Validation of a Parent Report on Externalizing Symptoms Scale: A Downward Extension of the Behavioral Health Screen

• Published in: School psychology 2023-07, Vol.38 (4), p.264-272
• Main Authors: Rivers, Alannah Shelby, Winston-Lindeboom, Payne, Ruan-Iu, Linda, Atte, Tita, Tien, Allen, Diamond, Guy
• Format: Article
• Language: English
• Subjects: Adolescent; Anxiety - psychology; Anxiety Disorders; Attention Deficit Disorder with Hyperactivity; Attention Deficit Disorder with Hyperactivity - diagnosis; Attention Deficit Hyperactivity Disorder; Behavior Disorders; Behavior Problems; Behavioral psychology; Child; Child Behavior; Child development; Computer Software; Conduct Disorder; Convergent Validity; Educational Measures; Externalizing Symptoms; Feedback (Response); Female; Health Care Psychology; Human; Humans; Item response theory; Male; Mental Health; Oppositional Defiant Disorder; Parent Report; Parents; Psychometrics; Referral; Screening Tests; Self Report; Student Behavior; Student Evaluation; Teacher Education; Teacher Improvement; Teacher Qualifications; Test Reliability; Test Validity; Validity
• ISSN: 2578-4218; 2578-4226
• DOI: 10.1037/spq0000520

Externalizing problems are common in children ages 6-14, can have lifelong consequences, and may pose a particular risk when combined with other risk factors and symptoms (like depression and anxiety). Schools are uniquely positioned to assess and address these types of behavioral health concerns, but many school-based assessments do not focus on mental health distress (partially because they often lack the infrastructure for identification, screening, and referral). To address this gap, the Behavioral Health Works program student mental health software system has integrated teacher training, psychometrically strong assessments, feedback, and referral tools. However, this self-report tool for adolescents needed to be adapted for younger children. Thus, a parent-report version was added as well as new scales for better assessing this age group. The present study examines the psychometric properties of the new parent-report attention-deficit hyperactivity disorder (ADHD) and oppositional defiant/conduct scales within a sample of 440 children referred for school-based assessments. Overall, the new scales demonstrated good structural validity, measurement invariance across most demographic groups, discrimination in item response theory analyses, and evidence of convergent validity and good classification accuracy in relation to a validation battery. These externalizing scales are distinct and precise and show promise for improving the effectiveness of school-based programs for identifying at-risk children. Impact and Implications To address the challenges of behavioral health school-based screening, this project tested new measures assessing parent-reported attention-deficit hyperactivity disorder and oppositional defiant/conduct symptoms for elementary age children. This study finds that the new scales show initial promise and work well for a sample of children referred to behavioral health services. These scales are part of an assessment system which may help close gaps in the receipt of services for students with these concerns.