Susan J. Frank

Initial Validation of the Functional Impairment Scale for Children and Adolescents

OBJECTIVE Two studies assessed the validity of the Functional Impairment Scale for Children and Adolescents (FISCA), a multidimensional parent-report questionnaire. METHOD In study 1, quasi-exploratory and confirmatory procedures tested whether FISCA data for 804 inpatients (mean age = 13.4, 456 boys), collected October 1994 through December 1995, fit a 3-factor model. Study 2 (n = 330) used survival and discriminant analyses to predict recidivism status at 3 and 6 months follow-up from FISCA scores at intake. RESULTS The 8 FISCA scales reduced to 3 factors describing undercontrolled aggression, social role violations, and self-focused aspects of child functional impairment. Serious impairment on the Aggression and School scales each predicted a 3-fold increase in recidivism risk. Together, impairment scores for Aggression, School, Thinking, and Delinquency correctly identified 73% of the recidivists. However, 51% of the nonrecidivists also were classified as recidivists. CONCLUSIONS Although these data initially support the FISCAs validity, they underscore the need for more effective strategies to identify severely impaired children whose problems will be sporadic or short-lived.

Daily behavior ratings among child and adolescent inpatients: the abbreviated Child Behavior Rating Form.

OBJECTIVE Child and adolescent psychiatric inpatient facilities are in need of standardized behavior rating scales to assess continuous change in patient behaviors. This study used daily staff ratings to examine the factor structure and psychometric properties of an abbreviated version of the Child Behavior Rating Form (CBRF-A). METHOD Three hundred eighty-seven inpatients, aged 3 to 17 years, were rated daily by unit staff. Subsamples of patients and/or their parents completed additional measures of behavior problems (Child Behavior Checklist, Functional Impairment Scale for Children and Adolescents) to assess the instruments validity. RESULTS Confirmatory factor analyses identified 5 behavior problem dimensions (Oppositionalism, Attention Problems, Overactivity, Withdrawal/Depression, and Anxiety), a second-order Externalizing dimension, and 2 positive behavior dimensions (Positive/Adaptive Social and Compliance/Self-Control). The scales were found to be internally consistent and showed expected age differences, and the scale factor structures were relatively stable over 1- and 2-week intervals. The scales correlated meaningfully with parent ratings of child behavior problems and functional impairment and were predictive of total hospital days. CONCLUSIONS The psychometric properties of the CBRF-A appear adequate for daily inpatient rating; additional research is needed to determine the usefulness of the CBRF-A in assessing treatment and medication effects over the hospital stay.