Results Population: Participants ranged in age from 15 to 19 years and had diagnoses of Cerebral Palsy, Spina Bifida, Progressive Spastic Paraparesis, Chromosomal Abnormalities, Developmental Coordination Disorder, or Head Injury with the majority of participants having Cerebral Palsy (73.3% of all participants). Participants’ GMFCS levels range from level 1 to level 4 with the majority of the participants at level 3 or 4 (both with 33.3% of participants respectively). COPM: Participants experienced significant improvement in their perception of performance (p
LOOKING AT CHILD BEHAVIOUR MEASURES FROM A DIFFERENT ANGLE Beverley Wasmund, MSc. OT candidate 2012; Peter Rosenbaum, MD, CanChild Centre for Childhood Disability Research Abstract Current attitudes and theories about child development, behaviour and disability are considerably different than they were at the time when many currently popular behavioural measures were originally developed. Modern approaches to the clinician-client relationship emphasize family-centred care and the tenet that parents are the experts on their child. It is important, therefore, to consider the history of commonly-used parent-rated behaviour measures. An awareness of the perspective, structure and functional capacity of these measures will enable clinicians to know whether these tools enable them to identify children with challenging behaviours accurately and measure the efficacy of interventions. In this paper we examine seven commonly-used behavioural measures and compare their features to concerns voiced by parents of children with challenging behaviours. We conclude with a discussion of an alternative method for evaluating children’s behaviour. Introduction Anecdotal reports from parents suggest that behavioural screening measures often do not capture their concerns. Common behavioural questionnaires are based on data obtained from a variety of test populations but they cannot possibly account for the unique situation of every child and their family environment. As a result, some parents find that their children’s behaviours are dismissed as ‘typical’ and they do not receive the support they feel they need. If the behavioural questionnaire is written in a language other than the first language of the parents, the intent of some of the questions may be misunderstood. Furthermore, based on the structure and items of some questionnaires, parents may not be able to convey adequately what they find most problematic in a way that is consistent with the content and format of the questionnaire. Most behavioural measures focus on specific behaviours and use closed-ended rather than open-ended questions. This limits parents’ ability to describe the impact and meaning of the behaviour on their daily lives. As a result, many nuances of the problem behaviour may be missed. Measures designed as diagnostic tools are not necessarily appropriate as outcome measures unless they have been validated for that purpose. With these limitations in mind, we asked the question: Do current child behaviour assessments measure what parents find most distressing about their child’s behaviour? If they do not, it is important to determine how to identify accurately those in need of service and ensure that the interventions provided are making a meaningful improvement. Literature Review The terms challenging behaviour or problem behaviour are often used interchangeably. Emerson (2001) defined challenging behaviour is as follows: ... culturally abnormal behaviour(s) of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit use of, or result in the person being denied access to, ordinary community facilities (p. 3). Emerson also noted, “many challenging behaviours appear to be functional adaptive responses to particular environments” (p. 4) and “behaviour can only be defined as challenging in particular contexts” (p. 8). Most qualitative research on challenging childhood behaviour is related to a specific disability such as autism, ADHD or developmental delay. There is a paucity of literature describing parents’ perspectives in general terms, i.e. regardless of what kind of behaviour is occurring, what characteristics of the behaviour are most distressing to parents. Researchers who have used qualitative methods to study the experiences of parents and family members have identified five common experiences: eternal vigilance, frenetic pace, worry, social isolation and a distinction between episodic, dangerous behaviour and more frequent, less dangerous behaviour described as difficult (Fox, Vaughn, Wyatte & Dunlap, 2002; Turnbull & Ruef, 1996; Werner Degrace, 2004). Keen and Knox (2004) noted the difficulty of measuring the efficacy of a behavioural intervention and suggested that clinicians work “collaboratively with the family to identify their own measures” (p. 62). Methods A database of 520 quantitative, peer-reviewed research articles dated 1986-2007 from a larger parenting study served as the basis for this research. Articles which had titles containing the word ‘behaviour’ were selected. A total of 43 studies were examined and a short list of the most frequently-occurring parent-rated measures was generated: Child Behavior Checklist (CBCL) (Achenbach and Edelbrock, 1981), Conners’ Parent Rating Scale (CPRS) (Conners et al., 1998), Parenting Stress Index – Short Form (PSI-SF) (Abdin, 1995), Questionnaire on Resources and Stress Short Form (QRSS-SF) (Friedrich, Greenberg, & Crnic,1983), Vineland Adaptive Behaviour Scales II (Vineland II) (Sparrow, Cicchetti & Balla, 2005), and Social Skills Rating System (SSRS) (Gresham & Elliott, 1990). The Social Skills Improvement System – Rating Scales (SSIS) (Gresham & Elliott, 2008), a revised version of the SSRS, was used for the analysis as the original could not be located in the public domain. Although used less frequently, the Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997), was also included in this list on the basis of its citation frequency elsewhere. The measures were compared with respect to the following features: dates of original and revised versions, intended population, source of items, test population, % of positive or prosocial items, % of items related to parents’ experiences or perceptions of their own lives, % of concepts other than the child’s behaviour, and measurement scale. Results Items - Although most child behaviour research involves children with disabilities, only three of the measures we examined were developed with data obtained from children with disabilities (ie., the QRSS-SF, the SSRS, and the Vineland II). The CBCL, CPRS and SDQ all used data from child psychiatric clinics in the development of the measures. It is noteworthy that the PSI, which is based on data from healthy, typically developing children, is often used in studies of atypically developing children. Furthermore, although most of the measures were originally designed to elicit feedback from parents, the items for the measures were generated by clinicians, not parents. Authors of the CBCL and QRS-SF
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