Measuring Treatment Outcome for Children with Serious Emotional Disturbances: Discriminant Validity and Clinical Significance of the Child and Adolescent Functioning Assessment Scale

We investigated the use of a popular measure, the Children and Adolescent Functional Assessment Scale (CAFAS), in treatment outcome research. The sample included 70 children who had been discharged from an elementary therapeutic classroom (Intensive Mental Health Program). Significant relationships were found between decreases in CAFAS scores and optimal educational placement, contributing to evidence of the scale’s discriminant validity. Clinically significant change in CAFAS scores was also investigated, with a 30 point change in score most accurately discriminating between placements after discharge. Further investigations of real world outcomes versus changes in score on this measure are warranted.     

Evaluating Cognitive Training Outcomes: Validity and Utility of Structural Knowledge Assessment

Conventional approaches to evaluating cognitive outcomes of training typically use paper-and-pencil tests that emphasize gains or differences in declarative knowledge. Yet a key factor in differentiating expert and novice performance is the way individuals organize their knowledge. Accordingly, the acquisition of meaningful knowledge structures and methods of assessing structural knowledge are potentially important issues for designing and evaluating training programs. Two studies were conducted to examine the validity and utility of one structural assessment technique called Pathfinder (Schvaneveldt, Durso, & Dearholt, 1989). Results from academic and organizational samples indicated that Pathfinder measures of structural knowledge quality predicted individual differences in performance self-efficacy. After controlling for differences in declarative knowledge, measures of structural knowledge quality added to the prediction of performance self-efficacy in the student sample, but not in the organizational sample. The unique features and potential advantages of structural assessment for training evaluation are discussed.     

A New Self-Report Scale for Assessment of Adolescent Psychopathology: Factor Structure, Reliability, Validity, and Diagnostic Sensitivity

This paper describes four studies on self-reported problems in 2,243 adolescent males and females, 12 to 17 years of age. In Study 1, principal-axis factoring of 102 items covering 11 problem domains revealed six factors comprising 49.5% of the variance. Study 2 used confirmatory factor analysis of a 64-item reduced set on a new sample of 408 adolescents. Goodness-of-fit indicators suggested that the six-factor model had excellent fit to the data. Study 3 used data from the 2,157 adolescents used in the first two studies. Coefficient alphas ranged from .83 to .92. Median test-retest reliability for the six factors was .86. There was a consistent structure of the correlation matrix across age and gender. Study 4 was a study of criterion validity, using an additional sample of 86 children with attention-deficit hyperactivity disorder (ADHD). Sensitivity and specificity were high, with an overall diagnostic efficiency of 83%. This new self-report scale, the Conners/Wells Adolescent Self-Report of Symptoms (CASS), may provide a useful component of a multimodal assessment of adolescent psychopathology.     

The Child and Adolescent Functional Assessment Scale (CAFAS): Review and Current Status

Measures of impairment in psychological and behavioral functioning have a long history in the field of children's mental health, and appear particularly useful in eligibility determination, treatment planning, and outcome evaluation of services for children and adolescents with serious emotional disturbance (SED). One recently developed multidimensional measure of functional impairment—the Child and Adolescent Functional Assessment Scale (CAFAS; K. Hodges, 1989, 1997)—has enjoyed widespread use nationwide. It has been adopted as a tool for making treatment eligibility decisions and documenting outcomes on a statewide level in more than 20 states and on a local level in dozens of research and demonstration projects. In this paper, the technical merits of the CAFAS are closely examined, with the conclusion that empirical evidence is lacking to support its valid use in making the types of treatment decisions for which it is currently being employed across the nation. Furthermore, there appears to be little concern among mental health researchers, practitioners, administrators, and state legislators about these apparent limitations of the CAFAS. The potential benefits of establishing objective and valid level-of-need criteria, using the CAFAS are numerous and the interest in doing so is clear; however, the psychometric limitations of the scale identified in this review need to be addressed before its full potential can be realized.     

Clinical Validity of a Dimensional Assessment of Self- and Interpersonal Functioning in Adolescent Inpatients

The Social Cognition and Object Relations Scale–Global Version (SCORS–G) is a clinical rating system assessing 8 domains of self- and interpersonal relational experience that can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943], early memories narratives) or oral data (e.g., psychotherapy narratives, relationship anecdotal paradigms). In this study, 72 psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS–G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating-disordered behavior, and history of nonsuicidal self-injury. SCORS–G composite ratings achieved an acceptable level of interrater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy, history of nonsuicidal self-injury). SCORS–G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS–G with adolescents.     

Construct Validity of ADHD-IN,ADHD-HI,ODD toward Adults,Academic and Social Competence Dimensions with Teacher Ratings of Thai Adolescents: Additional Validity for the Child and Adolescent Disruptive Behavior Inventory

Confirmatory factor analysis was used to test the construct validity of an attention-deficit/hyperactivity disorder-inattention, attention-deficit/hyperactivity disorder-hyperactivity/impulsivity, oppositional defiant disorder toward adults, academic and social competence factor model with teacher ratings of Thai adolescents (n = 872) with the Child and Adolescent Disruptive Behavior Inventory. The five-factor model resulted in an adequate fit in an absolute sense (i.e., CFI = .960; TLI = .985; RMSEA = .065; and WRMR = .883). All the items had significant and substantial loadings on their respective factors (i.e., > .78) with the five-factors showing discriminant validity. The five-factor model also resulted in similar results for boys and girls separately as well as younger and older adolescents. The current findings with the teacher version of the measure in conjunction with earlier research with mothers’ and fathers’ ratings of Brazilian, Thai, and American children (Burns et al., Psychological Assessment, 20, 121-130, 2008) and Thai adolescents (Burns et al., Psychological Assessment, 21, 635-641, 2009) provide increasing support for the construct validity of Child and Adolescent Disruptive Behavior Inventory within multiple cultures. Procedures are also outlined to improve the content validity as well as test the construct validity of forthcoming parent and teacher DSM-V ADHD/ODD rating scales.     

Assessment Center Graduate Selection: Decision Processes,Validity, and Evaluation by Candidates

In this contribution, results are presented of research on the predictive validity of a procedure for the career-oriented selection of graduates in The Netherlands. After selection on account of applicant letter, the selection procedure consists of four selective steps: interview with a ‘recruitment officer’, mental test, interview with line manager, and an assessment center comprising two situational exercises. Performance indicators investigated are present salary, average annual changes in function, appraisal of performance, appraisal of management potential, and average annual salary progression. We report on the relationships between the predictors, between the criteria, and between predictors and criteria. The assessment center, together with other steps from the selection procedure, appear to be valid for a number of performance indicators. The correlation between the overall assessment center rating and present salary, corrected for restriction in range, equals 0.55. Stepwise regression indicates that elements from all procedure steps contribute to the prediction of the criterion of average annual salary progression. The disturbing influence of possible ‘crown prince’ -effects on these results, are discussed. Also, the decision process taking place during the end meeting of the assessors is investigated. Finally, the evaluation of the procedure, both by accepted and by rejected candidates, is discussed. These and other results are compared to what is generally known about assessment centers.     

Child,Adolescent and Adult Psychiatric Disorders in Africa: Implications for Psychological Interventions

The authors start by critically discussing some core features of Western psychiatric diagnosis, and present the cultural formulation as one approach to ensure that the cultural aspects of the diagnostic process are addressed, followed by a summary of what is known about the causes of psychiatric disorder. Five arguments are presented that provide support for the importance of psychiatric disorders in Africa: prevalence rates are high; psychiatric disorder is associated with a considerable burden from disability; in most cases, adults with psychiatric disorders experienced the onset of their disorder in childhood or youth; psychiatric disorders are strongly associated with medical conditions; and effective interventions exist for the majority of people suffering from psychiatric disorders. Against this background, current mental health services in Africa are reviewed. Finally, some suggestions are provided for how those providing psychological interventions can contribute to addressing the challenges posed by psychiatric disorders in Africa.     

Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent Functional Assessment Scale

The Child and Adolescent Functional Assessment Scale (CAFAS) is a multidimensional measure of degree of impairment in functioning. Interrater reliability data are presented for lay raters, graduate students, and frontline staff. Reliability was high for the total score and behaviorally-oriented scales. Construct, concurrent, and discriminant validity were assessed with the sample of children and adolescents evaluated at the Fort Bragg Demonstration Evaluation Project. Youth and their caregivers were evaluated via interview and selfcompleted instruments at four time points. Significant correlations were found between the CAFAS and other related constructs. Concurrent validity was demonstrated by logistic regression analyses examining the relationship between CAFAS ratings and problematic behaviors endorsed on measures completed by parents, teachers, or the youth. Youth with higher CAFAS total scores were much more likely to have poor social relationships, difficulties in school, and problems with the law. Discriminant validity was assessed with a repeated measures analysis of variance with intensity of care at intake and time as factors. Youth who were inpatients or in residential treatment centers at intake had higher CAFAS scores than those who were outpatients. These findings provide strong evidence for the reliability and validity of the CAFAS.     

Eating Disorders,Impaired Mentalization,and Attachment: Implications for Child and Adolescent Family Treatment

ABSTRACT

This article reviews the attachment and neuroscience model of Mentalization Based Treatment (MBT) (Allen, Fonagy, & Bateman, 2008) and its application for understanding and treating eating disorders (Skarderud & Fonagy, 2012). Mentalization, or mentalizing, refers to the capacity to apprehend one’s own and others’ behavior in terms of underlying mental states (needs, emotions, desires, beliefs, goals, reasons, and thoughts). Evidence from prospective studies suggests that insecure attachment and poor mentalizing difficulties may be risk factors for the development of eating pathology (Jewell et al., 2015; Rothschild-Yakar, Levy-Shiff, Fridman-Balaban, Gur, & Stein, 2010; Rothschild-Yakar & Stein, 2013). Preliminary research on the use of MBT for treating eating disorders, with nonsuicidal self-injury co-morbidity, suggests some promise for this model (Robinson et al., 2015). The theoretical rationale and key interventions of the MBT eating disorder model (MBT-ED) used in a multicenter research and treatment project are discussed (Skarderud & Fonagy, 2012; Robinson et al., 2015). Modifications of MBT-ED’s structure and techniques are proposed for family treatment of adolescent and child patients with eating disorders. Case example illustrates the impact of problems in the family system with mentalizing capacities on family cohesion, the therapeutic process, and the family’s ability to help the child recover.     

Behavioral and Emotional Problems in Young Preschoolers: Cross-Cultural Testing of the Validity of the Child Behavior Checklist/2-3

The cross-cultural validity of the Child Behavior Checklist for Ages 2-3 (CBCL/2-3) was tested in three Dutch samples of children referred to mental health services, from the general population, and from a twin study. Six scales were derived from factor analyses and labeled Oppositional, Aggressive, and Overactive, which constituted a broadband Externalizing grouping; Withdrawn/Depressed and Anxious, which constituted a broadband Internalizing grouping; and Sleep Problems. Internal consistencies of the scales, their test-retest reliabilities, interparent agreement, discriminative power, predictive relations with problem ratings 2 years later, and relations to other instruments designed to measure general development and behavior problems were adequate, and highly comparable to psychometric properties in American samples. It was concluded that across languages and cultures behavioral/emotional problems of young preschoolers may be adequately assessed with the CBCL/2-3.