the first essential criterion of objective measurement (consistent
measurement of individual differences), self-report personality/affective measures tend
to have special difficulties when compared with tests that measure various forms of
cognitive functioning, such as intelligence and academic achievement tests (Anastasi &
Urbina, 1997). Part of the problem with the greater difficulty in obtaining high reliability
coefficients on personality or behavioral measures is the stability of the underlying
construct in general. Social and emotional behavior in humans tends to be less stable or
predictable than human cognitive functioning (Brown, 1983). A second potential reason
for psychometric problems on self-report tests noted by Brown is that these tests often
have been accepted uncritically or used for purposes that were not intended. Given the
differences in predictability between social–emotional and cognitive functioning in
humans, the psychometric gap between the two areas may be reduced in time but perhaps
never closed.
The characteristics measured by personality tests are also more changeable over time
than those measured by tests of ability. The latter fact complicates the determination of
test reliability because random temporal fluctuations in test performance are less likely
to become confused with broad, systematic behavioral changes. Even over relatively short
 Self-Report Assessment s 217

intervals, it cannot be assumed that variations in test responses are restricted to the test
itself and do not characterize the area of nontest behavior under consideration. A related
problem is the greater situational specificity of responses in the noncognitive than in the
cognitive domain (Anastasi & Urbina, 1997, p. 385).

Three Approaches to Developing Objective Self-Report Tests

Experts in personality assessment agree that the number of approaches for constructing
objective self-report tests is quite small, with most experts listing only three categories of
test construction methods. In this regard, the only variable that differs to any significant
extent is the name that is assigned to each category or type of approach. For a further
analysis of the basic types of test construction categories and names, readers are referred
to works by Anastasi (1988), Anastasi and Urbina, (1997), Goldberg (1974), Gregory
(2010), Kaplan and Saccuzzo (2012), Kline (2015), and Lanyon and Goodstein (1984,
1997). In the present text, the names assigned to the three basic categories of objective
test construction include the rational–theoretical approach, the factor analytic approach,
and the empirical criterion keying approach.

Rational–Theoretical Approach The rational–theoretical approach to developing self-

report tests involves the assumption by the test developer that a given set of personality
traits and behavioral correlates can be measured by developing a set of items or scales that
appear to fit within the definitions for those traits and behaviors. If the test developer
simply uses his or her own ideas about what constitutes appropriate items or scales, the
test is said to have been intuitively developed. If the test developer uses the judgments of
experts in developing and selecting items, the process is referred to as a content validation
method. The development process is said to be theory based if the construction of items
or scales is done according to a recognized theory of personality or personal social–
emotional functioning.
The rational–theoretical approach can be illustrated using the example of developing
a self-report test for measuring depression. A test developer might generate a list of items
that he or she believes represent the construct of depression (intuitive), ask a group of
mental health professionals to evaluate or generate potential items thought to measure
depression (content validation), or develop potential items based on how closely they
concur with an accepted theory of depression (theory based). In reality, these rational–
theoretical test construction methods often are used in conjunction with each other.
It is seldom the case that the content of a well-developed assessment tool was derived
from only one practice within this approach. In many cases, an objective measure initially
is developed using rational–theoretical methods, and then subjected to other forms of
developmental validation.
The main advantage of the rational–theoretical approach is that if the item and scale
development process proceeds thoughtfully, the end result is a group of items or scales that
have strong face validity and seem to be psychologically meaningful and theoretically
unified. The main disadvantage of this approach is that regardless of how much face
validity they may seem to have, the resulting items or scales may not have acceptable
psychometric properties or be able to differentiate between normal and abnormal behavior.

Factor Analytic Approach This approach to test construction is characterized by reliance

on a sophisticated group of statistical procedures to sort and arrange individual test items
218 s Foundations and Methods of Assessment

into groups that are mathematically related or that have specific properties. The term
stems from the factor analytic statistical technique. Other techniques are also used within
this general approach, including cluster analysis, path analysis, structural equation
modeling, item–response analysis, and hierarchical linear modeling, to name a few.
Presumably the arrangement of test items into statistically related groupings allows
for more precise measurement and interpretation of various personality or behavioral
constructs. Normally the test developer also uses a rational–theoretical approach in
developing the test items before subjecting them to factor analysis (or other techniques)
and subsequent interpretation. Chapter 4 provides several examples of how factor
analytic procedures were used in the development of some of the most commonly used
behavior rating scales and how the obtained factor solutions are commonly interpreted.
The same general procedures and practices are also true of factor analytic approaches to
the development of self-report measures.
The major advantage of the factor analytic approach is that it is capable of producing
mathematically precise groups of items and may bring a high degree of scientific preci-
sion to self-report measurement of behavioral, social, and emotional characteristics.
This mathematical sophistication can also be a disadvantage. Even among psychologists
who have received graduate training in measurement and psychometrics, few have the
skills to understand the nuances of factor analysis and make consistently good decisions
on factor analytic test data produced by computer programs. Factor analysis and related
statistical techniques are difficult to understand fully and even more difficult to imple-
ment adequately in the development of a clinical test. The use of more recent statistical
methods for testing or confirming factor structures presents additional challenges
for clinicians and researchers who are not conversant in the latest statistical thinking
(Crowley & Fan, 1997). If the test items themselves are constructed poorly, the mathemat-
ical sophistication offered by factor analysis is of little value in making the test useful and
may only confuse matters. It is not unusual to find test items in the same factor that do
not seem to have a great deal of clinical similarity based on their face validity. Factor
analysis cannot enhance a test that was poorly constructed in the first place. As the old
adage goes, “garbage in, garbage out.”

The Empirical Criterion Keying Approach Anastasi and Urbina (1997) referred to the
third major objective test construction method as empirical criterion keying. This
term alludes to the development of scoring keys in terms of some external criterion.
The manner in which this procedure is implemented typically involves administering a
large number of test items to groups of persons who are known to differ in some psycho-
logically meaningful way (e.g., those who are clinically depressed and those who are not
clinically depressed or those who have conduct disorders and those who do not have
conduct disorders). After the pool of items is administered, the items are analyzed to deter-
mine which ones reliably discriminate or differentiate between the two groups. The dis-
criminating items are considered to be a scale that is used in predicting or classifying
membership in the particular groups. The items that are initially administered to the two
groups are not just random descriptions of behavior; they are typically developed carefully
and selected using rational–theoretical construction methods.
The actual steps in the empirical criterion keying approach are more complex than this
brief description might indicate. Readers who are interested in learning more about the
specific steps in empirical criterion keying are referred to more thorough descriptions
 Self-Report Assessment s 219

found in general texts on psychological test construction. Some of the most widely used
and influential self-report measures (such as the various versions of the MMPI and the
Millon inventories) are based on the empirical criterion keying approach.
The major strength of the empirical criterion keying approach is that it relies on the
empirical properties of particular test items or scales rather than the presumed clinical
expertise of the test developer or the observed behavior of the person who takes the
test. With this approach, the clinical implications of the actual contents of items is less
important than the fact that the items are known to “sort” meaningfully among different
groups of persons. For example, if the item “I do not sleep well at night” is found to
differentiate between persons who are highly anxious and those who are not, we do
not actually know whether the anxious individuals have trouble sleeping. The important
consideration is that they report not sleeping well, and this discriminates them from
nonanxious persons. The same could be said for items that seem to lack any face validity,
and yet consistently result in score differences between groups who are known to differ
in some clinically important way.
The empirical criterion keying approach also has many drawbacks. R. P. Martin (1988)
noted that the scales of many tests constructed in this fashion do not have high internal
consistency, a statement that is illustrated by the surprisingly modest alpha coefficients
on the clinical scales of the MMPI-2, MMPI-A, and the MMPI-A-RF. Another possible
problem to consider is the precision with different diagnostic groups used to develop
scales selected in the first place. For example, if the tests or other selection procedures used
to identify depressed and nondepressed persons are unreliable or are reliable only within
specific geographical and cultural constraints, the utility of an empirical criterion keying
scale to differentiate these groups is suspect.

Response Bias and Error Variance

Although each of the three major forms of objective test construction has some advantages
and disadvantages, trying to determine the “best” method typically is not a fruitful endeavor.
There have been some empirical attempts to answer this question (Burisch, 1984; Hase &
Goldberg, 1967), which have concluded that the psychometric properties and validity evi-
dence of individual tests are more important markers of their usefulness than the method
employed in their construction. Regardless of the approach or method to test construction,
objective self-report measures invariably are subject to some degree of response bias on the
part of the examinee, a phenomenon that leads to error variance.
Error variance was defined by R. P. Martin (1988) as “variation of responses that is
uncorrelated with the trait being assessed and with any nontest behavior of interest”
(p. 60). This problem is created by the response bias of the examinee, which can be defined
as either conscious or unconscious attempts to respond to items in particular directions
or to create a specific type of impression. So, response bias may be either deliberate or
unconscious on the part of the examinee, but it can have the effect of increasing the error
present in the assessment.
Response bias can take several forms. One of the best researched forms is acquiescence,
which is a tendency of some test takers to answer true/false or yes/no items consistently in
one direction. Acquiescence is particularly a problem when test items are ambiguous or
unclear. A common method of attempting to control for acquiescence involves developing
items and scales so that there are equal numbers of true/false or yes/no responses keyed
into specific scales.
220 s Foundations and Methods of Assessment

Another well-known type of response bias is the social desirability response set. This
term refers to the conscious or unconscious tendency of most test takers to endorse
items in a socially desirable direction. For example, virtually all test takers faced with
the statement “Boys and girls should both be treated equally and fairly by teachers” would
answer “True,” regardless of their personal awareness or convictions regarding sexism,
gender roles, and public policy. Well-adjusted and poorly adjusted persons tend to respond
to items in the socially desirable direction, and their responses are usually not indicative
of their true behavior or feelings (R. P. Martin, 1988). It is difficult to gauge how much, if
any, error variance is created through this response set.
Another form of response bias is faking, which involves deliberate attempts by test
takers to manipulate or distort their responses to test items to create a particular impres-
sion. Faking usually takes the direction of manipulation to create a favorable or positive
impression (e.g., a test taker applying for a job or a person accused of a crime undergoing
pretrial assessment), but it also can involve deliberate distortion by the examinee to create
a negative impression or exaggerate their psychopathology (e.g., a “cry for help” or malin-
gering). Several adolescent and adult self-report instruments incorporate sophisticated
methods for detecting faking. The most notable example is the MMPI-A-RF, with various
validity scales that are designed to detect falsification, random answering, defensiveness,
and related styles of deliberate distortion. Other self-report tests for children (e.g., the
BASC-3 self-report scales) include lie or fake detection scales, but these efforts generally
are not as well researched or understood as are scales used with adults.
Another type of response bias is deviation, or the tendency to answer test items in
unusual or unconventional ways. The deviation hypothesis was proposed by I. A. Berg
(1967), who argued that deviation in test responses is content-free and can be found on
either verbal or nonverbal tasks. Little is known about deviation as a form of response
bias, and it is unclear how it contributes to error variance in self-report testing.
It thus far has been shown that several forms of response bias exist in testing and
that they may contribute to the error variance found in a given assessment situation.
We also have seen that test construction methods potentially can include efforts to reduce
or control response bias. What is the probable overall effect of response bias? Although
response bias in self-report assessment continues to be a problem, Anastasi (1988) con-
tended that some aspects of it may be “a tempest in a teapot” (p. 554). Perhaps the best
solution to reduce error variance through response bias is to make systematic efforts to
detect response styles and response sets, then evaluate the examinee’s responses to indi-
vidual test items in terms of their motivations, cognitive ability, and social–emotional
status.

REVIEWS OF SELECTED GENERAL-PURPOSE SELF-REPORT TESTS

Chapters 10 to 13 include reviews and comments regarding several self-report tests for
children and adolescents that are designed for assessing specific types of behavioral and
emotional problems. Several psychometrically sound and clinically useful self-report
instruments for children and adolescents have been developed for assessing specific
theoretical constructs and types of problems, such as depression, anxiety, social compe-
tence, and self-concept. Until more recently, there were few general-purpose self-report
tests for children and adolescents that meet the criteria of acceptable psychometric and
 Self-Report Assessment s 221

technical properties. With regard to the preadolescent age group (i.e., ages eight to 11), the
dearth of good general-purpose self-report measures has been particularly noticeable.
Research and development efforts in this arena have been encouraging, however. The
number of technically sound and useful general purpose self-report instruments developed
for use by children and adolescents has increased since about 1990 from barely a handful
to several, and the supporting research evidence for these newer tools has begun to accrue.
This section includes descriptions, technical information, and evaluative comments
regarding seven general-purpose self-report instruments, including the Adolescent
Psychopathology Scale (APS); the child and adolescent self-report forms of the Behavior
Assessment for Children, Third Edition (BASC-3); Minnesota Multiphasic Personality
Inventory, Adolescent Version (MMPI-A) and Restructured Form (MMPI-A-RF); Conners
3-Self Report and Conners Comprehensive Behavior Rating Scales Self Report, and Youth
Self-Report (YSR). These measures are included for review in this chapter as exemplars of
what is available and technically adequate in the area of self-report instruments for children
and adolescents. Each test is recommended, but each is differentially useful for various
purposes. It also should be noted that a few of these measures have not been updated to
reflect changes in DSM-5, but they still may be useful in practice. This section provides a
framework for selecting among several potentially useful measures that have strengths and
weaknesses in comparison with each other.

The Adolescent Psychopathology Scale (APS)

Description The Adolescent Psychopathology Scale (APS) (W. M. Reynolds, 1998) is a

346-item, broad-purpose self-report instrument designed for use with adolescents aged
12 to 19 to evaluate symptoms of psychological disorders and distress. The scale
breakdown of the APS is presented in Table 8.1. The APS has many unique characteristics.
Similar to many of the more recently developed social–emotional assessment instruments
designed for use with children and adolescents, the APS also is based on the conceptual
distinction between the internalizing and externalizing expression of problem symptoms.
The APS self-report questionnaire is a 12-page booklet that groups items according
to logical or similar clusters of characteristics. The publisher states that approximately
45 to 60 minutes are needed by most youths to complete this scale.
A unique aspect of the APS is that the items are rated in varying formats and according
to varying time periods. Although most of the items are rated using a 3-point (“Never
or almost never,” “Sometimes,” or “Nearly all the time”) response format, some item clus-
ters are completed as true/false statements, and a few are based on specific time periods
in which behaviors may have occurred, such as never, once or twice a week, or three or
more times a week. The response format for the APS items is highly sophisticated and
sensitive to time and behavioral intensity, requires a computer program for scoring,
and is available in limited or unlimited use options at varying price points. The items of
the APS are converted into one or more of 40 scales (using a T score system) that measure
Clinical Disorders (20 scales), Personality Disorders (5 scales), Psychosocial Problem
Content Areas (11 areas), and Response Style Indicators (4 scales). Many of the scales of
the APS are organized to be consistent with DSM-IV symptom classification, but the
author of the scale cautions that the APS should be used to establish severity of symptoms
associated with specific DSM-IV disorders and not to provide any formal diagnosis or
classification.
222 s Foundations and Methods of Assessment

Table 8.1 Adolescent psychopathology scale, listed by area and scales

Clinical disorders Psychosocial problem content

Attention deficit hyperactivity disorder Self-concept

Conduct disorder Psychosocial substance abuse difficulties
Oppositional defiant disorder Introversion
Adjustment disorder Alienation–boredom
Substance abuse Anger
Anorexia nervosa Aggression
Bulimia nervosa Interpersonal problems
Sleep disorder Emotional lability
Somatization disorder Disorientation
Panic disorder Suicide
Obsessive–compulsive disorder Social adaptation
Generalized anxiety disorder
Social phobia Response style indicator
Separation anxiety disorder Lie response
Posttraumatic stress disorder Consistency response
Major depression Infrequency response
Dysthymic disorder
Mania Critical item endorsement
Depersonalization disorder Factor score
Schizophrenia Internalizing Disorders Factor Score
Externalizing Disorders Factor Score
Personality disorder Personality Disorder Factor Score
Avoidant personality disorder
Obsessive–compulsive personality disorder
Borderline personality disorder
Schizotypal personality disorder
Paranoid personality disorder

Technical Characteristics Technical information on the development, standardization,

and psychometric properties of the APS is documented in an impressive manner in a
separate psychometric and technical manual. The items were developed carefully to
tap specific content areas and were refined using extensive input from a panel of experts
and from feedback obtained from adolescents during a field-testing procedure. The
40 scales of the APS were developed using a combination of rational–theoretical and
factor analytic approaches. Initial standardization of the APS was based on responses
from 2,834 adolescents from school settings and 506 from clinical settings, from several
U.S. states. The final norming sample is based on a pool of 1,837 adolescents selected
from the larger sample to approximate the 1990 U.S. Census with respect to gender,
ethnicity, and age.
Internal consistency reliability of the APS scales is generally in the 0.80s or 0.90s,
although a few of the smaller scales are in the 0.70s range or lower. A 14-day test–retest
reliability study reported in the APS manual showed that most of the scales had short-term
temporal stability coefficients of 0.80 or greater, with a small mean difference in obtained
scores across the two administrations. Extensive evidence for the validity of the APS is
presented with regard to within-scale relationships, content validity, and convergent and
discriminant construct validity based on relationships between APS scores and several
other established measures of adolescent personality, psychopathology, and well-being.
 Self-Report Assessment s 223

In addition, construct validity evidence is presented in the form of sensitivity to differences

between clinical and nonclinical groups and among diagnosed psychiatric subgroups
(Conduct Disorder, Major Depressive Disorder, and Substance Abuse Disorder).

The APS Short Form A separate short-form version of the APS (APS-SF) (W. M. Reynolds,
2000) is also available. The APS-SF includes 115 items from the APS. The APS-SF takes
an average of about 20 minutes to complete compared with about 60 minutes for the
APS. It includes 12 clinical scales and two validity scales. Of the clinical scales, six are
associated with symptoms of specific DSM-IV disorders (Conduct Disorder, Oppositional
Defiant Disorder, Major Depression, Generalized Anxiety Disorder, Posttraumatic Stress
Disorder, and Substance Abuse Disorder), and the other six are based on clusters of items
specific to areas of adolescent psychosocial problems and competencies, including
Eating Disturbance, Suicide, Academic Problems, Anger/Violence Proneness, Self-Concept,
and Interpersonal Problems. Because the APS-SF was derived from the APS, the same
standardization sample, reliability and validity studies, and scoring system were used for
both measures. The APS-SF may be a good choice in situations where a shorter screening
battery is desired.

Evaluation The APS and APS-SF are impressive adolescent self-report instruments and,
in my opinion, constitute one of the most innovative and promising developments of the
past two decades in broad-band self-report assessment of adolescent psychopathology.
The APS items and rating format were developed with great care, the scales cover all of the
major areas of importance for screening adolescent psychosocial problems, the technical
properties are impressive, and the user’s manuals are models of clarity and detail. Although
the APS does not have as extensive an externally published research base as some older
measures, the exemplary evidence presented in the technical manual and the many
strengths of this measure are notable. Readers should understand, however, that the norms
are now almost twenty years old. Hopefully, updated norms and a revised edition of the
measure will be made available soon.

The Behavior Assessment System for Children, Third Edition: Child and
Adolescent Self-Reports

Description The Behavior Assessment System for Children, Third Edition (BASC-3)
(C. R. Reynolds & Kamphaus, 2015), a comprehensive system of child and adolescent
assessment instruments, was discussed in some detail in Chapter 5 and is addressed in
other chapters as well. Of interest for this chapter are three instruments that are self-
reports of personality included in the system: the self-report for children aged eight to
11 (SRP-C), the self-report for adolescents aged 12 to 21 (SRP-A), and a self-report form
for college-age young adults, aged 18–25, (SRP-COL). The three BASC-3 self-report
measures, like the behavior rating scales of the system, are comprehensive instruments
that include a variety of items and scales reflecting clinical problems, interpersonal
adjustment, and adaptive competencies. The SRP-C includes 137 items, the SRP-A
includes 189 items, and the SRP-COL includes 192 items. Many of the items on these
three instruments are similar, but they were developed specifically for differing age and
developmental groups rather than being just slightly reworded. They can be considered
separate instruments, although they share many common features.
224 s Foundations and Methods of Assessment

The SRP-C, SRP-A, and SRP-COL take approximately 20 to 30 minutes to complete in

most situations. Telepractice options are available for youth that need additional support
with administration/completion of the form. The SRP items are completed by the
examinee using a combination of T (true) or F (false) (for about one third of the items)
and 4-point rating (for about two-thirds of the items, where N = Never, S = Sometimes,
O = Often, and A = Almost Always) formats by the examinee. The forms are scored using
scoring forms that tear off from the rating forms after they are completed. Q-Global
Digital scoring is a web-based scoring system available from the publisher. Raw scores are
converted to subtest scores within four general areas: School Problems, Internalizing
Problems, Inattention/Hyperactivity, and Personal Adjustment. In addition, an Emotional
Symptoms Index score (a global index of emotional distress) is derived. The SRP-COL
forms do not include items related to School Problems, but there is an Alcohol Abuse scale
unique to this particular form. Converted scores are all based on a T score system. The
Composites and Scales of the two SRP forms are shown in Table 8.2. In addition to
the SRP scale scores, these instruments include various validity scales. Both forms

Table 8.2 Composites and scales of the child and adolescent versions of the self-report form
of the Behavior Assessment System for Children, Third Edition

Composite scores Child (SRP-C) Adolescent (SRP-A)

Emotional Symptoms Index × ×

Inattention–Hyperactivity × ×
Internalizing Problems × ×
Personal Adjustment × ×
School Problems × ×
Primary scales
Anxiety × ×
Attention Problems × ×
Attitude to School × ×
Attitude to Teachers × ×
Atypicality × ×
Depression × ×
Hyperactivity × ×
Interpersonal Problems × ×
Locus of Control × ×
Relations with Parents × ×
Self-Esteem × ×
Self-Reliance × ×
Sensation Seeking ×
Sense of Inadequacy × ×
Social Stress × ×
Somatization ×
Content scales
Anger Control ×
Ego Strength ×
Mania ×
Text Anxiety ×
Functional impairment index × ×
 Self-Report Assessment s 225

include an F index (designed to detect abnormally high levels of symptom endorsement),

a V index (consisting of nonsensical items such as “I sleep with my schoolbooks” to help
detect random responding or failure to understand the directions), and an L index,
designed to detect “faking good” or a social desirability response set.

Technical Characteristics The voluminous BASC-3 manual is highly detailed, well written,
and provides extensive information regarding the development, standardization, and
supporting empirical base for the BASC-3 components. The general norm samples for the
SRP-C and SRP-A (total = 900) were derived from larger tryout samples, are geographically
diverse, and are similar to the general U.S. population in terms of racial/ethnic group,
socioeconomic status, gender distribution, and special education participation. Additional
clinical norm samples for both forms were obtained to assist in validity research and
the establishment of clinical cutoff score points. While the young adults representing the
SRP-COL are significantly represented in the manual, it is likely that the standardization
for this group is ongoing.
Internal consistency reliability coefficients of the SRP forms are acceptable to strong,
with data from the general norm samples showing median coefficients for the composite
scores ranging from the upper 0.80s to upper 0.90s, and individual scale scores mostly
ranging within the 0.80s. Additional internal consistency studies with clinical subsamples
produced alpha coefficients similar to or slightly lower than the reliabilities for the general
norm sample. Test–retest reliability of both scales was evaluated with medium-size sub-
samples at intervals ranging from 7 to 70 days between ratings. As should be expected, the
resulting stability coefficients were somewhat lower than the internal consistency coeffi-
cients, but still adequate. Composite score stability coefficients are reported as generally
being in the 0.60s to low 0.80s, with stability coefficients ranging from 0.59 to 0.86 for the
individual scale scores. Not surprisingly, lower coefficients were reflected in scales that
might be harder for young people to self-assess (e.g., self-reliance).
Various types of validity evidence for the SRPs are presented in the BASC-3 manual,
including extensive factorial validity and covariance structure analysis studies, con-
vergent and discriminant validity correlations with scores from the ASEBA Youth Self-
Report, Conners 3 Child Self-Report Scale, Conners 3 Adolescent Self-Report Scale, Delis
Rating of Executive Functions (D-REF), Children’s Depression Inventory 2, Revised
Children’s Manifest Anxiety Scale Second Edition, Beck Youth Inventories-II, Beck
Depression Inventory-II, MMPI-A, MMPI-A-RF, and the BASC-2 Self-Report forms.
In addition, SRP profiles of mean scores from clinical group samples (ADHD, Autism
Spectrum Disorder, Emotional/Behavioral Disturbance, Hearing Impairment, Specific
Learning Disorder, Speech or Language Disorder) that completed the SRP-C or SRP-A are
presented, with the results providing construct validity evidence regarding sensitivity to
theory-based group differences. Although there are some differences between the BASC-3
and original BASC and BASC-2 SRP forms, the modest externally published research base
from the original version of the scales also bolsters the reliability and validity evidence
of the SRP-C and SRP-A.

Evaluation The SRP-C and SRP-A of the BASC-3 are exemplary child and adolescent
self-report instruments in every respect. Based on the great popularity of the original
BASC and BASC-2, the BASC-3 tools, which include some significant and positive
improvements, will continue to be among the most widely used child and adolescent
226 s Foundations and Methods of Assessment

self-report measures and probably are as close to being a “standard work” for school-
based assessment as exists. The SRP-C continues to fill a void in the relatively small
number of general-purpose self-report instruments available for children aged eight
to 11. Although the SRP-A does not fill as large of a void for adolescent self-report
instruments because several other good-quality measures exist, it is definitely a positive
addition and should be considered seriously against other available instruments. These
self-report tools of the BASC-3 are practical, easy to use, and psychometrically strong,
and they have many other positive qualities to support them. The externally published
research base for these measures is still growing and provides additional supporting
technical evidence to the extensive information found in the BASC-3 manual. Practitioners
and researchers should have confidence in using the SRP-C and SRP-A for a variety of
purposes.

The Minnesota Multiphasic Personality Inventory–Adolescent Version and

Restructured Form (MMPI-A, MMPI-A-RF)

Description The Minnesota Multiphasic Personality Inventory–Adolescent (MMPI-A)

(Butcher et al., 1992; Graham et al., 2006) is the adolescent-specific version of the
MMPI, which is the most widely used objective self-report measure of personality and
psychopathology in existence. The original MMPI was first published in the 1940s
and was revised (the MMPI-2) in 2001. An adolescent version (the MMPI-A) was devel-
oped in early 1992 and revised in 2006. Although the original MMPI had been used
routinely with adolescents, with special norms and interpretation guides developed for
this purpose, the MMPI-A was the first version of the instrument designed specifically
for use with youth. The clinical applications, research uses, and psychometric properties
of the MMPI system in general have been the subject of an astounding number of
published research studies (more than 10,000) and professional books (more than 100).
It is arguably the most widely used and researched psychological assessment instru-
ment of any type in existence. A tremendous knowledge base exists in support of specific
clinical and research applications of these tools. Because the focus of this text is on
assessment of children and adolescents, the MMPI-A and the more recently developed,
MMPI-A-RF (restructured form) (Archer, Handel, Ben-Porath, & Tellegen, 2016) are
discussed here, but it is important to recognize that this instrument is part of a larger
system and a rich tradition.
The MMPI-A contains 478 true/false items, a reduction of nearly 100 from the MMPI
and MMPI-2. The items in the MMPI-A are based on the original MMPI, but with items,
scales, and norms specific to adolescents. The items that are specific to the MMPI-A
involve areas considered crucial in adolescent assessment, such as alcohol and other
drug use, school adjustment problems, family conflict, and maladaptive eating behaviors.
As in the case of the MMPI-2 revision, several of the items of the MMPI-A that were
retained from the original MMPI were reworded to make them more applicable and
relevant in contemporary society. Many of the features of the original MMPI were retained
in the MMPI-A, such as the L and K validity indicators and slightly revised versions of the
F validity scale and the basic clinical scales. Many significant changes in scale structure
from the other tools are found in the MMPI-A, however, including some validity scales
and 15 “content” scales that were developed to reflect content that is highly specific to
adolescent concerns and problems. In addition to the basic validity–clinical scales and the
 Self-Report Assessment s 227

content scales, the MMPI-A includes a virtual plethora of optional scale possibilities,
including:

s SUPPLEMENTARYSCALES
s (ARRISn,INGOESSUBSCALESTHATARESIMILARTOTHOSEDEVELOPEDFORTHE--0)AND
MMPI-2;
s #ONTENT#OMPONENTSCALESINCLUDINGFOREXAMPLETHEEVERPOPULARh-ISANTHROPIC
Beliefs” scale);
s 039 SCALESWHICHAREBASEDONTHEh"IGvPERSONALITYTRAITTHEORY!GGRESSIVENESS
Psychoticism, Disconstraint, Negative Emotionality/Neuroticism, Introversion/Low
Positive Emotionality);
s SPECIALINDICESRELATEDTORESPONSESTYLESANDPERCENTAGES

Although the optional or supplemental scale possibilities for the MMPI-A seem over-
whelming, they are not needed or used in most cases except by the most ardent students
and practitioners of the MMPI system. In general, the basic content and validity scales of
the MMPI-A are sufficient for most assessment purposes with adolescents. The break-
down of these basic scales from the MMPI-A is presented in Table 8.3.
Similar to the MMPI and MMPI-2, the MMPI-A may be scored several ways, including:
(1) hand-scoring with acetate scoring keys; (2) prepaid mail-in scoring services;
(3) Q Local, allows the user to score and store results on a personal computer; and
(4) computer scoring through Q-Global online administration or keyboard entry of com-
pleted answer forms. In addition to basic scoring options, Pearson, the publisher, provides
a range of report options, which includes detailed interpretive information based on the
configuration of validity, clinical, and supplemental scales from the publisher. These
reports include a Correctional Interpretive Report, General Medical Interpretive Report,
Inpatient Mental Health Interpretive Report, Outpatient Mental Health Interpretive
Report, School Interpretive Report, and Drug/Alcohol Treatment Interpretive Report.

Technical Characteristics The MMPI-A was designed specifically for use with adolescents
aged 14 to 18, and the instrument norms reflect this age group composition. These norms
are based on a representative nationwide sample of 805 boys and 815 girls aged 14 to 18.
Additionally, a clinical sample of 420 boys and 293 girls aged 14 to 18 was obtained,
recruited from clinical treatment facilities in Minnesota. The items are written at about
a sixth-grade reading level. The publisher has noted that the MMPI-A may be used with
13-year-old adolescents who have sufficient reading ability and cognitive maturity to
understand the items. As is the case with the MMPI and MMPI-2, the adolescent version
of the instrument includes separate norms for boys and girls, and uses a T score system.
The basic clinical scales of the MMPI-A and other versions of the MMPI were developed
using the empirical criterion keying approach. The MMPI-A manual is comprehensive
in detail and provides substantial evidence regarding the psychometric properties of the
test, which are adequate. The test–retest reliability studies presented in the manual show
strong evidence of short-term temporal stability of MMPI-A scores, although the internal
consistency coefficients of some of the scales are disappointingly low (in the 0.40 to 0.60
range in some cases).
The evidence presented in the manual regarding clinical sensitivity of MMPI-A scores
is impressive, however, and the hundreds of studies of this instrument that have been
228 s Foundations and Methods of Assessment

Table 8.3 Basic and content scales of the MMPI-A

Scale abbreviation Scale name

Basic validity scales

VRIN Variable Response Inconsistency
TRIN True Response Inconsistency
F1 Infrequency 1
F2 Infrequency 2
Infrequency
L Lie
K Correction
Basic clinical scales
Hs Hypochondriasis
D Depression
Hy Hysteria
Pd Psychopathic Deviate
Mf Masculinity-Femininity
Pa Paranoia
Pt Psychasthenia
Sc Schizophrenia
Ma Hypomania
Si Social Introversion
Content scales
A-anx Anxiety
A-obs Obsessiveness
A-dep Depression
A-hea Health Concerns
A-aln Alienation
A-biz Bizarre Mentation
A-ang Anger
A-cyn Cynicism
A-con Conduct Problems
A-lse Low Self-Esteem
A-las Low Aspiration
A-sod Social Discomfort
A-fam Family Problems
A-sch School Problems
A-trt Negative Treatment Indicators

published since its introduction in 1992 have bolstered the validity claims of the publisher
in a substantial way. In sum, the MMPI-A has exemplary technical properties and an
impressive array of evidence supporting its validity as a measure of personality and
psychopathology for adolescents. Pearson continues to distribute this version of the
MMPI but also markets the most up-to-date version, entitled the Minnesota Multiphasic
Personality Inventory-Adolescent-Restructured Form (MMPI-A-RF).

The Minnesota Multiphasic Personality Inventory–Adolescent–Restructured

Form (MMPI-A-RF)
The MMPI-A-RF (Archer et al., 2016) is structured in much the same way as the
restructured form of the MMPI-2. It includes 241 items, 48 scales, and can be used with
 Self-Report Assessment s 229

adolescents in a range of settings to identify problems, diagnose, and support treatment

planning. The MMPI-A-RF takes about 25–30 minutes to complete on the computer and
30–45 minutes to complete by hand. The items are written at about a 4.5 grade reading
level and forms are available in English and Spanish. Score reports include detailed inform-
ation from six validity scales; Higher Order Scales that provide broad-band information
about Emotional Internalizing Dysfunction, Thought Dysfunction, and Behavioral/
Externalizing Dysfunction; Somatic/Cognitive and Internalizing Scales; Externalizing,
Interpersonal, and Interest Scales; and updated PSY-5 scales. The norms for the MMPI-
A-RF are taken from the normative sample of the MMPI-A. The 48 scales are empirically
derived and users have the opportunity to customize reports so that individual scores are
compared to relevant comparison groups (e.g., psychiatric inpatient, forensic correctional,
school setting). Report options are the same for the MMPI-A-RF as they are for the
MMPI-A (i.e., hand-scoring, mail-in, Q-local, Q-global).

Evaluation Since its introduction in 1992, the MMPI-A, and now the MMPI-A-RF, have
become some of the most widely used instruments for self-report assessment of person-
ality and psychopathology of adolescents. The technical and psychometric properties of
the instrument are adequate to good, the heritage from the original MMPI is strong, and
there is a vast and continually growing body of literature attesting to the validity of these
measures for a variety of clinical and research purposes. Although the MMPI-A manual
is detailed and provides clear instructions and suggestions for administration, scoring,
and interpretation, there are several published books on this topic that are even better
than the manual. Books by Archer (2005), Archer and Krishnamurthy (2001), Ben-Porath
(1996), and Butcher, Williams, and Fowler (2000) are specifically recommended as the
best available guides to using the MMPI-A.
Despite the enviable position of the MMPI-A and MMPI-A-RF, they are not a good
choice in all situations and for all adolescents. There are two limiting factors to these
measures in this regard: their length and the cognitive maturity and reading ability (though
the MMPI-A-RF is more accessible) required to understand and complete it. They are a
poor choice in situations in which a brief screening is needed (the full MMPI-A can take
90 minutes to complete) or in which the adolescent who is being assessed is a poor reader
or has generally low cognitive ability. In situations where sufficient time is available and
where the adolescent is a reasonably good reader, who is in the average or higher range of
intellectual ability, the MMPI-A and MMPI-A-RF are excellent choices for a comprehensive
assessment of personality and psychopathology.

The Conners 3 Self-Report

Description The Conners 3 Self-Report Form (Conners 3 SR; Conners, 2008a) is appro-
priate for youth aged eight to 18 years old. Like the other measures represented within
the Conners 3 system, the Conners 3-SR includes a full-length form with 99 items, a short
form with 41 items, and an ADHD Index form with ten items. Depending on the form
used, administration time can take anywhere from five to 20 minutes, and the self-report
forms range from a 3.0–4.6 grade reading level. While this tool taps a variety of con-
structs, it is primarily considered a comprehensive measure of ADHD. The rating scales
in the Conners system are scored easily and converted to standardized subscale scores
based on gender and age-level breakdowns, using an innovative two-sided “Quickscore”
230 s Foundations and Methods of Assessment

format that requires minimal time and reduces the chance of committing scoring errors.
Online and software-based administration and scoring programs for the Conners scales
are also available from the publisher. The computer programs provide not only admin-
istration and scoring possibilities, but also the generation of brief interpretive summary
paragraphs related to individual score configurations and levels.
The Conners 3-SR content scales include Hyperactivity/Impulsivity, Learning Problems,
Inattention, Defiance/Aggression, and Family Relations. The DSM symptom scales include
ADHD Inattentive, ADHD Hyperactive-Impulsive, ADHD Combined, Conduct Disorder,
and Oppositional Defiant Disorder. There are items that screen for anxiety and depres-
sion and also validity scales that aim to identify children that report in an overly positive,
negative, or inconsistent way. There are items that target levels of impairment in schoolwork,
friendships, and home life, and there are also critical items that reflect severe conduct.

Technical Characteristics The Conners 3 was developed in three phases. The structure
of the various measures and the initial items were first developed, a pilot study was
conducted, and then a larger normative study was completed. During the pilot study,
200 youth from a general sample and 54 from a clinical sample completed the Conners
3-SR. Data were analyzed to understand ceiling and floor effects, item discrimination,
and overall factor structure. During the normative study, data were collected from 2,088
youth representative of the U.S. population. Reliability estimates for the content scales
and DSM-IV-TR scales were calculated. Internal consistency coefficients ranged from
0.81 to 0.92 and test–retest coefficients ranged from 0.71 to 0.83. The Conners 3-SR was
found to be moderately to highly correlated with the BASC-2 SRP, and the YSR from the
ASEBA System, particularly with scales targeting inattention, hyperactivity, and other
externalized behaviors.

Evaluation The Conners 3-SR is an excellent part of a multi-method, multi-source

approach to assessment. The Conners 3 system is comprehensive, user-friendly, and has
a history of quality research backing its use. Even though the Conners 3 was released prior
to the release of the DSM-5, Dr. Conners released information in 2014 that highlights
scoring and interpretative adjustments that have been suggested based on changes to
the DSM-5. These adjustments are minor but are available from the publisher upon user
request.

The Conners 3 Comprehensive Behavior Rating Scales Self-Report (CBRS-SR)

Description The Conners 3 CBRS-SR and the Conners Clinical Index (CI-SR) (Conners,
2008b) are integral to the CBRS assessment system. The CBRS-SR is appropriate for
youth aged eight to 18 and includes 179 items. Similar to the Conners 3-SR, the CBRS-SR
includes content scales, DSM scales, validity scales, impairment items, and critical items.
The content scales for the self-report measure Emotional Distress, Defiant/Aggressive
Behaviors, Academic Difficulties, Hyperactivity/Impulsivity, Separation Fears, Violence
Potential Indicator, and Physical Symptoms. Other clinical indicators are also reflected
and include Bullying Perpetration, Bullying Victimization, Panic Attack, Pervasive
Developmental Disorder, Pica, PTSD, Specific Phobia, Tics, and Trichotillomania. The
CI-SR is a short form with just 24 items and identifies Disruptive Behavior Disorder
Indicator, Learning and Language Disorder Indicator, Mood Disorder Indicator, Anxiety
 Self-Report Assessment s 231

Disorder Indicator, and ADHD Indicator. With the teacher and parent report features,
these self-reports can be useful in supporting diagnoses and/or educational classification,
and for screening and treatment planning.

Technical Characteristics Similar to the Conners 3, the CBRS was developed in three
phases—initial development, pilot study, and normative study. During the pilot phase,
nearly 200 youth from the general population and 51 from clinical populations completed
the CBRS-SR. Exploratory factor analyses were conducted and Other Clinical Indicators
were selected. During the normative study, data were collected between 2006 and 2007
in the U.S. and Canada, and sampled from 2,057 youth. Internal consistency coefficients
of the CBRS-SR ranged from 0.74 to 0.96 and temporal stability coefficients were 0.56 to
0.82. The CBRS-SR was compared to the self-report tools associated with the BASC-2,
ASEBA system, Children’s Depression Inventory, Multidimensional Anxiety Scale for
Children, and previous Conners forms. Across these measures, the CBRS-SR converged
and diverged with these measures in expected areas.

Evaluation The CBRS-SR and CI-SR are important contributions to the CBRS system.
The Conners 3 and the CBRS are both exemplary and comprehensive assessment systems
that have years of research supporting their development and iterations over time. The
Conners 3 and CBRS self-reports are particularly helpful in that they are additional
options for self-report measures that can be used with children under the age of 12.

The Youth Self-Report (YSR)

Description The Youth Self-Report (YSR) (Achenbach, 2001d) is the self-report compo-
nent of the ASEBA. The most recent revision is an update of the 1991 YSR (Achenbach,
1991c). The YSR may be used alone, but it is intended for use as a “cross-informant”
assessment instrument in conjunction with the CBCL and TRF, and was designed and
normed for use by subjects aged 11 to 18. The YSR requires about a fifth-grade reading
level to complete. The first section includes seven adaptive competency items where sub-
jects provide information about their interests, hobbies, peer and family relationships,
and school performance. These first seven items yield several competence scale scores.
This section also includes four open-ended questions (e.g., “Please describe any concerns
you have”). The major element of the YSR is 112 items, which are descriptive statements
that are rated by the subject using a 3-point scale (“Not True” to “Very True”). Of these
items, 101 are statements about various problem behaviors, whereas 11 items reflect
socially desirable characteristics that are endorsed by most subjects. These socially desir-
able items are not scored but were placed in the checklist to provide a balance to the
problem items and to help detect indiscriminate responding. The 101 problem items are
scored along two broad-band scales (Internalizing and Externalizing), eight narrow-
band syndromes, and a total problem score. The narrow-band cross-informant syndrome
scores are the same as those used with the CBCL and TRF (see Chapter 4). All raw scores
are converted to T scores in the scoring process, and the YSR can be scored using hand-
scoring templates, a computer-based scoring program, or machine-readable scoring forms
that require separate software and scanning devices. The scoring system provides separate
score norms for boys and girls, although the same cross-informant subscale configuration
is used with each gender.
232 s Foundations and Methods of Assessment

Technical Characteristics The norms and clinical cutoff points for the YSR are based
on a large standardization sample of 2,581 high-scoring (clinical) youths and 1,057
nonreferred youths. The standardization sample is nationally representative with respect
to socioeconomic status, race, and urbanicity. Data reported in the YSR manual and in
other sources indicate acceptable levels of test–retest reliability at one-week intervals
(a median reliability coefficient in low 0.80s). In terms of internal-consistency reliability,
the broad-band and total score alpha coefficients range from the low to upper 0.80s,
and the range for narrow-band and competence scores is more variable (about 0.40 to the
lower 0.80s range). Evidence of validity of the YSR presented in the manual includes
sufficient factorial validity data and correlational data between the YSR, CBCL, and TRF
(which are in the 0.40 range). Numerous independent studies using the current YSR and
its processor have been published. It appears that the YSR is now the second most widely
researched general-purpose objective self-report assessment tool for adolescents, next to
the MMPI-A. Although the findings of these many studies have been mixed, they have
demonstrated the technical adequacy and psychometric properties of the YSR as a self-
report measure of problem behavior. The external research evidence on the YSR is far
too extensive to review in this section. The many studies providing support for the validity
of the YSR, among other things, have detailed its effectiveness in differentiating among
clinical and nonclinical populations and various clinical populations, confirmed its
factor structure, provided evidence of its sensitivity to changes wrought by intervention,
and shown strong convergent construct validity in comparison with other measures.
Among the studies that have raised questions regarding the validity of the YSR are some
that have failed to detect score differences between differing clinical groups. In sum, the
research evidence in support of the YSR is mixed, but at the same time it is primarily
positive, and vast.

Evaluation Despite some potential cautions raised by a few researchers, the YSR has
become widely used and well supported for good reasons. It appears to be valid for
numerous clinical and research purposes, especially when used in conjunction with other
forms of assessment. While the norms are somewhat old, DSM-5 oriented scales have
been developed to help guide users in current decision-making practices. The YSR has the
distinct advantage of being part of the ASEBA, which is clearly the most comprehensive
cross-informant assessment system for children and adolescents. One issue to consider
regarding the YSR is that its items are very straightforward, even blunt at times. Items
such as “I physically attack people,” “I destroy things belonging to others,” and “I swear or
use dirty language” are not designed to be particularly subtle, and may raise defensiveness
or denial in some youths. In contrast to most of the other tools reviewed in this chapter,
it is for the most part a list of problem behaviors, and it lacks “validity scales” for deter-
mining how valid particular response patterns may be. It is my clinical experience and
that of several colleagues that it is not unusual for adolescents with externalizing behavior
problems (i.e., antisocial behavior and conduct disorders) to manipulate their responses
on the YSR so that their scores tend to minimize any problems (i.e., they may look
normal). Clinicians should be aware of this possible pattern. The YSR has many strengths
and features that warrant its use, however, including an easy-to-use response format, a
well-written manual with a great deal of technical information, a large and increasing
body of research documentation, and the empirical connection between the YSR and the
other components of the ASEBA.
 Self-Report Assessment s 233

SELF-REPORT TESTS AND DECISION MAKING

Objective self-report instruments can be useful for screening purposes and for making
decisions about additional forms of assessment that may be warranted. Not only can the
administration of self-report tests provide “red flags” that may be indicative of general
social or emotional distress, but in some cases they can isolate specific areas of concern
in which additional assessment is needed, or that may be entirely missed by direct
behavioral observation or parent/teacher reports. Each of the general-purpose self-report
tests reviewed in this chapter can provide specific information that can be used to generate
hypotheses about additional assessment of depression, low self-esteem, anxiety, conduct
problems, and even psychotic behavior. Anastasi and Urbina (1997) have emphasized that
self-report personality inventories are best used as “an aid for describing and understanding
the individual, identifying her or his problems, and reaching appropriate action decisions”
(p. 385), a conclusion that I also endorse. In assessing children and adolescents, obtaining
their own perspective through self-report assessment should be a crucial part of the
assessment design and may yield information pertinent to decision making that is not
possible through other sources.
Similar to most other forms of assessment, self-report tests should never be used
by themselves to make diagnosis or classification and placement decisions. These types
of decisions require a broad, multifactor assessment design wherein specific aspects of the
decision process are weighed against specific pieces of evidence obtained through a
carefully planned and implemented assessment process.
In terms of intervention or treatment planning decisions, self-report tests are normally
used to generate broad hypotheses about what to do, in conjunction with other forms of
assessment data, but seldom provide sufficient evidence by themselves to warrant the
design and implementation of intervention plans. The possible exception—and I wish to
emphasize the word possible—to this rule may be the use of the MMPI-A. Because of the
vast history of research and clinical use of the MMPI and the extensive research base that
has emerged specific to the MMPI-A, a great deal is understood about using actuarial
assessment data from this instrument in developing treatment plans. There is a substantial
amount of literature on the actuarial application of MMPI and MMPI-A data to treatment
planning, and there is currently a great deal of interest in expanding and refining work
in this area. A related decision-making use of self-report tests is their administration
as treatment outcome measures. Several studies with the MMPI-A and other tools have
shown that adolescent self-report measures may serve as sensitive indicators of subjective
changes that may occur as a result of treatment. Readministration of a self-report test after
treatment may provide some useful information regarding the efficacy of the intervention,
at least from the client’s own report of his or her symptoms.
In line with current RtI initiatives, self-report tests might also be useful to monitor the
progress of individuals throughout treatment. Increasingly, studies are being conducted
in which shorter and similarly reliable forms are being created from established rating
scales. Through factor analytic techniques and use of change sensitive metrics, researchers
are able to pull a smaller number of items with the highest factor loadings to create
shorter scales that are sensitive to change (see Gresham et al., 2010; Volpe, Gadow, Blom-
Hoffman, & Feinberg, 2009). A shorter form having good psychometric properties can be
a reliable, valid, and efficient means by which to measure an individual’s response to
intervention and assist in making important decisions for alterations in treatment and
maintenance of gains.
234 s Foundations and Methods of Assessment

CONCLUSIONS
Although there has been interest in personality assessment since antiquity, empirical
efforts at objective self-report assessment have been in place only since the early to mid-
1900s. The Personal Data Sheet and Berneuter Personality Inventory of the 1920s and
1930s served as prototypes for modern objective self-report measures. The development
and popularization of the MMPI in the 1930s and 1940s served as a model stimulus for
developments in this emerging field. Although the area of objective personality assessment
has faced many challenges, there has been increased interest in recent decades and
important new technological developments.
Although there are many approaches to assessing behavioral, social, or emotional status
through self-report means, there are specific technical criteria that must be in place for a
test to be considered an objective self-report measure. In comparison with other forms of
objective assessment, such as aptitude or ability testing, self-report assessment of social–
emotional characteristics presents many unique challenges. Perhaps the greatest difference
is that social–emotional characteristics of humans are much less stable and much more
subject to variations through situations than are general cognitive characteristics.
Three major approaches to developing objective self-report tests have been identified:
the rational–theoretical approach, the factor analytic approach, and the empirical crite-
rion keying approach. There are substantial differences in how each approach is used to
develop test items and scales. In reality, however, many test developers use combinations
of these approaches, and it is difficult to identify any one approach as being superior. The
characteristics and predictive power of particular tests are a better indicator of quality
than the method used to construct the test.
Several types of response bias and error variance have been identified relative to self-
report tests. Clinicians and researchers who use self-report tests should always consider
the possibility of how these phenomena may affect obtained test scores, either overtly or
subtly, and take these potential problems into consideration when interpreting results.
Descriptions and evaluative reviews of several illustrative general-purpose self-report
tests for use with children and youth were provided in this chapter. These instruments
include the Adolescent Psychopathology Scale, the child and adolescent self-report
forms of the Behavior Assessment for Children, Third Edition, Minnesota Multiphasic
Personality Inventory–Adolescent, Conners 3-SR, CBRS-SR, and YSR. Of these instru-
ments, only four (the SRP-C, YSR, and Conners 3-SR and CBRS-SR forms) are aimed at
the preadolescent population. These instruments represent the best of what is currently
available, and they represent major advances in self-report assessment of adolescents.
Before 1990, virtually nothing of value was available for children younger than age 11 or
12 in the way of psychometrically adequate general-purpose self-report forms. Although
more instruments have been available for use with adolescents, the recent developments
in this area have been encouraging as well. The field of self-report assessment of children
and adolescents is substantially more advanced today than it was only a few years ago.
Clinicians and researchers now are able to choose among several high-quality measures
for specific assessment issues.
Self-report measures may provide information useful in making various decisions,
such as screening, diagnosis, and treatment planning. An emerging decision-making use
of self-report measures stems from their increasing use as treatment outcome measures.
One caution that should be considered in making decisions with self-report data is the
 Self-Report Assessment s 235

fact that these data sometimes are at odds with assessment data supplied from other
sources, such as parent and teacher reports. Clinicians and researchers should include
self-report assessment as one aspect of the assessment design and consider the overall
picture provided by all sources of data when making decisions.

REVIEW AND APPLICATION QUESTIONS

1. What characteristics are considered to be essential for an assessment instrument to be
considered an objective self-report test?
2. Compare and contrast the three major methods of objective test construction: rational–
theoretical, empirical criterion keying, and factor analysis. Which, if any, of these is the
preferred method for constructing self-report tests?
3. What are the major forms of response bias discussed in this chapter, and how may they
be manifest in self-report assessment of children and adolescents?
4. You are a psychologist working in either a community-based clinic or a school. You are
interested in using the Adolescent Psychopathology Scale with the population you serve.
Discuss (1) the conditions under which this measure would be appropriate, and
(2) advantages and disadvantages of this measure, given these conditions.
5. Of the several general-purpose self-report tests reviewed in this chapter, several (the
SRP-C, YSR, Conners 3-SR and CBRS-SR) were developed for use with children younger
than 12 years old. If one were determining which of these two instruments to administer
to a nine- or ten-year-old child, how would the relative merits and drawbacks of each test
play into the decision?
6. How might child and adolescent self-report tests be used best in making decisions
regarding the effectiveness of treatment?
7. It is common for youth self-report instruments to yield data that differ—sometimes
markedly so—from assessment data provided through other sources (i.e., parent and
teacher reports). What are some realistic ways of treating these differences in assessment
results?
 9
PROJECTIVE–EXPRESSIVE ASSESSMENT TECHNIQUES

Projective and expressive assessment includes such techniques as drawing, storytelling,

and sentence completion. Although projective and expressive assessment techniques are
often at the center of a storm of controversy regarding reliability, validity, and appropriate
uses, there is no question that these techniques continue to be popular among many
clinicians. A review of the professional and scientific literature on projective–expressive
assessment does not easily lead to a consensus regarding the current state of the art. On
one hand, many researchers and clinicians who are concerned with assessment of children
and adolescents view projective–expressive assessment techniques as an important feature
of the clinical training of graduate students. This view is based on the notion that these
techniques may offer a unique window into an individualized idiographic assessment
of the “inner life” of children and adolescents. On the other hand, projective–expressive
assessment has a small army of very vocal critics who view this area with disdain and
rightly point out that the reliability and validity of many of these techniques fall short of
professional standards as well as those of other forms of social–emotional assessment.
Survey research on assessment practices of school and clinical psychologists during
the past two decades (e.g., Hojnoski, Morrison, Brown, & Matthews, 2006; Lubin, Larsen,
& Matarazzo, 1984; Norcross, Karpiak, & Santoro, 2005; Watkins, Campbell, & McGregor,
1988; Wilson & Reschly, 1996) indicates that despite some of the controversies surround-
ing them, projective–expressive and related social–emotional assessment techniques
remain popular among clinicians. For that reason alone, it is important to devote a chapter
in this book to a treatment of the topic. We share some of the views of authors of related
texts on psychological assessment of children (e.g., Groth-Marnat, 1997; Kamphaus
& Frick, 2002) that projective–expressive assessment techniques are a unique method of
assessing children, and in some cases may be a valuable component of a comprehensive
assessment design. Because projective–expressive assessment techniques often do not
meet the standards of technical adequacy of the primarily direct and objective techniques
emphasized in other chapters of this text, I also share the view that these techniques should
be used judiciously, cautiously, and rarely because of some of the unique psychometric
and ethical concerns surrounding them (e.g., R. J. Cohen & Swerdlik, 1999; Groth-Marnat,
1997; Knauss, 2001). In fact, I agree with the opinion of Hojnoski et al. (2006), who stated,
“Given issues of psychometric adequacy, treatment utility, and social validity, the contin-
ued use of projectives by school psychologists is puzzling” (p. 147). In short, I believe that
a comprehensive chapter devoted to this topic is essential if for no other reason than to
help readers evaluate the cautions and problems associated with projective–expressive
assessment, so that they might make informed and defensible choices.

237
238 s Foundations and Methods of Assessment

This chapter begins with a brief introduction to the theory and practice of projective–
expressive techniques, and then includes sections on using thematic approaches, drawing
techniques, and sentence completion tasks as methods of assessing social–emotional
behavior of children and adolescents. The chapter concludes with a set of recommendations
for best practice in using projective–expressive techniques, emphasizing appropriate and
defensible practices. In making a determination of which projective techniques were most
important to include in this chapter, some prominent techniques were left out because of
space and practical considerations. One technique that is prominently missing from this
chapter is the Rorschach Inkblot test. There are two reasons for this omission. First, the
use of the Rorschach has evolved to the point where it is not as loosely projective as it once
was, and the most widely used methods for scoring and interpretation treat it as a highly
structured perceptual task (e.g., Bornstein, 2012; Exner & Weiner, 1994). Second, given the
complexity of modern methods of using the Rorschach (i.e., the Exner system), readers
should be advised that a cursory overview of the Rorschach in a general chapter would not
prepare them even to begin administering this test. Rather, effective use of the Rorschach
with subjects of any age requires intensive training and study. Clinicians who desire to
become more familiar with it should refer to the appropriate comprehensive books, as well
as some of the controversies regarding the use of the Rorschach.

PROJECTIVE ASSESSMENT: AN INTRODUCTION

According to Gregory (1996), the projective hypothesis was first formally detailed by Frank
(1939) to describe a category of psychological tests designed to study personality through
responses to unstructured stimuli. Use of assessment techniques that might be considered
to be projective substantially predates the term itself, however, and some projective
techniques were clearly in use with children and adults by at least the 1920s, if not earlier.
The projective hypothesis is based on the assumption that “personal interpretations of
ambiguous stimuli must necessarily reflect the unconscious needs, motives, and conflicts of the
examinee” (Gregory, 1996, p. 511, italics added for emphasis). The basic task involved in
projective assessment is to evaluate information and products (i.e., statements, drawings,
key words) that are provided by the examinee in response to an ambiguous task, for the
purpose of deciphering their underlying personality processes and social–emotional
functioning. Without question, this task is formidable and, by the nature of the procedures
designed to enable it, will often become a highly subjective and speculative pursuit. Within
various projective methods, there is wide variation in how structured or unstructured the
processes of elicitation and interpretation are.
The term projective–expressive techniques is used throughout this chapter. The addition
of expressive to the constellation of projective techniques signifies that some methods that
are often lumped together with projectives are not really projectives in the strict sense,
given that they are not based singularly on the projective hypothesis. Expressive social–
emotional assessment techniques are procedures in which examinees are allowed to
express themselves in response to ambiguous or loosely structured stimuli, but their
responses may not necessarily be used in a true projective manner. Examples of techniques
that may be considered more expressive than projective include certain drawing tasks and
specific sentence completion tests. Throughout this chapter, the term projective–expressive
is used to denote a general category of assessment techniques that are based on similar
 Projective–Expressive Assessment Techniques s 239

assumptions and allow for individualized administration and interpretation by the

clinician.
Many advocates of projective–expressive assessment have been influenced strongly by
psychodynamic theory. Perhaps the most central psychodynamic tenet that is incorporated
into projective–expressive assessment is the assumption that responses to ambiguous
stimuli represent projections of the examinees’ unconscious psychological processes.
Within this psychodynamic–projective paradigm, the responses examinees make to ambig-
uous stimuli may be quite revealing (to the trained clinician) regarding their “inner pro-
cesses,” but the examinees may not be aware that the information is so revealing. Although
psychodynamic theory has been in the forefront of projective testing, more recently
humanistic theory also has been incorporated. In a strict sense, however, the purpose
of the test is no longer truly projective when the psychodynamic theory is deemphasized.
The major difference between psychodynamic and humanistic approaches to assessment
is that humanistic-based techniques do not rely as much on the latent or hidden content
of examinees’ responses (i.e., the examinees’ unconscious projections). Rather, assessment
techniques that are underpinned by humanistic theory are more likely to view responses
of examinees as direct statements about who they are as people. An example of a human-
istic approach to this type of assessment would be human figure drawings for the purpose
of identifying an examinee’s overt body image. Although there are some psychodynamic
and humanistic historical underpinnings to the area of projective–expressive assessment,
this area also seems to be conceptually aligned with more recent ideologies, including
postmodernism and constructivism.
Projective–expressive assessment seems to be as widely used with children and adoles-
cents as it is with adults. Some projective techniques have been developed or adapted
specifically to one age group or another, but many are adaptable across various age
ranges. Some of the presumed advantages of using projective–expressive techniques with
children and adolescents is that the examinees do not need to understand the specific
purposes of the task and that they may be less suspicious and defensive when asked to
engage in tasks such as drawing, finishing sentences, and telling stories about pictures
than they might be when asked specific questions about their social–emotional behavior
(Chandler & Johnson, 1991).
Like no other method of social–emotional or personality assessment, the use of
projective techniques has been controversial (R. J. Cohen & Swerdlik, 1999; Hojnoski et
al., 2006; Knauss, 2001; D. N. Miller & Nickerson, 2007). Most of the controversy regard-
ing projective assessment has been from within the professional community rather than
from the lay public (in contrast to the controversies surrounding IQ and academic achieve-
ment tests). There have been numerous points of contention regarding projectives, but the
essential controversies involve two main issues. First, many psychologists and other pro-
fessionals simply do not believe the argument that is evident in the projective hypothesis:
that responses to ambiguous stimuli may reveal important information about the person-
ality that is unconsciously projected. Second, and perhaps more important, projective–
expressive assessment does not fare particularly well in comparison with more direct and
objective assessment methods from the standpoint of scientific psychometric criteria
(Gregory, 1996).
Despite years of controversy regarding projective assessment, these techniques continue
to be popular, and in many cases are more popular than direct and objective methods that
fare much better in terms of empirical evidence. Despite one recent survey of clinical
240 s Foundations and Methods of Assessment

psychologists indicating that projective assessment is used less frequently among clinicians
than it was in the 1960s and 1970s (Norcross et al., 2005), studies by Hojnoski et al. (2006),
Lubin et al. (1984), Watkins et al. (1988), and Wilson and Reschly (1996) all indicated that
projective–expressive techniques are among the most widely used of all psychological
assessment methods and that they show no sign of declining in popularity. In commenting
on this paradox between evidence and use, Gregory stated:

The essential puzzle of projective tests is how to explain the enduring popularity of
these instruments in spite of their generally marginal (often dismal) psychometric
quality. After all, psychologists are not uniformly dense, nor are they dumb to issues
of test quality. So why do projective techniques persist?
(1996, p. 512)

In answering his own question, Gregory proposed two explanations for the continued
popularity of projective–expressive techniques. First, as humans, we are likely to cling to
preexisting notions and stereotypes, even after we are exposed to contradictory findings.
Second, there is a tendency toward illusory validation (Chapman & Chapman, 1967), a
phenomenon that is best put into context by the deftly ironic statement “If I didn’t believe
it, I wouldn’t have seen it.” In essence, clinicians who believe strongly in using particular
assessment methods are more likely to notice findings from those methods that confirm
their hypotheses, while being likely to ignore findings that contradict their expectations.
With this cautionary interpretation to the continued popularity of projectives as a pre-
amble, this chapter provides a comprehensive overview of three of the most popular areas
of projective assessment with children: thematic approaches, drawing techniques, and
sentence completion tasks.

THEMATIC APPROACHES
Thematic approaches to assessing personality and psychopathology are based on the
projective hypothesis, and their use became specifically associated with the study of ego
psychology as advocated by H. A. Murray, Bellak, and their associates at the Harvard
University Psychological Clinic in the 1940s. In a thematic-based assessment, the examinee
is presented with a series of drawings or pictures showing unstructured ambiguous
characters and situations and is asked to tell a story about each picture. The basis of
interpreting responses to thematic storytelling tasks is that the examinee is assumed to
project his or her needs, drives, conflicts, and emotions that form the foundation of the
personality into the picture stimulus and the resulting story.
Many of the early clinical and research uses of thematic storytelling approaches were
heavily oriented toward assessing creativity and imagination, and instructions to exami-
nees typically encouraged them in this regard (Gregory, 2000). As thematic approaches
became increasingly popular in the 1950s and 1960s, however, the emphasis on creativity
and imagination was replaced with a stronger emphasis on personality assessment,
particularly from a psychodynamic orientation.
Because there are so many thematic techniques available and because there are no
dominant standardized methods of administration, scoring, and interpretation, it is best
to refer to this category of assessment as thematic approaches rather than thematic tests.
 Projective–Expressive Assessment Techniques s 241

In contrast to the other projective–expressive techniques discussed in this chapter, it is

difficult to include a separate section on administration, scoring, and interpretation
because there is so much variation from one clinician to another and among various
thematic approaches (Gregory, 2000; Obrzut & Boliek, 1986; Teglasi, 2001; Worchel, 1990).
There are some recent handbooks that focus on thematic approaches, should readers
decide to pursue more information in this area (see Jenkins, 2008; Teglasi, 2010). This
section provides information on administration, scoring, and interpretation within the
description of three specific thematic approaches: the Thematic Apperception Test (TAT),
the Children’s Apperception Test (CAT), and the Roberts Apperception Test for Children
(RATC). Following the description of these three approaches, additional sections on
reliability–validity and concluding comments on using thematic approaches are provided.
Before proceeding with this discussion, it is important to recognize that this is a
relatively cursory and limited overview and cannot possibly do justice to the vast body of
literature on research and clinical applications of thematic approaches. Readers who
desire to become highly familiar and skilled in the use of thematic approaches are referred
to the recent volumes that have been written to provide in-depth explorations of thematic
approaches (e.g., Bellak, 1975; Rabin, 1986; Teglasi, 1993, 2001, 2010).

The Thematic Apperception Test (TAT)

The Thematic Apperception Test (TAT) should be considered “the mother of all thematic
approaches.” Without question, the TAT is the most influential and widely researched
thematic approach. Most other thematic approaches are modifications or extensions of the
TAT. Developed by Henry Murray and his colleagues at the Harvard Psychological Clinic
(Morgan & Murray, 1935; H. A. Murray, 1938), the TAT originally was designed to assess
personality constructs such as needs, press, and thema, which were essential elements to
Murray’s personality theory. In this theory, needs include processes that organize thought,
action, and behavior to be energized to satisfy underlying needs. Press refers to the power
of environmental events that may influence a person. Themas are themes of combined
needs and presses into a pattern that is played out in a story.
The TAT includes 31 black-and-white picture cards that contain a variety of unstruc-
tured and ambiguous characters, situations, and objects. The entire collection of cards is
never administered to an examinee; an individualized administration battery ranging
from ten or fewer cards to 20 cards is selected. The cards are numbered, and many cards
include letters with the number, to identify cards that are recommended for specific use
with boys (2), girls (G), adult males (M), and adult females (F), or some combination
thereof (e.g., GF). Obrzut and Boliek (1986) recommended that when administering the
TAT to children aged eight to 11, the following cards were particularly important: 1, 3BM,
7GF, 8BM, 12M, 13B, 14, and 17BM. For adolescents, Obrzuit and Boliek recommended
cards 1, 2, 5, 7GF, 12F, 12M, 15, 17BM, 18BM, and 18GF. Teglasi (1993) noted that cards
1, 2, 3BM, 4, 5, 6BM, 7GF, and 8BM were appropriate for use with children and adoles-
cents of either gender. Other writers have expressed similar and differing preferences
for constructing TAT batteries for child and adolescent use, but ultimately the clinician
needs to select an appropriate set of cards from the TAT that make sense for use with the
specific examinee. An important consideration in selecting an appropriate battery of TAT
cards is the presenting issues and problems of the examinee. For example, if the examinee
“appears depressed, those TAT pictures related to depression and suicide should be used”
(Obrzut & Boliek, 1986, p. 178).
242 s Foundations and Methods of Assessment

Administration instructions for the TAT tend to be nonstandardized, and many uses
of the TAT tend to deviate from H. A. Murray’s (1938) original directions, which empha-
sized creativity and imagination. Some writers have expressed the opinion that TAT
directions should provide as few cues as possible, permitting the examinees great leeway
in expressing themselves (Peterson, 1990). Teglasi (1993, 2001, 2010) argued, however, that
TAT administrations with children and adolescents should include more structure because
it allows for better follow-up questions by the examiner. Teglasi recommended the follow-
ing general instructions from H. A. Murray (1943) for administering the TAT to children
and adolescents:

Younger Children:
I am going to show you some pictures, and I would like you to tell me a story for
each one. In your story, please tell: What is happening in the picture? What happened
before? What are people thinking and feeling? How does it all turn out in the end?
So I’d like you to tell a whole story with a beginning, a middle, and an ending. You
can make up any story you want. Do you understand? I’ll write down your story.
Here’s the first card.

Older Children and Adolescents:

I am going to show you some pictures, one at a time, and your task will be to make
up a story for each card. In your story, be sure to tell what has led up to the event
shown in the picture, describe what is happening at the moment, tell what the
characters are feeling and thinking, and then give the outcome. Tell a complete story
with a beginning, middle, and end. Do you understand? I will write your stories as
you tell them. Here’s the first card.

After each TAT card story, a series of clarifying questions is recommended so that the exam-
iner will better understand the examinee’s story. This process is referred to as the inquiry
phase of administration. Questions may involve further clarification of the characters’
thoughts and feelings and how the story was generated (e.g., whether the examinee created
the story or adapted it from something he or she read, or watched on television). True
to the unstandardized nature of the TAT, some writers have expressed a preference for
conducting the inquiry phase only after all cards have been administered, so as to not
interfere with the examinee’s storytelling while it is happening (Bellak, 1975). If the clini-
cian considers the TAT to be a true projective test, it should be considered that the more
structure that is imposed on the administration process, the less projective or spontaneous
will be the examinee’s responses (Obrzut & Boliek, 1986).
Interpretation of the TAT tends to be even more nonstandardized than administration.
Numerous interpretation approaches have been proposed, and it is beyond the scope of
this chapter to review them all. In their review of using the TAT with children and ado-
lescents, Obzrut and Boliek (1986) recommended the inspection technique as being “the
simplest and, perhaps, most useful for TAT interpretation” (p. 179). This method is fairly
straightforward and involves the clinician’s simply treating the stories as being meaning-
ful psychological communications from the child or adolescent examinee. Data that seem
to be significant, specific, or unique are noted. This technique also incorporates the widely
used suggestion of the original TAT authors to identify a hero (or main character) within
each story, which is presumably the character that the examinee will identify with and
 Projective–Expressive Assessment Techniques s 243

project his or her unconscious motives and needs onto. “The motives, trends, and feelings
of the hero; the forces within the hero’s environment; the outcome of the stories; simple
and complex themes; and interests and sentiments attributed to the hero” (Obzrut &
Boliek, 1986, p. 180) are all considered to be important aspects of interpretation. Common
themes among the stories should be identified, and the expressive manner in which the
examinee relates the story should be noted carefully. This method of interpretation is
simple, allows the clinician extensive leeway, and if used conservatively, should provide
an effective bridge of understanding into the examinee’s stories. Readers interested in
practical strategies and applications of the TAT are referred to Aronow, Weiss, & Reznikoff
(2013).

The Children’s Apperception Test (CAT)

The Children’s Apperception Test (CAT) (Bellak & Bellak, 1949) was developed as a
downward extension of the TAT, specifically targeted for use with children aged three to
ten. The CAT includes ten cards that depict animal characters (e.g., lions, bears, chimps,
dogs) rather than human characters. The theory behind the use of animal characters by
the authors of the CAT is that young children would be better able to relate to animal
characters than human characters and might find them to be less threatening. A parallel
form of the CAT (the CAT-H) was developed that includes human rather than animal
figures (with the same picture scenarios as the CAT), which is thought to be more
appropriate for older children and preadolescents.
Because the CAT is conceptually and theoretically similar to the TAT, the same general
administration and general interpretation methods that were outlined for the TAT are
recommended. Bellak (1975), the author of the CAT, recommended that interpretation
of CAT stories should focus on identification of the following ten variables:

1. the main theme;

2. the main hero;
3. main needs and drives of the hero;
4. the conception of the environment;
5. how figures are seen;
6. significant conflicts;
7. nature of anxieties;
8. main defenses against conflicts and fears;
9. adequacy of superego as manifested by “punishment for crime”;
10. integration of the ego.

Bellak’s recommendations for interpretation are influenced heavily by psychodynamic

and traditional psychoanalytic theories. Clinicians not so psychodynamically inclined
who desire to use the CAT are advised to focus on the inspection technique of interpre-
tation, focusing on the issues and variables in the story content with which they are most
comfortable.

The Roberts Apperception Test for Children (RATC)

The Roberts Apperception Test for Children (RATC) (McArthur & Roberts, 1982),
developed more recently than the TAT or CAT, is a thematic technique for children that is
in wide use. The authors of the RATC intend for it to be used with children aged 6 to 15.
244 s Foundations and Methods of Assessment

Its stated purpose is to assess child and adolescent perceptions of interpersonal situations,
such as the thoughts, concerns, conflicts, and coping styles of examinees. The RATC
includes 27 stimulus cards. Some cards are labeled specifically for use with boys or girls,
and only 16 cards are administered at one time. The content of the RATC cards is more
modern and less ambiguous than that of the TAT or CAT, depicting specific scenes
involving such themes as parental discord and harmony, the observation of nudity,
aggression, and peer rejection. A “Black” version of the RATC stimulus cards is available
that depicts Black individuals in the same situations as on the standard cards.
Administration of the RATC is similar to that for the TAT and CAT. Scoring and
interpretation is much more of a structured process for the RATC, however. The test
includes a standardized T score scoring system and results in four areas of scores:

1. adaptive scales: reliance on others, support others, support child, limit setting,
problem identification, and three types of problem resolution;
2. clinical scales: anxiety, aggression, depression, rejection, unresolved;
3. critical indicators: atypical response, maladaptive outcome, refusal;
4. supplementary measures: ego functioning, aggression, levels of projection.

The RATC seems to be a well-designed assessment technique that may be useful as a

clinical tool when used with caution. The innovation and contribution of the RATC is its
emphasis on a standardized scoring and interpretation system that is more empirically
based than most thematic approaches (although the normative sample comprises only
200 cases). Worchel (1990) concluded that the RATC “appears to have significant benefits
over its predecessors,” while acknowledging that “the standardized scoring system is
admittedly lacking in validity evidence compared to more objective personality tests” (p.
424). Several empirical studies on the RATC have been completed since it was published.
During the preparation of an earlier edition of this text, a computer-assisted search located
more than 40 studies (mostly unpublished doctoral dissertations) wherein the RATC was
the primary topic or a major focus. A few more research studies on the RATC have
appeared in the past ten years. Clinicians who are interested in using thematic approaches
with children and young adolescents and who desire to use an objective scoring and
interpretation approach may find the RATC to be a potentially useful addition to their
assessment design. Clinicians who are not comfortable with the overt psychodynamic
theoretical orientation of the TAT and CAT may find the RATC appealing because it is not
expressively based on this theoretical approach.
A second edition of the RATC was published. The RATC-2 (G. E. Roberts, 2005) is
designed to assess social understanding of children and adolescents, as they express it
in free narrative. Thus, like the first edition, the RATC-2 does not include the explicit
reliance on psychodynamic theory. The second edition includes several improvements
on the original RATC, including updated test pictures that depict current hairstyle and
clothing preferences; an extended age range (up to 18); three parallel sets of test pictures
depicting White, Black, and Hispanic youths; and a new and larger norming sample that
is generally representative of the U.S. population in terms of geographical region, ethnic-
ity, and gender. The RATC-2 norming sample is based on a sample of 1,000 children and
adolescents, aged six to 18, with an additional clinically referred sample of 500 youths.
The scales of the RATC are somewhat different from those of the first edition, and include
subscales within the following areas: Theme Overview, Problem Identification, Outcome,
 Projective–Expressive Assessment Techniques s 245

Available Resources, Emotion, Resolution, and Unusual or Atypical Responses. The RATC-2
manual is generally well organized and includes some useful technical and psychometric
information. Although there is currently limited externally published research evidence
available on the RATC-2, it represents an improvement over the first edition, has received
positive reviews (Flanagan, 2008), and will likely become popular over time as it attracts
new users and as clinicians who are currently using the original RATC gradually switch to
the second edition.

Reliability and Validity

The technical adequacy of thematic approaches has been difficult to evaluate, not only
because there are numerous competing thematic techniques, but also because of the
plethora of nonstandardized scoring and interpretation methods. In their review of
psychometric properties of thematic approaches, Obzrut and Boliek (1986) stated that
much less in this area has been investigated with children and adolescents compared
with adults. They stated that the available evidence indicates thematic approaches have
shown substantial reliability and evidence of clinical validity. Obzrut and Boliek’s review
is notable because of the bold assertion they made in several instances that traditional
standards of reliability and validity are not particularly relevant with thematic approaches.
Other authors have been less charitable in their assessment of the psychometric proper-
ties of thematic approaches: “In large measure, then, the interpretation of (thematic tech-
niques) is based on strategies with unknown and untested reliability and validity”
(Gregory, 1996, p. 523). Although thematic storytelling techniques for social–emotional
assessment have many adherents, and a growing number of empirical studies have pro-
vided some evidence of convergent construct validity of various thematic approaches
used in conjunction with other social–emotional assessment methods (Teglasi, 1993,
2001), there are also numerous concerns regarding technical adequacy of these measures
(Hojnoski et al., 2006).

Concluding Comments on Thematic Approaches

Thematic approaches to personality assessment have a fascinating history and are inter-
esting to administer and interpret. Child and adolescent examinees often seem to enjoy
the process of making up stories to thematic stimulus cards and tend to find this assess-
ment technique nonthreatening. One drawback to using thematic approaches with
younger and less intellectually sophisticated children is that they often respond to the
stimulus cards in a short, concrete, and unenlightening manner, making for difficult
interpretation if one follows a true projective approach. As the review of psychometric pro-
perties of thematic approaches indicated, the evidence regarding reliability and validity
is mixed, and even advocates of such techniques tend to be cautious in their appraisals.
Caution is advised in using thematic approaches with children and adolescents, particu-
larly regarding making strong interpretive statements in the absence of any additional
supporting evidence. There are also some specific ethical concerns to consider regarding
the use of these techniques in school settings (Knauss, 2001). A thematic approach to
assessment may help facilitate communication and rapport with children and adolescents,
who often find such activities to be fun and nonthreatening. Clinicians may find thematic
approaches to be a useful part of a comprehensive social–emotional assessment design
that may provide insight into young examinees from their own perspective and in their
own words.
246 s Foundations and Methods of Assessment

DRAWING TECHNIQUES
Drawing techniques are perhaps the oldest category of assessment procedures that can
be placed in the general domain of projective–expressive assessment. Psychologically
based drawing techniques have been in use nearly as long as the field of psychology has
existed, as early as the 1890s by some accounts (Barnes, 1892). Historically, the first uses
of psychologically based drawing techniques were not for assessment of social–emotional
status or personality. Rather, the earliest uses of drawing techniques were focused
primarily on intellectual and developmental assessment (Cummings, 1986). According
to Hammer (1981), use of drawing techniques for projective–expressive assessment
of children occurred gradually, as clinicians noted interesting qualitative differences in
specific features of drawings (e.g., facial expression, size, position on page) produced by
children. These qualitative differences in drawings did not result in differential scoring
when intellectual or developmental screening procedures were being used, but led to
interpretations by clinicians that such differences should be considered important
emotional or affective expressions within the drawing. This type of reasoning led to the
widespread clinical use of children’s drawings for projective social–emotional and
personality assessment.
In his excellent review of using projective drawings with children, Cummings (1986)
stated that the literature indicates the use of four major functions for projective drawing
tests:

1. to allow graphic, symbolic communication between a nonverbal child and a

clinician;
2. to allow the clinician to develop an understanding of the inner conflicts, fears,
family interactions, and perceptions of others from the child’s perspective;
3. to provide a medium for understanding the child from a psychodynamic perspective
(e.g., sexual identification, ego strength);
4. to assist in planning for further evaluation through the generation of hypotheses
regarding the child.

As is true regarding virtually all projective–expressive techniques, a great deal of

controversy exists regarding projective drawings, despite their widespread use. It is my
opinion that many of the historical and current uses of projective drawing techniques with
children are indefensible and that in general the technical properties (i.e., reliability and
validity evidence) of such techniques tend to be vastly inferior to those of many of the
more recently developed social–emotional assessment technologies that have been refined
since the 1980s. It is also naive, however, to think that clinicians simply will abandon
projective drawing techniques. As we see herein, these techniques remain enormously
popular despite criticism, and supporting evidence that is mixed at best and abysmal at
worst. Given this set of conditions, it is important to review the major projective drawing
techniques for children in this chapter, with a specific focus on evaluating the supporting
evidence and identifying the most appropriate uses for these techniques. This discussion
includes separate overviews of three of the most widely used drawing techniques: The
Draw-A-Person (DAP) technique, the Kinetic Family Drawing (KFD) technique, and use
of the Bender-Gestalt Test (BGT) as a social–emotional screening device. Some related
drawing techniques are discussed in less detail.
 Projective–Expressive Assessment Techniques s 247

The Draw-A-Person Technique (DAP)

Without question, the most widely used drawing procedure in social–emotional
assessment of children is the Draw-A-Person Technique (DAP). The pre-eminent position
of this drawing technique was verified through Wilson and Reschly’s (1996) national
survey of assessment practices of school psychologists. The results of this survey indicated
that in the 1980s and 1990s the DAP was not only the most widely used drawing technique
for social–emotional assessment of children, but also the fourth most widely used psycho-
logical assessment technique overall. A more recent survey of projective test use among
school psychologists by Hojnoski and colleagues (2006) found that although the DAP
and related projective drawing tests were used less frequently among respondents than
sentence completion tasks, they were still very popular.
The exact origins of human figure drawings (the predecessor to the current DAP
technique) are unclear, but they have been in use by psychologists since the early part
of the twentieth century. Although human figure drawings were formally used by
Goodenough in the 1920s as a measure of cognitive development (Goodenough, 1926),
they also appear to have been used clinically for social–emotional assessment during this
time period (Chandler & Johnson, 1991). The first widely disseminated technique for
using human figure drawings in social–emotional assessment was Machover’s (1949)
highly influential book Personality Projection in the Drawing of a Human Figure. This
book was a major force behind the DAP as a social–emotional assessment technique, and
it continues to be an influential foundation for current methods of using the DAP.
Another book that has also been widely influential as a force behind the DAP for social–
emotional assessment is Koppitz’s (1968) Psychological Evaluation of Children’s Human
Figure Drawings, which was published two decades after Machover’s seminal text.
The basis of using the DAP as a social–emotional assessment technique is similar to
that of other drawing tests. Proponents of human figure drawings such as the DAP
purport that the quality of drawings made by children through these tasks may provide
important information regarding their psychosocial adjustment, including nonverbal
symbolic communication of their conflicts, fears, family interactions, and so forth. The
theoretical foundations and assumptions underlying DAP social–emotional assessment
techniques are varied, but psychodynamic and humanistic theories have been in the
forefront in this regard.

Administration, Scoring, and Interpretation Most advocates of DAP techniques suggest

a similar administration method. The child is given a blank sheet of 8.5-inch-by-11-inch
paper and a No. 2 lead pencil with an eraser. The child is instructed to “Draw a picture of
a whole person” (Cummings, 1986, p. 202). Some variations on DAP instructions have
been suggested by DAP devotees. Koppitz (1968) recommended that the examiner add
the statement, “It can be any kind of person you want to draw. Just make sure that it is a
whole person and not a stick figure or a cartoon figure” (p. 6). This clarification was
suggested to discourage older children from quickly drawing a simple stick figure just
to avoid the task. Another modification has been suggested by Chandler and Johnson
(1991), who recommend that younger children (i.e., kindergarten-age and younger) be
allowed to use a thick pencil, crayon, or felt-tip pen, for ease of drawing. Figure 9.1 is an
example of a DAP produced by a child through this instructional procedure.
Most DAP advocates suggest that the examiner use the words draw a person rather than
the less ambiguous instructions to draw a man, a woman, a girl, and so forth. The
248 s Foundations and Methods of Assessment

Figure 9.1 A human figure drawing produced by a five-year-old girl, using standard DAP directions

ambiguity of the more general instructions has been considered to result in increased
psychological projection regarding the subject’s identification of gender, which has been
the object of several empirical studies in and of itself (e.g., Dickson, Saylor, & Finch, 1990;
Zaback & Waehler, 1994). Most advocates of the DAP favor having the child make two or
more drawings, in a process where the second drawing is requested to be a person of the
opposite sex of the person depicted in the first drawing (Cummings, 1986). The entire
DAP process typically takes five to ten minutes to complete.
Scoring of the DAP tends to be nonstandardized and usually is done in conjunction
with interpretation. The exception to this statement is Naglieri, McNeish, and Bardos’s
(1991) structured scoring system for using the DAP as a screening procedure for emo-
tional disturbance, referred to as the DAP:SPED. The structured DAP:SPED system
includes scoring templates and specific scoring rules for various features of drawings.
Studies of the DAP:SPED have indicated that it can successfully distinguish students
who receive special education from students who do not receive services (Matto, Naglieri,
& Clausen, 2005), that it is moderately correlated with measures of social–emotional
strengths (Matto et al., 2005), and that scores do not differ significantly across ethnic
groups (Matto et al., 2005). However, most DAP advocates and users tend to favor a
nonstandardized holistic manner of scoring that is connected directly to interpretation.
Machover’s (1949) and Koppitz’s (1968) books provide general guidelines for scoring
DAP figures and are still widely influential.
Interpretation of the DAP is a process that also tends to be nonstandardized and often
is done in conjunction with a particular text or technique (i.e., Machover or Koppitz).
Despite the influence of one interpretation technique or another, it has been our
experience that many practitioners who use the DAP for clinical assessment use holistic,
 Projective–Expressive Assessment Techniques s 249

self-styled interpretation methods, occasionally borrowing from various interpretation

guidelines that have been integrated during their career.
Machover’s (1949) technique for interpretation of human figure drawings proposed
that interpretation should be based on a combination of indicators rather than individual
signs or characteristics. From this perspective, the social features of the drawing are
symbolically represented in the head. For example, “Closed eyes may suggest an attempt
to shut out the world” and “Large, accentuated eyes may be associated with hostility”
(Cummings, 1986, p. 203). From this perspective, the contact features of a drawing (i.e.,
the fingers, hands, arms, toes, feet, and legs) are said to represent a child’s interactions
with his or her environment. For example, “A relative lack of attention to feet and legs or
their omission may reveal a child’s insecurity about his or her problems dealing with
sexual impulses,” whereas “irrelevant emphasis of pockets” in drawings is seen in “infantile
and dependent individuals” (Cummings, 1986, p. 203). The Machover method also
emphasizes such factors as figure size, placement of figures on the paper, and drawing
themes.
The Koppitz (1968) method of interpretation is psychodynamically oriented and built
on Machover’s (1949) technique. One important difference in the Koppitz method is the
increased emphasis on empirical identification of low-frequency emotional indicators
through systematic investigation of clinical cases and normal cases. In the Koppitz system,
a particular characteristic in human figure drawings is considered an emotional indicator
if three criteria are met:

1. It must possess clinical utility through differentiating between drawings of children

with and without emotional problems.
2. It must be unusual or, in other words, something that is infrequently found in the
drawings of normal children.
3. It must not be related to developmental maturation.

Using these three criteria as a guide, Koppitz (1968) lists 38 emotional indicators, divided
into the areas of quality signs, special features, and omissions. A summary of these emotional
indicators is provided in Table 9.1. The Koppitz method of scoring and interpretation is
complex and comprehensive, and requires a more in-depth study than simply referring
to a table of emotional indicators.
A more recent system for scoring and interpreting the DAP is Naglieri et al.’s (1991)
DAP:SPED method, which differs substantially from traditional methods of interpreting
human figure drawings because of its emphasis on objective scoring and reliance on
empirical criteria within a normative standardization group. Within this system, specific
scoring indicators, such as legs together, placement of figure, various omissions, objects
in mouth, fists, and nude figures, were developed through identification of low-frequency
indicators that were significantly more likely to be found in clinical samples. Specific
criteria are provided for the presence of these figures (including objective scoring keys),
and each indicator is given a score of 1. The total raw score is converted to T scores and
percentile ranks, based on gender and age breakdowns. Using this system, interpretation
is based on “the higher the score, the more likely it is that emotional disturbance exists”
(p. 64). Indicators are interpreted in a combined manner from a normative perspective,
and individual indicators are not generally considered to have a great deal of clinical
meaning in and of themselves.
250 s Foundations and Methods of Assessment

Table 9.1 Summary of 38 emotional indicators for human figure drawings

from the Koppitz (1968) Scoring and Interpretation System

Quality signs
Broken or sketchy lines
Poor integration of parts of figure
Shading of the face or part of it
Shading of the body and/or limbs
Shading of the hands and/or neck
Gross asymmetry of limbs
Figure slanting by 15 degrees or more
Tiny figure, 2 inches or less in height
Big figure, 9 inches or more in height
Transparencies
Special features
Tiny head, one-tenth or less of total height of figure
Large head, as large or larger than body
Vacant eyes, circles without pupils
Side glances of both eyes, both eyes turned toward one side
Crossed eyes, both eyes turned inward
Teeth
Short arms, not long enough to reach waistline
Long arms that could reach below kneeline
Arms clinging to side of body
Big hands, as big as face
Hands cut off, arms without hands and fingers
Hands hidden behind back or in pockets
Legs pressed together
Genitals
Monster or grotesque figures
Three or more figures spontaneously drawn
Figure cut off by edge of paper
Baseline, grass, figure on edge of paper
Sun or moon
Clouds, rain, snow
Omissions
Omission of eyes, nose, mouth, body, arms, legs, feet, neck

Reliability and Validity With the DAP and other specific types of human figure drawing
techniques, there is no question that particular scoring systems can be used reliably across
raters. In his review of the DAP, Cummings (1986) integrated the results of 13 inter-rater
reliability studies, which revealed a range of agreement among judges from 75% to 95%
(0.75 to 0.95), with a median reliability in the 80% range. Naglieri et al.’s (1991) test
manual for the DAP:SPED also presents evidence as to internal consistency reliability,
which was relatively modest, with coefficients ranging from 0.67 to 0.78 at various
age and gender levels. Test–retest reliability of human figure drawings has been a more
problematic area, with stability coefficients typically much lower than those obtained for
behavior ratings scales and objective self-report tests. Naglieri et al. reported a test–retest
reliability coefficient of 0.67 at a one-week interval with a sample of 67 children, using
the DAP:SPED objective scoring system. Cummings (1986) integrated the findings of
 Projective–Expressive Assessment Techniques s 251

eight test–retest reliability studies from 1926 through 1978 with intervals ranging from
one day to three months, with the resulting reliability coefficients ranging from 0.68
to 0.96. However, these studies were all based on Goodenough and Harris’s scoring
approaches for using human figure drawings to evaluate cognitive development and intel-
lectual maturity. Few studies have been conducted wherein the more common use of the
DAP as a social–emotional assessment technique was evaluated over time. In discussing
the little evidence available in this area, Cummings (1986) commented that “drawings are
subject to mood changes or a trait variable may be manifested by varying indicators”
(p. 214). I would add to this restrained comment that children’s drawings are also very
likely to be influenced by a potentially large and complex array of other factors that are
outside of the child but within his or her environment, such as the time of day, recent
activities, environmental conditions, and peer behavior.
Validity evidence of using human figure drawings such as the DAP for social–
emotional assessment of children is mixed at best. Koppitz’s (1968) comprehensive book
on children’s human figure drawings was one of the first efforts to provide systematically
empirical evidence for the validity of emotional indicators of DAP productions and
reported several studies wherein specific types of emotional indicators were found to
differ significantly among emotionally disturbed and normal children through chi-square
analyses. Cummings’s (1986) review of validity evidence of the DAP concluded that the
evidence was mixed and sometimes contradictory regarding the ability of DAP drawings
to differentiate among clinical and normal groups. In the manual for Naglieri et al.’s
(1991) adaptation of the DAP, the results of four separate validity studies are presented,
wherein DAP:SPED standard scores of various clinical groups were compared with those
of normal children. Each of these studies showed statistically significant differences
among groups, with the clinical groups always receiving higher scores. Taken in combi-
nation, these studies provide some support for the construct validity of the DAP:SPED
scoring system. Several authors of more recent reviews and empirical investigations have
provided evidence, however, that various adaptations of the DAP fail to discriminate
accurately among clinical and nonclinical subjects (Bricceti, 1994; Feyh & Holmes, 1994;
Klein, 1986), causing some writers to assert that DAP techniques are “tests in search of a
construct” (Kamphaus & Pleiss, 1991, p. 395).
In addition, a study by Joiner, Schmidt, and Barnett (1996) examined reliability and
validity of three commonly used indicators of emotional distress in children’s projective
drawings (size, detail, and line heaviness) and found that these indicators fared much
more poorly than either self-report or thematic assessment techniques in converging with
objective evidence of depression and anxiety among youths in an inpatient setting. These
authors concluded that “in line with previous studies and reviews spanning almost five
decades of work . . . the results of this study do not support the practice of interpreting
individual drawing indices as indicators of emotional distress among children and
adolescents” (p. 138). As evidence of the fierce devotion of many adherents of projective
drawings, it is interesting to note that this study and the conclusions of its authors set
off a maelstrom of controversy and “point–counterpoint” pieces in the next issues of the
Journal of Personality Assessment (1996 and 1997), none of which convinced me that
the conclusions of Joiner and colleagues should be dismissed.

Additional Comments The DAP technique and related human figure drawing tests are
popular among clinicians and are currently among the most widely used social–emotional
252 s Foundations and Methods of Assessment

assessment procedures for children. The reliability and validity evidence for these pro-
cedures is mixed at best, however, and there will continue to be controversy surrounding
their use, even as they continue in popularity and widespread use. Little is actually known
regarding how clinicians use the DAP in practice. Some clinicians make the DAP and
related techniques a centerpiece of their assessments and make sweeping interpretations
of the child’s social–emotional status based on little else. It is my experience, however, that
many practitioners simply “throw” the DAP and related projective drawing tests into the
assessment battery to build rapport with the child and form some tentative hypotheses,
but they are actually quite conservative when it comes to clinical interpretation of these
drawings.
An important but missing piece of evidence regarding social–emotional assessment
with DAP is how they are actually used (and perhaps abused) in clinical practice. A final
consideration in using DAP (or any other social–emotional assessment technique, for
that matter) is how defensible the procedure might be if a clinician’s assessment had
to be defended in court or in a special education due process hearing. In respect to this
troubling issue, Lilly (2001) concluded, using contemporary criteria for guidelines in
forensic assessment, that the scoring procedures most commonly used for human figure
drawing tests (global impressions and specific signs) do not meet admissibility criteria.
If Lilly’s conclusions are correct, then even casual or conservative uses of DAP should
raise some concern among clinicians.

The Kinetic Family Drawing Technique (KFD)

Another adaptation of human figure drawings is the use of the Kinetic Family Drawing
Technique (KFD). As a social–emotional assessment technique for children and adoles-
cents, family drawings have been very popular with clinicians for decades and have
been advocated since at least the 1930s (e.g., Appel, 1931). By the 1950s, the use of family
drawings in psychological assessment of children had become widespread, as typified
by widely cited articles during that period by Hulse (1951, 1952). The basic idea behind
family drawings has always been that through the process of drawing a pictorial rep-
resentation of their family, children may provide important information regarding their
perspective on such issues as family dynamics, emotional relationships, and their place
within the family.
In the 1970s, a major new approach to children’s family drawings was introduced by
Burns and Kaufman (1970, 1972), which was denoted the KFD technique. In contrast to
earlier approaches to family drawings, which tended to provide a relatively open format
for making the drawings, the KFD included a carefully circumscribed set of directions
with a clear goal: to draw everyone in the family doing something. With the introduction
of the KFD, which eventually became the most widely used family drawing technique, the
emphasis was on actions. According to a critical review by Handler and Habenicht (1994),
“This seemingly minor modification of the instructions results in some surprisingly
revealing data concerning family dynamics, allowing a clearer picture to emerge of
interpersonal interactions and emotional relationships among family members” (pp. 440–
441). Compared with the DAP and House–Tree–Person techniques, the KFD has been
said to “often reveal conflicts and difficulties when the other two procedures indicate the
absence of problems” (Handler & Habenicht, 1994, p. 441). The hypothesized reason for
the more revealing nature of the KFD is that it allows the clinician to view the child as the
child feels he or she is reflected and expressed in the family, enabling the child to depict
 Projective–Expressive Assessment Techniques s 253

Figure 9.2 A Kinetic Family Drawing produced by an eight-year-old boy

the family as an active unit and enabling the clinician to see the child’s impressions of
family interactions (Burns, 1982; Burns & Kaufman, 1970, 1972).

Administration, Scoring, and Interpretation The procedures for administering the KFD
are simple. The examiner provides the examinee with a plain white sheet of 8.5-inch-by-
11-inch paper and a No. 2 lead pencil with an eraser. The paper is set ambiguously on the
table so that the child can determine whether to draw on it portrait or landscape.
The examiner then gives the following directions: “Draw a picture of everyone in your
family, including you, doing something. Try to draw whole people, not cartoons or stick
people. Remember, make everyone DOING something—some kind of actions” (Burns
& Kaufman, 1972, p. 5). An example of a KFD drawing produced by an elementary-age
child is shown in Figure 9.2.
While the drawing is being completed, the examiner is expected to observe the
examinee carefully, record verbal statements, and make other behavioral observations.
There is no specified time limit for the KFD, and if the examinee asks questions regarding
the procedure, the examiner is supposed to respond in a noncommittal manner.
After the drawing is completed, it is recommended that the examiner ask a series of
postdrawing questions (the inquiry phase), for the purpose of finding out the child’s
perspective on additional information related to the drawings.
As recommended by Knoff and Prout (1985), the areas of questioning should attempt
to find out who the figures in the drawing represent and what is the child’s relationship to
them; what the persons in the drawing are doing, feeling, and thinking; what is good and
bad about each person; what the child was thinking about while he or she was drawing;
what the drawing makes the child think of; what the weather is in the picture; and what
the child would like to change about the picture.
Various scoring systems have been used for the KFD, including many derivations from
what originally was proposed by Burns and Kaufman (1970, 1972). A variation on the
254 s Foundations and Methods of Assessment

original KFD scoring system was later proposed by one of the authors (Burns, 1982), is
distinctly psychodynamic in nature, and includes four major scoring categories: actions;
distances, barriers, and positions; physical characteristics of the figures; and styles. The
actions category refers to the type of activity depicted for each figure, and Burns grouped
possible actions into activities that are said to symbolize cooperation, communication,
masochism, narcissism, nurturance, sadism, or tension. The physical characteristics
category represents such formal aspects of the drawings as inclusion of essential body
parts, the size of figures, the size of figures relative to other figures, the size of various
body parts, and facial expressions. The distances, barriers, and positions category involves
such things as numbers of barriers between key figures in the drawing, the direction each
figure faces, and how far apart the figures are. The styles category involves the organization
of figures on the page. Some of the style variables proposed by Burns to reflect psycho-
pathology or emotional disturbance include intentional separation of family figures,
encapsulation of figures by lines of objects, folding the paper into segments and placing
each figure on individual segments, including more than one line across the entire bottom
or top of the drawing, underlining individual figures, and presenting figures from an
aerial or bird’s eye view. In listing these scoring categories and major indicators, it is
important to also note that the KFD scoring system is complex and requires careful study
from the original sources for effective and meaningful interpretation.

Reliability and Validity When the original KFD technique was proposed in the early
1970s, it was criticized for having insufficient psychometric data available. Because the
KFD has now been in widespread use for decades, reliability and validity studies have
accrued, and much more is known about its psychometric properties. In terms of
reliability, the yield of research on the KFD indicates that it has acceptable to excellent
inter-rater reliability with specific scoring systems, but its test–retest reliability is often
poor or marginal at best. In Handler and Habenicht’s (1994) review, it was noted that
median percentages of inter-rater agreement on the KFD typically ranged from 0.87 to
0.95 across studies, indicating that “the various KFD scoring systems can be scored with
a high degree of inter-rater reliability” (p. 443). Test–retest reliability studies of the KFD
have raised many questions and concerns, however. Many test–retest studies at short-
term intervals (i.e., two weeks) have been conducted with specific scoring systems, and
the reliabilities have ranged from the 0.40s to the 0.90s, which is a considerable spread.
Test–retest reliabilities in the 0.40 and 0.50 range at short-term intervals with other
types of social–emotional assessment procedures (e.g., objective self-report tests, behavior
rating scales) would be construed as evidence of extreme inconsistency. With the KFD,
poor to marginal test–retest findings have been interpreted in various other ways,
however. For example, Mangold (1982) suggested that the KFD is sensitive to antecedent
testing conditions, and performances may vary substantially depending on when and
where it is administered. Cummings (1980) stated that the KFD is probably a state-
dependent measure, in that it may tap a child’s feelings, perceptions, and general affect
for only a specific point in time. Other interpretations of the marginal test–retest reliability
of the KFD are possible, but it is sufficient to observe that it is likely that children will
produce qualitatively different drawings from one occasion to another.
In terms of test validity of the KFD, the evidence is equally mixed. In Handler and
Habenicht’s (1994) comprehensive review, it was noted that most of the validity studies
on the KFD involved comparisons of drawings of children who had been identified as
 Projective–Expressive Assessment Techniques s 255

having some form of psychopathology or poor adjustment status with those of normal
comparison children, and that various scoring systems have been used in these com-
parisons. In evaluating the yield of research of this type, it seems that many studies have
shown significant differences among clinical status groups, whereas many others have
not. There also have been a few studies wherein KFD scores were correlated with other
types of social–emotional measures, such as self-concept tests, family relations tests,
and behavior rating scales. Some of these studies have shown significant, but modest,
correlations between the KFD and criterion measures, providing some evidence of
construct and criterion-related validity.
Most of the validity studies of the KFD have used specific aspects of formal scoring
systems, a practice that has come under closer scrutiny in recent years. According to
Handler and Habenicht (1994), the best trend in KFD scoring is toward the use of a “holis-
tic, integrative approach rather than one that emphasizes the mere addition of signs or
symbols” (p. 458). Examples of these more “holistic” scoring systems are those used in
studies by Cook (1991) and Tharinger and Stark (1990), both of which were able to differ-
entiate clinical from nonclinical groups of children. The use of such systems necessitates
a great deal of creativity and flexibility, given the statement of the latter authors that “the
clearest sense of these characteristics can be gained through placing oneself in the drawing,
preferably in place of the child” (Tharinger & Stark, 1990, pp. 370–371).

Kinetic School Drawing One of the variations on the KFD is a technique known as the
Kinetic School Drawing (KSD). This technique was first proposed by Prout and Phillips
(1974), was refined by Sarbaugh (1983), and was integrated with the KFD by Knoff and
Prout (1985). The basic premise of the KSD is similar to that of the KFD, in that a child
who draws him- or herself within his or her school environment in an action-oriented
manner may provide important information on relationships and other dynamics within
the school environment.
The directions for the KSD are similar to those for the KFD. The examiner provides
the child with a standard-size piece of white paper and a No. 2 lead pencil with an eraser,
and states:

I’d like you to draw a school picture. Put yourself, your teacher, and a friend or two
in the picture. Make everyone doing something. Try to draw whole people and make
the best drawing you can. Remember, draw yourself, your teacher, and a friend or
two, and make everyone doing something.
(Cummings, 1986, p. 229)

As with the KFD, various procedures have been proposed for interpreting the KSD, and
formal scoring systems and qualitative–holistic methods of interpretation are possible.
Much less is known about the psychometric properties of the KSD in relation to those of
the KFD, however, because much less research has been reported. In general, the KSD
does not seem to have caught on to the extent that the KFD has. Because the tasks are so
similar and because there is similar variation in scoring and interpretation methods, it
probably can be assumed that the KSD has psychometric characteristics and problems
relatively similar to the KFD. Although the use of the KFD has become popular among
many clinical child psychologists and school psychologists, it remains to be seen whether
the KSD will attain this level of use.
256 s Foundations and Methods of Assessment

Additional Comments Although the reliability and validity evidence regarding the KFD
is mixed to say the least, perhaps the most salient issue is “For what purposes is the
KFD valid?” rather than whether it is valid per se. As with any of the drawing and other
techniques reviewed in this chapter, some uses are clearly indefensible, whereas other uses
may be prudent and helpful in rapport building, or perhaps even in a diagnostic sense.
In addition to basic reliability and validity evidence, Handler and Habenicht’s (1994)
review evaluated examinee variables that may strongly influence KFD production.
Specifically, it was noted that age, gender, and culture/ethnicity all have been shown to be
significant factors in the quality of children’s drawings. Clinicians who desire to use the
KFD should become familiar with the literature in this area and always take into account
these factors in scoring and interpretation. Based on the current state of the art in using
the KFD, it seems that there is definitely a trend toward the use of more naturalistic
clinical methods of scoring and interpretation, and methods that integrate various
scoring techniques rather than relying on single summative scoring systems. Although
caution regarding the clinical use of the KFD is advised, there also seems to be some
promise of improved clinical validity evidence in the future.

The Bender-Gestalt Test (BGT) as a Measure of Social–Emotional Status

Another drawing test that has been used for social–emotional assessment of children is the
Bender-Gestalt Test (BGT), which also has been referred to as the Bender Visual–Motor
Gestalt Test. The origins of this test stem from the foundation of Gestalt psychology. The
BGT was developed by Lauretta Bender (1938, 1946), who adapted nine figures that were
being used in perceptual experiments and added specific administration, scoring, and
interpretation guidelines so that this drawing technique could be used as a standardized
psychological test. The test was updated in 2003 by Brannigan and Decker. This test quickly
became one of the most popular and widely used of all psychological assessment tech-
niques, and it remains popular among the current generation of clinicians (Wilson &
Reschly, 1996). This test is largely used for neuropsychological assessment but has been
used for social–emotional assessment, too.
Because of its widespread use and continued popularity, numerous scoring and
interpretation systems have been developed for the BGT. The most recent interpretation
system is an update of the work by Elizabeth Koppitz and entitled the Koppitz-2
Developmental Scoring System for the Bender Gestalt Test (K2-BG) (C. R. Reynolds, 2007).
This version includes updated norms based on scores from 3,500 individuals, an addition
of six designs, and has been promoted mostly as a test of visual-motor perception and
construction. In a review of this most recent update, Hartman states that

neuropsychologists will find the phrase, “it’s alive!” to be an appropriate descrip-

tion of the new K2-BG. Dr. Reynolds has resuscitated an old test and given it a new
lease on life with a large normative base and excellent psychometrics. As a test of
developmental visual–motor skill and a neuropsychological measure of visuocon-
structional brain function, the test is better than it ever was and well worth using.
Neuropsychologists can only hope the parts of the monster that caused its original
burial—organicity screening and projective testing—do not reassert themselves
and weaken the reputation of a very useful neuropsychological reincarnation.
(2008, p. 95)
 Projective–Expressive Assessment Techniques s 257

Most comprehensive scoring and interpretation systems are clearly not designed to
aid in social–emotional assessment of children and are not discussed any further in this
chapter. As stated above, the BGT has been used primarily as a measure of visual percep-
tion, visual–motor perception, and motor coordination, for such diverse purposes
as screening for brain injury, assessing developmental motor coordination levels, and
providing rough estimates of intellectual functioning. The major force behind the use
of the BGT as a social–emotional assessment technique for children was the work
of Koppitz. In her two-volume series of books, The Bender Gestalt Test for Young Children
(Koppitz, 1963) and The Bender Gestalt Test for Young Children, Volume II: Research and
Application, 1963–1973 (Koppitz, 1975), Koppitz outlined the theory and practice of
using the BGT to screen for emotional indicators (EIs). These EIs are defined as drawing
characteristics that tend to occur primarily with emotionally disturbed and behaviorally
disordered children and that are associated with specific types of emotional–behavioral
problems, such as impulsivity, mental confusion, and low frustration tolerance. Other
social–emotional or psychopathology methods have been developed for the BGT, but
none has been nearly as influential for social–emotional assessment of children as
the Koppitz method. This next section is devoted exclusively to a brief description and
overview of the Koppitz method for EIs.

Administration, Scoring, and Interpretation Koppitz (1963, 1975) suggested that the
original administration method advocated by Bender (1938, 1946) be used. This
method of administration is straightforward and easy to follow. The examiner provides
a sheet of 8.5-inch-by-11-inch white paper (more than one sheet may be used if
needed) and a No. 2 lead pencil to the child, and sits with the child at a table suitable
for drawing. The examiner states to the child that the task of this test is for him or her to
carefully make copies on the paper of the figures that will be shown to him or her.
The examiner then presents the child the nine BGT figures, one at a time in succession
as he or she completes them. There is no time limit for this test, although it has been
noted that most children complete the task in about six minutes (Koppitz, 1975). The
examiner should provide minimal direction for the child, allowing him or her to copy
the drawings any way he or she wants, while carefully observing his or her behavior
during the testing task. An example of a child’s reproduction of the BGT figures is shown
in Figure 9.3.
With the Koppitz system, it is recommended that the developmental scoring system
and identification of possible emotional indicators be used by the examiner. Because the
developmental scoring system is not a primary concern of this text, it is not discussed
herein, and readers are referred to Koppitz’s (1963, 1975) two volumes and C. R. Reynolds’
more recent manual (2007) for more detailed instruction. Because Koppitz’s system
for identifying emotional indicators is the major emphasis of this section, it is briefly
presented herein. Users of this book who desire to become proficient in the Koppitz EI
identification method should carefully study the original texts and supporting evidence,
however, and not rely on this chapter alone as a training guide.
In her 1963 book, Koppitz presented ten EIs for the BGT. In her 1975 book, the
original ten EIs were presented, with new supportive evidence, and two more indicators
were presented, bringing the total number of EIs to 12. These EIs are described briefly as
follows.
258 s Foundations and Methods of Assessment

Figure 9.3 Bender-Gestalt Test designs produced by an 11-year-old boy

1. Confused Order. This EI is considered to be present if the designs are scattered

arbitrarily on the paper and if there is no logical sequence or order to the drawings.
Koppitz noted that confused order is associated with a lack of planning ability and
poor organizational skills but emphasized that it is common among younger
children (ages 5 to 7).
2. Wavy Line in Figures 1 and 2. If there are two or more abrupt changes in the
direction of the lines of dots or circles in BGT Figures 1 or 2, this EI is considered
to be present. Koppitz noted that Wavy Line appeared to be associated with poor
motor coordination and emotional instability.
3. Dashes Substituted for Circles in Figure 2. If at least half of all the circles in Figure 2
are replaced with dashes 1/16-inch long or more, this EI is considered to be present.
Koppitz noted that Substitution of Dashes for Circles in Figure 2 has been associated
with impulsivity and lack of interest, particularly with younger children.
4. Increasing Size of Figures 1, 2, or 3. If the dots or circles of drawings of Figures 1
through 3 progressively increase in size until the last ones are three times as large or
more than the first ones, this EI is considered to be present. Koppitz stated that
increasing size on these BGT designs is associated with low frustration tolerance and
explosiveness, particularly as children become older (e.g., age ten versus age seven).
5. Large Size. According to Koppitz, if the area covered by any one BGT figure drawing
is at least twice as large as the design area on the stimulus card, this EI, which is said
to be associated with acting-out behavior in children, is considered to be present.
6. Small Size. If the area covered by any BGT figure drawing is half as large or less than
the original stimulus area on any of the figures, the Small Size EI, which is thought
to be related to anxiety, withdrawal, timidity, and constriction in children, is
considered to be present.
7. Fine Line. If the pencil line for any BGT figure drawing is so fine that it requires
considerable effort to view the design, the Fine Line indicator is considered to be
 Projective–Expressive Assessment Techniques s 259

present. Koppitz noted that this EI is associated with timidity, shyness, and
withdrawal, specifically in young children.
8. Careless Overwork or Heavily Reinforced Lines. This EI is considered to be present
if a design or part of a design is redrawn with heavy lines. This category is not
scored if the drawing is erased and then redrawn or if it is corrected with careful
lines that improve the drawing. Koppitz noted that Careless Overwork and Heavily
Reinforced Lines have been associated with impulsivity, aggressiveness, and acting-
out behavior.
9. Second Attempt. The Second Attempt EI is considered to be present if a BGT design
or part of it is abandoned before or after its completion and a new drawing is made.
This EI should be scored only if there are two distinct drawings from one design on
two locations on the paper. Koppitz stated that the Second Attempt EI is associated
with impulsivity and anxiety.
10. Expansion. The Expansion EI, which is said to be associated with impulsivity
and acting-out behavior, is scored when two or more sheets of paper are used to
complete the nine BGT drawings.
11. Box Around Design. Koppitz noted that this EI is quite rare, but suggested that
children who exhibit it have “weak inner control; they need to be able to function
in school and at home” (1975, p. 86). This EI is considered to be present when a box
is drawn around one or more BGT designs after they have already been copied.
12. Spontaneous Elaboration or Additions to Designs. This EI is scored when a child
makes spontaneous changes on BGT test figures that “turn them into objects or
combine them into bizarre designs” (Koppitz, 1975, p. 88). Koppitz noted that:

[This El, which is also quite rare,] occur[s] almost exclusively on Bender Test
records of children who are overwhelmed by fears and anxieties or who are
totally preoccupied with their own thoughts. These youngsters often have a
tenuous hold on reality and may confuse fact with fantasy.
(p. 88)

When scoring and interpreting EIs on the BGT using the Koppitz system, it is important
to consider some suggestions and warnings from the author (Koppitz, 1975). First, EIs
“are clinical signs that should be evaluated individually like any other clinical symptom”
(p. 89). Second, “EIs lack internal consistency and cannot, therefore, be added together
into a meaningful total EI score” (p. 89). Finally, there is a concern that single EIs on BGT
drawings are not always indicative of emotional problems. Koppitz noted that “three or
more EIs are necessary before one can say with some degree of confidence that a child
has serious emotional problems and will need further evaluation” (p. 89). With a process
so tenuous as inferring emotional adjustment from a drawing task, these three recommend-
ations should be considered an absolute minimum.

Reliability and Validity Ample evidence exists indicating that the BGT can be scored
reliably across different scorers and is relatively stable over short periods. In her 1975
book, Koppitz summarized numerous studies showing that the inter-rater reliability
validity of the BGT is often in the 0.80 to 0.90 range and that test–retest reliability of the
BGT at short time intervals is often in the 0.70 to 0.80 range (although younger children
often demonstrate less reliable performances). These generally strong findings regarding
260 s Foundations and Methods of Assessment

reliability of the BGT typically are based on overall developmental scoring system results
and not just on the presence of EIs. The stability of EIs on BGT drawings is less clear.
In her 1975 book, Koppitz provided some empirical support for each of the 12 EIs.
Given the 1975 publication date of this book, these supporting references all were based
on research published in the 1960s and 1970s. A computer-based review of the PSYCHLIT
database by Merrell revealed only a few additional studies regarding the validity of the
Koppitz EI system. Most of the studies’ support of the validity of EIs on BGT is based on
methodology where frequency counts of specific EIs are compared between clinical and
nonclinical groups, and the clinical groups evidenced a higher EI prevalence. In some of
these studies, chi-square analyses were used to provide evidence of statistical significance
of these differences, whereas other studies analyzed the frequency counts qualitatively.
Many of these studies are in the form of unpublished Master’s thesis and doctoral
dissertation projects from the 1960s and 1970s and are virtually impossible to obtain for
evaluation. It is difficult to form strong conclusions regarding the validity of the BGT as
a social–emotional assessment procedure.

Additional Comments The Koppitz system for using the BGT for social–emotional
assessment has some supporting evidence, but most of this evidence is substantially dated
and does not meet current research standards for providing evidence of clinical validity
(i.e., large effect sizes among clinical and nonclinical groups, use of multiple regression
and structural modeling analyses for prediction purposes). Caution is advised in using the
BGT for social–emotional assessment of children. Although the BGT is still popular, even
as a social–emotional assessment technique, research on this particular use of the test
seems to have diminished substantially in the years after the publication of Koppitz’s two
books (1963, 1975). These books are well written, documented to a substantially greater
degree than most related books, and quite interesting. Given that the BGT is easy to
administer and is typically a nonthreatening if not enjoyable experience for children, it is
no surprise that it continues to be widely used, even for social–emotional assessment.
Potential users of the BGT for social–emotional assessment purposes are cautioned,
however, that the state of the art in social–emotional assessment has advanced considerably
during the past decades, and that the evidence supporting the BGT for this purpose has
not kept pace with the burgeoning evidence supporting other methods, such as behavior
rating scales, direct observation, and objective self-report tests.

Concluding Comments on Drawing Techniques In this section, the history, rationale, and
theory of using drawing tests for social–emotional assessment of children and adolescents
has been outlined, and an overview of three of the most popular techniques in this area
has been provided. These three techniques include human figure drawing techniques
(specifically the DAP technique), the KFD and a related school-based procedure, and the
use of the BGT as a social–emotional assessment procedure.
In addition to these three techniques, various other drawing techniques are popular
for social–emotional assessment. The so-called House–Tree–Person drawing technique
continues to be a widely used procedure that has many conceptual and practical
similarities to the DAP technique. Likewise, Burns, the most influential early proponent
of the KFD, later expanded his work in this domain to what he refers to as Family-
Centered Circle Drawings. These and other variations of projective–expressive drawing
techniques were not included in this section because of space constraints and their
 Projective–Expressive Assessment Techniques s 261

overlapping content with the procedures that were reviewed, and because the quantity of
use and research on these procedures appears to be substantially less than that for the
DAP, KFD, and BGT. Many variations and adaptations of social–emotional drawing tests
are possible, and they vary substantially in terms of their popularity and availability of
supporting evidence.
For the foreseeable future, it seems that projective–expressive and other types of
drawing tests will continue to be widely used by clinicians in the United States and
throughout the world. During the early 1980s, R. P. Martin (1983), an authority in the
field of social–emotional assessment of children, wrote a blistering and convincing
article in which he asserted that the use of projective–expressive drawing techniques is
unethical and that such practices reduce the overall reliability of an assessment and may
serve to reinforce biases held by the clinician. Such arguments are not new. Two decades
earlier, Roback (1968) made a similar assertion against some uses of projective–expressive
drawing tests, stating that “many clinicians apparently entertain grandiose delusions
that they can intuitively gain a great deal of information from figure drawings about
the personality structure and dynamics of the drawer” (p. 16). Such criticisms and the
questionable validity and mixed research base of many of these procedures have failed to
crush the desire of clinicians to use such techniques, as evidenced by their continued
widespread popularity among psychologists who work primarily with children and by
surveys of school psychologists for the past two decades (e.g., Hojnoski et al., 2006;
Wilson & Reschly, 1996). It seems futile to berate clinicians for continuing to use drawing
tests for social–emotional assessment of children and adolescents, given that past efforts
to do so have had little impact on curbing the appeal of these techniques. Perhaps a better
approach is to focus on appropriate or best uses of these tests. That said, I concur with
Joiner et al. (1996), who concluded, “We suggest, based on our data and a wealth of past
work, that although drawings may be useful rapport-building devices, they are not useful
measurement devices” (p. 139).

SENTENCE COMPLETION TASKS

Like thematic approaches and drawing techniques, sentence completion tasks appear to
be widely used for social–emotional and personality assessment (Lubin et al., 1984). In
fact, a recent survey of school psychologists’ projective test use indicated that 60% of all
respondents routinely used this method (Hojnoski et al., 2006). In a sentence completion
task, the examinee is presented a list of sentence stems (the beginning of a potential
sentence) with a blank space after each stem. The task of the examinee is to complete the
sentence. The typical way to conduct sentence completion tasks is for the examinee to
read the stems and then provide a written response, but oral administration and response
also is an option. Sentence completion tasks may range from only a few items (ten to 15)
to 50 or more items. The basis of all sentence completion tasks is that either qualitative
or systematic inspection of an examinee’s responses may provide insight into their self-
image, developmental characteristics, interpersonal relations, needs, and perceived
threats (Chandler & Johnson, 1991). A sample sentence completion task with 20 stems
is presented in Table 9.2. These stems are representative of the range of stems found
in various sentence completion tasks that have been advocated for use with children
and adolescents. There are several recurring types of stem content in these sample items.
262 s Foundations and Methods of Assessment

TABLE 9.2 20 sample stems typical of the content of sentence completion tasks advocated for use with older children and
adolescents

1. I wish . . . 11. I often feel . . .

2. Most people are afraid of . . . 12. Girls seem to . . .
3. I usually get mad when . . . 13. I am most proud about . . .
4. If I could only . . . 14. My mom . . .
5. At school . . . 15. I feel worse when . . .
6. Other kids think I . . . 16. Kids should . . .
7. I feel best when . . . 17. Teachers usually want you to . . .
8. I am the . . . 18. The worst thing that could happen . . .
9. The best thing about school . . . 19. My dad . . .
10. When Mom and Dad are together . . . 20. When I go to sleep . . .

Most advocates of sentence completion tasks recommend making inferences on clusters

of items rather than on individual items or responses in isolation.
There has been some debate regarding how best to conceptualize and use sentence
completion tasks. Some advocates of this assessment technique support a holistic,
qualitative method of analyzing and interpreting responses (Chandler & Johnson, 1991),
whereas other advocates contend that scoring and interpretation is best done using
standardized systems (Hart, 1986).
There has been substantial disagreement regarding how sentence completion tasks
should be conceptualized (Koppitz, 1982), and they have been alternately described as
projective, semiprojective, and nonprojective techniques (Hart, 1986). Regardless of how
these tasks are conceptualized and used, it is evident that they have been and continue to be
used widely with older children and adolescents and that many clinicians value this method.
Sentence completion tasks appear to have been in use since the early 1900s. Similar to
drawing techniques, the first uses of sentence completion tasks were for mental ability
testing, but interest in this use gradually waned and gave way to personality assessment
(Hart, 1986). Most of the early sentence completion tasks were developed for use with
adults and older adolescents. The Rotter Incomplete Sentences Blank (Rotter & Rafferty,
1950) is perhaps the most influential of all sentence completion tasks in terms of the
amount of research published on it and the influence it maintained in shaping subsequently
developed sentence completion tasks. This test, which includes high school, college, and
adult forms, has 40 items, has an objective scoring system, yields a single adjustment score,
and has been shown to have exceptionally high reliability (Gregory, 1996).
Although older adolescents have been targeted specifically for development and use of
sentence completion tasks since the early days of this procedure, specific extensions
of such tasks to children occurred much later. One of the challenges in administering
sentence completion tasks to children is that a certain reading level is required. In this
regard, McCammon (1981) found that by the sixth grade, most children are capable
of reading sentence completion tests and that oral administration is probably not
necessary. Another challenge is that preoperational children (i.e., most preadolescent
children) tend to think in a concrete manner and tend to provide factual, concrete
responses to sentence completion stems, possibly defeating the projective–expressive
purpose of the technique. Despite this history and the stated limitations, many clinicians
use sentence completion tasks as a projective method with children and adolescents.
Most of the sentence completion tasks in use by practitioners are nonstandardized and
 Projective–Expressive Assessment Techniques s 263

not commercially published or widely available (Gregory, 2000). They also tend to be
used in a qualitative, nonobjective manner.
In addition to the general orientation on sentence completion tasks that has just been
provided, this discussion includes sections on administration, scoring, and interpret-
ation procedures; a brief overview of reliability and validity evidence; short descriptions
of two sentence completion tasks that have been widely used with children (the Hart
Sentence Completion Test [HSCT]) and adolescents (the Washington University Sentence
Completion Test); and some concluding comments on the clinical uses of sentence
completion tasks with children and adolescents.

Administration, Scoring, and Interpretation

Administration, scoring, and interpretation of sentence completion tasks tends to be
highly dependent on the specific test used. Some tests have highly structured procedures,
whereas others provide only minimal guidelines and structure for clinicians. From a
projective psychodiagnostic perspective, a frequently used administration technique
involves the clinician reading the sentence stem to the examinee, who is encouraged to
complete the stem verbally with whatever words come to mind (Hart, 1986). If such an
approach is used, the clinician is encouraged to record carefully the responses of the
examinee and observations of behavior during the task. An inquiry phase often follows
the initial administration technique, in which the clinician asks about the content of the
response. Such inquiry is for the purpose of clarifying meaning, identifying reasons an
examinee responded in a particular way, and “tracking feelings or perceptions to deeper
levels and causes” (Hart, 1986, p. 252).
Various approaches to interpreting sentence completion tasks have been proposed.
The most structured tests include standardized scoring systems that are linked directly
with specific interpretative criteria. A common approach to interpretation has been rating
each response according to the degree of conflict apparent (e.g., negative to neutral to
positive), using a weighted scoring system such as that proposed for use in the Rotter
Incomplete Sentences Blank. Many (if not most) clinicians tend to score and interpret
sentence completion task responses in a subjective and qualitative manner, by reviewing
each item to develop clinical impressions about the underlying dynamics of the response
and to cluster sentence stems with similar content, and then focusing on the specific
impressions obtained from examining those item clusters.

Reliability and Validity

In terms of reliability or stability, sentence completion tasks share a common character-
istic with other projective–expressive techniques discussed in this chapter: They tend to
have good to excellent inter-rater reliability with specific scoring systems but poor stability
of children’s responses over even short-term time intervals. Reliability of sentence com-
pletion tasks has been reviewed by Gregory (2000) and by Hart (1986), both of whom
noted that interscorer or inter-rater reliability in the 0.70 to 0.90 range with specific tests
and structured scoring systems is common. Test–retest reliability of sentence completion
tasks is typically not reported, however, and the few studies that have investigated this
phenomenon have found that children’s responses are quite unstable over time. It is best
to view sentence completion tasks as a means of eliciting information from a child that
may be meaningful at that moment but probably will not generalize over time. Validity
of sentence completion tasks is also an area of inquiry that has yielded mixed results.
264 s Foundations and Methods of Assessment

Sentence completion tasks tend to have low convergence with other types of social–emo-
tional assessment data. Numerous investigations with adult-focused sentence completion
tasks have found them to differentiate among clinical and nonclinical groups, however,
at least to a modest degree (Gregory, 2000). There is some support for the construct
validity of sentence completion tasks. It is difficult, however, to generalize this validity
evidence across the many tests that have been developed because they tend to vary greatly
in terms of purpose, procedures, and scoring and interpretation methods.

The Hart Sentence Completion Test (HSCT) for Children

The Hart Sentence Completion Test (HSCT) (Hart, 1972, 1980; Hart, Kehle, & Davies,
1983) is a 40-item sentence completion task for children and adolescents aged six to 18.
According to the author of this test, it was developed for two reasons: (1) to provide a
sentence completion task developed specifically for children and adolescents rather
than modifying adult sentence completion tasks for child use: and (2) because “other
child-oriented sentence completion tests had poorly developed scoring systems or no
standardized scoring systems at all and little documentation of any reliability and validity
data” (Hart, 1986, p. 257). The HSCT was developed based on a four-dimensional theory
of areas that are important to child social–emotional adjustment: family environments,
social environments, school environments, and intrapersonal or internal conditions.
The HSCT seems to have been developed with a great deal of care and is clearly the most
objective, comprehensive, and clinically useful sentence completion task for children
currently available. Two scoring approaches are used with the HSCT: a scale rating system
and an item-by-item rating system. Information provided in the test manual and research
reports in the public domain indicate that the HSCT has shown excellent inter-rater
reliability; moderate test–retest reliability; and evidence of construct validity, including
significant differentiation of responses of emotionally disturbed, learning disabled,
and regular education students. For clinicians who desire a relatively objective, well-
documented sentence completion task for use specifically with children, the HSCT seems
to be peerless. This test is currently not available, however. The author of the HSCT does
not consider it to be complete at present and is not distributing it publicly until such a
time when additional research efforts are conducted for validation purposes (D. H. Hart,
personal communication, April 25, 1997). Such efforts do not appear to be forthcoming.
Researchers and clinicians interested in the HSCT will have a difficult time obtaining it
but may desire to study the references provided in this section for more information on
its development, structure, and use.

The Washington University Sentence Completion Test

The Washington University Sentence Completion Test (Loevinger, 1976, 1979) has been
used widely with adults and adolescents. It is considered to be the most theory driven
of all the sentence completion tasks (Gregory, 2000) because of its stated purpose of
assessing ego development. Using a relatively objective scoring system, responses are
classified according to seven stages of ego development, including presocial and symbi-
otic, impulsive, self-protective, conformist, conscientious, autonomous, and integrated.
Merrell’s computer-assisted review of the literature indicated that more scholarly journal
articles had been published using Loevinger’s sentence completion test than any other
sentence completion task with adolescents. Consistent with the stated purposes of this
test, most of the published studies using it involved the assessment of adolescent
and adult ego development from a psychodynamic perspective. Although this sentence
 Projective–Expressive Assessment Techniques s 265

completion test is one of the best constructed and most widely researched, little is known
regarding its ability to differentiate between emotionally disturbed or behaviorally
disordered and normal adolescents.

Concluding Comments on Sentence Completion Tasks

Although sentence completion tasks have been among the most widely used projective–
expressive assessment techniques of the twentieth century, theoretical and research
interest in them seems to have waned. Most of the seminal research and development
efforts and important literature on sentence completion tasks occurred in the 1940s,
1950s, and 1960s. Since the 1980s, there has been little in the way of new innovations with
sentence completion tasks. One of the few potentially valuable innovations during
this period has been the development and dissemination of the HSCT for Children, a tool
designed to consider the unique characteristics of childhood. This test also has the
advantage of good standardization and an objective scoring and interpretation scheme.
Research and development efforts on the HSCT have waned, however, and it is no longer
available in the public domain. Clinicians who desire to develop or modify sentence
completion tasks to meet their own needs and use them in a qualitative–holistic manner
may find them to be an interesting addition to their assessment design, particularly when
results are interpreted in a conservative manner.

BEST PRACTICES
This chapter has provided an overview of theory, practice, and research regarding some
of the most popular projective–expressive assessment techniques for use with children
and adolescents, including thematic approaches, drawing techniques, and sentence com-
pletion tasks. After reading this chapter, two facts should be obvious: (1) projective–
expressive techniques have been and continue to be an extremely popular and widely
used form of social–emotional assessment among clinicians; and (2) there continues to be
considerable controversy regarding the use of these techniques, primarily because of a
combination of extremely mixed psychometric evidence and the vagueness or difficulty
operationalizing some of the constructs purported to be measured by these techniques.
It also seems there have been relatively few new innovations in this area during the past
decades. In my opinion, most of the cutting-edge developments in assessing psychopa-
thology and personality of children during the past decades have been in the realm
of empirically based multiaxial assessment techniques, as illustrated by research and
innovation and such areas as behavior rating scales, objective self-report measures, and
multiple gating systems. Projective–expressive techniques are in a unique and paradoxical
position, being among the most popular assessment techniques used by clinicians, but
also becoming increasingly outdated and perhaps archaic.
Because of these issues and related concerns, prominent authors in the area of social–
emotional assessment of children have issued strong statements against the continued use
of projective–expressive techniques, in some cases calling for a moratorium on their
use (R. P. Martin, 1983). In this vein, Wilson and Reschly (1996), commenting on the
results of their survey of assessment practices of school psychologists, stated:

The persistence of using measures with poor technical adequacy and dubious
relationships to psychological constructs and to current child disability classification
266 s Foundations and Methods of Assessment

systems criteria is difficult to explain, other than to note that some psychologists
seem to be tied to poor assessment instruments. The Bender-Gestalt and Draw-A-
Something projective measures have poor technical adequacy, and, if used as a
primary basis for any decision, render the psychologist vulnerable to challenge in
legal proceedings such as due process hearings. Use of these measures, especially
in personality assessment, is difficult to justify from ethical as well as psychometric
grounds.
(pp. 18–19)

Despite such strong and clearly defensible statements, it is naive to think that projective–
expressive assessment techniques will just go away or that clinicians will simply abandon
them. There is something about these techniques that appeals to many clinicians and that
they must find to be useful. After looking at all the evidence, it seems the problem with
projective–expressive assessment techniques may not be in the techniques themselves,
but rather in how they may be used. Much of the heated dialogue regarding the pros and
cons of projective–expressive assessment has stemmed from proponents who blindly
argue for the merits of these techniques without regard to the evidence, or from opponents
who are diametrically opposed to their use on virtually all grounds. Little has been written
about how these tools are actually used, or how to make the best use of these assessment
techniques that are popular and under close scrutiny. This chapter concludes with some
basic suggestions for best practices in using projective–expressive techniques in an
appropriate and defensible manner.
One appropriate use of projective–expressive techniques in social–emotional assess-
ment of children and adolescents is to establish rapport with the examinee. As a general
rule, children find these assessment procedures to be safe and nonthreatening and in many
cases find them to be fun or enjoyable. Projective–expressive techniques such as thematic
approaches, drawing techniques, and sentence completion tasks may serve the purpose of
helping the examinee feel comfortable during the initial stages of the assessment and
helping to establish a positive relationship between the clinician and the child.
Another appropriate and potentially effective use of projective–expressive techniques
is to use them as a means of communication with extremely shy or verbally reluctant
children, or young children who are not yet verbally sophisticated enough to engage
in such processes as meaningful interviews. Even the most experienced and skilled
clinicians have difficulty from time to time in getting some children to communicate with
them through traditional means such as a clinical interview. Drawing techniques may
be especially useful in this regard, given that they make few or no demands on the child
to engage verbally with the clinician, yet provide the opportunity for observation under
structured conditions. This latter area may prove to be highly advantageous in some
cases; observing a child’s behavior under the semistandardized and structured conditions
of completing a drawing technique allows for making observations regarding comparison
with the behavior of numerous other children who may have been observed under the
same conditions.
If projective–expressive techniques have been used to fulfill either of the first two general
purposes just stated, another possible use would be to help form hypotheses about the
child’s social–emotional functioning for additional assessment with more direct and
objective approaches. For example, children sometimes are referred for assessment without
a clear assessment problem or stated objective, and such children or the referral source
 Projective–Expressive Assessment Techniques s 267

sometimes are not particularly helpful in pinpointing specific areas to target in the assess-
ment. In situations such as this, recurring themes found in nonthreatening projective–
expressive assessment results may provide a basis for shaping future assessment directions
(i.e., whether to target the internalizing or externalizing domain or whether to include
specific objective self-report measures within the battery).
Some clinicians find projective–expressive assessment techniques to be helpful in
developing an understanding of their child or adolescent client, particularly from the
examinee’s own worldview and personal perspective. Perhaps this sort of experiential
understanding of the child may be helpful in forming counseling goals or in developing
the rapport that will be useful in future counseling sessions.
Finally, it is important to articulate clearly and directly the inappropriate uses of
projective–expressive assessment techniques. Perhaps the most egregious use of these
techniques (and the use that continues to raise the most controversy) is to make factual
inferences based on inconclusive “signs.” For example, let’s say that a 6-year-old girl pro-
duces a kinetic family drawing in which she is separated from her father by a thick barrier
of some kind. Let’s also suppose that her picture of herself in this drawing includes sup-
posed signs of powerlessness (i.e., thin, weak arms) and that her picture of her father
includes some supposed signs of hostility or anger (i.e., large arms, large sharp teeth).
Suppose that in the final report, the clinician states, “This child feels weak, alienated, and
separated from her father, whom she views as domineering and aggressive.” In the absence
of any corroborating defensible evidence, this type of use of projective–expressive tech-
niques is unsupportable at best and inflammatory and unethical at worst. In our view, this
is the worst and most indefensible use of projective–expressive techniques, yet it seems to
happen routinely.
A related misuse of projective–expressive techniques is to use them as the sole basis for
making a diagnosis or classification decision. Although various ethical and legal guidelines
for assessment state that no single test or technique should be the basis for such a decision,
using assessment techniques, which have questionable reliability and validity, for this
purpose puts the clinician even further at risk. Such inappropriate uses of projective–
expressive techniques should be avoided at all costs.

CONCLUSIONS
Although projective–expressive techniques differ substantially from the primarily direct
and objective methods of assessment that are emphasized in this book, they are among
the most widely used of all social–emotional assessment methods and have an important
place in the history of social–emotional assessment. The basis of projective–expressive
techniques is that examinees may “project” their subconscious motives, conflicts, and
needs either verbally or in drawings when they are presented with ambiguous stimuli and
tasks. Most of these techniques are influenced heavily by psychodynamic theory. Although
projective–expressive techniques are popular among clinicians, they have been associated
with controversy because of the difficulty in defining specific constructs they may purport
to assess and because of psychometric properties that are often tenuous.
Thematic approaches to personality assessment are among the most widely used
projective–expressive techniques and have a long and storied history. The Thematic
Apperception Test (TAT) is among the oldest and most widely used techniques and is the
268 s Foundations and Methods of Assessment

basis for most other thematic approaches. The Children’s Apperception Test (CAT) was
the first downward extension of the TAT for use with younger children and includes
pictures of animal characters for use with very young children. The Roberts Apperception
Tests for Children (RATC and RATC-2) is a more recently developed thematic approach
that includes less ambiguous stimulus cards and a relatively objective scoring system. The
evidence regarding thematic approaches is mixed, but they continue to be popular among
clinicians and have the potential advantage of facilitating communication with shy or
reluctant examinees.
Drawing techniques for projective–expressive assessment have been in existence nearly
as long as the field of psychology. The Draw-A-Person (DAP) technique for personality
assessment is a later variation on human figure drawing tests, which originally were devel-
oped for cognitive and developmental assessment. Numerous methods have been articu-
lated for interpreting DAP drawings, including some more recently developed objective
methods of scoring and interpretation. The Kinetic Family Drawing system (KFD) is a
relatively recent technique for drawing members of a family in action situations. The
KFD has been purported to provide revealing information on the child’s perception of
the inner dynamics and conflicts of a family constellation. The Bender-Gestalt Test (BGT)
has been used primarily for perceptual motor and intellectual screening, but also has been
advocated as a projective–expressive test of social–emotional functioning. The most influ-
ential BGT technique in this regard is that proposed by Koppitz (1963, 1975). Overall,
projective–expressive drawing techniques remain popular with clinicians. They evidence
good inter-rater reliability using specific scoring systems, but evidence of test–retest
reliability and construct validity has been less convincing.
Sentence completion tasks as a projective–expressive technique peaked in popularity
in the 1940s and 1950s, and little has occurred in the way of new innovations during the
past few decades. The most acclaimed sentence completion task specifically for children
is the Hart Sentence Completion Test for Children (HSCT), but it was never considered
fully complete by its author, is not currently available in the public domain, and likely will
not be available in the future. The Washington University/Loevinger Sentence Completion
Test is currently the most widely used sentence completion task with adolescents. It is
privately published by its author and may be difficult to obtain. Most clinicians who use
sentence completion tasks clinically develop their own lists of stems and interpret them
in a qualitative manner.
In sum, projective–expressive assessment techniques are among the most popular
forms of social–emotional assessment currently used, but they still exist in a maelstrom
of controversy because of their occasional misuse and because of their technical properties,
which are often weak according to traditional psychometric conceptions. Projective–
expressive techniques likely will be in use for the foreseeable future, however, and do seem
to have certain advantages and benefits. Clinicians who use them should focus on the
recommended best practices that were provided in this chapter and avoid their misuse.

REVIEW AND APPLICATION QUESTIONS

1. What is the projective hypothesis? How can this hypothesis be operationally defined in
assessment practice?
2. How can the continuing popularity of projective assessment be explained in the face of
questionable empirical evidence?
 Projective–Expressive Assessment Techniques s 269

3. If using the Thematic Apperception Test with an adolescent girl, what would be
recommended stimulus cards?
4. How is the inspection technique best used in interpreting the Thematic Apperception Test
and other thematic approaches?
5. How can the accumulated reliability and validity evidence regarding thematic approaches
to assessment be best characterized?
6. For interpretation of the Draw-A-Person test and other human figure drawing tests, what
should be considered when attempting to determine if a specific characteristic is a
significant emotional indicator?
7. In comparison with the Draw-A-Person test, what is the active nature of the Kinetic Family
Drawing test purported to predict?
8. How can the accumulated reliability and validity evidence regarding human figure drawing
tests as social–emotional measures be best characterized?
9. What evidence exists to support the validity of Koppitz’s emotional indicators on the
Bender-Gestalt test?
10. How reliable over time are sentence completion tasks?
11. What are the most defensible and empirically supportable uses of projective–expressive
assessment techniques?
 Part II
ASSESSMENT OF SPECIFIC PROBLEMS,
COMPETENCIES, AND POPULATIONS
 10
ASSESSING EXTERNALIZING PROBLEMS

The domain of externalizing problems and its related symptoms is a particularly troubling
area for parents and teachers. By their nature, externalizing behavior problems are
difficult to overlook, they are usually annoying and disruptive, and they may be dangerous
at times. These behaviors also create problems for other individuals who are in the same
environments as the children or adolescents who exhibit them. Externalizing behavior
problems can be effectively assessed, and some of the assessment methods may be useful
in developing intervention plans.
This chapter begins with an overview of externalizing problems, including discussions
of specific disorders from the behavioral dimensions and DSM approaches to classification.
After this introduction to the externalizing domain, some of the prevalence, etiology,
developmental course, and prognosis indicators associated with externalizing disorders
are reviewed. The bulk of the chapter is devoted to discussions of how various methods
of assessment may be used best in evaluating the externalizing domain of problems. This
chapter also includes a brief discussion on how well the five methods of assessment are
linked to developing interventions to externalizing disorders and problems.

EXTERNALIZING DISORDERS: AN OVERVIEW

Experts in child psychopathology have long agreed that the behavioral dimension of
externalizing disorders includes a broad array of aggressive behavior, antisocial character-
istics, and hyperactivity (e.g., Cicchetti & Toth, 1991). Other terms that have been used to
identify this behavioral dimension include undercontrolled, antisocial, and outer-directed
behavior. The essential characteristics of this domain, regardless of the name used to
describe it, include aggressive, acting-out, disruptive, defiant, antisocial, oppositional, and
hyperactive behaviors. A child or adolescent who exhibits externalizing problems may not
show all of these behaviors, but the congruence or relatedness among such symptoms has
been well established.
The area of externalizing behavior problems has received significantly more attention
than internalizing problems in the research literature, perhaps because of the debate
over the reliability and long-term implications of internalizing disorders (Cicchetti &
Toth, 1991) and because of the practical consideration that externalizing problems are
seldom difficult to overlook. Many historically important empirical studies have provided
solid support for the construct of an externalizing dimension of behavior problems
(e.g., Achenbach, 1985; Ackerson, 1942; Coie, Belding, & Underwood, 1988; Ivanova

273
274 s Assessment of Specific Problems, Competencies, and Populations

et al., 2007; Robins, 1966; Sroufe & Rutter, 1984). In addition to the types of externalizing
symptoms that were noted at the beginning of this section, most of these sources
identified another commonality of externalizing disorders: peer rejection that stems from
aggressive behavior.

The Behavioral Dimensions Approach to Classifying Externalizing Disorders

Several prominent researchers have developed empirical behavioral dimensions classifi-
cation taxonomies of externalizing behavior disorders (see Chapter 3 for more details).
Quay’s model for externalizing disorders has been particularly influential and has had a
major influence on other researchers for many years. Quay (1986a) reviewed more than
60 studies that applied multivariate statistical approaches to the classification of child
psychopathology. These studies commonly identified several narrow-band dimensions of
symptoms, with each area of symptoms consisting of core behaviors and characteristics
that were replicated at least several times. Under the broad-band domain that we refer to
as externalizing, Quay isolated three major narrow-band dimensions of disorders, includ-
ing undersocialized aggressive conduct disorder, socialized aggressive conduct disorder, and
Attention Deficit Hyperactivity Disorder (ADHD). These three disorders are discussed
briefly in this section. Table 10.1 provides examples of specific behaviors that fit within
these domains.

Undersocialized Aggressive Conduct Disorder The narrow-band externalizing dimension

that Quay (1986a) referred to as undersocialized aggressive conduct disorder includes
a cluster of behaviors that involve aggression, violation of rules, temper tantrums and
irritability, attention seeking and impertinence, and a variety of other negative and oppo-
sitional behavioral characteristics. Quay noted that this particular domain had emerged
in multivariate classification studies “almost without exception” (p. 11), indicating that it
is a relatively stable confluence of associated behaviors. In addition to a pattern of aggres-
sive, disruptive, and noncompliant behaviors, the undersocialized aggressive conduct
syndrome includes two other noteworthy features. The first feature is that hyperactive and
restless behaviors (but usually not full-blown ADHD) often occur concomitantly with this
syndrome, indicating an element of motor overactivity within the domain but not atten-
tional problems. The second noteworthy feature is that “stealing has not been found at all
central to this dimension” (Quay, 1986a, p. 11). Instead, stealing behaviors are more central
to socialized aggressive conduct disorder.

Socialized Aggressive Conduct Disorder The second type of conduct disorder identified in
Quay’s (1986a) review and analysis is socialized aggressive conduct disorder. This cluster
of behaviors is seen less frequently than undersocialized aggressive conduct disorder
but still has received strong empirical support (Loeber & Schmaling, 1985). The principal
features of this narrow-band dimension include involvement with peers in illegal or
norm-violating behaviors. Some of the specific characteristic behaviors of socialized
aggressive conduct disorder include having “bad” companions, truancy from school and
home, stealing (at and away from home), lying, and gang activity. The essential feature
of the behavior problems in this disorder is that they occur as a way of maintaining
social acceptance within a deviant or antisocial peer group. Given that these conduct
problems are often aimed at violating the rights of other persons and social institutions,
delinquent behavior and involvement with juvenile justice systems often results. The onset
 Assessing Externalizing Problems s 275

Table 10.1 Major characteristics of three domains of externalizing

behavior disorders derived from Quay’s (1986a) classic literature review

Undersocialized Aggressive Conduct Disorder

Assaultive behavior (fights, hits)
Disobedient and defiant behavior
Temper tantrums
Destructive behavior
Impertinent or “sassy”; uncooperative
Attention seeking
Domineering/threatening behavior
Demanding/disruptive behavior; loud and boisterous
Irritable and explosive
Negativity and refusal
Restlessness, hyperactivity
Dishonest and undependable
Socialized Aggressive Conduct Disorder
“Bad” companions
Truancy from home and school
Gang membership
Steals with others; steals at home
Lies and cheats
Stays out late at night
Loyalty to delinquent friends
Attention Deficit Hyperactivity Disorder
Poor concentration, short attention span, distractibility
Daydreaming
Poor coordination and clumsiness
Stares into space; preoccupied
Passivity and lack of initiative
Fidgeting and restless behavior
Fails to complete tasks
Lazy or sluggish behavior, drowsiness
Impulsivity
Lack of interest, general boredom
Hyperactive motor behaviors

of socialized aggressive conduct problems typically occurs at a later developmental stage

than the undersocialized variety, usually in late childhood or early adolescence (Quay,
1986a). Another feature of this disorder is that it is much more likely to occur with males
and it often is accompanied by deficits or lack of development in moral reasoning
(Smetana, 1990).

Attention Deficit Hyperactivity Disorder (ADHD) The third narrow-band dimension

of externalizing behavior disorders identified by Quay (1986a) is Attention Deficit
Hyperactivity Disorder (ADHD), characterized by notable problems in maintaining
concentration and attention, and often including associated behavior features such as
impulsivity, clumsiness, and passivity. Overt motor overactivity (what we commonly
think of as hyperactivity) is not always a feature of this disorder; behaviors that are char-
acteristic of underactivity are often a prominent feature. Essentially, ADHD is a diverse
276 s Assessment of Specific Problems, Competencies, and Populations

group of behaviors and characteristics, and there are extremes in how the level of motor
activity is manifest in individual cases. Some children who exhibit this disorder are con-
stantly “on the move,” fidgety, and restless, and may be at heightened risk for developing
other conduct problems. The disorder may be exhibited in children who are more with-
drawn and passive and who seldom engage in aggressive or antisocial behaviors. As such,
this particular disorder does not fit into the broad band of externalizing problems as
neatly as undersocialized and socialized aggressive conduct disorders. ADHD more often
has been lumped in with the externalizing than the internalizing broad-band dimension,
based on statistical and clinical evidence. One of the principal problems in classification
of the behavioral symptoms of ADHD has been in distinguishing them from conduct
disorders, owing to the existence of so many overlapping behaviors (Campbell & Werry,
1986). There is strong evidence that active and aggressive behaviors usually coexist at an
early developmental stage (Campbell, 1991).

The DSM Approach to Classifying Externalizing Disorders

Although Quay’s behavioral dimensions approach to classification of externalizing
disorders is empirically supportable and has enjoyed wide influence among researchers,
the DSM system of classification is the most widely used among practitioners in the
United States and Canada. The DSM-5 includes four major categories of externalizing
behavior disorders relevant to children and adolescents. ADHD is found in the DSM
under the general heading of Neurodevelopmental Disorders, and Conduct Disorder,
Oppositional Defiant Disorder (ODD), and Intermittent Explosive Disorder are found
under the heading of Disruptive, Impulse-Control, and Conduct Disorders. These four
categories of externalizing behavior problems are reviewed briefly in this section. Two
additional DSM-5 classification categories, Other Specified Disruptive, Impulse-Control,
and Conduct Disorder and Unspecified Disruptive, Impulse-control, and Conduct Disorder,
are also used to classify or diagnose externalizing behavior problems. These categories are
not an integral part of the domain of externalizing behavior disorders, however, and are
not discussed further in this chapter.

Attention Deficit Hyperactivity Disorder (ADHD) The DSM-5 diagnostic criteria for
ADHD are shown in Table 10.2. The major behavioral characteristics of this disorder
are similar to the major characteristics identified through Quay’s (1986a) behavioral
dimensions approach, although more detailed, comprehensive, and specific. Perhaps
the most notable difference between the current DSM criteria and earlier editions of the
DSM is that ADHD is categorized with other neurodevelopmental disorders (e.g., learning
disorders, intellectual disabilities, autism). This is partially due to the persistence observed
within all of these disorders, common associated delays and risk for poorer outcomes,
and also the changes in neural development (Nigg & Barkley, 2014). Symptoms of ADHD
are separated into two major groups (inattention and hyperactivity), with the resulting
implication that the two symptom areas may be independent to some extent. A previous
DSM edition (DSM-III-R) (APA, 1987) did not separate symptoms into clusters by type,
but simply required that a diagnosis be based on the presence of a minimal number of
symptoms out of a larger broad symptom list. Current thinking on ADHD is that this
disorder is often manifest as a distinct pattern of either inattentiveness or hyperactivity–
impulsivity, although many individuals exhibit characteristics of both types (Barkley,
1997a, 1997b, 1997c; Holland et al., 1998; Nigg & Barkley, 2014). Another significant
 Assessing Externalizing Problems s 277

Table 10.2 Diagnostic criteria for Attention Deficit Hyperactivity Disorder from DSM-5

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or

development, as characterized by (1) and/or (2):
1. Inattention: Six (or more) of the following symptoms have persisted for at least six months to a
degree that is inconsistent with developmental level and that negatively impacts directly on social
and academic/occupational activities.
Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or
failure to understand tasks or instructions. For older adolescents and adults (aged 17 and older), at
least five symptoms are required.
a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work,
or during other activities (e.g., overlooks or misses details, work is inaccurate)
b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining
focused during lectures, conversations, or lengthy reading)
c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the
absence of any obvious distraction)
d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties
in the workplace (e.g., obvious distraction)
e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks;
difficulty keeping materials and belongings in order; messy, disorganized work; has poor time
management; fails to meet deadlines)
f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
(e.g., schoolwork or homework; for older adolescents and adults, preparing records, completing
forms, reviewing lengthy papers)
g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools,
wallets, keys, paperwork, eyeglasses, mobile telephones)
h. Is often easily distracted by extraneous stimuli (for adolescents and adults, may include
unrelated thoughts)
i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents
and adults, returning calls, paying bills, keeping appointments)
2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least
six months to a degree that is inconsistent with developmental level and that negatively impacts
directly on social and academic/occupational activities.
Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or
failure to understand tasks or instructions. For older adolescents and adults (aged 17 and older), at
least five symptoms are required.
a. Often fidgets with or taps hands or feet or squirms in seat
b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in
the classroom, in the office, or other workplace, or in other situations that require remaining
in place)
c. Often runs about or climbs in situations where it is inappropriate (in adolescents and adults,
may be limited to feeling restless)
d. Often unable to play or engage in leisure activities quietly
e. Is often “on the go,” activing as if “driven by a motor” (e.g., is unable to be or uncomfortable
being still for extended time, as in restaurants, meetings; may be experienced by others as being
restless or difficult to keep up with)
f. Often talks excessively
g. Often blurts out an answer before a question has been completed (e.g., completes people’s
sentences; cannot wait for turn in conversation)
h. Often has difficulty waiting his or her turn (e.g., while waiting in line)
i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may
start using other people’s things without asking or receiving permission; for adolescents and
adults, may intrude into or take over what others are doing)
(continued)
278 s Assessment of Specific Problems, Competencies, and Populations

Table 10.2 Diagnostic criteria for Attention Deficit Hyperactivity Disorder from DSM-5 (continued)

B. Several inattentive or hyperactive–impulsive symptoms were present prior to age 12 years.

C. Several inattentive or hyperactive–impulsive symptoms are present in two or more settings (e.g., at
home, school, or work; with friends or relatives; in other activities).
D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic,
or occupational functioning.
E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic
disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder,
dissociative disorder, personality disorder, substance intoxication or withdrawal).
Specify whether:
314.01 (F90.2) Combined Presentation: Of both Criterion A1 (inattention) and Criterion A2
(hyperactivity–impulsivity) are met for the past six months.
314.00 (F90.0) Predominantly Inattentive Presentation: If Criterion A1 (inattention) is met but
Criterion A2 (hyperactivity–impulsivity) is not met for the past six months.
314. 01 (F90.1) Predominantly Hyperactive/Impulsive Presentation: If Criterion A2 (hyperactivity–
impulsivity) is met and Criterion A1 (inattention) is not met for the past six months.
Specify if:
In partial remission: When full criteria were previously met, fewer than the full criteria have been met
for the past six months, and the symptoms still result in impairment in social, academic, or
occupational functioning.
Specify current severity:
Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and
symptoms result in no more than minor impairments in social or occupational functioning.
Moderate: Symptoms or functional impairment between “mild” and “severe” are present.
Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are
particularly severe, are present, or the symptoms result in marked impairment in social or occupational
functioning.
Source: Reprinted with permission from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (pp. 59–61).
Copyright 2013 by the American Psychiatric Association.

change from previous editions in the DSM criteria for ADHD is the requirement that
symptoms must be pervasive and persistent (Hinshaw, 1994). This change apparently
was intended to ensure that ADHD would not be diagnosed unless the associated
problems were substantial and observed across multiple contexts. The DSM-5 also
requires that symptoms be present before the age of 12. It has been argued, however, that
no specific research support exists for this age of onset criterion and that the primary
symptoms of ADHD may be present in very young children but that the six month
requirement for persistence of symptoms may be too short for young children (Barkley,
1997a, 1997b, 1997c; Barkley & Biederman, 1997; Nigg & Barkley, 2014).

Conduct Disorder The DSM-5 diagnostic criteria for Conduct Disorder are presented in
Table 10.3. In DSM terms, Conduct Disorder falls under the broad domain of Disruptive,
Impulse Control, and Conduct Disorders. The essential feature of this disorder is
“a repetitive and persistent pattern of behavior that violates the rights of others or in
which major age-appropriate societal norms or rules are violated” (APA, 2013; Kimonis,
Frick, & McMahon, 2014, p. 146). In other words, Conduct Disorder is characterized by
high levels of antisocial behavior. In contrast to Quay’s (1986a) behavioral dimensions
approach to classification of conduct disorders, the current DSM criteria do not
differentiate among various possible subtypes (other than age of onset and severity).
 Assessing Externalizing Problems s 279

Table 10.3 DSM-5 diagnostic criteria for Conduct Disorder

A. 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 at least three of the
following 15 criteria in the past 12 months from any of the categories below, with at least one criterion
present in the past six months:
Aggression to people and animals
1. Often bullies, threatens, or intimidates others
2. Often initiates physical fights
3. Has used a weapon that can cause serious physical harm to others (e.g., bat, brick, broken bottle,
knife, gun)
4. Has been physically cruel to people
5. Has been physically cruel to animals
6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
7. Has forced someone into sexual activity
Destruction of property
8. Has deliberately engaged in fire setting with the intention of causing serious damage
9. Has deliberately destroyed others’ property (other than by fire setting)
Deceitfulness or theft
10. Has broken into someone else’s house, building, or car
11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)
12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without
breaking and entering, forgery)
Serious violations of rules
13. Often stays out at night despite parental prohibitions, beginning before age 13 years
14. Has run away from home overnight at least twice while living in the parental or parental surrogate
home, or once without returning for a lengthy period
15. Is often truant from school, beginning before age 13 years
B. The disturbance in behavior causes clinically significant impairment in social, academic, or
occupational functioning
C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder
Specify whether:
312.81 (F91.1) Childhood-Onset Type: Individuals show at least one symptom characteristic of
conduct disorder prior to age ten years.
312.82 (F91.2) Adolescent-Onset Type: Individuals show no symptom characteristic of conduct
disorder prior to age ten years.
312.89 (F91.9) Unspecified Onset: Criteria for a diagnosis of conduct disorder are met, but there is not
enough information available to determine whether the onset of the first symptom was before or after
age ten years.
Specify if:
With limited prosocial emotions: To qualify for this specifier, an individual must have displayed at
least two of the following characteristics persistently over at least 12 months and in multiple
relationships and settings. These characteristics reflect the individual’s typical pattern of interpersonal
and emotional functioning over this period and not just occasional occurrences in some situations.
Thus, to assess the criteria for the specifier, multiple information sources are necessary. In addition to
the individual’s self-report, it is necessary to consider reports by others who have known the individual
for extended periods of time (e.g., parents, teachers, co-workers, extended family members, peers).
Lack of remorse or guilt: Does not feel bad or guilty when he or she does something wrong (exclude
remorse when negative consequences of his or her actions). For example, the individual is not
remorseful after hurting someone or does not care about the consequences of breaking rules.
(continued)
280 s Assessment of Specific Problems, Competencies, and Populations

Table 10.3 DSM-5 diagnostic criteria for Conduct Disorder (continued)

Callous-lack of empathy: Disregards and is unconcerned about the feelings of others. The individual is
described as cold and uncaring. The person appears more concerned about the effects of his or her
actions on himself or herself rather than their effects on others, even when they result in substantial
harm to others.
Unconcerned about performance: Does not show concern about poor/problematic performance at
school, at work, or in other important activities. The individual does not put forth the effort necessary
to perform well, even when expectations are clear, and typically blames others for his or her poor
performance.
Specify current severity:
Mild: Few if any conduct problems in excess of those required to make the diagnosis are present, and
conduct problems cause relatively minor harm to others (e.g., lying, truancy, staying out after dark
without permission, other rule breaking).
Moderate: The number of conduct problems and the effect on others are intermediate between those
specified in “mild” and those in “severe” (e.g., stealing without confronting a victim, vandalism).
Severe: Many conduct problems in excess of those required to make the diagnosis are present, or
conduct problems cause considerable harm to others (e.g., forced sex, physical cruelty, use of a weapon,
stealing while confronting a victim, breaking and entering).
Source: Reprinted with permission from Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (pp. 469–471).
Copyright 2013 by the American Psychiatric Association.

Previous versions of DSM have included various typologies for conduct disorders,
however. For example, the DSM-III-R (APA, 1987) included code types for group type
and solitary aggressive type, two categories that roughly correspond to Quay’s typology
of socialized aggressive conduct disorder and undersocialized aggressive conduct disorder.
Within the current DSM system, to make a diagnosis of Conduct Disorder, a minimum
of three symptoms from a diverse list of 15 symptoms must be present. Such generality
in classification precision presents some obvious challenges. One such classification issue
is the required existence of three (as opposed to, say, four or five) symptoms in the absence
of any compelling empirical evidence to justify the criterion of three (Kazdin, 1995).
Another issue exists regarding the diversity of symptoms on the list of 15 and the lack of
any developmental anchors for these symptoms. As Kazdin has noted:

The symptoms are delineated in a fixed way so that they are applied equally across
the full period of childhood to adolescence. Yet perhaps symptoms required to
meet the diagnosis should vary with age. It is unlikely that a four-year-old child
would steal or confront a victim or force sex on someone. Does this mean that
Conduct Disorder does not emerge before the age of four years or that the criteria
for a four-year-old child ought to be different?
(p. 26)

These have been commonly stated concerns among scholars. The DSM-5 does account
for developmental variation and intensity of symptoms with the inclusion of new specifi-
ers. Those diagnosing are now able to specify whether onset occurs during childhood,
adolescence, or at an unspecified time period. Further, one can specify if individuals
present with limited prosocial emotions such as lack of remorse or guilt, callous—lack of
empathy, unconcerned about performance, and/or shallow or deficient affect and whether
symptoms are considered mild, moderate, or severe. Despite ongoing concerns regarding
 Assessing Externalizing Problems s 281

the previous, and even current, DSM approach to classifying Conduct Disorder, it still
results in identification of adolescents who, as a group, tend to show remarkable distin-
guishing behavioral characteristics and tend to have a much poorer prognosis for general
life adjustment and success when compared with “normal” youth (McMahon & Estes,
1997; Walker, Colvin, & Ramsey, 1995; Walker, Ramsey, & Gresham, 2004).

Oppositional Defiant Disorder (ODD) The DSM-5 diagnostic criteria for Oppositional
Defiant Disorder (ODD) are listed in Table 10.4. There is no parallel behavioral dimen-
sions category corresponding to ODD, but its symptoms seem to be subsumed under
the undersocialized aggressive conduct disorder category. ODD is characterized by
angry/irritable mood, argumentative/defiant behavior, and vindictiveness (APA, 2013).
Although some researchers and clinicians may doubt the existence of ODD as an empirical
category that is unique from Conduct Disorder (some have derisively referred to ODD
as a “weeny conduct disorder”), DSM-5 considers the angry/irritable dimension and

Table 10.4 DSM-5 diagnostic criteria for Oppositional Defiant Disorder

A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least

six months as evidenced by at least four symptoms from any of the following categories, and exhibited
during interaction with at least one individual who is not a sibling.
Angry/irritable mood
1. Often loses temper
2. Is often touchy or easily annoyed
3. Is often angry and resentful
Argumentative/defiant behavior
4. Often argues with authority figures or, for children and adolescents, with adults
5. Often actively defies or refuses to comply with requests from authority figures or with rules
6. Often deliberately annoys others
7. Often blames others for his or her mistakes or misbehavior
Vindictiveness
8. Has been spiteful or vindictive at least twice within the past six months.
Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that
is within normal limits from a behavior that is symptomatic. For children younger than five years,
the behavior should occur on most days for a period of at least six months unless otherwise noted
(Criterion A8). For individuals five years or older, the behavior should occur at least once per week for
at least six months, unless otherwise noted (Criterion A8). While these frequency criteria provide
guidance on a minimal level of frequency to define symptoms, other factors should also be considered,
such as whether the frequency and intensity of the behaviors are outside a range that is normative for
the individual’s developmental level, gender, and culture.
B. The disturbance in behavior is associated with distress in the individual or others in his or her
immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social,
educational, occupational, or other important areas of functioning.
C. The behaviors do no occur exclusively during the course of a psychotic, substance use, depressive, or
bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder.
Specify current severity:
Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers).
Moderate: Some symptoms are present in at least two settings.
Severe: Some symptoms are present in three or more settings.
Source: Reprinted with permission from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (pp. 462–463).
Copyright 2013 by the American Psychiatric Association.
282 s Assessment of Specific Problems, Competencies, and Populations

argumentative/defiant dimension to hold up as factors that are distinct from Conduct

Disorder, while vindictiveness overlaps considerably and could be thought of as a
developmental precursor to Conduct Disorder. To be clear, DSM-5 does consider ODD
and Conduct Disorder to be mutually exclusive classifications, however. If symptom
criteria for both disorders are met, Conduct Disorder should be the appropriate classi-
fication. Making a differential diagnosis between the two disorders would be a problem
because of their apparently hierarchical relationship. Perhaps the most salient feature that
might separate ODD from Conduct Disorder is the absence of overtly aggressive behavior,
which also is a major predictor of future problems.

Intermittent Explosive Disorder Intermittent Explosive Disorder has been incorporated

in versions of the DSM since 1980 (Coccaro, 2012). It is a disorder characterized by
behavioral outbursts that include verbal or physical aggression that either persist over time
but do not cause physical damage or harm, or they occur on at least three occasions within
a year and do cause harm (APA, 2013). This disorder is often diagnosed in late childhood
or adolescence and is mostly considered a categorical disorder versus a dimensional one
(Coccaro, 2012). Intermittent Explosive Disorder cannot be diagnosed if it can be better
described as another disorder, but it does often co-occur with a number of disorders such
as depression, anxiety, ADHD, Conduct Disorder, and ODD.

Subdimensions of Externalizing Problems: Classification Studies

In addition to the classic behavioral dimensions efforts and the DSM approaches to
classifying externalizing problems, some more recent classification efforts by prominent
researchers have shed additional light on this area and help us understand better the
shape and complexity of the externalizing domain. Regarding ADHD, the hyperactive–
impulsive and inattentive subtypes from DSM-5 that are based on earlier behavioral
dimensions efforts have been verified by more recent multivariate studies using large
data sets. It seems that the two subdimensions of ADHD are stable and emerge consistently
across varying samples. In research reports detailing the factor structure and psychometric
properties of newly developed ADHD assessment tools, DuPaul and colleagues (DuPaul
et al., 1997; DuPaul, Anastopoulos, et al., 1998) and Holland et al. (1998) found a robust
and consistent division of ADHD-related behaviors into the hyperactive–impulsive and
inattentive subtypes.
It seems that the ADHD dimension of the externalizing domain can be divided clearly
into these two subtypes; however, there is evidence to suggest that subtypes are not par-
ticularly stable over time (Lahey, Pelham, Loney, Lee, & Willcutt, 2005; Lahey & Willcutt,
2010). Regarding the subdivision of the Conduct Disorder and ODD DSM divisions of
the externalizing domain, there has been less consistency among more recent research
findings than with ADHD, indicating that these behavioral clusters are complex and
of varying stability. One of the more widely influential investigations in this regard was
conducted by Frick and colleagues (1993, cited in Frick, 1998), who did a meta-analysis
of teacher and parent ratings of child behavior that used multidimensional scaling.
This meta-analysis reviewed more than 60 factor analytic studies and involved ratings of
more than 28,000 children. The results were presented in a grid with two bidirectional and
bipolar axes: a vertical axis that included destructive behavior at one end and nondestructive
behavior at the other and a horizontal axis that included covert behavior at one end and
 Assessing Externalizing Problems s 283

overt behavior at the other. Using the resulting four quadrants with their associated behav-
ioral clusters as a guide, these researchers identified four subdomains of conduct
problems:

1. property violations (cruel to animals, sets fires, steals, engages in vandalism, lies), a
dimension that falls along the destructive–covert segment of the quadrant;
2. aggression (assault, is spiteful, is cruel, blames others, fights, bullies), which falls in
the destructive–overt quadrant;
3. status violations (runs away, plays truant, engages in substance use, breaks rules,
swears), which falls in the nondestructive–covert quadrant;
4. oppositional (is touchy, argues, is angry, is stubborn, shows temper, defies, annoys),
in the nondestructive–overt quadrant.

Another important recent development in understanding subtypes of externalizing

problems is the work of Frick and colleagues regarding the identification and character-
istics of the callous–unemotional trait among youths (e.g., Barry et al., 2000; Frick & Ellis,
1999; Frick, Lilienfeld, Ellis, Loney, & Silverfeld, 1999; Kimonis, Ogg, & Fefer, 2014). As
described by these researchers, the callous–unemotional trait appears to be related to a
combination of impulsivity and antisocial behavior. Many of the youths who fit this profile
have received DSM diagnoses of both Conduct Disorder and ADHD. What seems to
make the callous–unemotional group unique is that children high on these traits tend
to show a lack of fearfulness and anxiety, as well as low levels of responsiveness to rewards
(Marini & Stickle, 2010). They also are not easily aroused and show little distress regard-
ing the results of their behavior problems. In other words, the callous–unemotional trait
reflects a form of psychopathy common among persons who feel little or no guilt or
remorse, have a low general level of arousal and emotionality, are indifferent to the pain
they may cause others, and have a shrewd approach to getting what they want through
antisocial means. Research also suggests that youth with callous–unemotional character-
istics may differ from others in terms of the severity of their antisocial behaviors and
deficits in processing not only social scenarios but the affective component of social
interactions (Marini & Stickle, 2010; Stickle, Kirkpatrick, & Brush, 2009). The “With
Significant Callous–Unemotional Traits” specifier for the diagnosis of Conduct Disorder
is an important addition to the DSM-5, especially considering the research of Kahn, Frick,
Youngstrom, Findling, and Youngstrom (2012) that suggested 10% to 50% of youth with
Conduct Disorder would meet criteria for the DSM specifier. The research that has iden-
tified and articulated this trait has been extremely influential during the past few years
and is widely accepted among researchers in the areas of developmental psychopathology
and antisocial behavior.
These important efforts by Frick, Stickle and their respective colleagues have made a
substantial contribution to understanding of conduct problems and the externalizing
domain in general. Future efforts may help to clarify further the subdomains of conduct
problems, especially under varying conditions and across widely varying groups of
adolescents.
284 s Assessment of Specific Problems, Competencies, and Populations

PREVALENCE, DEVELOPMENT, AND PROGNOSIS OF

EXTERNALIZING DISORDERS

Prevalence
Prevalence estimates for externalizing disorders vary depending on definitional criteria,
specific populations studied, and assessment methodology. There is a general consensus,
however, that externalizing problems tend to be quite common. Most research suggests
ADHD may be increasing in prevalence with it being diagnosed in up to 8.7% of U.S.
children aged eight to 15 (Froehlich et al., 2007). More recently, however, Nigg and
Barkley (2014) have noted that more sophisticated analyses that enable researchers to
take into account the variability in assessment and diagnostic procedures may result in
true prevalence being closer to 2–3%. ADHD is known to occur much more frequently
in boys than in girls, with prevalence ratios for the genders ranging from 2:1, depending
on the type of setting.
Regarding Conduct Disorder, DSM-5 states that in the child and adolescent population,
the prevalence rate ranges from 2% to 10% and that it is observed in boys more often than
girls. These rates are similar to what B. Martin and Hoffman (1990) cited in prevalence
studies that placed the range of estimation for conduct disorders from about 4% to 8%
in the entire school-age population, with boys outnumbering girls at about a 3:1 ratio on
average. More conservative figures were noted by McMahon and Estes (1997), who listed
the prevalence of conduct disorders in the 2% to 9% range and noted that there has been
comparatively little research on the development and prevalence of conduct disorders
in girls.
Less information is available regarding the prevalence of ODD. DSM-5 provides a
wide range (1% to 11%) for the estimate of prevalence and notes that it is more likely
to be observed in pre-pubertal males than in females, but the rates are probably more
similar following onset of puberty (APA, 2013). In contrast with what is known about
the prevalence and gender features of ADHD and Conduct Disorder, relatively little
evidence exists in the professional literature regarding ODD. When viewed as a whole, the
prevalence estimates for externalizing disorders indicate that this band of disorders is
relatively common in school-age children, boys are more likely than girls to exhibit them,
and Conduct Disorder is more common than ADHD.

Comorbidity
A well-known finding that has emerged from the literature on externalizing disorders
in children is that they tend to occur in a comorbid pattern, meaning that two or more of
these disorders coexist in a substantial percentage of cases. This finding has been verified
with respect to the relationship between ADHD and Conduct Disorder (Hinshaw, 1987,
1994; Kazdin, 1995; Larson, Russ, Kahn, & Halfon, 2011; Loney & Milich, 1982; McMahon
& Estes, 1997; Paternite & Loney, 1980), Conduct Disorder and ODD (Biederman, Faraone,
Milberger, & Jetton, 1996; Kazdin, 1995), and ODD and ADHD (Biederman et al., 1996;
Nock, Kazdin, Hiripi, & Kessler, 2007). Although the existence of one of these disorders
does not mandate the presence of another (remember that a diagnosis of Conduct Disorder
precludes a diagnosis of ODD), they have been linked through theory and research for
many years. Loeber (1985a) posited an interesting speculation on the link between
ADHD and Conduct Disorder, suggesting that ADHD symptoms (particularly hyperactive
behavior) may be a necessary precursor for the development of severe forms of Conduct
 Assessing Externalizing Problems s 285

Disorder in many children. This speculation is certainly consistent with the more recent
work of Frick, Stickler, and others regarding the connection between impulsivity, antiso-
cial behavior, and the callous–unemotional trait. In addition, several researchers have con-
sidered ODD a developmental precursor to Conduct Disorder, while others have found
that ODD and Conduct Disorder develop through parallel pathways (Diamantopoulou,
Verhulst, & van der Ende, 2011). Whatever the relationship among the various externaliz-
ing disorders, it is clear that they share extensive common ground. The substantial comor-
bidity or co-occurrence of specific forms of externalizing disorders “raises questions
about the categories themselves and about what is the most meaningful and useful way to
delineate disruptive behaviors” (Kazdin, 1995, p. 25).
It is important to consider that the opposing categories of externalizing and internal-
izing are not necessarily mutually exclusive. McMahon and Estes (1997) and Kimonis,
Frick, and McMahon (2014) stated that the presence of internalizing problems in children
and adolescents who have conduct problems is higher than would be expected by chance
and that the conduct problems typically precede the internalizing problems in a develop-
mental pathway. Barkley (1997c) noted the same general relationship between ADHD and
internalizing disorders. More recently, researchers have also observed that more intense
externalizing behaviors are often associated with increases in internalizing behaviors for
younger children (Gilliom & Shaw, 2004), and there is also the hypothesis that adolescents
who are genetically predisposed to one dimension may also be predisposed to the other
(Cosgrove et al., 2011).

Etiology and Development

The development and etiology of externalizing disorders has been the focus of much
speculation and research. The major models for explaining causation have been social
learning, biochemical/neurological, and familial/genetic approaches, or variants thereof.
Hinshaw (1994), in his excellent overview of the various competing etiological models
for ADHD, noted that researchers are “actively searching for unifying themes that could
account for the symptomatology, associated features, and course of the disorder” (p. 51).
With respect to ADHD, Campbell and Werry (1986) noted that although there has been
a tremendous amount of speculation that a biological basis for the disorder exists, “specific
conclusions remain elusive” (p. 116). If there is a biological basis for ADHD, as Deutsch
and Kinsbourne (1990) contend, it may be obscured because of its heterogeneous nature
and by the fact that there may be differing causal factors and risk factors for diverging
subgroups of children with ADHD (Hinshaw, 1994). A more recent theory regarding
the etiology of ADHD, one that promises to be highly influential, has been postulated and
continuously studied by Barkley (1997a, 1997b, 1997c, 2011), who argued that the root of
this disorder is not attentional, but rather a developmental problem of self-control or a
deficit in behavioral inhibition. It is anticipated that the tremendous surge of interest
regarding ADHD will result in continued theoretical developments and empirical advances
regarding etiology.
With respect to conduct disorders (including Conduct Disorder and ODD), there has
been increasing speculation of a biologically based etiology (Dick et al., 2011; Kazdin,
1995; Werry, 1986), but specific conclusions are difficult at this point. Similar to ADHD,
conduct disorders may have a familial/genetic connection (Deutsch & Kinsbourne, 1990;
Plomin, Nitz, & Rowe, 1990). Even with the inclusion of some well-designed twin studies
and adoption studies, however, ferreting out the specific contributions of social learning
286 s Assessment of Specific Problems, Competencies, and Populations

and genetics has been problematic (Deutsch & Kinsbourne, 1990; Hetherington & Martin,
1986; Meier, Slutske, Heath, & Martin, 2011; Werry, 1986).
Despite the increasing amount of attention and interesting evidence regarding the
possible biochemical or neurological basis for conduct disorders, the social learning model
may offer a more elegant and substantiated developmental model at present. For example,
researchers at the Oregon Social Learning Center have conducted numerous high-quality
studies and published many reviews of their research showing that such factors as harsh
and inconsistent discipline practices, lax parental monitoring, coercive behavior in families,
and exposure to adult models of antisocial behavior are all powerful predictors of the
development of aggressive and antisocial behavior in children (e.g., Capaldi, DeGarmo,
Patterson, & Forgatch, 2002; Lahey et al., 2008; Lorber & Egeland, 2011; Patterson, 1976,
1982, 1986, 2002; Patterson & Bank, 1986; Patterson & Dishion, 1985; Patterson et al.,
1992; J. Snyder & Stoolmiller, 2002). Another influential social learning–based model of
the development of childhood conduct problems was proposed by Wahler and colleagues
in the 1980s and 1990s (Wahler, 1994; Wahler & Dumas, 1986). This model includes many
of the features identified by Patterson and colleagues but takes a different approach,
focusing on social continuity and predictability of coercive interactions between parents
and children as key variables in developing and maintaining antisocial–aggressive child
behavior. Despite efforts to identify single essential variables that lead to development of
conduct disorders, researchers who investigate this area seem to be focusing less on specific
sole etiological factors and are viewing these possible causes as being risk factors or factors
that increase vulnerability to the development of the disorders. Perhaps the most useful
method of approaching the etiology of Conduct Disorder and ODD for assessment
purposes is to integrate the various findings and speculations into a reciprocal determinism
model consistent with Bandura’s (1986) social–cognitive theory. It is likely that behavioral,
environmental, and personal factors all contribute to development of externalizing
disorders and that they work together in an interactive fashion.

Developmental Course and Prognosis

There is more evidence regarding developmental patterns and long-term implications of
externalizing disorders than for internalizing disorders (Cicchetti & Toth, 1991; Mash &
Terdal, 1997). The general developmental course of ADHD seems to include several com-
ponents, including onset in infancy or early childhood; continuation during childhood
and adolescence with concomitant academic, behavioral, and social problems; and mar-
ginal adjustment to the disorder during adulthood (Barkley, 1997c; Campbell & Werry,
1986; Hinshaw, 1994). “Overall, ADHD is far from a benign disorder: It carries significant
risk for antisocial outcomes and for continuing patterns of disinhibited behavior, cogni-
tive dysfunction, and interpersonal difficulties” (Hinshaw, 1994, p. 87). Longitudinal
studies of ADHD (Weiss, 1983; Weiss, Hechtman, Perlman, Hopkins, & Wener, 1979) have
shown that although individuals with ADHD may exhibit less impulsivity, restlessness,
and antisocial behavior as adults than they did as adolescents, they are more likely to be
“underemployed” than individuals without ADHD. These same studies have indicated
that ADHD by itself is not predictive of severe psychopathology later in life. A related
review of studies by Whalen and Henker (1998) concluded that although adults who were
diagnosed with ADHD as children may have continuing problems with ADHD symptoms
and related externalizing problems, there is no compelling evidence that children with
ADHD are at increased risk for later development of internalizing disorders, such as mood
 Assessing Externalizing Problems s 287

or anxiety disorders. More recent work does suggest, however, that females who are diag-
nosed with ADHD in childhood are more likely to have conflictual relationships with their
mothers, fewer romantic relationships, and more experiences with symptoms of depres-
sion than females without ADHD (Babinski et al., 2011). If ADHD during childhood is
accompanied by other externalizing disorders, substance abuse, familial discord, and low
levels of intelligence and academic achievement, however, the long-term prognosis is
poorer, and there is a greater likelihood of criminal behavior and psychiatric problems
(Barkley, 1990, 1997c; Whalen & Henker, 1998).
With respect to conduct problems (including Conduct Disorder and ODD from the
DSM system), their developmental course and long-term prognosis seem to be related
strongly to the amount and intensity of aggressive behavior that is present and the time
of the onset of symptoms. Quay (1986b) suggested that aggression is more likely to be a
major characteristic of unsocialized rather than socialized types of conduct disorders and
that the best prognosis for long-term adjustment is likely with individuals who have
socialized aggressive conduct disorder in conjunction with high intelligence and good
social skills. Previous research on aggressive behavior resulted in findings that indicate
reasonably strong stability over time. The likelihood that children’s aggressive behavior
will persist into adulthood increases with age. In other words, there is a modest probability
that very young children (e.g., preschoolers) who exhibit persistent patterns of aggressive
behavior also will exhibit aggressive behaviors as adults, but if these children are still
exhibiting the same pattern of behavior by age ten or 12, the probability is that aggressive
behavior as adults increases significantly. This pattern of continuity was shown in a classic
review of the literature from 1935 to 1978 by Olweus (1979), who found that stability of
aggressive behavior was almost as strong over ten-year periods (0.60) as that of intelligence
(0.70). Quay (1986b) suggested that the pattern of persistence of aggressive behavior is
stronger for males than for females. Whether aggressive and antisocial conduct results in
involvement with the justice system (i.e., reported delinquent and criminal behavior)
seems to be related strongly to whether the child or adolescent has a parent who was
convicted of a crime before the child reached age ten (Farrington, 1978). The long-term
developmental course of Conduct Disorder leads to the conclusion of a poor prognosis:
“Longitudinal studies have consistently shown that Conduct Disorder identified in
childhood or adolescence predicts a continued course of social dysfunction, problematic
behavior, and poor school and occupational adjustment” (Kazdin, 1995, p. 69).
There have been substantial research and writing efforts to illuminate what seem to
be two distinct developmental pathways for severe conduct problems, an “early starter”
pathway and a “late starter” pathway (for example, several decades of research on this
issue at the Oregon Social Learning Center are summarized in Patterson & Yoerger, 2002).
In their excellent review of these constructs, McMahon and Estes (1997) noted several key
characteristics that define each pathway. The early-starter pathway is characterized by the
onset of conduct problems in early childhood and by a high degree of continuity of these
problems throughout childhood and into adolescence and adulthood. The late-starter
pathway begins during adolescence rather than early childhood and is less likely to persist
into adulthood. The strongest paths that predict outcomes for late starters include poor
parental monitoring, association with deviant peers, and conflict with parents (Patterson
& Yoerger, 2002). Fewer children are involved in the early-starter pathway than the late-
starter pathway, but the early-onset variety of conduct problems tends to be more overt,
serious, and intractable than the late-starter variety. In fact, early starters (as indicated by
288 s Assessment of Specific Problems, Competencies, and Populations

the presence of several risk factors by fourth grade) have an astonishingly high probability
of being arrested prior to age 14 (14 times higher than their peers who score low on risk
factors) and are likely to exhibit patterns of social maladjustment, occupational problems,
involvement with the justice system, and relationship problems throughout their early
adult life (Patterson & Yorger, 2002).
Although considered to be a less severe disorder than Conduct Disorder, ODD also
seems to have a poor long-term prognosis, primarily because it is considered to be either
a developmental antecedent or developmental parallel to Conduct Disorder. The amount
and intensity of aggressive behavior that develops over time may be a key to understand-
ing the long-term prognosis. The change in development from childhood to adolescence
to adulthood of children who develop and maintain patterns of antisocial behavior
is additive. That is, these children usually “do not change the types of behaviors they
display but instead add the more severe conduct problem behaviors” (Frick, 1998, p. 215).
To sum up our discussion on the long-term implications of conduct problems, it is
important to consider two major findings: (1) Present aggressive behavior is the most
important variable in the prediction of future aggressive and antisocial behavior (Quay,
1986b; Robins, 1966); and (2) although almost all adults with antisocial aggressive behav-
ior exhibited these same patterns as children, many antisocial children do not become
antisocial adults (Frick, 1998; B. Martin & Hoffman, 1990; Robins, 1974). A diagnosis of
Conduct Disorder, although often associated with a poor prognosis for future adjust-
ment, does not mandate such a prognosis, particularly if the onset of symptoms occurs
later rather than in early childhood and involves more covert rather than overt antisocial
behaviors.

METHODS OF ASSESSING EXTERNALIZING PROBLEMS

Each of the major direct and objective assessment methods emphasized in this book can
be used successfully to measure externalizing problems of children and adolescents. In
terms of the state of the art and the utility of each method for day-to-day assessment of
externalizing problems, direct observation and rating scales have received more attention
in the literature. In terms of interview techniques, the behavioral interview with parents
or teachers offers a great deal in the assessment of externalizing problems, and some
structured and semistructured interview schedules have shown promise. Sociometric
techniques have been shown to be extremely strong predictors of externalizing behavior
disorders but may not be implemented as easily in routine assessment designs. Objective
self-report assessment also may be used to evaluate externalizing problems, but it does
seem to be more limited in scope and utility than observation, rating scales, and interviews.
Each of these five methods is discussed in this section.

Behavioral Observation
There is widespread professional agreement that direct behavioral observation is one of
the most useful procedures for assessing externalizing behavior disorders (Alessi, 1988;
Patterson & Forgatch, 1995; Reid et al., 1988). McMahon and Forehand (1988) suggested
that behavioral observation is “the most reliable and valid assessment procedure for
obtaining a functional analysis of conduct disorders in children” (p. 138). Although direct
observation is not without limitations (such as the number of observations needed for
 Assessing Externalizing Problems s 289

reliability, as well as issues of training observers reliably), there is no question that it has
proven useful in assessing externalizing problems.
There are two major reasons that direct behavioral observation is a preferred method
for assessing externalizing problems. The first has to do with the nature of externalizing
disorders. In contrast to internalizing disorders, which often involve highly subjective
perceptions and internal states, externalizing disorders are characterized by overt behav-
ior patterns that are easy to observe, such as excessive motor activity, physical aggression,
and verbal intimidation and opposition. Behavioral observation is an assessment method
that easily measures externalizing target behaviors and is highly objective. The second
reason for preference of direct observation in assessing externalizing disorders has to do
with behavior–environment interactions and the need to identify aspects of the environ-
ment that may be modified usefully in a treatment plan. Similar to internalizing prob-
lems, externalizing behavior problems do not occur in a vacuum; they are elicited and
maintained in a complex interaction between the person, the behavior, and the environ-
ment, as illustrated in Bandura’s (1977, 1978, 1986) notion of reciprocal determinism.
In contrast to internalizing problems, these interactive relationships in externalizing
behavior problems are easier to observe directly. Specific interactions and environmental
variables that may play a role in the development of interventions are relatively easy for
a skilled observer to identify, which is the reason that direct observation is the key method
in conducting functional behavior assessments. Studies suggest, for example, that direct
observation is a preferred method of assessment by most school psychologists and that
practitioners appreciate the ease with which direct observation data can be linked to
effective and targeted intervention practices (Landau & Swerdlik, 2005; Riley-Tillman,
Chafouleas, Briesch, & Eckert, 2008; Shapiro & Heick, 2004).
Chapter 4 includes a detailed discussion of general observation methods and coding
procedures, including examples of systems useful in clinic, home, and school settings
and a description of the process of conducting functional behavior assessments. This
information is not repeated in this chapter. Provided in this section is an example of a
direct observation system that has been used successfully to assess externalizing disorders
in clinic settings. Although home-based observation and school-based observation systems
for externalizing problems have been demonstrated successfully (see Chapter 4 for
examples), our focus is on a clinic-based example in this section because this is a setting
that can be used easily by most clinicians on a daily basis.
Although mental health, pediatric, or school psychology clinics are usually not consid-
ered to be naturalistic settings for conducting observations, these clinic environments can
be effective settings for observing externalizing behavior problems (H. M. Hughes &
Haynes, 1978). Clinic observations are usually analog in nature because they can create
conditions in which behavior can simulate the home setting or the school setting (Hintze
et al., 2000). A major advantage of clinic-based observation is that it is more efficient and
cost-effective and less obtrusive than home-based observations (McMahon & Forehand,
1988).

The Dyadic Parent–Child Interaction Coding System (DPICS) An example of an excellent

clinic-based observation system is Eyberg and Robinson’s (1983) Dyadic Parent–Child
Interaction Coding System (DPICS), a coding procedure developed more than three
decades ago that has proved to be a highly reliable and valid method for assessment of
externalizing problem behaviors of children, and that is still in wide use. Now in its fourth
290 s Assessment of Specific Problems, Competencies, and Populations

edition, DPICS is particularly interesting in that it goes beyond simply focusing on child
behavior problems and assesses these behaviors in the context of parental interactions in
the parent–child dyad (Eyberg, Chase, Fernandez, & Nelson, 2014). The DPICS requires
observation of the parent–child dyad in three different situations in the clinic: a free-play
situation (child-directed interaction), a situation in which the parent guides the child’s
activity (parent-directed interaction), and a situation referred to as clean-up, in which the
parent attempts to get the child to clean up the toys in a playroom. The observations occur
for five minutes in each of the three settings using a continuous frequency recording
system, for a total of 15 minutes of direct behavioral observation. Parent behaviors are
coded along 12 domains, including direct and indirect statements, descriptive and
reflective statements, descriptive and reflective questions, acknowledgment, irrelevant
verbalization, unlabeled and labeled praise, positive and negative physical interactions,
and critical statements. Child behaviors are coded along seven different domains, including
cry, yell, whine, smart talk, destructive, physical negative, and change activity. The authors
of the DPICS (Robinson & Eyberg, 1981) also developed composite behavioral coding
variables (total praise, total deviant, total commands, command ratio, no opportunity
ratio, compliance ratio, and noncompliance ratio), which consist of specific combinations
of individual coding domains.
Results of several studies have shown the DPICS to have solid psychometric properties.
The inter-rater reliability of the DPICS has been found to range from 0.65 to 1.00
(Aragona & Eyberg, 1981; Eyberg & Matarazzo, 1980), with mean reliability coefficients
of 0.91 and 0.92 for parent and child behaviors in the standardization study (Robinson
& Eyberg, 1981). Although the DPICS has been used primarily in clinic-based observations,
one investigation (Zangwill & Kniskern, 1982) found overall cross-setting interobserver
agreement of 0.68 and 0.69 between home and clinic observations.
In terms of validity evidence, Robinson and Eyberg (1981) showed that the DPICS
can discriminate accurately between groups of children with conduct disorders from their
siblings and from normal children and that it has a high correct classification rate for
each of these child groups and their families. This finding has been replicated through
other studies (Forster, Eyberg, & Burns, 1990). Additional studies have shown the DPICS
to be sensitive to treatment effects (Eyberg & Matarazzo, 1980; Webster-Stratton, 1984).
It appears to be relatively easy to implement with trained observers and to provide assess-
ment data that are not only descriptive of problems, but also can be used to construct
treatment plans.
The DPICS is just one example of a clinic-based coding procedure that has proved
useful in assessing externalizing problems. Many other clinic-based systems that have been
validated empirically for assessing externalizing disorders have been reported in the
literature. More information about the comprehensive manual for the DPICS, updated in
2000, 2005, and 2014, is currently available online at www.pcit.org/measures.
One of the main advantages of behavioral observation is that the methodology is
flexible and tailored easily to the specific assessment problem in question. Observational
coding systems that have been well researched offer certain advantages, but clinicians
and researchers who understand the dynamics of observational assessment are able to
develop systems that are uniquely suitable for the settings in which they are working.
If the referred child or adolescent client is reported to exhibit serious behavioral problems
at school and at home, it may be necessary to observe directly in the classroom, using an
observation system similar to the school-based examples that we looked at in Chapter 4.
 Assessing Externalizing Problems s 291

As McMahon and Forehand (1988) have suggested, the therapist usually does not have
the option of observing teacher–child interactions in the clinic, and naturalistic
observation in the classroom may be warranted. If the problem behavior is related to a
school-based referral, direct observation in the classroom should be a high priority, if not
an essential part of the assessment.

Behavior Rating Scales

Behavior rating scales are potentially one of the most useful methods of assessing exter-
nalizing behavior problems. Because externalizing behavior is often overt and directly
observable, an informant who knows the child or adolescent well may be in a position to
provide a comprehensive rating of a wide variety of problem behaviors. Similar to direct
observation, rating scales can provide relatively objective measurement, yet they are much
less time-intensive to use. As a method of initial screening of problem behaviors and sub-
sequent hypothesis generation, behavior rating scales may be one of the best choices.
Theoretically, there are some important differences between even the best rating scales
and direct observation, and these differences usually indicate the need for using both
types of measures. Rating scales usually provide a retrospective method of assessment,
given that a parent or teacher rates child or adolescent problem behaviors according to his
or her observations and perceptions over a past time period, say, the preceding six months.
Direct observation provides a format for measuring behaviors as they occur over a limited
period. Rating scales seldom provide information on environmental variables relating
to problem behaviors, whereas direct observation over short periods is likely to miss
low-frequency but important behaviors. The multimethod, multisource, multisetting
assessment model that was described in Chapter 1 provides a format for overcoming the
limitations of individual assessment sources and still using their strengths.
For assessment of general externalizing problems or conduct problems, the general-
purpose problem behavior rating scales or systems that were illustrated in Chapter 5 (the
Behavior Assessment System for Children, Third Edition; the Child Behavior Checklist;
the Teacher’s Report Form; the Conners 3; and the Conners Comprehensive Behavior
Rating Scales) are all excellent choices for screening externalizing behavior problems.
These rating scales all have many items and scales specific to the externalizing domain.
The School Social Behavior Scales and Home and Community Social Behavior Scales,
which are discussed in Chapter 13, also may prove useful in assessing certain externalizing
problems. The antisocial behavior scale of these instruments provides a specific format
for measuring aggressive, disruptive, and antisocial behavior, in conjunction with a rating
of social skills from their co-normed social competence scales. The Preschool and
Kindergarten Behavior Scales, Second Edition, which are discussed in Chapter 14, provide
an excellent means for screening externalizing behavior problems with preschool-age and
kindergarten-age children.

Narrow-Band Rating Scales for Attention Deficit Hyperactivity Disorders

Although the four general-purpose behavior rating scales reviewed in Chapter 5 are all
excellent choices for screening and assessing general externalizing behaviors and conduct
problems, they may have some limitations when it comes to assessing ADHD, a specific
narrow-band cluster of the externalizing domain. Although each of these general-
purpose tools provides screening items and scales for assessing ADHD symptoms, it may
be useful or necessary to screen for ADHD characteristics using a narrow-band scale
292 s Assessment of Specific Problems, Competencies, and Populations

developed specifically for this purpose. Such narrow-band instruments typically include
a greater range of items designed specifically for evaluating ADHD characteristics and
symptoms than would be found on a general-purpose behavior rating scale. This section
includes brief reviews of four such narrow-band instruments that have been developed
specifically for assessing ADHD. These instruments, which are representative of the
several available instruments in this area, include the ADHD Rating Scale-5, Attention
Deficit Disorders Evaluation Scales, ADHD Symptoms Rating Scale, and the Conners
ADHD Scales (Conners 3AI). These four instruments all are parent and teacher rating
scales designed for assessing the behavioral symptoms of ADHD specifically based on
the DSM-IV or DSM-5 diagnostic criteria. As such, they include certain advantages over
general-purpose behavior rating scales when assessing ADHD symptoms. Additionally,
another tool that is often associated with assessment of behaviors associated with ADHD
will be reviewed. This is the Behavior Rating Inventory of Executive Functioning, Second
Edition. Any of these instruments may prove to be a valuable addition to an assessment
design in situations in which attention problems, impulsivity, and hyperactivity are a
major focus of concern.

The ADHD Rating Scale-5 (ADHD-5) The brief (18-item) ADHD Rating Scale-5
(ADHD-5) (DuPaul, Power, Anastopoulos, & Reid, 2016) is designed for use by parents
and teachers for diagnosing ADHD symptoms and assessing treatment response in
children aged five to 18. Measures are available in both English and Spanish, and the
18 items are linked specifically to the DSM-5 symptom descriptors and are based on
the classification system organization of ADHD symptoms into the Inattention and
Hyperactivity–Impulsivity domains (nine items each). This two-domain structure of the
ADHD-5 is also empirically validated based on factor analytic research. To be consistent
with changes to ADHD diagnostic criteria in the DSM-5, authors updated this measure
in two primary ways. First, they created two slightly different, developmentally appropri-
ate forms: one for children and another for adolescents. Second, they added questions
to help reflect the level of impairment symptoms cause in a child/adolescent’s life (e.g.,
in getting along with family, completing schoolwork). The items on both forms are rated
using a 4-point scale (“Never or rarely” to “Very often”). The two domain scores and a
total score are converted to percentile ranks based on separate gender and age groupings.
These score conversion tables are based on national norms, with approximately 2,079
well-stratified cases for the parent norms and 1,070 for the teacher norms represented in
the national standardization sample.
Psychometric evidence is presented in the ADHD-5 manual and in separate published
studies (DuPaul & Stoner, 2015). The scale has been shown to have strong internal
consistency reliability (0.89 to 0.95) and test–retest reliability (0.61 to 0.93) at six-week
intervals for the symptom items and strong test–retest reliability for the impairment
items (0.62 to 0.92). Inter-rater agreement between parents and teachers has been shown
to range from 0.01 to 0.77 for symptom items and –0.06 to 0.77 for impairment items,
which is in the expected range for cross-informant reliability across settings. Evidence of
convergent and discriminant construct validity for the ADHD-5 includes correlational
comparisons with other behavior rating scales and comparisons with direct observations
of student behavior in classroom settings. The scale also has been shown to discriminate
effectively between children with and without ADHD, and to show sensitivity to treatment
effects of children with ADHD who receive stimulant medication.
 Assessing Externalizing Problems s 293

The ADHD-5 offers many advantages, is easy to use, and is psychometrically sound.
The brief 18-item format might be considered a disadvantage (i.e., not providing as much
evaluation depth as scales with larger item pools), but the brevity is advantageous in some
situations, such as when used for tracking treatment progress and for conducting initial
screening when a more in-depth assessment is not possible.

The Attention Deficit Disorders Evaluation Scales (ADDES-4) The Attention Deficit
Disorders Evaluation Scales–Fourth Edition (ADDES-4) (McCarney & Arthaud, 2013)
include a set of instruments designed specifically for measuring the behavioral character-
istics of ADHD in children and adolescents aged four to 18, and for making program
planning and intervention decisions. The scales originally were published in 1989, with a
second edition published in 1995 to reflect changes in the scales based on the changes in
ADHD diagnostic criteria from the DSM-IV. The fourth edition reflects changes within
the DSM-5.
Two versions of the ADDES-4 are available: (1) a 46-item home version designed to be
completed by parents; and (2) a 60-item school version designed to be completed by
teachers and other school-based professionals. The items of the ADDES-4 are descriptions
of a variety of behaviors reflecting inattentiveness and hyperactivity–impulsivity. The
items are divided into two sections and scales consistent with this DSM-5 symptom area
breakdown. The items are rated using a unique 5-point scale in which each rating point is
anchored to a specific time element under which the behaviors may occur (0 = “does not
engage in the behavior,” 1 = “one to several times per month,” 2 = “one to several times per
week,” 3 = “one to several times per day,” and 4 = “one to several times per hour”). Raw
scores are converted to standard scores (with a range of 0–20 and representing a mean of
10 and standard deviation of 3) and percentile ranks based on the two subscale breakdowns
and a total score. These scores are keyed to three different diagnostic levels (normal score,
some problems, and serious problems), based on standard deviation units from the
normative population. These scales are easily hand-scored, but a computer-assisted scoring
problem is also available, as is a Spanish-language version for home or parent raters.
The technical manuals for the home and school versions of the ADDES-4 provide a
variety of information on the technical properties of each instrument. All versions of the
ADDES were normed on large nationwide population samples. The ADDES-4 School
Version was normed on 3,356 students. The stability of the ADDES across time, settings,
and raters seems to be good. Test–retest reliability at 30-day intervals has been measured
in the low 0.90 range for the total scores, with ranges from the upper 0.80s to mid-0.90s for
the subscales. Reported inter-rater reliabilities and internal consistentcy of the ADDES-4
forms and its predecessors are very high. The factor/subscale structure of the instruments
is very consistent with the DSM-5 symptom area breakdown of ADHD. Diagnostic validity
data gathered during the standardization of the ADDES show that each version of the
instrument can discriminate between groups of children who have been diagnosed as
having ADHD and randomly selected comparison subjects. Strong convergent construct
validity evidence for both versions has been found with a variety of other ADHD and
problem behavior rating scales.
The ADDES-4 is recommended as a narrow-band behavior rating scale for screening
and assessment of children and adolescents in whom ADHD symptoms are the sole or
primary concern. Parents and teachers likely will find the scales easy to use, and clinicians
likely will find both versions of the ADDES-4 to be practical. The addition of some
294 s Assessment of Specific Problems, Competencies, and Populations

externally published research studies supporting the ADDES-4 would bolster the
confidence with which researchers and clinicians might use these instruments, however,
and would bolster their reputation within the professional community.

The Conners 3 ADHD Index (Conners 3AI) The Conners ADHD Index is part of the third
edition of Conners comprehensive system for behavioral assessment that was overviewed
in Chapter 5 (Conners, 2008a). The ADHD Index includes three forms: Conners 3AI-P
(parent), Conners 3AI-T (teacher), and Conners 3AI-SR (self-report). The forms are
appropriate for children aged six to 18 (eight to 18 for self-report). Each of these forms
includes ten items and can be used as stand-alone behavioral measures. They are particu-
larly useful in determining whether a more extensive evaluation is warranted or to monitor
intervention progress over the course of time. The Conners 3AI is easy to score and, in
addition to T scores, probability scores can be generated. For example, for youth receiving
a probability score of 80% or higher, the likelihood that their behaviors are similar to
those of youth with ADHD is very high. The reliability estimates provided in the manual
suggest excellent internal consistency (0.83 to 0.93) and solid temporal stability (0.79 to
0.93). The Conners 3AI was carefully developed and has proven to discriminate between
children with and without ADHD. It is an excellent tool for assessment situations in which
the referral questions are specific to attentional problems, hyperactivity, or both, and for
which there is no indication of coexisting conduct or affective problems.

The Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) While
not a measure specific to the assessment of ADHD, the Behavior Rating Inventory of
Executive Functioning, Second Edition (BRIEF-2; Gioia, Isquith, Guy, & Kenworthy,
2015) is a tool that was first developed in 2000 and has experienced exponential growth
in terms of its use. This growth mirrors the growth that has been observed in the study
of executive functioning over the last 20 years. Since the development of the original scale
in 2000, there have been over 800 peer-reviewed articles published and approximately
40 clinical trials including the BRIEF, and it has been translated into 60 languages.
The BRIEF-2 includes parent, teacher, and self-report forms, and assesses weaknesses in
executive functioning in children and adolescents (aged five to 18). This tool takes about
ten minutes to complete (approximately 60 items), and there is a 12-item screening tool
that takes approximately five minutes to complete.
Three factors have emerged from analyses, including a Behavior Regulation Index,
Emotional Regulation Index, and Cognitive Regulation Index. Items from the Behavior
Regulation Index reflect an individual’s ability to self-monitor and appropriately inhibit
behavioral responses. Emotion Regulation Index items include one’s ability to transition
between activities easily and handle emotions appropriately. Finally, the Cognitive
Regulation Index includes multiple concepts such as one’s ability to plan, organize, initiate
and monitor tasks. This second edition includes new norms generated from a sample of
over 3,500 children and adolescents. Reliability coefficients range between 0.80 to 0.90 and
the BRIEF-2 is correlated with behavior rating scales such as the CBCL, BASC-2, Conners
3 and IQ measures such as the Weschler Intelligence Scale for Children, Fourth Edition
(WISC-IV) and Weschler Adult Intelligence Scale, Fourth Edition (WAIS-IV).
Overall, the BRIEF-2 is a widely used and well-developed tool that is quickly becoming
the gold standard for measurement of executive functioning skills and abilities of children
and adolescents. While executive functioning, as a construct, is related to a wide range of
 Assessing Externalizing Problems s 295

behaviors, including internalized behaviors like anxiety and depression, I included it here
as children with poor executive functioning skills also often engage in impulsive and
externalized behaviors.

INTERVIEWING TECHNIQUES
Of the interviewing techniques discussed in Chapter 6, the behavioral interview appears
to be a particularly appropriate approach for assessing externalizing problems. Although
traditional (i.e., unstructured) interviewing techniques may be useful in obtaining a
general appraisal of the cognitive and affective status of the client or informant, they are
not as likely to result in a clear picture of the specific problems that are occurring. Given
that child and adolescent conduct problems tend to be conceptualized in terms of inter-
action with others (McMahon & Forehand, 1988), the behavioral interview should
include input from parents and input from teachers if the conduct problems are present
in the school setting. The characteristics of externalizing disorders may make conducting
an effective interview directly with the child or adolescent client difficult. For conduct
disorders, characteristic problems such as lying, defiance of authority, and oppositional
behavior may result in the child or adolescent client providing information that is suspect.
Children or adolescents with ADHD may not show such overt defiance to the interviewer
but still may provide poor-quality data because of typical difficulties in concentration,
self-awareness, and behavioral self-control. Behavioral interviews with parents and
teachers are an important first step in assessing externalizing disorders.
Whether the externalizing problems in question involve conduct disorders, ADHD,
or some combination thereof, the effectiveness of the behavioral interview is enhanced
greatly by the specificity of questions. For assessing ADHD, DuPaul (1992) and DuPaul
and Stoner (1994, 2003, 2015) suggested using a semistructured behavioral interview
format in which teachers and parents are asked questions pertaining to the presence or
absence and intensity of symptoms from the DSM criteria. Such an interview format is
simple, yet potentially effective in ruling in or out various diagnostic criteria. An example
of this type of interview was provided by Forehand and McMahon (1981), who described
the use of the Problem Guidesheet, a semistructured format for conducting behavioral
interviews to assess child conduct problems. This interview format, which is shown in
modified format in Figure 10.1, assists the clinician in structuring questions so that
specific information on the frequency, duration, and parent or child responses to the
problem behaviors can be obtained. The Problem Guidesheet also provides a format
for asking questions about problem behaviors in specific settings and at specific times
(e.g., mealtime, public places). This tool is not intended to be a standardized interview
instrument but simply a format to help clinicians structure behavioral interviews so that
effective information about conduct problems can be obtained.
In terms of using standardized structured and semistructured interview schedules to
assess externalizing problems, the instruments that were overviewed in Chapter 6 may be
useful. These instruments were designed to assess a broad range of child disorders along
the lines of DSM criteria and are not specifically designed for assessing externalizing
problems. Conduct Disorder, ODD, and ADHD are all mainstay childhood disorders in
the DSM-III-R, DSM-IV/DSM-IV-TR, and DSM-5 and various characteristics of these
disorders are covered within the K-SADS and SCICA.
296 s Assessment of Specific Problems, Competencies, and Populations

Name of Child: Interviewer:

Name of Interviewee(s): Date of Interview:
Settina. Parent Child
Description Frequencv ResDonse
Time ResDonse ResDonse

At bedtime

At mealtime

At bath time

With parent
on the phone

With visitors
at home

When
visiting
others

Traveling
in the car

In public
places

At school

With
siblings

With peers

With other
parent!
relative

Disciplinary
procedures

Other

Figure 10.1 Forehand and McMahon’s (1981) Problem Guidesheet, a tool for conducting behavioral interviews to assess child
conduct problems
Source: Reprinted with permission.

The National Institute of Mental Health Diagnostic Interview Schedule for Children
(Fisher, Wicks, Shaffer, Piacentini, & Lapkin, 1992; Shaffer et al., 2000), currently in its
fourth revision (DISC-IV) is another structured interview schedule that seems to be
highly relevant for assessing externalizing problems. The DISC-IV is an interview schedule
for use with children aged nine to 17 and their parents. This interview schedule originally
 Assessing Externalizing Problems s 297

was designed as a screening instrument for research purposes, but its clinical uses are
currently being refined and investigated. The DISC-IV provides scores in 27 symptom
areas that are outlined according to DSM classification criteria. The child version of the
DISC-IV has more than 200 items and requires 40 to 60 minutes to administer, whereas
the parent version includes more than 300 items and takes 60 to 70 minutes to administer.
Both versions are highly structured and include specific codes for each item. The DISC-IV
requires little training to administer and score, although interpretation is a more difficult
task. Edelbrock and Costello (1988) reviewed several studies of previous versions of this
tool and noted that it has strong inter-rater reliability, fair to adequate test–retest reliability,
and modest agreement between parent and child forms. The DISC-IV also has been shown
to have strong concurrent validity with the DICA-R and weaker but still significant
concurrent validity with the parent version of the Child Behavior Checklist (Costello,
Edelbrock, Dulcan, & Kalas, 1984).
A comprehensive user’s manual and computerized diagnostic program are available.
Another innovation has been the development of the computerized Voice DISC, which
was released in 1999. This version allows interviewees to listen to the interview questions
through headphones rather than face to face with an interviewer and to respond to the
questions (which appear simultaneously on a computer screen) by using a computer
keyboard. The computerized Voice DISC does not require a trained interviewer and
relies primarily on the verbal comprehension skills of the adolescent who is being
interviewed. The advantage of this method of administration is that it may elicit more
honest responding from adolescents, who are able to avoid the potential embarrassment
of personally answering a highly sensitive question from an adult they do not know.
Overall, the DISC-IV seems to offer several advantages. It is relatively easy to use, it is
highly structured, and it should be a particularly good choice for assessing adolescents
with externalizing problems.
An additional semistructured interview tool to consider for use in assessing adolescents
aged 12 to 18 with externalizing conduct problems is the Hare Psychopathy Checklist:
Youth Version (PCL:YV) (Forth, Kosson, & Hare, 2003). This instrument was identified
to help assess some of the main markers of “psychopathy” or antisocial traits, including
cheating, fighting, bullying, and other antisocial acts. The PCL:YV uses a semistructured
interview format as well as adjunct information to derive dimensional scores that are
designed to predict the seriousness of problems and their likelihood of continuing into
adulthood. Completion of the PCL:YV interview takes from 1.0 to 1.5 hours, with an
additional hour required for gathering and entering collateral information. This tool was
standardized with interview data from 2,438 youths in three nations. One of the interesting
aspects of the norming sample is that there are data on 19 different samples of adolescents
(e.g., institutionalized offenders, youths on probation, community samples, etc.) which
allow for comparisons of individual scores with very specific group subsets. Raw scores
for the PCL:YV are converted into dimensional scores in the Interpersonal/Affective and
Social Deviance areas. Research data presented in the PCL:YV manual indicate that it has
sound psychometric properties, including internal consistency coefficients ranging from
the mid-0.80s to mid-0.90s across various settings, and sensitivity in differentiating
various subgroups of adolescents with high accuracy. A fair amount of externally
published research on this instrument has been published (e.g., Corrado, Vincent, Hart,
& Cohen, 2004; Poythress, Dembo, Wareham, & Greenbaum, 2006), which provides
additional supporting evidence regarding the construct validity and uses of the PCL:YV.
298 s Assessment of Specific Problems, Competencies, and Populations

This instrument appears to be very well designed and psychometrically sound, and may
be an interesting assessment interview choice for clinicians who work primarily in settings
that serve antisocial and delinquent youths. It will be interesting to see if publishers
continue to offer these measures and also to note if newer versions are made available that
are specifically aligned to the DSM-5.

Sociometric Techniques
In Chapter 7, four types of sociometric assessment techniques were examined in detail,
including peer nomination, peer rating, sociometric ranking, and alternative procedures
such as picture sociometrics, the Class Play, and “guess who” measures. If properly applied,
any one of these sociometric procedures is potentially an excellent choice for screening
and assessing externalizing disorders.
The utility of sociometrics for assessing externalizing problems depends on two things:
(1) the specific design of the sociometric question or task; and (2) the purposes for which
the sociometric assessment will be used. To be most effective in assessing conduct dis-
orders or ADHD, the sociometric tasks need to be structured carefully so that the peer or
teacher informants will make selections based on the most salient behavioral character-
istics. For instance, negative ranking or rating procedures in which participants are
asked to list or rate peers who “fight a lot” will likely be more effective in externalizing
assessment than procedures in which participants are asked to list or rate peers who
“don’t get along with other students.” The latter example could have a great deal of cor-
relation with internalizing problems. Sociometric assessment of externalizing problems
is generally a more useful procedure for screening purposes or research than it is for
individual assessment. Conducting a sociometric procedure as part of an individual
assessment in the classroom of a referred student might provide some useful data on that
student, but the amount of time and intrusiveness involved in doing this rarely would
be warranted.
Because Chapter 7 provided an overview of the specifics of conducting sociometric
assessments, that information is not repeated here. Some examples of studies employing
sociometric procedures to assess externalizing characteristics and outcomes are provided,
however. In their review of studies documenting the predictive validity of sociometrics,
McConnell and Odom (1986) cited several investigations in which sociometric procedures
were employed in the assessment of externalizing problems. One of the most frequently
cited of these studies is a classic longitudinal investigation by Roff et al. (1972) of peer
and teacher ratings of 40,000 children. One of the interesting findings of this classic study
was that children rated least liked by their peers were significantly more likely to appear
on registers of juvenile delinquency than children who were rated most liked by peers.
Other longitudinal studies have found that peer ratings or nominations of classmates as
mean, noisy, or quiet (Victor & Halverson, 1976) and troublesome or dishonest (West &
Farrington, 1973) were significantly related to conduct problems and juvenile delinquency
at a later age. Roff (1961) conducted a prospective study of 164 boys who were referred
to child guidance clinics and later served in the military and found that children whose
records indicated poor peer adjustment were significantly more likely to receive bad-
conduct discharges from military service than children with good peer relations. Other
studies documenting the utility of sociometric procedures in assessing externalizing
problems could be cited, but these four classic studies provide sufficiently strong evidence.
In sum, sociometric assessment procedures have been shown to be highly effective in the
 Assessing Externalizing Problems s 299

assessment of a variety of externalizing conduct problems and are particularly useful for
screening and research purposes.

Self-Report Instruments
As shown in Chapter 11, the use of objective self-report instruments is often the primary
method of choice for assessing internalizing problems. A much different picture of the
usefulness of self-report assessment emerges, however, when it is applied to the measure-
ment of externalizing behavior disorders. There are three measurement problems that
emerge in using self-report tests for assessing antisocial behavior, conduct disorders, and
ADHD. First, externalizing problems usually are assessed best through direct measure-
ment and unbiased reporting by objective observers or informants (McMahon & Estes,
1997; McMahon & Forehand, 1988). Second, children and adolescents with externalizing
disorders may not always be reliable or insightful reporters of their own behavior because
of social perception distortions or because of oppositional defiance to the assessment
process (McMahon & Estes, 1997), which may include efforts to deliberately and con-
sciously distort or falsify information. Third, the nature of most objective self-report tests
requires that a fair amount of inference be used in applying the results to actual behaviors
exhibited, particularly with conduct problems. Although objective self-report tests may
be extremely useful in the assessment of internalizing problems, they present some
substantial challenges in assessing externalizing behavioral problems.
Despite the apparent limitations of using self-report instruments in assessing
externalizing problems, there are times when it is highly desirable to include a suitable
self-report instrument in an assessment battery. For instance, a clinician may want to
gather systematic data on a child or adolescent client’s perceptions of his or her behavior,
or compare the client’s personality profile with that of a normative or clinical group.
Another possible advantage of self-report assessment of adolescents with externalizing
disorders exists with regard to obtaining their own report of covert conduct problems
(e.g., vandalism, theft, drug use) that may not be observed easily by third-party informants
(Kazdin, 1995).
There are a few standardized self-report instruments that are a potentially valuable
addition to the multimethod, multisource, multisetting assessment design for measuring
externalizing disorders. The general-purpose self-report instruments that have been
discussed in previous chapters—Adolescent Psychopathology Scale, child and adolescent
self-report forms of the Behavior Assessment System for Children (BASC-3), Minnesota
Multiphasic Personality Inventory–Adolescent (MMPI-A) and the restructured form
(MMPI-A-RF, the Conners 3, and Conners Comprehensive Behavior Rating Scales
(CBRS), and Youth Self-Report (YSR)—all may be useful to some extent in assessing
externalizing problems and their correlates. Each of these instruments includes subscales
that are associated with externalizing and antisocial behavior problems, such as the
Psychopathic Deviate and Conduct Problems scales of the MMPI-A; the Impulse Control
and Societal Conformity scales of the MMPI; and the Aggressive Behavior, Attention
Problems, and Delinquent Behavior scales of the YSR. The APS and MMPI-A are best
described as measures of personality that may be useful in predicting psychopathology.
The YSR, BASC, and Conners require that adolescents rate their own levels of specified
problem behaviors. Regarding the personality-related measures, it is important to draw
the distinction between assessing information regarding a specific behavior and assessing
response styles that may be associated with those characteristics. For example, many
300 s Assessment of Specific Problems, Competencies, and Populations

investigations have shown that the MMPI-2 and MMPI-A 2-point code type of 4 to 8 or
8 to 4 is a common pattern among individuals who have been incarcerated for severe
antisocial acting-out behavior. Yet the MMPI-A does not assess antisocial and violent
behavior directly; the vast amount of research on the instrument merely has identified
response patterns that are correlated with these behaviors on the basis of group research.
In addition to the general-purpose self-report instruments just described, this section
also provides brief evaluative reviews of another instrument that was designed expressly
or primarily for self-report assessment of youth with externalizing behavior problems.
This includes the Jesness Inventory (JI). This tool is described here. Again, a revision of
this measure could not be found at the time of this publication. It will be interesting
to see if a newer version is developed and aligned to DSM-5. At this time, the JI is still
available for purchase from Multi-Health Systems.

The Jesness Inventory–Revised (JI-R) The Jesness Inventory–revised (JI-R) (Jesness,

2003) is the result of an extensive effort to update and restandardize previous versions
of the scales, which have also been referred to as the Jesness Adolescent Personality
Inventory (Jesness, 1962, 1996). This test originally was developed in the early 1960s and
was based on outcome research with adolescents identified as delinquent in California
(Jesness, 1962, 1963, 1965). The newer JI includes many characteristics of the previous
versions, but has a greatly expanded norm sample and age span. The JI and its predecessors
are among the oldest and most widely used self-report instruments specifically developed
for assessing attitudes of adolescents with conduct disorders and antisocial or delinquent
behaviors.
The revised instrument is a 160-item true/false questionnaire designed to measure
attitudes and personality characteristics associated with antisocial and delinquent
behavior. This tool is designed to be used across youth and adult age spans, and includes
separate subscale norms for the following age groups: eight to 11, 12 to 14, 15 to 17, and
18 to 35. The 160 items yield T scores on nine personality scales, 11 subtype scales,
two DSM-IV scales, and two validity scales. The scale structure of the JI is detailed in
Table 10.5. As with all arbitrarily named test scales, the scales on the JI may not measure
characteristics that a literal interpretation of the scale name might suggest. For example,
the poorly named Autism scale does not measure characteristics of autism. Rather, it is
designed to evaluate distortion of reality or superficial self-enhancement.
Normative data for the revised JI are based on samples of 4,380 individuals aged
eight to 35 from North America, including a sample of 3,421 nondelinquents and
959 delinquents. Reviews of the revised JI (Rhoades, 2005; Yetter, 2005) have noted that
there are no delinquent or antisocial youth under the age of 12 specifically represented
in the sample, and that there are significant differences in the demographics of the
delinquent and nondelinquent samples. Whereas the nondelinquent sample is more than
80% White, the delinquent sample is more than 70% non-White. In addition, the delin-
quent sample was derived primarily from one correctional site and is not geographically
representative of the larger population.
Internal consistency estimates for the JI scales reported in the test manual range
from 0.61 to 0.91, and should be considered as generally adequate to good. Test–retest
reliability of the JI was evaluated with a sample of 131 delinquent individuals at eight- to
12-month intervals, with stability coefficients ranging from 0.35 to 0.67 across personality
scales.
 Assessing Externalizing Problems s 301

Table 10.5 Scale structure of the Jesness Inventory–Revised

Personality Scales
Social Maladjustment
Asocial Index
Withdrawal–Depression
Value Orientation
Manifest Aggression
Immaturity
Social Anxiety
Alienation
Denial
Repression
Autism
Subtype Scales
Unsocialized, Aggressive/Undersocialized Active
Unsocialized, Passive/Undersocialized Active
Immature Conformist/Conformist
Cultural Conformist/Group-Oriented
Manipulator/Pragmatist
Neurotic Acting-Out/Autonomy-Oriented
Neurotic Anxious/Introspective
Situational Emotional Reaction/Inhibited
Cultural Identifier/Adaptive
DSM-IV Scales
Conduct Disorder
Oppositional-Defiant Disorder
Validity Scales
Random Response Scale
Lie Scale

Validity of the revised JI has been documented through studies showing that several
of the scales reliably differentiate between subsamples of offenders and nonoffenders.
In addition, research on previous versions of the JI has provided additional reliability
evidence and has indicated that the instrument has strong convergent validity with other
personality measures, is sensitive to treatment changes, and can reliably differentiate
delinquent from nondelinquent groups (e.g., Jesness & Wedge, 1984; Kahn & McFarland,
1973; G. Roberts, Schmitz, Pinto, & Cain, 1990; Shark & Handel, 1977; Shivrattan, 1988).
The JI can be recommended as an objective self-report test for assessing personality
and attitudes of antisocial children, youth, and young adults, although with some reser-
vations and cautions. The recent revision was a welcome and needed change, and the new
norming sample (despite its geographical, racial, and other limitations) is vastly better
than the previous samples. Perhaps the most important caution to consider is that the
JI was designed to assess attitudes and attributes of antisocial individuals; it does not
actually assess conduct problems. Despite its limitations, the JI is a unique tool with a rich
tradition and research base, and will likely continue to be a valued assessment instrument
for many years.
302 s Assessment of Specific Problems, Competencies, and Populations

LINKING ASSESSMENT TO INTERVENTION

Each of the five general methods for assessing externalizing disorders that I have discussed
in this chapter have their own advantages and limitations, and are useful for various
purposes and situations. When it comes to linking assessment data to interventions for
externalizing problems, however, it is fairly clear that the five methods are not equal.
Direct behavioral observation, particularly observational coding systems that take into
account environmental variables and interactions between the subject and significant
others, is the method that is potentially of most use in developing function-based
hypotheses and intervention plans. Behavioral interviewing with parents and teachers
of the referred child or adolescent client is another assessment method that allows for
collection of the same type of function-based assessment data, albeit in a less direct
fashion.
Behavior rating scales have many advantages and uses in assessing externalizing
problems, but may be less useful than direct observation or behavioral interviews in
generating hypotheses regarding functions of behavior and in designing function-based
behavior supports, despite their psychometric superiority to these more direct methods.
If rating scales completed by different raters in different settings consistently portray
certain behaviors or situations as significant problems, the clinician will have some salient
clues as to what specific behaviors or situations to focus on in the intervention plan. The
Keystone Behavior Strategy (R. O. Nelson & Hayes, 1986) is an intervention selection
strategy for which behavior rating scales may be useful. This strategy is based on the idea
that identification of a group of crucial behaviors or responses linked to a particular
disorder, something that is quite possible with rating scales, leads to the immediate
targeting of those responses as “keystone” behaviors for intervention.
Sociometric assessment of externalizing problems is a highly reliable and valid descrip-
tive method for screening or research, but it offers a much weaker link to intervention
planning. Objective self-report tests also provide a tenuous link to treatment planning for
externalizing disorders, owing to the fact that they assess responding and personality
patterns rather than actual behaviors. There have been some attempts to link MMPI-A
profile types to treatment planning, but these efforts cover only one specific self-report
instrument and are based on actuarial prediction with groups and may not prove to be
useful with all individuals who exhibit particular profiles. In sum, externalizing disorders
by their nature are distinctly suited to the most direct methods of assessment, which
in turn are capable of providing the most useful links to function-based intervention
planning.
It is important to view the idea of linking assessment to intervention for externalizing
behavior disorders within a realistic perspective. The more direct approaches to assessment
(i.e., direct observation, behavioral interviews, behavior rating scales) offer the promise
of linkage to intervention planning. A large body of evidence clearly indicates, however,
that externalizing behavior disorders present many challenges for effective intervention.
Reviews of the treatment literature on antisocial behavior and conduct disorders (Frick,
1998; Kazdin, 1995; McMahon & Estes, 1997; Reid & Eddy, 2002) and ADHD (Hinshaw,
1994; Whalen & Henker, 1998) point to a consensus that although there are several
promising psychological treatments for externalizing disorders, they typically do not
produce extremely large and long-lasting effects because these disorders tend to be
relatively intractable. Treatment of externalizing disorders should be viewed in many cases
 Assessing Externalizing Problems s 303

as more of a long-term management strategy than as a “cure,” and interventionists should

be realistic in understanding that lasting change of significant externalizing problems will
require significant and often resource-intensive approaches.

CONCLUSIONS
The area of externalizing disorders is perhaps the most clearly defined and extensively
researched broad-band domain of child psychopathology. Externalizing disorders, which
typically are thought of as being behavior problems rather than emotional problems
(although the two categories are not exclusive), involve a variety of acting-out, aggressive,
antisocial, disruptive, and overactive behaviors. This domain of behavioral problems has
been referred to as undercontrolled and outer-directed in nature.
The two major approaches to classification of child psychopathology have resulted
in similar, although slightly differing, diagnostic and classification categories, all of which
tend to co-occur with each other in a large percentage of cases. Quay’s behavioral dimen-
sions classification scheme for the externalizing disorders includes three categories:
(1) undersocialized aggressive conduct disorder; (2) socialized aggressive conduct disor-
der; and (3) ADHD. The DSM-5 includes the major diagnostic categories of ADHD,
Conduct Disorder, and ODD. Refinements in the DSM classification system for external-
izing disorders of children have occurred from the two previous editions and likely will
continue as better empirical evidence mounts.
Externalizing disorders often begin early in life, with the developmental antecedents
sometimes present as early as infancy (difficult temperament) and early childhood
(attention-seeking and acting-out behavior). There are many competing theories regard-
ing the etiology of these disorders, ranging from biological to behavioral, but most recent
notions of causality tend to view specific etiological components as risk factors rather
than sole causes. With respect to conduct disorders, earlier development and the presence
of aggressive behavior tend to be associated with a poorer long-term prognosis, whereas
later onset, less aggressive behavior, the presence of good social skills, and higher levels of
intelligence tend to be associated with a better prognosis. With ADHD, the presence
of other externalizing disorders, substance abuse, and antisocial–aggressive behavior
tends to be associated with a poorer long-term prognosis. All forms of externalizing
behavior disorders tend to present substantial challenges for long-term adjustment.
Behavioral observations are one of the hallmark methods for assessing externalizing
problems because they tend to be readily observable and because observation may be
linked more functionally to intervention than some other methods. Behavior rating scales
are another potentially useful method for assessing externalizing problems, for many of
the same reasons as behavioral observation and because of their superior psychometric
properties. Each of the general-purpose behavior rating scales discussed in Chapter 5 is
potentially useful in assessing externalizing problems, as are the externalizing-specific
rating scales discussed in this chapter. Interviewing, particularly behavioral interviewing
and structured interview schedules, is another excellent assessment for externalizing
problems. The advantage of behavioral interviewing for this purpose is that it allows for
identification of possible behavior–environment relationships that may be useful in
treatment planning. Sociometric assessment techniques have a long history of successful
use with externalizing problems but often are impractical to use as part of individual
304 s Assessment of Specific Problems, Competencies, and Populations

assessment; their best uses in this regard tend to be for research and for general screening.
Self-report instruments are probably the most tenuous of the five assessment methods
for externalizing problems, but even this method has some advantages, such as obtaining
self-report of covert conduct problems that may not be readily observed by parents,
teachers, or observers. The general-purpose self-report instruments discussed in Chapter
8 all seem to have some degree of relevance for assessing externalizing problems, as do the
externalizing-specific self-report instruments discussed in this chapter.
Although treatment for externalizing disorders tends to be difficult and is usually more
of a long-term management proposition rather than a short-term “cure,” there are some
promising treatment modalities. Linkage between assessment and effective treatment of
externalizing problems is most direct when using behavioral observation, behavioral
interviewing, and behavior rating scales.

REVIEW AND APPLICATION QUESTIONS

1. What are some possible reasons the externalizing domain of child psychopathology is more
easily defined and well documented than the internalizing domain?
2. Contrast Quay’s behavioral dimensions approach to classifying externalizing disorders with
the DSM approach. Does either approach present any salient advantages for assessment
or treatment planning?
3. In recent years the callous–unemotional subtype or trait among children with externalizing
problems has been identified and researched. What are the major characteristics associated
with this trait, and why are these characteristics particularly troubling?
4. For children with conduct disorders, what characteristics tend to be associated with the
poorest long-term prognosis? What characteristics tend to be associated with a more
favorable long-term prognosis?
5. Substantial research efforts have been directed at identifying specific etiologic factors in
the development of externalizing disorders. Why do you suppose that the current trend is
to view specific possible causes as risk factors rather than as a sole causal explanation?
6. If one were to design an optimal observation coding system for detecting the broad band
of externalizing disorders, what crucial observable behaviors would need to be coded?
7. Contrast the narrow-band behavior rating scales for assessing ADHD discussed in this
chapter with the general-purpose rating scales presented in detail in Chapter 5. Under
what circumstances would an assessment design be enhanced by one of these more
focused instruments?
8. Regarding covert conduct problems, such as vandalism, stealing, drug use, and so forth,
what advantages do interviews and self-report instruments offer over direct observation,
parent or teacher interviews, and behavior rating scales? How much confidence should a
clinician have regarding the truth or accuracy of self-report statements obtained from an
adolescent with serious conduct problems?
9. What are the crucial components needed to link assessment of externalizing problems
most effectively to intervention planning?
 11
ASSESSING INTERNALIZING PROBLEMS

Internalizing problems, which include a broad domain of characteristics or symptoms

related to depression, anxiety, social withdrawal, and somatic complaints, are an intriguing
and sometimes problematic area for assessment. As will be discussed in greater detail
later, internalizing problems can be difficult to detect, and the symptoms of various specific
internalizing disorders often are mingled together. For these reasons, one expert has
referred to internalizing problems in children as secret illnesses (W. M. Reynolds, 1992a).
After carefully reading this chapter, readers will gain a greater understanding of the
complexity and various dimensions of internalizing problems and how various assessment
strategies are used in the investigation, identification, and classification process.
This chapter begins with a discussion of the nature of internalizing problems, including
overviews of each major area of syndrome. This introductory overview is followed
by discussions of the implications of developing internalizing problems and how this
broad band of symptoms is related to self-concept. The chapter then provides detailed
information on direct and objective methods of assessing internalizing problems, using
behavioral observation, rating scales, interview techniques, sociometric approaches,
and self-report tests. A special assessment section also is provided for methods of measur-
ing self-concept. The chapter ends with a brief discussion of the challenges of linking
assessment of internalizing problems to intervention.

INTERNALIZING PROBLEMS: AN OVERVIEW

As indicated in Chapters 3 and 10, efforts at creating sophisticated and empirically
sound taxonomies of child psychopathology (i.e., the behavioral dimensions approach)
have tended to sort general types of behavioral and emotional problems along two broad
dimensions, usually referred to as internalizing (overcontrolled) and externalizing
(undercontrolled) disorders (Cicchetti & Toth, 1991).
The domain of internalizing problems or disorders includes a seemingly broad array
of symptoms, such as dysphoric or depressive mood states, social withdrawal, anxious
and inhibited reactions, and the development of somatic problems (physical symptoms
with no known organic basis). Although these various internalizing conditions at least
superficially may appear to be distinct symptoms, there has long been strong evidence
that they often tend to exist together in a comorbid or co-occurring relationship (Ackerson,
1942; Fish & Shapiro, 1964). There is a large and growing body of evidence that strongly
indicates a great deal of behavioral covariation between the characteristics of mood

305
306 s Assessment of Specific Problems, Competencies, and Populations

disorders, anxiety disorders, and somatic complaints (e.g., Achenbach & McConaughy,
1992; Maser & Cloninger, 1990). The chances may be quite high that a child or adolescent
who presents the obvious symptoms of depression also may experience anxiety, social
inhibition and withdrawal, and physical concerns (Merrell, 2008). It is useful, if not
necessary, to study the assessment of these types of problems together within a common
framework.

Behavioral Dimensions Classification

Consistent with previous discussions of the behavioral dimensions classification approach
(see Chapters 3, 5, and 10), specific areas of internalizing problems have been identified
using multivariate statistical techniques. Quay (1986a) identified the two major dimen-
sions that coincide with internalizing problems as Anxiety–Withdrawal–Dysphoria and
Schizoid–Unresponsive. The major characteristics of these two internalizing behavioral
dimensions are listed in Table 11.1. There is a fair amount of overlap in characteristics
between the two major internalizing domains from this perspective.
Other researchers have described the domains within internalizing problems in a
different manner (e.g., Achenbach, 1982b; Achenbach & McConaughy, 1992; Compas,
1997; Ebmeier, Donaghey, & Steele, 2006), but Quay’s description serves to illustrate the
point of overlapping characteristics within types of internalizing problems.

The DSM Classification

The DSM system includes several general diagnostic categories that fit specifically within
the internalizing domain, such as Depressive Disorders, Anxiety Disorders, Obsessive-
Compulsive and Related Disorders, Trauma- and Stressor-Related Disorders and Somatic
Symptoms and Related Disorders. An overview of the major DSM-5 diagnostic categories
for internalizing disorders is presented in Table 11.2. More details on some of the major
DSM-5 diagnostic categories for internalizing disorders are presented later in this chapter.
The classification categories presented in Table 11.2 do not include the more general
“not otherwise specified” categories, and they do not include several classification
categories that are not primarily internalizing in nature but may have specific internalizing
manifestations, such as Dissociative Disorders, Eating Disorders, Bipolar Disorders,

Table 11.1 Major characteristics of two dimensions of internalizing problems

identified through Quay’s (1986a) Review of Multivariate Classification Studies

Anxiety–Withdrawal–Dysphoria Schizoid–Unresponsive

Anxious, fearful, tense Won’t talk

Shy, timid, bashful Withdrawn
Depressed, sad, disturbed Shy, timid, bashful
Hypersensitive, easily hurt Cold and unresponsive
Feels inferior, worthless Lack of interest
Self-conscious, easily embarrassed Sad
Lacks self-confidence Stares blankly
Easily flustered and confused Confused
Cries frequently Secretive
Aloof Likes to be alone
Worries
 Assessing Internalizing Problems s 307

Table 11.2 Major diagnostic categories of internalizing disorders from DSM-5

Depressive Disorders
Disruptive Mood Dysregulation Disorder Major Depressive Disorder
Persistent Depressive Disorder Premenstrual Dysphoric Disorder
Substance/Medication-Induced Depressive Depressive Disorder Due to Another Medical Condition
Disorder
Other Specified Depressive Disorder Unspecified Depressive Disorder
Anxiety Disorders
Separation Anxiety Disorder Selective Mutism
Specific Phobia Social Anxiety Disorder
Panic Disorder Panic Attack Specifier
Agoraphobia Generalized Anxiety Disorder
Substance/Medication-Induced Anxiety Anxiety Disorder Due to Another Medical Condition
Disorder
Other Specified Anxiety Disorder Unspecified Anxiety Disorder
Obsessive Compulsive and Related Disorders
Obsessive-Compulsive Disorder Body Dysmorphic Disorder
Hoarding Disorder Trichotillomania
Excoriation Substance/Medication-Induced Obsessive Compulsive
and Related Disorder
Substance/-Medication Induced OCD and OCD and Related Disorder Due to
Related Disorder Another Medical Condition
Other Specified OCD and Related Disorder Unspecified OCD and Related Disorder
Trauma- and Stressor-Related Disorders
Reactive Attachment Disorder Disinhibited Social Engagement Disorder
Posttraumatic Stress Disorder Acute Stress Disorder
Adjustment Disorders Other Specified Trauma- and Stressor-Related Disorder
Somatic Symptom and Related Disorders
Somatic Symptom Disorder Illness Anxiety Disorder
Conversion Disorder Psychological Factors Affecting Other Medical Conditions
Factitious Disorder Other Specified Somatic Symptom and Related Disorder
Unspecified Somatic Symptom and Related
Disorder

Schizophrenia and Psychotic Disorders, Neurodevelopmental Disorders, and Tic Disorders.

Many of these other disorders are discussed in Chapter 12. In contrast to the externalizing
disorders discussed in Chapter 10, these DSM-based classification categories for internal-
izing disorders bear little resemblance to the corresponding behavioral dimensions classi-
fication categories discussed previously and presented in Table 11.1. This lack of similarity
among the major classification approaches to internalizing disorders indicates that this
domain is still amorphous or difficult to define precisely to clinicians and researchers.

Prevalence
Prevalence rates for internalizing disorders of children and adolescents have been much
more difficult to ascertain accurately than prevalence estimates for externalizing disorders.
These rates tend to vary considerably from one investigation to another depending on
the particular disorder under investigation and the diagnostic criteria that were used
(Michael & Merrell, 1998). Examples of prevalence rates from epidemiologic studies
average about 4.8% or higher for adolescent depression and 2.5% for childhood depression
308 s Assessment of Specific Problems, Competencies, and Populations

(Beauchaine & Hinshaw, 2013). Prevalence rates for Separation Anxiety Disorder are
about 3.9%, 6.7% for specific phobias, 2.2% for social phobia, and 1.7% for Generalized
Anxiety Disorder in children. For adolescents, the average estimate of overall anxiety
disorders are at 11% with 6.6% for specific phobia, 5.0% for social phobia, 2.3% for
separation anxiety, 1.9% for Generalized Anxiety Disorder, and 1.1% for Panic Disorder
(Beauchaine & Hinshaw, 2013). The DSM-5 provides some general prevalence estimates
for specific internalizing disorders, but these data tell researchers nothing about the
prevalence of such problems in children and adolescents. There are many young people
who are significantly affected by internalizing symptoms, but whose problem character-
istics do not fit neatly into a specific diagnostic category. The DSM system does not have
a category for Childhood Internalizing Disorder. Reviews (e.g., Dopheide, 2006) that
address prevalence estimates do not necessarily clarify the picture, and indicate widely
varying estimates of percentages of children and youth who experience functional
impairment from internalizing problems.
Despite the lack of precision of current prevalence rates for internalizing disorders in
children and adolescents, even the more conservative estimates are cause for concern.
For example, assume that there is a median prevalence rate of about 5% of the general
school-age population that either has a specific internalizing disorder or has significant
enough internalizing symptoms to interfere with their academic and personal adjustment.
This figure would represent an average of one or two children in each class of 30 who are
so afflicted. Perhaps most distressing is the fact that in contrast to children with externalizing
disorders, many of these internalizers are overlooked or not identified as needing help.
Even if effective interventions are available, the lack of detection and attention result in
continued and unnecessary difficulties for many children and adolescents.

Gender Issues in Prevalence

Most prevalence estimates for internalizing problems and disorders indicate that they
occur with greater frequency in girls than in boys, particularly in the case of depression,
and especially following the onset of puberty. These adult gender prevalence patterns seem
to be true for adolescents also, and it seems that “girls show an enhanced susceptibility for
a number of internalizing disorders” (W. M. Reynolds, 1992b, p. 314). Most recent research
suggests that girls and women experience both depression and anxiety twice as often as
males (Beauchaine & Hinshaw, 2013; Maeng & Milad, 2015). Gender characteristics
of internalizing disorders among younger children are much more speculative, however,
with some studies showing no gender difference, some studies showing a higher prevalence
among boys, and some studies showing a higher prevalence among girls (Merrell &
Dobmeyer, 1996). In general, most descriptive studies indicate that internalizing disorders
are more common in girls than in boys after the onset of puberty, but the evidence is still
lacking in some respects, particularly with respect to prepubertal gender differences
(e.g., Merikangas, Cui, & Kattan, 2012; Merrell, 2008; Twenge & Nolen-Hoeksema, 2002;
Zahn-Wexler, Shirtcliff, & Marceau, 2008).

SYMPTOMS OF MAJOR INTERNALIZING DISORDERS: DEPRESSION,

ANXIETY, AND RELATED PROBLEMS
To identify and more clearly define the major subcomponents of internalizing problems,
this section includes brief discussions of symptoms based on a breakdown into three
 Assessing Internalizing Problems s 309

areas: depression, anxiety, and related problems. When using this three-part breakdown of
internalizing problems, it is important to consider that there is more confusion among
researchers over terminology and classification subtypes for internalizing problems than
for externalizing problems (Merrell, 2008; Merrell, Crowley, & Walters, 1997). Any cate-
gorical breakdown in the internalizing domain will have some level of imprecision. This
section follows a hybrid of behavioral dimensions and DSM approaches to categorization.
This discussion of general characteristics of internalizing disorders addresses etiology
and developmental course of specific problems only at a superficial level; a thorough treat-
ment is beyond the scope of this book. Some useful sources for a comprehensive treatment
of various internalizing problems include books or chapters by Barrios and Hartmann
(1997), Beauchaine & Hinshaw (2013), Compas (1997), Lewis and Miller (1990), Mash
and Barkley (2014), Merrell (2008), W. M. Reynolds (1992a), Schwartz, Gladstone, and
Kaslow (1998), and Silverman and Ginsburg (1998).

Depression
To understand better what the target is when assessing depression, some definitions and
distinctions are needed. The term depression may be construed to indicate a broad range
of behaviors, characteristics, and symptoms. This broad and imprecise use of the term
has been a problem in the research literature, resulting in many studies that have used the
same basic terminology to describe differing facets of behavioral and emotional func-
tioning. Cantwell (1990) noted three common uses of the term depression: depression as
a symptom, depression as a syndrome, and depression within the context of a depressive
disorder.

Depression as a Symptom As a symptom, depression involves a dysphoric mood state—

feeling unhappy or sad, being “down in the dumps,” feeling miserable, or feeling melan-
cholic or “blue.” These subjective states are only a smaller part of the syndrome or disorder
of depression. Depressive symptoms are typical across the life span of most persons, are
typically transient, and are usually not part of a depressive disorder or serious problem.
It also is possible that depressive symptoms may exist as part of other disorders. Symptoms
of depression alone usually do not provide the impetus for conducting an assessment of
depression.

Depression as a Syndrome The term syndrome is used to describe something that is more
than a dysphoric mood state. This term usually is understood to describe the coexistence
of behavioral and emotional symptoms that often occur together and are not simply
associated by chance. Cantwell (1990) noted that a depressive syndrome commonly
involves not only mood changes, but also additional changes in psychomotor functioning,
cognitive performance, and motivation. These additional changes usually occur in a
negative direction, reducing the functional capacity of the person who experiences them.
Depression as a syndrome is less common than depression as a symptom. It may be
brought on by certain types of life stress, exist concurrently with various medical problems,
or occur in conjunction with psychological and psychiatric disorders, such as disruptive
behavior disorders, schizophrenia, and anxiety disorders. Depression as a syndrome also
may occur as the primary problem, with no preexisting or co-occurring problems.
Depressive syndromes also may be a part of depressive disorders, such as what the DSM-5
has called Persistent Depressive Disorder (Dysthymia).
310 s Assessment of Specific Problems, Competencies, and Populations

Depression as a Disorder The distinction between depressive syndromes and depressive

disorders is not as clear as the distinction between depressive symptoms and depressive
syndrome. Although depressive syndromes typically are part of depressive disorders,
more is usually implied by the latter term. By saying that a depressive disorder exists, there
is an implication not only that a depressive syndrome exists, but that the syndrome has
occurred for a specified amount of time, has caused a given degree of functional incapacity,
and has a characteristic outcome such as duration and responsiveness to treatment
(Cantwell, 1990). The most common way of referring to depression as a disorder is within
the context of the DSM classification system. As seen in Table 11.2, the DSM-5 has several
general categories for diagnosis of depressive disorders, including three categories for
the diagnosis of depressive disorders. To make a diagnosis of a Major Depressive Episode,
which is the most commonly considered way of looking at depression, at least five out of
nine possible specified symptoms (ranging from a depressed mood to recurrent thoughts
about death) must have occurred within a two-week period, one of which must be
depressed mood or loss of interest or pleasure, in addition to certain exclusionary criteria
being met, as is shown in Table 11.3.
One of the major challenges of using standard criteria such as the DSM system for
diagnosing depressive disorders with children and adolescents is that these systems
may not be equally effective or useful across various age ranges (Carlson & Garber, 1986).

Table 11.3 DSM-5 diagnostic criteria for Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same two-week period and
represent a change from previous functioning; at least one of the symptoms is either (1) depressed
mood or (2) loss of interest or pleasure Note: Do not include symptoms that are clearly attributable
to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective reports (e.g., feels
sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents,
can be irritable mood
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every
day (as indicated by either subjective account or observations made by others)
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body
weight in a month) or decrease or increase in appetite nearly every day. Note: In children, consider
failure to make expected weight gains
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective
feelings of restlessness or being slowed down)
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every
day (not merely self-reproach or guilt about being sick)
8. Diminished ability to think or concentrate or indecisiveness nearly every other day (either by
subjective account or as observed by others)
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific
plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning
C. The episode is not attributable to the physiological effects of a substance or another medical condition.
D. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
Note: Criteria A–C represent a major depressive episode.
 Assessing Internalizing Problems s 311

Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a
serious medical illness or disability) may include the feelings of intense sadness, rumination about the
loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive
episode. Although such symptoms may be understandable or considered appropriate to the loss, the
presence of a major depressive episode in addition to the normal response to a significant loss should
also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on
the individual’s history and the cultural norms for the expression of distress in the context of loss.
E. The occurrence of the major depressive episode is not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified
schizophrenia spectrum and other psychotic disorders.
F. There has never been a manic episode or a hypomanic episode.
Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-
induced or are attributable to the physiological effects of another condition.
Coding and recording procedures
The diagnostic code for major depressive disorder is based on whether this is a single or recurrent
episode, current severity, presence of psychotic features, and remission status. Current severity and
psychotic features are only indicated if full criteria are currently met for a major depressive episode.
Remission specifiers are only indicated if the full criteria are not currently met for a major depressive
episode.
In recording the name of a diagnosis, terms should be listed in the following order: major depressive
disorder, single or recurrent episode, severity/psychotic/remission specifiers, followed by as many of
the following specifiers without codes that apply to the current episode.
Specify:
With anxious distress
With mixed features
With melancholic features
With atypical features
With mood-congruent psychotic features
With catatonia
With peripartum onset
With seasonal pattern
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(Copyright © 2013). American Psychiatric Association.

Assessment of depression as a disorder in children and adolescents requires particular

care, skill, and caution given that particular symptoms may be more frequently observed
in children with depression versus adults (e.g., somatic complaints, irritability, social
withdrawal). Although DSM notes that depression may present differently in children
than in adults, there is still no alternative method of classification for children, and the
DSM system does not typically include any of the internalizing disorders in separate
categories usually first diagnosed in infancy and childhood. One of the new categories
presented in the DSM-5, however, seems to be intended specifically for children as
an alternative to a diagnosis of bipolar disorder or depression (Hammen, Rudolph, &
Abaied, 2014). Disruptive Mood Dysregulation Disorder (DMDD) includes symptoms
that focus on irritability and temper outbursts. In my clinical experience, I think of
these as the children that are often angry and seem uncomfortable in their own skin.
While this disorder has very limited research behind it at this point, it will be interesting
to see how DMDD is differentiated from depression and bipolar disorders in children and
adolescents.
312 s Assessment of Specific Problems, Competencies, and Populations

Causal Factors Given that entire volumes have been devoted to the etiology of depression,
treating these topics in such a short space is highly presumptuous, to say the least. The
purpose of this discussion is simply to provide a brief description of some of the key
findings on causal factors. Reviews of the literature on etiology of childhood depression
by Beck (2008), Compas (1997), S. M. Miller, Birnbaum, and Durbin (1990), and Schwartz
et al. (1998) have articulated some of the crucial psychosocial variables or issues such as
parental influences, life events, and family interaction patterns that are associated with
depression in children. A relationship has been found to exist between what is commonly
referred to as “loss” and childhood depression, with this relationship most readily verified
by studies of parent loss due to death or family separation. Children of parents who are
depressed themselves have been shown to be at heightened risk for developing depression
and other psychological disorders. High rates of parental stress and family conflict also
have been found to be associated with childhood depression. There is some evidence that
negative events that occur outside the family context in the lives of children, such as
school and friendship problems, contribute to depression.
Children who become depressed may develop maladaptive or unhealthy cognitive styles
and concurrent impaired coping skills. The learned helplessness model, first proposed
by Seligman (1974), posits that some forms of depression may occur under learning con-
ditions where the child does not recognize a relationship between his or her actions and
the consequences of these actions. Lewinsohn (1974) proposed a highly influential model
in which he suggested that the disruption of pleasurable and otherwise reinforcing events
may predispose a person to depression, an idea that is worth considering when conducting
a comprehensive child assessment wherein environments and behavioral characteristics
are evaluated.
Additionally, there is strong evidence emerging in the psychobiology literature indi-
cating that some forms of childhood depression are related to biological variables, such
as the interrelated areas of family genetics and brain chemistry (Schwartz et al., 1998).
For example, some research suggests that hyperreactivity of the amygdala can contribute
to differences in how one perceives negative events (Beck, 2008), and that a certain version
of a serotonin transporter gene (5-HTTLPR) can create increased reactivity of cortisol
when an individual is faced with stressful events (Uher & McGuffin, 2010). Another
interesting theory that has become prominent in recent years is the kindling hypothesis,
first proposed by Post (1992). Although this theory is not specific to depression, it has
often been cited as a supportive explanation with biological implications. The essence
of the kindling hypothesis is that repeated or successive shocks or traumas (such as epi-
sodes of depression and antecedents associated with depression) predispose individuals
to more easily develop the problem in the future, precipitated by even a moderate amount
of stress or difficulty. As with small, dry pieces of kindling that have been set to start a fire,
even a small spark may be enough to ignite the flames. It has been posited that repeated
episodes of depression or other disorders might actually create permanent changes
in neural pathways that lead to optimum conditions for easier onset of the problem in
the future.

Anxiety
Anxiety is a class of internalizing responses that may involve subjective feelings (e.g.,
discomfort, fear, dread), overt behaviors (e.g., avoidance, withdrawal), and physiological
responding (e.g., sweating, nausea, general arousal). Anxiety is related closely to two other
 Assessing Internalizing Problems s 313

areas: fears and phobias. Although anxiety, fears, and phobias have a great deal of overlap,
there have been some historical distinctions drawn between these three categories.
Fears have been described as “reactions to perceived threats that involve avoidance of
the threatening stimuli, subjective feelings of discomfort, and physiological changes”
(Barrios & Hartmann, 1988, p. 197). Fears usually are distinguished from anxiety because
the former involves distinctive reactions to specific stimuli (e.g., darkness or noise),
whereas the latter tends to involve a more diffuse type of reaction (apprehension) to
stimuli that are not as specific in nature. Phobias are similar to fears in that they involve
intense reactions to specific stimuli but are differentiated from fears in the sense that they
are more persistent, maladaptive, and debilitating (Barrios & Hartmann, 1988, 1997;
Morris & Kratochwill, 1983). Because the focus of this section is a general discussion of
the subject, anxiety is the topic of this overview, rather than the more specific categories
of fears and phobias.
The topic of anxiety in children has often been overlooked. Particularly in view of
evidence that a significant portion of child clients at mental health clinics are treated
for anxiety disorders (S. M. Miller, Boyer, & Rodoletz, 1990) and that childhood anxiety
may be predictive of adult psychopathology (Bowlby, 1973), the topic deserves attention.
One of the reasons that anxiety in children may be overlooked is the belief that it is
common and transient (Wolfson, Fields, & Rose, 1987). In reality, many anxiety problems
experienced by children are quite stable, with the combined literature indicating that
20% to 30% of anxiety disorders diagnosed during childhood show strong stability over
intervals of two to five years (Silverman & Ginsburg, 1998).
With the publication of the DSM-IV in 1994, significant changes were made in the
DSM classification criteria for anxiety disorders in children and adolescents. Perhaps
the most significant of these changes was the elimination of the DSM-III and DSM-III-R
broad diagnostic category Anxiety Disorders of Childhood and Adolescence. From this
former diagnostic category, Overanxious Disorder was incorporated into the adult
General Anxiety Disorder, and Avoidant Disorder was removed. The only childhood-
specific anxiety disorder that remained from DSM-III-R was Separation Anxiety Disorder,
but this category also was reclassified under another broad category, Other Disorders
of Childhood and Adolescence. It is unclear what prompted the changes between
DSM-III-R and DSM-IV with regard to child and adolescent anxiety disorders, but
these changes may have some unintended effects. Silverman and Ginsburg (1998) noted
that although research regarding anxiety in youth historically has lagged behind
comparable research with adults, “research interest in anxiety in youth burgeoned with
the establishment of the broad diagnostic category, Anxiety Disorder of Childhood and
Adolescence” (in DSM-III and DSM-III-R) (p. 239). Although it is still too early to tell,
it would be unfortunate if the elimination of youth-specific diagnostic categories for
anxiety disorders in the DSM resulted in less research in the area. The DSM-5 general and
specific categories of anxiety disorders, all of which may potentially pertain to children
and adolescents, are outlined in Table 11.2. Few changes were made in this area from the
previous edition.
The current DSM classification categories for anxiety disorders, as shown in Table 11.2,
are extensive and broad, yet also specific and narrow in some cases. Clinicians who
work extensively with young children probably would use the diagnostic category of
Separation Anxiety Disorder at least occasionally, and clinicians working with children
and adolescents of various ages undoubtedly occasionally would encounter a specific type
314 s Assessment of Specific Problems, Competencies, and Populations

Table 11.4 Diagnostic criteria for Generalized Anxiety Disorder from the DSM-5

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least
six months, about a number of events or activities (such as work or school performance).
B. The person finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least
some symptoms present for more days than not for the past six months).
Note: Only one item is required in children.
1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling asleep or staying asleep, or restless unsatisfying sleep)
D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
E. The disturbance is not attributable to the direct physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition (e.g., hyperthyroidism).
F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about
having panic attacks in panic disorder, negative evaluation in social anxiety disorder (social phobia),
contamination or other obsessions in obsessive–compulsive disorder, separation from attachment
figures in separation anxiety disorder, reminders of traumatic events in posstraumatic stress disorder,
gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived
appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder,
or the content of delusional beliefs in schizophrenia or delusional disorder).
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(Copyright © 2013). American Psychiatric Association.

of anxiety disorder. Realistically, however, most clinicians who work with anxious children
and adolescents probably would classify most cases of anxiety under the more general
category of Generalized Anxiety Disorder, which is presented in Table 11.4.

Causal Factors Although a fair amount of effort has been devoted to exploring the etio-
logy of depression, comparatively little has been done in this area related to the develop-
ment of anxiety, particularly in relation to children. One of the problems in making a
few general statements about the causes of anxiety in children is that they have been
viewed differently by professionals from differing theoretical orientations, such as psycho-
analytic, behavioral, and cognitive perspectives (S. M. Miller, Boyer, & Rodoletz, 1990).
A review of etiologic perspectives by Silverman and Ginsburg (1998) divided the major
areas of etiologic research into genetic biology, neurobiology, psychosocial, psycho-
analytic, behavioral, cognitive, family, and peer influence and indicated that with the
exception of psychoanalytic, there is at least a small body of empirical evidence to support
each perspective.
While more empirical work has recently been devoted to the causes of anxiety in
children, perhaps the most appropriate statement about causation is old, but is one that
is compatible with the overall perspective of this book, is that “the child’s temperamental
characteristics, in combination with early socialization experiences and the nature of
the current . . . environment, probably account for the development (of anxiety-related
problems)” (Kauffman, 1989, p. 334).
 Assessing Internalizing Problems s 315

Related Internalizing Disorders

In addition to the characteristics of depression and anxiety, the broader category of
internalizing disorders includes many other associated behavioral, social, and emotional
problems. This section discusses some of the more prominent of these associated problems.

Social Withdrawal One of the major correlates of depression and anxiety is social with-
drawal or isolation. As Kauffman (2000) has noted, social isolation can result from
either behavioral excesses (e.g., aggression or hyperactivity) or behavioral deficits. The
category of behavioral deficits is linked most closely with internalizing disorders.
Children who are socially isolated or withdrawn because of behavioral deficits tend to
lack responsiveness to the social initiations of others—in other words, they lack the spe-
cific social skills to make and keep friends. Often a severe lack of social skills is accompa-
nied by immature or socially inadequate behavior that compounds the problem further
by making the child an easy target of ridicule (Kauffman, 2000). Internalizing social
withdrawal and isolation seems to be related not only to exposure to incompetent adult
social models, but also to a temperamental characteristic referred to by Kagan, Reznick,
and Snidman (1990) as behavioral inhibition to the unfamiliar. When present, this char-
acteristic seems to emerge in infants at about age eight months and leads to a tendency
to become inhibited or withdrawn when presented with unfamiliar stimuli. There may
be biological contributions to this temperamental characteristic, but it probably interacts
with behavior and environment in a complex manner to result in characteristic social
withdrawal.

Somatic Problems Another common correlate of internalizing disorders is a broad range

of physical symptoms and problems that collectively are referred to as somatic complaints.
There is a strong probability that persons who experience significant depression or anxiety
have concurrent physical symptoms. These somatic symptoms associated with inter-
nalizing characteristics presumably are based on a psychological origin, although physical
infections or injuries may cause similar symptoms. The Child Behavior Checklist and
Youth Self-Report of Achenbach’s ASEBA system include several items that reflect somatic
complaints and that are within the internalizing broadband scale, including “feels dizzy,”
“overtired,” and “physical problems without known medical cause.” This last item has
seven possible specifications, including aches and pains, headaches, nausea, problems with
eyes, rashes or other skin problems, stomachaches or cramps, and vomiting. Any or all of
these physical symptoms may be reported by children who are experiencing depressive,
anxious, or withdrawn symptoms. The congruence of somatic complaints and anxious–
depressed–withdrawn characteristics in psychological assessment even predates the use of
factor analytic assessment techniques.
The first three of the MMPI-A clinical scales (formally referred to as Hypochondriasis,
Depression, and Hysteria), sometimes referred to as the Neurotic Triad, all contain items
relating to physical complaints and statements about depressive, anxious, and withdrawn
symptoms. First developed in the 1940s using empirical criterion keying procedures, these
three scales have been shown to differentiate reliably among different psychiatric groups
in numerous studies.
An additional health issue to consider within the context of internalizing disorders is
that of obesity. It is well known that obesity rates among Americans have soared during
the past three decades, and that childhood and adolescence are by no means exempt from
316 s Assessment of Specific Problems, Competencies, and Populations

obesity or from problems associated with being overweight. Although much has been
written in the scientific and popular media regarding physical health problems associated
with obesity or overweight in children, social–emotional and psychological problems are
also a significant concern. Some of these problems—such as a lessened overall quality
of life and increased absences from school—are not necessarily thought of as internalizing
problems, but there is often a clear pattern of increased depression that goes along
with this pathway. For example, a widely cited study by Mustillo and colleagues (2003)
published in the journal Pediatrics found that depression was a significant correlate of
obesity among a large cohort of boys that were studied longitudinally for more than eight
years. Given that anxiety and other internalizing problems are associated with depression,
it seems likely that children who are overweight may be at increased risk for these concerns
as well. Although the exact nature of the relationship between obesity and internalizing
problems is not yet fully understood, it is clear that there is a link.

Fears and Phobias Fears and phobias, a more specific group of characteristics that relate
to anxiety, were briefly touched on earlier. What is commonly referred to as school phobia
deserves some additional discussion, however, because it is a set of problems commonly
encountered by mental health professionals who work with children and adolescents.
The DSM-5 does not have a separate diagnostic classification for school phobia but
considers it one of the nine key features of Separation Anxiety Disorder. Traditional
thinking considers that fears of, and subsequent refusal to attend, school are internalizing
problems that relate to a child’s inner state of anxiety. More recently, this traditional
anxiety-based view of school phobia has come under criticism, and the problem has
been reconceptualized as school refusal, a broader term that indicates the possible
heterogeneity of symptoms. Pilkington and Piersel (1991) conducted a comprehensive
review of the literature on school phobia and criticized the separation anxiety-based
theory on three grounds: (1) methodological problems of the research; (2) lack of gener-
alizability concerning pathological mother–child relationships; and (3) lack of emphasis
on possible external or ecological variables. With respect to this third criticism, an alter-
native conceptualization of school phobia has been presented, in which many cases of
refusal to attend school can be explained as “a normal avoidance reaction to a hostile
environment” (Pilkington & Piersel, 1991, p. 290). Realistically, avoidance of or refusal
to attend school probably includes a more heterogeneous group of conditions than once
was thought, and anxiety problems and avoidant behavioral reactions are both likely
explanations. What is often seen in clinical practice is that school refusal co-occurs with
an emerging or pre-existing generalized anxiety disorder or separation anxiety disorder,
or it is a manifestation from stressful environmental factors, such as bullying or school
performance anxiety. The implication of this conceptualization of school phobia is that
clinicians should consider assessing the school environment and child characteristics
when refusal to attend school is a presenting problem. This implication is compatible
with the transactional–interactional model within social learning theory and may indi-
cate that the refusal to attend school may be explained by an interaction of parent and
child characteristics, coupled with environmental and behavioral conditions at school.

Other Problems There are a few additional conditions that often are part of the larger
internalizing syndrome. Obsessive thought processes and compulsive behavioral rituals
are related closely to the anxiety disorders, but in DSM-5, Obsessive–Compulsive Disorder
 Assessing Internalizing Problems s 317

is now included in a diagnostic category under the broad category of Obsessive–Compulsive

and Related Disorders rather than Anxiety Disorders. Various forms of eating disorders,
including anorexia nervosa, bulimia, pica, and rumination disorders, also appear to be
related to the broad internalizing syndrome (Kauffman, 2000). Some stereotypical
movement disorders, such as motor tics, also may co-occur with internalizing problems,
although tic disorders are widely conceptualized as a neurological phenomenon. Finally,
elimination disorders (enuresis and encopresis) may occur with other internalizing
problems, although there also are many physiological causes for these problems. Some of
these problems are discussed in more detail in Chapter 12.

Implications of Internalizing Disorders

There has been some disagreement in the developmental psychopathology literature as
to the potential long-term consequences of internalizing disorders, and more research in
this area is needed. At present, there seems to be general agreement in the field that
serious internalizing symptoms of childhood are not brief and transient and may persist
for long periods, perhaps two to five years (Merrell, 2008; Quay & Werry, 1986; Silverman
& Ginsburg, 1998). In terms of the persistence of these characteristics into adulthood,
there is much less agreement. Quay and Werry (1986) stated that symptoms of anxiety–
withdrawal “do not have the rather foreboding prognosis that is associated with
undersocialized conduct disorders” (p. 101) and cited Robins’ (1966) long-term follow-up
research of children with neuroses as an example that internalizing symptoms during
childhood may not predict accurately the presence of internalizing problems during
adulthood. Other researchers have found evidence, however, for a less optimistic prognosis
for children with internalizing disorders. Social withdrawal and inadequate levels of
social competence have been found to be associated with many later negative outcomes,
although the evidence to date suggests that the prognosis is worse for aggressive than
nonaggressive socially withdrawn children (Kauffman, 2000; Pullatz & Dunn, 1990).
When childhood depression is the internalizing disorder of interest, there seems to be
stronger evidence for persistence across the life span, particularly in the case of adolescent
depression (Cantwell, 1990; McLaughlin & King, 2015). There may be some hope that the
existence of internalizing disorders during childhood does not hold as poor a prognosis
as do externalizing disorders, but nevertheless there is evidence to suggest the potential
for negative outcomes later in life (Barrios & Hartmann, 1997; W. M. Reynolds, 1992b).

POSITIVE AND NEGATIVE AFFECTIVITY: A MODEL FOR

UNDERSTANDING INTERNALIZING PROBLEMS
An interesting development in the 1980s and 1990s regarding the understanding of inter-
nalizing disorders is the research that has been conducted on cognitive and mood states of
these disorders. The constructs of positive and negative affectivity (or affect) involve the
positive or negative presentations of various mood symptoms. This conceptualization
of affectivity is not considered to be a specific dimension of internalizing disorders, but it
is considered to be an important characteristic that may help differentiate among various
types of internalizing disorders. D. Watson and Tellegen (1985) originally proposed this
two-dimensional model of affect in an attempt to discriminate empirically between
depression and anxiety. Positive affect has been defined as “the extent to which a person
318 s Assessment of Specific Problems, Competencies, and Populations

avows a zest for life” (D. Watson & Tellegen, 1985, p. 221) and is reflected by such descrip-
tors as active, alert, energetic, enthusiastic, interested, joyful, and determined. Conversely,
descriptors such as drowsy, dull, fatigued, lethargic, and sluggish reflect low levels of positive
affect. In contrast, negative affect has been defined as “the extent to which a person reports
feeling upset or unpleasantly aroused” (p. 221). The terms distressed, fearful, hostile, and
nervous reflect high levels of negative affect, whereas adjectives such as calm, placid, and
relaxed reflect low levels of negative affect.
In various studies on expressions of affectivity with internalizing disorders (e.g.,
Blumberg & Izard, 1986; Carey, Finch, & Carey, 1991; Jolly, Dyck, Kramer, & Wherry,
1994; Mikolajewski, Allan, Hart, Lonigan, & Taylor, 2013; Stark, Kaslow, & Laurent,
1993; Tellegen, 1986; D. Watson, 1988; D. Watson & Clark, 1984), a general consensus
has emerged, notwithstanding the fact that there have been some minor differences
among findings. In general, it is understood that measures of depression and anxiety tap
negative affectivity. Persons who report high symptoms of either depression or anxiety
are reporting high levels of negative affect. There also seems to be a general consensus,
however, that individuals with high levels of depressive symptoms are likely also to be
low in positive affect, whereas individuals with high levels of anxiety but no depression
are not necessarily low in positive affect. In cases in which anxiety and depression
can be differentiated, it may be that the presence or absence of positive affect is a key
distinguishing feature.
Although there is still much that is not understood regarding the role of affectivity in
child emotional and behavioral disorders, it seems to be an important element, particularly
with respect to the internalizing domain. Although including dimensions of affectivity
within clinical assessment and diagnostic practices is an endeavor that is still experimental,
future developments in this area may prove to be essential to furthering assessment and
intervention practices with children and adolescents who exhibit internalizing problems.
For example, recent work related to affectivity has included examination of emotion
regulation and, specifically, use of the strategies labeled reappraisal and suppression.
Hughes, Gullone, and Watson (2011) found that children and adolescents with significant
symptoms of depression were less likely to “reappraise” a situation and think or feel more
optimistically, and were more likely to “suppress” or hide depressive feelings that they were
experiencing. Research related to intervention processes that aim to boost positive affect
and healthy emotion regulation will likely be incredibly helpful.

INTERNALIZING PROBLEMS AND SELF-CONCEPT

Because internalizing problems sometimes have been thought of as being self-related or
inner directed, a psychological construct that is particularly relevant to this discussion is
self-concept. The constructs of depression and self-concept have been linked clearly in
the professional literature because diminished self-esteem is often a prominent feature
of depression (Kazdin, 1988), particular styles of self-esteem beliefs are likely to increase
substantially the risk of depression (Hammen, 1995), and irrational beliefs regarding
self-worth often constitute a clear target for cognitive treatment of depression (Merrell,
2008; Swallow & Segal, 1995). Although less is known regarding specific links between
other variations of internalizing problems (e.g., anxiety, social withdrawal, and somatic
problems) and self-concept, it is logical to assume that self-concept and internalizing
 Assessing Internalizing Problems s 319

symptoms in general may be negatively associated, given the strong overlap among various
internalizing symptoms and disorders.
In considering the connection between self-concept and internalizing symptoms, it is
important to understand that the association is well established and is moderately strong.
The directionality of this relationship is less clear, however. In other words, although it
is known that self-concept is negatively associated with internalizing symptoms, it is not
entirely clear whether there is a causal relationship. Does poor self-concept cause depres-
sion? Does depression cause poor self-concept? Or, do the two constructs coexist in some
kind of symbiotic relationship? Answers to these questions are sparse and tentative.
There have been a few attempts to understand the directionality of this relationship. For
example, Sowislo and Orth (2013) conducted a meta-analysis of 77 studies including
participants with depression, and found that self-esteem more strongly predicted depres-
sion than the other way around. Although one could argue convincingly that poor
self-concept is a risk factor for developing depression or other internalizing problems,
it is still also possible that depression causes low self-esteem. Martin Seligman (1998), a
former past president of the American Psychological Association, argued (with substantial
empirical support) that a healthy self-concept or self-esteem is the result of what one does
and that interventions designed to improve self-esteem in the absence of any positive
behavior changes are misguided and potentially dangerous.
As is true with internalizing symptoms, there is some evidence for gender differences
in self-concept. The strength of these gender differences tends to be substantially weaker
for self-concept than for internalizing problems, however, and the direction of these
differences tends to be much less systematic. A comprehensive meta-analysis of the
research on gender differences in child and adolescent self-concept found that with
respect to specific domains of self-concept, there were more areas of similarity than
difference between boys and girls, and the areas that did produce gender differences
were about equally divided across gender (Wilgenbusch & Merrell, 1999). There were
about as many self-concept domains where boys were likely to have lower scores than girls
as there were where girls were likely to have lower scores than boys. Where significant
gender effects were found, they tended to produce small to modest effect sizes, usually
less than half a standard deviation. The findings of this meta-analysis do not support
the notion that girls tend to experience a plummeting of self-esteem when they reach
adolescence, a pop psychology idea that has become widely accepted through promotion
in popular media.
Harter (1990, 1999) noted that self-concept might have many different definitions
depending on the theoretical framework that is adopted. The definition of self-concept
that is used in this book is that of multidimensional self-concept. When defined from
a multidimensional viewpoint, self-concept includes not only a person’s overall self-
evaluation and level of self-esteem, but also his or her self-evaluation of particular aspects
of functioning, such as physical appearance and skills, academic competence, and social–
emotional functioning. In a multidimensional framework, a person’s overall self-concept
is not merely a summation of how he or she feels about or evaluates any of these different
aspects of life. Rather, the evaluation of a particular aspect of self-functioning may
contribute to his or her overall view of the self, but each dimension of the self may operate
independently. A person might have a negative evaluation of some particular dimensions
of the self (e.g., physical appearance and athletic competence) but still have a relatively
high global self-concept, or overall view of the self.
320 s Assessment of Specific Problems, Competencies, and Populations

Earlier work in the area of self-concept, as typified by research and theoretical writing
before the 1970s, tended to regard self-concept in a unidimensional fashion. The unidi-
mensional view indicates that self-concept is assessed best by presenting the subject with
many different items that tap various aspects of self-functioning, giving each different
aspect of the self-concept equal weight, then providing a global estimate of self-concept by
simply summing the item responses. The assessment of self-concept from this unidimen-
sional viewpoint is typified by two instruments originally developed during the 1960s, the
Coopersmith Self-Esteem Inventory (Coopersmith, 1981) and the Piers–Harris Children’s
Self-Concept Scale (Piers & Harris, 1969), neither of which is reviewed in this text because
they are based primarily on the older notions of self-concept and its assessment.
During the 1970s and 1980s, many researchers began to explore self-concept in a
manner that identified specific domains of self-evaluation, which were thought to operate
independently while correlating moderately with each other. This multidimensional
approach to self-concept was typified during this period by the work of Harter (1985a,
1986) and Marsh (1987). Proponents of this view contend that individual areas of self-
evaluation affect overall self-concept, but the contribution from each individual area is not
the same. From a practical standpoint, viewing self-concept from a multidimensional
perspective has important implications for a clinician who is conducting an assessment.
For example, a child or adolescent might have a negative view of his or her academic
competence, but not consider it to be important and feel okay about himself or herself in
a general sense. A child or adolescent may see himself or herself as being competent and
successful in most areas of functioning but assign great or undue weight to an unfavorable
self-concept in the area of physical appearance and have a poor global self-concept, despite
the many other areas in which he or she feels competent and successful.
Although the evidence regarding the relationship between self-concept and internaliz-
ing disorders still raises many unanswered questions, the overall evidence on self-concept
is that it may play a strong mediational role in various aspects of human functioning.
In this vein, Harter stated:

There have also been concerns with the mediational role that self-worth may play
in impacting both affective state, along a dimension of depressed to cheerful, and
motivation, along a dimension of low to high energy. Our studies provide strong
support for the impact that self-worth has on affect, which in turn influences the
child’s energy level. The implications of these findings for childhood depression as
well as adolescent suicide have also been explored within this context.
(1990, p. 319)

In sum, self-concept seems to be an important construct in the overall psychological

and social functioning of children and adolescents, and it may have significant implications
for youth with internalizing problems. Assessment of self-concept is an important clinical
consideration.

METHODS OF ASSESSING INTERNALIZING PROBLEMS

Assessment of internalizing problems presents a challenge for clinicians and researchers.
By definition and practice, internalizing problems tend to involve internal states and
 Assessing Internalizing Problems s 321

subjective perceptions. Assessing characteristics such as depression and anxiety using

external methods (e.g., direct observation, sociometrics, and, to some extent, rating
scales) can be problematic. Partly as a result of this problem, the research base on inter-
nalizing problems historically has lagged behind that of externalizing problems (Cicchetti
& Toth, 1991). In terms of clinical practice with internalizing problems, this state of
affairs has created similar problems. Because for the most part they are assessing internal
and subjective states when evaluating internalizing problems, clinicians necessarily must
rely on various forms of self-reporting as the primary method of assessment or as an
important adjunct to other methods. Although this chapter discusses assessment of inter-
nalizing problems using each of the major methods of assessment, the larger focus is on
the use of objective self-report tests and interview methods.

Behavioral Observation
Although assessment of internalizing problems through methods other than self-report
presents many problems, some internalizing characteristics can be observed directly,
and there has been some experimentation with the use of behavioral observation codes
for assessment. In contrast to self-report methods, which assess client perceptions of
internalizing symptoms, or rating scales, which assess third-party perceptions of inter-
nalizing symptoms retrospectively, the aim of direct behavioral observation is to assess
these symptoms as they occur. Kazdin (1988) listed several symptoms of depression that
are measurable through direct behavioral observation. Some of these include diminished
motor and social activity, reduced eye contact with others, and slowed speech. Additional
anxiety-related internalizing symptoms that might be assessed through direct observa-
tion include avoidance of feared or anxiety-provoking stimuli, facial expressions, physical
proximity, crying, posture or stance, and trembling voice or lip (Barrios & Hartmann,
1997; S. M. Miller, Boyer, & Rodoletz, 1990). Using these characteristics as examples, it
becomes clear how important some of the basic rules of conducting effective observa-
tions might be, such as defining the observation domain and selecting an appropriate
recording system, which were discussed in Chapter 4.
An observational technique that has been used in the assessment of anxiety and related
symptoms since the 1930s (Jersild & Holmes, 1935) is the Behavioral Avoidance Test
(BAT). The BAT can be implemented in a variety of ways and is simple to use. The original
BAT technique involved having the subject enter a room where the anxiety- or fear-
provoking stimulus is present (e.g., an animal, insect, separation from parent, darkness),
then having them approach the feared stimulus. The observational measures that can be
taken include latency of approach, duration of time in the presence of the stimulus, and
number of approaches completed (S. M. Miller, Boyer, & Rodoletz, 1990). A variation of
the BAT involves having the subject imagine the feared stimulus or situation, then record
his or her overt responses to the task. This variation of the BAT may be particularly useful
for assessing overt responses to anxiety-provoking situations that cannot be contrived in
a clinical setting, such as fear of imagined “monsters,” injury or death of a caregiver, or
clouds. In addition to the numerous variations of the BAT that have been used clinically
or reported in the literature, there are several experimental observational systems for
anxiety-related symptoms that have been described and reported in journal articles. For
example, in their excellent review on assessing children’s fears and phobias, Barrios and
Hartmann (1997) identified several research-oriented experimental observation systems
that had been used successfully with anxious children.
322 s Assessment of Specific Problems, Competencies, and Populations

Kazdin (1988) listed three general classes of behavioral codes that could be used for
direct observational assessment of childhood depression. These general codes are listed
as follows, with types of specific target codes that might be included under each class:

1. social activity: talking, playing a game, participating in a group activity;

2. solitary behavior: playing a game alone, working on an academic task, listening and
watching, straightening one’s room, grooming;
3. affect-related expression: smiling, frowning, arguing, complaining.

These types of observational target codes have been used successfully in the measurement
of depression and related internalizing problems in several studies. Williams, Barlow, and
Agras (1972) found significant negative correlations with self-reports of depression
and observations of verbal activity, smiling, and motor activity in depressed patients.
Kazdin, Esveldt-Dawson, Unis, and Rancurello (1983) used behavioral codes from these
three general categories to observe inpatient children (aged eight to 13) over a one-week
period and found that those children who were high in depression engaged in significantly
less social behavior and exhibited significantly less affect-related expression than other
children. More recently, Mian, Carter, Pine, Wakschlag, and Briggs-Gowan (2015) devel-
oped an observational measure that targets anxiety in younger children. This tool, the
Anxiety Dimensional Observation Scale (Anx-DOS) aims to measure children’s responses
to threat (e.g., spiders, loud sounds, separation from parents) and has seven codes includ-
ing Fear Arousal, Physical Avoidance, Exaggerated Startle, Separation Distress, Proximity
Seeking, Hypervigilance, and Dissociation. Researchers have worked to understand the
reliability and validity of the Anx-DOS and have found that inter-rater reliability was
generally very strong across codes. Hypervigilance had the lowest reliability coefficient
of 0.37 and Dissociation had very few observations. Further, the Anx-DOS correlates with
parent reports of anxiety. From these three studies, internalizing problems appear to be
assessed effectively through direct observation. It is important always to consider,
however, that the overt or easily observable characteristics of internalizing problems are
only a part of the picture (and often a small part). The subjective emotional state and
cognitive processes of the subject are also important, and these must be assessed primarily
through client self-report. Because so many aspects of internalizing problems are subtle
or covert, it is important to design the observation carefully, using procedures such as
those outlined in Chapter 4.
Self-monitoring, a specific facet of direct behavioral observation, has not been
researched widely as an assessment method for internalizing problems, but it seems to
hold some promise in this regard. Because there is considerable evidence that children
and adolescents can be trained to monitor and record their own behavior accurately
(Cole et al., 2000; Gettinger & Kratochwill, 1987; Pincus, May, Whitton, Mattis, & Barlow,
2010; Shapiro & Cole, 1994), there is no obvious reason why they could not also be trained
to monitor and accurately record internal or private events. For example, a clinician
working with depressed adolescents might train them to record periodically the number
of positive and negative internal self-statements they make and use this data to chart
baseline rates and treatment progress. Likewise, children or adolescents could be trained
to record their own perceptions of various somatic complaints, their pulse rate, engage-
ment in pleasurable activities, or positive self-affirming thought processes. There may be
some important limitations of self-monitoring observation with internalizing problems.
 Assessing Internalizing Problems s 323

Self-monitoring may be reactive, in the sense that it may produce change in the subject
(Kratochwill, 1982). Self-monitoring may be more useful in assessment during a
follow-up or intervention period than during baseline data gathering. An obvious concern
with self-monitoring of internalizing problems may surface when working with children
or adolescents who exhibit obsessive–compulsive behaviors. It is logical and realistic
to think that obsessive thoughts or compulsive behaviors potentially could be strength-
ened because of the increased focus placed on them. Despite these potential problems,
self-monitoring of internalizing problems seems to be a plausible alternative to direct
observation by an independent observer, although it has not been reported widely for
these uses in the professional literature.

Functional Assessment and Internalizing Problems An additional issue to consider with

respect to direct observation of internalizing problems is whether functional assessment
techniques may be used effectively with this domain. In previous versions of this book,
Merrell has taken the position that the clinical assessment technology is not sufficiently
advanced to allow for reliable functional assessment of internalizing problems, and as a
result, provided little or no coverage of the topic. In addition, he had serious questions
regarding whether the same rules of behavior that allow for using assessment data to
develop good working hypotheses regarding possible functions of behavior for external-
izing problems even apply to the internalizing domain. During the past several years, he
began to reconsider these issues, and came to the conclusion that it is likely possible to
develop a reliable framework for functional assessment of internalizing characteristics.
I am particularly intrigued by the role of discriminative stimuli (antecedents) in the
development of depression and anxiety, as well as the possible reinforcing properties
that may exist with some consequents of behaving in a depressed or anxious manner. In
particular, the possible functional relationship between anxiety–depression and escape/
avoidance and social attention should be considered. Imagine, for example, a student who
hesitates to initiate play with others during unstructured classroom time. This child often
plays by himself or seeks attention/conversation from the teacher. The teacher could
feasibly aid in reinforcing this boy’s avoidance by engaging in conversation or by “allow-
ing” him to continuously play on his own. One might be able to observe the child’s
frequency of alone time or of engaging with the teacher rather than peers. The observer
may be able to identify contextual antecedents such as unstructured social time, too. At
some level, however, professionals would need to rely on the child’s verbal skills and self-
report to truly understand the nature of the anxiety (e.g., he is afraid he won’t know how
to play). Although I am not convinced that such consequences provide a sufficient explan-
ation for development of internalizing problems, they could have a strong link to effective
intervention, and there are ample reasons to at least consider these possibilities. Recent
work in the field of clinical behavior analysis has begun to directly take on the internalizing
domain (e.g., Barnes-Holmes & Stewart, 2000; Bolling, Kohlenberg, & Parker, 2000;
Dymond & Roche, 2009; Forsyth, 2000; Friman, Hayes, & Wilson, 1998), and may lead to
additional efforts resulting in practical and reliable functional assessment methods.

Behavior Rating Scales

Each of the general-purpose behavior rating scales or rating scale systems that were
discussed in Chapter 5 includes rating items and subscales specifically directed at
measuring internalizing problems, and all of these instruments have been validated to
324 s Assessment of Specific Problems, Competencies, and Populations

some extent for this purpose. In addition, there are several other widely used general
purpose rating instruments that are pertinent to the assessment of such varied internal-
izing symptoms areas as anxiety, depression, and social withdrawal. Although a few
research instruments have been reported in the literature that are aimed at specific types
of internalizing symptoms (see Barrios & Hartmann, 1997, and Compas, 1997, for a
discussion of experimental behavior rating scales for assessing anxiety and depression),
for the most part these behavior rating scales have not been validated sufficiently or are
not in wide enough use to justify their inclusion in this chapter. The general-purpose
instruments evaluated in Chapter 5 are recommended as the instruments of choice when
objective third-party behavior ratings of internalizing problems are desired.
Another potentially useful behavior rating scale for assessing internalizing problems
is the Preschool and Kindergarten Behavior Scales, which are discussed in Chapter 14.
These scales include a broadband internalizing problems subscale with two internalizing
problems subscales and may be useful for objective evaluation of internalizing problems
of young children. Also, it may be useful to consider the use of any of the social competence
rating scales or systems that are discussed in Chapter 13 (the Social Skills Improvement
System, School Social Behavior Scales and Home and Community Social Behavior Scales,
and Walker–McConnell Scales of Social Competence and School Adjustment) when there
are concerns about assessing internalizing problems. Given that social withdrawal often
accompanies depression and anxiety, and that deficits in social competence may be
correlated with internalizing problems, such an assessment strategy may be useful.
Although the use of behavior rating scales is recommended as part of a comprehensive
assessment design for evaluating internalizing problems of children and adolescents,
this recommendation is not without caution. As has been mentioned numerous times
in this chapter, many aspects of internalizing problems are not readily detectable to an
external observer, even one who knows the child or adolescent relatively well. Because
many of the core symptoms of internalizing disorders (such as cognitions and affect) are
not externally observable in any reliable way, behavior rating scales should be used for this
purpose with a great deal of caution. Because the evidence indicates that parent reports
(and, by inference, teacher reports) may be more accurate for assessing externalizing prob-
lems, but child self-reports may be more accurate for assessing internalizing problems
(Kolko & Kazdin, 1993), there always should be a strong assessment emphasis on the latter
method when internalizing symptoms are concerned.

Interviewing
Whether structured, traditional, or behavioral in nature, the clinical interview is perhaps
the most widely used method for the assessment of internalizing problems (S. M. Miller,
Boyer, & Rodoletz, 1990). Virtually any of the interview techniques discussed in Chapter
6 can be useful in assessing depression, anxiety, social withdrawal, and related internaliz-
ing symptoms. In terms of structured or semistructured interview schedules, each of
those discussed in Chapter 6 (e.g., K-SADS and SCICA) are directly relevant for assessing
internalizing symptoms and include many areas of questioning that are specific to this
area. As such, any of these interview schedules is worthy of consideration for assessing
internalizing problems. An example of the utility of these structured interview schedules
in assessing internalizing problems is a study by King (1997), who examined the diagnos-
tic efficacy of one interview tool, the DISC (version 2.3), for diagnosing depressive dis-
orders in a large sample of inpatient adolescents and found it to have strong concurrent
 Assessing Internalizing Problems s 325

validity for this purpose. This study found that the highest rates of diagnostic accuracy
were obtained when results from parent and adolescent versions of the interview were
combined. Another interesting facet of this investigation is that parents reported a higher
prevalence of depressive symptoms in their children than the adolescents themselves
reported.
An interview schedule that has been developed specifically for use in assessing depres-
sion is the Children’s Depression Rating Scale (CDRS), which was originally developed
by Poznanski, Cook, and Carroll (1979) but has since been revised and developed into a
short form by some researchers. This instrument was developed as a downward extension
and adaptation of the Hamilton Rating Scale for Depression, an interview rating instru-
ment for use in assessing depression in adults. Although the CDRS-R may not be as
widely used as the interview schedules reviewed in Chapter 6, it is of interest because of
its specificity of design. The CDRS-R includes 17 symptom areas that cover a range
of depressive symptoms, such as inability to have fun and the appearance of sad affect.
The clinician, who conducts a semistructured interview, questions the child about each
item but may consult other informants such as parents or teachers. Each interview item
ultimately is rated for symptom severity by the clinician, using an 8-point scale (0 =
unable to rate to 7 = severe symptoms). The research base on the CDRS-R is growing, and
there have been some encouraging findings. For example, the CDRS has been found
to have relatively high inter-rater agreement (coefficients of 0.75 and higher), high
correlations with global clinical ratings of depression (0.85 and higher), high test–retest
reliability at six-week intervals (low 0.80s), and good convergent validity with other
diagnostic interview schedules. Additionally, some evidence has been gathered that
suggests the CDRS-R is sensitive to change and can be used to monitor treatment for
depression (Mayes, Bernstein, Haley, Kennard, & Emslie, 2010). This instrument seems
to be useful for research purposes or as part of a comprehensive assessment battery when
measurement of depressive symptoms is specified.

Sociometric Techniques
Similar to direct behavioral observation, sociometric approaches may be used to assess
internalizing problems, but they pose some difficult challenges in the process. As is true in
the case of behavioral observation, a major difficulty with the use of sociometric assess-
ment for measuring internalizing problems is that subjective internal states, thought pat-
terns, and other covert characteristics may not be observed easily, or otherwise perceived
by peers. An additional difficulty surfaces when young children are being assessed. Given
their experiential limitations owing to their age, very young informants may lack the
maturity to make differentiations between subtle emotional characteristics. Although it
may be relatively easy for a child to name three classmates who are likely to fight on the
playground, the identification of peers who are sad, lonely, or nervous may become con-
founded with many other personality characteristics. With adults, sociometric assessment
of internalizing characteristics is perhaps more effective, although not necessarily practi-
cal for day-to-day clinical use. Kane and Lawler (1978) reviewed 19 peer assessment
studies in which the subjects were adults and concluded that several of the investigations
were reasonably valid in measuring various internalizing-type characteristics.
Although sociometric approaches seldom would be the first method of choice for
assessing internalizing problems, they nevertheless can and have been useful for this
purpose. As an assessment component for internalizing problems, sociometric approaches
326 s Assessment of Specific Problems, Competencies, and Populations

probably are best used as a screening device for identifying potentially at-risk children
who might be administered further assessments. Virtually all of the general sociometric
assessment methods presented in Chapter 7 are flexible enough to be implemented
appropriately in this manner. The teacher ranking procedure for internalizing problems
from the Systematic Screening for Behavior Disorders (Walker & Severson, 1992; Walker,
Severson, & Feil, 2014) that was discussed in Chapter 7 is an example of a sociometric type
of method targeted specifically at internalizing characteristics. Typical peer nomination,
rating, or ranking methods all could be used to target specific internalizing characteristics.
As is true in using behavioral observation, it is necessary to define carefully the target
characteristic for a valid assessment. For example, a nomination procedure used to screen
for social withdrawal by wording the statement something like “Write down the names of
three students who always seem to be alone” also might screen in children who are socially
isolated because of their antisocial–aggressive behavior.
Despite the challenges inherent in doing so, several studies have shown that sociometric
assessment approaches can screen effectively for internalizing problems in children.
McConnell and Odom (1986) reviewed 46 investigations that used sociometric methods
with children for various research purposes, and several of these studies directly assessed
at least some internalizing characteristic, such as withdrawal or depression. Several of the
studies reviewed by McConnell and Odom found that targeted subjects were likely to
exhibit internalizing and externalizing symptoms. The distinction between these two
domains of problems that has been found through behavioral dimensions research does
not always exist in individual cases.
An additional sociometric assessment procedure that was used quite a bit in the 1980s
and 1990s in the measurement of depression for research is the Peer Nomination Inventory
for Depression (PNID) (Lefkowitz & Tesiny, 1980). The PNID consists of 20 statements
that comprise three subscales (Depression, 14 items; Happiness, four items; and Popularity,
two items). Individuals within a group (usually a classroom) are asked to identify to whom
the statements apply. Examples of some of the statements on the Depression subscale
include “Often plays alone,” “Often sleeps in class,” “Worries a lot,” and “Often looks sad.”
Kazdin (1988) noted that the PNID has solid internal consistency (0.85), acceptable
test–retest reliability at two- to six-month intervals, and adequate inter-rater agreement,
and that normative data on the PNID have been gathered for more than 3,000 children
in grades 3 to 5. Several validation studies of the PNID (e.g., Crowley & Worchel, 1993;
Lefkowitz, Tesiny, & Gordon, 1980; Lefkowitz & Tesiny, 1985; Tesiny & Lefkowitz, 1982)
have shown that it has relatively weak correlations with self-report and teacher ratings
of depression but strong correlations with measures of school performance, self-concept,
teacher ratings of social behavior, and other peer ratings of happiness and popularity.
An interesting finding from the PNID validation research is that children who evidence
greater depressive symptoms as measured by self-report instruments are more likely to
rate other children as more depressed on the PNID (Crowley & Worchel, 1993). This
instrument is an innovative assessment technique that is one of the few sociometric meas-
ures designed specifically or solely for assessing internalizing problems. At present,
however, it probably is best used as a research or broad screening tool.

Narrow-Band Self-Report Instruments

In addition to the general-purpose self-report instruments discussed in Chapter 8,
numerous self-report instruments have been developed for assessing specific internalizing
 Assessing Internalizing Problems s 327

Table 11.5 Self-report instruments for assessing internalizing problems and self-concept: Summary of instruments reviewed in
Chapter 11, listed in order of review

Instrument Focus Ages Items and format Norm sample

Children’s Depression Characteristics 6–17 28 items, forced choice 1,100 (national)

Inventory, Second Edition of depression among three statements
Revised Children’s Manifest Characteristics 6–17 49 yes/no statements 2,300 (national)
Anxiety Scale, Second Edition of anxiety
Reynolds Child Depression Characteristics 8–12 30 statements (11 states)
Scale, Second Edition of depression responded to on a
4-point scale
Reynolds Adolescent Characteristics 11–20 30 statements 3,300 (national)
Depression Scale, Second of depression responded to on a
Edition 4-point scale
State-Trait Anxiety Inventory State Anxiety 9–12 2 scales with 20 items 1,554 (Florida)
for Children and Trait each; forced choice
Anxiety among 3 statements
Multidimensional Self- Dimensions of 9–19 150 items rated using a 2,501 (national)
Concept Scale Self-Concept Likert-type scale
Self-Description Dimensions of 8–12 76 items rated using a Over 1,000
Questionnaire I Self-Concept Likert-type scale (international)
Self-Description Dimensions of 13–17 102 items rating using Over 1,000
Questionnaire II Self-Concept a Likert-type scale (international)
Self-Perception Profile for Dimensions of 9–14 36 statement pairs with 1,543 (Colorado)
Children Self-Concept two score options each
Self-Perception Profile for Dimensions of 13–18 45 statement pairs with 651 (Colorado)
Adolescents Self-Concept two score options each

disorders and symptoms in children and adolescents. There are many more objective self-
report instruments for assessing this area than can be addressed adequately in this chapter.
Six of these self-report instruments have been selected for further discussion and
evaluation in this chapter. Three of these instruments are designed specifically to assess
symptoms of depression, two of them are designed to assess symptoms of anxiety, and
one is designed to assess the broad range of internalizing symptoms and positive/negative
affect. These six instruments were selected over other potential measures for inclusion
because of their commercial availability, psychometric properties, ease of use, and amount
or sophistication of available research evidence. Table 11.5 presents summary information
on the major characteristics of each of these instruments.

The Children’s Depression Inventory (CDI) and the Children’s Depression Inventory-2
(CDI-2) The Children’s Depression Inventory (CDI) (Kovacs, 1980–1981, 1991) is a
27-item self-report measure of depressive symptoms for use with school-age children and
adolescents (aged six to 17). Without question, this instrument is the most widely used
and researched child self-report depression scale, with several hundred studies using the
CDI appearing in the professional literature by 2002. The CDI was developed as a down-
ward extension of the Beck Depression Inventory and was first reported in the research
literature in the early 1980s. For several years, the instrument and an accompanying
328 s Assessment of Specific Problems, Competencies, and Populations

unpublished manuscript were available in various versions from the author. In 1991, the
CDI was commercially published and more easily available. In addition to the standard
hand-scored, paper and pencil version of the CDI, the publisher also makes available a
version that is computer administered and scored.
Each of the 27 items of the CDI has three statements about a particular depressive
symptom, and the respondent chooses the statement that best describes his or her feelings
during the past two weeks. Each item is scored 0, 1, or 2, with the statements reflecting the
greater severity of symptoms receiving the higher value. The following is an item similar to
those found in the CDI, to illustrate the structure of the items and how they are scored:

_____I feel very unhappy (scored 2)

_____I feel somewhat unhappy (scored 1)
_____I feel happy (scored 0)

The CDI is easy to administer and score, usually taking no more than ten to 20 minutes
for the entire process. The CDI manual suggests that a cutoff score of 11 be used if the
purpose of the administration is to screen for depression while making few false negative
errors. If the purpose of the administration is to assess the presence of depression in children
with behavioral and emotional problems, 13 is suggested as the appropriate cutoff score.
Normative data for CDI score conversions are based on a study by Finch, Saylor, and
Edwards (1985), wherein CDI score norms for 1,463 Florida public-school children in
grades 2 to 8 were reported. These normative data are broken down by gender and grade
level. Previous versions of the unpublished CDI manual manuscript provided score
norms based on a sample of 860 Canadian schoolchildren aged eight to 13.
Additional samples have been reported in the literature. Although the CDI total score
is the measure of interest, various factor analyses of the CDI have been reported in the
literature, wherein five to seven factors typically have been extracted. The current version
of the CDI manual advocates a five-factor solution.
The psychometric properties of the CDI have been documented in many published
research reports. Most studies have found the internal consistency of the CDI to be in the
mid- to upper 0.80s. With some exceptions in which lower correlations were obtained,
test–retest reliability of the CDI typically has been found to be in the 0.70 to 0.85 range
at short (one week to two months) intervals and in the same general range at several-
month intervals.
The most common method of determining the validity of the CDI has been through
obtaining correlations of concurrent scores from other internalizing measures, and a
plethora of studies have found the CDI to have significant relationships to other depres-
sion instruments and techniques purported to measure depression and related constructs.
Other types of validity studies have included finding negative correlations between the
CDI and measures of self-esteem (e.g., Kovacs, 1983) and social competence (e.g., Helsel
& Matson, 1984), using CDI scores as a predictive measure of psychiatric diagnoses
(e.g., Cantwell & Carlson, 1981; Hodges, 1990), and using CDI scores to predict future
emotional and behavioral adjustment problems (e.g., Mattison, Handford, Kales, &
Goodman, 1990). Also, the CDI has been used as a treatment outcome measure in many
studies, and its ability to gauge change from treatment has been documented.
The CDI-2 was recently released (Kovacs, 2010) and includes much of the content from
the original version with some added features. The self-report measure consists of 28 items
 Assessing Internalizing Problems s 329

and is appropriate for children aged seven to 17. Total scores, two scale scores (Emotional
Problems and Functional Problems), and four subscale scores (Negative Mood/Physical
Symptoms, Negative Self-Esteem, Interpersonal Problems, and Ineffectiveness) are derived
from this measure. A short form, consisting of 12 items has also been developed for
screening and progress-monitoring purposes. A parent form (17 items) and teacher form
(12 items) are also available. Given that the normative data from the CDI were outdated,
new norms have been established, based on data gathered from 1,100 children and
adolescents from 26 states across all regions of the United States.
The CDI has the distinct advantage of being perhaps the most widely researched child
self-report instrument in existence, and its psychometric properties and discriminant
abilities are generally quite good. The CDI-2 should continue to have wide use in research.
Until more research is conducted on this updated version, a conservative approach to the
use of cutoff scores is recommended, given some previous criticisms of the predictive
value of the cutoff scores.
The Revised Children’s Manifest Anxiety Scale (RCMAS) and the Revised Children’s
Manifest Anxiety Scale, Second Edition (RCMAS-2) The Revised Children’s Manifest
Anxiety Scale (RCMAS) (C. R. Reynolds & Richmond, 1985) is a self-report instrument
for use with children aged six to 17. It includes 37 statements that are responded to in a
yes/no fashion and is designed to be a measure of trait anxiety (the tendency to be anxious
over settings and time). Scoring the RCMAS simply involves summing the number of “yes”
responses for each of three subscales (Physiological Anxiety, Worry and Oversensitivity,
Concentration Anxiety) and a Lie scale and calculating a total score. The three RCMAS
subscales were developed through factor analytic research (C. R. Reynolds & Paget, 1981),
whereas the Lie scale consists of nine items that are socially desirable but almost never true
(e.g., “I never say things I shouldn’t”).
Normative data for the RCMAS are from nearly 5,000 cases obtained in the United
States, with each geographical region represented. These data first were reported in a study
by C. R. Reynolds and Paget (1983) and include separate norm samples based on age,
gender, and Black/White racial breakdowns.
Psychometric properties of the RCMAS as reported in the test manual and in numerous
published studies are indicative of generally adequate levels of reliability and validity.
Internal consistency reliability of the total RCMAS score has been reported at 0.79 for boys
and 0.85 for girls in a study with kindergarten children (C. R. Reynolds, Bradley, & Steele,
1980). Internal consistency coefficients for the RCMAS subscales are at a troubling lower
level than for the total score, ranging from 0.50 to 0.70 across groups for Physiological
Anxiety and 0.70 to 0.90 for the Lie scale. One test–retest reliability study of the RCMAS
found short-term reliability coefficients of 0.88 (one week) and 0.77 (five weeks)
(Wisniewski, Mulick, Genshaft, & Coury, 1987), whereas another study found a coefficient
of 0.68 at a nine-month interval (C. R. Reynolds, 1981). Evidence for the convergent valid-
ity of the RCMAS comes from a large number of studies comparing the RCMAS with
other self-report measures of anxiety and related internalizing symptoms. Evidence for
theory-based sensitivity to group differences of the RCMAS (an indicator of construct
validity) comes from studies such as one that found the scores of gifted children to be
lower than the scores of average children (C. R. Reynolds & Bradley, 1983) and one that
found scores of learning-disabled children to be higher than those of average children
(Paget & Reynolds, 1982). Many other studies have found RCMAS score elevations in
children with various internalizing disorders.
330 s Assessment of Specific Problems, Competencies, and Populations

The RCMAS-2 (C. R. Reynolds & Richmond, 2008) is similar to the RCMAS, and
scores on each of the forms tend to be highly correlated with one another. The RCMAS-2
includes 49 items for children aged six to 19. Physiological Anxiety, Worry, Social
Anxiety, and Defensiveness are scales derived from the items. The Social Anxiety scale
includes ten additional items reflective of performance anxiety and takes the place of the
Social Concerns/Concentration scale on the RCMAS. The Defensiveness scale is in place
of the former Lie scale and there is also a new Inconsistent Responding index. A short
form consisting of just ten items is also available. Updated norms were derived from a
sample of 2,300 diverse individuals.
Although the internal consistency of the original RCMAS subscales is lower than
desirable (although generally acceptable), this instrument can be recommended on several
grounds. There are many published studies (approximately 200 at present) that attest to
various properties and uses of the scale. The RCMAS-2 appears to improve upon some
of the weaknesses noted in the original and also reflects norms that are up to date. The
RCMAS is easy to use, has strong face validity, and can be recommended as part of a
battery for assessing internalizing problems with children. Given the more marginal
stability of the three RCMAS subscales as opposed to the total score, however, it is recom-
mended that the total score be used for most assessment purposes and that subscale scores
be interpreted with caution when they are used.

The Reynolds Child Depression Scale (RCDS) and the Reynolds Child Depression Scale,
Second Edition (RCDS-2) The Reynolds Child Depression Scale (RCDS) (W. M. Reynolds,
1989) is a self-report measure of depression-related symptoms for use with children in
grades 3 through 6 (ages eight to 12). It contains 30 items that are rated using a 4-point
scale (“Almost never” to “All the time”). The 30 items primarily were developed based on
depressive symptoms from the DSM-III. Some of these items are phrased to represent the
presence of depressive symptoms (e.g., “I feel I am no good”), whereas others are phrased
to reflect the absence of such symptoms (e.g., “I feel like playing with other kids”). The
items are written at about a second-grade level and are administered orally to children in
grades 3 and 4 and to older children who have reading problems. Scoring of the self-report
protocol is done through an easy-to-use transparent overlay key that assigns values from
1 to 4 for each item, with higher scores reflecting item endorsement in the direction of
depressive symptoms.
The RCDS was standardized with a group of more than 1,600 children from the
midwestern and western United States. Technical information provided in the test manual
indicates that the instrument has acceptable to excellent psychometric properties. Internal
consistency of total score is 0.90 for the entire normative sample, with similar levels
reported by grade, gender, and ethnic group breakdowns. Test–retest reliability estimates
are reported at 0.82 at two-week intervals and from 0.81 to 0.92 at four-week intervals.
A variety of information on the validity of the RCDS is presented in the test manual,
including six studies correlating the RCDS with CDI and four studies correlating the
RCDS with self-report measures of anxiety and self-esteem. Several other convergent
construct validity studies also have appeared in the professional literature. Factor analytic
research indicates the presence of a reasonably strong five-factor structure, although
separate factor scores are not obtained in normal scoring of the RCDS. Interpretation of
RCDS total scores is based on raw score to percentile score conversions and critical raw
score values. The raw score value of 74 is considered to be the critical value for “clinical”
 Assessing Internalizing Problems s 331

level scores, and evidence presented in the test manual suggests that scores at this level
have a high “hit rate” for identifying children who meet other criteria for having significant
symptoms of depression.
The manual for the RCDS is exceptionally well written and documented, the research
data presented therein are impressive, and the instrument has a great deal of face validity.
It appears to be an excellent self-report instrument for assessing the symptoms of
depression with elementary-age children, and it should be useful for research and clinical
purposes.
The RCDS-2 reflects an updated version of the RCDS. The 30 items are similar to the
original version but are also aligned with DSM-IV diagnoses. This new measure is
now appropriate for children in grades 2 to 6, and a new short form is also available
that can be completed in just two to three minutes. Updated normative data were derived
from a sample of students from 11 states in the United States. While this measure is
aligned to the DSM-IV, it is still used widely and provides extremely useful information,
particularly since the definition for depression did not change dramatically in the
DSM-5.

The Reynolds Adolescent Depression Scale, Second Edition (RADS-2) The Reynolds
Adolescent Depression Scale, Second edition (RADS-2) (W. M. Reynolds, 2002) is a revi-
sion of the original RADS (W. M. Reynolds, 1986). This instrument is a self-report
measure of depressive symptoms for adolescents and young adults aged 11 to 20. It is a
companion instrument to the RCDS (the original RADS was the first of the two instru-
ments to be developed), and it is similar in structure and format to the RCDS. Similar to
the RCDS, the RADS-2 contains 30 items that are responded to in a 4-point format
(“Almost never” to “All the time”) that were developed to coincide with depressive symp-
toms from the DSM. The RADS-2 can be administered individually or with groups, and
the items seem to be written at a low enough reading level that even most adolescents
with reading problems should be able to understand them. The RADS-2 rating forms are
hand-scored using a convenient scoring key.
The RADS-2 was standardized on a group of 3,300 adolescents and young adults from
a variety of U.S. regions, reduced from an original sample of over 9,000 individuals. This
norm sample is stratified to the 2,000 U. S. census estimates. There are three age divisions
within the norming sample for scoring purposes, each with 1,100 normative cases: ages
11 to 13, 14 to 16, and 17 to 20.
Technical information provided in the RADS-2 test manual, and additional studies
(e.g., Osman, Guiterrez, Bagge, Fang, & Emmerich, 2010) indicate that the instrument
has acceptable to excellent psychometric properties. Internal consistency for the total
sample is reported in the low 0.90s, with similar high levels reported by age and gender
breakdowns. Test–retest reliability estimates are reported at approximately 0.80 for
short-term retest intervals. Adequate validity information is presented in the RADS-2 test
manual, and additional validity evidence has accrued through subsequent published
studies using the RADS-2, as well as through its lineage from the very popular RADS. The
manual, and several of these additional studies, have shown convergent validity evidence
for the RADS-2 through correlational comparisons with other measures of depression
and related internalizing symptoms. In correlational studies, the RADS-2 was compared
with various adolescent self-esteem measures, with results showing a moderate to strong
inverse relationship between RADS depression scores and self-concept scores.
332 s Assessment of Specific Problems, Competencies, and Populations

Factor analytic research on the RADS-2 indicates the presence of a four-factor subscale
structure. Interpretation of RADS-2 scores is based on raw score to T score and percentile
score conversions, as well as critical raw score values, based on six items. Cutoff points for
“clinical” level scores are provided, and evidence presented in the test manual suggests
that scores at this level have a high “hit rate” for identifying adolescents who meet other
criteria for having significant symptoms of depression.
Similar to the RCDS, the manual for the RADS-2 is exceptionally well written and
documented, the research data presented therein are impressive, and the instrument has
a great deal of face validity and usability. The RADS-2 items are related specifically and
logically to adolescent concerns, the size of the standardization group is impressive,
and the documentation of research evidence specific to adolescent populations is substan-
tial and growing. The RADS-2 represents an excellent addition to the adolescent self-
report instrumentation. The original RADS gained wide clinical and research acceptance,
and there is little doubt that the RADS-2 will continue in this vein.

The Multidimensional Anxiety Scale for Children, Second Edition (MASC-2) The
Multidimensional Anxiety Scale for Children, Second Edition (MASC-2; March, 2013)
self-report is part of a multi-source rating system for children aged eight to 19. The
MASC-2 is distributed by Multi-Health Systems and can be completed through a paper
and pencil administration or online via the QuikScore. It takes about 15 minutes to com-
plete and is written at about a second grade reading level. Total scores and Anxiety
Probability Scores are generated as well as scale and subscale scores. Primary scales include
Separation Anxiety/Phobias, Social Anxiety, GAD Index, Obsessions and Compulsions,
Physical Symptoms, and Harm Avoidance. An Inconsistency Index is also available to
screen for inconsistent responding. The technical manual is detailed and outlines changes
made from the original MASC as well as updated normative data. The most recent
normative sample involved 1,800 children in the United States and Canada with rep-
resentation across groups including race/ethnicity, gender, parent education level, and
age. A clinical sample was also recruited to help identify whether the MASC-2 is able to
distinguish between clinical and normative populations. Internal consistency coefficients
for the MASC-2 averaged at 0.92, while test–retest reliabilities ranged from 0.80 to 0.93.
The MASC-2 converges moderately with the Beck Anxiety Inventory for Youth, and the
Conners CBRS.
The MASC-2 self-report is a well-developed tool that is comprehensive in its measure-
ment of the varying facets of anxiety. March recommends that it be used to screen and
to progress monitor anxiety symptoms in children and adolescents. It can be used in a
variety of settings and provides useful information that can add to a multi-pronged
assessment process.

The State-Trait Anxiety Inventory for Children (STAIC) While it is an older measure,
I feel it is necessary to continue to comment on the State-Trait Anxiety Inventory
for Children (STAIC) (Speilberger, Edwards, Montuori, & Lushene, 1973). The STAIC is
a self-report assessment of trait anxiety and state anxiety for children aged nine to 12. It
was developed as a downward extension of the State-Trait Anxiety Inventory (Speilberger,
Gorsuch, & Luchene, 1970), a self-report measure for adolescents and adults. The STAIC
consists of two separate scales with 20 items in each: one to assess state anxiety (how
anxious the child feels at the time the inventory is being completed) and one to assess trait
 Assessing Internalizing Problems s 333

anxiety (how anxious the child feels in general). The state anxiety items ask the respondents
to determine how they “usually feel,” whereas the trait anxiety items ask the respond-
ents to rate how they feel “right now, at this very moment.” The two scales can be admin-
istered separately or together. The STAIC may be administered individually or in groups
and typically requires about ten minutes for each scale. Similar to the CDI, each item of
the STAIC requires the participants to choose one of three statements that best describes
how they feel. The items are scored 1, 2, or 3 points, with the higher score reflecting the
statement indicating stronger symptoms of anxiety. Some of the STAIC items are reverse-
worded and keyed, to control for the presence of acquiescent response sets. The most
common version of the STAIC is a paper and pencil rating form with hand-scoring keys.
A computerized version of the STAIC is also available.
The differentiation between state and trait anxiety is based on theoretical underpin-
nings previously postulated by Speilberger (1966, 1972). Children who are trait anxious
tend to respond to a variety of situations as if they are threatening, whereas children
who score high on the state anxiety scale but low on the trait anxiety scale are thought to
feel anxious because of a specific situation or event. Previous reviews of the STAIC (e.g.,
R. P. Martin, 1988) have considered the theoretical orientation of the instrument to be a
definite advantage.
Overall, the normative data of STAIC are old, but the tool has many qualities to
recommend its use. The division of state and trait types of anxiety scales is interesting and
useful from a theoretical standpoint, and many studies have validated the differential
measurement properties of the two scales. Previous reviews of the STAIC (e.g., R. P.
Martin, 1988) noted that the two major weaknesses of the instrument were a shortage
of psychometric validation studies and a geographically limited normative population.
The first weakness is now less of a problem because more than 200 studies have been
published that used the STAIC as a primary measure and it continues to be used in
research. The second weakness continues to be a problem. Not only is the norm sample
limited to one state, but also the norms are now more than 35 years old. A current and
nationally representative standardization of the STAIC would be of great use in increas-
ing the confidence of obtained test scores and in ensuring the continued use of the test,
which is deserved.

Concluding Comments on Internalizing Symptoms Self-Report Measures To conclude this

section on self-report assessment of internalizing symptoms, it is important to recognize
that self-report instruments designed to measure anxiety and depression have shown
varying degrees of effectiveness in classifying children with internalizing disorders, despite
the otherwise generally good psychometric properties of these measures. Historically, it is
fair to say that classification studies have shown instruments for depression to be more
effective than instruments for anxiety in differentiating among youth with the disorder in
question. In commenting on this assessment problem regarding self-report measures of
childhood anxiety, Silverman and Ginsburg stated that

despite the advantages of children’s self-rating scales . . . groups defined as anxious

via these rating scales are not necessarily defined this way via diagnoses . . .
specifically, it is not clear that these scales can differentiate children with anxiety
disorders from children with other types of disorders.
(1998, p. 254)
334 s Assessment of Specific Problems, Competencies, and Populations

As was suggested in the discussion of positive and negative affectivity earlier in this chapter,
perhaps the crucial problem in this regard is that most self-report scales may be assessing
global negative affectivity rather than a specific internalizing disorder. Negative affectivity
appears to be related to anxiety and depression, whereas the absence of positive affec-
tivity appears to be related only to depression. Perhaps a newer generation of self-report
measures that take into consideration the differential effects of positive and negative
affectivity ultimately would be helpful in solving some of the diagnostic problems
presented by internalizing disorders.

Self-Report Instruments for Assessing Multidimensional Self-Concept

An overview of five of the most widely used self-report instruments for measuring
self-concept is provided in this section. In our earlier discussion of self-concept, it was
made clear that the definitional focus for self-concept in this chapter would be a multi-
dimensional, as opposed to a unidimensional model. The following overview precludes
any of the several instruments designed to assess the latter view of the construct. The
empirically demonstrated nature of self-concept necessarily precludes any assessment
methods that rely on observations or perceptions of persons other than the target child or
adolescent. Within the realm of self-report, the preferred assessment method is objective
self-report tests rather than interviews because no structured or standardized interview
methods have been developed yet to assess self-concept systematically. The self-report
instruments presented in this section include Bracken’s (1992) Multidimensional Self-
Concept Scale, Marsh’s (1992a, 1992b) Self-Description Questionnaires, and Harter’s
(1985b, 1988) Child and Adolescent Self-Perception Profiles. Harter and Pike (1984) devel-
oped a pictorial self-concept test for use with very young children; this instrument is
reviewed in Chapter 14 (assessing young children). Although several other self-concept
assessment tools for use with children and adolescents have been developed, the five instru-
ments reviewed in this section generally outstrip the others in terms of sophistication,
psychometric properties, and validity evidence.

The Multidimensional Self-Concept Scale (MSCS) The Multidimensional Self-Concept

Scale (MSCS) (Bracken, 1992) is a self-report instrument for assessing self-concept in a
multidimensional fashion. The MSCS was developed for use by children and adolescents
in grades 5 to 12 and includes 150 items. These items are rated by examinees on a Likert-
type response scale, with 4 points ranging from “Strongly agree” to “Strongly disagree.”
The construction of MSCS items and the overall scale structure were theoretically
driven, based on a view of self-concept as being “a behavioral construct, not a part of a
larger cognitive self-system” (Bracken & Howell, 1991, p. 323). The items are divided into
six subscales of 25 items each, based on Bracken’s multidimensional factors and global
self-concept theory: Affect, Social, Physical, Competence, Academic, and Family. A score
also is produced for Global Self-Concept. For each of the seven possible score areas, raw
scores are converted to standard scores with a mean of 100 and standard deviation of 15.
Tables for T score conversions, percentile scores, and self-concept classifications are
provided in the MSCS manual.
The MSCS was normed on 2,501 students in grades 5 to 12 in the United States,
with adequate representation given to each U.S. geographical region. Strong internal
consistency reliabilities are reported for the six subscales (0.85 to 0.90) and the total score
(0.98). The MSCS also has been found to have strong stability over time, with subscale
 Assessing Internalizing Problems s 335

reliability coefficients ranging from 0.73 to 0.81 and a total score coefficient of 0.90 at four-
week retest intervals. A body of externally published empirical evidence has begun to
accumulate and has shown moderate to strong relationships between the MSCS and other
multidimensional and unidimensional self-construct instruments, and convergent and
discriminant support for the construct of multidimensional self-concept as measured by
the MSCS. The MSCS manual is well written and documented, the instrument is easy to
use, and it seems to be a well-designed and useful self-report instrument. While it is almost
25 years old at this point, a brief search of scholarly articles suggests that this tool continues
to be widely used nationally and internationally, often in the context of research.

The Self-Description Questionnaire I (SDQ-I) The Self-Description Questionnaire

I (SDQ-I) (Marsh, 1992a) is a 76-item self-report inventory that is designed to provide a
multidimensional measure of self-concept for children and preadolescents (aged eight
to 12). It may be administered individually or to groups and takes approximately 15 to
20 minutes for most children to complete. Australian researcher Herbert Marsh, an inter-
nationally recognized expert in the study of self-concept, developed the SDQ-I. This
instrument has been in use in various versions internationally for years, including
several years before the 1992 publication date. The 76 items of the SDQ-I load into
11 subscales in three domains: Academic (Mathematics, Reading, General-School), Non-
Academic (Physical Abilities, Physical Appearance, Peer Relations, Parent Relations),
and Global (Total Academic, Total Non-Academic, Total Self, General Self). The items are
rated using a Likert-scale format, and the self-report rating form is hand-scored using a
scoring profile.
In contrast to most of the other instruments reviewed in this book, which are intended
for use primarily in the United States and Canada and standardized in these nations, the
SDQ-I was standardized with a large sample of children who were primarily from
Australia. Extensive research with the SDQ-I has been conducted internationally (includ-
ing the United States), however, and the standardization and spelling differences should
not pose a large barrier for use in the United States or Canada. Because of the extensive
international use of the SDQ-I, researchers have translated it into several languages.
Based on information presented in the test manual and in extensive externally published
research reports, the psychometric properties of the SDQ-I are solid. Internal consistency
of the scales generally has been found to be in the mid-0.80s to mid-0.90s range. Short-
term test–retest reliability has been shown to be in the 0.70s to 0.80s range. The factor
structure on which the scales are based is solid and has been shown to replicate well across
various samples. Validity evidence is extensive and ranges from strong correlations with
other measures, to strong associations with external criteria and outcomes, to sensitivity
in detecting theory-based group differences. Most reviews of the SDQ-I have been positive,
and one expert reviewer has championed it as being unquestionably the most validated
self-concept measure available for use with preadolescent children (Byrne, 1996). The
SDQ-I is a comprehensive and solid measure of multidimensional self-concept and
continues to be used by clinicians and researchers.

The Self-Description Questionnaire II (SDQ-II) The Self-Description Questionnaire II

(SDQ-II) (Marsh, 1992b) is a companion instrument to Marsh’s SDQ-I, designed for use
with adolescents (aged 13 to 17). This instrument may be administered individually or to
groups. Like the SDQ-I, the SDQ-II is designed to provide a multidimensional assessment
336 s Assessment of Specific Problems, Competencies, and Populations

of self-concept. The 102 items of the SDQ-II load into 12 scales in three areas: Academic
(Mathematics, Verbal, General-School), Non-Academic (Physical Abilities, Physical
Appearance, Same Sex Peer Relations, Opposite Sex Peer Relations, Parent Relations,
Emotional Stability, Honesty/Trustworthiness), and Global (Total Academic, General
Self). The items of the SDQ-II have many similarities with the SDQ-I items but are written
at a higher reading level and address many adolescent-specific concerns. The items are
rated using a 6-point Likert scale, and the self-report rating form is hand scored using a
convenient scoring profile.
The SDQ-II manual includes extensive information on reliability, validity, and other
technical properties, and the instrument has been researched extensively with samples
from various nations. It was developed in British English but has been translated and
researched in several other languages. The SDQ-II was normed with a large, representative
sample of adolescents from several English-speaking nations, primarily Australia. Because
the SDQ-II has been in development and used internationally for several years and because
numerous research standardization samples have been gathered, it is best to view it as
having several norming samples rather than just the norming sample presented in the
manual. An American standardization study by Gilman, Laughlin, and Huebner (1999)
with a sample of 291 adolescents in the United States found the SDQ-II to have similar
psychometric properties with this sample as have been reported in other samples. Internal
consistency reliability of the SDQ-II scales has been shown to vary from the low-0.80s to
mid-0.90s range. Short-term test–retest reliability has been shown to be strong, in the
0.70s to 0.80s range. The subscale or factor structure proposed by the author has been
confirmed in several studies across various standardization groups. Validity evidence
has accrued in several forms, including correlations with other measures, evidence of
theory-based group differences in scores, and strong relationships to important criteria or
outcomes. One expert recognized the SDQ-II as the most validated self-concept measure
available for use with adolescents (Byrne, 1996), with favorable reviews from other authors
as well (e.g., Keith, 1995). The SDQ-II is a comprehensive, extensively researched, and
useful instrument that should be considered seriously as a choice for assessing self-concept
in adolescents.

The Self-Perception Profile for Children (SPPC) The Self-Perception Profile for Children
(SPPC) (Harter, 1985b, 2012) is a self-report instrument designed to assess multidimen-
sional self-concept in children aged eight to 15. The SPPC includes 36 pairs of statements
that reflect opposing views of particular aspects of self-concept (e.g., “Some kids wish their
body was different, BUT Other kids like their body the way it is”). Examinees are asked first
to choose which statement in the pair is most like them, and after they have made this
initial choice they are asked to determine whether the statement they have chosen is really
true or sort of true for them. Each test item is scored using a 4-point scale, with 1 reflecting
the lowest and 4 reflecting the highest self-concept rating.
The 36 SPPC items are divided into six dimensions: Scholastic Competence, Social
Acceptance, Athletic Competence, Physical Appearance, Behavioral Conduct, and Global
Self-Worth. In contrast to the MSCS, the global self-worth scale is not a summation of
the other subscales, but comprises six statements that reflect how the subject feels about
himself or herself in an overall sense. Scoring the SPPC is done by determining the
raw score mean value for each of the six dimensions, then comparing these scores with
means and standard deviations of grade- and gender-specific score breakdowns from the
 Assessing Internalizing Problems s 337

normative group and plotting the mean scores on a pupil profile form where score levels
are seen to be in the low, medium, or high range. Higher mean scores for each scale
indicate higher perceptions of self-worth. The SPPC also includes two corollary instru-
ments: a rating scale for teachers and an importance rating scale for subjects. The teacher
rating scale provides a basis for comparing a child’s responses with an objective rating,
whereas the importance rating allows the examiner to determine if any discrepancies
exist between the child’s self-perception ratings and the importance of those ratings to
the child’s overall self-esteem. For example, a low score on athletic competence may or
may not be cause for concern, depending on how important athletic competence is for
the child.
The SPPC was originally normed in the 1980s and 1990s on four samples of children
(1,543 total) from Colorado in grades 3 to 8. Tables of mean scores and standard deviations
from the norm group are presented in the test manual based on gender and grade-level
breakdowns. Internal consistency reliabilities on the SPPC range from 0.80 to 0.90 across a
number of samples, and test–retest correlations across subscales have been found to range
from 0.40 to 0.65 at one-month to one-year intervals (Harter, 1990). The factor structure
of the SPPC seems to be sound, with items loading well into their respective factors and the
six scales having only moderate intercorrelations. Gender differences in self-concept scores
are reported in the SPPC manual, with the most systematic effects indicating that boys see
themselves as significantly more athletically competent than girls, and girls see themselves
as significantly better behaved than boys. Some additional significant gender effects were
found in the areas of global self-worth and physical appearance, but these effects were not
consistent across grade levels. An interesting finding in this regard is that at the elementary
level there are no significant differences between boys’ and girls’ scores on these two dimen-
sions, but at the middle school level, boys’ scores in both areas are significantly higher than
girls’ scores.
The SPPC is a unique and innovative instrument and can be recommended on several
grounds. Because it is a relatively brief measure (in comparison with the other measures
reviewed in this section), it offers the advantage of brevity when a short screening tool is
needed. There are some potential weaknesses, however, that warrant using it with caution.
The SPPC norm group was taken from only one state, reducing the confidence with which
score interpretations can be generalized. Although the accumulated research evidence
regarding the SPPC is substantial (there were less than 75 studies by 1998), a large national
norm sample would be extremely useful, as would raw score to standard score and
percentile conversion tables.

The Self-Perception Profile for Adolescents (SPPA) Harter’s (1988, 2012) Self-Perception
Profile for Adolescents (SPPA) is a 45-item self-report instrument that is similar in design
to the SPPC. The items and scales use the same type of rating and scoring format as the
SPPC; only the SPPA characteristics that differ from those of the SPPC are discussed
in this section. The items in the SPPA are mostly similar to those in the SPPC but are
worded specifically for use by teenage subjects (e.g., “Some teenagers wish their physical
appearance was different, BUT Other teenagers like their physical appearance the way it
is”). In addition to the rewording of items from the SPPC, more items were added to the
SPPA to reflect specific concerns of teenagers, such as job competence, close friendship,
and romantic appeal. These three areas of concern appear as additional subscales on
the SPPA, and the SPPA has a total of nine subscales instead of the six that are found
338 s Assessment of Specific Problems, Competencies, and Populations

on the SPPC. Like the SPPC, the SPPA includes an importance rating scale for examinees
and a teacher’s rating scale for assessing actual student behavior (e.g., “This individual is
good looking OR This individual is not that good looking”).
The SPPA was normed on a group of 651 students in grades 8 to 11 from four samples
in Colorado. For each of the three grade levels, separate norms are provided for boys and
girls. Internal consistency reliability of the SPPA is reported to range from 0.74 to 0.91.
The factor structure of the SPPA appears to be adequate, and the generally moderate
intercorrelations among the nine subscales suggest a basis for a multidimensional con-
struction of self-concept. Like the SPPC, the SPPA has good face validity and offers an
innovative and comprehensive method of assessing adolescent self-concept. A reasonable
amount of external research evidence regarding this instrument has accumulated. The
SPPA is also limited by the lack of a large nationwide norm sample and scant technical
information in the manual. It has been the object of several external validity studies, has
held up well over several years of research and clinical use, and offers a good alternative
for a brief screening instrument.

LINKING ASSESSMENT TO INTERVENTION

In comparison with externalizing problems, in the domain of internalizing problems it is
more difficult to establish a solid link between assessment and intervention. One of the
major reasons that this link has been tenuous has to do with the nature of internalizing
problems. Given that these types of problems often involve subjective individual percep-
tions and states, it is more difficult to identify tangible and directly observable behaviors
to consider for intervention. For example, if a comprehensive assessment reveals that a
child feels excessive sadness and has an extremely low opinion of himself or herself,
a clinician should know that this child needs some attention. This type of assessment
information does not give obvious clues, however, regarding what kind of attention
would be best in ameliorating these symptoms. In contrast, comprehensive assessment
data regarding externalizing problems often provide direct cues regarding what is needed
because the problem behaviors are overt and defined easily as problems. Externalizing
problems are a good choice for conducting a functional behavior assessment. As has
been discussed previously in this chapter, functional behavior assessment methods are
becoming more accepted but are still a challenge when used with internalizing problems.
Although there is some promise in this regard, there is still not a standard methodology
in place for functional assessment of internalizing problems.
This challenging state of affairs on linking assessment to treatment does not mean
that effective treatment for internalizing disorders is not possible. On the contrary, reviews
in this area have shown that although the number of controlled treatment studies are
somewhat limited, there are several potentially effective interventions for a variety of
internalizing problems of children and adolescents (e.g., Durlak et al., 2011; Hops &
Lewinsohn, 1995; Mash & Barkley, 1989; Merrell, 2008; Schwartz, Gladstone, & Kaslow,
1998; Silverman & Ginsburg, 1998). The key problem is not the absence of effective
interventions for internalizing problems. Rather, it is determining how to select, target,
deliver, and monitor these interventions.
Despite the sometimes challenging link between assessment and intervention with
internalizing problems, there is no question that carefully gathered assessment information
 Assessing Internalizing Problems s 339

can guide the development and delivery of effective interventions. It has been shown
convincingly that comprehensive combined cognitive and behavioral treatment methods
constitute the strongest evidence-based psychosocial approach to treating depression
in children and adolescents (Merrell, 2008). Careful scrutiny of the assessment inform-
ation, including a qualitative evaluation of individual self-report items and interview
results, may be helpful in targeting and tailoring specific cognitive–behavioral techniques,
such as identification of automatic negative thoughts, reduced engagement in positive
activities, and distorted perceptions. Likewise, similar strategies may be used to link
assessment information to cognitive–behavioral treatment techniques for anxiety.
Specific behavioral information regarding anxiety symptoms, which might be obtained
from rating scales and direct observation, might prove to be useful in forming hypotheses
to design a behaviorally oriented intervention, such as systematic desensitization or
relaxation training. The use of brief self-report measures of internalizing problems
may be useful for monitoring intervention progress or response to treatment, whereas
comprehensive self-report instruments may prove useful for evaluating the overall effects
of an intervention at its conclusion. Finally, short forms of self-reports are becoming
more commonly used in schools to screen universally and identify students at risk for
developing depression and/or anxiety. Developing systems to support these practices are
critical and can serve to prevent more serious internalizing problems from occurring.
Students who score in an elevated range on screening measures may be eligible for
targeted intervention and may show quicker improvement in symptoms than if screening
never had occurred.

CONCLUSIONS
In contrast to externalizing problems, the domain of internalizing problems includes
overcontrolled and inner-directed characteristics and is generally thought of as consisting
of emotional rather than behavioral problems. The major areas within the internalizing
domain are depression, anxiety, social withdrawal, and somatic problems. Specific classi-
fication paradigms, prevalence estimates, and division of symptoms have been more
difficult to achieve with internalizing disorders than externalizing disorders, partly because
of the more covert nature of internalizing symptoms and partly because the research in
this area has lagged behind the research focused on the externalizing domain.
Although internalizing disorders of childhood may not have as negative long-term
implications for later life adjustment as do externalizing disorders, they do pose serious
problems for the children and their families who suffer from them. Not only do internal-
izing disorders create substantial barriers to present adjustment and success, but they also
may persist for several years in some cases and may become lifelong debilitating problems.
Research is increasingly indicating that internalizing disorders in childhood are not as
benign as once thought; they seem to be associated with various negative outcomes later
in life, particularly if they are left untreated.
A more recent development in understanding internalizing disorders is the articula-
tion of the theory of positive and negative affectivity. These differing aspects of mood
states appear to contribute to the development and classification of specific internalizing
disorders. For example, persons who are depressed tend to have high levels of negative
affectivity and low levels of positive affectivity, whereas persons who are anxious tend to
340 s Assessment of Specific Problems, Competencies, and Populations

have high levels of negative affectivity but normal levels of positive affectivity. Positive
and negative affectivity may be useful in future paradigms of these disorders.
An inverse relationship exists between internalizing problems, particularly depression,
and self-concept. That is, poor self-esteem or poor perceived self-competence is often an
attribute or product of internalizing disorders. Assessment of internalizing problems also
should take into account the possibility of self-concept assessment. The most sophisticated
current self-concept theories are multidimensional in nature, meaning that they view
global self-concept as something more complex than a simple summation of one’s self-
concept in specific areas.
Assessment of internalizing problems is uniquely suited for self-report methods,
including clinical interviews and the use of self-report instruments. Increasingly, experts
in this area consider obtaining the self-report of a referred child or adolescent with
internalizing problems as an essential part of the overall assessment design. Clinical
interviewing, whether unstructured or highly structured, provides an excellent means of
assessing perceptions of internalizing problems, as do the many technically sound self-
report instruments that have been developed in this area. Behavioral observation of
internalizing problems is difficult because so many internalizing symptoms are not
observed easily through external means. There are certain situations, however, in which
direct observation may be helpful. Behavior rating scales suffer from some of the same
drawbacks as direct observation as a means for assessing internalizing problems, but they
typically are considered to be an important part of the overall assessment design, and
improvements in this area have been encouraging. Sociometric assessment of internalizing
problems also has similar limitations related to external observation of internalizing
characteristics, but there have been some impressive developments in this area as well.
Although there are numerous intervention strategies that have proven to be effective
in treating internalizing problems, it is often challenging to link assessment results directly
to intervention planning in this area. Careful evaluation of assessment information may
prove to be helpful, however, in targeting specific assessment techniques and in monitor-
ing and evaluating intervention. Clinicians should be encouraged by findings regarding
the potential efficacy of psychological treatments for depression, anxiety, and related
internalizing problems.

REVIEW AND APPLICATION QUESTIONS

1. This chapter states repeatedly that internalizing disorders are more difficult than external-
izing disorders to identify, empirically classify, and count. Beyond the obvious explanation
that internalizing disorders are harder to observe through objective means than externalizing
disorders, what are some other possible explanations for these difficulties?
2. Compare the behavioral dimensions approach to classifying internalizing disorders with
the DSM diagnostic categories relevant to internalizing disorders. What do the large
differences between the two approaches to classification imply about the current state of
classification?
3. What are the major differences between depression as a symptom, depression as a
syndrome, and depression as a disorder?
4. What is known regarding persistence and long-term implications of internalizing disorders?
5. What are some assessment issues to be considered, and what is known regarding differences
between parent report and child self-report of internalizing symptoms of children and
adolescents?
 Assessing Internalizing Problems s 341

6. If you had to choose between conducting a clinical interview and using an objective self-
report instrument with a child or adolescent who had significant internalizing symptoms,
under which conditions would you choose each, and why would you choose them?
7. Characterize the state of the art regarding child and adolescent self-report instruments
for internalizing problems compared with any other general category of problems. Related
to this issue, what are some of the problems that still exist with internalizing self-report
measures?
8. Discuss the idea of applying a function-based assessment to internalizing problems.
Describe the questions you might ask the child or adolescent and how you would plan an
intervention based on this information.
9. Ironically, assessment of externalization problems is linked more easily to intervention
planning than is assessment of internalizing problems, yet the interventions for internalizing
problems seem to be more effective than those for externalizing problems. What are some
reasons for this state of affairs?
 12
ASSESSING OTHER BEHAVIORAL, SOCIAL,
AND EMOTIONAL PROBLEMS

Throughout this book, various behavioral, social, and emotional problems of children
and adolescents have been discussed most frequently in terms of their place within the two
broad dimensions of externalizing and internalizing psychopathology or disorders. This
broad-band taxonomic division has become the standard paradigm among researchers
who investigate developmental psychopathology. Not all childhood behavioral or emo-
tional problems fit neatly within this model, however. Some disorders, as evidenced by
some of the narrow-band cross-informant syndromes in the ASEBA, are considered to
be mixed disorders. Within these syndrome scales, some items may load into the external-
izing domain, other items may load into the internalizing domain, and some items may
not load specifically into either of the two broad-band domains. Some severe problems,
such as psychotic disorders and pervasive developmental disorders, occur with such low
frequency in the general child population that it is difficult to justify even including rele-
vant items for them in general screening instruments. Large-scale epidemiologic studies
usually identify so few cases in which these low-frequency behaviors are present that it is
difficult to ascertain accurately their appropriate classification dimensions.
This chapter discusses several of the problems and disorders that do not fit neatly
within the externalizing–internalizing dichotomy, or that occur infrequently in general
child populations. For lack of a better descriptive term, these are referred to in this chapter
as “other behavioral, social, and emotional problems.” Because the major emphasis of this
text is on assessment and classification of more common externalizing and internalizing
problems, the issues and disorders discussed in this chapter are not examined in substantial
depth. Rather this chapter is intended to provide a brief general overview for understanding
and assessment of the lower base-rate and more diagnostically nebulous problems that
occasionally may be encountered by school psychologists, clinical child psychologists, and
related professionals, particularly those working in generalist educational and mental
health settings. Professionals who work in pediatric, psychiatric, or highly specialized
education settings would encounter some of these problems more frequently than the
generalists and likely would have developed a more comprehensive network of assessment,
diagnostic, and intervention aids. School and clinical child psychologists (and related
mental health professionals) who are more generalist in nature likely need to develop a
network of contacts among their more specialized colleagues for purposes of consultation
and referral when some of these other problems are encountered.
The format of this chapter differs from the chapters on assessment of externalizing
(Chapter 10) and internalizing disorders (Chapter 11). The chapter begins with discus-
sions of the two major approaches to classification and how they treat the various types of

343
344 s Assessment of Specific Problems, Competencies, and Populations

problems in question. Because of the wide variety of characteristics and assessment needs
of the various problems and disorders discussed in this chapter, each problem area is
covered separately, including Autism Spectrum Disorder, Schizophrenia Spectrum
Disorders, Psychotic Disorders, Tic Disorders (specifically, Tourette’s Disorder), and
Eating Disorders. Rather than including separate discussions of the major methods of
assessment, as is the case in Chapters 10 and 11, details on assessment of specific problems
and disorders covered herein (limited in some cases) are presented in conjunction with the
general descriptions of these problems. The chapter concludes with a brief discussion on
future directions in this area and some ideas for linking assessment to intervention.

CLASSIFICATION AND TAXONOMY

From the beginnings of psychology as a scientific discipline in the late 1800s, definition
and classification of low-frequency and severe behavioral, social, and emotional problems
have been a continuing problem. Because these disorders are relatively rare and because
some of the classification categories have a fair amount of common or overlapping
characteristics, the research base for classification and taxonomy in this area has lagged.
Until about the 1960s, it was common for the generic term childhood psychoses to be used
in the classification of all severe childhood disorders, although many other labels were
used previously with some regularity, including dementia precocissma, dementia infantilis,
childhood schizophrenia, infantile autism, autistic psychopathy, symbiotic psychosis, and
atypical child (Howlin & Yule, 1990). Because the term childhood psychoses has no precise
meaning, it is seldom used today, and most current classification paradigms are connected
to the DSM system.

Behavioral Dimensions Classification

As mentioned in previous chapters, empirical efforts to establish a reliable classification
taxonomy of severe and other low-frequency behavioral disorders were plagued by
problems stemming from small sample sizes to overlapping behavioral and emotional
characteristics. An early effort at developing a statistical taxonomy of the broad category
of childhood psychoses was a study by Prior, Boulton, Gajzago, and Perry (1975), who
used an analysis of 162 cases that ultimately led to a division into two categories: one
subgroup with early onset of autistic-like features and the other subgroup with a later
onset of symptoms and less debilitating impairment in social relationships. This study
was never replicated, but the general idea of two similar divisions has caught on to some
extent among researchers (Cantor, 1987; Howlin & Yule, 1990).
An effort at establishing a behavioral dimensions taxonomy for severe behavioral
disorders was conducted by Quay (1986a), who through his analysis of 61 multivariate
statistical studies described facets of child psychopathology. Although Quay (1986a)
noted that “the problems associated with describing childhood psychosis have not readily
yielded to clarification by multivariate statistical analysis” (p. 16), his effort resulted in an
organization into two types of syndromes that are relevant for this chapter. One of these
syndromes was labeled schizoid–unresponsive, with the most frequently identified behav-
iors being refusal to talk, social withdrawal, extreme timidity, and an aloof behavioral
presentation referred to as “cold and unresponsive.” The second of these two syndromes
was labeled psychotic disorder, with the few key behavioral features identified including
 Assessing Other Behavioral, Social, and Emotional Problems s 345

Table 12.1 Major behavioral characteristics of two types of severe

behavioral syndromes identified through Quay’s (1986a) analysis

Schizoid–Unresponsive Psychotic Disorder

Refusal to talk Incoherent speech

Socially withdrawn Repetitive speech
Shy, timid, bashful Acts bizarre, odd, peculiar
Cold and unresponsive Visual hallucinations
Lack of interest Auditory hallucinations
Sad affect Has strange ideas, behavior
Stares blankly
Confused
Secretive behavior
Prefers to be alone

incoherent and repetitive speech, bizarre behavior, auditory and visual hallucinations,
and a group of odd characteristics referred to as “strange ideas, behaviors” (Quay, 1986a,
p. 16). These two syndromes are listed with their characteristic behavioral symptoms in
Table 12.1.
This taxonomy effort, which was conducted over three decades ago, was complicated by
methodological difficulties and should be considered a preliminary or experimental effort.

The DSM Classification

The DSM classification system has evolved substantially. With regard to classification
categories for some more severe and lower base-rate childhood disorders, changes over
time have been particularly noticeable. Such continuing evolution provides evidence that
the field of developmental psychopathology has evolved rapidly and that understanding
of specific problems and disorders is likewise evolving.
The DSM-5 includes several general classification categories, some with numerous
specific diagnostic categories, that involve the “other” problems and disorders that are
the focus of this chapter. For our purposes, the general categories from the DSM-5 that
are pertinent to this chapter include Neurodevelopmental Disorders, Schizophrenia and
Other Psychotic Disorders, Feeding and Eating Disorders, and, to a limited extent, Personality
Disorders. These general categories, with their more relevant specific diagnostic categories,
are presented in Table 12.2.
There are additional general and specific categories within the DSM system that at
times are associated with behavioral or emotional disorders of children, such as Intellectual
Disabilities, Substance-Related and Addictive Disorders, Elimination Disorders, and
Disruptive, Impulse Control and Conduct Disorders. Readers who desire a more detailed
description of any of these categories that are beyond the scope of this book should refer
to the DSM-5 or specific books on psychopathology classification or developmental
psychopathology.

AUTISM SPECTRUM DISORDER

Autism Spectrum Disorder falls under the broad category of Neurodevelopmental
Disorders in the DSM-5. Autism Spectrum Disorder can constitute some of the most
346 s Assessment of Specific Problems, Competencies, and Populations

Table 12.2 Some major diagnostic areas and categories from DSM-5 that constitute severe, low base rate, or less differentiated
types of behavioral, social, and emotional disorders among children and adolescents

Neurodevelopmental Disorders
Autism Spectrum Disorder
Motor Disorders (e.g., Tic Disorders and other movement disorders)
Schizophrenia Spectrum and other psychotic disorders
(Numerous types and subtypes of schizophrenia and other disorders are also listed)
Feeding and eating disorders
Pica
Rumination Disorder
Avoidant/Restrictive Food Intake Disorder
Anorexia Nervosa
Bulimia Nervosa
Binge-Eating Disorder
(Other specified and unspecified feeding or eating disorders)

debilitating psychological conditions of children. This disorder is not focused exclusively

on the domain of behavioral, social, and emotional problems, which is the focus of this
text; however, it is primarily characterized by deficits and impairments in social commu-
nication and by narrow interests and repetitive behaviors. These deficits and associated
problems of social behavior can be severe and debilitating and certainly require an
extensive system of supports and interventions, making Autism Spectrum Disorder
an important part of this chapter. This section provides an overview of Autism Spectrum
Disorder and specific information on assessment. Because several other disorders have
been subsumed under Autism Spectrum Disorder or have been eliminated from the DSM
altogether, I will describe previous disorders categorized under the DSM-IV Pervasive
Developmental Disorders, but will provide much more detail on the history of autism and
the changes to the DSM-5 and characteristics of Autism Spectrum Disorder.
Rett’s Disorder, Childhood Disintegrative Disorder, and Asperger’s Disorder were
added to the DSM-IV but were not included in DSM-III-R and are now not part of the
DSM-5. Substantially less knowledge has accumulated regarding these disorders, which
tend to have many features in common with autism, and their brief discussion in this
section is a reflection of this fact. In addition to the discussion of each of these disorders,
their major characteristics and associated features are summarized in Table 12.3. Readers
are encouraged to take note of the significant overlap in characteristics that have defined
these disorders. The classification and description systems for this cluster of disorders have
undergone major changes and will continue to evolve significantly.
The best current estimates according to the Centers for Disease Control and Prevention
(2016) indicate that approximately one in 68 children were diagnosed with an Autism
Spectrum Disorder in 2012. This disorder has been found to occur at least four times
more frequently in boys than in girls, and has also been found more often in Caucasian
populations than in multiracial populations (CDC, 2016). In most cases, the Autism
Spectrum Disorder has an onset before three years of age but often is not diagnosed until
later, when more social demands and expectations for flexibility with routines are placed
upon the child (Shattuck et al., 2009). Hence, some children are not identified until
formally entering school, are interacting with similar-age peers, and are more objectively
observed by multiple adults in the classroom.
 Assessing Other Behavioral, Social, and Emotional Problems s 347

Table 12.3 Some major characteristics and associated features of four primary
pervasive developmental disorders that were in the DSM-IV

Autistic Disorder
Onset before age three years
Markedly impaired communication and social interaction
Markedly restricted repetitive stereotyped behavior
More common among males than females
Often associated with mental retardation
Rett’s Disorder
Onset before age four years
Decreased head growth after normal growth for first five to 48 months
Stereotyped behavior and loss of hand skills at five to 30 months
Loss of social engagement skills
Decrease in gait/trunk motor coordination
Impaired language and psychomotor ability
Very rare
Reported to occur only among females
Associated with severe/profound mental retardation
Childhood Disintegrative Disorder
Onset between aged two and ten years
Loss of acquired skills after normal growth up to age two
Abnormal social interaction skills
Impaired language ability
Stereotypic and restricted behavior, activities, interests
Very rare
Appears to be more common among males
Associated with severe mental retardation
Asperger’s Disorder
Onset during preschool years
Impaired social interaction
Restricted stereotyped behavior, interests, activities
Appears to be more common among males

Description

Autism Spectrum Disorder Psychiatrist Leo Kanner, a pioneer in the study of what is now
called Autism Spectrum Disorder, first described 11 children in 1943 who fitted this
general diagnostic picture. He noted that their fundamental disorder was the “inability to
relate themselves in the ordinary way to people and situations from the beginning of life,”
and that a characteristic of this disorder is an aloneness that “disregards, ignores, shuts out
anything that comes to the child from the outside” (Kanner, 1943, p. 243). This syndrome
was labeled by Kanner as early infantile autism because it was noted that the tendency to
display these characteristics seemed inborn and present from birth. For many years after
Kanner’s initial description, children with these characteristics were informally referred to
as having Kanner syndrome (Newsom & Hovanitz, 1997). Howlin and Rutter (1987)
noted that although there have been many changes since 1943 in the way that this disorder
is conceptualized, Kanner’s general description of autism is still fundamentally accurate.
Based on the DSM-5 diagnostic criteria (Table 12.4), the major characteristics of
Autism Spectrum Disorder include severe impairment in social communication and
348 s Assessment of Specific Problems, Competencies, and Populations

Table 12.4 Diagnostic criteria for Autism Spectrum from the DSM-5

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested
by the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Deficits in social–emotional reciprocity, ranging, for example, from abnormal social approach and
failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect;
to failure to initiate or respond to social interactions
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example,
from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and
body language or deficits in understanding and use of gestures; to a total lack of facial expressions
and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from
difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative
play or in making friends; to absence of interest in peers
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the
following, currently or by history (examples are illustrative, not exhaustive, see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor
stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases)
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or
nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid
thinking patterns, greeting rituals, need to take same route or eat same food every day)
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to
or preoccupation with unusual objects, excessively circumscribed or perseverative interests)
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
(e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures,
excessive smelling or touching of objects, visual fascination with lights or movement)
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
C. Symptoms must be present in the early developmental period (but may not become fully mainifest
until social demands exceed limited capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of
current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental
disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently
co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social
communiation should be below that expected for general developmental level.
Note: Individuals with well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or
pervasive developmental disorder not otherwise specified should be given the diagnosis of autism
spectrum disorder. Individuals who have marked deficits in social communication, but whose
symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for
social (pragmatic) communication disorder.
Specify if:
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor (Coding note: Use
additional code to identify the associated medical or genetic condition).
Associated with another neurodevelopmental, mental, or behavioral disorders (Coding note: Use
additional code(s) to identify the associated neurodevelopmental, mental, or behavioral disorder(s)).
With catatonia (refer to the criteria for catatonia associated with another mental disorder for
definition) (Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism
spectrum disorder to indicate the presence of the comorbid catatonia).
Source: Reprinted with permission from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (pp. 50–51).
Copyright 2013 by the American Psychiatric Association.
 Assessing Other Behavioral, Social, and Emotional Problems s 349

interaction and a severely restricted and repetitive repertoire of activities and interests.
These two primary symptom domains represent a significant change from the DSM-IV,
which described autism as a three-pronged disorder involving deficits in social behavior,
communication, and the presence of restrictive or repetitive behavior. The DSM-5 does
include specifiers that can be used to further describe the individual’s specific clinical
presentation, such as with or without accompanying language impairment, and there is also
a DSM-5 category of Social Communication Disorder, which may be a more appropriate
diagnostic category for some higher functioning individuals. Specific characteristics that
commonly are seen in children with autism are varied, but a common general pattern
often is observed. In terms of severely impaired social relationships, individuals with
Autism Spectrum Disorder may appear to be socially aloof and detached; they may fail
to make eye contact, have a noticeably flat affect, shrink from physical contact, and often
seem to relate to other persons as objects or conglomerations of parts rather than as
people (Newsom & Hovanitz, 1997; Ornitz, 1989; Schreibman & Charlop-Christy, 1998).
Additionally, individuals with autism often lack or fail to grasp the pragmatics of social
or interpersonal communication, possibly because of an inability to interpret facial
expressions, intonation, gestures, and other social cues (Prior & Werry, 1986). The severely
restricted repertoire of activities and interests that is part of the disorder is characterized
by stereotyped body movements (spinning, twisting, head banging, flapping the hands),
a peculiar preoccupation with parts of objects (e.g., doorknobs, on–off switches), and
exhibition of great distress when routines or insignificant parts of the environment
are changed. Behaviors that are part of this second characteristic often take the form of
obsession with routine and objects, such as a child repetitively dumping a pile of sticks
on the floor and then lining them up in a particular manner. The additional specifiers
in the DSM-5 may be used to reflect individuals who may not engage in speech, or they
may speak in a peculiar manner, such as using a robotic monotone voice, displaying an
odd vocal rhythm and meter, or repeating words and phrases in a stereotypical manner
(Howlin & Yule, 1990; Schreibman & Charlop-Christy, 1998). Individuals with autism
may also experience a host of other challenges. For example, they may experience gastro-
intestinal problems, sleep problems, immune system problems, social anxiety, aggression,
ADHD, and OCD.
Aside from the major features of Autism Spectrum Disorder, there are some other
correlates to consider. IQ scores of individuals with autism often are in the normal range
or higher, but this is not always the case; many individuals with autism consistently test in
the moderate to severely intellectually impaired range (Klinger, Dawson, Barnes, & Crisler,
2014; Prior & Werry, 1986). Autism Spectrum Disorder often may be associated with prob-
lems of sensory integration and perception (Kern et al., 2006; Klinger et al., 2014; Wing,
1969) and poor psychomotor development (Fulkerson & Freeman, 1980; Klinger et al.,
2014). Because the combination of social impairment and low intellectual ability is often
part of the picture, persons with Autism Spectrum Disorder may have significant difficulty
learning new materials or tasks.
Kanner’s (1943) early writings on autism considered that there was a strong probability
that the disorder had a constitutional or biological origin. During this same seminal period
of discovery, however, Kanner and others noted that parents of children with autism often
showed a tendency toward emotional insulation, aloofness, or detachment toward the
child. The notion was born and perpetuated by prominent writers (e.g., Bettelheim, 1967;
O’Gorman, 1970) that autism may be due to abnormal family functioning. Although
350 s Assessment of Specific Problems, Competencies, and Populations

based on some important clinical observations, the problem with these theories was that
they usually failed to take into account the reciprocal effect of parent–child inter-
actions and placed too much weight on parent behaviors. The transactional–interactional
approach would indicate that although parents of children with Autism Spectrum Disorder
might respond at times in a manner that could be interpreted as emotionally detached, the
characteristics of the child may have a great deal of influence on eliciting these behaviors.
Despite this line of thinking, which was popular until about the 1970s, research efforts
have failed to support the notion that autism is caused by abnormal parenting or family
functioning (Howlin & Yule, 1990).
Although there is no conclusive evidence on the specific causes of Autism Spectrum
Disorder at present, current thinking suggests that genetic and other biochemical influ-
ences are clearly involved in the disorder. In a large study, Ozonoff et al. (2011) found that
there is indeed an increased risk for families with one child with autism to have multiple
children with autism. Others have described a “broader phenotype” or the likelihood for
family members to present with characteristics that may be consistent with Autism
Spectrum Disorder, even if they don’t necessarily meet criteria for disorder (e.g., poor
social skills) (Klinger et al., 2014). The complexity of the biologically linked explanations
for autism is captured in the following statement by Travis and Sigman:

The etiology of autism is not well understood. Research has established that psycho-
logical or social stressors do not cause autism, focusing attention squarely on biolog-
ical underpinnings. However, it now appears unlikely that autism is caused by any
single organic factor. Rather, there is probably a heterogeneous set of biological factors
and multiple causal paths that may result in autism. The search for biological under-
pinnings has revealed that autism is associated with a number of organic conditions,
such as prenatal and obstetric complications, the onset of epilepsy in adolescence or
adulthood, and two genetic disorders, tuberous sclerosis and Fragile X syndrome . . .
The reasons for these links are not yet understood.
(2000, p. 642)

The best evidence from follow-up studies of children with autism indicates that although
some improvements may occur over time (particularly with intense early intervention
efforts), many, if not most, individuals with the disorder will continue to exhibit some
characteristic problem symptoms over the course of their life. Howlin and Yule (1990)
noted that individuals with Autism Spectrum Disorder who have the greatest chance of
achieving social independence and making satisfactory adjustment are those few with
high IQ scores and reasonably good language skills and that “total social independence
is gained by only a very small minority of autistic individuals” (p. 376). For many with
Autism Spectrum Disorder, the long-term implications of the disorder are severe, and
many require a high degree of personal, social, and occupational support throughout life.

Asperger’s Disorder Asperger’s Disorder is now subsumed under Autism Spectrum

Disorder in the DSM-5. According to the DSM-IV, this disorder was described as the follo-
wing: “The essential features of Asperger’s Disorder are severe and sustained impairment
in social interaction and the development of restricted, repetitive patterns of behavior,
interests, and activities” (APA, 1994, p. 75). Based on this description, readers can begin to
understand how there may be an overlap between what was previously defined as Autistic
 Assessing Other Behavioral, Social, and Emotional Problems s 351

Disorder and Asperger’s Disorder. The major difference that clinicians and scholars con-
sidered between the two was that Asperger’s Disorder did not include significant delays
in language development and functioning. Also, Asperger’s Disorder was characterized
by the lack of clinically significant delays in cognitive development, self-help skills, and
nonsocial adaptive behaviors. In several respects, Asperger’s Disorder was already consid-
ered to be a form of “high functioning” autism (Mesibov, Shea, & Adams, 2001). Despite
an upsurge of interest in this condition in the 1990s and 2000s, information regarding
the prevalence of Asperger’s Disorder is quite limited, but it was thought to appear more
commonly in boys. It seemed to have a later onset than autism. Perhaps the most critical
feature of Asperger’s Disorder were the significant difficulties in social interaction.
DSM-IV stated that “individuals with the condition may have problems with empathy and
modulation of social interaction” (APA, 1994, p. 76). Asperger’s Disorder seemed to follow
a continuous developmental course, almost always throughout the life span. This dis-
order bore some similarity to the major characteristics of the schizoid–unresponsive
behavioral dimension shown in Table 12.1. This disorder was named after Hans Asperger,
who, according to Wolf (1989), was the first person to discuss the so-called schizoid dis-
orders in the 1940s. These disorders were identified as separate diagnostic categories
in DSM-IV, but they also had some similarity to Schizoid and Schizotypal Personality
Disorders, which might be diagnosed in older adolescents. This general class of schizoid
disorders is discussed later. There was a tremendous increase in interest in Asperger’s
Disorder in the 1990s, particularly since it was included as a separate diagnostic category
in the DSM-IV in 1994 (Bashe & Kirby, 2001; Klin, Volkmar, & Sparrow, 2000; Myles &
Simpson, 1998). There seemed to have been a significant increase in the number of diag-
nosed cases due to this category, which was either due to increased awareness or true
increased prevalence.

Rett’s Disorder A very rare condition, the most “essential feature of Rett’s Disorder is the
development of specific deficits following a period of normal functioning after birth”
(APA, 1994, p. 71). These deficits include deceleration of head growth between the ages
of five and 48 months, loss of previously acquired hand skills between five and 30 months,
loss of social engagement early in the course of the disorder, poor motor coordination,
and severe impairments in expressive and receptive language development (a major
defining characteristic), coupled with severe psychomotor retardation. This is a very low-
incidence disorder that has been reported only in girls. Exact prevalence estimates are
unknown, but Rett’s Disorder seems to occur much less frequently than autism. In most
cases, affected individuals make some modest developmental gains, but the various
difficulties they encounter tend to remain throughout their life span. Given that Rett’s
Disorder is no longer part of the DSM, there could be instances when individuals meet
criteria for Autism Spectrum Disorder and have Rett’s Disorder. In these cases, this could
be specified as Autism Spectrum Disorder “associated with a known medical or genetic
condition or environmental factor.”

Childhood Disintegrative Disorder This pervasive developmental disorder is character-

ized by marked regression in several areas of functioning, after a period of two or more
years of apparently normal development. With this disorder, the child shows a sub-
stantial loss of functioning in two or more of the following areas: expressive or receptive
language, social skills or adaptive behavior, bowel or bladder control, play, or motor skills.
352 s Assessment of Specific Problems, Competencies, and Populations

Children who develop Childhood Disintegrative Disorder typically exhibit some of the
social, communication, and behavior features associated with autism. It is usually accom-
panied by severe mental intellectual impairment. Prevalence data for this disorder are
limited. It does seem to be rare (occurring much less frequently than autism), however, and
is probably more common among boys. The duration of the disorder is lifelong in most
cases. Again, using DSM-5 criteria, individuals may still be diagnosed with Autism Spectrum
Disorder and Childhood Disintegrative Disorder would be identified as a specifier.

Assessment
Assessment of Autism Spectrum Disorder necessarily relies heavily on direct behavioral
observation; clinical interviews with parents, caretakers, and teachers; and, in some
instances, specialized behavior rating scales. In addition to behavioral and psychological
assessment data, it is crucial to recognize that separate medical assessments of children with
serious developmental disorders should be conducted by qualified behavioral pediatricians
or specialists. With the exception of children and adolescents having adequate language
and intellectual abilities, direct interviews with the child, self-report instruments, and
sociometric techniques typically are not very relevant or useful for this class of problems.
Most of the general-purpose behavior rating scales discussed in Chapter 5 would be useful
for initial screening of Autism Spectrum Disorder symptoms. These general-purpose rating
scales rarely contain more than a handful of items, however, that are directly relevant to the
low-frequency problem behaviors that occur with Autism Spectrum Disorder.
Several behavioral observation coding systems, behavior rating scales, and structured
interview schedules have been developed specifically for use in the assessment of autism,
and several of them have been documented widely through research efforts. Brief reviews
of several of these instruments are presented in this section.

The Autism Diagnostic Observation Schedule (ADOS) The Autism Diagnostic

Observation Schedule (ADOS; Lord et al., 1989) is a standardized protocol for the obser-
vation of social and communicative behaviors that typically are associated with autism in
children. The ADOS differs from most other standardized observation schedules in that
it is interactive, requiring the observer to engage with the target child as an experimenter
or participant on several standardized tasks that are designed to yield a better qualitative
analysis of autistic behaviors than would be possible through simple observation and
coding. The ADOS does not focus as much on specific autistic-type behaviors as some
other observation schedules, but was designed to “facilitate observation of social and
communicative features specific to autism rather than those accounted for or exacerbated
by severe mental retardation” (Lord et al., 1989, p. 187). Through its interactive nature,
emphasis on examiner behavior, and qualitative focus, the ADOS allows for assessment
of some of the crucial features of autism that may distinguish the disorder from other
severe developmental disorders.
The ADOS consists of eight tasks that are presented to the subject by the observer
within a 20- to 30-minute timeframe. Two sets of materials are required for most tasks
(a puzzle or pegboard and a set of familiar and unusual miniature figures), and the content
and specific demands of these tasks can vary according to the age and developmental level
of the subject. The eight tasks include construction, unstructured presentation of toys,
drawing, demonstration, a poster task, a book task, conversation, and socioemotional
questions. Within these tasks, 11 strands of target behaviors are coded, and general ratings
 Assessing Other Behavioral, Social, and Emotional Problems s 353

are made after the interaction or observation according to a 3-point qualitative severity
scale in four different areas: reciprocal social interaction, communication/language,
stereotyped/restricted behaviors, and mood and nonspecific abnormal behaviors.
Reliability and validity data presented by the authors of the ADOS are encouraging and
have shown that the observation has adequate inter-rater and test–retest reliability and
discriminant validity between autistic subjects and subjects with and without other types
of developmental disabilities. Although the ADOS was developed as a research tool and is
experimental, it seems to be an observational method that may provide a rich array of
information on the qualitative aspects of autism.
The ADOS-2 (Lord et al., 2012) is similar to the original in that it includes a semistruc-
tured and standardized approach to the assessment of Autism Spectrum Disorder. This
new version includes five modules, which vary based on the child’s age and verbal fluency.
The newest module is the Toddler Module and can be used with children aged 12 to
30 months, who do not fluently speak in phrases. Children are only administered one
module, which takes about one hour. The ADOS-2 also includes updated algorithms that
allow one to identify the range of concern (Toddler Module) or descriptive classifications
(Modules 1–4) such as Autism, Autism Spectrum, or Non-Spectrum. These new algorithms
have established predictive validity and increase the sensitivity of classification descrip-
tions for many of the modules (Gotham et al., 2008). The ability to calculate a Comparison
Score is also available with this version, which means that one will be able to understand
how a child’s scores compare to those of other children who are the same age, have similar
language patterns, and already have been diagnosed with Autism Spectrum Disorder.
This new version of the ADOS is often considered as a “gold standard” for the assessment
of Autism Spectrum Disorder.

The Autism Diagnostic Interview (ADI) The Autism Diagnostic Interview (ADI) (Le
Couteur et al., 1989) is a standardized structured interview schedule designed to assess the
crucial characteristics of Autistic Disorder and to differentiate pervasive developmental
disorders from other developmental disorders such as mental retardation. The ADI was
developed for use by highly trained clinicians in conducting interviews with the principal
caregivers of children who are at least five years old, with a mental age of at least two years.
The ADI is considered to be an investigator-based rather than a respondent-based interview
because it requires the interviewer to be familiar with the conceptual distinctions of
pervasive developmental disorders and to actively structure the interview probes by
providing examples and getting the interviewees to provide highly detailed qualitative
information rather than simple yes/no responses.
The basic interviewing task is to obtain detailed descriptions of the actual behavior
of the target subject in three general areas: reciprocal social interaction; communication
and language; and repetitive, restricted, and stereotyped behaviors. The caregiver descrip-
tions are scored according to a scale ranging from 0 to 3, where a score of 0 indicates the
specified behavior is not present and 3 indicates that the behavior is present to a severe
degree. Individual item scores are converted into three area scores and a total score, based
on a scoring algorithm that was devised using the World Health Organization ICD-10
diagnostic criteria for autism. The length of time required for the interview varies accord-
ing to the skill of the examiner and the amount of information provided by the caregiver,
but the developers of the ADI note that test interviews conducted during initial research
tended to last two to three hours.
354 s Assessment of Specific Problems, Competencies, and Populations

Reliability and validity research reported by the authors of the ADI indicate strong
psychometric properties. The ADI item, area, and total scores have been shown to have
good reliability (generally in the 0.70 range), based on agreement between raters from an
experiment with 32 videotaped interviews that were scored by four independent raters.
The ADI area scores, total scores, and most individual item scores have been shown to
differentiate between subjects with autism and subjects with intellectual disabilities
to a significant degree, which indicates that the instrument is sensitive to qualitative
differences in developmental problem patterns. The ADI item scores and many of the
individual items also were found to have high sensitivity and specificity properties in
differentially diagnosing autism and mental retardation. It should be assumed that the
ADI would easily differentiate between autism and the milder developmental disorders
(e.g., developmental delays and routine learning disabilities).
In sum, although there are few standardized interviews for autism, the ADI represents
a strong preliminary step in this area. The ADI-R (Rutter, LeCouteur, & Lord, 2003) is the
current available version and has been revised to be consistent with the DSM-IV. This
newest version is shorter than the original and is appropriate for children with a mental
age of 18 months and can be used through adulthood. It should be considered seriously
by researchers conducting epidemiological studies and by clinicians who desire a struc-
tured method of obtaining information on autism from caregivers. Proper use of the
ADI-R requires intensive training of interviewers and a considerable amount of time in
administering the interview, so potential users should consider these constraints. It will
be interesting to see if an updated version of the ADI-R, aligned with DSM-5, becomes
available.

The Childhood Autism Rating Scale, Second Edition (CARS-2) The Childhood Autism
Rating Scale, Second Edition (CARS-2) (Schopler, Van Bourgondien, Wellman & Love,
2010) consists of two brief (15-items) behavior rating scales designed to identify children
with Autistic Disorder (CARS2-SF: Standard Form) and High-Functioning Autism or
Asperger’s Disorder (CARS2-HF: High-Functioning Form) and to distinguish them from
children with other types of developmental disorders. They were designed to be completed
by professionals who work with children in educational, medical, or mental health settings
and can be used with children aged two and older. The behaviors on the CARS-2 are rated
according to frequency, intensity, peculiarity, and duration. The item content of the CARS-2
is based on a broad view of autism (not just Autistic Disorder) from multiple diagnostic
systems, including the DSM. The ratings may be based on a direct observation of child
behavior within a given setting, a review of other relevant assessment data, or impressions
of observations over time. After the child has been rated on each item on the standard
form, a total score is obtained, and a percentile rank is given according to a normative
sample of 1,034 children with Autism Spectrum Disorder. The CARS2-HF, new with
this latest revision of the CARS-2, applies specifically to children aged six and older
with more fluent verbal skills, and an IQ of 80 or higher. This form is based on a develop-
mental sample of 994 children and assesses skills in the domains of Social–Emotional
Understanding, Emotional Expression and Regulation of Emotions, Object Use in Play,
Adaptation to Change/Restricted Interests, Fear or Anxiety, and Thinking/Cognitive
Integration Skills. Unique to the CARS-2 is a Questionnaire for Parents or Caregivers
(CARS-2-QPC). While this form does not derive quantitative data, it enables the family to
provide important qualitative data that can help frame the results of the other forms.
 Assessing Other Behavioral, Social, and Emotional Problems s 355

In a recent review of the CARS-2 (Vaughan, 2011), technical adequacy data were
reported. Internal consistency coefficients for the CARS2-ST (0.93) and the CARS-HF
(0.96) were strong. The CARS-ST has been found to distinguish children with autism
from children without autism, and the CARS-HF has similarly been found to distinguish
children with high-functioning autism from children without. Concurrent validity
data also suggest that both forms correlate moderately with the original ADOS (Lord
et al., 1989).
In sum, the CARS-2 will likely follow its predecessor and become one of the most widely
used and proven assessment instruments for autism. It has sound technical properties, is
easy to use, and is one of the best available rating scales for screening and assessing children
who exhibit symptoms of autism.

The Gilliam Autism Rating Scale, Third Edition (GARS-3) The Gilliam Autism Rating
Scale, Third Edition (GARS-3) (Gilliam, 2013), is a recently published revision and
expansion of the original two Gilliam Autism Rating Scales (Gilliam, 1995, 2006), which
proved to be a very popular and widely accepted assessment tool. The GARS-3 is a behavior
rating scale designed for use by teachers, parents, and professionals in identifying and
diagnosing autism in individuals ages three to 22. The GARS-3 is aligned with the DSM-5
criteria for Autism Spectrum Disorder and includes 56 items. There are six subscales
including Restrictive/Repetitive Behaviors, Social Interaction, Social Communication,
Emotional Responses, Cognitive Style, and Maladaptive Speech.
New normative data were collected for this edition in 2010 and 2011 and included
1,859 youth. Psychometric properties appear strong with internal consistency coefficients
exceeding 0.85 for the subscales and 0.93 for the Autism Indexes. Inter-rater reliability
ranged from 0.80 to 0.84, and the GARS-3 is correlated with other measures that target
symptoms of autism. This measure is able to discriminate children with Autism Spectrum
Disorder from those without.
In sum, the GARS-3 may be a good choice as a brief screening measure for assessing
and screening children, adolescents, and young adults who have symptoms of autism.
It has adequate technical properties, is easy to use, and seems to be valid for the purposes
for which it was developed.

The Assessment of Basic Learning and Language Skills-Revised (ABLLS-R) The

Assessment of Basic Learning and Language Skills-Revised (ABLLS-R) (Partington, 2006)
is a criterion-based measure that is becoming more established, particularly in the fields
of behavior analysis, developmental disabilities, and autism. This measure aims to assess
the early learning, language, and functional skills of children and can be used to evaluate
a child’s current level of performance and progress made throughout an instructional
program. The measure includes 544 items that are split across 25 domains such as
Cooperation and Reinforcer Effectiveness, Visual Performance, Receptive Language,
Vocal Imitation, Requests, Play and Leisure, Group Instruction, etc. In each domain, the
beginning items are reflective of the simplest understanding of a skill area and become
increasingly difficult with the introduction of each consecutive item. This measure
includes a manual and a protocol book that outlines the procedures, tasks and materials
needed to administer each item. The protocol book also includes a graph for each domain,
so that those who are administering the assessment or who are charged with developing
and implementing instruction can easily view the child’s current skill level and logical
356 s Assessment of Specific Problems, Competencies, and Populations

next objective for instruction. Currently, there is also a web-based version of this graph
(WebABLLS 2.0). Through this web-based application, consumers can enter data and
track progress easily.
The manual for the ABLLS-R does not identify a specific age range for its use, and it
can take a significant amount of time to administer; however, it is one of the few measures
available allowing practitioners to easily link assessment data to intervention for children
with developmental disabilities and autism. Limited research on the efficacy of ABLLS-R
use is available at this time. I hope that research in this area develops, as this tool appears
to be comprehensive and my clinical use of it suggests that it is a promising approach.

SCHIZOID DISORDERS

Description
As has previously been discussed, Quay’s (1986a) exploratory attempt at developing a
multivariate behavioral dimensions taxonomy for severe behavior disorders identified
a classification category he labeled as schizoid–unresponsive (see Table 12.1). The exact
meaning of the term schizoid, which was first coined by Asperger in the 1940s, is
not precise. It generally is thought of as indicating “schizophrenic-like” (but not quite
schizophrenic) symptoms. The term unresponsive was used by Quay to indicate not only
detached and aloof peer relations, but also a general pattern of alienation and social
withdrawal. These terms describe a cluster of behavioral, social, and emotional problems
that have some things in common with autism and schizophrenia, but are generally
subtler and less debilitating. Wolf (1989) noted that a perplexing number of terms have
been used to describe the so-called schizoid disorders over the years, which has not helped
to clarify the confusion that generally exists regarding them. Children and adolescents
who exhibit the characteristics found in the schizoid–unresponsive category may not
meet the diagnostic criteria for Autism Spectrum Disorder or Psychotic Disorders, but
are likely to exhibit the following core characteristics: (1) solitariness; (2) impaired
empathy and emotional detachment; (3) increased sensitivity (to external stimuli); (4) a
rigid mental set; and (5) an odd or unusual way of communicating (Wolf, 1989).
Quay (1986a) suggested that the schizoid–unresponsive dimension may be the extreme
of the personality style commonly referred to as introversion. As was discussed previously,
this schizoid–unresponsive dimension bears some similarity to the characteristics of
Asperger’s Disorder. It also may be a counterpart of the DSM-5 categories of Schizoid
Personality Disorder and Schizotypal Personality Disorder. These two personality disorders
are typified by various degrees and manifestations of social withdrawal, unresponsiveness,
and peculiar or odd thought and behavior patterns. It would be highly unusual to diagnose
a child with a personality disorder, but it is certainly possible by late adolescence.
The DSM-5 states that the essential feature of Schizoid Personality Disorder “is
a pervasive pattern of detachment from social relationships and a restricted range of
expression of emotions in interpersonal settings” (APA, 2013). Individuals who fit this
diagnostic picture do not desire or enjoy close social relationships, including familial
relationships. They exhibit a highly restricted range of emotional behavior and come
across to others as being cold and aloof. This disorder is one of the least researched within
the DSM (Hummelen, Pedersen, Wilberg, & Karterud, 2015). Schizotypal Personality
 Assessing Other Behavioral, Social, and Emotional Problems s 357

Disorder is described as “a pervasive pattern of social and interpersonal deficits marked

by acute discomfort with, and reduced capacity for, close relationships, as well as by
cognitive or perceptual distortions and eccentricities of behavior” (APA, 2013). Although
there is some common ground in the symptoms of these two personality disorders, there
is a clear line of demarcation for differential diagnosis: Schizoid Personality Disorder
does not include peculiarities of thought, behavior, and speech, whereas Schizotypal
Personality Disorder is not so much characterized by the extreme voluntary social
detachment of the former disorder.
Little is known about the prevalence of these disorders in the general population. The
DSM-5 states that the prevalence of both conditions is low. Some have estimated that
Schizotypal Personality Disorder is at about a 4% prevalence with higher rates in men than
in women (Rosell, Futterman, McMaster, & Siever, 2014). Although we can assume that
these disorders are rare among adolescents, there is no benchmark to go by for determining
how often they can be expected. Part of the problem in conducting an epidemiological
study in this area is that it is difficult to define the boundaries between normal variations
of personality and psychopathology (Wolf, 1989) and it can also be difficult to differentiate
these disorders from high-functioning autism.
The essential features of these disorders most likely are present during early childhood,
but differential diagnosis at this stage is difficult, given the overlapping symptoms that
exist between them and several of the developmental disorders. Onset of the schizoid
disorders tends to be clearest and well defined in middle childhood (Wolf, 1989).
There is no clear evidence at present as to the etiology of the schizoid disorders, but
some interesting speculations have been offered. One prominent theory contends that a
genetic link between the schizoid disorders and schizophrenia should be considered
because about half of individuals with schizophrenia displayed schizoid characteristics
before the onset of psychosis, children of schizophrenics often exhibit schizoid-like
characteristics, and parents of children with schizoid disorders often exhibit similar
behaviors (Blueler, 1978; Erlenmeyer-Kimling, Kestenbaum, Bird, & Hildoff, 1984; Wolf,
1989). Another theory is based on evidence that children who are at the highest risk for
developing schizoid disorders may have suffered substantial neglect during early and
middle childhood (Lieberz, 1989).
Based on Wolf and Chick’s (1980) ten-year follow-up study of children with schizoid
disorders, there is evidence that the essential features of the schizoid disorders carry on
into adult life. Further evidence from Wolf ’s (1989) follow-up research with this cohort
indicated that the intellectual ability of individuals with the disorder may be a crucial
variable in the quality of their social adaptation over time:

Our tentative impression is that the more gifted people are now less solitary, some
having married, but their basic personality characteristics remain distinct. On the
other hand, some of the less able and withdrawn people, while often working
satisfactorily, remain single and excessively dependent on their families.
(Wolf, 1989, p. 223)

Aside from this information, little is known about the long-term implications of the
schizoid disorders. It is probably prudent to assume that children and adolescents who
exhibit these characteristics to the point where their social and personal judgment is
severely impaired will continue these struggles to some extent during adult life.
358 s Assessment of Specific Problems, Competencies, and Populations

Assessment
Assessment of the broad constellation of problems subsumed under the schizoid–
unresponsive behavioral dimension is a difficult challenge. The confusion in terminology,
overlapping symptoms among a few DSM-5 categories, and lack of substantial prevalence
data all combine to create a situation in which there is little standard practice for
assessment. Direct observation of behavior and general behavior rating scales likely
would be useful in identifying patterns of severe social disengagement and peculiar
thought or behavior patterns. The Child Behavior Checklist and Teacher’s Report Form,
in particular, have several items pertinent to these areas. Clinical interviewing likely
would be helpful, not only in understanding the self-perceptions of the child, but also
in allowing the clinician to observe social behavior of the client under standardized
conditions. For youth who have sufficient cognitive maturity and reading ability (i.e., at
least a sixth-grade level), certain adolescent self-report instruments may be helpful in
screening for schizoid-like characteristics. Because of the breadth and depth of items
and subscales relevant to clinical maladjustment in adolescents, the MMPI-A is recom-
mended in this regard. Although neither one of these instruments contains specific scales
developed to identify patterns of responding associated with the schizoid–unresponsive
dimensions, it is possible that certain profile configurations or more than one scale
may be helpful in generating or verifying hypotheses regarding these problems. The more
recently developed Adolescent Psychopathology Scale (APS) seems to be particularly
promising for assessing the symptoms of the schizoid disorders and associated personality
disorders in adolescents. The APS includes five personality disorder scales (consisting of
eight to 13 items each), including two that are specifically relevant here: an Avoidant
Personality Disorder scale (consisting of ten items that measure social inhibition, shyness,
feelings of inadequacy, and oversensitivity) and a Schizotypal Personality Disorder scale
(consisting of 13 items that measure paranoid thoughts, odd beliefs and perceptions and
the perception that one is behaving in a way that is “different” or inappropriate). Although
it is a scale with less accumulated research evidence at present than the Millon Adolescent
Clinical Inventory or MMPI-A, the APS seems to have all the qualities and characteristics
to be an excellent choice for self-report assessment of youth who exhibit symptoms
consistent with the schizoid disorders.

TIC DISORDERS
By definition, tic disorders are disorders of movement. Tics are defined as “a sudden, rapid,
recurrent, nonrhythmic, stereotyped motor movement or vocalization” (APA, 1994, p. 100).
Tics are often described by the affected person as urges that are very hard to control.
However, many individuals find that they are able to suppress tic vocalization and/or
movements for a time, only to experience a deluge of tic expression afterwards. All types of
tics may be worsened by stress. Tic disorders are considered to have a neurological basis and
should not be confused as having a behavioral, social, or emotional origin, despite the
co-occurrence of these problems and worsening of tics when an individual is under stress.
One specific tic disorder, Tourette’s Disorder, is noteworthy in this regard, however, because
it is often accompanied by behavioral and social adjustment difficulties and often co-occurs
with disorders in these areas.
 Assessing Other Behavioral, Social, and Emotional Problems s 359

Description of Tourette’s Disorder/Tourette Syndrome

Tourette’s Disorder (otherwise known as Tourette Syndrome) is characterized by multiple
motor tics and one or more vocal tics. The motor tics often involve the head and may
involve other parts of the body such as the torso and limbs. Eye tics, such as blinking, eye
rolling, or wide eye opening, are a common first motor tic symptom of Tourette’s (Sallee
& Spratt, 1998). The vocal tics that accompany Tourette’s Disorder may include a variety
of words and sounds, such as clicking noises, grunts, yelps, barks, sniffs, snorts, or coughs.
One specific vocal tic that Tourette’s has been associated with is coprolalia, which involves
the seemingly uncontrollable uttering of obscenities. This unusual tic has become
inaccurately associated among the public and some less astute professionals as a hallmark
characteristic of Tourette’s, perhaps because it is such an unusual and attention-getting
activity. In reality, only a small percentage of individuals with Tourette’s (perhaps 10%,
according to Sallee and Spratt) exhibit coprolalia.
The average age of first onset for Tourette’s Disorder is 8.1 years, and by definition,
onset is always before age 18. The symptoms of this disorder are often misunderstood or
attributed to other problems. About 0.19% of children in the U.S. are diagnosed with
Tourette’s Disorder. Consistently, this disorder is three times more common in boys than
in girls. Although the duration of Tourette’s is usually lifelong, it is common for the
frequency, severity, and variability of symptoms to diminish during adolescence and early
adulthood. In some cases, the symptoms disappear entirely (Sallee & Spratt, 1998). The
etiology of Tourette’s Disorder is not specifically understood at this time but is widely
assumed to have a biological or genetic component (APA, 1994).
Perhaps the most relevant aspect of Tourette’s Disorder for this book is that it frequently
is accompanied by co-occurring behavioral disorders and social–emotional problems.
According to the DSM-5, obsessive–compulsive behavior is the most common associated
feature. Other common co-occurring symptoms include hyperactivity, distractibility,
impulsivity, social discomfort, shame, extreme self-consciousness, and depression. As a
result, it is not unusual for individuals with Tourette’s to experience problems in academic,
social, or occupational functioning. The major defining characteristics and related
features of Tourette’s Disorder are summarized in Table 12.5.

Table 12.5 Major characteristics and associated features of Tourette’s Disorder

Multiple motor tics, often involving the head, upper body, and limbs
Vocal tics, which may vary considerably from person to person in presentation
Tics are chronic, occurring nearly daily in some form
Marked disturbance or impairment in adjustment and functioning
Onset before age 18, with median onset at age seven
1.5 to 3 times more prevalent in males than in females
Frequently accompanied by symptoms associated with attention deficit hyperactivity disorder and
obsessive–compulsive disorder, with high rates of co-occurrence among these disorders
Frequently accompanied by social discomfort, self-consciousness, shame, and depressed mood
Frequently misdiagnosed or confused with other disorders
Frequently not diagnosed for several years after initial onset

Assessment
Assessment and accurate diagnosis of Tourette’s Disorder can be a difficult proposition
because some of the co-occurring symptoms may lead the clinician down the wrong path
360 s Assessment of Specific Problems, Competencies, and Populations

and because the core tic symptoms tend to be transient. Specific tic symptoms of Tourette’s
may not be noted directly through behavioral observation or in a clinical interview situ-
ation in most cases (Sallee & Spratt, 1998). Because of these difficulties, direct behavioral
observation is often challenging and sometimes uninformative. General problem behav-
ior rating scales may be useful for initial screening purposes but typically do not include
enough specificity for accurate assessment of Tourette’s symptoms.
It is crucial that assessment of children suspected of having Tourette’s Disorder involve
extensive clinical interviewing with the referred child or adolescent and parents. The
interview should include an extensive developmental history, family history, and questions
regarding specific and associated behavioral problems across various situations and
settings. A referral for neurological or related medical examination of children suspected
of having Tourette’s Disorder may be helpful or even necessary, but it should be understood
that “results of the neurological exam of patients with primary [Tourette’s Disorder] are
usually unremarkable with no focal or lateralizing signs” (Sallee & Spratt, 1998, p. 343).
Some assessment instruments specific to evaluation of Tourette’s Disorder have been
developed and reported in the literature. The Tourette’s Syndrome Questionnaire (Jagger
et al., 1982) is an interview instrument designed to obtain historical information regarding
the development of tic symptoms and associated features of Tourette’s. The Tourette’s
Syndrome Symptom Checklist (D. J. Cohen, Leckman, & Shaywitz, 1984) is a rating scale
designed to be used on a daily and weekly basis to evaluate the presence and disruptiveness
of major Tourette’s characteristics. The Yale Global Tic Severity Scale (Leckman et al.,
1989) is a semistructured interview instrument designed to provide an evaluation of the
number, frequency, intensity, complexity, and interference of various Tourette’s symptoms.
These instruments are not of the commercially published, nationally norm-referenced
variety, and the various citations in the research literature should be consulted for more
information regarding their appropriate uses. Additionally, Kurlan (2010) reports that tic
disorders are often diagnosed clinically and that it takes skill and expertise to identify them
appropriately, as clients can often suppress tics during interviews but be more likely to
engage in tic behaviors prior to entering or following leaving the interview context.

SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS

The DSM-5 diagnostic categories presented in Table 12.2 indicate that there are numer-
ous classification categories of schizophrenia and related psychotic disorders. These
categories have been developed almost exclusively based on research and clinical efforts
with adults, however, and are not generally descriptive of psychotic disorders that occur
among children and early adolescents. While schizophrenia often develops in late ado-
lescence and into adulthood, early-onset schizophrenia can occur prior to the age of 18
and childhood-onset prior to age 13 (Kuniyoshi, & McClellan, 2014). This section pro-
vides some general descriptive information on psychotic disorders of childhood and early
adolescence, and recommendations and guidelines for conducting effective assessments
of such youth.

Description
The term psychosis does not have an exact or universal meaning but generally is used to
indicate a break with reality or a severe impairment of one’s sense of reality and ability
 Assessing Other Behavioral, Social, and Emotional Problems s 361

to perceive things and function as most other persons do. The terms childhood psychosis
and childhood schizophrenia were used earlier in the twentieth century to indicate what
we now refer to as Autism Spectrum Disorder, but the modern common understanding
of these terms generally precludes autism. A defining feature of psychotic disorders is
that the advent of the disorder causes a lowering or impairment of functioning from a
previous level. Autism is considered to be a developmental disorder, in which the feature
characteristics involve severe limitations in the normal course of development, whereas
schizophrenia normally occurs after the early childhood developmental period and brings
with it a loss of functioning.
The major diagnostic picture of schizophrenia includes the following symptoms: delu-
sions of thought, prominent and lasting hallucinations, incoherence or a marked loosening
of associations, catatonic behavior (severe restriction of motor activity that sometimes
alternates with wild hyperactivity), and flat or grossly inappropriate affect. The delusions
of thought in schizophrenia are typically bizarre and implausible, and hallucinations
characteristically are pronounced, such as hearing voices for long periods. Along with these
severe disturbances of perception, thought, and affect, a severe decline in personal and
social functioning typically occurs, which might include significantly poor personal
hygiene, inability to function effectively at school or work, and a severe impairment in
social relationships. Using the DSM system, these characteristic symptoms must be present
on a continuous basis for at least six months for a diagnosis to be made. Individuals with
schizophrenia tend to display markedly peculiar behavior, such as talking to themselves
in public, collecting garbage, and hoarding food or items that appear to be of little value.
Schizophrenia often is accompanied by strange beliefs or magical thinking not in line
with the cultural standard; the afflicted person might believe that their behavior is being
controlled by another person or force, or that he or she has the power of clairvoyance.
Some characteristics of schizophrenia can be brought on by other conditions, such
as severe affective disorders or the use of psychoactive substances. A true diagnosis of
schizophrenia implies that the symptoms are pervasive and long-lasting, however, and
not brought on by a temporary biochemical or affective change. Although the DSM-5
criteria are the best working guidelines for schizophrenia currently available, it is
important to consider that they may not always accurately describe the development of
the disorder during childhood. Cantor (1987, 1989) noted that the DSM symptoms may
not always be the most prominent features of schizophrenia that develops during
childhood and that the childhood diagnostic picture is often complicated and clouded.
Tolbert (1996) noted that when psychotic disorders are manifest in children, they are
frequently accompanied by symptoms that are not always seen in adults. Some of these
hallmark characteristics of childhood psychosis are presented in Table 12.6.
Because the trademark DSM symptoms of schizophrenia are rare before puberty,
accurate prevalence estimates with children have been difficult to determine. For example,
the child psychiatry division of the National Institute of Health has spent the last 20 years
screening over 3,000 cases, with just 105 children meeting criteria for schizophrenia
before the age of 12 (Addington & Rapoport, 2009). Reviews of evidence from the 1990s
indicate, however, that the prevalence figure may be lower, closer to one in 10,000 children,
and that only 0.1% to 1% of all cases of schizophrenia are manifest before age ten and only
4% before age 15 (Tolbert, 1996). It should be noted however, that studies of prevalence
of schizophrenia across the lifespan result in widely variable estimates (El-Missiry et al.,
2011), but that the CDC and NIMH both suggest a 1.1% 12-month prevalence in adults
362 s Assessment of Specific Problems, Competencies, and Populations

Table 12.6 Behavioral, emotional, and cognitive symptoms associated with

schizophrenia and related psychotic disorders in children

Severe speech problems

Difficulty distinguishing between dreams and reality
Hallucinations (visual and auditory)
Vivid and often bizarre ideas and thoughts
Confused thinking
Diminished interest in normal activities
Severe moodiness
Odd or peculiar behavior
Lack of inhibition
Believes that someone is “out to get” him or her
Behaves like a much younger child
Severe fears or anxiety
Confuses television programs with reality
Significant peer problems, difficulty making and keeping friends

in the U.S. With adults and older adolescents, schizophrenia tends to occur in similar
numbers with males and females. With the preadolescent population (up to about age 14),
the equal gender balance does not hold true, with males being diagnosed more often.
The cause of schizophrenia has been a controversial topic for centuries; explanations
have run the gamut from demon possession to a weak constitution to poor parenting.
In more recent years, a plethora of research has strongly suggested that schizophrenia has
a biochemical basis. The neurotransmitter dopamine has been implicated as a crucial
variable because drugs that block dopamine receptor sites tend to be highly effective
at controlling the more severe symptoms of schizophrenia, such as delusions and halluci-
nations. Family studies and investigations of adoption conducted in the United States and
Europe over the past several decades have provided additional evidence for a genetic expla-
nation of schizophrenia, because the degree of genetic relatedness to an individual with
schizophrenia is a strong factor in predicting the occurrence of the disorder (Gottesman,
1991). In cases in which one individual in a set of twins develops schizophrenia, the prob-
ability is almost four times greater that the other twin will develop the disorder when the
twins are identical rather than fraternal. Although biochemical–genetic factors are prom-
inent in explaining etiology, behavioral and environmental factors are likely to interact
with the person variables to increase or decrease the likelihood of schizophrenia; if two
individuals have an equal biochemical–genetic predisposition for developing the disorder,
the individual with a dramatically higher level of psychosocial distress may ultimately be
more likely to exhibit the symptoms.
The prognosis for children and adolescents who develop schizophrenia is variable and
seems to hinge on such factors as age level, severity of symptoms, and family history. In
his review on childhood psychoses, Tolbert (1996) stated that prognosis is poorest when
the onset of the disorder occurs before age ten to 14 and for youth with a family history
of psychotic disorders, and only about 25% of patients with adolescent-onset schizophre-
nia achieve a partial remission of symptoms. There seems to be wide variability in how
schizophrenia affects individuals over the life span, and the availability of social support,
medical care, and mental health services may be crucial factors in determining how
debilitating the disorder becomes.
 Assessing Other Behavioral, Social, and Emotional Problems s 363

Assessment
Children and adolescents with schizophrenia and other psychotic disorders typically expe-
rience characteristic private or internal events (such as various disorders of thought and
sensation) and exhibit characteristic overt and easily observed behaviors (such as psycho-
motor agitation or retardation, highly unusual verbal behavior, and wildly inappropriate
social behavior). The assessment design for these youth must be planned carefully and
must include techniques and instruments designed to evaluate overt and covert symptoms.
In addition to the behavioral–psychological types of assessment covered in this text, assess-
ment of children and adolescents with schizophrenia and other psychotic disorders should
include appropriate medical assessment data, such as a physical examination, neurologic
examination, and laboratory studies (Tolbert, 1996).

Behavioral Observation Behavioral observation generally proves to be valuable in assess-

ing children and adolescents with psychotic disorders. Effective observational systems for
this purpose require that the observation domain is defined carefully and that appropriate
coding strategies are used. There are some specific problems with behavioral observation
assessment that should be considered, however. Many of the characteristic problem behav-
iors in this domain are not overt or blatant, and they may be difficult to assess adequately
with direct behavioral observation. For example, hallucinations, delusions, odd thought
processes, and a desire to avoid other persons may be extremely difficult to observe unless
they also are accompanied by overt behavioral signals, such as language, psychomotor
agitation with explanatory language signs, or obvious social withdrawal. To design an effec-
tive observational system for assessing the characteristics of psychotic disorders, one must
focus on the more overt aspects, operationally define them so that they can be observed
and coded without question, and defer the assessment of the more internal or covert charac-
teristics of the disorders to other methods (i.e., interviews, self-report, or rating scales
completed by individuals who have observed the child over a long period).

Behavior Rating Scales Some of the general problem behavior rating scales reviewed in
Chapter 5 may be helpful as screening tools. Specifically, the Child Behavior Checklist
(CBCL) seems to be useful for initial screening of childhood psychotic disorders. The
CBCL includes the Thought Problems cross-informant scale, which contains items perti-
nent to hallucinations, sensory distortions, and bizarre behaviors. The CBCL and other
ASEBA instruments have shown sensitivity in discriminating among youth with psychotic
disorders and youth with other types of disorders. Endorsement of items contributing to
the Thought Problems scale can also be followed up with interview questions that probe
these specific areas.
The Symptom Scale is an example of an experimental rating scale (or checklist)
designed specifically for use in assessing the symptoms of schizophrenia in children and
young adolescents (Cantor, 1987, 1989; Cantor, Pearce, Pezzot-Pearce, & Evans, 1981).
This instrument consists of 18 checklist-style descriptors that were found through a
review of the literature to be associated with schizophrenia in children and adolescents.
Examples of these descriptors include “constricted affect,” “perseveration,” “inappropriate
affect,” “anxiety,” “loose associations,” “grimacing,” and “incoherence.” In one study, each
of 54 children and adolescents with schizophrenia was rated by two clinical psychologists
for the presence or absence of these 18 symptoms. The population was broken into three
age groups: preschool (N = 525), latency (N = 515), and adolescent (N = 514). Most of
364 s Assessment of Specific Problems, Competencies, and Populations

the symptoms were found to be present in more than 50% of the subjects in each group,
and a few of the symptoms were found to be present in more than 50% of the subjects in
one or two groups, but three symptoms (clang associations, echolalia, and neologisms)
were found to be present in less than 50% of the subjects in all three groups, indicating
that they had relatively poor diagnostic validity. Although the Symptom Scale was not
designed to be a norm-referenced diagnostic test, it may be useful in research or in
validating behavioral characteristics of schizophrenia obtained from multiple assessment
data. It is not commercially published and must be obtained by researching the references
cited earlier in this section.

Clinical Interviews Most of the interview methods discussed in Chapter 6 can be used to
some extent in assessing psychotic disorders. The specific choice of technique varies
depending on the presenting problems exhibited by the referred child or adolescent; his
or her age level, language capability, and social maturity; and the availability and cooper-
ation of a parent or primary caregiver. The parent or caregiver behavioral interview is
crucial if the child or adolescent is not capable of engaging in a traditional interview
or if the referral necessitates the immediate development of a behavioral intervention
plan. Traditional unstructured types of interviews with the child or adolescent may be of
limited use in these cases but may provide some additional insights in cases in which
psychotic features are emerging. Virtually any of the structured interview schedules
reviewed elsewhere in this book are potentially useful in assessing youth with psychotic
disorders. These structured interview schedules all include at least some items that are
relevant to the severe behavioral and emotional disorders and include scoring algorithms
that are designed to generate hypotheses about the existence of disorders from the DSM.
An example of the utility of one of these structured interviews in assessing and diagnos-
ing psychotic disorders is from research conducted by Haley, Fine, and Marriage (1988),
who compared Diagnostic Interview Schedule for Children (DISC) data from psychiat-
rically hospitalized adolescents who were experiencing depression with or without psy-
chosis symptoms. In this case, several strands of the DISC interview data were found to
discriminate between the two groups because the subjects experiencing psychosis were
more likely to have a history of sexual abuse, to have more serious depression, and to
have more symptoms of hypomanic behavior than the subjects who were experiencing
depression but no psychosis symptoms. Other research lending support to the use of
structured interviews for assessing the severe disorders comes from an epidemiological
study conducted by Cohen, O’Connor, Lewis, Velez, and Noemi (1987), who found that
the DISC and Kiddie-Schedule for Affective Disorders (K-SADS) provided moderate to
moderately high accuracy estimates of the prevalence of various DSM disorders. Another
tool that still appears to be frequently used is the Positive and Negative Syndrome Scale
(PANSS) (Kay, Fiszbein, & Opler, 1987). This is a well-operationalized structured inter-
view tool that targets the presence and severity of positive and negative symptoms of
schizophrenia. This tool includes a 35 to 45 minute interview and is followed by a rating
of 30 symptoms on a 7-point Likert scale. While this tool, like many others in this section,
was developed years ago, it still appears to be widely used.
A potential caution in conducting interviews for the assessment of psychosis involves
making inquiries about low-frequency and bizarre symptoms, such as delusions, halluci-
nations, thought problems, and severe obsessive–compulsive behaviors. The clinician
must word questions about these areas carefully and gauge the responses of children and
 Assessing Other Behavioral, Social, and Emotional Problems s 365

parents with caution. Research by Breslau (1987) has helped to verify the notion that
referred children and their parents may misunderstand structured interview questions
about psychotic behavior and related characteristics and may provide answers that lead
to high false positive errors. This research found that subjects often misunderstand
the intent of these types of questions, and when appropriate follow-up questioning is
introduced, many of the positive responses to questions are recoded as negative responses.
A child might respond positively to a question such as “Do you ever see things that no
one else can see,” when he or she is thinking about seeing unique shapes in cloud forma-
tions or wallpaper designs rather than any visual hallucinations. When questioning about
“the bizarre,” it is important to follow up on affirmative responses and to obtain specific
examples.

Sociometric Techniques Although sociometric techniques tend to be difficult to imple-

ment for basic clinical assessment of specific children and adolescents, they have been
shown to be effective in identifying youth with psychotic disorders and may be of interest
to researchers. Of the 20 studies cited by McConnell and Odom (1986) as providing
evidence of the predictive validity of sociometrics, three were designed specifically to test
sociometric assessment with schizophrenic or similar severity populations (Bower,
Shelhamer, & Daily, 1960; Kohn & Clausen, 1955; Pritchard & Graham, 1966). These and
other studies have proved that sociometric techniques that are designed and implemented
specifically for assessing and predicting psychotic disorders can be effective.

Self-Report Instruments Depending on the type and severity of presenting symptoms,

self-report instruments range in usefulness from not useful at all to highly useful in assess-
ing children and adolescents with psychotic characteristics. In cases of severe and active
psychotic behavior, the most serious manifestations of these problems usually make the
self-reflective tasks involved in a self-report instrument impossible. For emerging, less
active, or residual cases of schizophrenia, however, self-report instruments may be of some
use. Some of the items and cross-informant scales of the Youth Self-Report (YSR) seem
to have some utility in the assessment of psychotic symptoms. The cross-informant
Thought Problems scale of the YSR is potentially useful in this regard, containing some
items that are highly congruent with some of the characteristics of psychotic behavior,
such as hoarding behavior (not to be confused with the hoarding of objects that is some-
times observed in Obsessive–Compulsive Disorder), sensory distortions, and disordered
thought processes. As is discussed in Chapter 8, the YSR should be used cautiously because
it contains no controls to detect manipulation or faking, and some research has suggested
that it may not effectively discriminate groups of children and adolescents with severe
psychopathology (e.g., Thurber & Snow, 1990). Another important consideration in using
the YSR is that unusual responses on some of the items on the Thought Problems scales
should be followed up with additional questioning; they are not always indicative of
psychopathology. For example, it is common for adolescent respondents to endorse an
item such as “I hear things that nobody else seems to be able to hear” when they are simply
thinking of a favorite song continually repeating in their mind or to endorse an item such
as “I store up things I don’t need” to indicate a normal activity such as collecting stickers
or baseball cards.
The MMPI-A is probably the best-documented and best-validated self-report
instrument for use in assessing some of the characteristics of psychotic behavior with
366 s Assessment of Specific Problems, Competencies, and Populations

adolescents. With the MMPI-A, screening and classification accuracy for severe disorders
of youth can be improved greatly through carefully interpreting code types and under-
standing the meaning of absolute score levels on individual scales. For example, extremely
high T scores on scale 8 (Schizophrenia) usually are not indicative of psychotic behavior
but are commonly reflective of intense, acute situational distress. Extreme elevations
(T scores of 75 or higher) on scale 6 (Paranoia) typically identify persons with a psychotic
degree of paranoid symptoms, such as paranoid schizophrenia and individuals mani-
festing paranoid states. Certain two-point code types also may be indicative of the
types of serious psychopathology associated with psychotic behavior, most notably
6–8/8–6 (Paranoia–Schizophrenia), 8–9/9–8 (Schizophrenia–Hypomania), and 4–8/8–4
(Psychopathic Deviate–Schizophrenia). The MMPI-A manual contains correlates of the
various scales for the normative and the clinical samples, and some interesting differences
between the two groups are found on items from several scales, including 4, 6, and 8.
In addition to the MMPI-A, the more recently developed APS seems to be potentially
useful for self-report assessment of youth who exhibit or are beginning to develop the
symptoms or characteristics of psychotic disorders. Although less is known about
the validity of the APS than the MMPI-A at present regarding its use for this purpose, it
clearly was designed to take into consideration psychotic symptoms of youth and has
obvious content validity in this regard. Among 20 clinical disorder scales, the APS includes
a 27-item Schizophrenia scale, which, as the name suggests, was developed specifically for
screening and assessment of the symptoms of schizophrenia.

EATING DISORDERS
The essential feature of eating disorders is severe disturbances in eating behavior. Anorexia
Nervosa, Bulimia Nervosa, and now Binge Eating Disorder, are the three most common
types of eating disorders and the focus of this section. These are not considered to be
problems that usually first exist during infancy and childhood, rather they typically have
a late adolescent or early adult onset. However, school-based clinicians (particularly
those working with secondary school populations) and community-based clinicians who
work extensively with adolescents often find these disorders to exist in alarming numbers
among their clientele and to cause significant problems for many adolescents and their
families. Previous research has indicated that these disorders seem to occur dispropor-
tionately in females. This is less true with Binge Eating Disorder, and may actually not be
as extreme as once was thought for the other disorders, particularly since study of eating
disorders in males is not as lagging as it once was (Von Ranson & Wallace, 2014). They
also were historically more likely to be observed in the Western industrialized nations
than in other parts of the world and have increased substantially in prevalence since
about the 1950s and 1960s (Foreyt & Mikhail, 1997; Von Ranson & Wallace, 2014;
Williamson, Bentz, & Rabalais, 1998). The major characteristics and associated features
of these latter two disorders are summarized in Table 12.7.
Some experts (e.g., W. M. Reynolds, 1992a, 1992b) have included eating disorders
under the general domain of internalizing problems. Behavioral dimensions approaches
to classifying child and adolescent psychopathology have not consistently identified a
separate eating disorders sector within the internalizing domain, however, even though
they do have many characteristics in common, such as covert maladaptive behaviors,
 Assessing Other Behavioral, Social, and Emotional Problems s 367

Table 12.7 Major characteristics and associated features of the primary eating disorders

Anorexia Nervosa
Low body weight
Significant disturbance in self-perception of shape/size of body
Often resulting menstrual irregularities
Includes food-restricting and binge eating/purging specifiers
Often co-occurs with depression, obsessive–compulsive disorder, and personality disorders
May result in menstrual problems, heart problems, biochemical imbalances 5% to 10% long-term
mortality rate
Bulimia Nervosa
Binge eating episodes
Inappropriate compensatory strategies
Self-evaluation excessively influenced by perceptions of body shape/weight
Individuals are usually within normal weight range
Often accompanied by excessive shame and depressed mood
Often co-occurs with mood disorders, substance-related disorders, and anxiety symptoms
May result in dental problems and biochemical imbalances
Binge Eating Disorder
Binge eating episodes
Often associated with obesity
Less focus on evaluation of body shape/weight
Often co-occurs with anxiety, mood disorders, substance-related disorders

diminished self-esteem, and mood disturbances. This topic is addressed in this chapter
rather than in Chapter 11.
There are other types of eating and feeding disturbances, including Pica, Rumination
Disorder, and Avoidant/Restrictive Food Intake Disorder, that are considered to be first
evident in infancy or early childhood. Nevertheless, these problems are not discussed in
this text because they have an extremely low base rate and tend to be dealt with in more
specialized settings and by highly focused professionals, such as in children’s medical
centers by pediatric psychologists. Readers who desire more details on these problems
should consult more specialized texts or the pediatric/pediatric psychology literature.

Description

Anorexia Nervosa The DSM-5 definition for Anorexia Nervosa has changed substantially.
This continues to be a disorder in which individuals restrict their food intake, fear gaining
weight, and experience disturbance in their perceptions of their bodies. The changes
with the DSM regard the low weight criterion and are worded as individuals having
“significantly low body weight” (APA, 2013, pp. 338–339) rather than “a refusal to main-
tain body weight at or above a minimally normal weight for age and height” (APA, 1994,
p. 554). Further, there is no particular weight cut off and individuals no longer require
amenorrhea as criteria for diagnosis. There are specifiers that allow diagnosticians to
clarify individual presentations such as “restricting type” or “binge-eating/purging type”
and that allow to identify severity indicators based on body mass index.
Anorexia Nervosa often co-occurs with depressive disorders, obsessive–compulsive
characteristics, and personality disorders (Gaudio & DiCiommo, 2011; Williamson et al.,
1998). Prevalence studies among adolescent girls and young women indicated that 0.3%
368 s Assessment of Specific Problems, Competencies, and Populations

to 1% of the population within the United States meet full criteria for Anorexia Nervosa,
and there are many other individuals who exhibit symptoms but do not meet the full
criteria threshold (e.g., Swanson, Crow, Le Grange, Swendsen, & Merikangas, 2011).
Theories of etiology have focused on possible biologic underpinnings, psychosocial
explanations, and sociocultural pressures for thinness, particularly among females.
According to data based on DSM-IV diagnoses, the mean age of onset for Anorexia
Nervosa is 17 years, with possible bimodal peaks at ages 14 and 18. Clinicians working
with children in middle school or junior high school should become familiar with the
disorder. In addition to the often co-occurring psychological problems, there are serious
physical effects of Anorexia Nervosa, including heart problems, fluid and electrolyte
imbalances, and death.

Bulimia Nervosa Bulimia Nervosa is characterized by ongoing episodes of binge eating

followed by engaging in some type of compensatory behavior such as self-induced
vomiting, use of laxatives, fasting, etc. (APA, 2013). Additionally, individuals with this
disorder tend to evaluate themselves excessively by their own perceptions of body
shape and weight. For a diagnosis of Bulimia Nervosa, the binge eating and maladaptive
compensatory behaviors must happen on average at least once a week for three months.
By definition, binge eating occurs in a circumscribed period of time wherein the individual
consumes a substantially larger amount of food (often sweet, high-calorie foods such as
desserts) than is normal. These episodes of binge eating often are characterized by
a frenzied psychological state, a feeling of being out of control, and sometimes even a
dissociative sensation. Binge eating episodes often are brought on by depressed mood
states, interpersonal problems, or extreme hunger that is a result of dietary restraint.
DSM-5 includes specifiers to help describe the severity of individuals’ behavior in terms
of the average number of episodes occurring per week.
In contrast to the physical size of individuals with Anorexia Nervosa, individuals with
Bulimia Nervosa tend to be within normal weight ranges, although it is common for
them to be slightly overweight or slightly underweight. The prevalence of this disorder
among individuals living in industrialized nations has been estimated to range from
1% to 1.6%, with a typical onset during late adolescence or early adulthood (Swanson
et al., 2011). Etiological theories of Bulimia are the same as those referred to for Anorexia
Nervosa (Williamson et al., 1998). Depressed mood states and feelings of extreme shame
often follow an episode of binge eating, and it has been shown that individuals with
Bulimia Nervosa have an increased incidence of mood disorders and substance abuse and
dependence than individuals in the general population. Frequent purging episodes may
lead to fluid and electrolyte imbalances, metabolic problems, permanent damage to the
teeth through erosion of dental enamel, and noticeably enlarged salivary glands.

Binge Eating Disorder Binge Eating Disorder is characterized by weekly binge eating
episodes without the purging or compensatory behaviors observed in Bulimia. It is often
associated with a loss of control. Binge Eating Disorder was diagnosed in the Eating
Disorder Not Otherwise Specified category in the DSM-IV. In the DSM-5, it is listed as
its own disorder and research on this disorder has rapidly expanded (Von Ranson &
Wallace, 2014; Wonderlich, Gordon, Mitchell, Crosby, & Engel, 2009). Binge Eating
Disorder is most often associated with obesity, but this relationship appears complex and
in need of further study (Wonderlich et al., 2009). Like other eating disorders, this
 Assessing Other Behavioral, Social, and Emotional Problems s 369

disorder appears to co-occur with anxiety, specific phobias, social phobia, mood
disorders, and substance-related disorders. While this Binge Eating Disorder most often
begins in early adulthood, it can be observed in children (Von Ranson & Wallace, 2014).

Assessment
Assessment of Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder is typically
difficult through direct behavioral observation and informant-based behavior rating scales
because the major behavioral characteristics of these disorders tend to be covert or done
in secret (i.e., binge eating, self-induced vomiting) and because other major characteristics
tend to involve self-perceptions. However, two important aspects of Anorexia Nervosa
may be externally observable at times by individuals who are close to the affected person:
food restriction and excessive weight loss. The most effective and widely used methods
of assessment for these eating disorders are clinical interviewing and self-report instru-
ments. Clinical interviewing should focus not only on the core aspects of the maladaptive
eating and compensatory behaviors, but also on possible coexisting psychosocial prob-
lems, such as depression, anxiety, distorted thinking patterns, and obsessive–compulsive
characteristics.
The most widely used self-report instrument in this area is probably the Eating
Disorders Inventory-3 (EDI-3) (Garner, 2004). This 91-item revision includes several
new features, such as a computerized scoring program, T score and percentile score con-
version profiles, a new normative sample ranging in age from 13 to 53, a short form brief
self-report checklist, and the inclusion of separate clinical and nonclinical norm samples.
This latest version of the EDI promises to continue the prominence of this instrument as
the standard assessment tool for eating disorders. The items focus on various core and
ancillary characteristics of eating disorders and a four-page symptom checklist. Raw
scores are converted to 12 empirically derived subscales, which are based on a large nor-
mative sample. Various comparison norms (e.g., high school students, college students)
are also provided in the test manual. The Eating Disorders Inventory–3 is a revision of
the original Eating Disorders Inventory–2 and Eating Disorders Inventory, which were
two of the first objective self-report measures developed specifically for evaluating eating
disorders. Combined, the three instruments are the most widely researched self-report
instruments for assessing eating disorders, with nearly 300 published studies to date. The
psychometric properties, including the diagnostic validity of the instrument, are shown
in the test manual and in several of the numerous published studies.
In addition to the standard psychological assessment methods that may be useful for
evaluation of youth with eating disorders, physical assessments may be necessary. Because
of the physical problems that may accompany eating disorders, “a complete medical exam
is recommended for all persons with an eating disorder” (Williamson et al., 1998, p. 300).
Direct measurement of daily caloric intake and eating diaries are strategies in treating
eating disorders.

LINKING ASSESSMENT TO INTERVENTION

Virtually all of the categories of assessment data obtained in evaluating Autism Spectrum
Disorder, schizoid disorders, tic disorders, psychotic disorders, and eating disorders
of children and adolescents that are discussed in this chapter have direct utility for
370 s Assessment of Specific Problems, Competencies, and Populations

diagnostic purposes. Whether the assessment data are useful in intervention planning
and implementation for these problems depends, however, to a great extent on the spe-
cifics of the assessment data, the problem, and the type of intervention that is needed. The
emerging technology of functional behavior assessment has been proved to be useful for
linking assessment to intervention for youth with pervasive developmental disorders, and
it is likely that further refinements in this technology will increase its utility further. There
have been minimal applications of functional behavior assessment reported thus far for
assessment of children and adolescents who exhibit personality disorders, psychotic
symptoms, eating disorders, and other conditions discussed in this chapter.
The most widely used and documented interventions for Autism Spectrum Disorder at
present are behavioral in nature and tend to focus on altering either behavioral deficits
(i.e., lack of communication and poor eye contact) or behavioral excesses (i.e., stereotypical
behaviors such as echolalia and spinning) that tend to compound the social consequences
of the disorder. Kauffman (2000) noted that early and intensive behavioral interventions
are especially crucial for successful treatment of pervasive developmental disorders and
that the prognosis for future adjustment is much better when early interventions are
successfully employed. Interventions employing behavioral techniques (e.g., applied
behavior analysis) have also been found to be most effective (Wilczynski, 2009). Most of
the assessment methods for gauging the characteristics of Autism Spectrum Disorder and
its related counterparts that have been described in this chapter are useful in pinpointing
specific behavioral excesses and deficits that are cause for concern, and the ABLLS-R, in
particular, has some promise for linking assessment data to specific intervention targets.
The “schizoid” disorders and related personality and social problems are notoriously
difficult to treat effectively. Part of the problem in linking assessment data to interventions
in an effective manner in these cases is that the individuals involved are often resistant to
treatment, particularly when the treatment involves establishing a trusting relationship
with a therapist in a one-to-one intervention setting. Self-report data from structured
interviews and self-report tests may be useful in diagnosis but difficult to convert to an
intervention plan with the schizoid disorders. Behavioral assessment data from observa-
tions, rating scales, and behavioral interviews with parents or caregivers are potentially
useful in pinpointing target behaviors for intervention and, in some cases, in determining
potential sources of reinforcement available within the immediate environment. Part of
the clinical picture that usually is seen with the schizoid disorders is extremely poor social
skills and peer rejection. In this regard, there is some hope that structured social skills
training conducted in group settings might be an effective approach, although generaliz-
ing social skills training effects across settings and time is difficult and takes specific plan-
ning (Merrell & Gimpel, 1998). If a child or adolescent exhibits schizoid-like characteristics
with severe social deficits and poor relationships, the assessment design could benefit
from the inclusion of a specific social skills appraisal (see Chapter 13), which might help
in identifying distinctive clusters of social skills deficits.
Children with Tourette’s Disorder may benefit from pharmacologic interventions that
reduce tics and in some cases ameliorate some of the related attentional problems. The
assessment data that lead to appropriate diagnosis of Tourette’s may provide the basis for
making a medical referral. A comprehensive assessment of the child often identifies
related or co-occurring problems, however, such as attentional problems, mood distur-
bances, social problems, and obsessive–compulsive symptoms. A thorough assessment
often results in the identification of specific psychosocial problems that should be the
 Assessing Other Behavioral, Social, and Emotional Problems s 371

focus of appropriate intervention planning. Functional behavior assessment (FBA) is

often helpful in helping to identify antecedents to tic behaviors, and such behavioral
assessment approach is often a first step in identifying the best course of intervention.
Linking assessment to intervention planning in cases of schizophrenic or other psy-
chotic disorders can be a complex challenge. Kauffman (2000) stated that behavioral
interventions have been highly successful with psychotic children in many research situa-
tions, but the results of these projects have not always provided direct and practical
treatment implications for classroom teachers. Functional assessment data from observa-
tions or behavioral interviews might provide a basis for modifying the child’s immediate
environment to remediate specific behavioral excesses or deficits, but implementing these
interventions outside of a highly controlled environment may be challenging. Smith and
Belcher (1985) noted that such individuals often require considerable training in basic
life skills, such as grooming, hygiene, and community living. For identifying specific areas
for these life skills interventions, the use of behavior rating scales may prove to be useful.
In most cases, effective management of psychotic disorders may involve medical referral
and the possible use of neuroleptic (antipsychotic) medications. Medical referral and
intervention is especially crucial in cases in which the child or adolescent is experiencing
full-blown psychotic symptoms, such as hallucinations and delusions, or when there is
an increased probability for him or her doing harm to himself or herself or others. Rating
scales, interviews, observations, and in some cases self-report tests may be useful for
identifying the overt symptoms of schizophrenia that warrant intervention. Because chil-
dren with psychotic disorders (and pervasive developmental disorders) usually exhibit
behaviors that are so blatantly maladaptive and different from those of their normal
peers, the template matching strategy discussed by Shapiro (1996) may be useful in linking
assessment to intervention. This strategy involves systematic comparison of the behavior
of the troubled individual with behavior of well-adjusted youth, identifying the discrep-
ancies between the two, then using the “normal” behavior as a template for targeting
intervention.
Assessment of eating disorders must rely heavily on extensive clinical interviewing and
self-report instruments because many of the core characteristics of these disorders are
covert and may not be easily detectable through external methods of objective assess-
ment. The various data obtained through assessment may be useful in selecting related
areas to target for intervention. That is, the core targets for intervention will always be
the maladaptive eating behaviors themselves, but there may need to be ancillary inter-
vention targets, such as depression, distorted thinking patterns, obsessive–compulsive
characteristics, and various other maladaptive behaviors and cognitions. Self-report
instruments and clinical interviews may be helpful in identifying the appropriate ancil-
lary targets and perhaps in determining how best to approach the core eating disorder
symptoms with particular individuals.

CONCLUSIONS
Not all forms of child and adolescent psychopathology fit neatly within the broad
externalizing and internalizing domains that have been well documented in the research
literature. Some types of behavioral, social, and emotional problems are considered to be
“mixed,” given that the major characteristics may lead into either or both of the major
372 s Assessment of Specific Problems, Competencies, and Populations

broad-band domains. Other types of problems contain characteristics specific to either

of the two major domains and stand alone in taxonomy to some extent. Additionally,
some forms of child and adolescent psychopathology have such an extremely low base
rate of prevalence that it is difficult to account for enough cases in large etiological studies
to make broad-band classification possible or desirable.
This chapter provides descriptive information and brief comments on assessment
methodology for several of these “other” domains of problems, including autism, the
so-called “schizoid” disorders, Tourette’s Disorder (a specific tic disorder that often has
social–emotional overlays), schizophrenia and other manifestations of childhood psycho-
ses, and the major eating disorders. Developing an adequate classification taxonomy for all
of these disorders has been an ongoing problem. The behavioral dimensions approach to
classifying severe childhood psychopathology (as illustrated by Quay’s taxonomy system)
has resulted in two clusters or subdomains of problems. The DSM approach to classifica-
tion of severe problems seems to be in a continual state of flux, at least in part because
of the low base rate for occurrence of many of the problems under consideration. Many of
the DSM diagnostic categories are based on adult models of psychopathology (particularly
in the case of schizophrenia and other psychotic disorders), even though there is evi-
dence that childhood and early adolescent manifestations of these severe problems differ
markedly from adulthood manifestations in many cases.
Autism Spectrum Disorder constitutes a class of severe problems that are first evident
during infancy and childhood. It is manifest by age three and is typified by severe impair-
ment in social communication and by the occurrence of stereotyped and markedly
restrictive behaviors, activities, and interests. Three deletions from the previous DSM
pervasive developmental disorders include Rett’s Disorder, Childhood Disintegrative
Disorder, and Asperger’s Disorder. These three disorders are rare compared with autism,
and little is known about prevalence and etiology. Many of the essential features of these
other pervasive developmental disorders include symptoms similar to those found in
Autism Spectrum Disorder but with specific and peculiar manifestations. Assessment of
Autism Spectrum Disorder typically must rely heavily on direct behavioral observation,
behavior rating scales, and clinical interviews with parents and teachers. Several widely
researched instruments of these types have been developed for assessing autism.
The so-called “schizoid” disorders have been in and out of DSM throughout various
editions but have been verified through behavioral dimensions research and have been of
continual interest to researchers, particularly in parts of Europe. The schizoid disorders
are characterized in general by extreme deficits in social interaction skills and by extreme
difficulty in developing and maintaining close human relationships. Schizoid and
Schizotypal Personality Disorders from DSM-5 seem to be close parallels to the schizoid
symptoms identified through behavioral dimensions research with children, even though
these two personality disorders are not typically appropriate for childhood diagnoses.
Asperger’s Disorder, recently deleted from the DSM, overlaps quite a bit with characteris-
tics of schizoid disorders. In some respects, Asperger’s Disorder or high-functioning
Autism seems to be a childhood parallel to Schizoid and Schizotypal Personality Disorder,
in much the same way as Conduct Disorder is a childhood parallel to Antisocial Personality
Disorder. Assessment of schizoid disorders is a difficult proposition, with few or no
domain-specific instruments available. It seems that a broad assessment design is appro-
priate for assessment, which would include self-report measures such as the MMPI-A and
YSR with adolescent clients who have adequate reading skills.
 Assessing Other Behavioral, Social, and Emotional Problems s 373

Tourette’s Disorder is a specific type of tic disorder that is characterized by multiple

and frequent motor and vocal tics, and that often includes social–emotional problems.
Tourette’s Disorder co-occurs with ADHD and OCD in a surprisingly large percentage of
cases, and it is often misunderstood, misinterpreted, and misdiagnosed. This disorder
usually occurs in early to middle childhood and often is characterized by an abating or
lessening of symptoms by late adolescence or early adulthood. Assessment of Tourette’s
Disorder among children is accomplished best through a comprehensive assessment
design that relies heavily on clinical interviewing of parents and the child in question.
Some research interviews and rating scales have been developed specifically for use in
assessing Tourette’s Disorder. A particular assessment problem in this area is differential
diagnosis and dual diagnosis, given the frequent co-occurrence of other disorders.
Schizophrenia Spectrum and other psychotic disorders rarely occur before mid-
adolescence, with onset usually occurring in late adolescence or early adulthood. Psychotic
episodes have been reported with children aged ten to 14 years, however, and as young as
five or six years. The manifestation of psychotic symptoms among these younger subjects
typically differs in important ways from the typical adult-oriented classification criteria
of DSM-5. The effective assessment of psychotic behavior in children and adolescents
requires a variable approach, depending on the age and developmental level of the youth
in question. Each of the major assessment methods may prove to be useful or even essential
for assessment and classification of psychotic disorders with specific clients, including
self-report measures such as the MMPI-A with high functioning adolescents.
Although eating disorders sometimes have been lumped together with the broad
band of internalizing psychopathology and do share some important characteristics
and correlates, behavioral dimensions analyses have not placed them consistently as a
subcategory of this area, so they are covered in this chapter rather than in Chapter 11.
The three major eating disorders of interest for this chapter include Anorexia Nervosa,
Bulimia Nervosa, and Binge Eating Disorder. The major diagnostic distinction between
the disorders is that Anorexia involves low body weight, either through caloric restriction
or a combination of food restriction and purging, while Bulimia tends to occur among
individuals with normal body weight and involves binge eating accompanied by inappro-
priate compensatory strategies, such as self-induced vomiting. Binge Eating Disorder is
characterized by binging without compensatory behaviors. Anorexia and Bulimia involve
distortions in self-perceptions regarding body shape and size, tend to co-occur with
mood disorders and other problems, and may have serious, even lethal, consequences.
Binge Eating Disorder is associated with all of these characteristics, except the distorted
perceptions of body weight. This aspect is less clear. Assessment of eating disorders
through external objective means is difficult. Assessment must rely heavily on extensive
clinical interviews and self-report instruments, such as the Eating Disorders Inventory,
which is now in its third edition.
Linkage of these various “other” disorders to effective intervention strategies varies
considerably across categories in terms of how easy and effective it is. For Autism Spectrum
Disorder, functional assessment and analysis strategies are crucial, because intervention
tends to be behavioral in nature and requires identification of antecedent–behavior–
consequence relationships. Linking the assessment of the schizoid disorders to intervention
is potentially problematic because of the often difficult-to-treat nature of these problems.
Assessment of social skills is essential and may assist in planning social skills training
interventions. Less is known regarding linkage of Tourette’s Disorder to intervention,
374 s Assessment of Specific Problems, Competencies, and Populations

other than the necessity of making an appropriate diagnosis and the strong possibility of
referring for medication intervention coupled with appropriate social–emotional support.
Assessment of childhood psychotic disorders is difficult to link effectively to intervention,
which usually requires a combination of medication and structured behavioral programm-
ing. For higher functioning adolescents, the MMPI-A may provide some empirically
developed templates for selection of treatment strategies. Treatment of eating disorders
tends to be eclectic, using a variety of behavioral and psychosocial strategies. Assessment
of these disorders probably is linked best to intervention through identification of the key
problems, which then are targeted for intervention.

REVIEW AND APPLICATION QUESTIONS

1. What are the most likely reasons why the “other” behavioral, social, and emotional problems
discussed in this chapter do not fit neatly within the major domains of internalizing and
externalizing psychopathology?
2. The DSM-5 lists changes in its description of Autism Spectrum Disorder. Three disorders
(all but autism) were deleted from the DSM in the fourth edition. Make an argument for
these other three disorders (Rett’s, Childhood Disintegrative, and Asperger’s) being either
separate disorders or just variations of autism.
3. In assessing a child with Autism Spectrum Disorder, what practices can be implemented
to make the assessment as “functional” as possible in providing information useful for
intervention planning?
4. Examine the characteristics of the schizoid disorders vis-à-vis the information on social
skills assessment presented in Chapter 13. How could an assessment be designed to
maximize the usefulness of the obtained information in addressing the most notable
social–interpersonal deficits through intervention?
5. What are some of the major cautions that should be considered for interpreting parent
and teacher general-purpose problem behavior rating scales that have been completed on
a child who may have Tourette’s Disorder?
6. In making a differential diagnosis with an elementary-age child who may have either
Autism Spectrum Disorder or a psychotic disorder, what would be the key discriminating
features to consider in making a diagnostic decision, and how could the assessment best
be designed to be useful in this decision?
7. Individuals with eating disorders often are secretive regarding their maladaptive eating
behaviors. Because effective assessment of these problems must rely heavily on clinical
interviewing and self-report instruments, how can these assessments best be used so that
the important problems and characteristics are not minimized or ignored?
8. Which factors are important in determining whether a self-report instrument may be a
useful part of an assessment battery for an adolescent who may have psychotic symptoms?
 13
ASSESSING SOCIAL SKILLS AND
SOCIAL–EMOTIONAL STRENGTHS

Assessment of social skills of children and adolescents has been a topic of strong interest
in the fields of education and psychology since the 1970s (Merrell & Gimpel, 1998, 2014).
School and clinical child psychologists, special educators, and professionals from related
fields who work with children and adolescents encounter numerous assessment and
intervention questions that require a sound knowledge of the overall construct of social
skills and effective methods of assessing these skills. Understanding one’s skills from a
strength-based perspective has also come to the forefront of research and practice as the
“positive psychology” movement has gained momentum.
This chapter provides the reader with the prerequisite background knowledge needed
to conceptualize appropriately various aspects of social skills of children and adolescents,
conduct effective assessments of these skills with an emphasis on strength-based assess-
ments, and use the obtained assessment information to develop sound intervention rec-
ommendations. The chapter begins with an overview of the broad construct of social
competence and some of the domains that are hypothesized to comprise it. A theoretical
model for conceptualizing the related constructs of social competence, social skills, and
peer relations is reviewed as well as discussion of how emotional competencies may influ-
ence social development. Research by Merrell and colleagues regarding the development
of a classification taxonomy for child and adolescent social skills is discussed, as is the
research base regarding the importance and long-term implications of social skills and
peer relations. Next, specific methods for assessing various aspects of social skills and peer
relations are presented, particularly as they relate to the direct and objective assessment
methods emphasized most prominently in this book. Included are assessments that spe-
cifically contribute to practice in their emphases on capturing the social and emotional
strengths and assets of children and adolescents. The chapter ends with a discussion of best
practices in using assessment data to develop effective interventions within an RtI model.

SOCIAL COMPETENCE: A COMPLEX CONSTRUCT

Although the terms social skills and social competence are often used interchangeably,
these terms indicate differing but related constructs. Most expert definitions regard social
competence as a broader construct that is superordinate to and inclusive of social skills
(see Merrell & Gimpel, 1998, 2014, for a comprehensive review of theoretical definitions).
Social competence has been conceptualized as a complex, multidimensional construct
that consists of a variety of behavioral and cognitive characteristics and various aspects

375
376 s Assessment of Specific Problems, Competencies, and Populations

of emotional adjustment that are useful and necessary in developing adequate social
relations and obtaining desirable social outcomes. Characteristics related to social
competence that are reflective of cognitive and emotional adjustment have drawn more
attention in the research literature and include those indicating effortful control (the
ability to inhibit or initiate a behavior purposefully; Rothbart & Bates, 2006), resiliency
(the ability to respond flexibly and positively in adverse situations; Spinrad et al., 2006),
social-information processing (the ability to appropriately encode a social message and
respond prosocially; Crick & Dodge, 1994), emotion knowledge (the ability to identify
emotions in oneself and others; Denham et al., 2003), and emotion expressiveness (the
ability to accurately express activated emotions; Denham et al., 2003). Social competence
transcends the divisions of internalizing and externalizing behaviors, which are discussed
at length in Chapters 10 and 11. Peer relationship problems and deficits in social skills
have been shown, however, to be a component of the internalizing and the externalizing
domains (Kauffman, 2000; Merrell & Gimpel, 1998, 2014).
Several other constructs have a strong relationship to the domain of social competence.
Three of these constructs—adaptive behavior, social skills, and peer acceptance—are particu-
larly related to social competence and are discussed briefly in the following sections.

ADAPTIVE BEHAVIOR
Adaptive behavior as defined by the American Association on Intellectual and
Developmental Disabilities (AAIDD, 2008) is “the conceptual, social, and practical skills
that people have learned to be able to function in their everyday lives” (p. 2). Adaptive
behavior is assumed to be a developmental construct, given that expectations for
independent and responsible behavior vary, depending on mental and chronological age
(AAIDD, 2008; Reschly, 1990). It also is important to consider that adaptive behavior must
be viewed within cultural and environmental contexts because expectations and demands
for independence and responsibility vary, depending on the specific culture or subculture
in which the individual resides (AAIDD, 2008; Reschly, 1990).
Assessment of adaptive behavior is a crucial aspect of the classification of developmental
delays and intellectual disabilities. The most recent definition of intellectual disabilities
from the AAIDD prominently includes the construct of adaptive behavior (or adaptive
skills) (AAIDD, 2008). In practice, the measurement of adaptive behavior includes
assessing functional living skills, which tend to require a qualitatively different evaluation
approach and are essential for individuals with pervasive intellectual disabilities and
developmental disorders. Because these particular populations and assessment methods
differ from those focused on in this book, this chapter does not discuss adaptive behavior
assessment per se, but focuses specifically on the other two aspects of social competence:
social skills and peer relationships. Readers desiring a more comprehensive treatment of
the broader construct of adaptive behavior are referred to several other excellent sources,
including AAIDD (2010), Kamphaus (1987), Reschly (1990, 1991), and Wehmeyer and
Agran (2005).

Social Skills
Social skills have been explained and defined in many ways, including cognitive,
behavioral, and ecological definitions (Merrell & Gimpel, 1998, 2014). There is no single
 Assessing Social Skills and Social–Emotional Strengths s 377

or unitary definition of social skills that has been agreed upon by most experts in the
field. In a comprehensive review of theories and definitions of social skills, Merrell
found 15 different expert definitions. For purposes of this chapter, a good working
definition of social skills is that they are specific behaviors, that when initiated, lead to
desirable social outcomes for the person initiating them. From a behavioral standpoint,
initiation of social skills increases the probability of reinforcement and decreases the
probability of punishment or extinction based on one’s social behavior (Gresham &
Reschly, 1987a). According to Gresham and Elliot (2008), examples of behavioral classes
representing social skills include communication, cooperation, assertion, responsibility,
empathy, engagement and self-control.

Peer Relations
The construct of peer relations is also sometimes referred to as peer acceptance. Peer
relations generally has been considered to be a subcomponent of social competence
(Gresham, 1986) and often is considered to be a result or product of one’s social skills.
This view of peer relations is reasonable because social reputation and the quality of one’s
social relations are in great measure a result of how effectively one interacts socially with
peers (Landau & Milich, 1990; Oden & Asher, 1977). Positive peer relations are associated
with peer acceptance, whereas negative peer relations are linked with peer rejection.

Theoretical Model
Without a doubt, the constructs of social competence, adaptive behavior, social skills,
and peer relations are interrelated. There have been varying viewpoints, however, on the
direction or path of the relationship among these constructs. Two decades ago, Gresham
(1986) proposed a hierarchical model of social competence (also outlined in Gresham,
1981a, and Gresham & Reschly, 1987a) and considered social competence to be a superor-
dinate construct to adaptive behavior and peer acceptance or relations. At the present
time, there have not been any large-scale multivariate studies that have answered definitely
the question of how specifically these constructs are related and what the direction and
strength of the paths are among them. To do so would require a carefully designed large-
scale study using complex statistical techniques, such as structural equation modeling.
Although no single study of this nature can be identified as a seminal or definitive work at
this time, numerous studies conducted during the 1980s, 1990s, and 2000s shed additional
light on the relationships among the constructs discussed in this section. Given the overall
yield of research in this area, it is our opinion that the constructs of social competence,
adaptive behavior, social skills, and peer relations are connected according to some specific
hierarchical relationships and path directions.
It is proposed that adaptive behavior should be viewed as the overarching superordinate
construct, of which social competence is one specific subordinate construct (along with
other constructs, such as communication competency and motor skills). This is a modern
view of adaptive behavior, a construct that has taken on significant importance in more
recent years. As was indicated previously, the most recent definitions and discussion of
intellectual disabilities from the AAIDD (2008, 2010) views social competence or social
functioning as one component of the broader construct of adaptive behavior. This view
also is supported through empirically derived factor structures of some adaptive behavior
assessment instruments (Bruininks, Woodcock, Weatherman, & Hill, 1984; Harrison,
1987; Harrison & Oakland, 2000).
378 s Assessment of Specific Problems, Competencies, and Populations

Adaptive Behavior

Social Competence

Peer
Relationships Social Skills

Figure 13.1 Outline of a proposed theoretical model of the relationships among the constructs of adaptive behavior, social
competence, social skills, and peer relationships

Regarding the relationship between social competence and social skills, we contend
that social competence is a broader superordinate construct that includes social skills in
a subordinate position. This line of reasoning is illustrated clearly in a widely cited article
by McFall (1982), who proposed that social competence is a summary or evaluative term
based on conclusions or judgments regarding how adequately an individual performs
social tasks. Social skills are specific social behaviors one must perform to be judged as
competent on a given task. This operational definition of social skills was outlined earlier.
As for the relationship of peer acceptance or peer relations to these other constructs,
Merrell proposes that it is a product or outcome of social skills rather than a separate
component of adaptive behavior that is parallel with social skills. In essence, peer relations
are determined by the quality and quantity of one’s social skills. The relationship between
peer relations and social skills is probably more complex, however, than being reduced to
a simple existence–outcome formula. There is good evidence that the relationship between
peer relations and social skills also is reciprocal in nature, or that the two constructs
mutually influence each other. In other words, although the existence or nonexistence of
social skills results in the outcome of good or poor peer relations, the quality of one’s peer
relations is also likely to influence the future development of social skills, by enhancing or
decreasing opportunities for future observation and modeling of social skills.
To recap this model for understanding the relationship among the four constructs we
have been exploring, adaptive behavior is viewed as the most broad and superordinate
construct in the scheme. Social competence, an evaluative or summary term reflecting
judgment regarding the overall quality of one’s social performance, is a construct that is
circumscribed within the broader construct of adaptive behavior. Social skills can be
characterized as one of several important behavioral components that lead to social
competence. Social skills, in turn, result in the quality of relationships one has with peers.
Peer relations should be viewed as a product or outcome of social skills and something that
reciprocally affects the development of social skills in the future. A graphic outline of this
proposed model of relationships among social constructs is presented in Figure 13.1.

DIMENSIONS OF SOCIAL SKILLS

As research and clinical applications regarding children’s social skills have increased in
importance and volume since the 1980s, it is curious that relatively little work has been
done related to identifying the specific underlying dimensions of social skills. In contrast
 Assessing Social Skills and Social–Emotional Strengths s 379

to the area of child psychopathology, where there have been numerous empirical efforts
aimed at developing and improving classification taxonomies, there has been a dearth
of attention paid to developing a parallel taxonomy for social skills of children and
adolescents. Perhaps one of the obstacles to such efforts is that the fields of child psychiatry
and psychology traditionally have been pathology oriented, or focused on understanding
behavior in terms of a medical model of disease and dysfunction.
To counter this lack of attention to such a potentially important endeavor, Caldarella
and Merrell (1997) sought to develop an empirical taxonomy of child and adolescent
social skills by employing a similar methodology to that used by Quay (1986a) in developing
his widely influential empirical taxonomy for child emotional and behavioral disorders
that is discussed in some detail in Chapter 3 and in other chapters in this volume. A brief
overview of this social skills meta-analysis review is presented in this section. For more
detail on the methodology or results of this investigation, the reader is referred to the
full article.
Following an extensive literature search and study elimination process, 21 studies that
used multivariate approaches to classifying social skills with more than 22,000 children
and adolescents were included. The review and synthesis of these studies were accomplished
by examining the name of each social skill factor derived in the studies and the underlying
behaviors subsumed by the factor (the approach used by Quay, 1986a). For example, items
composing a factor labeled “Peer Interaction” were examined to ensure that most of the
items (at least 50%) were directly related to peers. If so, that factor would be grouped with
other “peer-related” factors under a common dimension. The most common social skill
dimensions, those noted as occurring in one-third or more of the studies, were identified.
This method was used to eliminate outliers and study-specific findings. Using this
methodology five primary dimensions of child and adolescent social skills were identified.
These dimensions are labeled and described briefly in Table 13.1.
After the identification phase, the five dimensions presented in Table 13.1 were
examined more closely to determine the most common social skills associated with each.

Table 13.1 The five most common dimensions of social skills, developed from a review and analysis by Caldarella and
Merrell (1997)

Names of the most common social skill dimensions Frequency Percentage

(in descending order of frequency) (number of studies) of studies

Peer Relations: social interaction, prosocial, interpersonal, peer 11 52.38

preferred social behavior, empathy, social participation, sociability–
leadership, peer reinforcement, general, peer sociability
Self Management: self-control/social convention, social 11 52.38
independence, social competence, social responsibility, rules,
frustration tolerance
Academic: school adjustment, respect for social rules at school, task 10 47.62
orientation, academic responsibility, classroom compliance, good
student
Compliance: social cooperation, competence, 8 38.09
cooperation–compliance
Assertion: assertive social skills, social initiation, social activator, 7 33.33
gutsy
380 s Assessment of Specific Problems, Competencies, and Populations

This next step was accomplished by first listing the specific social skill components
constituting each of the factors that composed the dimension. For example, all of the
items constituting the first Peer Relations factor were listed. Then individual items of
the next Peer Relations factor were listed, with similar items being grouped together.
This process was carried out for all five of the most common dimensions. Similar social
skills were grouped together to determine the principal behavioral characteristics
(those occurring in one-third or more of the studies) associated with each dimension.
These principal social skills were rank-ordered (based on frequency) as they appear in
Table 13.1.
The Peer Relations dimension occurred in 11 (52.38%) studies. This dimension seems
to be dominated by social skills, reflecting a child who displays positive behaviors and
skills with his or her peers. Such skills as complimenting or praising others, offering help
or assistance, and inviting others to play or interact seem to describe this dimension well.
The Self-Management dimension also occurred in 11 studies. This dimension reflects a
child who might be labeled by others as emotionally well adjusted. This dimension also
reflects a child or adolescent who is able to control his or her temper, follow rules and
limits, compromise with others, and receive criticism well. The Academic dimension
occurred in ten (47.62%) studies reviewed. This dimension is dominated by social skills,
reflecting a child or adolescent who might be called an independent and productive
worker by his or her teacher. Such skills as accomplishing tasks or assignments inde-
pendently, completing individual seatwork and assignments, and carrying out teacher
directions all seem to describe this dimension well. The Compliance dimension occurred
in eight (38.09%) studies reviewed. The picture that emerges here is a child who essen-
tially gets along with others by following rules and expectations, using free time appropri-
ately, and sharing things. Essentially, this dimension involves complying with appropriate
requests made by others. The Assertion dimension occurred in seven (33.33%) studies
reviewed. This dimension is dominated by social skills that reflect a child or adolescent
who might be called “outgoing” or “extroverted” by others. Such skills as initiating conver-
sations with others, acknowledging compliments, and inviting others to interact all seem
to describe this dimension well.
These five most common dimensions of child and adolescent social skills have a strong
base of empirical support, being derived in more than one-third of the studies reviewed,
with two derived in more than half the studies. To date, no other research has been located
that has done such an extensive review of empirically derived social skill dimensions
of children and adolescents. This review could be said to have broken new ground by
applying the influential research method used by Quay (1986a), which combines aspects
of meta-analysis and qualitative review, to an area of crucial importance, child and
adolescent positive social behaviors.
On the basis of the frequency with which these dimensions of social skills have been
identified in 20 years of research, practitioners and researchers should consider focusing
on these areas for assessment and intervention. Many of the social skills subsumed by
these dimensions already have been incorporated into validated assessment and inter-
vention strategies (see Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Walker,
Colvin, & Ramsey, 1995; Walker, Ramsey, & Gresham, 2004). What this study provides
is further empirical support for the five essential social skills dimensions composing
the taxonomy. Gesten (1976) noted that competencies in clients must be identified and
reinforced to maximize (treatment and research) outcomes. While this review is now
 Assessing Social Skills and Social–Emotional Strengths s 381

almost 20 years old, the resulting taxonomy hopefully has helped to identify appro-
priate behaviors to reinforce and balance the scales between assessing for positive and
negative behaviors in children and adolescents. The fields of psychology and psychiatry
have long been pathology driven, and the worldview created by this focus perhaps has had
the unfortunate effect of steering clinicians and researchers concerned with behavioral,
social, and emotional assessment to take a pathology-confirming approach to assessment
of children and adolescents. The fact that our present diagnostic and classification systems
are disorder or disability oriented is evidence of this bias. In our view, it is time to begin
to balance our emphases on adaptive and maladaptive behavior. The notion of focusing
on positive outcomes or traits as opposed to a sole focus on pathology has gained atten-
tion in more recent years, as evidenced by the growing interest in the notion of positive
psychology (Larson, 2000; Seligman & Csikszentmihalyi, 2000; Snyder & Lopez, 2001).

THE IMPORTANCE OF SOCIAL (AND EMOTIONAL) SKILLS

A growing body of literature in the fields of child development, education, and psychology
collectively points to the conclusion that the development of adequate social skills and
peer relationships during childhood has important and far-reaching ramifications. Some
of the most influential studies from previous decades highlight these issues. It has been
established that development of appropriate social skills is an important foundation for
adequate peer relationships (Asher & Taylor, 1981). There also is evidence that childhood
social skills and consequent peer relationships have a significant impact on academic
success during the school years (Malecki & Elliot, 2002; Walker & Hops, 1976). In reviewing
the literature on peer relations, Hartup (1983) showed that the ability to relate effectively
to others is essential to the progress and development of the child.
More recently, researchers have been working to better understand how emotional
competence relates to social development. It seems that having an ability to understand,
regulate, and cope with emotions can be related to successful social behaviors and peer
relationships. Children who acquire emotion knowledge and emotion regulation skills
early in life may be able to respond prosocially to others and may demonstrate attentional
control in the classroom (Denham et al., 2003; Denham & Weissberg, 2004; Trentacosta,
Izard, Mostow, & Fine, 2006; Joseph & Strain, 2003). For example, Denham et al. (2003)
found that preschoolers’ emotion knowledge and expressiveness uniquely predicted social
competence in kindergarten and that these skills also predicted overall preschool social com-
petence. This relationship suggests that students who are able to understand the emotions of
others may also be able to be more responsive to peers in the classroom.
Given that adequate social skills and peer relations are an important foundation for
various types of success in life, it stands to reason that inadequate development in these
areas is related to a variety of negative outcomes. A classic and frequently cited investiga-
tion by Cowen and colleagues (1973) involving an 11- to 13-year follow-up study of
third-grade students provides convincing evidence that early peer relationship problems
are strong predictors of mental health problems later in life. These researchers found
that “peer judgment (using a negative peer nomination procedure) was, by far, the most
sensitive predictor of later psychiatric difficulty” (p. 438). Other frequently cited studies
have indicated that inadequate social skills and poor peer relations during childhood may
lead to a variety of other problems later in life, such as juvenile delinquency, school
382 s Assessment of Specific Problems, Competencies, and Populations

dropout, being fired from jobs, conduct-related discharge from military service, chronic
unemployment and underemployment, and psychiatric hospitalizations (Loeber, 1985a,
1985b; Parker & Asher, 1987; Roff, 1963; Roff & Sells, 1968; Roff et al., 1972).
As the literature on the social, emotional, and behavioral characteristics of children
with disabilities continues to grow, it has become increasingly clear that these children are
at significantly heightened risk for developing social skills deficits and experiencing peer
rejection (e.g., Merrell & Gimpel, 1998, 2014). Students identified as having a learning
disability have been found to experience high rates of social rejection by other children
(Bryan, 1974; Cartledge, Frew, & Zacharias, 1985; Sater & French, 1989), to be rated by
teachers as having poor interpersonal behavior (Gresham & Reschly, 1986), and to exhibit
maladaptive social behaviors in instructional settings (Epstein, Cullinan, & Lloyd, 1986;
McKinney & Feagans, 1984; McKinney, McClure, & Feagans, 1982). Students identified
as intellectually impaired have been found to exhibit deficits in adaptive social competen-
cies (Gresham & Reschly, 1987b), to experience high rates of peer rejection (Gresham,
1981b), and to receive inadequate amounts of social support (Park, Tappe, Carmeto, &
Gaylord-Ross, 1990). Likewise, students identified as having behavior disorders have
been found to be discriminated from students without disabilities by their maladaptive
social–emotional behaviors (Merrell, Merz, Johnson, & Ring, 1992; Stumme, Gresham,
& Scott, 1982; Vaughn, 1987) and to experience significant rates of social rejection by
other children (Hollinger, 1987). Clinicians who work with children with disabilities
and other at-risk children should be especially aware of the social problems these children
face and keep up to date on appropriate methods of assessment of positive and negative
social behavior.

METHODS OF ASSESSING SOCIAL AND EMOTIONAL SKILLS

Each of the five primary direct and objective assessment methods discussed in this
book can be used in assessing social and emotional skills and peer relations. By contrast,
projective–expressive techniques, the sixth assessment method covered in this book, may
provide some clues for hypothesis building regarding social and emotional skills and peer
relations of children, but it also requires a tremendous amount of inference and follow-up
with one of the five more direct methods of assessment. Direct behavioral observation
and behavior rating scales have been used most frequently for assessing social skills and
peer relations in educational and clinical settings. Sociometric approaches also have been
employed frequently in research on social skills and peer relations but are more limited in
terms of day-to-day clinical use. Interview methods hold some promise for assessing
social skills and peer relations but are used most commonly for other purposes, such as
clinical diagnoses. The use of self-reports in assessing social competence is a relatively new
endeavor with few exemplars, but it does show some promise. The use of each of these five
direct and objective assessment methods in evaluating social competence is discussed in
this section.

Direct Behavioral Observation

Many of the general behavioral observation techniques presented in Chapter 4 are highly
relevant for assessing social skills and peer relations. In discussing behavioral observation
as a method of assessing social skills, Elliott and Gresham (1987) optimistically stated
 Assessing Social Skills and Social–Emotional Strengths s 383

that “analyzing children’s behavior in natural settings . . . is the most ecologically valid
method of assessing children’s social skills” (p. 96). Although some recent research has
illustrated some challenges in being able to reliably capture children’s social behavior
through a limited number of observations (e.g., Doll & Elliott, 1994; Hintze, 2005; Hintze
& Mathews, 2004), direct observation of social skills is still an essential method, and
clinicians who are serious about conducting valid assessments of child and adolescent
social behaviors must master the basic methods of observational measurement, such as
those reviewed in Chapter 4
Several other sources have provided reviews of methods for assessing child and
adolescent social behavior through direct behavioral observation (e.g., Asher & Hymel,
1981; Gresham, 1981b; Hops & Greenwood, 1981; Leff & Lakin, 2005), but for this chapter
it is useful to look at three examples of how behavioral observation techniques have been
used for this purpose in published investigations, even though two of the three tools
described are over 20 years old. The first example is an observation of social behavior
observed within a system, whereas the second and third examples are interval-based
coding systems for use with individual children in naturalistic settings.

The Student Interaction in Specific Settings Tool (SISS) As schools and school districts are
beginning to think systemically about how to support the development of positive social
behaviors and reduction of maladaptive behaviors, observation tools such as the Student
Interaction in Specific Settings (SISS) can be useful. The SISS is a unique tool that allows
researchers and practitioners to objectively gather system-wide social–behavioral data.
Developed by Cushing and Horner (2003), this tool allows observers to record social
interactions occurring within a hallway, during lunch periods in a cafeteria, or out at
recess, for example. Observation “zones” are defined and all children that enter the zone
are observed. Behaviors targeted are those that suggest: (1) Rule Violations/Low Intensity
Behaviors; (2) Moderate Intensity Behaviors; and (3) High Intensity Behaviors. These
types of behaviors are operationally defined, and observers code the behaviors observed
as well as the consequence following the behavior. Consequences are considered to be:
(1) Positive; (2) Negative; or (3) No Response (in addition to the manual, see Leff & Lakin,
2005 for further description of behaviors). Positive consequences are those that make the
behavior more likely to occur in the future, while negative consequences are those that
serve to diminish the behaviors. Gathering data in this way allows observers to determine
the rate at which each type of behavior happens and the probability that the behaviors are
followed by particular consequences. Essentially, this tool allows one to look “functionally”
at the social behavior of a group. Studies have established the SISS as a reliable tool that
moderately correlates with measures of school climate (Cushing, Horner, & Barrier, 2003).
The SISS holds much promise for schools as they work to obtain a reliable “snapshot” of
social behavior across school settings.

The Peer Social Behavior Code The Peer Social Behavior Code is the third and final stage
or gate of Walker and Severson’s (1992) and Walker, Severson, and Feil’s (2014) Systematic
Screening for Behavior Disorders (SSBD), the multiple gating screening system for use
with children in grades 1 to 6 that was discussed in some detail in Chapter 3. Because the
assessment method conducted at each successive gate results in a narrowing down of
the population using increasingly intensive procedures, by the time the population has
been narrowed after the direct observational process (the third gate), it should consist of
384 s Assessment of Specific Problems, Competencies, and Populations

children who are truly at risk for social behavior problems, including social skills deficits.
The Peer Social Behavior Code observation system consists of a series of ten-second
intervals. The actual number of intervals used in an observation is variable, depending
on the situation. The recording forms each include spaces for 40 different intervals.
Observations always are conducted during free-play situations (e.g., at recess), and a
typical observation period might last 15 minutes.
Five different recording categories are included in the Peer Social Behavior Code:
Social Engagement (SE), Participation (P), Parallel Play (PLP), Alone (A), and No Codeable
Response (N). Behavior in the first two categories may be coded as either positive (1) or
negative (2). Behavior in the PLP and A categories is coded by simply checking the
appropriate box. No Codeable Response is coded with a check when the child is out of view
and with a dot when the child is interacting with an adult rather than a peer. After the
observation, the observational data are transferred from the recording forms (Figure 13.2)
to an observational summary sheet (Figure 13.3).

Systematic Screening for Behavior Disorders

PEER SOCIAL BEHAVIOR RECORDING FORM

Student Name Teacher Name

School Grade Observer
Reliability Observer Date Time Start
Time Stop Length of Session

Interval terval
Number SE P PLP A N Jmber SE P PLP A N
0-1 21
2 22
3 23
4 24
5 25
6 26
7 27
8 28
9 29
10 30
11 31
12 32
13 33
14 34
15 35
16 36
17 37
18 38
19 39
20 40

Figure 13.2 Peer Social Behavior Recording Form

Source: From Systematic Screening for Behavior Disorders, Second Edition, by H. M. Walker, H. Severson, and E. Feil (2014).
Eugene, OR: Pacific Northwest Publishing. Reprinted with Permission.
 Assessing Social Skills and Social–Emotional Strengths s 385

Systematic Screening for Behavior Disorders

PEER SOCIAL BEHAVIOR
OBSERVATION SUMMARY SHEET

Student Name
School Grade
Dates Observed and
Session #1 Session #2

Number of Observation Number of Observation Average of

Intervals' #1" Intervals' #2** 1 and 2

1. Social Engagement (SE) % % %

2. Participation (P) % % %
3. Parallel Play (PLP) % % %
4. Alone (A) % % %
5. No Codeable Response (N) % % %
6. Social Interaction (SI) % % %
7. Negative Interaction (NI) % % %
8. Positive Interaction (PI) % % %
9. Total Positive Behavior % % %
10. Total Negative Behavior % % %

'Enter the number of intervals recorded for each category.

"Enter the percentage of time spent for each category by dividing the total number of
intervals that you observed during the observation session into the intervals recorded under
different categories and multiplying by 100.

Figure 13.3 Peer Social Behavior Observation Summary Sheet

Source: From Systematic Screening for Behavior Disorders, Second Edition, by H. M. Walker, H. Severson, and E. Feil (2014).
Eugene, OR: Pacific Northwest Publishing. Reprinted with Permission.

The number of intervals recorded are entered for each category, then the percentage
of time spent for each category is calculated by dividing the total number of intervals in
the session into the intervals recorded under different categories and multiplying by 100.
The SSBD manual contains thorough directions for interpreting Peer Social Behavior
Code observation data using the normative tables provided. In addition, an excellent
observer training tape is provided as part of the SSBD kit, which also includes an audio
timing tape for accurately using the ten-second intervals. Extensive research went into the
development of the Peer Social Behavior Code, and the validity evidence and technical
properties reported in the manual and in other sources are impressive. The Peer Social
Behavior Code is an exemplary interval-based coding procedure for direct observation of
child social behavior and may serve as a model for constructing similar coding systems
for more specific purposes.

The Target/Peer Interaction Code Several related studies of the development of antisocial
behavior in boys (e.g., Shinn, Ramsey, Walker, Steiber, & O’Neil, 1987; Walker, Shinn, O’Neil,
& Ramsey, 1987; Walker, Steiber, & O’Neil, 1990; Walker, Steiber, Ramsey, & O’Neil, 1993)
used a variety of assessment methods, including direct observation, to assess positive and
negative social behaviors. Of specific interest for this chapter is the use of an observational
386 s Assessment of Specific Problems, Competencies, and Populations

code for recording the social behavior of children in playground settings, the Target/Peer
Interaction Code (TPIC). This direct observation coding system was developed by the
researchers in these studies to help answer specific research questions. Because it is
empirically sound and practical and was developed for use in a commonly accessible
naturalistic setting (e.g., school playgrounds), it may be of interest to researchers and
clinicians.
The TPIC requires coding of social behaviors of the target subject and interacting peers
during continuous ten-second intervals. Although a complete description of the TPIC
codes is beyond the scope of this chapter, certain aspects of the coding structure are of
unique interest for assessing social skills and peer relations. One of the observational areas
is target subject interactive behavior, which includes the behavioral classes of verbal behav-
ior and physical contact. Within these response classes, behaviors are recorded as being
positive or negative and initiated or noninitiated. Another observational category of inter-
est is peer interactive behavior, which includes verbal and physical interactive behavior
directed at the target child by his or her peers and is coded in a similar way as was described
in the previous category of target subject interactive behavior. Additionally, under the peer
interactive behavior category, target subjects’ responses to the peer behaviors are coded
according to whether they ignored, complied with, or appropriately resisted negative
requests from peers.
Although each of the four studies cited in this section on the TPIC varied in overall
methodology and findings, some generalized results were found to be consistent. Direct
observations using the TPIC were extremely effective at discriminating subjects with anti-
social behavior versus at-risk and normal control subjects, and certain components of the
observational data were found to correlate significantly with teacher ratings of social skills.
Finally, classroom observations of academic engaged time were also found to correlate
significantly with teacher ratings of social competence, in some cases to a higher extent
than the playground social–behavioral observations did.

Comments on Direct Observation of Child Social Behavior These examples of using the
Student Interaction in Specific Settings Tool, Peer Social Behavior Code, and Target Peer
Interaction Code illustrate how direct behavioral observation can be used to effectively
assess social skills and peer relations of children and adolescents. Such observations may
be conducted effectively in naturalistic and analogue settings. Many variations are possi-
ble in deciding which social behaviors to observe and which observational methods
to employ. In using behavioral observation techniques to assess social skills and peer rela-
tions, two specific observational validity issues seem to be particularly important: defining
the observation domain and obtaining social comparison data (see Chapter 4 for details).
In defining which social behaviors to observe and how to code them, clinicians and inves-
tigators would do well to base their targeted behaviors and codes on established domains
of social skills and peer relations and to define each class of behavior within the domains
narrowly, in order to increase the specificity of the observation. Additionally, obtaining
social comparison data is especially important for observations within these domains
because it allows the observer to make inferences about whether the observed child’s
social skills and peer relations are effective or deficient. In the event that deficiencies are
observed, increased specificity of behavioral definitions allows for targeted interventions
and progress monitoring over time.
 Assessing Social Skills and Social–Emotional Strengths s 387

Behavior Rating Scales

Until the mid-1980s, most behavior rating scales or checklists were developed to be
omnibus measures of problem behavior or to assess specific dimensions of problem behav-
ior, such as hyperactivity. Few, if any, widely available rating scales were designed primarily
for assessing children’s social skills. In the 1980s and 1990s, there was a strong surge of
interest in school-based assessment of social skills and providing training to children with
social skills deficits. This increased interest stimulated the development of several commer-
cially available social skills rating scales that have good standardization characteristics
and psychometric properties. Two of these rating scales or systems are detailed in this
section. Both instruments meet the criteria of having large, nationwide standardization
samples and good psychometric properties. The Preschool and Kindergarten Behavior
Scales (PKBS) (Merrell, 1994, 2002a), a social-behavior rating scale designed specifically for
use with the early childhood/preschool population, is reviewed in Chapter 14. Although,
the scales mentioned here are either entirely or partially comprised of items related to
adaptive behaviors, two rating scales that are solely strength based and includes indicators
of emotional adjustment will also be reviewed (for an extensive review of strength-based
measures of social and emotional skills, see Jimerson, Sharkey, Nyborg, & Furlong, 2004,
and Nickerson & Fishman, 2013).

The Social Skills Improvement System (SSIS)—Parent and Teacher Forms The Social
Skills Improvement System (SSIS) (Gresham & Elliott, 2008) is a multicomponent
social skills rating system focusing on behaviors that affect parent–child relations, teacher–
student relations, and peer acceptance. This measure was recently updated from the
Social Skills Rating System (SSRS) (Gresham & Elliott, 1990) and is part of a larger system
that includes a Performance Screening Guide (described below), the SSIS Classwide
Intervention Program, and the SSIS Intervention Guide for small groups and individuals.
In 2017, the SSIS SEL (Social Emotional Learning) System will also be available. The
availability of this overall package of assessment materials and intervention programs is
timely, given that they can be used together to provide a comprehensive, tiered system of
increasingly intensive social skills support to children and adolescents. The rating-scale
system described here could ideally be used once a child is found to be “nonresponsive” to
the classwide intervention program. This rating-scale system includes separate rating
scales for teachers and parents and a self-report form for students, which is described
later in this chapter. Each component of the system can be used alone or in conjunction
with the other forms. Separate instruments and norms are provided for each of three
developmental groups, which include preschool level (ages three to five), elementary level
(grades K to 6), and secondary level (grades 7 to 12). Each form includes validity scales,
and the parent forms now include Spanish translations. Because there is considerable
overlap among the different rating forms of the SSIS, an overview of only the elementary-
level teacher rating form is provided here as an example (the preschool forms are discussed
in Chapter 14).
The elementary-level teacher rating form of the SSIS consists of 83 items divided over
three scales: Social Skills, Problem Behaviors, and Academic Competence. For Social
Skills and Problem Behaviors items, teachers respond to descriptions using a 3-point
response format based on how often a given behavior occurs (0 = never, 1 = sometimes,
and 2 = very often). On the Social Skills items, teachers are also asked to rate how important
a skill is (on a 3-point scale) to success in the classroom. The importance rating is not
388 s Assessment of Specific Problems, Competencies, and Populations

used to calculate ratings for each scale but is used for planning interventions. On the
Academic Competence scale, teachers rate students as compared with other students on
a 5-point scale. Scale raw scores are converted to standard scores (M = 100, SD = 15) and
percentile ranks. Subscale raw scores are converted to estimates of functional ability
called Behavior Levels.
The Social Skills scale consists of 46 items used to rate social skills in the areas of teacher
and peer relations. This scale contains seven subscales, including Communication,
Cooperation, Assertion, Responsibility, Empathy, Engagement, and Self-Control. The
Communication subscale includes items that reflect adaptive social communication
(e.g., “Asks for help from adults”). The Cooperation subscale identifies compliance behav-
iors that are important for success in classrooms (e.g., “Finishes class assignments on
time” and “Uses time appropriately while waiting for help”). The Assertion subscale
includes initiating behaviors that involve making and maintaining friendships and
responding to actions of others (e.g., “Invites others to join in activities” and “Appropriately
questions rules that may be unfair”). The Responsibility subscale includes items that
indicate ownership of behavior (e.g., “Takes responsibility for her or his own actions). The
Empathy subscale reflects understanding of others (e.g., “Is nice to others when they are
feeling bad”). The Engagement subscale indicates responsiveness to others (e.g., “Responds
well when others start a conversation or activity”). The Self-Control subscale includes
responses that occur in conflict situations such as turn-taking and peer criticism (e.g.,
“Cooperates with peers without prompting” and “Responds appropriately to teasing by
peers”).
The Problem Behaviors scale consists of 29 items that reflect behaviors that might inter-
fere with social skills performance. The items are divided into five sub-scales: Externalizing
Problems, Bullying, Hyperactivity/Inattention, Internalizing Problems, and Autism
Spectrum. The Externalizing Problems subscale items reflect inappropriate behaviors
that indicate verbal and physical aggression toward others and a lack of temper control
(e.g., “Threatens or bullies others” and “Has temper tantrums”). The Bullying subscale
reflects coercive behavior (e.g., “Keeps others out of social circles”). The Hyperactivity/
Inattention subscale includes activities that involve excessive movement and impulsive
actions (e.g., “Disturbs ongoing activities” and “Is inattentive”). The Internalizing Problems
subscale includes behaviors that indicate anxiety, sadness, and poor self-esteem (e.g.,
“Shows anxiety about being with a group of children” and “Likes to be alone”). Finally, the
Autism subscale primarily focuses upon social communication deficits and perseverative
behaviors (e.g., “Uses odd physical gestures in interactions” and “Is preoccupied with
object parts”).
The third scale, Academic Competence, includes seven items that reflect academic
functioning, such as performance in specific academic areas, student’s motivation level,
general cognitive functioning, and parental support (e.g., “In terms of grade-level
expectations, this child’s skills in reading are:” and “The child’s overall motivation
to succeed academically is:”). Behavior is rated on a 5-point scale that corresponds to
percentages (1 = lowest 10% to 5 = highest 10%).
The SSIS is intended specifically to be linked to intervention ideas. Standard scores and
percentile ranks are provided for the Social Skills, Problem Behaviors, and Academic
Competence domains. In addition, behavior levels (Below Average, Average, and Above
Average) are given for the subscale scores. If scores fall within the concerning range, the
Model of Social Behavioral Strengths and Weaknesses can be used for further analysis.
 Assessing Social Skills and Social–Emotional Strengths s 389

This framework allows one to identify strengths, acquisition deficits, performance deficits,
or behaviors that might compete with other skills within a child’s repertoire.
The SSIS was standardized on a national sample of more than 4,700 children (when
considering all forms combined) representing all four U.S. geographical regions and the
U.S. population in terms of ethnic background, gender, and socioeconomic status. Given
the overall large number of participants who were rated in the SSIS national standardi-
zation, however, it is assumed that the norms for each rating form in the system at the
elementary and secondary levels were developed using a sufficient number of cases.
The overall psychometric properties obtained during scale development ranged from
adequate to excellent. For the teacher scale, reliability was measured using internal
consistency (i.e., coefficients ranged from 0.73 to 0.95), inter-rater and test–retest (i.e.,
0.70 to 0.93 correlations across the three scales) procedures. Criterion-related and
construct validity were established by finding significant correlations between the SSIS
and other rating scales. Subscale dimensions were originally determined through factor
analyses of each scale. Items that met a criterion of a 0.30 or greater factor loading were
considered to load on a given factor.
The SSIS has the distinct strength of consisting of an integrated system of instruments
for use by teachers, parents, and students, which is its major advantage (Demaray et al.,
1995). The manual is well written, and the rating instruments are easily understood and
used. The research base on the SSIS has grown since its publication and continues to
expand. The sections of the instruments that measure social skills are comprehensive
and useful. The sections measuring problem behaviors and academic competence are
brief and should be considered as short screening sections to be used in conjunction
with more appropriate measures of behavioral/emotional problems, when indicated.
The SSIS Performance Screening Guide is also a strength of the SSIS assessment and
intervention package. This tool is a very brief measure of students’ prosocial behavior,
motivation, reading, and math skills. Teachers can complete this form on students in
preschool through high school. Skills are rated on a scale of 1 to 5 and can provide teach-
ers with a quick estimate of which students need extra support in what areas. Test–retest
reliability estimates of this scale were generally moderate, suggesting that the tool is likely
appropriate for global screening purposes and might serve as an excellent way to gather
data on all children within a RtI model.

The School Social Behavior Scales, Second Edition (SSBS-2)/Home and Community
Social Behavior Scales (HCSBS) The School Social Behavior Scales, Second Edition
(SSBS-2; Merrell, 2002b), a revision of the original School Social Behavior Scales (Merrell,
1993b), is a school-based social behavior rating scale for use by teachers and other school
personnel in assessing social competence and antisocial problem behaviors of students in
kindergarten through grade 12. It includes two separate scales (Figures 13.4 and 13.5)
with a total of 64 items that describe positive and negative social behaviors that commonly
occur in educational settings. Items are rated using a 5-point scale (1 = “never” to 5 =
“frequently”). Each of the two scales of the SSBS yields a total score using a raw to T score
conversion with a mean of 50 and standard deviation of ten. The two scales have three
subscales each, with scores reported as four different Social Functioning Levels, including
High Functioning, Average, At-Risk, and High Risk.
Scale A, Social Competence, includes 32 items that describe adaptive, prosocial
behavioral competencies as they commonly occur in educational settings. The Interpersonal
390 s Assessment of Specific Problems, Competencies, and Populations

Scale A Never Sometimes Frequently Scoring Key

1. Cooperates with other sudents 1. 2 3 4 5

2. Makes appropriate transitions between different activities 2. 2 3 4 5
3. Completes school work without being reminded 3. 2 3 4 5
4. Offers help to other students when needed 4. 2 3 4 5
5. Participates effectively in group discussions and activities 5. 2 3 4 5
6. Understands problems and needs of other students 6. 2 3 4 5
7. Remains calm when problems arise 7. 2 3 4 5
8. Listens to and carries out directions from teachers 8. 2 3 4 5
9. Invites other students to participate in activities 9. 2 3 4 5
10. Asks appropriately for clarification of instructions 10. 2 3 4 5
11. Has skills or abilities that are admired by peers 11. 2 3 4 5
12. Is accepting of other students 12. 2 3 4 5
13. Completes school aSSignments or other tasks independently 13. 2 3 4 5
14. Completes school assignments on time 14. 2 3 4 5
15. Will give in or compromise with peers when appropriate 15. 2 3 4 5
16. Follows school and classroom rules 16. 2 3 4 5
17. Behaves appropriately at school 17. 2 3 4 5
18. Asks for help in an appropriate manner 18. 2 3 4 5
19. Interacts with a wide variety of peers 19. 2 3 4 5
20. Produces work of acceptable quality for his/her ability level 20. 2 3 4 5
21. Is good at initiating or joining conversations with peers 21. 2 3 4 5
22. Is sensitive to feelings of other students 22. 2 3 4 5
23. Responds appropriately when corrected by teachers 23. 2 3 4 5
24. Controls temper when angry 24. 2 3 4 5
25. Enters appropriately into ongoing activities with peers 25. 2 3 4 5
26. Has good leadership skills 26. 2 3 4 5
27. Adjusts to different behavioral expectations across settings 27. 2 3 4 5
28. Notices and compliments accomplishments of others 28. 2 3 4 5
29. Is assertive in an appropriate way when he/she needs to be 29. 2 3 4 5
30. Is invited by peers to join in activities 30. 2 3 4 5
31. Shows self-control 31. 2 3 4 5
32. Is "looked up to" or respected by peers 32. 2 3 4 5
Totals
PR SM AB

Figure 13.4 Scale A (Social Competence) of the School Social Behavior Scales
Source: From School Social Behavior Scales, Second Edition, by K. W. Merrell (2002b). Eugene, OR: Assessment-Intervention
Resources. Copyright 2002 by Kenneth W. Merrell. Reprinted with permission.
 Assessing Social Skills and Social–Emotional Strengths s 391

Scale A Never Sometimes Frequently Scoring Key

1. Blames others for his/her problems 1. 2 3 4 5

2. Takes things that are not his/hers 2. 2 3 4 5
3. Is defiant to teachers or other school personnel 3. 2 3 4 5
4. Cheats on schoolwork or in games 4. 2 3 4 5
5. Gets into fights 5. 2 3 4 5

6. Is dishonest; tells lies 6. 2 3 4 5

7. Teases and makes fun of other students 7. 2 3 4 5
8. Is disrespectful or "sassy" 8. 2 3 4 5
9. Is easily provoked; has a "short fuse" 9. 2 3 4 5
10. Ignores teachers or other school personnel 10. 2 3 4 5
11. Acts as if he/she is better than others 11. 2 3 4 5
12. Destroys or damages school property 12. 2 3 4 5
13. Will not share with other students 13. 2 3 4 5
14. Has temper outbursts or tantrums 14. 2 3 4 5
15. Disregards feelings or needs of other students 15. 2 3 4 5
16. Is overly demanding of attention from teachers 16. 2 3 4 5
17. Threatens other students; is verbally aggressive 17. 2 3 4 5
18. Swears or uses offensive language 18. 2 3 4 5
19. Is physically aggressive 19. 2 3 4 5
20. Insults peers 20. 2 3 4 5
21. Whines and complains 21. 2 3 4 5
22. Argues or quarrels with peers 22. 2 3 4 5
23. Is difficult to control 23. 2 3 4 5
24. Bothers and annoys other students 24. 2 3 4 5
25. Gets into trouble at school 25. 2 3 4 5
26. Disrupts ongoing activities 26. 2 3 4 5
27. Boasts and brags 27. 2 3 4 5
28. Is not dependable 28. 2 3 4 5
29. Is cruel to other students 29. 2 3 4 5
30. Acts impulsively without thinking 30. 2 3 4 5
31. Is easily irritated 31. 2 3 4 5
32. Demands help from other students 32. 2 3 4 5
Totals
HI AA DD

Figure 13.5 Scale B (Antisocial Behavior) of the School Social Behavior Scales
Source: From School Social Behavior Scales, Second Edition, by K. W. Merrell (2002b). Eugene, OR: Assessment-Intervention
Resources. Copyright 2002 by Kenneth W. Merrell. Reprinted with permission.
392 s Assessment of Specific Problems, Competencies, and Populations

Skills subscale includes 14 items measuring social skills that are important in estab-
lishing positive relationships with, and gaining social acceptance from peers (e.g., “Offers
help to other students when needed” and “Interacts with a wide variety of peers”). The
Self-Management Skills subscale includes ten items measuring social skills relating to self-
restraint, cooperation, and compliance with the demands of school rules and expectations
(e.g., “Responds appropriately when corrected by teacher” and “Shows self-restraint”). The
Academic Skills subscale consists of eight items relating to competent performance and
engagement on academic tasks (e.g., “Completes individual seatwork without being
prompted” and “Completes assigned activities on time”).
Scale B, Antisocial Behavior, includes 32 items that describe problematic behaviors that
either are other-directed in nature or are likely to lead to negative social consequences, such
as peer rejection or strained relationships with the teacher. The Hostile–Irritable subscale
consists of 14 items that describe behaviors considered to be self-centered and annoying
and that will likely lead to peer rejection (e.g., “Will not share with other students” and
“Argues and quarrels with other students”). The Antisocial–Aggressive subscale consists of
ten behavioral descriptors relating to overt violation of school rules and intimidation
or harm to others (e.g., “Gets into fights” and “Takes things that are not his or hers”). The
Disruptive–Demanding subscale includes nine items that reflect behaviors likely to disrupt
ongoing school activities and to place excessive and inappropriate demands on others
(e.g., “Is overly demanding of teacher’s attention” and “Is difficult to control”).
Many studies and procedures are reported in the SSBS-2 manual and subsequent
published articles concerning the psychometric properties and validity of the instrument.
The scales were standardized on a group of 2,280 students in kindergarten through
12th grade from the United States, with each of the four U.S. geographical regions repre-
sented in the standardization process. The percentage of special education students in
various classification categories in the standardization group closely approximates the
national percentages of these figures.
Various reliability procedures reported in the SSBS-2 manual indicate the scales have
good to excellent stability and consistency. Internal consistency and split-half reliability
coefficients range from 0.91 to 0.98. Test–retest reliability at three-week intervals is reported
at 0.76 to 0.83 for the Social Competence scores and 0.60 to 0.73 for the Antisocial Behavior
scores. Inter-rater reliability between resource room teachers and paraprofessional aides
ranges from 0.72 to 0.83 for the Social Competence scores and 0.53 to 0.71 for the Antisocial
Behavior scores.
Validity of the scales has been shown in several ways. Moderate to high correlations
between the SSBS and five other behavior rating scales (including the Child Behavior
Checklist, Conners Teacher Rating Scale–39, Teacher’s Report Form, Waksman Social
Skills Rating Scale, and the adolescent version of the Walker–McConnell Scale of
Social Competence and School Adjustment) indicates that the scale has strong con-
vergent and discriminant construct validity (Emerson, Crowley, & Merrell, 1994). Other
findings indicate the scales can discriminate adequately between gifted and nongifted
children (Merrell & Gill, 1994), between students with disabilities and regular education
students (Merrell, 1993b; Merrell, Sanders, & Popinga, 1993), and between students with
behavioral disorders and others receiving special education services (Merrell et al., 1992).
The factor structure of the two scales is strong, with all items having a factor loading into
their respective subscale of 0.40 or greater and no items being duplicated across subscales
(Merrell, 1993b).
 Assessing Social Skills and Social–Emotional Strengths s 393

The SSBS-2 is a practical and easy-to-use school-based rating scale that provides norm-
referenced data on positive social skills and antisocial problem behavior. It has satisfactory
to good psychometric properties, it is easy to use, and the items and structure are highly
relevant to the types of behavioral issues encountered by school-based professionals. The
original SSBS has been reviewed positively in the professional literature (Demaray et al.,
1995; Kreisler, Mangione, & Landau, 1997), and the minor revisions that went into the
second edition of this instrument have only improved it. The Antisocial Behavior scale of
the SSBS-2 is designed specifically to measure behavior problems that are directly social
in nature or that would have an immediate impact on strained relations with peers and
teachers. The scale was not designed to measure overcontrolled or internalizing behavior
problems, such as those associated with depression and anxiety, and it was not designed
to measure behavior problems associated with ADHD. If these types of problem behaviors
are a significant issue on an assessment case, the assessment should be bolstered by the
addition of an appropriate measure targeting these behaviors.
In addition to the revised SSBS-2, a cross-informant version of this instrument for use
by parents and other home-based informants is available, the Home and Community
Social Behavior Scales (HCSBS) (Merrell, 2002c). The HCSBS includes the same general
rating format, social competence/antisocial behavior scale division, and items as the
SSBS-R. Some of the items were reworded slightly, however, to reflect behaviors in home
or community settings rather than school settings. The norming sample of the HCSBS
includes more than 1,500 cases that were drawn from a national sample of more than
2,200 ratings of children and youth aged five to 18. The gender and ethnic/racial back-
ground of the norming sample is consistent with the 2000 U.S. Census. Findings from
research to date on the HCSBS have indicated that this instrument has: (1) strong psycho-
metric properties, as evidenced by high internal consistency coefficients (0.96 to 0.98 for
the total scores) (Merrell & Caldarella, 1999); (2) the ability to differentiate accurately
between at-risk and not-at-risk students (Merrell & Caldarella, 1999; Robbins & Merrell,
1998) and between students with learning and behavioral disorders and general education
students (Lund & Merrell, 2001); (3) sensitivity to treatment outcomes (Snyder, Kymissis,
& Kessler, 1999); (4) moderate cross-informant convergence with the SSBS (Robbins &
Merrell, 1998); (5) the ability to differentiate between students with and without ADHD
(Merrell & Boelter, 2001); and (6) strong convergent validity with several other child
behavior rating scales (Merrell & Boelter, 2001; Merrell, Caldarella, Streeter, Boelter, &
Gentry, 2001).
In sum, the HCSBS and SSBS together comprise a cross-informant behavior rating
system for screening and assessing social and antisocial behavior of children and adoles-
cents across school, home, and community settings. These instruments are easy to use, are
practical, are aimed at routine or garden-variety social behaviors rather than psychiatric
symptoms, and share strong psychometric properties and an expanding research base. They
are designed to be useful in screening, classification, and development of interventions for
at-risk children and adolescents.

The Social Emotional Assets and Resilience Scales—Teacher and Parent Reports (SEARS-T,
SEARS-P) The Social Emotional Assets and Resilience Scales (SEARS; Merrell, 2011),
a multirater assessment system, is a compilation of strength-based rating scales that
can be completed by teachers (SEARS-T), parents (SEARS-P), children (SEARS-C) and
adolescents (SEARS-A). These measures aim to describe the social and emotional
394 s Assessment of Specific Problems, Competencies, and Populations

strengths and assets of individual children and adolescents (aged five to 18) in a feasible
and socially valid manner. Each SEARS measure also has a short form of approximately
12 items that can be used for screening and potentially for progress monitoring purposes.
These measures include a 4-point Likert scale, and items reflect student strengths in peer
relationships, empathy, responsibility, and awareness of cognitions and behavior. The
SEARS forms are made of perforated, carbonless paper and once administered can be
easily scored. Once raw scores are totaled, T scores and percentiles can be derived. Higher
scores on each scale are reflective of more adaptive or “resilient” behaviors. The SEARS
forms also include unique behavioral levels or descriptors that align with RtI tiered
models of intervention. These include Tier 1: Average to High Functioning, Tier 2: At
Risk, and Tier 3: High Risk. The SEARS-T and SEARS-P are described here and the
SEARS-C and SEARS-A are described later in this chapter.
The SEARS-T is comprised of 41 items and takes very little time to complete. The tech-
nical properties of the SEARS-T were recently analyzed using a sample of approximately
1,500 teachers from diverse regions of the United States. Validity studies including both
exploratory and confirmatory factor analyses resulted in four factors: Responsibility, Social
Competence, Self-Regulation, and Empathy. Items reflective of Responsibility include “Is
dependable, someone you can rely on” and “Makes good decisions.” Social Competence
item examples include “Other people see him/her as a leader” and “Asks others for help
when he/she needs it.” Self-Regulation items included “Thinks of her/his problems in ways
that help” and “Can identify errors in the way he/she thinks about things.” Finally, Empathy
is described in items like “Cares what happens to people” and “Knows when other students
are upset, even when they say nothing.” Internal consistency coefficients ranged from 0.91
to 0.98, and test–retest reliability coefficients ranged from 0.84 to 0.94 in reliability studies.
(Merrell, Cohn, & Tom, 2011). Furthermore, the short form of the SEARS-T (SEARS-SF-T)
was found to be internally consistent and reliable with the long form.
The SEARS-P is very similar in format to the SEARS-T and consists of 39 items.
In another study aiming to evaluate the technical adequacy of the SEARS-P (Merrell, Felver-
Gant, & Tom, 2010), similar results were found. A three-factor structure emerged that
included Self-Regulation/Responsibility, Social Competence, and Empathy. Strong internal
consistency was demonstrated, ranging from 0.87 to 0.95, and strong test–retest reliability
was established at a two-week interval (0.88 to 0.92). The SEARS-SF-P also correlated very
well with the full-length form, and internal consistency estimates were strong.
While these are new measures, the SEARS is a comprehensive system that can provide
a great deal of information about a child’s strengths from a number of perspectives. Ideally,
measures like the SEARS will be used more often in practice to guide development of
strength-focused interventions and to monitor the progress of interventions in place.
As data management systems that compile and track data of larger populations are becom-
ing more of a norm, measures like the SEARS can be used as preventative screening tools
that capture wellness and identify the strengths and needs of a population through a less
pathology-oriented lens.

The Devereux Student Strengths Assessment (DESSA) The Devereux Student Strengths
Assessment (DESSA) is a 72-item strength-based measure that can be completed by
caregivers and teachers to assess the resilience and social–emotional competencies
of children in grades kindergarten to 8 (LeBuffe, Shapiro, & Naglieri, 2014). The DESSA
takes about ten minutes to complete and is written at a sixth-grade reading level. An
 Assessing Social Skills and Social–Emotional Strengths s 395

overall Social Emotional Composite score is generated as well as subscale scores including
Self-Awareness, Self-Management, Goal-Directed Behavior, Relationship Skills, Personal
Responsibility, Decision Making, and Optimistic Thinking. A Protective Factor Index is
also generated. Developers of the DESSA engaged in a multi-step process to develop the
DESSA forms. They started with a pool of over 765 items that were developed on
the basis of the social–emotional competencies identified by the Collaborative for
Academic and Social Emotional Learning (www.casel.org) and then reduced the pool,
based on redundancies, reading level, etc. A national pilot study was conducted, through
which researchers were able to develop the final prototype for the measure.
Researchers conducted a national standardization study, through which they were able
to generate national norms representative of the U.S. population (see Lebuffe et al., 2014).
Internal consistency coefficients across forms and subscales were high and ranged from
0.82 to 0.99. Test–retest reliability was calculated based on scores generated from forms
completed four to eight days apart. These coefficients were also high (0.84 to 0.94) but
would be likely to decrease significantly with a longer retest window. Further, inter-rater
reliability estimates were strong. In terms of validity, the DESSA has been shown to accu-
rately discriminate between students who receive regular education versus those who are
identified as emotionally disordered and receiving special education support. Additionally,
the DESSA converges with the BASC-2 and the Behavioral and Emotional Rating Scale-
Second Edition (BERS-2) (Epstein, 2004).
Overall, the DESSA is an impressive tool that effectively targets resiliency and social–
emotional skills. There is also a brief screening tool (DESSA-mini; Lebuffe et al., 2014)
that consists of eight items and can be used to identify children in need of further
assessment or for classroom Tier 1 problem solving. What is most impressive is that the
DESSA and DESSA-mini are just a few measures that are part of a much larger effort on
the part of the Center for Resilient Children (see www.centerforresilientchildren.org) to
increase these skills in children and adults. The Devereux Early Childhood Assessment has
multiple forms targeting the development of these skills and competencies from infancy
through preschool. These will be reviewed in Chapter 14. Further there are resources and
supports to help practitioners, clinicians, and caregivers to use these data tools to plan
prevention and intervention-oriented activities. This comprehensive, data-based approach
to improving children’s mental health will be very interesting to monitor as more studies
are conducted in the years to come.

Interviewing Techniques
Direct assessment of social skills and peer relations is difficult at best to assess through
interviewing techniques. The essence of these constructs are the behavioral skills a child
or adolescent uses to initiate and maintain social communication, and the quality and
nature of his or her resulting relationships with peers. In attempting to obtain high-quality
information about a client’s social skills or peer relations within the context of an interview,
the clinician is in the position of having to rely on observations within an analogue
environment, subjective and difficult-to-verify reports from the child or adolescent clients,
or interview information obtained from parents or other informants. Elliott and Gresham
(1987) noted that although behavioral interviews may be the most frequently used
assessment method in the initial stages of intervention planning, they have not been
investigated systematically as a social skills assessment technique. Little has changed in the
three decades since that statement.
396 s Assessment of Specific Problems, Competencies, and Populations

At present, there are no widely available structured or semistructured interview

schedules that have been developed primarily for the assessment of social skills and peer
relations. Accordingly, the use of less structured techniques is the only alternative for
clinicians wishing to assess social skills and peer relations through interviews. Although
this method may not be as desirable or direct as behavior rating scales or sociometric
approaches, a good clinician still may find it useful in obtaining information on a client’s
social skills and peer relations.
Within the context of interviewing a child or adolescent client, there are several points
and techniques that facilitate the process of obtaining good data on the client’s social
skills or peer relationships. One of the first points to consider is that when a child is
experiencing strained peer relationships or rejection, his or her report may be colored by
lack of insight, distorted perceptions, defensiveness, or hurt. The younger the subject, the
more likely it is that the interview information may be influenced by these factors.
As Boggs and Eyberg (1990) noted, children may not accurately or completely describe
the events in their environment because of limited verbal skills or compliance with self-
censoring rules they have learned. Clinicians who are skilled in interviewing children
known to be experiencing severe rejection by peers often find that when subjects are
asked to report on the amount and quality of their peer relations, most report having
several friends and getting along with them well, and when asked to “name names,” they
even provide a detailed list of their “best friends.” Clinicians conducting interviews in this
manner need to use caution in corroborating the client’s report with more objective data
and are advised to conduct the interview in a structured, detailed manner to increase the
objectivity of the results.
The use of role-playing within a child or adolescent interview, when combined with a
careful observation of the client’s behavior, can provide some potentially useful inform-
ation on their level of social skills. Given a carefully structured analogue situation, the
clinician may be able to obtain a direct observation within the interview session of such
important social skills as eye contact, entering into a conversation, dealing with peer
pressure or harassment, requesting help, and giving or receiving a compliment. The
process of social skills observation during role-playing is relatively easy: the interviewer
simply needs to set up the format and expectations, then observes the client functioning
within his or her designated role. For example, the clinician might say something like the
following:

Let’s pretend that I am a kid at your school who you might want to become friends
with. I am going to act like I am sitting down in the cafeteria eating my lunch, and
I want you to come up to me and start talking with me about anything you want.
OK? Let’s give it a try now.

Engaging in a role-play situation such as this may alert the interviewer to any potential
social skills deficits the child or adolescent client has that may be negatively affecting
their peer relations. The type of information obtained through this process not only can
provide good assessment data, but also can be helpful in establishing an appropriate
intervention after the assessment. Behavioral role-play techniques, such as the example
just provided, may be considered to be a bridge between interviewing and direct behavioral
observation because they use some traditional components of each method. Gresham
(1986) noted that behavioral role-play interview techniques have several advantages for
 Assessing Social Skills and Social–Emotional Strengths s 397

assessment, particularly when the interview setting is tightly controlled and simulated to
be similar to the natural environment in which the child’s normal social interactions
occur. In this regard, it is crucial to consider that behavioral generalization and meaningful
results are more likely to occur if the role-play situation is constructed to parallel the real
environment (Stokes & Baer, 1977).
When conducting an interview with a parent of a child or adolescent client, useful social
skills and peer relations information may be obtained by structuring the interview
questions carefully and by providing the parent with specific guidelines on how to respond
to questions. It is important to note that the behavior of the interviewer may have a
significant impact on the responses of the client during the interview (Gross, 1984).
Because the goal of the interview in this instance is to obtain specific information on
the social skills and peer relations of the child, it is helpful for the interviewer to provide
specific prompts to the parent to increase the quality of the interview data. The following
scenario illustrates how an interviewer can maximize the quality of the information they
obtain by carefully structuring questions and prompts:

Interviewer: Tell me about how Jamie gets along with other children.
Parent: Not very well.
Interviewer: Can you tell me some more about that?
Parent: Jamie doesn’t have many friends . . . when she does have another child over to the
house to play, they usually don’t want to come back again because they get mad at her.
Interviewer: Could you tell me specifically what kind of things the other kids seem to get
mad at Jamie about?
Parent: Usually, when they are playing with toys or a book or something, Jamie won’t
share with them . . . she wants to dominate everything and gets upset when they have
something that belongs to her. She wants to take toys and things that they bring over
and use them the whole time.
Interviewer: So Jamie has a difficult time sharing with others and doing what they want
to do . . . this seems to be a real problem for her in making friends.
Parent: It’s a real problem all right . . . if she could see the other kid’s point of view, give in
a little bit, and not be so jealous of her things, I think she could have a lot more friends
to play with.

This interchange shows how the interviewer, by going from the general to the specific and
by providing the parent with express prompts, is able to pinpoint specific types of social
skills and peer interaction problems. The parent interview can vary from being open-
ended to being highly structured; the specific level of structure should depend on the
purpose of the interview. If the goal is to obtain useful information on the social skills
and peer relations of the child, a higher degree of structure and prompting seems to be
most useful.

Sociometric Approaches
Sociometric approaches are a valid method for assessing social skills and peer relations.
In fact, the constructs of social skills and peer relations are perhaps more closely suited
to assessment through sociometrics than any other constructs. Virtually any of the
approaches discussed in Chapter 7 can be adapted easily for directly assessing different
aspects of peer relations, which is their main purpose and use. Actual social skills tend be
398 s Assessment of Specific Problems, Competencies, and Populations

assessed less directly with sociometric approaches than do peer relations. Because peer
relations are linked closely with social skills (Hartup, 1978), sociometric assessment
should hold a great deal of heuristic interest for conducting social skills assessments as
well. Because the general methods, techniques, and properties of sociometric approaches
were discussed in detail in Chapter 7, this section focuses on a few issues and applications
of sociometric assessment for measuring social skills and peer relations, rather than on
duplicating the general information presented elsewhere.
Some discussion on the nature of the relationship between the two constructs of
interest for this chapter—social skills and peer relations—may be useful at this point.
Perhaps the best way of conceptualizing this relationship is to look at it as being reciprocal
in nature. On one hand, peer relations are seen as being an outcome of social skills, in that
the greater degree of adaptive social competency a person possesses, the greater his or
her ability to develop positive and fulfilling relationships with other persons (Gresham
& Reschly, 1987a). On the other hand, it also has been shown that to some extent peer
relations are determinants of social skills, in that the social learning process involved in
peer relationships contributes significantly to the development of social skills (Hartup,
1978, 1983). The relationship between these two subdomains of social competence is
complex and is described best as being mutually influential or reciprocal. Figure 13.1
shows this theorized relationship between the two constructs. In one sense, peer relations
may be considered an outcome of social skills, but in another sense, the constructs are
mutually reciprocal in nature.
In preparing to conduct an assessment of social skills or peer relations using any of
the sociometric approaches discussed in Chapter 7, the clinician or investigator must
consider two aspects to make the assessment as useful as possible. The first area to be
considered is which general technique to use. On the basis of Connolly’s (1983) review,
the choice of sociometric approaches at the general level is between using a peer nomi-
nation procedure and a peer rating procedure. Peer nomination procedures have been
the traditional method of choice in sociometrics, but peer rating procedures may also be
a useful alternative. The main difference between the two general types of procedures is
that peer nominations tend to produce a measure of popularity, whereas peer ratings tend
to produce a measure of average “likability” (Connolly, 1983). Although these two proce-
dures seem to tap similar constructs, there is an important difference, which is illustrated
by the example of a child who through peer ratings receives an average rating but is
not positively or negatively nominated by any other children in the peer nomination
procedure. Is this a typical child or a socially neglected child? It depends on which proce-
dure you use and how you interpret it. A good compromise would be to use both types
of sociometric approaches in the assessment if possible, which should strengthen the
generalizability of your results. When practical considerations keep you from using
both types of procedures in an assessment, it is important to define carefully what your
intended goal or outcome for the assessment is and accordingly to select the general type
of procedure to be used.
The second aspect to be considered is what specific procedure to use within your
selected general method. Two needs will guide this decision. The first need to consider is
the capability level of your subjects. When assessing younger or lower-performing
children, it is necessary to select a procedure that will not require any extensive reading
or writing. In such a case, McAndless and Marshall’s (1957) picture board adaptation of
the peer nomination procedure would be a good choice, as would the simplified pictorial
 Assessing Social Skills and Social–Emotional Strengths s 399

rating scale procedure for peer ratings (Asher et al., 1979). The other need that will guide
your decision regarding the specific procedure to use is the aspect of peer relations
or social skills that you want to measure. In this regard, it is sufficient to say that you
should evaluate carefully the face validity of the procedures you are considering (and
formal validity properties) against the specific assessment needs you have and to choose
accordingly.
In sum, the use of sociometric approaches is a time-honored empirically validated
method of assessing peer relations that also has indirect validity in assessing social skills.
Virtually any of the general methods and specific procedures discussed in Chapter 7, with
proper selection and modification, may be of great use to the clinician or investigator in
assessing these specific aspects of behavioral, social, and emotional problems.

Assessment with Self-Reports

At present, very little has been done in the area of developing a self-report assessment
instrument for measuring social competence with children or adolescents. Perhaps one
of the problems with developing effective self-report measures of social skills and peer
relations is that children with deficits in these areas may not be reliable judges of their
own behavior. It has been noted that youth with ADHD or conduct disorders, two groups
that are extremely prone to exhibit social skills deficits and peer relation problems,
have a tendency to perceive and interpret ambiguous information regarding the social
behavior of other persons in a distorted manner (Merrell & Gimpel, 1998). Regarding the
accuracy of self-perceptions of youth with social behavior problems, little empirical work
has been conducted. Many clinicians have observed a tendency of these youth to perceive
the effectiveness of their own social skills in more glowing terms than would be attributed
by objective observers. Researchers and clinicians who obtain self-reports from at-risk
children and adolescents regarding their own social skills and peer relations should be
cautious regarding bias and distortions in their responses.
A few experimental or research instruments have been developed for self-report assess-
ing of social skills, social emotional assets, or peer relations, but only a few instruments of
this type are commercially published and widely available at present. These instruments, the
self-report forms of the SSIS and SEARS, are reviewed in the following section.

The Social Skills Improvement System—Student Forms As part of the larger, cross-
informant Social Skills Improvement System that was described earlier in this chapter,
there are two different self-report forms for a child or adolescent to use in assessing his or
her own social skills. The Student (Ages 8–12) Form is designed to be used by children in
grades 3 to 6, and the Student (Ages 13–18) Form is designed to be used for children in
grades 7 to 12. Each form includes items rated on a 4-point scale. Both forms include two
scales (Social Skills, Problem Behaviors) and 11 subscales (Communication, Cooperation,
Assertion, Responsibility, Empathy, Engagement, Self-Control, Externalizing, Bullying,
Hyperactivity/Inattention, and Internalizing), with the raw scores being converted to
Behavior Levels and a total score, which is converted to a standard score (based on a mean
of 100 and standard deviation of 15) and percentile ranking based on same gender norms.
Three examples of items on the elementary form include “I make friends easily,” “I do my
homework on time,” and “I ask classmates to join in an activity or game.”
The Student Form–Secondary Level includes two sets of ratings. The first set of ratings
is a “How True” rating, where the student rates how true each item is for him or her.
400 s Assessment of Specific Problems, Competencies, and Populations

Similar to the elementary student version, the “How True” rating on the secondary
student form is done according to the criteria of N = Not True, L = A Little True, A =
A Lot True, and V = Very True. The second set of ratings is a “How Important” rating,
where the student rates how important the specific behavior is in their relationship
with others. This second set of ratings is also on a 0 to 2 scale, where 0 = Not Important,
1 = Important, and 2 = Critical. The inclusion of the importance ratings allows for a
comparison on specific rating items for any discrepancies between the way a behavioral
item was rated and how important it is to that student. For example, if a student rates not
true on item 1, “I ask for information when I need it,” yet his or her importance rating is
critical, this discrepancy suggests that the student’s perceived difficulty in asking for
information is particularly painful for him or her.
The psychometric properties of the two student forms reported in the SSIS manual
seem to be stronger than those from the original SSIS. They are generally in the acceptable
range, particularly when considering that the student forms are designed to be used as
part of a multirating system rather than by themselves. Internal consistency coefficients
for the student scales range from 0.70 to 0.95. Reported test–retest reliability coefficients
for the student forms ranged from 0.59 to 0.81. Convergent and discriminant validity
of the student forms was assessed through correlations with the SSRS and BASC-2,
and the obtained coefficients ranged from 0.25 to 0.58 on the Social Skills scale of the
SSRS. The Problem Behaviors were not compared, as they were not included in the SSRS,
and the correlations with the BASC-2 were all weak. These weak correlations probably
have a great deal to do with the possibility that the BASC-2 measures different constructs.
Similar to the other components of the SSIS, the two student forms have the advantage
of being part of an integrated social skills assessment structure and having been developed
using a large, nationwide sample of respondents. These self-report forms, when used with
appropriate caution, may be a useful adjunct to the teacher and parent rating forms in
assessing social skills and may provide validity to the process of assessing social skills and
peer relations by obtaining the student’s own perspective.

The Social Emotional Assets and Resilience Scales—Child and Adolescent Forms
(SEARS-C, SEARS-A) Similar to the SEARS-T and SEARS-P described earlier in the
chapter, the SEARS-C and SEARS-A were developed by Merrell (2011) to measure
the social and emotional strengths of students from the perspective of students. The
SEARS-C is appropriate for children in grades 3 to 6 and the SEARS-A is for adolescents
in grades 7 to 12. Scoring is similar to that described above and includes the same behav-
ioral descriptors. The items on these forms are very similar to those seen on other forms
and tap constructs such as empathy, self-regulation, responsibility, and social compe-
tence. That being said, factor analytic studies suggested that the SEARS-C items load
on to one global factor, meaning that only one total score is derived. Items included on
this measure are “I feel sorry for other people when bad things happen to them” and
“I can name lots of different feelings.” Internal consistency of the SEARS-C was measured
at 0.92 and the SEARS-C-SF was less strong but still impressively stable with a coefficient
of 0.85. The temporal stability of the SEARS-C was equally impressive (two week = 0.81,
four week = 0.79, six week = 0.73). The SEARS-C also converged nicely with other meas-
ures of social and emotional health, the Internalizing Symptoms Scale for Children
(Merrell & Walters, 1998 and the Behavior and Emotional Rating Scale (Epstein &
Sharma, 1998).
 Assessing Social Skills and Social–Emotional Strengths s 401

The SEARS-A, appropriate for adolescents in grades 7 to 12, includes four subscales
derived from factor analyses (Self-Regulation, Social Competence, Empathy, and
Responsibility). The SEARS-A includes 35 items such as “I am comfortable talking to lots
of different people” and “I am someone you can rely on.” Internal consistency estimates
ranged from 0.80 to 0.93 and temporal stability of total scores and subscales was moderate
to strong across three occasions (two week = 0.63 to 0.83, four week = 0.72 to 0.81, and
six week = 0.68 to 0.81). The internal consistency and temporal stability of the SEARS-
A-SF were as strong, if not stronger, than those estimates derived from the long form.
Convergent validity estimates suggested modest overlap with the SSRS (Gresham &
Elliott, 1990) and the Student Life Satisfaction Scale (SLSS) (Huebner, 1991).
Overall, the SEARS-C and SEARS-A are unique measures that capture resilience and
social and emotional health. While the SEARS-C and SEARS-A are newly published tools
with limited research measuring their use in conjunction with strength-based intervention,
we are hopeful that these tools will be used in this way. Developing a better understanding
of how this tool can be best used to plan targeted interventions and progress monitor those
interventions would be a useful contribution to the field.

LINKING ASSESSMENT TO INTERVENTION

In this chapter, the construct of social competence was defined, its importance was
illustrated, and various methods and instruments for assessing social skills, social and
emotional assets, and peer relations were reviewed. Although each of the five primary
assessment areas covered in this chapter have some relevance for measuring social com-
petence, behavioral observation, behavior rating scales, and sociometric approaches are
particularly useful and have been reported widely in the research literature. Some summary
information on the standardized assessment instruments that have been covered in this
chapter is presented in Table 13.2. Assessing social competence is important for making
classification and intervention decisions, but the specific link between social competence
assessment data and effective social competence interventions is sometimes vague.
This chapter concludes with two suggestions for increasing the treatment validity of
social skills assessment. The first suggestion is that recommended treatments should
match identified problems. Over the course of several years serving individually as a
school psychologist, teacher, educational consultant, program administrator, university
educator of school psychologists, and clinical supervisor, I have read assessment reports
in which certain social skills deficits and peer relations problems were identified, and
the resulting recommendation from the clinician was that “social skills training should
be provided.” This generic type of treatment recommendation is akin to a physician
diagnosing bronchial pneumonia in a patient, then recommending that the client needs
“medical treatment for the pneumonia”; neither recommendation is particularly helpful
in developing an effective treatment. One of the consistent findings over several years
of research on effective interventions for children and adolescents with behavioral and
emotional problems is that the closer the treatment matches the problem, the more
chance the intervention has of being successful (Peacock Hill Working Group, 1991). An
effective assessment of social skills, developmental assets, and peer relations may result in
identifying some specific aspects of the child or adolescent’s behavior that need some
attention. A best practice is to identify the specific skills deficits or behavioral excesses that
402 s Assessment of Specific Problems, Competencies, and Populations

Table 13.2 Summary of standardized assessment instruments for measuring social skills and peer relations

Name of instrument Type Rater Number of items Grade range

Social Skills Improvement Behavior rating School personnel 83: 46 social skills, Pre-K–12
System—Parent and scale and parents 29 problem behaviors,
Teacher Forms (Gresham 7 academic competence
& Elliott, 1990)
School Social Behavior Behavior rating School personnel 64: 32 social K–2
Scales, Second Edition scale competence,
(Merrell, 2002b) 32 antisocial behavior
Home & Community Behavior rating Parents and 64: 32 social K–12
Social Behavior Scales scale community competence,
(Merrell, 2002c) based informants 32 antisocial behavior
Social Emotional Assets Strength-based School personnel 41: teacher report K–12
and Resilience Scale social and and parents 39: parent report
emotional 12: short forms
rating scale
Devereux Student Strength-based Parents and 72: parent/school forms K–8
Strengths Assessment social and school personnel 8: short forms
emotional
rating scale
Social Skills Improvement Self-report Students 75 for secondary 3–6 and 7–12
System—Student Forms
(Gresham & Elliott, 2008)
Social Emotional Assets Self-report Students 35: SEARS-C and 3–6 and 7–12
and Resilience Scale— SEARS-A
Child and Adolescent 12: Short forms
Forms

exist, to identify what the purpose of the current behaviors are, and to recommend
prosocial interventions for those areas, rather than a generic treatment regimen that may
or may not address the problems that have been identified. This method of using
assessment results to inform or guide intervention is similar to the Keystone Behavior
Strategy for academic skills interventions that was discussed by Shapiro (1996) nearly
20 years ago. This strategy essentially is based on the notion that assessment information
may be linked to intervention planning through assisting in identification of the primary
problems at hand, which then are targeted specifically for treatment. Several of the
measures discussed in this chapter have been developed or improved upon across iterations
to more explicitly address this issue. Additionally, many measures are now also developed
or refined with the understanding that schools are moving toward implementation of
RtI as it applies to behavior and mental health. As schools are examining their social
climate and attempting to develop universally applied behavioral expectations that are
being taught to students across multiple settings (e.g., Positive Behavior Interventions and
Support; e.g., Horner, Sugai, Todd, & Lewis-Palmer, 2005), it is necessary that measures
of social skills become a standard part of screening and treatment planning, so that
students with more significant needs can be identified early and provided with support
based on assessment data.
The second suggestion, which is aimed specifically at school-based practitioners, is
that Individual Education Plan goals can be developed by modifying rating scale items or
 Assessing Social Skills and Social–Emotional Strengths s 403

small clusters of items. One of the advantages of using rating scales is that the descriptions
they contain are usually concise, well thought out, and specific in nature. As such, social
skills rating scale items are often amenable to being developed into good intervention
goal statements with a minimal amount of modification. For example, if a boy named
Stefen consistently received “never” ratings on item 4 (“Offers help to other students
when needed”) and item 19 (“Interacts with a wide variety of peers”) on the Interpersonal
Skills subscale of the School Social Behavior Scales, these items could be reworded into
general goal statements as follows:

1. Stefen will increase his level of providing help to other students when it is
appropriately needed.
2. Stefen will increase his number of interactions with other students in the classroom
and on the playground.

Of course, specific behavioral objectives would need to be developed after the statement
of the general goals.
These two examples illustrate how clinicians may develop intervention recommenda-
tions using the actual data obtained during the assessment. Research on interventions for
social skills deficits and peer relations problems was reported increasingly in the profes-
sional literature in the 1980s and 1990s, allowing us to make some generalizations about
their effectiveness. Several meta-analyses of social skills training intervention research
have been shown to be effective but still modest in terms of the amount of change they
typically produce (Beelmann, Pfingsten, & Losel, 1994; Gresham, Sugai, & Horner, 2001;
Mathur, Kavale, Quinn, Forness, & Rutherford, 1998). There still are numerous difficul-
ties, however, in producing generalization across settings or maintenance over time with
these changes. Two of the key aspects of promoting generalization and maintenance
with social skills training include: (1) making the training setting and situation as
similar to the naturalistic setting as is possible; and (2) involving parents and teachers in
helping to promote practice opportunities for the new skills that are learned (Merrell &
Gimpel, 1998). Consequently, any steps that can be taken to make the assessment of social
skills and peer relations ecologically valid and to base intervention recommendations on
specific assessment findings are especially important.

CONCLUSIONS
The terms social competence and social and emotional skills are often used interchangeably
but in reality are considered to be separate, but related, constructs. Social competence is a
summary term reflecting the judgment of the overall quality of one’s social and emotional
adjustment, whereas social skills are specific behaviors that lead to peer relations and
social competence. Based on evidence and informed by the 2008 definitions of intellectual
disability from the AAIDD, a theoretical model of the relationship among the constructs
of adaptive behavior, social and emotional competence, and peer relations was proposed.
In this model, adaptive behavior is considered to be the inclusive superordinate construct,
with social and emotional competence and social skills constituting sequentially smaller
links into adaptive behavior, and peer relations being considered a product or outcome
of social skills and a mutually reciprocal agent that may influence the development of
social skills.
404 s Assessment of Specific Problems, Competencies, and Populations

Surprisingly little attention has been paid to the development of a classification

taxonomy for child and adolescent social skills that is parallel to the several classification
systems that have been developed for child and adolescent psychopathology. This lack
of attention to a potentially important area was the stimulus for research by Merrell and
colleagues, wherein a classification taxonomy for child and adolescent social skills was
developed after an extensive review and analysis of multivariate studies of dimensions
of social behavior. Using this methodology, five primary dimensions of social skills were
identified: Peer Relations, Self-Management, Academic Skills, Compliance, and Assertion.
This new classification taxonomy may have implications for the development of new
assessment measures and treatment protocols.
A large body of research, some of it considered to be classic, has been generated regard-
ing the importance and long-term outcomes of social skills and peer relations. Essentially,
development of solid social skills early in life provides a foundation for later personal,
social, academic, and occupational adjustment and is linked to many positive outcomes
in life. Conversely, social skills deficits and peer relationship problems early in life are
part of a pathway that may lead to a variety of negative outcomes, such as mental health
problems, conduct-related discharge from military service, antisocial behavior and incar-
ceration, and unemployment or underemployment. These striking outcomes underscore
the importance of early detection of children who have social skills problems so that
appropriate interventions may be implemented.
Direct behavioral observation is one of the most empirically validated methods
for assessing child and adolescent social behavior. The Student Interactions in Specific
Settings Tool, Peer Social Behavior Code, and Target/Peer Interaction Code all are examples
of observational coding systems that are specifically relevant for assessing social skills.
Clinicians and researchers can easily adapt various types of observational coding systems
to target the crucial social skills behaviors they seek to assess.
Behavior rating scales are being used increasingly as a means of assessing social skills, and
there have been some impressive developments in this area. The Social Skills Improvement
System, School Social Behavior Scales, Second Edition, Home and Community Social
Behavior Scales, the Social Emotional Assets and Resilience Scale, and the Devereux Student
Strengths Assessment are examples of modern applications of rating scale technology to
child and adolescent social skills assessment.
Interviewing is an assessment method that has been reported less frequently for
assessing social skills but does seem to hold some promise in this regard. Specifically,
behavioral role-playing during interviews may help to facilitate an analogue type of
assessment of social skills of a child or adolescent client. If behavioral role-plays are used
during an interview, it is crucial that they be designed to be as similar as is possible to the
naturalistic setting that is being emulated.
Sociometric approaches to assessing child and adolescent social skills and peer relations
have been in use for several decades. Most of the sociometric techniques described in
Chapter 7 have some potential uses for social skills assessment. In conducting sociometric
techniques for this purpose, it is important to recognize the overall goal for assessment
and to plan accordingly. Peer nominations may provide a different kind of information
than peer ratings. Sociometric assessment may be suited better for research purposes and
screening than for individual assessment because of practical considerations.
Self-report instruments have only recently begun to be used on a large scale for
assessing child and adolescent social skills. One of the possible reasons self-report
 Assessing Social Skills and Social–Emotional Strengths s 405

assessment lags behind other types of assessment in this regard is that individuals with
social skills deficits may not be highly reliable reporters of their own social behavior. Two
self-report measures, the student report forms of the Social Skills Improvement System
and Social Emotional Assets and Resilience Scales, are a potentially useful development
in self-report assessment of social skills.
Social skills assessment data, if used carefully, may provide important information with
which intervention planning may be informed. It is preferable to use assessment data to
target specific areas for social skills training (the Keystone Behavior Strategy) rather than
identifying deficits and simply recommending generic social skills training. Items from
social skills rating scales are potentially useful for rewording into IEP goal statements. On
the basis of the yield of research from social skills training interventions, assessment
information may be helpful to the extent that it helps to identify important intervention
targets and environments and to serve in progress monitoring of interventions.

REVIEWS AND APPLICATION QUESTIONS

1. Describe the difference between social competence and social and emotional skills, and
state what types of practical assessment techniques are used to assess both of these
constructs.
2. Describe how peer relations may be a product or outcome of social skills and a reciprocal
influence for the future development of social skills.
3. In what ways might the development of a classification taxonomy for child and adolescent
social skills be useful for social skills assessment and treatment?
4. Using the Peer Social Behavior Code as a guide, describe how this playground-based
observational system could be used as a model for developing a classroom-based social
behavior observation system.
5. What are some of the considerations and specific practices that should be used to make
behavioral role-playing an effective means of social skills assessment during interviews?
6. In comparing the SSBS-2, SSIS, DESSA, and SEARS, what are the advantages, disadvan-
tages, and best uses of each for assessing child and adolescent social behavior?
7. Why is it important to plan carefully the purpose of assessment before choosing between
peer nomination and peer rating techniques for assessing peer relations?
8. What are some possible problems in using self-report instruments for assessing child and
adolescent social skills?
 14
ASSESSING SOCIAL AND EMOTIONAL
BEHAVIOR OF YOUNG CHILDREN

Commenting on the state of the art in assessing young children, Malcom (1993) stated,
“A request to assess a child who has not reached school age often strikes fear in the hearts
of psychoeducational diagnosticians” (p. 113). This statement may not be true for all
clinicians, but it goes right to the center of the issue: there are often substantial challenges
in assessing young children. In commenting on some of these challenges, Bracken (1987,
1994) noted that the technical adequacy of assessment measures for preschool-age
children tends to lag behind that of measures for school-age children. With regard to
social–emotional assessment technology for young children, the lag in technical adequacy
appears to be more pronounced (Merrell, 1996a). The specific difficulties in conducting
effective social–emotional assessments with young children are many and varied but can
be summed up in general as follows:

1. In relation to what is available for use with school-age children and adolescents, there
is substantially less assessment instrumentation and fewer specifically developed
methods for assessing social and emotional behavior of young children.
2. The technical adequacy (standardization samples, reliability, validity) of many
of the social–emotional assessment instruments available for young children is less
than desirable, and in general their technical adequacy is not as strong as what
typically is seen with instruments for school-age children and adolescents.
3. Some of the social–emotional assessment instruments available for use with young
children are not sufficiently developmentally sensitive and specific to the early child-
hood age range; they are often simply downward-age extensions of tools developed
for use with older children, sometimes developed as an afterthought.
4. Social and emotional behavior is exceptionally variable and inconsistent among
young children, making it difficult to determine a standard normative perspective.
5. Social and emotional behavior of young children tends to be influenced tremendously
by contexts and settings, which often results in undermining confidence in social–
emotional assessment results obtained in specific situations at specific points in time.
6. Some of the standard methods of social–emotional assessment (i.e., interviews and
self-report tests) commonly used with children and adolescents are extremely
difficult and in some cases impossible to implement adequately with young children.

Despite these and other challenges inherent in assessing the social and emotional
behavior of young children, there have been some encouraging developments in this area.
There also is an increasing need for school psychologists, clinical child psychologists, and

407
408 s Assessment of Specific Problems, Competencies, and Populations

early childhood special education diagnosticians to provide services to young children

and their families, including comprehensive assessment services (Merrell, 1996a). This
chapter serves a particularly important purpose as a resource for social–emotional
assessment of young children. Many of the other chapters are relevant to this topic, but
none is designed specifically to address assessment of young children, as this chapter is.
At the onset of this chapter, some definition of what is meant by the terms young
children and early childhood as they are used herein is useful. There is no universally
agreed-on definition of these terms. The focus of this chapter is for the most part on what
is considered the preschool age range, which is typically ages three to five. It makes sense
to focus on this age range because these are the young children who are the most likely to
be in various settings where assessment referrals may be generated, such as developmental
preschools, Head Start programs, medical clinics, and Child Find clinics. There are some
areas within this chapter where the age focus extends down to the infant or toddler years
or up to the kindergarten or first-grade level, but the three to five preschool-age focus is
clearly my target.
This chapter begins with a review of an alternative diagnostic classification system for
behavioral and emotional problems of young children. The largest section of the chapter
is devoted to specific applications of the five primary direct and objective methods of
assessment with young children. Additionally, recommended best practices for effective
social–emotional assessment of young children are presented.

AN ALTERNATIVE DIAGNOSTIC CLASSIFICATION SYSTEM

In Chapter 3, diagnostic classification systems for behavioral and emotional disorders are
presented, with a primary focus on the DSM-5 and the behavioral dimensions approach
to classification. One of the limitations of the DSM system is that many of the classification
categories either have limited utility or are clearly inappropriate for use with young chil-
dren, particularly those who are in the early stages of the preschool age range and younger.
For example, ADHD, one of the most common childhood diagnoses, can be difficult to
accurately diagnose in early childhood because there is a great deal of variability in behav-
ior at this age, and many of the symptoms of ADHD (e.g., impulsive behavior) are fairly
typical in young children. Further, challenging behaviors present in early childhood may
reduce significantly over time. This can impact early diagnoses of Conduct Disorder, for
example. In analyzing data from the Avon Longitudinal Study of Parents and Children in
England, Barker and Maughan (2009) found that of the sample of young children with
high levels of conduct problems, 60% of children showed minimal behavioral difficulties
at adolescence. Both of these examples are worthy to consider, and the truth of the matter
is that the younger the child, the more difficult and tenuous the diagnosis. Behavioral
dimensions classification systems also have limitations with very young children, such as
lack of age-proportional sampling in research programs and difficulties differentiating
normal from abnormal development. Despite this difficult state of affairs, clinicians who
work frequently with young children and their families still may desire to have at their
disposal a diagnostic nomenclature appropriate for young children, for the same purposes
that these systems are used with older children and adolescents.
As a response to these problems in diagnostic classification methodology for young
children, an experimental diagnostic classification was initially released in 1994 by the
 Assessing Social and Emotional Behavior of Young Children s 409

ZERO TO THREE National Center for Clinical Infant Programs, an interdisciplinary

organization for leadership in infant development and early childhood mental health.
This system was titled Diagnostic Classification: 0–3 (DC: 0–3) and subtitled Diagnostic
Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood.
In 2005, a revised version of the system was released (DC: 0–3R), which maintained the
same basic multiaxial structure as the initial version (with some wording changes), but
included some minor to moderate modifications based on several years of research
and user feedback, including changes to some of the Axis I diagnostic classifications. The
authoring committee for the initial version stated that “Diagnostic Classification: 0–3 is
intended to complement existing approaches” (ZERO TO THREE, 1994, p. 15), and
the DC: 0–3R authoring committee maintained the same complementary stance for the
system, indicating that it is designed to be used in conjunction with, and to complement,
existing diagnostic classification systems, particularly the DSM and ICD systems (ZERO
TO THREE, 2005). The system initially caught on slowly, as would be expected, but it has
gradually become accepted and known among clinicians who serve young children, and
its diagnostic codes have been approved for use in obtaining third-party reimbursements
by many healthcare insurance companies and health maintenance organizations (HMOs).
It is clearly a comprehensive and well-designed system that was much needed and offers
many advantages.
DC: 0–3R uses a multiaxial system for classification that is quite reminiscent of the
DSM-IV system. The following axes, which are identified in more detail in Table 14.1,
constitute the diagnostic framework:

1. Axis I: Clinical Disorders

2. Axis II: Relationship Classification
3. Axis III: Medical and Developmental Disorders and Conditions
4. Axis IV: Psychosocial Stressors
5. Axis V: Emotional and Social Functioning

The Clinical Disorders axis (Axis I) is designed to reflect the most prominent
feature of the disorder. The Relationship Classification (Axis II) is designed to assist in
understanding the quality of the parent–child relationship, which sometimes may be an
important aspect of the overall presenting problem. Medical and Developmental Disorders
and Conditions (Axis III) is used to note mental health or developmental diagnoses that
have been made using other systems, such as DSM-IV, ICD-10, or specific classifications
used by speech–language pathologists, occupational therapists, physical therapists, and
special educators. Psychosocial Stressors (Axis IV) is simply a method of listing various
forms and severity of psychosocial stress that seem to be influencing factors in childhood
disorders. The Emotional and Social Functioning axis (Axis V) is used to denote or
estimate age-expected functional developmental level. An appendix to DC: 0–3R provides
a reproducible Functional Rating Scale that provides a format for rating the child or
infant in six different areas, using a 1 to 6 rating system. Examples of some of the items on
this scale include “Complex gestures and problem solving,” “Use of symbols to express
thoughts/feelings,” and “Forming relationships/mutual engagement.” Additionally,
DC: 0–3R provides in another appendix, a Parent–Infant Relationship Global Assessment
Scale, which is used to assess the quality of the infant–parent relationship. Specific
descriptive anchor points are provided in 10-point increments ranging from 1–10
(documented maltreatment) to 91–100 (well adapted).
410 s Assessment of Specific Problems, Competencies, and Populations

Table 14.1 Multiaxial organization of the Diagnostic Classification: 0–3, Revised (DC: 0–3R)

Axis I: Clinical Disorders

100. Posttraumatic Stress Disorder
150. Deprivation/Maltreatment Disorder
200. Disorders of Affect
210. Prolonged Bereavement/Grief Reaction
220. Anxiety Disorders of Infancy and Early Childhood
221. Separation Anxiety Disorder
222. Specific Phobia
223. Social Anxiety Disorder
224. Generalized Anxiety Disorder
225. Anxiety Disorder NOS
230. Depression of Infancy and Early Childhood
231. Type 1: Major Depression
232. Depressive Disorder Not Otherwise Specifed
240. Mixed Disorder of Emotional Expressiveness
300. Adjustment Disorder
400. Regulation Disorders of Sensory Processing
410. Hypersensitive
411. Type A: Fearful/Cautious
412. Type B: Negative Defiant
420. Hypersensitive/Underresponsive
430. Sensory Seeking/Impulsive
500. Sleep Behavior Disorder
510. Sleep Onset Disorder (Protodyssomnia)
520. Night Waking Disorder (Protodyssomnia)
600. Feeding Behavior Disorder
601. Feeding Disorder of State Regulation
602. Feeding Disorder of Caregiver–Infant Reciprocity
603. Infantile Anorexia
604. Sensory Food Aversions
605. Feeding Disorder Associated with Concurrent Medical Condition
606. Feeding Disorder Associated with Insults to the Gastrointestinal Tract
700. Disorders of Relating and Communicating
710. Multisystem Developmental Disorder
800. Other Disorders (DSM-IV-TR or ICD-10)
Axis II: Relationship Classification
Parent–Infant Relationship Global Assessment Scale
Relationship Problem Checklist
Axis III: Medical and Developmental Disorders and Conditions
Axis IV: Psychosocial Stressors
Axis V: Emotional and Social Functioning

At the time of publication of this book, Zero to Three is getting ready to release a new
version of this system entitled the DC: 0–5 (Zeanah et al., 2016). The new title reflects the
fact that this classification system will be used with children aged zero to five. A task force
was developed in 2013 to plan for this extensive revision. This task force began by soliciting
feedback from over 20,000 researchers and practitioners worldwide. Through analysis
of this feedback and an in-depth review of current research in early childhood mental
health, this task force embarked on a process of revision. The DC: 0–5 will maintain
the multiaxial structure from the previous version, even though it was eliminated from
 Assessing Social and Emotional Behavior of Young Children s 411

the DSM-5. It is likely the axis structure will be changed significantly, however. Further
changes reflect attempts to identify disorders that may be precursors to other disorders
listed in the DSM. For example, Overactivity Disorder of Toddlerhood (OAD) reflects
the extreme behaviors related to hyperactivity and impulsivity often seen very early in
childhood (Gleason & Humphreys, 2016), and Early Atypical Autism Spectrum Disorder
(EA-ASD; Soto, Giserman Kiss, & Carter, 2016) is for children between nine and 36
months that are displaying some symptoms associated with autism. While earlier
classification is possible with some disorders, the DC: 0–5 will also require functional
impairment and severity ratings to help preclude diagnoses of disorders when behaviors
may be truly reflective of a developmental or transient phase (Zeanah et al., 2016).
It is clear that the DC: 0–3R system and its predecessor, DC: 0–3 have made major
and much-needed inroads into mental health and developmental diagnosis of infants and
young children, and that the system has become increasingly accepted among professionals
and health care administration organizations. The DC: 0–5 will provide users with an
updated approach and will likely continue to offer several advantages over the DSM system,
most notably that it is developmentally targeted and appropriate for use with infants and
young children. It is comprehensive and well designed, and it is worthy of continued
consideration and adoption by the professional community.

METHODS FOR ASSESSING YOUNG CHILDREN

With varying degrees of modification and effectiveness, each of the five primary direct
and objective methods of assessment can be used to evaluate social and emotional behav-
ior of young children. Projective–expressive social and emotional assessment techniques
may be extremely problematic for use with young children because of the difficulty in
determining whether unusual or aberrant responses are indicative of social–emotional
functioning, cognitive maturity, or physical development (such as fine motor skills).
Although it was noted in Chapter 9 that projective–expressive techniques have appropri-
ate and helpful uses, these methods are highly questionable for use with young children
and should be avoided in favor of direct and objective techniques that are developmentally
appropriate and ecologically valid. At present, the most technically adequate methods of
assessment in this domain for use with young children are direct behavioral observation
and behavior rating scales. Both of these methods include a variety of empirically vali-
dated procedures, systems, and instruments designed specifically for use with young
children. Assuming that appropriate modifications are made, sociometric assessment
methods can be effective choices for use with young children, especially for screening and
research purposes. Clinical interviewing has long been a popular method of assessing
young children but, as shown in this section, requires special care and caution with young
children, and is probably best used as a way to gather information about the child and his
or her environment from another person, such as a parent or teacher. Objective self-report
assessment is the least-validated and least-available method for assessing young children,
although some interesting innovations have occurred in this area. This section includes
comments, recommendations, and reviews of specific techniques and instruments for
social–emotional assessment of young children. It concludes with a description of an
innovative and comprehensive new multiple gating program for screening young children
for behavioral and emotional disorders.
412 s Assessment of Specific Problems, Competencies, and Populations

Direct Behavioral Observation

One of the most commonly used methods of assessing the social–emotional behavior
of young children in naturalistic settings is systematic behavioral observation (Lehr,
Ysseldyke, & Thurlow, 1987). Direct observation of preschool-age children in natural
settings is a preferred strategy because it directly measures the behavior of interest, does
not impose artificial test-room demands (to which young children are known to be highly
reactive), and provides data that are less likely to be distorted by the expectations and
biases of parents and caretakers (Doll & Elliott, 1994). Given the obvious advantages of
direct behavioral observation with young children, coupled with the fact that some other
methods of assessment would prove to be extremely questionable with this age group,
each of the general methods and coding procedures of behavioral observation described
in Chapter 4 is recommended for use with young children.
In addition to the general threats to reliability and validity of observational data that
are described in Chapter 4, direct observation of preschool-age children may require
some special precautions to ensure an adequate representativeness of the child’s behavior.
Because the social–emotional behavior of preschool-age children may change suddenly
in response to situational variables (Wittmer & Honig, 1994), and because their develop-
mental level and progress may influence the content of observed behavior strongly
(Graham, 1980), it is commonly accepted that special care must be taken to attempt to
conduct multiple observations in several settings. The issue of behavioral inconsistency
with young children and the practical difficulty of conducting multiple observations
pose some serious challenges to clinicians and researchers. One of the issues in this domain
that is not fully understood yet is how much observational data should be collected when
assessing young children. One of the few studies attempting to answer this question was
conducted by Doll and Elliott (1994), who investigated the degree to which observations
consistently described the characteristic social behaviors of 24 preschool-age children
who were each observed nine times in free-play settings. By comparing partial and
complete observational records, these researchers showed that at least five observations
were required to represent the children’s social behavior reliably. A similar finding was shared
in a more recent study that observed the generalizability and dependability of system-
atic direct observations and direct behavior ratings of kindergarten children (Briesch,
Chafouleas, & Riley-Tillman, 2010). In this study, researchers determined that three to five
observations would likely be needed to obtain dependable direct observation data. In this
study, the dependability of direct behavior ratings (DBRs) of young children was less clear,
as there appeared to be some rater bias involved. It is unclear how much these results
should generalize to routine assessment practice, but the implication is clear: To obtain
consistent and representative social observational data with young children, you must be
prepared to conduct several different observations across short to moderate periods of
time. Clinicians and researchers who are relying heavily on single observations of young
children to make inferences about their behavior may be in a precarious position.

Example: Early Screening Project (ESP) Social Behavior Observations Because direct
behavioral observation systems tend not to be norm-referenced in the same manner as
behavior rating scales, and because observational systems usually are developed and
modified by researchers and clinicians for specific purposes and settings, there are few
commercially produced observation systems available for general use with young children.
One exception to this generalization is the Social Behavior Observations from the Early
 Assessing Social and Emotional Behavior of Young Children s 413

Table 14.2 Categories and examples of antisocial and nonsocial behavior from the Social Observations of the Early Screening Project

1. A Negative Reciprocal Interchange, Either Verbal or Physical

Negative Verbal Behavior
name calling, bossy commands or statements, statements of rejection, possessive statements,
accusations, highly critical or uncomplimentary statements, aggressive threats, pestering, taunts,
demanding or quarrelsome behavior
Negative Physical Behavior
rough or harmful bodily contact, rough, painful, or irritating contact with objects or materials
2. Disobeying Established Classroom Rules
3. Tantrumming
yelling, kicking, and/or sulking after a negative social interaction
4. Solitary Play
not playing within three feet of another child, not exchanging social signals

Screening Project (ESP) (Walker, Severson, & Feil, 1995). The first tier of the ESP system
is now part of the Systematic Screening of Behavior Disorders system (Walker & Severson,
1992; Walker, Severson, & Feil, 2014; Walker, Severson, Nicholson, Kehle, Jenson, & Clark,
1994), described in Chapter 15, but it is useful to focus more closely on its Social Behavior
Observations component in this section to provide a specific example of a practical
systematic behavioral observation system designed for use with young children. The
ESP observations are designed to assess children’s social behavior in free play or un-
structured activities, with a more specific purpose being measurement of social adjust-
ments and interactions with peers and adults. This system uses a duration coding
procedure wherein the observer uses a timer to assist in recording the total amount of
time that a child is engaged in a particular category of social behavior, antisocial behavior
(negative social engagement, disobeying rules), or nonsocial behavior (tantrumming,
solitary play). The resulting duration of time in these categories is calculated into a
percentage of total time of the observation (which should be for at least ten minutes).
Categories and examples of antisocial and nonsocial behavior are presented in Table 14.2.
The ESP kit includes comprehensive training materials for use in observer training.
Normative comparison data for antisocial or nonsocial behavior are presented in the
ESP manual and provide ranges of percentages of engagement for specific groups. For
example, with girls, engagement in antisocial or nonsocial behavior 37% to 45% of the
time places them in the At-Risk group, whereas the ranges of 46% to 54% and 55% or
more place them in the High Risk and Extreme Risk groups. The Social Observations are
designed to be an optional part of the broader ESP screening process. Because normative
data are available, however, and because the system has been tested comprehensively
and possesses good technical properties, it seems appropriate for researchers or clinicians
to use Social Observations separately from the system for specific purposes as needed. An
updated version of this observation code is in process and will hopefully be released soon.

Behavior Rating Scales

In the 1980s and 1990s, there were few behavior rating scales designed for use with young
children, most of them were not widely available, and few were developed with nationwide
norming samples or possessed adequate technical properties and a solid research base.
Within the past 15 years or so, there have been substantial new developments in this
414 s Assessment of Specific Problems, Competencies, and Populations

arena, and there are now several widely available and technically sophisticated behavior
rating scales designed exclusively for use with young children. This section provides an
overview of several such commercially published instruments that seem to be among the
most widely researched and adequately developed of what is currently available for use
with young children.

The Ages and Stages Questionnaires: Social–Emotional, Second Edition (ASQ:SE-2) The
Ages and Stages Questionnaires: Social–Emotional, Second Edition (ASQ:SE-2; Squires,
Bricker, & Twombly, 2015) is a highly innovative behavior rating instrument completed
by parents to evaluate social–emotional competencies and problems of children aged one
month to six years. The ASQ:SE-2 was designed to provide a low-cost, simple screening
instrument that may be scored and interpreted by individuals with minimal training in
standardized assessment and measurement, such as paraprofessionals, teachers, and child-
care professionals. The ASQ:SE-2 uses a set of nine questionnaires for each of nine age
levels (two, six, 12, 18, 24, 30, 36, 48, and 60 months). The rating forms increase in length
for each age level, and the items for each age-level questionnaire were designed to be devel-
opmentally specific for that age. Each questionnaire can be used within about three
months (for the two- through 30-month intervals) or six months (for the 36- through
60-month intervals) of the chronological age targeted by the questionnaire. The items are
rated using a format that requires the parent to check one of three options for the specified
behavior: Often or Always, Sometimes, and Rarely or Never. There is a separate section
that parents may check if that behavior is a concern for them. The scoring process is
simple, and only raw scores and percentiles are used. Additionally, developers added a
“monitoring zone,” which is near the cutoff score that would indicate an area of concern.
The ASQ:SE-2 items are divided into seven behavioral areas: Self-regulation, Compliance,
Communication, Adaptive functioning, Autonomy, Affect, and Interaction with people.
English and Spanish language forms are available.
Standardization information and technical properties are described in a detailed
technical report that constitutes a section of the ASQ:SE-2 manual and can also be down-
loaded from www.agesandstages.com (Squires, Bricker, Twombly, Murphy, & Hoselton,
2015). Over the years, normative groups were developed from a sample of more than
14,000 parent ratings of children from several U.S. states and stratified by gender and
ethnicity. Typical and at-risk children were included in the norms for each level. Average
internal consistency coefficients of the ASQ:SE-2 forms by age range was 0.84. The average
test–retest coefficient was 0.89. Cutoff levels were developed to place children’s ASQ:SE-2
scores into risk levels (“At-Risk” and “Okay”), and the evidence presented in the technical
report regarding the correct classification rates for these risk levels is impressive, with
respectable specificity and sensitivity percentages. The technical report provides evidence
of strong associations between ASQ:SE-2 scores and those of comparison measures, and
an ability to differentiate between typical and atypical or at-risk children. The ASQ:SE-2
has been found to specifically discriminate between groups of children with social–
emotional disabilities versus those without. Also, the ASQ:SE-2 was able to identify
those identified with autism as “at-risk” in 83.5% of the cases. This could be useful when
clinicians are using the ASQ:SE-2 as a screening tool that helps them make decisions
about cases in need of further assessment. Further studies of the original ASQ:SE (Squires,
Bricker, & Twombly, 2004) also suggest that this tool can be more helpful than other
strategies or tools available for screening for psychosocial concerns. Jee et al. (2010) found
 Assessing Social and Emotional Behavior of Young Children s 415

that the ASQ:SE was more sensitive in identifying children with psychosocial concerns
than clinical judgment alone or developmental screening tools that were broader in scope
(e.g., ASQ).
The ASQ:SE-2 has much to offer and is worthy of recommendation. The care the
authors took in developing the ASQ:SE-2 based on developmental theory and the need
for a simple and efficient screener is obvious, and the technical evidence presented in
the manual is impressive. The ASQ:SE-2 is one of only a small handful and perhaps the
most sophisticated and technically sound of available assessment tools that are useful for
social–emotional screening with children ages one month to 72 months. For screening
of young children—those who are too young to fall within the norming samples of the
predominantly preschool-age measures that are reviewed in this section—the ASQ:SE-2
is an excellent choice and is perhaps the best tool available. Its unique features and
developmental specificity make it a good potential choice for screening children in the
preschool age range as well.

The Social Emotional Assessment Measure (SEAM) The Social Emotional Assessment
Measure (SEAM) is a tool that was developed by the authors of the ASQ and ASQ:SE
(Squires & Bricker, 2006). This tool is intended for use as a curriculum-based assessment
measure, meaning that results from the SEAM can be logically linked to social–emotional
intervention targets appropriate for young children. The SEAM includes two versions for
children aged three to 18 months and 18 to 36 months, respectively. The SEAM can be used
within a 5-step process that authors describe as Activity-Based Intervention: Social-
Emotional (ABI:SE). The first step in the ABI:SE includes a questionnaire, the Environmental
Screening Questionnaire, that caregivers complete and aims to help assessment profes-
sionals to screen the environment in which the child is developing. The second step
includes completion of the SEAM measure. The SEAM is a comprehensive questionnaire
that assesses a child’s social–emotional competencies as well as the caregivers’ strengths
and weaknesses. The third step in the ABI:SE includes setting goals for intervention based
on the assessment data gathered, and the last two steps include intervention implement-
ation and evaluation. Squires et al. (2013) conducted a large psychometric study of the
SEAM and found moderate to strong evidence of reliability and validity. Internal con-
sistency coefficients ranged from 0.69 to 0.90, test–retest ranged from 0.97 to 0.99, and
inter-rater reliability ranged from 0.64 to 0.95. The SEAM demonstrated strong convergence
with other early childhood social–emotional measures (e.g., Devereux Early Childhood
Assessment). Additionally, parents and early interventionists found that the SEAM was
useful, clear, and gave meaningful information about children’s social–emotional abilities.
The SEAM serves as a functional, curriculum-based assessment tool and could potentially
enhance current approaches to early intervention services for young children and families.

The Devereux Early Childhood Assessments (DECA) The Devereux Early Childhood
Assessments include an infant and toddler measure (DECA-I/T; Mackrain, LeBuffe, &
Powell, 2007) and a second edition of a preschool measure (DECA-P2; LeBuffe & Naglieri,
2012). These measures are behavior rating scales that are strength-based and measure
resilience through report of three protective factors including Initiative, Self-Regulation,
and Attachment/Relationships.
The DECA-I is a 33-item measure that can be used by parents, caregivers, and teachers
of infants aged four weeks to 18 months, and takes about five to ten minutes to complete
416 s Assessment of Specific Problems, Competencies, and Populations

on paper and three to five minutes to complete electronically through a web-based plat-
form (see www.e-deca2.org). There are English and Spanish forms available. Factor
analyses indicated that Initiative and Attachment/Relationships are the two primary
factors on this scale. A Total Protective Factors score is also generated and scores are
reported as T scores and percentile ranks. This tool can also be used to compute a per-
centage delay, comparisons across sources, and at pretest and posttest. The toddler
version, the DECA-T is appropriate for children aged 18 months to 36 months and has a
similar structure as the DECA-I. There are 36 total items and three primary factors:
Initiative, Self-Regulation, and Attachment/Relationships. Both the DECA-I and the
DECA-T have excellent technical properties that were established through data collected
from a sample of 2,183 children from 29 states in geographically diverse locations in the
U.S. Internal consistency coefficients ranged from 0.80 to 0.94. Test–retest coefficients
were obtained at 24- and 72-hour intervals for the infant measure, ranging from 0.83 to
0.94, while the DECA-T coefficients ranged from 0.72 to 0.99. Inter-rater reliability
(between parents and teachers) was lower, which is not surprising. The DECA I/T do
show evidence that they can discriminate between young children with and without
social–emotional concerns.
The DECA-P2 targets preschool children aged three to five. This tool also is brief
and consists of 38 items with the same factor structure as the DECA-T and an additional
Behavioral Concerns subscale. Internal consistency coefficents were very high, ranging
from 0.80 to 0.95. Test–retest reliabilities ranged from 0.88 to 0.95 for the subscale scores
and inter-rater reliabilities were again lower as they reflect the differences in perceptions
between caregivers and teachers. The DECA-P2 is able to discriminate between those with
identified behavior disorders and those without.
Overall, the DECA behavior rating scales are well developed, brief, strength-based
measures that target children as young as four weeks old. This assessment system, in
combination with intervention and prevention resources available on www.centerfor
resilientchildren.org, is another excellent example of a strength-based approach of linking
assessment to intervention for the youngest children.

The Behavior Assessment System for Children, Third Edition (BASC-3) The Behavior
Assessment System for Children, Third Edition (BASC-3) (C. R. Reynolds & Kamphaus,
2015) is the most recent version of the popular comprehensive system for assessing per-
sonality and behavior of children and adolescents. The BASC-3 includes parent and
teacher rating scales, self-report forms, a structured observation form, a screening tool,
and a developmental history interview form. The parent and teacher rating scales of the
BASC-3 were reviewed in general in Chapter 5, and the self-report forms were reviewed in
Chapter 8. Included in the BASC-3 rating scales are parent and teacher rating scales for
use with children aged two to five, which were not discussed specifically in the previous
chapters. These are reviewed herein.
The teacher rating scale for ages two to five (TRS-P) includes approximately 100 items
that are rated according to four dimensions: never, sometimes, often, and almost always.
The parent rating scale for ages two to five (PRS-P), designed and used in a similar way
to the TRS-P, includes more than 100 items. The items on both forms represent a broad
range of positive and negative behaviors of various types. These instruments have a complex
and sophisticated structure that includes the following empirically derived subscales,
listed alphabetically: Adaptability, Aggression, Anxiety, Attention Problems, Atypicality,
 Assessing Social and Emotional Behavior of Young Children s 417

Depression, Functional Communication, Hyperactivity, Social Skills, Somatization, and

Withdrawal. Content scales include Anger Control, Bullying, Developmental Social
Disorders, Emotional Self-Control, Executive Functioning, Negative Emotionality, and
Resiliency. Composite scores are also a part of the BASC-3 system, including a Behavioral
Symptoms Index, Adaptive Skills, Externalizing Problems, and Internalizing Problems.
Finally, there is a Clinical Probability Index, Functional Impairment Index, and an Executive
Functioning Index (comprised of Attentional Control, Behavioral Control, Emotional
Control). Raw scores in these areas are converted to T scores and percentile ranks.
Additionally, the BASC-3 rating forms provide a means of evaluating unusual response
patterns and critical items.
The national norm samples for the BASC are large and well stratified, and are quite
similar in terms of ethnic-group breakdown to the 2013 U.S. Census Bureau American
Community Survey (U.S. Census Bureau, 2013). The TRS-P general norms are based on
teacher ratings of 500 children aged two to five, whereas the PRS-P norms are based
on parent ratings of 600 children aged two to five. As stated in previous chapters, the
BASC-3 manual is extensively documented, is well written, and details substantial
reliability and validity evidence. Internal consistency reliabilities for the TRS-P are in the
0.75 to 0.92 range for the scale scores and in the 0.86 to 0.96 range for the composite
scores. Short-term test–retest reliability for the preschool forms is high, with a median
composite value of 0.90. Inter-rater reliability between teachers for the preschool form is
reported and spans the 0.42 to 0.83 range. Convergent construct validity for TRS-P is
shown in the manual through significant correlations with the Child Behavior Checklist
and BASC-2, as well as the Autism Spectrum Rating Scales. Construct validity of the BASC
rating scales is shown further in the manual through showing sensitivity to differences
among various clinical groups, although it is unclear how much the preschool forms were
represented in these studies. Reliability and validity coefficients for the parent forms were
as impressive as those for the TRS-P. Although the BASC manual is extensively detailed,
there has been little additional research published documenting the validity of the system
for use with young children. One published study (McNamara, Holman, & Riegal, 1994)
evaluated the usefulness of the BASC-2 in determining the mental health needs of a Head
Start population and provided some additional supporting construct validity evidence.
In sum, the rating scale components of the BASC that are designed specifically for
use with young children, the TRS-P and PRS-P, seem to be an excellent addition to the
available rating scale instrumentation for this age group. The scales are well constructed,
are comprehensive, and seem to have good technical properties. The only possible negative
comment regarding the TRS-P and PRS-P is the modest size of the normative samples.
If these instruments were introduced as separate tests rather than as part of the larger
BASC system, it is likely that the modest norm samples would be a frequent criticism. On
the basis of the overall strength of the BASC system, however, there is certainly enough
supporting evidence to justify recommending the rating scales designed for assessment of
young children.

The Early Childhood Rating Forms of the ASEBA System The comprehensive Achenbach
System of Empirically Based Assessment offers two comprehensive rating scales for
use with young children. The Child Behavior Checklist for Ages 1½–5 (CBCL/1½–5)
(Achenbach & Rescorla, 2000) is the most recent revision of the Child Behavior Checklist
for younger children (CBCL/2–3) (Achenbach, 1992). The Caregiver–Teacher Report
418 s Assessment of Specific Problems, Competencies, and Populations

Form for Ages 1½–5 (C-TRF) (Achenbach, 2001a) is the most recent revision of this form,
which previously extended downward only to age two. These instruments are discussed in
this section.
The CBCL/1½–5 was designed to obtain parent ratings of child behavior using
99 problem items. Many of these items have counterparts on the CBCL for older children
and youth, and some of the items were developed uniquely for the CBCL/1½–5, specific
to the early childhood developmental period. The CBCL/1½–5 is designed to be completed
by parents. Items are rated using a 3-point scale, ranging from 0 (Not True) to 2 (Very True
or Often True). The individual items of this measure are added in various combinations
into empirically derived clinical syndrome scores (subscales), broad-band scores (internal-
izing and externalizing), and a total problems score. The six cross-informant scales
include Emotionally Reactive, Anxious/Depressed, Somatic Complaints, Withdrawn,
Attention Problems, and Aggressive Behavior. Also included are five DSM-oriented scales,
including Affective Problems, Anxiety Problems, Pervasive Developmental Problems,
Attention Deficit/Hyperactivity Problems, and Oppositional Defiant Problems. Like the
rest of the ASEBA system, raw scores on the CBCL/1½–5 are converted to T scores and
percentile ranks, and hand-scoring forms and computer scoring programs are available.
Additionally, Achenbach (2013) released a guide to interpretation of the DSM-oriented
scales, given its revision to align with DSM-5. The computer scoring program takes less
time and has the advantage of calculating agreement indices (referred to as Q correlations)
between two parents who have rated the same child.
The CBCL/1½–5 includes an important and potentially useful change from the
previous version of the instrument. Included with this scale is a Language Development
Survey (LDS) for ages 18–35 months, a questionnaire that obtains information from
parents about language development issues and problems of very young children. The
LDS is a two-page form that includes eight general questions about the child’s development,
as well as a list of 310 words in 14 domains that parents are asked to review, and to circle
if their child spontaneously uses the word.
The normative group for the CBCL/1½–5 consists of scores from a national sample of
700 children, derived from an initial norming sample of 1,728 child ratings. The norm
sample is well stratified by race/ethnicity, gender, region, socioeconomic status, and
urban–rural residence. Mixed gender norms are used. The manual for the CBCL/1½–5
provides adequate documentation of the technical properties of the test, which are
generally quite good. Additional published research on the CBCL/1½–5 and its predecessor
provide validity evidence in such areas as cross-cultural uses (Auerbach, Yirmiya, & Kamel,
1996; Leadbeater & Bishop, 1994), gender differences (van den Oord, Koot, Boosma, &
Verhulst, 1995), relationships between child problem ratings and maternal depression,
social support and stress (Leadbeater & Bishop, 1994), and group differences between
children in and outside of daycare situations (Caruso, 1994).
The CBCL/1½–5 is a much-needed downward extension of the sophisticated ASEBA
rating scale system on which it was based. This instrument is particularly useful because
many of the items were developed specifically for the lower registers of the early childhood
age range, and because the Language Development Survey provides opportunities for
assessing language skills in early childhood that were not previously possible with the
ASEBA system.
The C-TRF was designed to be a downward extension of the TRF and is designed for
use by preschool and Head Start teachers, daycare center personnel, and kindergarten
 Assessing Social and Emotional Behavior of Young Children s 419

teachers. This instrument includes 99 problem items and contains the same cross-informant
and DSM-oriented scales, as well as the same scoring and score conversion procedures
that were described for the CBCL/1½–5. The norm group for the C-TRF includes 1,113
children who were rated by teachers or childcare providers, a sample derived from an initial
pool of ratings of 1,192 children. This is a robust sample size for a limited age range and
has the additional advantage of being well stratified. A guide for the test is available and
provides information on development, reliability, validity, and applications. The C-TRF
seems to be a promising instrument and, although the research base is still somewhat sparse
in comparison with other components of the ASEBA system, can be recommended for use
with young children.

The Preschool and Kindergarten Behavior Scales, Second Edition (PKBS-2) The Preschool
and Kindergarten Behavior Scales, Second Edition (PKBS-2) (Merrell, 2002a) is a 76-item
behavior rating scale designed to measure typical problem behaviors and social skills
of children aged three to six. The PKBS-2 is an updated and revised version of the original
PKBS (Merrell, 1994), including additional norm sample cases, an improved scoring
system, and new research data. This instrument may be completed by teachers, parents,
daycare providers, or others who are familiar with a child’s behavior. The items are suffi-
ciently generic that a common rating form is used across different informants and settings.
The PKBS-2 was developed with a national normative sample of 3,313 children from
across the United States, roughly comparable to the general U.S. population in terms of
ethnicity, gender, and socioeconomic status. A Spanish-language version of the PKBS-2 is
also available.
Rather than being a downward extension of an existing rating scale designed for use
with older children, the PKBS-2 and its items were designed specifically for the unique
social–behavioral aspects of the early childhood/preschool developmental period, and
systematic item development and content validation procedures were employed. In other
words, the initial PKBS item pool was developed after a systematic and comprehensive
review of clinical and research literature describing the social, behavioral, and emotional
problems of young children, particularly how these problems are manifested in preschool
and kindergarten-age children.
The items on the PKBS-2 constitute two separate scales each designed to measure a
separate domain: a 34-item Social Skills scale and a 42-item Problem Behavior scale. Each
of these two scales includes an empirically derived subscale structure. The Social Skills
scale includes the following subscales: Social Cooperation (12 items describing cooperative
and self-restraint behaviors), Social Interaction (11 items reflective of social initiation
behaviors), and Social Independence (11 items reflecting behaviors that are important in
gaining independence within the peer group). The Problem Behavior scale includes two
broad-band subscales, Internalizing Problems and Externalizing Problems. Consistent
with the theoretical and empirical breakdown of the externalizing/internalizing problem
dichotomy (see Cicchetti & Toth, 1991), the former broad-band scale includes 27 items
describing undercontrolled behavioral problems, such as aggression, overactivity, and
coercive antisocial behaviors, whereas the latter broad-band scale includes 15 items
describing overcontrolled emotional/behavioral problems, such as social withdrawal,
somatic problems, anxiety, and behaviors consistent with depressive symptoms. For the
broad-band problem behavior scores of the PKBS-2, there are supplemental problem
behavior subscales available which may be used to provide more details about the
420 s Assessment of Specific Problems, Competencies, and Populations

Social Skills Scale

Never Rarely Sometimes Often
1. Works or plays independently 0 2 2 3
2. Is cooperative 0 2 2 3
3. Smiles and laughs with other children 0 2 2 3
4. Plays with several different children 0 2 2 3

Figure 14.1 Social Skills Examples from the Preschool and Kindergarten Behavior Scales, Second Edition
Source: From Preschool and Kindergarten Behavior Scales, Second Edition, by K. W. Merrell (2002a). Austin, TX: Pro-Ed. Copyright
2002 by Pro-Ed. Adapted with permission.

Problem Behavior Scale

Never Rarely Sometimes Often
1. Acts impulsively without thinking 0 21 2 3
2. Becomes sick when upset or afraid 0 2 2 3
3. Teases or makes fun of other children 0 2 2 3
4. Does not respond to affection from others 0 2 2 3

Figure 14.2 Problem Behavior Examples from the Preschool and Kindergarten Behavior Scales, Second Edition
Source: From Preschool and Kindergarten Behavior Scales, Second Edition, by K. W. Merrell (2002a). Austin, TX: Pro-Ed. Copyright
2002 by Pro-Ed. Adapted with permission.

breakdown of internalizing and internalizing problem symptoms. The Internalizing

Problems broad-band scale includes two supplemental subscales (Social Withdrawal and
Anxiety/Somatic Problems), whereas the Externalizing Problems broad-band scale
includes three supplemental subscales (Self-Centered/Explosive, Attention Problems/
Overactive, and Antisocial/Aggressive). Sample items from the PKBS-2 are presented in
Figures 14.1 and 14.2.
Technical data reported in the PKBS-2 test manual and in other published sources
provide evidence for adequate to excellent psychometric properties. Test–retest reliability
estimates for the Social Skills and Problem Behavior total scores at three-month intervals
were found to be 0.69 and 0.78. Child ratings by preschool teachers and teacher aides
for the respective total scores have been shown to correlate at 0.48 and 0.59. Internal
consistency reliability estimates for the Social Skills and Problems Behavior total scores
were found to be 0.96 and 0.97. Content validity of the PKBS has been shown through
the documentation of item development procedures and through moderate to high cor-
relations between individual items and total scale scores. Discriminant convergent
construct validity has been shown by examining relationships between the PKBS and four
other established preschool behavior rating scales: the Matson Evaluation of Social Skills
with Young Children, the Conners Teacher Rating Scale, the School Social Behavior
Scales, and the Social Skills Rating System (Merrell, 1995a). Construct validity has been
shown through analysis of intrascale relationships, factor analytic findings with structural
equation modeling (Merrell, 1996b), and documentation of sensitivity to various group
differences (Holland & Merrell, 1998; Jentzsch & Merrell, 1996; Merrell, 1995b; Merrell
& Holland, 1997; Merrell & Wolfe, 1998).
 Assessing Social and Emotional Behavior of Young Children s 421

Reviews of the PKBS and PKBS-2 in the professional literature have been positive
(e.g., Bracken, Keith, & Walker, 1994, 1998; MacPhee, 1998; Riccio, 1995; Watson, 1998),
and these scales have the advantage of being easy to use and well documented. In sum,
the PKBS-2 is useful as a general problem behavior and social skills assessment tool for
young children, particularly those exhibiting typical types of behavioral problems in
typical types of settings such as Head Start programs and preschool or kindergarten
classrooms. For assessing children with severe low-frequency behavior problems, such as
might be exhibited by children in psychiatric treatment centers, instruments such as the
Child Behavior Checklist may be more appropriate.

The Social Skills Improvement System (SSIS) The Social Skills Improvement System
(SSIS) (Gresham & Elliott, 2008), which was reviewed in general in Chapter 13, is a
comprehensive social skills assessment system for children and adolescents. The SSIS is
updated from the widely recognized Social Skills Rating System (SSRS), and included in
this update are improved measures of three- to five-year-old children’s behavior. The SSIS
system includes teacher and parent preschool-level rating forms for use with children
aged three to five. These forms have been improved upon and include updated norms.
Because these preschool level forms are highly relevant to the topic of social–emotional
assessment of young children, and because they were not reviewed specifically in the
previous general review, they are reviewed in this chapter.
The two SSIS preschool-level forms are similar to each other and contain many
common items. The teacher form includes 30 social skills items that are rated on a 4-point
scale based on how often the behaviors occur and how important they are for success
in the particular setting. It also includes a brief ten-item problem behavior screen. The
parent form includes 39 social skills items and ten problem behavior items, which are
rated in the same manner as described for the teacher form. The main difference in content
between the two forms involves the specificity of items across the home and preschool
settings. The teacher form includes an item stating, “Appropriately questions rules that
may be unfair,” whereas the related item on the parent form states, “Appropriately questions
household rules that may be unfair” (italics added). Given that these two forms are part
of the general SSIS rating scale system, they were developed as downward extensions of
the elementary and secondary parent and teacher rating forms, with minor item revisions,
deletions, and additions to make them appropriate for use with young children. Similar
to the other rating forms in the SSIS system, raw scores on the preschool level forms are
converted to behavior levels, standard scores, and percentile ranks. Also like the other
versions of the SSIS, the preschool-level forms include empirically derived Communication,
Cooperation, Assertion, Responsibility, Empathy, Engagement, and Self-Control subscales
within the social skills area and Internalizing, Externalizing, Bullying, Hyperactivity/
Inattention, and Autism Spectrum areas within the problem behavior screening items.
The SSIS manual includes significantly more technical data regarding the psychometric
properties for the preschool-level forms than the SSRS had. Factor analyses and normative
data for the SSIS preschool forms were based on only 200 ratings for the teacher form
and 400 ratings for the parent form, and the geographic, racial, mother’s educational
level, and education classification/diagnostic stratification of the preschool form norms
generally matched U.S. population estimates in 2006. Coefficient alpha reliabilities for the
subscales of the preschool forms range from the lower 0.70 to upper 0.90 levels, with total
social skills score reliabilities in the high 0.90 range and total problem behavior score
422 s Assessment of Specific Problems, Competencies, and Populations

reliabilities in the mid 0.90 range for both parent and teacher forms. Test–retest reliability
data are collapsed across age groups in the SSIS manual, with coefficients on the parent
and teacher forms ranging from 0.72 to 0.93 across subscales. Convergent validity studies
resulted in the SSIS preschool forms being moderately to highly correlated with the SSRS
and the BASC-2 forms.
The external research base including use of the SSRS (previous version) preschool
forms has expanded rapidly during the past few years, too. Convergent construct validity
of the SSRS preschool version forms has been established by finding significant cor-
relations with the Preschool and Kindergarten Behavior Scales (Merrell, 1995a) and the
Behavioral Assessment System for Children (Flanagan, Alfonso, Primavera, & Povall,
1996). Additionally, cross-cultural validity evidence for the preschool forms of the SSRS
has been reported (Elliott, Barnard, & Gresham, 1989; Powless & Elliott, 1993). Several
studies have shown the usefulness of the SSRS preschool forms for identifying risk factors
and theory-based differences among children in Head Start programs (Fagan & Fantuzzo,
1999; Fagan & Iglesias, 2000; Kaiser, Hancock, Cai, Foster, & Hester, 2000; Redden et al.,
2001).
In addition to the rating forms described above, the SSIS manual also includes a
Performance Screening Guide. This tool serves as a screener that can be used to efficiently
measure student behaviors and academic performance class-wide. The preschool version
of this tool specifically measures student performance as compared to grade level
expectations in the areas of prosocial behaviors, motivation to learn, early reading skills,
and early math skills. Teachers are asked to rate behaviors of each student in these areas
on a scale of 1 to 5. Information can be used to identify students who may be in need
of more targeted intervention or to progress monitor class progress based on the SSIS
Classroom Intervention Program. Intraclass correlations derived within test–retest and
inter-rater reliability studies suggested moderate to substantial correlations. The one
area with a low coefficient in the inter-rater reliability study was in the area of prosocial
behaviors (0.37).
In sum, the preschool level forms of the SSIS seem to be potentially useful in the
assessment of social skills of young children and have the definite advantage of being
part of the excellent and comprehensive SSIS system that is now linked to intervention
programming, which is well designed and easy to use. With the updated normative and
technical information, there is increasing external evidence to bolster reliability and
validity claims.

Interviewing Techniques
In Chapter 6, there is some discussion of specific challenges, developmental issues, and
recommendations regarding interviewing preschool-age and primary-age children. This
section provides additional insights and suggestions regarding conducting interviews
with young children. Perhaps the first issue that should be addressed in this area is the
question, “How useful is it to interview young children?” The answer to this question
depends on the purpose of the interview. It is well known that interviews with young
children in which the intended purpose is to gather specific recollections of past events are
problematic, to say the least. This problem becomes a particularly thorny issue when
interviewing young children who may have been sexually abused, when the purpose of the
interview is to gather evidence to document whether abuse occurred and to begin to
identify a perpetrator (e.g., Boat & Everson, 1988; Coolbear, 1992).
 Assessing Social and Emotional Behavior of Young Children s 423

In general, it is difficult for interviewers to obtain detailed and historically accurate

information regarding events in a young child’s life. A memory enhancement and interview
preparation technique called Narrative Elaboration (NE) has shown considerable promise
in enhancing the accuracy of recall in young children. The intervention teaches children to
organize event-related information into relevant categories, such as actions, participants,
settings, conversation, and so forth. Each category is represented to the child through the
use of a generic drawing on a visual cue card. The card is used to remind the child to
provide details according to each category. Before a recall interview in which the child is
asked about a specific event, the child is provided with opportunities to practice using
the cards to recall details about situations or stimuli that are not related to the pending
interview situation. The visual cue cards are presented during the recall interview to remind
the child of the categories of information and type of detail that he or she is expected to
provide regarding the target event or situation.
The evidence of the effectiveness of NE in increasing accurate recall during interviews
with children is promising. Children trained using the NE technique have been shown to
increase the accuracy of their recall by more than 50% in comparison with control group
children. NE originally was developed and researched by Saywitz and colleagues for use
with elementary-age children, (e.g., Saywitz & Snyder, 1996), but more recent studies by
Dorado and Saywitz (2001) and Peterson, Warren, and Hayes (2013) showed impressive
results with young (preschool- and elementary-aged) children. In sum, although obtaining
accurate historical recall from interviews with young children has been a perpetual
challenge, it seems that careful preparation and instructions may substantially enhance
the accuracy of obtained information.
Children’s competence in verbal communication gradually increases with age, and
preschool-age children certainly tend to be less competent than school-age children. This
fact does not mean, however, that young children cannot be assessed effectively in an
interview situation. Hughes and Baker (1990) noted that researchers have shown that
some of the supposed cognitive limitations of young children that were documented
through Piagetian tasks are “artifacts of the way they (the children) are questioned”
(p. 30). It is crucial to consider and remember that the skill and sensitivity of the interviewer
will be a major determinant in whether an interview yields valid and useful results. Hughes
and Baker also noted that when interviewing young children, adult interviewers often err
in attempting to assume too much control in the conversation, usually by asking too many
questions or by asking questions that are primarily forced-choice or closed-ended.
Given the current state of what is known regarding the cognitive and social develop-
mental characteristics of young children, several techniques can be recommended to
enhance the quality of clinical interviews. Hughes and Baker (1990) recommended that
interviewers should: (1) use a combination of open-ended and direct questions; (2) not
attempt to assume too much control over the conversation; (3) gain familiarity with
the child’s experience and use this understanding in developing questions; (4) reduce the
complexity of interview stimuli to the greatest extent possible; and (5) reduce the com-
plexity of the child’s responses by allowing him or her to communicate with props or
manipulatives at times. Regarding open-ended versus direct (closed-ended) questions,
even open-ended questions can be misused with young children. A particular problem is
referred to as leading questions, or asking a seemingly open-ended question in a manner
that slants the content of the response. For example, asking a child a question such as
“Tell me about what happens when your dad gets angry” in the absence of strong evidence
424 s Assessment of Specific Problems, Competencies, and Populations

to suggest this is even an issue will likely result in a response that confirms that dad is truly
an angry person. Young children tend to want to please adults, and providing the kind of
statements that they think an adult wants is one way of doing it. In terms of the issue
of control over the conversation, clinicians should balance the natural tendency of
children to move in and out of a specific topic with their own need to obtain information.
A mental reminder before the interview that it is okay to have the interview seem direc-
tionless at times may help in this regard. The other suggestions made by Hughes and Baker
are fairly self-explanatory.
An additional consideration for interviewing young children involves the difficulty
many young children have in separating from their parents. If an interviewer prematurely
requests the child to separate from the parent and go into the interview room with him
or her, a likely effect will be a poor interview, and a possible effect may be elicitation of
crying in the child. A technique that works well for many clinicians in working with
young children is to invite the child and parent into the clinic room or office together first
and invite them to engage in a nonthreatening activity, such as drawing pictures on a
whiteboard or playing with a toy. After the child begins to show signs of feeling comfortable
and secure, the clinician can matter-of-factly ask the parent to go into the other room to
fill out forms or engage in some similar activity. If the child becomes upset, some empathy
and gentle reassurance usually helps calm him or her. Statements such as “It’s okay to feel
scared when your mom is gone, but she will be back soon” and behaviors such as physically
getting down to the child’s level and engaging in a fun activity with him or her also help
in this regard.
In sum, although clinical interviews with young children do possess inherent challenges,
these challenges can usually be overcome with additional care, caution, and training.
Assuming that the interview is only one part of a comprehensive assessment design, it can
provide invaluable insights and information, even under less than ideal circumstances.

Sociometric Approaches
Each of the four general sociometric assessment methods illustrated in Chapter 7 (peer
nomination, peer rating, sociometric ranking, alternative procedures) has been adapted
and used with preschool-age children. Yet, despite their frequency of use with young
children, these methods have been shown to have inconsistent psychometric properties
and usefulness with this age group. Such findings, when considered in conjunction with
some of the unique social development aspects of early childhood, have resulted in
questions and cautions regarding the use of sociometric methods with young children
(e.g., Connolly, 1983; Hymel, 1983). Despite some legitimate concerns regarding these
cautions, it is my opinion that sociometrics can be used reliably and effectively with
preschool-age and kindergarten-age children and that the overall evidence regarding
validity of sociometric assessment with young children is supportive. This section adds to
the material presented in Chapter 7 some particular comments regarding issues in using
sociometrics with young children.
It is useful to understand the basis of concerns regarding the effective use of sociometrics
with young children. In a comprehensive review on this topic, Hymel (1983) concluded
that with regard to reliability, the data are less encouraging with children younger than
four years old. Hymel also noted that there was a paucity of predictive validity evidence
(as opposed to concurrent validity evidence) for sociometric measures obtained with
preschool populations. Bullock, Ironsmith, and Poteat (1988) also reviewed the literature
 Assessing Social and Emotional Behavior of Young Children s 425

on sociometric assessment with young children, finding mixed evidence regarding the
stability of measurement over time. Given these findings, we must ask the question why
would the sociometric ratings of young children be less stable than those of older children?
Perhaps the best answer to this question is that the constructs of friendship and peer
popularity are probably less stable with young children. The review by Bullock et al.
(1988) concluded that younger children’s friendships tend to fluctuate more than those
of older children. Related to this conclusion is a consistent finding that peer nominations
and peer ratings tend to have more similarity with preschool-age children than with
elementary-age children, indicating that in comparison with school-age children, younger
children do not differentiate as much between being best friends with another child and
simply liking that child. Any parent of young children can attest personally to these two
findings. Preschool-age children may be quite likely to state that a child with whom they
have played at preschool on one or two occasions is their “best friend,” but fail to mention
the same child only a few months (or days!) later if asked to name their best friends.
Despite the sometimes amorphous quality that young children’s social relationships
have and the resulting lowered temporal consistency with certain types of sociometric
procedures, there is still much to be said for using them with this age group. Simple adap-
tations of basic sociometric methods, such as the use of picture sociometrics for peer
nominations and the additional use of happy, sad, and neutral face drawings to serve as
anchor points for peer rating procedures (see Asher et al., 1979), can make sociometric
procedures useful with young children. Although some experts (e.g., Hymel, 1983) have
recommended that rating scales should be used instead of nomination procedures with
young children, others (e.g., Poteat, Ironsmith, & Bullock, 1986) have argued convincingly
that with proper modifications, the two methods may both be reliable. The sociometric
method of choice by a particular researcher or clinician in assessing young children should
be based on the particular questions needing answers and the particular characteristics of
the children being assessed. Although there is still more to be learned regarding effective
use of sociometrics with young children, they can be recommended. The evidence is clear
that negative nominations or ratings are associated with negative behavior, and positive
nominations or ratings are associated with positive behavior. It is this demonstrated
strong relationship between assessment results and actual behavior that continues to
advocate for the use of sociometrics, and their use with young children should be no
exception. Further, it will be interesting to observe if there is an increase in the use of
sociometric procedures over time, as researchers and children are more and more savvy
with the use of technology. In one recent study, researchers compared a traditional peer
nomination approach with a computerized version, where preschool children could
click on a happy, sad, or neutral face (Endedijk & Cillessen, 2015). They found that these
approaches were comparable, and the computerized sociometric approach provided
additional data and more evaluation possibilities.

Self-Report Tests
Self-report tests are seldom useful with young children, and very few are even available
for use with this age group. As explained in Chapter 8, objective self-report tests typically
require three prerequisite abilities: (1) the ability to read and understand test items;
(2) the cognitive maturity or sophistication to make specific incremental judgments in
responding to test items; and (3) the ability to translate these judgments correctly into the
marking of the appropriate answer. Several self-report tests designed for social–emotional
426 s Assessment of Specific Problems, Competencies, and Populations

assessment of elementary-age children do allow for the examiner to read the items and
mark the chosen responses for children who have difficulty reading, which might lead us
to believe that they are appropriate for preschool-age and kindergarten-age children. This
belief almost always is wrong. Even allowing for the examiner to read the test items to the
children and to mark their answer forms for them does not solve the more fundamental
problem of cognitive maturity or sophistication. Most preschool-age and kindergarten-
age children simply do not possess the cognitive maturity needed to make appropriate
discriminating judgments on self-report tests of social–emotional functioning. Most
young children lack the intrapersonal insight regarding social and emotional function-
ing to understand adequately the concepts that they would be asked to evaluate in most
self-report tests. It is best to assume that researchers and clinicians must rely on other
means for assessing the social–emotional behavior of young children, with particular
emphases on behavior rating scales, direct behavioral observation, and, where appropriate,
sociometric approaches.
Despite the limitations of self-report methods for assessing social–emotional status
of young children, there are a few ingenious self-report instruments that have been devel-
oped specifically to overcome the limitations that most self-report tests have for young
children and that have been proven to be reliable and valid. The instruments reviewed
in this section are examples of seminal self-report tests available for social–emotional
assessment of young children, with a structure and approach to gathering information
from young children that has been used to develop other measures in this area and in
related areas.

The Pictorial Scale of Perceived Competence and Acceptance for Young Children The
Pictorial Scale of Perceived Competence and Acceptance for Young Children (Harter &
Pike, 1980, 1984) is a unique self-report test designed to evaluate the general self-concept
and social acceptance of young children, according to their own perceptions. In contrast
to most self-report social–emotional assessment instruments for children, this instrument
does not require that the child subject either read or make detailed response discrimina-
tions. The examiner leads the child through the items with a series of picture plates, and
the child is asked to make simple discriminations among paired items by pointing at the
picture or symbol that is most like him or her.
Separate gender picture plates (one depicting male characters and the other depicting
female characters) are used at two different developmental levels: one for preschool-age
and kindergarten-age children and the other for children in first or second grade. The
picture plates for the two different age levels are relatively similar but, for some items,
depict children in activities that are developmentally appropriate at that specific level.
For example, the preschool and kindergarten plates show children working on puzzles,
and the parallel item for the first and second grade shows children working on number
problems at school. There are 24 items in this test. The manner in which the items are
presented to the child involves the examiner first showing a plate with two opposing
pictures on it, then asking a simple question about it. For example, all children are shown
a plate in which one picture shows a child who appears to be sad, and the other picture
shows a child who appears to be happy. The examiner asks, “This girl (or boy) is usually
kind of sad (points to the first picture), and this girl (or boy) is usually kind of happy
(points to the second picture). Now I want you to tell me which of these boys/girls is most
like you?” The child then responds by pointing to the picture within the pair that he or she
 Assessing Social and Emotional Behavior of Young Children s 427

selects as being most like him or her. Then the examiner asks the child how much the
selected picture is like him or her, and the child responds by pointing to a large or small
circle that is located directly below the picture. For example, if the child had originally
pointed to the picture of the child who was usually sad as being most like them, the
examiner would say “Are you always sad?” (points to the large circle) or “Are you usually
sad?” (points to small circle). A value of 1 to 4 points is given for each item response, keyed
so that the lowest value always indicates the lowest level of perceived competence or
acceptance, whereas the highest value always indicates the highest level. Items are clustered
into four subscales: Cognitive Competence, Physical Acceptance, Peer Acceptance, and
Maternal Acceptance. The scales are scored by calculating a mean value for the items
within that scale, then identifying the general level indicated by that value. For example,
if a child received a mean score of 3.83 on Cognitive Competence, this score would be
interpreted as a high level of perceived self-competence in the cognitive domain, whereas
a score of 1.2 would be considered a low level. Scores for this test typically are interpreted
in a criterion-referenced rather than norm-referenced manner.
Although the test manual provides no technical data on the uses and properties of
this instrument, several publications have provided evidence that it is a potentially
useful instrument for use with young children. Significant relationships have been shown
between this test and measures of academic readiness (Anderson & Adams, 1985), self-
perception items have been found to correspond with actual criterion behaviors and
teacher ratings (Jongmans, Demetre, Dubowitz, & Henderson, 1996; Priel, Assor, &
Orr, 1990), and interesting relationships between test scores and differences in the way
that boys and girls tend to respond to other stimuli have been found (Harter & Chao,
1992). Additionally, the psychometric properties (i.e., basic reliability and validity) of
this test have been shown to be acceptable (e.g., Cadieux, 1996; Holguin & Sherrill, 1990).
Although the normative research base and psychometric properties of the Pictorial Scale
of Perceived Competence and Acceptance for Young Children are not as strong and
extensive as those available for many self-report instruments designed for use with
older children and adolescents, this is virtually the only self-report instrument for young
children that has been widely researched (with more than 50 published studies by 2002),
and it must be considered that social–emotional behavior is typically a less stable trait
in young children. As such, this instrument is particularly valuable as a research tool.
Clinical use of the test with young children can be recommended, provided that it is done
as part of a comprehensive battery and that hypotheses generated through evaluating
scale scores are supported through other means. It seems, however, that this test is used
most often in the context of research.

The Berkeley Puppet Interview (BPI) Additional measures have been developed that
utilize a similar approach to Harter’s scale. The ingenuity of this approach involves making
the questions as concrete as possible and using pictures and props to help young children
make meaning and answer reliably and validly. One measure that was originally developed
in the 1990s is the Berkeley Puppet Interview (BPI) (Ablow & Measelle, 2003). This is
somewhat of a combination of a self-report and interview approach in which children
interact with puppets and answer a series of questions. There are two puppets that each
make a statement, such as “I have lots of friends” and “I don’t have lots of friends.” Then,
one of the puppets will say, “How about you?” This invites children to share their perceptions
of their friendships with the puppets.
428 s Assessment of Specific Problems, Competencies, and Populations

The BPI consists of three major domains and multiple subscales. The domains include
the BPI Family Environment Scales, the BPI Academic and Social Scales, and the BPI-
Social Scales. Additionally, items from multiple scales have been used in research to obtain
children’s self-perceptions on the Big Five personality factors (i.e., extraversion, agreeable-
ness, conscientiousness, neuroticism, and openness) (Measelle, John, Ablow, Cowan, &
Cowan, 2005). Researchers have actually found that young children can answer questions
on dimensions of their personality as reliably as college students. The BPI is an impressive
methodology that has been used in over 100 studies and has been translated into seven
languages. It offers important information that can be considered when intervention
planning for young children.

BEST PRACTICES
As has been shown throughout this chapter, social–emotional assessment of young
children can be conducted using any or all of the five major assessment methods. To be
done effectively with young children, however, such assessment must be conducted with
particular precautions, modifications of design, extra care, and special sensitivity. At this
point, it is important to emphasize particular recommendations for social–emotional
assessment with young children that have an important bearing on research and practice.
One of the major recommendations for assessment of young children is that it is essen-
tial to include parents and teachers in the assessment process to the greatest extent possi-
ble. Although including parents and teachers is an important consideration in assessing
all children and adolescents, it is especially crucial where young children are concerned.
As has already been discussed, situational specificity of behavior is a particularly salient
issue with young children. Obtaining multiple reports and normative perspectives across
settings may help to clarify discrepancies in social–emotional behavior. Involvement of
parents of young children is also important because they may not yet be experienced
in dealing with professionals from educational and mental health systems. Parents who
are dealing with such systems for the first time may feel intimidated by professional
terminology and knowledge, unsure of the processes that they will encounter, and genu-
inely scared of what may be ahead for their child. In sum, they may need extra attention
and reassurance.
Involving teachers in the assessment process and developing models to assess the class-
room environment is also critical, given that newer intervention initiatives in education
are focused on prevention of academic and social–emotional problems and that preschool
teachers, in particular, are often the least trained and supported in our U.S. educational
system. There have been several recent developments in this area, one of which is called
the Teaching Pyramid Model (Fox, Hemmeter, Snyder, Binder, & Clarke, 2011; Hemmeter,
Ostrosky, & Fox, 2006), which is very similar to conceptualizations of RtI. In this model,
universally applied prevention efforts include an emphasis on teachers building nurturing
relationships with children and designing clear, consistent and caring classroom environ-
ments. Secondary or more targeted support includes systematic teaching of social and
emotional skills, and tertiary support includes intensive interventions that are functional
and supportive of individual needs (Fox et al., 2011). One assessment tool that is specifi-
cally aligned with this model is called the Teaching Pyramid Observation Tool (TPOT)
(Hemmeter, Fox, & Snyder, 2013). The TPOT is a rating scale that can be completed
 Assessing Social and Emotional Behavior of Young Children s 429

based on a two-hour observation in a preschool classroom. This tool has been described
as a reliable and dependable measure and has been useful in measuring progress of
Teaching Pyramid implementation over time (Fox et al., 2011).
Another recommended best practice for social–emotional assessment with young
children is to use extra caution in the diagnosis/classification process and to avoid patho-
logizing children. Many DSM-5 diagnostic categories for psychiatric disorders are simply
not appropriate for young children. Making classification decisions regarding diagnostic
categories that may be appropriate for young children is often extremely difficult because
the way that behavioral problems are exhibited by them often differs markedly from that of
older children. Given these diagnostic/classification concerns and other related concerns,
it is especially important for clinicians to use extra caution and conservatism in making
decisions that may have a lasting impact. Approaching referral issues from a functional
and disconfirmatory perspective may be helpful in this regard. The referral should be
approached from the standpoint of clarifying a possible problem and identifying what
may be done to solve the problem. The clinician should not automatically assume that
psychopathology exists.
A final best practice to consider in social–emotional assessment of young children is
effectively linking such assessment results to intervention strategies. With older children
and adolescents, there is typically a greater availability of empirically validated assess-
ment and intervention technologies. Practitioners who work with young children are faced
not only with fewer technically sound assessment methods and instruments, but also
possibly more difficulty in selecting appropriate intervention strategies. Assessment that
takes into consideration the important elements that will be needed to develop effective
intervention has been referred to as intervention-based assessment (Barnett, Bell, Stone,
Gilkey, & Smith, 1997). In this regard, Flugum and Reschly (1994) identified six quality
indicators that have been related to successful interventions: (1) behavioral definition
of the problem; (2) direct measurement of the targeted behavior in the natural setting;
(3) detailed intervention plan; (4) intervention integrity; (5) graphing of intervention
results; and (6) comparison of postintervention performance with baseline data. The link
to intervention with young children would be enhanced by selecting methods, instruments,
and an overall assessment design that allows for as much eventual intervention integrity as
possible. Without a doubt, most of these characteristics could be used as benchmarks on
which to develop and judge the efficacy of a planned assessment.

CONCLUSIONS
School psychologists, clinical child psychologists, special education diagnosticians, and
other child-serving professionals are increasingly being asked to provide comprehensive
services to young children, including social–emotional assessments. The state of assessment
technology designed specifically for the unique needs of this age group lags behind what
is available for use with older children and adolescents. An additional problem is that
many clinicians have received minimal or no formal training in assessing young children,
which requires special knowledge, care, and sensitivity to do effectively. Despite the
problems and challenges involved in social–emotional assessment of young children, there
have been numerous improvements and new developments in this area.
Traditional diagnostic classification systems for emotional and behavioral disorders of
childhood (e.g., the DSM-5) are often of limited use with young children. An alternative
430 s Assessment of Specific Problems, Competencies, and Populations

diagnostic classification system designed specifically for use with young children, the
Diagnostic Classification: 0–3, Revised and soon to be Diagnostic Classification: 0–5, is
available to supplement the more traditional systems. This system uses a multiaxial
classification format that is similar to that of DSM-IV but is designed to take into account
the specific ways in which behavioral and emotional problems are manifest by young
children. This system also is unique because of its strong focus on the quality of the
relationship of the child and his or her parent.
Each of the five major assessment methods that are the focus of this book can be
used with varying degrees with young children, assuming that certain modifications
or precautions are taken into consideration. Direct behavioral observation has a long
history of use for assessing social and emotional behavior of young children and offers
the advantage of empirical assessment within naturalistic settings. Research has indicated,
however, that the social behavior of young children is highly variable, and multiple
observations of behavior may be needed to provide a reliable assessment. Developers of
behavior rating scales for children historically have ignored the special characteristics
and needs of young children, but this situation is changing. Rating scales such as the
ASQ:SE-2, the SEAM, the DECA, the Behavioral Assessment System for Children, Third
Edition, the preschool forms of the ASEBA, Preschool and Kindergarten Behavior Scales,
Second Edition, and Social Skills Improvement System have helped to move rating scale
technology for use with young children to increasingly higher standards of technical
adequacy and usability.
Clinical interviewing of young children has been an extremely popular method of
assessment, albeit one fraught with obstacles. Although even the best clinicians who
employ interview methods with young children may have difficulty obtaining consistent
or highly objective information, interviews can be used effectively for various purposes.
With proper modifications and precautions, interviews can help clinicians better under-
stand and gain rapport with the child, and may serve as a valuable component of com-
prehensive assessment design. Specific training and practice before the interview, using
procedures such as Narrative Elaboration, may result in improved accuracy of recall.
Although the research on using sociometric assessment approaches with young children
has yielded mixed results, there is convincing evidence that such techniques may be useful
and predictive of future behavior, particularly when appropriate modifications are made,
such as using photographs of children and alternative picture-based response formats.
Self-report methods of social–emotional assessment are challenging to implement with
young children because they require the ability to read and make cognitive differentiations
that are simply beyond the capabilities of almost all children younger than about second
grade. There are exceptions, however, to the dearth of appropriate self-report assessment
instruments for young children; these include the Pictorial Scale of Perceived Competence
and Acceptance for Young Children and the Berkeley Puppet Interview.
For optimal effectiveness, certain practices should be incorporated into social–
emotional assessment of young children, without regard to the type of design or method-
ology that is employed in the assessment. Among these practices and modifications,
full participation and partnerships with parents, caution with respect to “pathologiz-
ing” child behavior, and developing effective linkages to interventions are especially
recommended.
 Assessing Social and Emotional Behavior of Young Children s 431

REVIEW AND APPLICATION QUESTIONS

1. What are some of the major difficulties in conducting adequate social–emotional
assessments with young children?
2. How does the Zero to Three diagnostic classification system (DC: 0–3R/DC: 0–5) for young
children compare with the major classification systems discussed in Chapter 3?
3. What is known regarding the reliability or stability of behavior of young children over time?
How does this knowledge translate into practice in terms of conducting direct behavioral
observations?
4. Five behavior rating scales or checklists for use with young children were reviewed in this
chapter. In what circumstances or for what types of referral problems would each of these
instruments be best used?
5. Given that interviewing with young children is problematic at best, what can be done to
minimize the problems and enhance the validity and accuracy of interviews?
6. What are some explanations for the lower reliability over time of sociometric procedures
with young children in comparison with school-age children? Does this lower reliability
reduce validity of sociometric procedures with younger children?
7. What are some specific practices in assessment of young children that may be helpful to
avoid “overpathologizing” them?
 15
UNIVERSAL SCREENING IN SCHOOLS
With Kayla Gordon

The purpose of this chapter is to provide readers with an overview of methods and specific
measures that can be used to screen populations for behavioral, social, and emotional risk
and to target school-wide instructional priorities. While the concept of school-wide
screening is certainly not new, implementing such practices is a large paradigm shift for
many and requires organizational and systemic support to do effectively and efficiently.
In this chapter, we provide readers with a conceptual overview of school-wide screening
within a prevention model. We reflect on the purpose of screening for both externalizing
and internalizing symptoms and we consider opportunities and challenges that emerge as
school systems take on this approach. Multiple tools will be described with an emphasis
placed on the technical adequacy and accessibility of these tools.

CONTEXT FOR UNIVERSAL SOCIAL–EMOTIONAL SCREENING

It is no secret that school professionals are currently called to engage in more than academic
instruction. Approximately, 20% of American children and adolescents are struggling with
social–emotional problems that warrant additional support, and few receive the support
that they need (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003). In fact, if they do
receive counseling or intervention support, it is likely to happen within the school context.
However, school-based mental health professionals cannot respond to the rising social–
emotional needs of students alone. To effectively and efficiently address these concerns,
school professionals are encouraged to think about preventatively assessing and teaching
social–emotional skills as they would academics.
Scholarly work and practical applications related to prevention efforts have grown
tremendously over the last several years, and are often organized within a Multitiered
System of Support (MTSS) or Responsiveness-to-Intervention (RtI) framework (Costello
& Angold, 2000; Merrell & Buchanan, 2006; Sugai & Horner, 2009). According to
a National Association of School Psychologists (NASP, 2010) position statement, an
MTSS framework includes three tiers of integrated academic and behavioral assessment
and instructional supports that become increasingly intensive based on student needs.
Tier 1 aims to prevent onset of academic or behavioral challenges through high-quality
instruction and universal screening. Tier 2 reflects targeted interventions for students
that are displaying some risk, and Tier 3 includes individualized and specialized
interventions for students that have not responded to the Tier 1 and 2 supports offered.
An MTSS model has been found to be particularly effective for students who may have

433
434 s Assessment of Specific Problems, Competencies, and Populations

been vulnerable to risky or negative outcomes, such as suspension, dropout, etc. (Cortiella
& Horowitz, 2014).
Based on years of accumulated research, NASP (2010) recommends particular practices
to be incorporated into each tier within MTSS. For behavior in particular, Tier 1 includes
providing students with high-quality instruction related to behavioral expectations, a
continuum of positive feedback for meeting expectations as well as explicit redirection
when expectations are not met (Sugai & Horner, 2009). Further, school professionals may
engage in coordinated and planned instruction to help students access critical social–
emotional learning skills (SEL) such as self-awareness, self-management, social awareness,
responsible decision making, and relationship building (Durlak et al., 2011; Greenberg,
Weissberg, Utne O’Brien, & Elias, 2003).
To plan Tier 1 instruction that is aligned with a school or district’s particular circum-
stances (e.g., cultural, economic) and needs, it is recommended that schools develop
an MTSS Tier 1 team that can work together to gather school-wide screening data that will
help to drive Tier 1 instructional efforts. Additionally, Tier 2 teams, or problem-solving
teams, can use these data to identify students in need of further assessment or more
targeted support. These teams are not those that meet a handful of times to plan a set of
practices that will be implemented once; rather, they are groups that develop a way
of working in which data are consistently shared and used to monitor the effects of Tier 1
and Tier 2 instruction over time, as well as keep a finger on the pulse of students that may
be emerging with social–emotional risk factors.
Schools are places that are often rich with extant data, which can be part of a universal
screening effort. For example, schools that have methods to reliably collect office discipli-
nary data can use such data to understand and intervene around aspects of school-wide
behavior. For example, if a school team identifies that most referrals include disrespect
between peers on the playground then they can develop a Tier 1 instructional target to
explicitly teach students about respectful and kind behavior at recess time. Further, many
school teams use office disciplinary referrals as a method to identify students for Tier 2
interventions (Walker, Cheney, Stage, & Blum, 2005). In these cases, teams usually develop
a data decision-rule (e.g., two or more referrals) to help determine when a student will be
given additional intervention. While screening with office disciplinary information might
be an efficient process, research suggests that this data source might not capture a complete
picture of a school community’s mental health (McIntosh, Campbell, Carter, & Zumbo,
2009). Office disciplinary referrals likely miss behaviors related to internalizing problems
like symptoms of depression and anxiety. Given this limitation, schools have begun to turn
toward use of further social–emotional screening methods and measures.

SOCIAL–EMOTIONAL SCREENING
Universal social–emotional screening in schools includes gathering brief amounts of
information about the social–emotional functioning of all students in a school or district.
This can take the shape of structured teacher nomination efforts, in which teachers learn
to identify social–emotional symptoms and then can nominate students, about whom
they have concerns, for further assessment and/or intervention (Walker, Severson, & Feil,
2014). Screening also includes brief teacher behavioral ratings or self-report methodology.
In this chapter, we will primarily review behavioral rating screening tools.
 Universal Screening in Schools s 435

While universal screening tools vary in terms of behavioral targets, response formats, and
recommended frequency of administration (Glover & Albers, 2007), there are some
standard considerations for those selecting instruments that we describe here. Glover and
Albers (2007) suggest that users build an understanding of the appropriateness of a tool for
its intended use, the technical adequacy of the measure, and feasibility of implementation
of data collection and use. It is very important that users select a tool that includes social–
emotional targets that are relevant to their school population. While screening is intended
to be efficient, it is also intended to provide useful information that drives instruction and
decision making.
As with any behavioral rating tool, having an understanding of the psychometric
properties of a tool is a necessary consideration. Users should be aware of the normative
sample, reliability, and validity of measures. For screening tools in particular, predictive
validity is helpful to understand. For example, one should understand the sensitivity of a
measure. The sensitivity index represents the proportion of those correctly identified as at
risk that later turn out to be at risk. The specificity index, on the other hand, is the proportion
of individuals who do not ultimately engage in at-risk behaviors and are not mistakenly
identified as at-risk. These concepts are practically important for users because they don’t
necessarily want to over identify students and provide them with a great deal of unnecessary
programming or intervention. On the other hand, users clearly would not aim to under
identify students and then deprive them of needed support (Glover & Albers, 2007).
The final essential concept for school professionals to consider is the usability or
feasibility of a screening measure (Glover & Albers, 2007). Screening efforts are not meant
to be resource intensive. Schools need to consider how much they are willing to invest in
terms of money, time, and personnel. Further, these considerations need to happen
with the perspective that screening aims to support efficient Tier 1 decision making. Some
of the measures that we describe in this chapter are freely available, while others are not.
Some measures are incorporated into larger data management systems, which schools
might be using anyway to screen and progress monitor academic skills (e.g., FastBridge).
Others may require data entry and analysis. Finally, it is important for professionals to
think through personnel time that will be needed to commit to training, administration,
and analysis of screening data. While it is important for screening tools to be efficacious
in accurately identifying concerning behaviors, it is also important for them to be effective,
meaning that they can be feasibly used within a real-world setting (Levitt et al., 2007).
In this chapter, we have chosen to extensively review seven available screening measures/
approaches. Given the scope of this chapter, we could not review every existing measure,
but we did try to select tools that are emerging as effective and efficient. For a more
comprehensive review of screening efforts, see Jenkins et al. (2014), and Lane, Menzies,
Oakes, & Kalberg (2012). In addition to the seven reviews, we will also share an example
of another tool with a research base that is in its infancy but holds promise for future
practical application.

SCHOOL-WIDE SCREENING MEASURES

The Systematic Screening for Behavior Disorders, Second Edition (SSBD-2)

The first screening that we give here is not one tool; rather it is a well-established,
systematic screening process. The Systematic Screening for Behavior Disorders, Second
436 s Assessment of Specific Problems, Competencies, and Populations

Edition (SSBD-2) (Walker, Severson, & Feil, 2014) is an empirically validated multiple
gating system for screening students in preschool through ninth grade for behavior
disorders. This screening system was one of the first ever developed and has a large body
of about 30 years of research supporting its use. The second edition was released in 2014,
which updated the SSBD to an online format from its previous version (SSBD) (Walker
& Severson, 1992) which was available solely in paper format. Additionally, the second
edition includes assessment of preschool-aged children, which had previously been
accomplished through a separate, though very similar method called the Early Screening
Project (ESP) (Walker, Severson, & Feil, 1995). The ESP also represented an innovative
multiple gating system designed to assist in screening preschool-age children (aged three
to five) who were at high risk for developing significant emotional or behavioral disorders.
The SSBD-2, can be used to screen a class through a series of assessment and decision-
making steps, which are successively refined and selective. An outline of the gating system
is outlined in Figure 15.1. The first two stages in the SSBD rely on the judgment of teachers.
Stage 1 involves a teacher nomination and rank ordering process to identify the children

Stage 1
Teacher Ranking

on Externalizing and Internalizing Behavior Criteria

Universal 3 highest ranked students

Screening pass to Stage 2
with SSBD
Screening Time:
-45 minutes pel
classroom Stage 2
Teacher Ratings

, on Critical Events and Combined Frequency Indexes

Plus Aggressive Behavior and Social Interaction Scales
(Prek-K only)
Students who meet criteria
pass to Stage 3 or go directly
.J;o intervention and/or referral.

(Optional) (Optional)

Stage 3 Stage 3
Observation School Archival
Codes Records Search

Intervention and/or Referral

Figure 15.1 Diagram of the multiple gating stages of the Systematic Screening for Behavior Disorders
Source: From Systematic Screening for Behavior Disorders, Second Edition, by H. M. Walker, H. Severson, and E. Feil (2014).
Eugene, OR: Pacific Northwest Publishing. Reprinted with Permission.
 Universal Screening in Schools s 437

Stage 1 Screening for Internalizing Students

Rank Ordering on Internalizing Dimensions

Step 1. Carefully study the definition of internalizing behavior below and then review your class roster.

Internalizing refers to all behaviour problems that are directed inwardly (Le., away from the external
social environment) and that represent problems with self. Internalizing behavior problems are
often self-imposed and frequently involve behavioral deficits and patterns of social avoidance.
Non-examples of internalizing behavior problems would be all forms of social behavior that
demonstrate social involvement with peers and that facilitate normal or expected social development.

Examples Include: Non-Examples Include:

Having low or restricted activity levels Initiating social interactions with peers
• Not talking with other children • Having conversations
Being shy, timid, and/or unassertive Playing with others, having normal rates or
Avoiding or withdrawing from social situations levels of social contact with peers
• Preferring to play or spend time alone • Displaying positive social behaviour toward
Acting in a fearful manner others
Not participating in games and activities Participating in games and activities
• Being unresponsive to social initiations by others • Resolving peer conflicts in an appropriate
Not standing up for one's self manner
Appearing depressed Joining in with others

Step 2. In Column One, enter the five students whose characteristic behavior patterns most closely match
the internalizing behavior definition.

Step 3. In Column Two, rank order students you have listed in Column One according to the degree or
extent to which each displays internalizing behavior. The student who exhibits internalizing behavior to the
greatest degree is ranked first and so on until all five students are rank ordered. The three highest ranked
students will be rated on Stage 2 measures.

Column One Column Two

List Internalizers Rank Order Internalizers
Student and/or ID No. Student and/or ID No.

Figure 15.2 Instructions for rank-ordering students with internalizing social–emotional problems, from stage 1 of the SSBD
multiple gating system. A rank-ordering procedure for externalizing problems is also included in stage 1
Source: From Systematic Screening for Behavior Disorders, Second Edition, by H. M. Walker, H. Severson, and E. Feil (2014).
Eugene, OR: Pacific Northwest Publishing. Reprinted with Permission.

in the class who exhibit the highest rates of internalizing and externalizing problems (see
Figure 15.2). Five children from the classroom are selected to pass through the Stage 1 gate
on to Stage 2. In this stage, the top three students with internalizing and externalizing
problems are again rated by their teacher on two indices: the Critical Events Index and the
Combined Frequency Index of Adaptive and Maladaptive Behavior, as well as an Aggressive
Behavior and Social Interaction Scale for PreK and kindergarten students only. Students,
who further exceed what would normally be expected, move along to stage three where
direct observations are conducted, which are called the Screening, Identification, and
Monitoring System (SIMS) Observation Codes.
Behaviors Targeted During the first stage, teachers are instructed to nominate their top
five students displaying internalizing behaviors and the top five students displaying
438 s Assessment of Specific Problems, Competencies, and Populations

externalizing behaviors. The SSBD provides guidance on this by giving teachers examples
and non-examples of what these behaviors entail. For internalizing behaviors, the
examples given include not talking to other children, acting fearful, or appearing depressed.
For externalizing behaviors teachers are asked to identify students who exhibit behaviors
such as arguing, having tantrums, or being hyperactive. Out of these five students, the top
three in each category pass through the first gate to Stage 2.
During Stage 2, a screening process through a series of questionnaires takes place.
For students identified during Stage 1 behaviors, a Critical Events Index is completed by
the student’s teacher. This targets behaviors that have serious implications for long-term
adjustment including stealing, reporting nightmares or sleep disturbance, and exhibiting
a sad affect. Another questionnaire is also completed for each student by their teacher that
assesses for adaptive and maladaptive behaviors including manipulating other children,
completing classwork, and following the rules. Half of the items focus on adaptive student
behavior and half focus on maladaptive. The teacher is asked to rate each child on each
item on a 3-point Likert scale based on how often they have observed the student exhibiting
that behavior this year. As was mentioned above, PreK and K students are also rated on
aggressive behaviors and social interactions.
Students who receive scores on these measures that exceed normal limits pass through
the second gate and move on to Stage 3. During Stage 3, a professional in the school con-
ducts direct observations. These observations are conducted in both academic and other
settings in order to assess both academic engaged time in the classroom and positive
prosocial behavior.

Technical Adequacy The SSBD is validated for use in preschool through to grade 9 and
is widely used as a multigated universal screening tool. It can reliably identify students
displaying either internalizing or externalizing behaviors that may be in need of additional
support. New norms were added in 2013 from 7,000 youth across the country in order to
ensure that the measure was still reliable and relevant to today’s youth. The technical
manual for the SSBD is available for free online and includes additional specific inform-
ation about the validation and reliability of the tool. The manual describes multiple
studies that have accumulated evidence supporting the SSBD’s reliability and validity
since the 1980s. The original standardization sample included about 4,400 cases for Stage
2 and 1,300 cases for the SIMS Behavior Observation Codes. These participants were from
eight states across all regions of the U.S. During initial pilot testing, the original inter-
rater reliability coefficients for Stage 1 were low, so authors revised the descriptions of
behaviors and saw improved coefficients, ranging from 0.82 to 0.94. Test–retest reliability
ranged from 0.74 to 0.88. When initially testing the sensitivity of Stage 1, researchers
found that 90% of students with behavior disorders were in teachers’ lists of top three
candidates. Over the next several years, multiple studies were conducted, where the
reliability and validity of Stages 2 and 3 were further established.
The initial ESP national norm sample was large and diverse, consisting of 2,853 children
aged three to six who were enrolled in a variety of typical and specialized preschool
educational programs. The technical adequacy of the ESP has been solidly researched.
Median inter-rater reliability coefficients were in the 0.70 range, and median test–retest
coefficients at medium-length intervals were also in the 0.70 range. The ESP manual and
subsequent published studies have documented various forms of test validity, based on
correlations with specific assessment instruments and estimation of classification accuracy,
 Universal Screening in Schools s 439

among other procedures. The ESP has been shown empirically to result in relatively low
false positive and false negative error rates in identification (Feil & Becker, 1993; Sinclair,
Del’Homme, & Gonzalez, 1993) and to have strong construct validity when compared
with other methods of assessment and when researched for accuracy of classification
results (Jentzsch & Merrell, 1996).

Feasibility The SSBD takes less than an hour for a teacher to screen his or her entire
classroom. As soon as teachers have completed their screenings, the individual student
reports are automatically scored and generated by the SSBD online. Administrators
and other professional support staff with administrative access can also see both the
individual student reports and school level reports. The SSBD is available for purchase
online (www.pacificnwpublish.com). It costs $550.00 per school for a 12-month sub-
scription. Moving the SSBD to an online platform increases its feasibility tremendously,
as now an individual or group of professionals are no longer needed to aggregate all of
the data to be able to understand school-wide patterns and trends. The ingenuity and
longevity of the SSBD is truly impressive, and it will be interesting to see how the online
addition contributes to more widespread use.

The Student Risk Screening Scale—Internalizing and Externalizing (SRSS-IE)

The Student Risk Screening Scale Internalizing and Externalizing (SRSS-IE) is an
empirically validated tool designed to be used for screening. It was initially developed as
a universal screening tool for use at the elementary level, but it is now validated for use
at the elementary, middle, and high school levels (Drummond, 1994; Lane, Kalberg,
Parks, & Carter, 2008; Lane, Parks, Kahlberg, & Carter, 2007; Schatschneider, Lane, Oakes,
& Kahlberg, 2014). The SRSS-IE is comprised of both the SRSS-E, or the externalizing
composite of the SRSS, and the SRSS-I, or the internalizing composite of the SRSS.
All items on the SRSS are rated on a 4-point Likert scale indicating how often the
behavior is likely to occur from never to frequently. On the externalizing scale, there are
seven items, and the internalizing composite adds a total of five to six items to the SRSS-IE
depending on the age of the students. For elementary school students, there are five
internalizing items while at the secondary level there are six.

Behaviors Targeted The SRSS-E focuses solely on externalizing symptoms while the
SRSS-I adds an internalizing symptoms component. Together, the SRSS-IE assesses risk
for both externalizing and internalizing symptoms. A total score is also calculated that
incorporates both internalizing and externalizing behaviors. The following risk factors
are the externalizing symptoms measured by the SRSS-E: stealing, lying, cheating, and
sneaking, behavior problems, peer rejection, low academic achievement, negative attitude,
and aggressive behavior. For the SRSS-I, the items ask about internalizing symptoms
such as a student being emotionally flat, shy or withdrawn, sad or depressed, anxious, and
lonely. At the middle and high school level, the peer rejection item is moved from the
externalizing scale to be a part of the internalizing scale.
The report produced by using the SRSS-IE shows if a student’s level of risk is low,
moderate, or high. This is based on the total score of all risk factors on either the internalizing
or externalizing scales. It is not suggested that the individual items are predictive of a
student’s overall level of risk.
440 s Assessment of Specific Problems, Competencies, and Populations

Technical Adequacy The SRSS has been validated for use at the elementary, middle, and
high school levels (Drummond, Eddy, & Reid, 1998; Lane et al., 2008; Lane, Parks, Kalberg,
& Carter, 2007). Lane, Kalberg, Lambert, Crnobori, and Bruhn (2010) examined the
internal consistency estimates of the SRSS and found that they were 0.81, 0.82, and 0.81
at fall, winter, and spring administration time points, respectively. In addition, the authors
examined test–retest reliability, which indicated that Pearson correlation coefficients
ranged from 0.68 to 0.74. In terms of predictive validity, Lane et al. (2010) also found that
the SRSS had similar accuracy to the SSBD for identifying externalizing disorders, but that
it was less accurate at identifying students with internalizing characteristics.

Feasibility To use the SSRS-IE, each teacher rates each of their students on how often they
exhibit the behaviors indicated by each item on a 0–3 scale. It is estimated that the SSRS-IE
takes approximately 15–20 minutes to complete for an entire class. It is recommended that
each teacher individually records each student’s scores and then a coordinator or coach
enters them into an online database to aggregate the data. The SRSS-IE is designed to be
used three times per year.
The SRSS is a free screening tool for schools to use. Scoring sheets are available via an
excel file online (www.ci3t.org). Responses should be entered by the SRSS coordinator,
who should be selected by each school in order to enter and manage the data prior to
using the SRSS. Once the data are entered, the excel file available online will automatically
calculate the level of risk for each student as data are entered. In addition, the excel file
will automatically color code the SRSS-E and the SRSS-I composite scores according to
level of risk. The cell will remain white for low risk, yellow for moderate risk, and red for
high risk. A total composite score is also calculated by the excel file encompassing both
internalizing and externalizing symptoms. Two different excel files are available with one
being only for elementary school students and the other being for use with middle and
high school students.

The Strengths and Difficulties Questionnaire (SDQ)

The Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997) is a brief validated
screening tool available for use with children and adolescents. Educator and parent
forms are available online to be downloaded (www.sdqinfo.com) for children aged two to
17 years old. The SDQ has self-report forms available for individuals aged 11 to 17. There
is also a self-report form and an informant report form for individuals aged 18 and over.
The SDQ can be used for school-wide or program-wide screening, in addition to being
used in clinic settings as part of an initial assessment. The SDQ can also be used in either
clinics or schools to evaluate treatment effects before and after an intervention.

Behaviors Targeted The SDQ has three main components: a 25-item core questionnaire,
an impact supplement, and a follow-up supplement. The items on the core questionnaire
are divided among five subscales summarizing emotional symptoms, conduct problems,
hyperactivity/inattention, peer relationship problems, and prosocial behavior (Goodman,
1997). Each subscale has five items. Four subscales, excluding prosocial behavior, are also
added together to generate a total difficulties score. An internalizing symptoms composite,
comprised of the emotional symptoms and peer relationship problems, and an external-
izing symptoms composite, made up of conduct problems and hyperactivity/inattention
symptoms, are also derived from the data (Goodman, Lamping, & Ploubidis, 2010).
 Universal Screening in Schools s 441

The impact supplement asks the individual or informant to denote how much of an
influence their impairments have on others. Specifically, these items ask about how long
difficulties have occurred for, whether the client seems upset or distressed by the impair-
ments, and whether the difficulties impact different areas of the client’s life. The follow-up
supplement asks questions about whether an intervention has reduced the problem or if
it has found other ways to make the problem more bearable.

Technical Adequacy Norms for the SDQ are available from ten different countries. The
current norms available on the SDQ website for the United States are from when the SDQ
was included in the 2001 National Health Interview Survey (NHIS) Supplement. In total,
10,367 children between the ages of four and 17 participated in the study in order to
obtain norms for the parent report form. In addition, Stone, Otten, Engles, Vermulst, and
Janssens (2010) estimated the internal consistency scores for the SDQ to be between 0.53
and 0.76 for the parent report form with the total difficulties score having an internal
consistency of 0.80. For the teacher report form, it is estimated that the subscales have a
slightly higher reliability between 0.63 and 0.83 with an internal consistency score on the
total difficulties composite of 0.85 (Stone et al., 2010). It is estimated that concurrent
validity between the SDQ and the Child Behavior Checklist (CBCL) is between 0.52 and
0.71 for each of the parent reported subscales, and 0.76 for the total composite on the
parent form. In comparison, on the teacher report form, the concurrent validity is
estimated to be between 0.57 and 0.79 with the total composite concurrent validity also
being a 0.76 (Stone et al., 2010).

Feasibility The SDQ is inexpensive to use, and parent, teacher, and self-report forms are
available online. The core questionnaire can be completed by educators, parents,
or clients in about five to ten minutes. Items are rated on a 3-point Likert scale where
0 = not true, 1 = somewhat true, 2 = certainly true to determine behavior during the last six
months or during the current school year. The questionnaires are available to administer
in over 80 different languages to accommodate most clients, educators, and families.
Scoring can currently be done either online or by hand through instructions provided
online. The free online scoring website also generates reports to be used to summarize the
data provided by the SDQ. Online scoring and transparent overlays for hand scoring are
provided in many different languages. In addition, the SDQ website has syntax available
to score the SDQ using SPSS, SAS, Stata, and R.

The Social, Academic, and Emotional Behavior Risk Screener (SAEBRS)

The Social, Academic, & Emotional Behavior Risk Screener (SAEBRS; Kilgus, von der
Embse, Chafouleas, & Riley-Tillman, 2014) is a newly developed tool that is used to
screen for social, emotional, and behavioral problems in students in kindergarten through
grade 12. It is available online via the FastBridge data management system (www. fastbridge.
org). The SAEBRS is a teacher report questionnaire comprised of 19 items on three scales.
Each item is rated on a 4-point Likert scale where the respondent is asked to indicate how
often the behavior occurred in the last month from never to almost always. The SAEBRS
is designed to be used for universal screening to determine behavioral and emotional risk,
which has been shown to be connected to academic success.

Behaviors Targeted The SAEBRS assesses risk for social behavior problems, academic
behavior problems, and emotional behavior problems. These three types of behavior
442 s Assessment of Specific Problems, Competencies, and Populations

problems make up the three scales of the SAEBRS. The Social Behavior and Academic
Behavior scales have six items each, while the Emotional Behavior scale has seven items.
There is also a Total Behavior composite score that encompasses both the Social Behavior
and Academic Behavior items for a total of 12 items (Kilgus et al., 2014; Kilgus, Eklund,
Nathaniel, Taylor, & Sims, 2016). In addition to numerical scores, descriptors of “risk” or
“no risk” are used to describe a student’s current status.
Social behavior problems include behaviors that may limit a student’s ability to maintain
relationships with either peers or adults. Academic behavior problems may inhibit a
student from being prepared for, engaging in, and benefiting from academic material that
is taught. Emotional behavior problems are those that limit a student’s coping mechanisms
and appropriate responses to stressful and challenging events. In addition, students who
display these concerns are likely to have a more difficult time adapting to change.

Technical Adequacy Kilgus et al. (2016) examined the current psychometric properties
of the SAEBRS. They found that the internal consistency reliability at the elementary
school level was estimated to be 0.83 through 0.92 on the three scales with the Total
Behavior composite at 0.93. Sensitivity coefficients ranged from 0.79 to 0.97, and specificity
ranged from 0.73 to 0.93. For middle school students, reliability ranged from 0.77 to 0.93
on the three scales with the Total Behavior reliability slightly higher than at the elementary
school level at 0.94. Sensitivity coefficients ranged from 0.86 to 0.95 and specificity ranged
from 0.73 to 0.92. The SAEBRS was also significantly correlated with the Behavioral
Assessment System for Children, Third Edition: Behavioral and Emotional Screening
System (BASC-3: BESS) on all scales and the total composite at both age levels (Kilgus
et al., 2016).

Feasibility The SAEBRS is a tool that can be downloaded for free for paper and pencil
administration or it can be purchased for online administration and scoring through
FastBridge. It consists of a social–emotional rating scale with 19 items. Teachers can com-
plete the rating scale online and it typically takes one to three minutes per student. Scoring
is done automatically online, and the results are immediately available. The SAEBRS can
be given multiple times per year. Educators may also complete the SAEBRS for individual
students, all students in a classroom, across a grade level, or for an entire school or district.
Reports are available at the individual student level, or teachers can select to see all of the
students in their classroom to evaluate scores against local norms.

The Behavior Intervention Monitoring Assessment System (BIMAS)

The Behavior Intervention Monitoring Assessment System (BIMAS; McDougal, Bardos,
& Meier, 2009) is a tool to assess social, emotional, and behavioral functioning in children
and adolescents aged five to 18. The BIMAS can be used for universal screening, student
progress monitoring, and program evaluation. There are teacher, parent, and clinician
forms available for students aged five to 18 (grades K–12), and student self-report forms
are available for students in grades 6 to 12 or 12–18 years old.

Behaviors Targeted The BIMAS has 34 items and 5 subscales. The scales are grouped
into two categories: Behavioral Concern Scales and Adaptive Scales. The Behavioral
Concern Scales include Conduct, Negative Affect, and Cognitive/Attention. On the
Conduct scale, items relate to anger management, bullying, substance abuse, and deviance.
 Universal Screening in Schools s 443

The Negative Affect scale items focus on anxiety and depression symptoms. The Cognition/
Attention scale examines behaviors related to attention, focus, organization, planning,
and memory. The Adaptive Scales include social and academic functioning items that
relate to communication with others, academic performance, attendance, and attitude
toward learning.
The BIMAS is designed to be used within a multitiered model of support. At the
universal level, the BIMAS Standard can be used to screen students for emotional and
behavioral problems. At the advanced tiers, the BIMAS Standard and BIMAS Flex can
be used for progress monitoring, treatment planning, and intervention and program
evaluation.

Technical Adequacy The BIMAS is a research based and technically sound screening
system with change-sensitive items that allow for treatment monitoring as well as universal
screening. Normative data for the BIMAS includes 1,400 teacher ratings, 1,400 parent
ratings, and 700 self-report ratings that are representative of the United States population
as of the census data in 2000. In addition, 1,300 clinical cases were also collected. Internal
consistency on subscales on all forms ranged from 0.75 to 0.91, and inter-rater reliability
estimates ranged from 0.54 to 0.86, with lower coefficients on subscales comparing
students with teachers and students with parents. Test–retest reliability at two to four
weeks ranged from 0.79 to 0.91. Validity evidence has also been established as the BIMAS
has been compared to all forms of the Conners Comprehensive Behavior Rating Scales.
The BIMAS includes sensitivity coefficents that range from 0.76 to 0.84 and specificity
coefficients that range from 0.69 to 0.86.

Feasibility It is estimated that the parent, teacher, clinician, and student report forms take
about five to ten minutes each to complete per student. The Standard form has 34 items
on the parent, teacher, and self-report forms. The clinician form has 31 items. It is available
online and through a paper and pencil version. The BIMAS is available through MHS
assessments (www.mhs.com). The manual costs $99.00 and the price for each questionnaire
ranges from $2.00 to $4.00 depending on how many forms are purchased.
There are four report categories for the BIMAS, and they are all available online.
Assessment reports can be generated at the individual student level, which can be parti-
cularly helpful for identifying students needing additional intervention, as well as at the
multi-student level. Progress reports can compare multiple administrations of either
the BIMAS Standard or Flex to progress monitor and detect changes over time. Comparative
reports look at differences between results of different BIMAS assessments, such as between
different raters. Demographic reports are used at the multi-student level to identify and
plan prevention and intervention strategies around specific risk factors related to a class,
grade, school, or district.

The BIMAS Flex In addition to the BIMAS Standard scales, the BIMAS Flex includes
additional items that provide more specific information on each of the five scales that
the standard BIMAS assesses. More specific behavioral items are included for each of the
items on the standard form. Each item on the standard form has ten to 30 items associated
with it on the BIMAS Flex. Items on the BIMAS Flex are available both positively and
negatively worded, and a clinician can use the BIMAS Flex to customize treatment goals
and evaluate the effectiveness of treatment.
444 s Assessment of Specific Problems, Competencies, and Populations

The Behavioral Assessment System for Children, Third Edition: Behavioral

and Emotional Screening System (BASC-3: BESS)
The Behavioral Assessment System for Children, Third Edition: Behavioral and Emotional
Screening System (BASC-3: BESS) (Kamphaus & Reynolds, 2015) is a universal screening
system for measuring behavioral and emotional strengths and weaknesses in preschool
through high school. It is designed to be used by schools, mental health clinics, pediatric
clinics, communities and researchers, and forms are available for administration for
children and adolescents in preschool through grade 12. The teacher form has two levels
available: Preschool (aged three to five) and Child/Adolescent (grades 3 to 12). There is a
student self-report form that is available for children and adolescents in grades 3 to 12. A
parent form is also available with two levels: Preschool (aged three to five) and Child/
Adolescent (grades K–12). Any of these forms may be used individually or in combination.
The BESS is available through Pearson on Q-Global.

Behaviors Targeted The BASC-3: BESS measures behavioral and emotional competencies
across four domains which are internalizing problems, externalizing problems, school
problems, and adaptive skills. The parent form has 29 items that assess these four domains,
while the teacher form has 20 items and the self-report form has 28. Items that are both
positively and negatively worded are included on the BASC-3: BESS. Items are rated on a
4-point Likert scale where the rater is asked to indicate whether the behavior never occurs,
sometimes occurs, often occurs, or almost always occurs.

Technical Adequacy Scores are not provided for the scales individually, but a total
Behavioral and Emotional Risk Index score is calculated for each client by each rater. For
each scoring option, raw scores, T scores, and percentiles may be obtained. In addition,
the report generated will produce a Behavioral and Emotional Risk Index score and a
classification based on the T score. Scores of 0–60 indicate normal risk while scores
between 61–70 depict an elevated risk. Scores 71 and higher indicate extremely elevated
risk. If more than one form is completed for each client (i.e., a parent report form and a
teacher report form), the scores are displayed side by side. Individual item responses are
also recorded and indicated in the report that is generated. Validity indexes that identify
responses that may be overly negative or inconsistent are also included in the report.
Much like all of the other measures within the BASC-3 system, the BESS includes
impressive psychometric properties. Evidence of reliability and validity has grown since
the original release of the BESS. Jenkins et al. (2014) summarized the psychometric
properties of the BESS and found strong reliability coefficients with internal consistency
ranging from 0.91 to 0.97, test–retest ranging from 0.79 to 0.96, and inter-rater ranging
from 0.71 to 0.82. The BESS has also been found to appropriately converge and diverge
with a range of other instruments (e.g., the ASEBA system).

Feasibility It is estimated to take approximately five to ten minutes to complete each

BASC-3: BESS questionnaire. Teacher, parent, and self-report forms are available in both
English and Spanish. Individuals may purchase a kit that includes both the manual and
age-appropriate forms (parent and teacher for preschool students and all three for
children and adolescents). The Preschool kit is $111.30 and the Child/Adolescent Kit
is $136.30. Each kit includes a manual and 25 copies of each form. Additional forms may
be purchased for an additional cost.
 Universal Screening in Schools s 445

There are a few scoring options available for the BASC-3: BESS. It can be administered
and scored either manually or through Q-Global. If an individual is selecting to administer
and score electronically, they can order a comprehensive kit for $321.00 or they can
choose a package that also includes intervention recommendations for $404.00.

The BASC-3 Flex Monitor The Flex Monitor is designed to monitor the effects of a
behavioral intervention plan. It can be used as a progress monitoring tool and to track
changes in behavioral and emotional functioning. The BASC-3 Flex can be used to
monitor changes and progress in students who have been identified as needing addi-
tional support through the BASC-3: BESS after an intervention has been put in place.
There are teacher, parent, and self-report forms available. Parent and teacher forms are
available to track behaviors associated with ADHD, internalizing problems, disruptive
behaviors, and developmental social disorders. Self-report forms can track both inter-
nalizing problems and school problems. Custom forms can also be created from a pool
of over 600 items as teacher, parent, or self-report forms. Standard forms have five items,
and custom forms may have up to 45. Standard forms take approximately five minutes
to complete.

The Social Skills Improvement System—Performance Screening Guide (SSIS-PSG)

The Social Skills Improvement System—Performance Screening Guide (SSIS-PSG)
(Gresham & Elliott, 2008) is a universal screener designed to be used with children aged
three to18 years old in order to screen for social, motivational, and academic behaviors.
Three different administration forms, preschool, elementary (grades K–6), and secondary
(grades 7–12), are available to reach a wide age range. The SSIS-PSG is designed to be
completed by each student’s teacher three times per year to screen all students and monitor
those receiving interventions.
The Social Skills Improvement System also has three other tools that can be used in
combination with the SSIS-PSG. The Classwide Intervention Program is a ten-unit
program covering five major prosocial behavior areas for preschool through secondary
school students. It is designed to increase social skills including cooperation, assertion,
responsibility, empathy, and self-control. The other two tools, the rating scale and the
intervention guide were developed to be used for targeted assessment and intervention
rather than school or classroom screening and intervention. The rating scales assess
social skills, problem behaviors, and academic competence and are described in detail in
Chapter 13. The Intervention Guide is designed to deliver interventions to students that
are directly linked to their scores on the SSIS Rating Scales.

Behaviors Targeted The SSIS-PSG targets four main areas: prosocial behaviors, motiv-
ation to learn, reading skills, and math skills. Teachers rate each student within these four
domains on a 5-point scale (4-point scale for preschoolers). After an educator fills out a
form for each student in their classroom, the report indicates whether each student’s
score places them within a green, yellow, or red range for each domain, indicating various
levels of risk or concern. The SSIS-PSG can be used within a multitiered system of support
where interventions are provided for students whose scores place them in the yellow or
red range for any of the four domains assessed. The SSIS-PSG is criterion-referenced and
designed to measure students’ skills against grade level expectations.
446 s Assessment of Specific Problems, Competencies, and Populations

Technical Adequacy During the standardization for the SSIS Rating Scales, the SSIS-PSG
data were collected from 138 teachers in PreK through high school classrooms, which
meant that 497 students were screened. Test–retest reliability coefficients ranged from
0.53 through 0.74, with lower coefficients represented with the preschool sample. Inter-
rater reliability ranged from 0.37 to 0.72. Internal consistency was not included as this is
a criterion-referenced measure. In terms of validity evidence, the manual includes
correlations of the SSIS-PSG with the SSIS Teacher Form (comprehensive rating scale).

Feasibility During the pilot study for the SSIS-PSG, authors also surveyed teachers
about the usability of this brief measure. It takes approximately 20 minutes for a teacher
to complete the SSIS-PSG booklet and materials are available through Pearson. Users
felt that the directions and scores were easy to understand and it was easy to sort the
information gained to best determine which students might need additional instruction
or support.
Students’ scores are placed into three categories: green, yellow, or red. Students who
have a score of 1 (red) are identified as experiencing significant difficulty on that scale
and having a high level of risk. Intervention should be provided for these students. For
preschool students, a score of a 2 (yellow) indicates some level of risk, and this is indicated
by a score of a 2 or 3 (yellow) for older students. For preschool students, a score of a 3 or
4 (green) indicates an average score and a low level of risk. For elementary and secondary
students, this is indicated by a score of a 4 or 5 (green). Prevention and intervention for
students should be tied to their level of risk and difficulty that they are experiencing and
should be delivered within a multitiered model of support.

Additional Promising Tool

As universal screening efforts are gaining momentum in schools, more tools are regularly
generated. One tool that puts an interesting spin on school-wide screening is the Protective
Factor Index (PFI). The PFI is a screening tool that was developed based on Squier, Nailor,
& Carey’s (2014) review of constructs that are strongly related to academic achievement.
These constructs include Motivation, Self-Direction, Self-Knowledge, and Relationships.
The PFI is a 13-item measure that was developed collaboratively between a suburban
school district and members of the Center for School Counseling Outcome Research
and Evaluation at the University of Massachusetts Amherst. In an initial psychometric
study of this measure, confirmatory factor analyses yielded 3 (not 4) factors, which were
determined to be Academic Temperament, Self-Knowledge, and Motivation (Bass, Lee,
Wells, Carey, & Lee, 2015).
While psychometric information on the PFI is in its early stages, the potential utility
of the measure is what makes it most interesting. Through the partnership between the
school district and university, the measure was incorporated into the school district’s
standards-based report card. This meant that teachers were rating students three times
per year, when they were completing report cards. From an “implementation” perspective,
this was quite innovative, as it did not require teachers to learn a new system or do different
work than they were used to doing. They simply had replaced the behavioral domains
previously used on the report card with the PFI. Data were then also analyzed by class,
much like the SSRS-IE, to identify potential classroom concerns that could be instructional
targets.
 Universal Screening in Schools s 447

STRENGTHS AND IMPORTANCE OF SCHOOL-WIDE SCREENING

There are significantly more children in need of mental health services than those who
receive them. Multitiered systems of support is a way to decrease the magnitude of needs
through prevention. School-wide screening for social, emotional, and behavioral concerns
is a major component of implementing a multitiered system of support (Burke et al.,
2016). Systematic screening is essential for schools in order to support all students and
identify those who may need additional support or intervention (Lane et al., 2012).
Screening tools not only help to identify students in need of intervention early when
unexpected or problem behaviors occur, but they also help to identify students in need
of additional support early in their educational career (Schatschneider et al., 2014). In
addition, as the role of mental health professionals including school psychologists, is
changing from solely individual intervention to population-based prevention practices,
school-wide screening is becoming even more essential (Dever, Dowdy, Raines, &
Carnazzo, 2015).
When implementing a multitiered framework, it is important to have systematic ways
of identifying students who are in need of support at the advanced tiers. Traditionally,
teacher referral has been a common way of identifying students who need additional
support (Eklund & Dowdy, 2014). While students spend the majority of their time
in school with their teachers and teacher input is very valuable, this system alone is
insufficient. Emotional and behavioral problems are often underreported, particularly
internalizing symptoms, and a student must often display significant impairment prior
to a referral being made. In addition, teachers have different backgrounds and abilities
in terms of working with struggling students, which can lead to different rates of reporting
depending on the teacher (Eklund & Dowdy, 2014). That is, a student who is identified
by their teacher as needing additional support in one classroom would not necessarily be
a student identified in another. Office discipline referrals have also traditionally been used
for screening purposes, but they are far more effective at identifying externalizing
problems than internalizing (McIntosh, Ty, & Miller, 2014).
Through an effective system for school-wide screening, schools can place more resources
into prevention rather than crisis response (Eklund & Dowdy, 2014). It is well known
that effective prevention and early intervention can have a huge impact on social and
behavioral functioning (Burke et al., 2016; Lane et al., 2012). In addition to some of the
validated measures discussed, schools can use data collected as part of regular school
practices including report cards, curriculum based measurement, and office discipline
referrals as secondary measures to identify students in need of more support (Lane et al.,
2012). These are data that are already being collected within schools. In addition, many
screening tools are free and time efficient to use. The benefits to school-wide screening
outweigh the costs to stakeholders (Eklund & Dowdy, 2014).

IMPLEMENTATION CHALLENGES ASSOCIATED WITH

SCHOOL-WIDE SCREENING
Despite the many benefits to school-wide screening, there are also challenges associated
with the selection of appropriate measures, consistent implementation across multiple
users, and use of data to make instructional decisions. School-wide change efforts are
challenging and new practices take time to take hold. In their review of implementation
448 s Assessment of Specific Problems, Competencies, and Populations

science, Fixsen, Naoom, Blase, Friedman, & Wallace (2005) suggest that there are particular
stages that organizations move through when they adopt a new practice or initiative.
Exploration and Adoption reflects a readiness building stage in which individuals within
an organization build an awareness of their needs and explore options for a new set of
practices. In considering selection of new screening efforts, criteria for choosing tools
for screening at the universal level is not widely available (Glover & Albers, 2007). While
screening tools need to be reliable, valid, and able to measure progress (Lane et al., 2012),
research on the efficacy of universal screening is emerging for elementary and middle
schools and is minimal at the secondary school level (Chin, Dowdy, & Quirk, 2013;
Lynne, Parks, Robertson, & Carter, 2007). Professionals tasked with selecting an appro-
priate measure must sift through the technical adequacy information available on a range
of tools and consider the behavioral targets of tools to ensure that the tool chosen meets
the needs of students in the current context.
The Program Installation stage reflects all that an organization might do to build the
capacity for the implementation of a new set of practices. Schools are charged with having
to think through the best methods for effective and efficient roll out of a school-wide
screening effort. This might include consideration of the various systems needed to
support staff in their implementation. This could involve thinking through the level of
professional development that staff may need to understand the purpose and importance
of universal screening, as well as to build their self-efficacy in being able to complete
screening measures and use the data to make helpful decisions. During this phase, prac-
tices might be implemented in a limited way so that individuals can build an understand-
ing of how the new practice works. For example, a small handful of teachers may
implement screening in their classrooms to get a feel for administration and analysis.
They might observe how long the screening process takes, and consider what additional
resources may be needed to implement screening school-wide.
The Initial Implementation phase is complex, as it is a time when all are trying imple-
mentation for the first time, likely with varying levels of skill and understanding. During
this time professionals are calibrating their practices, often experiencing doubts and frus-
tration. I often describe this to schools, with whom I work, as the “awkward adolescent
phase.” In one school district in which I consult, teachers became accustomed to adminis-
tering the SAEBRS three times per year during this phase, but had not reached a place
where they knew what to do with the data and the data were not being shared back to them
in an instructionally driven way. Given that this is also a time for troubleshooting and
problem solving, the MTSS team in this school developed some procedural facilitators/
guidance documents to support their teachers in making class-wide Tier 1 observations
about the data and instructional adjustments.
The Full Operation phase occurs within a system when the adopted practice becomes
a routine “way of work.” School professionals are regularly screening their students at
established intervals and have the systems and structures developed (e.g., established
MTSS teams) to take time to look at the data, analyze what the data suggest, explore
Tier 1 instructional changes that may need to be made, and identify students with more
specific intervention needs. Once practices have been implemented with fidelity, organ-
izations then move into an Innovation phase, in which they are able to fine tune practices
and generalize practices to other conditions or situations. Fixsen et al. (2005) suggest that
innovation is different from “drift,” where practices are fading or changing in a way that was
not purposeful.
 Universal Screening in Schools s 449

Finally, the Sustainability phase is one that is about “survival” of a practice. Schools are
faced with consideration of how the practice will survive even when school priorities shift
or funding streams diminish. In these last phases, schools must consider what elements of
the screening effort have been and should continue to be institutionalized and what can
be adapted based on the current context. For example, the function of teams who engage
in data-based decision making may not change, but perhaps a new screening tool is needed
to meet the needs of the current population. Overall, the adoption, implementation and
sustainability of a new set of practices, such as school-wide screening, takes time, years
even, in order for schools to actually know the extent to which it has been an effective and
worthwhile pursuit.

CONCLUSIONS
In this chapter, we reviewed the concept of universal social–emotional screening in
schools. We framed screening as being an important effort for schools to incorporate into
their MTSS framework. Screening aims to prevent new social–emotional challenges from
developing through implementation of efficient and effective measurement that enables
targeted, population-wide instructional efforts. Screening also aims to help professionals
identify students that might benefit from additional dosages of social–emotional and
behavioral instruction, from more targeted instruction, and from increased monitoring
and behaviorally specific feedback. We reviewed a number of screening systems and tools
that are available and encourage readers to understand the variability that exists in terms
of behaviors these tools target, technical adequacy of the measures, and usability of the
measures within a school-wide implementation effort. Finally, we considered the many
benefits of universal screening as well as the significant thought and perseverance that it
takes to implement a school-wide screening effort well over time.

REVIEW AND APPLICATION QUESTIONS

1. Describe your understanding of where universal screening “fits” within a multitiered
system of support in a school system. What might be some of the specific benefits and
drawbacks to universal screening?
2. What are the practical implications of a screening measure with high sensitivity and low
specificity?
3. Compare and contrast a multiple gating system like the SSBD from a universal screening
tool like the SAEBRS? What are the pros and cons to each screening approach?
4. What is more important, the efficacy of a tool or the effectiveness/usability of a tool? Why?
5. Imagine you are a facilitator of your school’s MTSS team. Your principal charged you with
leading an effort to implement a new school-wide social–emotional screening approach
within your school. Discuss some of the steps you would take to move this effort forward.
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 INDEX

acculturation 44, 46, 66; and identity development American Counseling Association 22
38–42; recognizing extent of 57, 59 American Education Research Association
Achenbach System of Empirically Based (AERA) 35–7
Assessment (ASEBA) 82–4, 106, 107–8, 180–1; American Psychiatric Association 27
Early Childhood Rating Forms 417–19; American Psychological Association (APA) 4,
Teacher’s Report Form 133–8, 152; see also 22, 24, 25, 26, 27, 34, 34–5, 35, 35–7, 319,
Child Behavior Checklist; Youth Self Report 357, 367
Achenbach, T. M. 13, 55, 82, 83, 92, 142 analogue observation 97, 98–9, 120, 121, 123–4,
acquiescence 219 386, 395, 396
adaptive behavior 376–8, 403 Anastasi, A. 214, 215, 217, 218, 220, 233
ADHD see Attention Deficit Hyperactivity Disorder anorexia nervosa 317, 366, 367–8, 369, 373
(ADHD) antisocial behavior 272, 276, 278, 283, 285,
ADHD Conners Rating Scales 143–4; Conners 3 286, 287, 288, 291, 297–8, 299–300, 385–6,
145–7; revised 144–5 391–3, 413
ADHD Rating Scale-5 292–3 Antisocial Personality Disorder 373
ADHD Symptoms Rating Scale 132, 292 anxiety 312–14, 317–18
Adolescent Psychopathology Scale 221–2, 234, Anxiety Dimensional Observation Scale (Anx-
299 DOS) 322
affectivity: positive/negative 317–18, 333–40, 334; Archer, R. P. 162–3, 229
self-report measures 334–8 Ascione, F. R. 102
African Americans 45–7 Asher, S. R. 59–60, 192, 199
Ages and Stages Questionnaires: Social–Emotional, Asian Americans 43, 47–8; communication style
Second Edition (ASQ:SE-2) 414 164–5
aggregation principle 130, 149–50, 153 Asperger, H. 351, 356
aggressive behavior 274–5, 276, 280–1, 287, 303 Asperger’s Disorder 346, 347, 348, 350–1, 354, 356,
Agran, M. 376 372
Agras, W. S. 322 assent doctrine 24
Albers, C. A. 435 assessment: bias in 33–4, 65; culturally appropriate
Alberto, P. A. 100, 117 34–8, 43–4, 53–63; design of 18–20, 29; legal
Albin, R. W. 119 and ethical issues 22–7; multimethod,
Alessi, G. J. 96, 115 multisource design 18–20, 29; philosophical
Alvarez-Jimenez, A. 49 foundations of 11–14; as problem-solving
Ambrosini, P. J. 179 15–18; public health approach to 20–1, 29
American Association on Intellectual and Assessment of Basic Learning and Language
Developmental Disabilities (AAIDD) 376, Skills-Revised (ABLLS-R) 355–6, 370
377, 403 assumption of comparability 39, 54–5

497
498 s Index

Attention Deficit Disorders Evaluation behavior rating scales: use in assessment 133–52;
Scales (ADDES-4) 293–4 internalizing problems 323, 340; pervasive
Attention Deficit Hyperactivity Disorder (ADHD) developmental disorders 354–6; psychotic
275–6, 282–3; assessment of 291–5; and conduct disorders 363, 371; schizoid disorders 387–95,
disorder 284–5; development of 286–7, 303; 404; young children 413–22, 430
DSM Diagnostic criteria for 276–8; etiology Behavioral Avoidance Test 321
of 285–6; gender differences 36; in young behavioral covariation 85
children 408 behavioral dimensions classification 82, 83–5, 92,
attractiveness 163 408; and the ASEBA system 82–3, 84;
Autism Diagnostic Interview (ADI) 353–4 externalizing problems 273, 274–6; internalizing
Autism Diagnostic Observation Schedule (ADOS) problems 306; severe and low frequency
352–3 problems 344–5, 355, 372
Autism Spectrum Disorder 73, 345–7, 351, 356, behavioral interviews 172–82, 194–5, 295, 302
361; assessment of 352–3, 369–70, 372, 373; behavioral observation 97–8, 121–2, 123–5, 358;
description of 347–50; etiology of 349–50 basic principles and concepts 95–6; clinic-based
Autistic Disorder 347, 353, 354–5 109–10, 111, 289–91; coding procedures
Autobiography of Malcolm X (Haley) 42 100–11, 123–4; cultural diversity and 54–5;
Avon Longitudinal Study of Parents and decision-making and 122–3; and ecological
Children 408 assessment 96–7; and functional behavior
Axelson, D. 179–80 assessment 119–21; home-based 109, 111;
reliability and validity of 109–10, 112–18, 290,
Baer, D. M. 116 353, 411; scorer generalization 114;
Baker, D. B. 158, 159, 423, 424 technological advances in 111–12
Bandura, A. 5–9, 7, 289 behavioral observation: use of in assessment
Bardos, A. N. 248 97–100; externalizing problems 288–91, 302,
Barker, E. D. 408 303; internalizing problems 321–3, 340;
Barkley, R.A. 284, 285, 309 pervasive developmental disorders 347–53;
Barlow, D. H. 322 psychotic disorders 363; schizoid disorders
Barnett, D. W. 12 358; social skills 382–6, 404; young children
Barnett, J. 251 411–13, 430
Barrios, B. A. 309, 313, 321 behaviorism 4–5, 28, 96, 215
Barton, E. J. 102 BehaviorSnap 111–12
BASC Flex Monitor 445 Belcher, R. 371
Beauchaine, T. P. 309 Bell-Dolan, D. J. 206
Beaver, B. R. 174, 175 Bellak, L. 240
Beck, A. T. 312 Ben-Porath, Y. S. 229
Beery, C. R. 192 Bender Gestalt Test 256–60, 266, 268
Behavior and Emotional Rating Scale 400 Bender, L. 257
Behavior Assessment for Children, 3rd Edition Berg, I. A. 220
(BASC-3) 221, 234,; Flex Monitor 142, 445; Berkeley Puppet Interview (BPI) 427–8, 430
self-report for adolescents 223, 225–6, 299; Berman, A. L. 182
self-report for children 223, 225–6, 299; Berneuter Personality Inventory 214, 234
Structured Development History Form 171 bias: cultural 56; in observation 117–18; test and
Behavior Assessment for Children, 3rd Edition: assessment 33–8
Behavioral and Emotional Screening System Bierman, K. L. 158
(BASC-3: BESS) 444–5; Flex Monitor 445 Binge Eating Disorder 366, 368–9, 373
behavior coding system 106, 108–9 Birmaher, B. 180
Behavior Intervention Monitoring Assessment Birnbaum, A. 312
System (BIMAS) 442–5 Blase, K. A. 448
behavior rating scales 127–33, 152–3, 280, 291–5, “Bobo Doll” experiments 5
302, 303; advantages and problems associated Boggs, S. R. 396
with 128–30, 152; best practice 149–50, 153; Boliek, C. A. 241, 242, 243, 245
versus checklists 128; cultural diversity and Bonney, M. E. 193
54–5; decision-making and 150–3, 153; Borg, W. R. 131
definition and foundations of 127–8; BOSS (Behavioral Observation of Students in
measurement and technical issues 131–3; Schools) 108, 112
reliability and validity of 128, 131–2, 136–7, Boulton, D. 344
141–2, 147–8, 355, 392, 393 Bower, E. 204
 Index s 499

Bower, E. M. 80 ClassMaps 200–1

Bracken, B. A. 334, 407 Clinical Assessment of Behavior (CAB) 298
Brannigan, G. G. 256 clinical interviews 155–6, 168–72, 188; cultural
Brehm, K. 200 diversity and 57–60; decision-making and
Breslau, N. 365 187–8; developmental issues 157–63; factors
Brief Problem Monitor 137 affecting quality of 163–8; lying in 166–7;
Briggs-Gowan, M. J. 322 reliability and validity of 157, 180, 181;
Brock, S. E. 182 structured and semi-structured 179–82, 189;
Bronfenbrenner, U. 9, 169 suicidal behavior and 182–7; traditional
Brown, F. G. 216 techniques 169–72, 173–4, 188
bulimia nervosa 366, 367, 368, 369, 373 clinical interviews: use of in assessment 156–7;
Bullock, M. J. 424–5 eating disorders 369; externalizing problems
Burns, R. 252, 253, 254, 260 295–8; internalizing problems 324–5; pervasive
Busse, R. T. 174, 175 developmental disorders 353–4; psychotic
Butcher, J. N. 229 disorders 364; schizoid disorders 358; social
skills 395–7, 404; tic disorders 360; young
Caldarella, P. 379 children 422–4, 430
Campbell, S. B. 285 Coders Impression Measure (CI) 109–10
Cantor, S. 361 cognitive behavior therapy 4
Cantwell, D. P. 309 cognitive development 159–60, 188, 190, 247, 251,
capabilities 6 351; formal operations stage 161
Caregiver-Teacher Report Form 417–19 Cohen, E. 111
Carey, J. C. 446 Cohen, P. 364
Carjuzza, J. 32 Coie, J. D. 194, 195, 199, 206
Carr, E. G. 119 Cole, C. L. 100
Carroll, B. J. 325 comparability 36, 39, 54
Carter, A. 350 Compas, B. E. 309, 312
Carter, A. S. 322 Conduct Disorder 79, 90, 145, 180, 274–5, 287, 288,
Centers for Disease Control 183 303, 372; comorbidity 281–2, 284–5; DSM
Chambers, W. 180 diagnostic criteria for 276, 278–82, 283, 284;
Chandler, L. A. 247 etiology of 285–6; prevalence of 284; young
Chick, J. 357 children 287, 295, 408
Child Behavior Checklist (CBCL) 55, 82–3, 133–8, conduct problems 283, 298, 303; development of
153, 297, 315, 358, 417, 441; Language 287–8; etiology of 285–6
Development Survey 418; Thought Problems Cone, J. D. 114, 151
Scale 363 confidentiality 26–7
Childhood Autism Ratings Scale 354–5 Conners 3 143–4, 145–9, 291, 294, 299
Childhood Disintegrative Disorder 346, 347, 351–2 Conners 3 ADHD Index 292, 294
childhood psychoses 344 Conners 3 Adolescent Self-Report Scale 225
Children’s Apperception Test (CAT) 243, 268 Conners 3 Child Self-Report Scale 225
Children’s Depression Inventory (CDI) 63, 145, Conners 3 Comprehensive Behavior Ratings
327–9 Scale Self-Report 230–1
Children’s Depression Inventory-2 (CDI-2) 327–9 Conners 3 Self-Report 221, 229–30, 234, 235
Children’s Depression Rating Scale 325 Conners ADHD Index 294
Children’s Interview for Psychiatric Syndromes 182 Conners Comprehensive Behavior Rating Scales
Child’s Game/Parent’s Game 110 143–4, 148, 299
Christopher, J. S. 206 Conners Global Index 144
Clark, M. L. 60 Conners, K. 143, 145, 146
Class Play 197–8, 204, 210, 298 Conners Rating Scales 143–9, 152, 153
classification 69–70, 91–3; classification error 70–1; Connolly, J. A. 201
current systems 71–85; differential diagnosis Cook, K. 255
and 70–1; low-frequency problems 344–5; Cook, S. C. 325
multiple gating approaches to 85–9, 92, 93, 151; Cooper, D. H. 193
reasons for 70; stigmatizing effects 91; use of Cooper, J. O. 100
term 69; young children 408–11, 429, 430; see Coopersmith Self-Esteem Inventory 320
also behavioral dimensions classification; Coppotelli, H. 194, 195
Diagnostic and Statistical Manual for Mental coprolalia 359
Disorders (DSM) classification Cormier, L. S. 163
500 s Index

Cormier, S. 163 Disruptive Mood Dysregulation Disorder 311

Cormier, W. H. 163 Docherty, E. M. 15
Costello, A. J. 297 Dodge, K. A. 194, 195
Cowen, E. L. 195–6, 209, 381 Doll, B. 121, 200, 412
Cronbach, L. J. 85, 147, 214 Draw-A-Person technique 247–52, 260, 261, 268;
Crone, D. A. 119 DAP:SPED 248, 249, 250, 251
cultural diversity 31–52; assessment methods drawing techniques 246–61, 266, 268
52–63 DuPaul, G. J. 282, 295
cultural identity, development of 40–2 duration recording 106, 112
Cummings, J. A. 246, 250–1, 251, 254, 255 Durbin, D. 312
Curtin, S. C. 183 dyadic parent-child coding system 289–91
Cushing, L. S. 383
Early Atypical Autism Spectrum Disorder 411
Dana, R. H. 31–2, 37–8, 39, 40, 56, 61, 62–3 Early Childhood ratings Forms of the ASEBA
Darnell, A. J. 49 System 417–19
data-oriented problem solving 16–18 Early Screening Project 436, 438–9; Social Behavior
Davis, C. J. 175, 176 Observations 412–13
Davis, J. M. 182 eating disorders 317, 366–9, 371, 373
Decker, S. L. 256 Eating Disorders Inventory-3 (ED1-3) 369, 373
delinquent behavior, subtypes of 83–4 Eckert, T. L. 213
DeMers, S. T. 22, 27 ecological assessment 96–7, 123
Denham, S. A. 381 ecological systems theory 9–11, 14, 28
Deno, S. L. 16, 17 Edelbrock, C. S. 55, 297
depression 309–12, 318; assessment of 326, 327–9; Edwards, G. L. 328
behavioral observation and 321, 322; causes of ego psychology 240
312; learned helplessness model 312; as Elliott, S. N. 121, 377, 382–3, 395, 412
self-concept 319, 340; use of term 309 emotional development 162–3
Deutsch, C. K. 285 emotional skills 381–401
deviation 220 emotionally disturbed: definition 77–9, 80–1; or
Devereux Early Childhood Assessments 415–16 socially maladjusted 79–80, 92
Devereux Student Strengths Assessment (DESSA) empirical approach to assessment 13–14
394–5 empirical criterion keying 218–19, 227, 234,
Dewry, D. L. 60 315
diagnosis, use of term 69 Engels, R. C. 441
Diagnostic and Statistical Manual for Mental Erbacher, T. A. 182
Disorders (DSM) classification 71–4, 92–3, Erikson, E. 160, 162
276–82, 303, 345, 408, 429; and ADHD error variance 129–30, 152, 219–20, 234
276–8; and Autism Spectrum Disorder 346, Ervin, R. A. 16
347–8, 350–1; diagnostic decisions 187; Estes, A. M. 284, 285
eating disorders 368; improvements and Esveldt-Dawson, K. 322
changes to 74–6, 346, 349; and internalizing Ethical Principles of Psychologists and Code of
problems 306–7, 309, 310, 313–14, 316–17; Conduct (APA) 34
and interviewing adolescents 162–3; ethics 23–7, 66, 267; and culturally appropriate
psychotic disorders 360, 361; schizoid disorders assessment 34–7; sociometrics and 205–8,
356, 372; severe and low frequency problems 209
345–7, 372; and Social Communication ethnicity 43, 164–5; language problems 77; suicidal
Disorder 349 behavior 183
Diagnostic Classification 0-3 409–11 event recording 101–3, 107–8, 109, 117
Diagnostic Classification 0-3 Revised 430 exosystem 10
Diagnostic Classification 0-5 430 expertness 163
Diagnostic Interview Schedule for Children 182, externalizing problems 81, 82, 135, 202,
296–7, 324, 364 273–83; comorbidity 284–5; developmental
differential diagnosis 70–1, 91, 282, 357, 373, 374 course and prognosis 286–8; etiology and
DiPerna, J. C. 106 development 285–6; interviewing techniques
direct behavioral observation 412–13 295–301; linking assessment to intervention
direct behavior ratings (DBR) 123, 412 302–3; methods of assessment 288–95;
Direct Observation Form 107–8 prevalence of 284
Dishion, T. J. 86 Eyberg, S. M. 289, 290, 396
 Index s 501

factor analytic approach 217–18, 234 Hamilton, C. 207, 210

faking 220 Hamilton Rating Scale for Depression 325
Family Centered-Circle drawings 260 Hammer, E. F. 246
family drawings 252–5 Handler, L. 252, 254–5, 256
Family Educational Rights and Privacy Act Hare Psychopathology Checklist - Youth Version
(FERPA) 23, 26 (PCL-YV) 297
Family Interaction Code 107, 109 Harris, A. M. 108, 251
Fan, X. 55 Hart, D. H. 263
fears 313, 316 Hart Sentence Completion Test for Children 264,
Feil, E. G. 383 268
Finch, A. J. 328 Harter, S. 319, 320, 334, 427
Findling, R. L. 283 Hartmann, D. P. 256, 309, 313, 321
Fine, G. A. 192 Hartup, W. W. 381
Fischer, P. 182 Hawken, L. S. 119
Fixsen, D. L. 448 Hawkins, R. P. 90
Ford, Richard Thompson 44 Hayden-Thompson, L. 195
Forehand, R. 288, 291, 295 Hayes, S. C. 151
Foster, S. L. 206 Haynes, S. N. 173
Fowler, R. D. 229 Hayvren, M. 206
Frank, L. K. 238 Hedegaard, H. 183
Frick, P. J. 282, 285, 288 Henker, B. 285
Friedman, R. M. 448 Hepworth, D. H. 39
friendship 192–3 Hernstein, R. J. 31
Fuchs, D. 207 Heron, T. E. 100
Fuchs, L. S. 207 Heward, W. L. 100
Functional Assessment Checklist for Students 178 Hinshaw, S. P. 309
Functional Assessment Checklist for Teachers Hintze, J. M. 106, 113, 121–2
and Staff 176 Hispanic Americans 48–9, 61; communication
functional behavior assessment (FBA) 119–21, style 165
124, 370, 371; of externalizing problems 338; of Hoffman, J. A. 284
internalizing problems 323 Hoier, T. S. 151
Hojnoski, R. L. 240, 247
Gajzago, C. 344 Holland, M. L. 132, 282
Garland, A. 182 Home and Community Social Behavior Scales 291,
Gatlin, D. 60 324, 389–93
Gender Dysphoria 27 homosexuality 27
Gesten, E. L. 380 Hood, A. B. 62
Gill, M. K. 180 Horner, R. 383
Gilliam Autism Rating Scale 355 Horner, R. H. 16, 119
Gilman, R. 336 House-Tree-Person drawing technique 252, 260
Gimpel, G. A. 16, 132 Howell, C. T. 13
Ginsburg, G. S. 309, 313, 314, 333 Howlin, P. 347, 350
Gladstone, T. R. G. 309 Hoza, B. 206
Gleser, G. C. 85 Huebner, E. S. 336
Glover, T. A. 435 Hughes, E. K. 318
Goldberg, L. R. 217 Hughes, J. N. 158, 159, 423, 424
Goodenough, F. L. 251 Hulse, W. 252
Goodstein, L. D. 217 humanistic psychology 163, 168, 215
Gould, M. 182 humanistic theory 5, 28, 239, 247
Gray, S. W. 16 Hymel, S. 192, 195, 206
Gregory, R. J. 217, 238, 240, 245, 263
Gresham, F. M. 175, 176, 195, 377, 382–3, 395, 396 ICD-10 74, 353
Gross, A. M. 172, 175 identity development 38–42
“guess who” measures 203–5, 210, 298, 371 identity versus confusion 162
Gullone, E. 318 idiographic/nomothetic approach 12–13, 29
Individual Education Plans 402–3
Habenicht, D. 252, 254–5, 256 Individuals with Disabilities Education
Hall, G. S. 162 Improvement Act (IDEIA) 22, 23–4, 23–5, 92,
502 s Index

123, 138, 145, 149; assessment guidelines 76–7; Kelly, E. J. 79

definition of “emotionally disturbed” 77–9, Keystone Behavior Strategy 151, 302, 402
80–1 Kilgus, S. P. 442
intellectual disabilities 348, 354, 376, 377, 403 Kimonis E. R. 285
interactional/transformational model of kindling hypothesis 312
development 7, 11, 316, 350 Kinetic Family Drawing technique (KFD) 252–5,
internalizing problems 305–6, 339; assessment 268
methods 320–38, 340; behavioral dimensions Kinetic School Drawing 255–6
classification 306; DSM classification 306–7, Kinsbourne, M. 285
309, 310, 313–14, 316–17; gender issues in Kistner, J. 60
prevalence 308; linking assessment to Kiuru, N. 208
intervention 338–9, 340; positive and negative Kline, A. 217
effect and 317–18, 339–41; prevalence of 307–8; Knoff, H. M. 14, 253, 255
and self-concept 318–20, 340; symptoms of Kohlberg, L. 159, 161
308–17, 340 Koppits-2 Developmental Scoring System for the
Internalizing Symptoms Scale for Children (ISSC) Bender Gestalt Test (K2-BG) 256
62, 400 Koppitz, E. M. 249, 251, 256, 257, 259, 260, 268
interval recording 100, 103–7, 108, 112, 124 Kraepelin E. 214
interventions 18, 150, 151, 153, 371; assessment Krishnamurthy, R. 229
linked to 119, 302–3, 338–9, 369–71, Kumabe, K. T. 39
401–3, 416; responsiveness to 20–2, 122–3, Kuperminc, G. P. 49
137, 433
interview behavior 165–6 La Greca, A. M. 156
Interview Schedule for Children 182, 296, 364 Landau, S. 194, 195, 202, 206, 207
interviewing see behavioral interviews; clinical Lane, K. L. 435
interviews Language Development Survey 418
introversion 356 language skills 46, 49, 77
Ironsmith, M. 424–5 Lanyon, R. I. 217
Iverson, A. M. 206 latency recording 100, 106, 124
Iverson, G. L. 206 Laughlin, J. E. 336
Lawler, E. E. 325
Jackson, R. L. 116 legal constraints 22–7
Janssens, J. M. 441 Lewinsohn, P. 312
Jee, S. 414–15 Lewis, M. 309
Jenkins, L. N. 435 Lewis, S. 364
Jensen, P. S. 91 liberty 23
Jesness Inventory-Revised 300–1 Lilly, S. J. 252
Jobes, D. A. 182 Loeber, R. 86
Johnson, R. 180 Loevinger, J. 264
Johnson, R. W. 62 Lord, C. 352
Johnson, V. J. 247 Lubin, B., 240
Joiner, T. E., Jr. 251
Jones, R. R. 97 Mace, F. C. 119
Machover, K. 249
Kagan, J. 315 macrosystem 10
Kahn R. E. 283 Malcom, K. K. 407
Kalberg, J. R. 435 Mangold, J. 254
Kamphaus, R. W. 376 Marsh, H. 335
Kane, J. S. 325 Marsh, H. W. 320
Kanner, L. 347, 349 Marshall, H. 203, 398
Kapes, J. T. 55 Martin, B. 284
Kaplan, R. 217 Martin, E. 195
Kaslow, N. J. 309 Martin, R. P. 129, 156, 216, 219, 220, 261
Kauffman, J. M. 7, 70, 80, 180, 314, 315, 370, 371 Mash, E. J. 309
Kaufman, S. 252, 253 Masten, A. S. 204
Kaye, J. H. 115 Mathews, W. J. 121–2
Kazdin, A. E. 116, 280, 321, 322 mature minor doctrine 24–5, 26, 27
Keller, H. R. 96 Maughan, B. 408
 Index s 503

Mayer, G. R. 96, 100 Native Americans 49–51, 62; behavior rating scales
Mayeux, L. 206 54–5; parenting 50
McAndless, B. 203, 398 naturalistic observation 97–8, 99, 121, 123–4
McCammon, E. P. 261 Nelson, R. O. 151
McComas, J. J. 119 Nezu, A. M. 16
McConaughy, S. H. 13, 155, 166, 167, 182 Nigg, J. T. 284
McConnell, S. R. 207, 298, 326, 365 Nishida, C. 39
McFall,, R. M. 378 Noemi, S. 364
McMahon, R. J. 284, 285, 288, 291, 295
McNeil, C. B. 90 Oakes, W. P. 435
McNeish, T. J. 248 obesity 315–16, 368
McReynolds, P. 214 objective self-report tests 217–19, 234; response
Meehl, P. 12 bias and error variance 219–20
Mental Health Assessment Form 182 Obrzut, J. E. 241, 242, 243, 245
Menzies, H. M. 435 !Observe 112
Merenda, P. F. 142 observation see behavioral observation
Merrell, K. W. 16, 80, 132, 185, 260, 264, 309, 375, observational learning 5, 7–9
377, 379 observer reactivity 53, 115–16
mesosystem 9–10 observer training 114
Metzler, A. 60 obsessive-compulsive disorder 134, 148, 306,
Mian, N. D. 322 316–17, 323, 359, 364–5
microsystem 9 O’Connor, P. 364
Oden, S. L. 199
Milich, R. 194, 195, 202, 206, 207
Odom, S. L. 207, 298, 326, 365
Miller, D. N. 182
Olweus, D. 287
Miller, J. A. 120
O’Neill, R. E. 119
Miller, S. M. 309, 312
Oppositional Defiant Disorder (ODD) 90, 135, 145;
Minnesota Multiphasic Personality Inventory
DSM diagnostic criteria for 74–5, 276, 281–2
- Adolescent-Restructured Form (MMPI-A-RF) Oregon Social Learning Center 7, 85, 86, 87, 98,
219, 220, 221, 226–8, 229 286, 287
Minnesota Multiphasic Personality Inventory Orth, U. 319
- Adolescent Version (MMPI-A) 219, 221, Orvaschel, H. 180
226–8, 299–300; and cultural diversity 61–2; Otten, R. 441
neurotic triad 315; psychotic disorders 365–6; Overactivity Disorder of Toddlerhood 411
reliability and validity of 225, 229, 232, 233, 300; Ozonoff, S. 350
schizoid disorders 358, 373
Minnesota Multiphasic Personality Inventory Paget, K. D. 329
(MMPI) 61–2, 163, 215, 219, 226–7, 229, Patterson, G. R. 97, 285
233, 234 Patterson, G.R. 7
Moreno, J. L. 193, 197 Pattillo-McCoy, M. 47
Morris, T. L. 90 Peach, L. 182
Morrison, P. 204 Peer Nomination Inventory for Depression 326
Multicultural Supplement to the Manual for the peer nomination procedures 197–9, 207, 209, 326,
ASEBA School-Age Forms and Profile 134 398, 404, 425; cultural diversity and 59–60
Multidimensional Self-Concept Scale 334–5 peer rating procedures 199–201, 209–10, 398, 399,
multiple gating 85–9, 92, 93, 151 404, 425
Murray, C. 31 peer relations 377, 403; assessment of 395–6, 397–9;
Murray, H. A. 240, 241, 242 see also social skills
Mustillo, S. 316 Peer Social Behavior Code 383–5
Pelligrini, D. S. 204
Naglieri, J. A. 248, 249, 250, 251 Perry, D. 344
Nailor, P. 446 Personal Data Sheet 214, 234
Naoom, S. F. 448 personality assessment 213, 241; historical
Narrative Elaboration 423 foundations of 214–15, 234; validity of 216–17;
National Association of School Psychologists see also projective-expressive assessment
(NASP) 25, 35 Personality Inventory for Youth 62
National Council on Measurement In Education pervasive developmental disorders 370, 372
(NCME) 35–7 philosophical foundations 11–14
504 s Index

phobias 313, 316, 321 Reynolds Adolescent Depression Scale 205

Piaget, J. 159, 160, 161 Reynolds, C. R. 329
Pictorial Scale of Perceived Competence and Reynolds Child Depression Scales 330–1, 331–2
Acceptance for Young Children 426–7, 430 Reynolds, W. M. 184, 308, 309
picture boards 398–9 Reznick, J. S. 315
picture sociometrics 202–4, 425 Rhodes, R. L. 38–9, 54, 56
Piers-Harris Children’s Self-Concept Scale 320 Risi, S. 60
Piersel, W. C. 316 Risser, S. D. 206
Pilkington, C. L. 316 Roberts Apperception Test for Children 243–5, 268
Pine, D. S. 322 Roberts, H. 207
Pipe, M. E. 161 Robins, L. N. 317
Poland, S. 182 Robinson, E. A. 289, 290
Post, R. M. 312 Robinson-Wood, T. 46
post-traumatic stress 134 Roff, M. 196, 209, 298
Poteat, G. M. 424–5 Rogers, C. 96
Poznanski, E. O. 325 Rogers-Warren, A. K. 97
Preschool and Kindergarten Behavior Scales 387, role-playing 396–7, 404
419–21 Rorschach inkblot test 238
Priestley, G. 161 roster rating 199–201
Principles for Professional Ethics 25, 35 Rotter Incomplete Sentences Blank 262, 263
Prior, M. 344 Rousseau, J.-J. 162
privacy 23, 26–7, 29 Rozenblat, R. 111
Problem Guidesheet 295 RtI (response to intervention) 20–2, 122–3, 137,
problem identification interview 175–7 233, 402, 433
projective-expressive assessment 237–40, 382, 411; Rubin, K. H. 195
best practices 265–7; cultural diversity and 62–3; Rudolph, L. B. 163–4, 168
drawing techniques 246–61, 268; reliability/ Ruff, W. G. 32
validity of 245, 250–1, 254–5, 259–60, 263–4; Rutter, M. 347
sentence completion tasks 261–5, 268; thematic
approaches 240–5, 267–8 Saccuzzo, D. 217
projective hypothesis 238–9 Sallee, F. R. 359
Protective Factor Index (PFI) 446 Salmivalli, C. 208
Prout, H. T. 253, 255 Sandoval, J. 182
psychodynamic theory 5, 239 Sarbaugh, M. E. 255
psychotic disorders 343, 344–5, 360–6; in children Sattler, J. M. 39, 49, 57–8, 59, 155, 182
371, 372, 373, 374; interventions 371 Saylor, C. F. 328
public health approaches 20–2, 29 Schedule for Affective Disorders and Schizophrenia
Puig-Antich, J. 180 for School-Age Children (K-SADS) 179–80,
189, 364
Quay, H. 82, 83, 92, 274, 275, 276, 278, 287, 303, schizoid disorders 356–8, 370, 372; interventions
306, 317, 344–5, 356, 372, 379, 380 371
schizoid-unresponsive syndrome 344, 356, 358, 371
race 43 schizophrenia 84, 357, 360–6, 371, 372, 373;
Rancurello, M. D. 322 assessment 363–6
rank-ordering 202–3 Schmidt, K. L. 251
rational-theoretical approach 217, 234 Schneider, K. C. 15
reciprocal determinism 6–7, 286, 289 School Archival Records Search (SARS) 89
Reddick, T. L. 182 school phobia 316
referrals 14–15, 429 School Social Behavior Scales 291, 324, 389–93,
Reid, J. B. 87, 97, 108 403, 404, 420
Reschly, D. J. 240, 265–6, 376, 377 Schwartz, J. A. 309, 312
response bias 152; behavior rating scales 129–30; scorer generalization 114
self-report tests 219–20, 234 Scotti, J. R. 90
responsive assessment 38 self-concept: gender differences 319, 337;
Rett’s Disorder 351, 372 internalizing problems 318–20, 340; self-report
Revised Children’s Manifest Anxiety Scale instruments 334–8; young children 426
(RCMAS) 62, 329–30 Self-Descriptive Questionnaires 335–6
Revised PRIME Guess Who Measure 205 self-monitoring 99–100, 123, 124, 322–3
 Index s 505

Self-Perception Profile for Adolescents 337–8 social skills 375, 376–7, 378, 403, 405; assessment of
Self-Perception Profile for Children 336–7 382–401; dimensions of 378–81; importance of
self-report assessment 220–32, 234; cultural 381–2; linking assessment to intervention
diversity and 60–2; and decision-making 233, 401–3; reliability and validity of 386, 389, 392,
234–5; development of 217–19; of eating 396, 401; young children 412, 419–20, 421–2
disorders 370; of externalizing problems Social Skills Improvement System (SSIS) 324,
298–301, 302, 304; foundations of 214–17; of 421–2; Parent and Teacher Forms 387–98;
internalizing problems 326–32, 340; and Performance Screening Guide 445–6
multidimensional self-concept 332–8; of social skills training 150, 370, 401, 403, 405
psychotic disorders 365–6; reliability and social status 191, 192–3, 194–5, 197–200, 203–4
validity of 223, 225–6, 229, 230, 231, 232, 234, social withdrawal 315, 324, 326
301, 302, 304, 329–30, 332, 335, 336; response socialized aggressive conduct disorder 274–5
bias and error variance 219–20, 234; of social sociometric ranking procedures 201–4
skills 399–401; social skills 404; of young sociometric techniques 191–205, 196–205, 209–10;
children 234, 425–9, 430 cultural diversity and 59–60; and decision-
Seligman, M. 312, 319 making 208–9; ethical concerns 205–8, 210;
Semistructured Clinical Interview for Children reliability and validity of 194–6, 200–1, 203–4,
and Adolescents (SCICA) 180–1, 180–2, 210; sociometric techniques: use in assessment
189 197–205; externalizing problems 298–9, 303;
sentence completion tasks 261–5, 268 internalizing problems 325–6, 340; psychotic
Sentse, M. 208 disorders 365; social skills 397–9, 404; young
Separation Anxiety Disorder 308, 313–14, 316 children 424–5, 430
setting variance 130 somatic problems 315–16
Severson, H. H. 202, 383 Sowislo, J. F. 319
Shaffer, D. 182 special education classification 21–2, 69–70, 82,
Shapiro, E. S. 100, 106, 112, 151, 371, 402 88–9, 115, 187
Sheffield, J. R. 205 Speilberger, C. D. 333
Sigman, M. D. 350 Sprague, J. R. 119
Sikora, D. M. 206 Spratt, E. G. 359
Silverman, W. K. 309, 313, 314, 333 Squire, K. 446
Singer, J. B. 182 Squires, J. 415
Singleton, L. C. 59–60 standardization fallacy 55
situational specificity 53, 116, 121, 123, 124, 130, Standards for Educational and Psychological Testing
428 35–6, 54, 55
Skinner, B. F. 4, 123 Stark, K. 255
Slenkovitch, J. 79 State-Trait Anxiety Inventory for Children 332–3
Sloves, R. E. 15 Steege, M. 119
Smith, M. D. 371 Stickle, T. R. 283
Snidman, N. 315 Stokes, T. F. 116
Social, Academic, and Emotional Risk Behavior Stone, L. L. 441
Screener (SAEBRS) 441–2 Stoner, G. 295
social cognitive theory 4, 5–9, 11, 28, 114–15 Storey, K. 119
Social Communication Disorder 349 Strengths and Difficulties Questionnaire (SDQ)
social competence 375–6, 403; theoretical model of 440–1
377–8 Stuart, D. 195
social desirability response 220 Student Interaction Specific Settings Tool 383
Social Emotional Assessment Measure 415 Student Life Satisfaction Scale 401
social-emotional assessment with young children Student Risk Screening Scale Internalizing and
408–9, 408–11, 411–28, 429–30; alternative Externalizing (SRSS-IE) 439–40
classification 408–11; best practices 428–9; Sue, D. 41, 42, 47, 164, 165
methods of assessment 411–28 Sue, D. W. 41, 42, 47, 164, 165
Social Emotional Assets and Resilience Scale-Child Sugai, G. 16
and Adolescent Forms 400–1 suicidal behavior 182–4; clinical interviews and
Social Emotional Assets and Resilience Scale- 184–7, 189; Native Americans 51
Teachers and Parent Forms 393–4 suicidal ideation 182–4; adolescents 162
Social Interaction Coding System 109 Sulzer-Azaroff, B. 96, 100
social learning theory 96, 316 summary judgments 127
social maladjustment 79–80, 92 Symptom Scale 363–4
506 s Index

syndrome, use of term 309 Veldman, D. J. 205

Systematic Screening for Behavior Disorders Velez, C. 364
(SSBD) 87–9, 202, 383, 385 Vermulst, A. A. 441
Systematic Screening for Behavior Disorders, Voice DISC 297
second edition (SSBD-2) 435–6, 438, 439 Volpe, R. J. 106

Tabrizi, M. A. 180 Wahler, R. G. 116

Target/Peer Interaction Code 385–6 Wakschlag, L. S. 322
Tartakovsky, E. 39 Walker, H. M. 80, 202, 383
taxonomy 344–5; use of term 69 Walker-McConnell Scales of Social Competence
Teacher Behavior Code 111 and School Adjustment 324, 392
Teacher’s Report Form 133–8, 152, 291, 358, Wallace, F. 448
392 Walser, T. M. 16
Teaching Pyramid Model 428 Warner, M. 183
Teaching Pyramid Observation Tool 428 Washington University Sentence Completion
Teglasi, H. 241, 242 Test 264–5, 268
Tellegen, A. 317–18 Watkins, C. E. 240
template matching strategy 371 Watson, D. 317–18
Tharinger, D. 255 Watson, S. D. 318
Thematic Apperception Test 63, 241–3, 267–8 Watson. T. S. 119
theoretical foundations 3–11, 29 Wehmeyer, M. L. 376
Theory of Psychology Journal 12 Werry, J. S. 285, 317
Thompson, C. L. 163–4, 168 Whalen, C. K. 285
Thought Problems Scale 363, 365 White, K. R. 131
tic disorders 358–60, 369 white majority culture 51, 52, 56
time-sample recording 105 Williams, C. L. 229
Tolbert, H. A. 361, 362 Williams, J. G. 322
Tourette’s Disorder 105, 358–60, 372, 373–4; Wilson, C. C. 173
assessment 359–60, 370; children 370; Wilson, M. S. 240, 265–6
interventions 370, 373–4 Wilson, V. T. 55
Tourette’s Syndrome Questionnaire 360 Windelband, W. 12
Tourette’s Syndrome Symptom Checklist 360 Wolf, S. 351, 357
Trautman, P. 182 Worchel, F. F. 244
Travis, L. L. 350 Worthen, B. R. 131, 197
triadic reciprocity 5, 6–8
triangle of support model 20–2, 29 Yale Global Tic Severity Scale 360
Troutman, A. C. 100, 117 young children: alternative classification 408–11;
trustworthiness 163 best practices 428–9; methods of assessment
411–28; social emotional assessment 408–11,
Ullman, C. A. 196, 209 429–30
undersocialized aggressive conduct disorder 274, Young, G. S. 350
280, 281, 303 Young, L. L. 193
Underwood, M. K. 206 Youngstrom, E. 283
Unis, A. S. 322 Youngstrom, J. K. 283
Urbina, S. 214, 215, 217, 218, 233 Youth Self Report 231–2, 299, 315, 365
U.S. Census Bureau 43, 45, 48, 49, 50, 51, 64 Yule, W. 350
U.S. Constitution 22, 26, 29
Zelazny, J. 180
validity of assessment 54–5, 77, 194–6, 215 ZERO TO THREE 409
Vasquez-Nuttall, E. 164, 165 Zucker, K. B. 12
Veenstra, R. 208 Zucker, S. 200