Last week, we presented the first part of a two-part series on unraveling the ED/SM dilemma. This week, we talk to the experts on how to use various assessments to evaluate emotional disturbance and social maladjustment. Catch up on last week's blog here. School staff members often have difficulties when it comes to assessing a student who may have emotional disturbance (ED), and getting hard data to back up the decision can be just as difficult. PAR spoke with experts in the field about the use of various instruments that have proven to be useful in gathering the hard data needed in order to make an informed decision about ED eligibility. Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) Peter K. Isquith, PhD, is a practicing developmental school neuropsychologist and instructor in psychiatry at Harvard Medical School. He’s the coauthor of the BRIEF2, the new BRIEF2 Interpretive Guide, and the Tasks of Executive Control (TEC). PAR: Why would it be helpful to include a measure of executive functioning in the assessment of a student being evaluated for an ED eligibility? PI: In general, the purpose of including the BRIEF2 when asking about ED is to know whether or not the child actually has an emotional disturbance or if his or her self-regulation gives that appearance. So, if a child is referred who has frequent severe tantrums, we want to know if this is an emotional disturbance or if it is part of a broader self-regulatory deficit. That is, is the child melting down because he or she truly experiences emotional distress? Or is he or she doing so because of poor global self-regulation? To answer this, I would want to look at two things: Is there evidence of an actual emotional concern? Does the child exhibit mood problems, anxiety, or other emotional issues? And does the child's self-regulation have an impact on other domains, including attention, language, and behavior? That is, is he or she physically, motorically, attentionally, and/or verbally impulsive or poorly regulated? If the first answer is yes, then there is likely an emotional disturbance. But if it is no, then there may be a self-regulatory issue that is more broad. By using the BRIEF2, clinicians can quickly learn if a student is impulsive or poorly regulated in other domains, not just emotionally. A BRIEF2 profile with high Inhibit and Emotional Control scales suggests that the child is more globally disinhibited. If it is primarily the Emotional Control scale that’s elevated, and there is an emotional concern like mood problems, then it may be more of an emotional disturbance. Pediatric Behavior Rating Scale (PBRS) Richard Marshall, EdD, PhD, is an associate professor in the Department of Educational and Psychological Studies in the College of Education at the University of South Florida. He is also an adjunct associate professor in the Department of Psychiatry and Behavioral Neurosciences at the USF College of Medicine. In addition to the PBRS, published in 2008, he is the author of 2011’s The Middle School Mind: Growing Pains in Early Adolescent Brains. PAR: How does the PBRS fit into the diagnosis of ED? RM: Two gaps in practice prompted us to develop the PBRS. The first was that the assessment instrument available at the time had few if any items about rage attacks, irritability, assaultive aggression, and other symptoms associated with early onset bipolar disorder. Hence, despite significantly abnormal behaviors, results of assessments were often within normal limits because they failed to capture symptoms of interest. So, our first goal was to include these new behaviors into parent and teacher ratings. A second problem was that symptom overlap between ADHD and early onset bipolar disorder made it difficult to differentiate ADHD and bipolar disorder. The problem is that the standard treatment for ADHD, stimulant medication, induces mania in individuals with bipolar disorder. Thus, diagnosis accuracy is paramount. What we learned during the PBRS norming sample was that students with ADHD and bipolar disorder produce a similar pattern of scores, but students with bipolar disorder produce a higher level of scores. That is, both groups have similar symptoms, but individuals with bipolar disorder have more serious symptoms. Thus, the PBRS can assist clinicians in differentiating individuals with mood disorders from those with ADHD. PAR: Decades of research in cognitive neuroscience, combined with changes in our understanding and classification of mental illness in children, impels us to continually reevaluate theory and practice. Formulated more than a half-century ago, the idea of social maladjustment is one of those policies in desperate need of revision. In 1957, the idea of being able to identify students who were socially maladjusted may have seemed reasonable. RM: There are two problems with this idea. First, the government has never defined social maladjustment, and states (and practitioners) have been left without clear ways of differentiating students who are or are not socially maladjusted. Second, without a clear definition, the concept of social maladjustment has created what Frank Gresham refers to as a “false dichotomy” that is used to exclude students from receiving interventions that would help them and to which they are entitled. Emotional Disturbance Decision Tree (EDDT) Bryan Euler, PhD, author of the EDDT as well as the EDDT Parent Form and the new EDDT Self-Report Form, has a background in clinical and counseling psychology, special education, and rehabilitation counseling. He has 27 years of experience as a school psychologist working in urban and rural settings with multicultural student populations. PAR: Can you describe the overall benefits of the EDDT system and what makes it unique from other instruments? BE: The EDDT series was designed to map directly onto the IDEA criteria for emotional disturbance, which are different from and broader than constructs such as depression or conduct. The federal criteria are, some might say, unfortunately wide and “fuzzy,” rather than clean-cut. The EDDT scales are written to address these broad domains thoroughly and help school psychologists apply the unwieldy criteria. The EDDT also includes a social maladjustment scale (SM). Since students who are only SM are not ED eligible, the EDDT is useful in ruling out these students and in identifying those for whom both conditions may be present. This can be helpful with program decisions, so children or adolescents who are primarily “fragile” are not placed in classrooms with those who have both depression/anxiety and severe aggression. The EDDT also has an Educational Impact scale, which helps to document that the student’s social-emotional and behavioral issues are having educational effects, which IDEA requires for eligibility. All of the EDDT forms include a Severity scale, which helps to gauge this and guide service design. The EDDT Parent and Self-Report forms also include Resiliency and Motivation scales, which help to identify a student’s strengths and determine what may most effectively modify his or her behavior. The presence of all these factors in the EDDT scales is intended to facilitate the actual practice of school psychology with ED and related problems. PAR: Why is it important to have multiple informants as part of an evaluation? BE: Having multiple informants is, in effect, one way of having multiple data sources. Multiple data sources add incremental validity, or accuracy, to evaluations as well as breadth of perspective. A rough analogy might be to lab tests, which are often done in panels, or multiples, rather than in singles, to help with insight, efficiency, and decisions. PAR: What are the benefits of having the student perspective as part of an evaluation with multiple informants? BE: Having a student’s perspective on his or her behavior and social-emotional adjustment is a critical but sometimes overlooked component of assessment, especially for ED and ADHD evaluations. If only teacher anecdotal reports, teacher-completed ratings, and behavior observations are used, this vastly increases the chance that the evaluation will be skewed toward externalized behavior like aggression and rule-breaking. Internal factors such as depression or anxiety, which may be causing the behavior, will be deemphasized, if noted at all. Research corroborates that if teachers rate a student, and ratings are also obtained from the parent and the child, the teacher results tend to highlight difficult, disruptive behavior, while other ratings may result in other insights. Relatedly, in children and adolescents, depression is often primarily manifest in irritability or anger rather than sadness. If there is no observable sadness and only problem behavior, teacher ratings may understandably focus on what stands out to them and complicates classroom management. Even if students minimize their depression, anxiety, or social problems, they do sometimes rate one or more of these as “at risk.” This can provide a window into subjective emotional pain that may otherwise be obscured. Finally, gathering student-derived data enhances school psychology professional practice. Psychologists who complete child custody or juvenile corrections evaluations gather data directly from the child to facilitate insight, which can also aid in school psychology. Adolescent Anger Rating Scale (AARS) Darla DeCarlo, Psy S, has been a clinical assessment consultant with PAR for nine years. She is a licensed mental health counselor and certified school psychologist in the state of Florida. PAR: Can you speak about your use of the AARS in ED evaluations? DD: Within the context of assessing those students referred for behavior-related evaluations, I found the AARS to be a great compliment to the various other instruments I used during the evaluation process. Making an ED determination is a sensitive issue, and I wanted as much hard data as possible to help me make a well-informed decision. The AARS allowed me to assess a student’s level of anger and his or her response to anger through a self-report. Limited instruments are able to give clinicians information that can help them look at the ED/SM issue. The AARS helped me identify students who were at risk for diagnoses of conduct disorder, oppositional defiant disorder, or ADHD. Combine these results with results on the EDDT and other instruments, and I was able to get a good picture (not to mention some hard data) on whether SM factored into the student’s issues. PAR: What about interventions? Does the AARS help with that in any way? DD: Anger control, as defined by the AARS, “is a proactive cognitive behavioral method used to respond to reactive and/or instrumental provocations. Adolescents who display high levels of anger control utilize the cognitive processes and skills necessary to manage anger related behaviors.” What I liked about the instrument is that it qualifies the type of anger the student is displaying and then gives the clinician information about whether or not the student displays anger control or even has the capacity for anger control. As a school psychologist, I needed to know if the student already had the skills to follow through with some of the possible interventions we might put in place or if we needed to teach him or her some skills before attempting the intervention. For example, something as simple as telling a student to count to 10 or walk away when he or she feels anger escalating may seem like an easy task, but not all students recognize the physiological symptoms associated with their outbursts. Therefore, asking them to recognize the symptoms and then act by calming themselves is pointless. I have seen this mistake many times, and have made the mistake myself by suggesting what I thought was a useful and effective intervention, only to find out later that the intervention failed simply because the student did not possess the skills to perform the task. The AARS gave me information that helped guard against making this type mistake. As with every evaluation, the instruments we choose in our assessments are important, but even the best instrument is useless without the keen skills of well-trained school staff to properly administer and interpret results with accuracy and precision.
Since 2000, school psychologists have turned to the Behavior Rating Inventory of Executive Function (BRIEF) to examine executive function in the everyday, real-world environments of children ages 5 to 18 years. A revision to that groundbreaking test, the BRIEF2, was published in 2015. Featuring more concise scales, increased sensitivity to executive function problems in key clinical groups like autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), and new screening forms for parents, teachers, and students, the BRIEF2 is the gold-standard for executive function testing. A new companion piece, developed and written by the BRIEF2 authors, is now available. The BRIEF2 Interpretive Guide helps school psychologists and educators gain a deeper understanding of BRIEF2 scores, write reports, plan intervention strategies, and monitor progress of students with executive function concerns. Using case examples of students with ASD and ADHD and written in a straightforward, reader-friendly style, the authors weave a narrative that will be familiar to most education professionals. This helpful guide offers optional interpretive steps and demonstrates uses for screening, basic, and advanced interpretation. Included are step-by-step guides to interpreting BRIEF2 scores and parallel sentence-by-sentence guides to help professionals write findings in reports using language that is concise, accurate, and clear to parents and teachers. “It is so enjoyable to witness how outstanding clinicians learn what they know, teach what they know, and practice what they know,” writes Elaine Fletcher-Janzen, EdD, ABPdN, professor of school psychology, in the book’s foreword. “This book is a glimpse into how clinical practice and the assessment and treatment of EF should be done, or how the experts do it. The reader is left with a comforting thought that if the practices and recommendations in the book are followed, then the best has been done for the child and the family. I feel very comfortable handing this book over to my students and saying, Do what they do!” The BRIEF2 Interpretive Guide is available in both hardcover and electronic formats. Order or learn more.
BRIEF2_titlePageWhether you’re a long-time user of the BRIEF family of products or you are considering your first purchase of the Behavior Inventory of Executive Function®, 2nd Ed., now you can take view a free training course to learn more about this assessment! The BRIEF2 makes the assessment of executive function impairments easier than ever. The most widely used gold-standard rating scale for assessing executive function, the original BRIEF has been cited in more than 800 peer-reviewed studies. The new BRIEF2 provides even more useful information for practitioners. The BRIEF2 assesses executive function behaviors in the school and home environments through questionnaires developed for parents, teachers, and children and adolescents. Designed to assess the abilities of a broad range of individuals, the BRIEF2 is useful when working with children who have learning disabilities and attention disorders; traumatic brain injuries; lead exposure; pervasive developmental disorders; depression; and other developmental, neurological, psychiatric, and medical conditions. This free, interactive course will give you a quick overview of the product, explain what makes it unique, discuss the updates made in this edition, and provide insight into how it was developed. And, best of all, the Training Portal is always available, so you can learn more on your schedule. To access the Training Portal, use your parinc.com username and password to log in. Don’t have a free account? Register now. Training courses are also available on the Vocabulary Assessment Scales™ (VAS™), the Test of General Reasoning Ability™ (TOGRA™), the Reynolds Adaptable Intelligence Test™ (RAIT™), the Academic Achievement Battery™ (AAB™), the Child and Adolescent Memory Profile™ (ChAMP™), the Feifer Assessment of Reading™ (FAR™), and many more!
Are you headed to New Orleans for NASP? Be sure to stop by booth #306. PAR will be there to demonstrate PARiConnect, show you how to access our free online Training Portal, and give you a hands-on look at our latest products.  The following PAR authors will be at the booth to answer your questions: The following PAR authors will be presenting at the conference. Make sure to check out these can't-miss sessions:
  • Reynolds Intellectual Assessment Scales™ (RIAS™-2): Development, Psychometrics, Applications, and Interpretation (MS061), Cecil R. Reynolds, PhD, Wednesday, February 10, 12:30 p.m. to 2:20 p.m.
  • The Neuropsychology of Mathematics: Diagnosis and Intervention (MS057), Steven G. Feifer, DEd, Thursday, February 11, 8 a.m. to 9:50 a.m.
  • Unstuck and on Target: An Elementary School Executive Function Curriculum (MS155), Lauren Kenworthy, PhD, Friday, February 12, 8 a.m. to 9:50 a.m
  • DBR Connect™: Using Technology to Facilitate Assessment and Intervention (MS140), Lindsey M. O’Brennan, PhD, and T. Chris Riley-Tillman, PhD, Friday, February 12, 4 p.m. to 5:50 p.m.
  • Concussion Management Skill Development for School-Based Professionals (DS006), Gerard A. Gioia, PhD, Friday, February 12, 1 p.m. to 2:20 p.m.
  • Introducing the BRIEF®2: Enhancing Evidence-Based Executive Function Assessment (WS038), Peter K. Isquith, PhD, and Gerard A. Gioia, PhD, Saturday, February 13, 9 a.m. to 12 p.m.
Plus, all orders placed at the PAR booth during NASP will receive 15% off as well as free shipping and handling! Follow PAR on Facebook and Twitter for updates throughout the conference!
bostonWill we see you at the INS Annual Meeting? If you are attending INS, make sure to stop by the PAR booth to see our newest products, get a demo of PARiConnect, or check out our free online Training Portal. Don’t miss this chance to learn from PAR authors: Plus, all orders placed at the PAR booth during INS will receive 15% off as well as free shipping and handling! Follow PAR on Facebook and Twitter for updates throughout the conference!
We are proud to announce that we have deepened the offerings available from the PAR Training Portal.   “The Behavior Rating Inventory of Executive Function™, 2nd Edition (BRIEF™2): An Introduction by Peter K. Isquith” is a video featuring Dr. Isquith discussing this new assessment and how it was updated during this revision. “Reynolds Intellectual Assessment Scales™, 2nd Ed. (RIAS™-2): An Overview with Cecil R. Reynolds” is a video featuring Dr. Reynolds discussing the RIAS-2 and what users should know about this revision. Both videos are excellent ways to learn about the key points of the product direct from the authors themselves! Full-length, interactive training courses on both the BRIEF2 and RIAS-2 will be added to the PAR Training Portal in 2016. Furthermore, to complement the full-length interactive training course on the Feifer Assessment of Reading™ (FAR™) currently live on the portal, we have added seven pronunciation guides. Each of the seven audio files offers the correct pronunciation for items appearing on subtests from the FAR. These audio presentations are meant to help users learn the most accurate enunciations of items and/or responses. The PAR Training Portal offers our Customers the unique opportunity to receive training through online presentations that provide an overview of the development, scoring, sample item content, and normative and clinical data of selected assessments. To access the Training Portal, use your parinc.com username and password to log in. Don’t have a free account? Register now.  
BRIEF2The wait is over! The gold-standard rating scale you’ve come to trust for executive function assessment is now even better. Developed by practicing pediatric neuropsychologists, the BRIEF2 continues to be as efficient, comprehensive, and consistent with current models of executive function as its predecessor but with enhanced features.
  • Parallel structure. Parent, Teacher, and Self-Report forms are now in one manual. Items are now more parallel across forms.
  • Concise scales. New scale structure reduces the burden on the parent, teacher, or adolescent respondent.
  • Increased sensitivity. Quickly identify executive function problems in key clinical groups such as ADHD and autism spectrum disorder.
  • New screening forms. In 5 minutes, determine whether a full executive function assessment is needed.
  • Updated norms. Normative data were drawn from a large, diverse, nationally stratified sample of individuals from all 50 U.S. states.
The BRIEF2 is available now! Order today: A Comprehensive Parent/Teacher/Self-Report Hand-Scored kit is just $330 or a Parent/Teacher Hand-Scored kit is just $250! The BRIEF2 is available for administration, scoring, and interpretation on PARiConnect.