Redmond (2002) Revisited: Have Standardized Behavioral Rating Scales Gotten Better at Accommodating for Overlapping Symptoms with Language Impairment?

Seventeen years ago, Redmond reviewed five standardized behavioral rating scales and identified several aspects of their design that made them prone to mischaracterize language impairments as socioemotional behavioral disorders. The purpose of this report is to provide an update and extension of the original audit. We consulted test manuals to evaluate: (1) representation of children with language impairments in their standardization samples; (2) presence of language, or academic items within their inventories; (3) accommodations for administering the measure to children with language impairments; and (4) procedures for identifying inordinately punitive ratings. Overlapping language and academic symptoms continued to be a problem across current behavioral rating scales. Improvements since Redmond occurred in the representation of children with language impairments in standardization samples and in procedures for identifying inordinately punitive ratings. We discuss implications for clinical assessment, research programs, and instrument development.

Measuring executive dysfunction in an acute rehabilitation setting: Using the dysexecutive questionnaire (DEX)

It is recognized that existing neuropsychological measures of executive dysfunction lack adequate sensitivity and selectivity. While attempts have been made to develop improved measures, these have not yet been of great value to those who need to accurately identify executive deficits in a clinical setting. Several behavioral rating scales have been developed for this reason, including the 20-item Dysexecutive Questionnaire (DEX), which forms part of the Behavioral Assessment of the Dysexecutive Syndrome (BADS) test battery. To investigate the ability of the DEX to identify executive dysfunction in an acute rehabilitation setting, the BADS was administered to 64 persons who had sustained traumatic brain injury. It was found to be almost as sensitive to executive dysfunction, as measured by the total score obtained on the BADS battery, as an extended 65-item version of the scale, when completed by either the occupational therapist or clinical neuropsychologist working with each patient. Family members and the patient themselves provided, as expected, less accurate information. Our results indicate that the DEX can be used with some confidence as a screening instrument to identify executive dysfunction in an acute rehabilitation setting, provided it is completed by professional personnel, trained to be sensitive to the cognitive and behavioral concomitants of this disorder. (JINS, 2005,11, 376–385.)

Growth status, behavior and neuropsychological performance: a study of Brazilian school age children

AIM: To assess the association between child growth and teacher-reported behavior and academic standing, and neuropsychological performance. METHOD: The heights of 344 public-school children were measured using standard procedures. Teachers were requested to complete two behavioral and one academic performance rating scales. Neuropsychological assessment consisted of the Edinburgh Handedness Inventory, the Steadiness Test and the Purdue Pegboard. Height-for-age z (HAZ) scores were calculated based on an international reference. Standard (z) scores for each factor of the first two behavioral rating scales and for each neuropsychological variable were computed for each child based on locally-derived norms. RESULTS: HAZ scores were negatively correlated with factors related to hyperactivity, conduct problem, impulsivity and inattention of the behavioral rating scales. In addition, the lower the HAZ score the worse the academic performance. CONCLUSION: These results add to the existing evidence indicating a strong association between growth status and child behavior and academic performance.

The Use of Rating Scales With Children Who Have Language Impairments

Several reports suggest that socio-emotional disorders and language impairments frequently co-occur in children receiving special education services. One explanation for the high levels of co-occurrence is that limitations inherent to linguistic deficiencies are frequently misinterpreted as symptomatic of underlying socioemotional pathology. In this report, five commonly used behavioral rating scales are examined in light of language bias. Results of the review indicated that children with language impairments are likely to be overidentified as having socioemotional disorders. An implication of these findings is that speech-language pathologists need to increase their involvement in socioemotional evaluations to ensure that children with language impairments as a group are not unduly penalized for their language limitations. Specific guidelines for using ratings with children with language impairments are provided.