Development process of an assessment tool for disruptive behavior problems in cross-cultural settings: the Disruptive Behavior International Scale – Nepal version (DBIS-N)

ABSTRACT

Systematic processes are needed to develop valid measurement instruments for disruptive behavior disorders in cross-cultural settings. We employed a four-step process in Nepal to identify and select items for a culturally valid assessment instrument: (1) we extracted items from validated scales and local free-list interviews; (2) parents, teachers and peers (n = 30) rated the perceived relevance and importance of behavior problems; (3) highly rated items were piloted with children (n = 60) in Nepal; (4) we evaluated internal consistency of the final scale. We identified 49 symptoms from 11 scales, and 39 behavior problems from free-list interviews (n = 72). After dropping items for low ratings of relevance and severity and for poor item-test correlation, low frequency and/or poor acceptability in pilot testing, 16 items remained for the Disruptive Behavior International Scale – Nepali version (DBIS-N). The final scale had good internal consistency (α = 0.86). A 4-step systematic approach to scale development including local participation yielded an internally consistent scale that included culturally relevant behavior problems.

KEYWORDS:

• Disruptive behavior disorders
• oppositional defiant disorder
• conduct disorder
• scale
• validation
• Nepal
• low-income countries

Acknowledgements

The authors thank the families that participated in this study and Transcultural Psychosocial Organization – Nepal for their support.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Matthew D. Burkey is an Associate in the Department of Health, Behavior, and Society at Johns Hopkins University School of Public Health, Baltimore, USA.

Lajina Ghimire is currently a Project Officer with the Centre for Victims of Torture in Nepal.

Ramesh Prasad Adhikari is currently a Research Manager with Helen Keller International in Nepal.

Brandon A. Kohrt is an Assistant Professor at Duke Global Health Institute and Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA.

Mark J.D. Jordans is the Director of Research and Development with War Child Holland, Amsterdam, Netherlands.

Emily E. Haroz is an Assistant Scientist in the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.

Lawrence S. Wissow is a Professor in the Department of Health, Behavior, and Society at Johns Hopkins University School of Public Health, Baltimore, USA.

ORCiD

Matthew D. Burkey http://orcid.org/0000-0002-5539-0195

Ramesh P. Adhikari http://orcid.org/0000-0002-9548-9106

Brandon A. Kohrt http://orcid.org/0000-0002-3829-4820

Additional information

Funding

This work was supported by the Johns Hopkins Clinical Research Scholars Program [grant number 1KL2TR001077, PI: Matthew Burkey], the American Academy of Child and Adolescent Psychiatry (AACAP) Pilot Research Award (PI: Matthew Burkey), and the National Institute of Mental Health of the National Institutes of Health under award number [grant number 1U19MH095687-01] through the South Asian Hub for Advocacy, Research and Education on Mental Health (SHARE) (fellowship to Ramesh Adhikari). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.