Reliability, validity, and change over time in disinhibited and disruptive behaviors assessed with the age-adapted disruptive behavior diagnostic observation schedule in children aged 5-12 years with ADHD.

Abstract

Background: Previous research has shown that the disruptive behavior diagnostic observation schedule (DB-DOS) is a valid and reliable clinic-based assessment of disinhibited and disruptive behaviors in preschoolers. We adapted the DB-DOS for use in children aged 5-12 years, examined its psychometric properties, and evaluated its ability to capture change over time across repeated assessments.

Methods: Children (N = 212; baseline age M = 8.5 years, SD = 2.0; 75.8% boys) with a clinical diagnosis of ADHD participated between 2015 and 2021. Follow-up data were available for 97% (N = 206) at 5 weeks and 75% (N = 160) at 1 year. Blinded videotaped sessions were coded by five trained psychologists who had no knowledge of the child, treatment condition, or timing of the observation. Psychometric properties were examined using principal component analysis (PCA), inter-item correlations, correlations with validated parent and teacher reports, internal consistency estimates, and intraclass correlation coefficients. DB-DOS change scores at 5 weeks and 1 year were examined in relation to change scores based on parent and teacher reports.

Results: PCA indicated that the correlational structure was captured by two components: Behavioral Regulation (BR; e.g., "Talks excessively," "Difficulty waiting") and Anger Modulation (AM; e.g., "Noncompliance," "Verbal aggression"). Inter-item correlations and associations between DB-DOS scores and parent and teacher reports provided partial support for validity, particularly in the parent context (PC). Internal consistency ranged from acceptable to good, and interrater reliability was excellent. Psychometric properties at 5 weeks and 1 year were broadly comparable to those at baseline. Changes in disinhibited and disruptive behaviors observed with the DB-DOS, particularly in the PC, showed modest associations with changes reported by parents and teachers.

Conclusion: The age-adapted DB-DOS showed acceptable to good reliability and provided partial support for validity as a clinic-based observational tool for assessing disinhibited and disruptive behaviors in children aged 5-12 years with ADHD. Preliminary evidence suggests that the DB-DOS may capture change over time, particularly in the PC, although change cannot be attributed uniquely to intervention effects. This standardized clinic-based assessment method holds promise for supporting diagnostic assessment and intervention research in school-aged children with disinhibited and disruptive behaviors.