Observation Scale For Evaluation Research Articles

Concordance rates between parent and teacher clinical evaluation of language fundamentals observational rating scale

Research has shown that early identification of children with language issues is critical for effective intervention, and yet many children are not identified until school age. The use of parent-completed rating scales, especially in urban, minority populations, might improve early identification if parent ratings are found to be reliable and valid. To evaluate the reliability and validity of the Observational Rating Scale (ORS) in an urban setting where it may be difficult to distinguish language difficulties from cultural language differences. The present study examined the degree to which parent and teacher ORS scores for 73 7-10-year-old children (47 boys) had concordance for the four ORS dimensions of Listening, Speaking, Reading, and Writing, as well as for a composite ORS score. The relationship between the ORS ratings and the children's scores on the CELF-3, or CELF-4 Receptive and Expressive scores, and the WIAT Reading Composite scores were also examined. Parent and teacher concordance rates for the ORS were significant, but moderate for the Speaking, Reading, and Writing categories and for the overall ORS score. There were also significant relationships between the ORS scores and performance on standardized language and reading tests supporting the validity of the ORS. The reliability and validity of the ORS have been replicated and extended to a diverse, urban population. Further, parent ratings were shown to provide as least as good information about language function as teacher ratings. Finally, it was suggested that an overall ORS score may provide a better indicator of overall language function than the domain scores.

Family characteristics of stuttering children

Stuttering is a functional impairment of speech, which is manifested by conscious, but nonintentionally interrupted, disharmonic and disrhythmic fluctuation of sound varying in frequency and intensity. Aetiology of this disorder has been conceived within the frame of theoretical models, which tend to connect genetic and epigenetic factors. The goal of the paper was to study the characteristics of the family functioning of stuttering children in comparison to the family functioning of children without speech disorder, which confirmed the justification of the introduction of family orientated therapeutic interventions into the therapy spectrum of child stuttering. Seventy-nine nucleus families of 3 to 6-year-old children were examined; of these, 39 families had stuttering children and 40 had children without speech disorder. The assessment of family characteristics was made using the Family Health Scale, an observer-rating scale which according to semistructured interview and operational criteria, measures 6 basic dimensions of family functioning: Emotional State, Communication, Borders, Alliances, Adaptability & Stability, Family Skills. A total score calculated from the basic dimensions, is considered as a global index of family health. Families with stuttering children compared to families with children without speech disorder showed significantly lower scores in all the basic dimension of family functioning, as well as in the total score on the Family Health Scale. Our research results have shown that stuttering children in comparison with children without speech disorder live in families with unfavourable emotional atmosphere, impaired communication and worse control over situational and developmental difficulties, which affect children's development and well-being. In the light of previous research, the application of family therapy modified according to the child's needs is now considered indispensable in the therapeutic approach to stuttering children. The assessment of family characteristics with special reference to the ability of parents to recognize specific needs of children with speech disorder and adequate interaction, as well as readiness of parents for therapeutic collaboration are the necessary elements in legal custody evaluations.

Motivational Areas Rating Scale: Developing a New Tool for Studying Psychotherapy Process and Outcome

This article presents theoretical principles, coding modalities, and the first empirical evidences regarding Motivational Areas Rating Scale (MARS), a new tool designed for studying psychotherapeutic process and outcome. The MARS is an observer rating scale, which is codified on the basis of audioregistered psychotherapeutic transcripts. It consists of 16 macroitems, which cover the problematic aspects in four motivational areas (active relational, passive relational, corporeal, and self-realization) from four different perspectives (objective object, subjective object, objective self, subjective self). In preliminary studies, the MARS appears to be reliable, sensitive to change in psychotherapeutic process, practical, and inexpensive. It provides a brief but complete research instrument for assessing patients’ psychological distress. This report contains the full description of the instrument for learning and application by interested users.

Efficacy and safety of a mixture of ketamine, midazolam and atropine for procedural sedation in paediatric oncology: a randomised study of oral versus intramuscular route

To evaluate the efficacy and safety of a mixture of ketamine, midazolam and atropine given orally by comparing the same mixture given through the intramuscular route in children with malignancy undergoing minor invasive procedures. Sixty children, aged between 1 and 10 years, scheduled to undergo minor procedures were randomised into two groups to receive a mixture of ketamine (6 mg/kg), midazolam (0.05 mg/kg) and atropine (0.02 mg/kg) intramuscularly (Group 1) or ketamine (10 mg/kg), midazolam (0.2 mg/kg) and atropine (0.05 mg/kg) orally (Group 2). Sedation score, observer-rated visual analogue scale for pain were noted by an observer blinded to the route of drug administration. Optimum sedation was present in all children in both groups after drug administration, with Group 1 being more deeply sedated than Group 2 at the start of the procedure. Supplementation with intravenous ketamine was required in four children in Group 1 and eight children in Group 2 (P = 0.33). The mean (+/-SD) observer-rated visual analogue scale for pain during the procedure was 8.33 (+/-15.99) and 9.33 (+/-16.39) in Group 1 and Group 2, respectively (P = 0.892). One patient in Group 1 had vomiting after the procedure. There were no differences in proportion of patients with hallucinations and nystagmus in both groups. A mixture of ketamine, midazolam and atropine given orally provides sedation and analgesia similar to that produced by the same drugs given intramuscularly. It offers advantage over the intramuscular route as it is painless and can be given for minor paediatric oncology procedures with appropriate monitoring.

The Bipolar Depression Rating Scale (BDRS): its development, validation and utility

Unipolar and bipolar depression differ neurobiologically and in clinical presentation. Existing depression rating instruments, used in bipolar depression, fail to capture the necessary phenomenological nuances, as they are based on and skewed towards the characteristics of unipolar depression. Both clinically and in research there is a growing need for a new observer-rated scale that is specifically designed to assess bipolar depression. An instrument reflecting the characteristics of bipolar depression was drafted by the authors, and administered to 122 participants aged 18-65 (44 males and 78 females) with a diagnosis of DSM-IV bipolar disorder, who were currently experiencing symptoms of depression. The Bipolar Depression Rating Scale (BDRS) was administered together with the Hamilton Depression Rating Scale (HAM-D), Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). The BDRS has strong internal consistency (Cronbach's alpha = 0.917), and robust correlation coefficients with the MADRS (r = 0.906) and HAM-D (r = 0.744), and the mixed subscale correlated with the YMRS (r = 0.757). Exploratory factor analysis showed a three-factor solution gave the best account of the data. These factors corresponded to depression (somatic), depression (psychological) and mixed symptom clusters. This study provides evidence for the validity of the BDRS for the measurement of depression in bipolar disorder. These results suggest good internal validity, provisional evidence of inter-rater reliability and strong correlations with other depression rating scales.

Measurement of quality of life in schizophrenia: a comparison of two scales

People with schizophrenia have an impaired quality of life (QoL), and various QoL assessment scales are available. However it is not clear which scale should be used in different situations. We aimed to compare a patient-rated subjective QoL scale with an observer-rated QoL scale by measuring their degree of correlation and their respective associative profiles with outcome measures. Patients of the UK Schizophrenia Care and Assessment Program completed a patient-rated QoL questionnaire (MANSA). Research staff completed the observer-rated QoL tool (QLS) as part of an assessment of symptomatology and functioning. The two QoL tools were moderately positively correlated (r = 0.39). Both scales were negatively correlated with positive and negative symptoms of schizophrenia and depressive symptoms, and positively correlated with functioning scores. However the two scales were influenced by different factors. The patient-rated QoL was more significantly influenced by depressive symptoms, and the observer-rated QoL was more heavily influenced by negative symptoms. Patient-rated and observer-rated QoL are moderately related, with a number of joint determinants, but the former is sensitive to depressive influences, whilst the latter is sensitive to the negative symptomatology of schizophrenia.

Depression or apathy and functional recovery after stroke

While depression and apathy are common after stroke, past studies have done little to examine the influence of these two symptoms on functional outcome respectively. This study was designed to examine the effect of depression or apathy on functional recovery after stroke in 237 Japanese stroke patients. We assessed the psychological status using self-rating scales [the Zung Self-Rating Depression Scale (SDS) for depression and the Apathy Scale (AS) for apathy] and an observer-rating scale [the Neuropsychiatric Inventory (NPI)]. We assessed physical disability using the Functional Independence Measurement (FIM). Post-hoc test and multiple regression analysis were used to determine the independent effects of post-stroke depression and apathy on functional outcome. Depression was observed in 75 (31.6%) using SDS and 88 (40.2%) using NPI, and apathy in 95 (40.1%) using AS and 42 (19.2%) using NPI, respectively. Post-hoc test and multiple regression analysis indicated that the cognitive variable (Mini-Mental State Examination: MMSE score) and AS score, but not SDS score, correlated negatively with improvement in FIM. Apathy might be more frequently associated with functional abilities and likely interact with the recovery process as compared with depression after stroke.

Depression rating scales in Parkinson's disease: Critique and recommendations

Depression is a common comorbid condition in Parkinson's disease (PD) and a major contributor to poor quality of life and disability. However, depression can be difficult to assess in patients with PD due to overlapping symptoms and difficulties in the assessment of depression in cognitively impaired patients. As several rating scales have been used to assess depression in PD (dPD), the Movement Disorder Society commissioned a task force to assess their clinimetric properties and make clinical recommendations regarding their use. A systematic literature review was conducted to explore the use of depression scales in PD and determine which scales should be selected for this review. The scales reviewed were the Beck Depression Inventory (BDI), Hamilton Depression Scale (Ham-D), Hospital Anxiety and Depression Scale (HADS), Zung Self-Rating Depression Scale (SDS), Geriatric Depression Scale (GDS), Montgomery-Asberg Depression Rating Scale (MADRS), Unified Parkinson's Disease Rating Scale (UPDRS) Part I, Cornell Scale for the Assessment of Depression in Dementia (CSDD), and the Center for Epidemiologic Studies Depression Scale (CES-D). Seven clinical researchers with clinical and research experience in the assessment of dPD were assigned to review the scales using a structured format. The most appropriate scale is dependent on the clinical or research goal. However, observer-rated scales are preferred if the study or clinical situation permits. For screening purposes, the HAM-D, BDI, HADS, MADRS, and GDS are valid in dPD. The CES-D and CSDD are alternative instruments that need validation in dPD. For measurement of severity of depressive symptoms, the Ham-D, MADRS, BDI, and SDS scales are recommended. Further studies are needed to validate the CSDD, which could be particularly useful for the assessment of severity of dPD in patients with comorbid dementia. To account for overlapping motor and nonmotor symptoms of depression, adjusted instrument cutoff scores may be needed for dPD, and scales to assess severity of motor symptoms (e.g., UPDRS) should also be included to help adjust for confounding factors. The HADS and the GDS include limited motor symptom assessment and may, therefore, be most useful in rating depression severity across a range of PD severity; however, these scales appear insensitive in severe depression. The complex and time-consuming task of developing a new scale to measure depression specifically for patients with PD is currently not warranted.

IASP global year against pain in older persons: highlighting the current status and future perspectives in geriatric pain

This year represents the international year against pain in older persons and it is opportune, therefore, to reflect upon the current status and possible future directions in pain-management practice for this large and growing segment of the population. Epidemiologic studies show a very high prevalence of persistent pain, often exceeding 50% of community-dwelling older persons and up to 80% of nursing home residents. Recently, there has been a major push to develop age-appropriate pain assessment tools, including several observer-rated scales of behavioral pain indicators for use in those with dementia. There has also been the release of several comprehensive guidelines for the assessment and management of pain in older persons, although the current evidence-base used to guide clinical practice is extremely limited. Unfortunately, despite these advances, pain remains grossly under treated in older persons, regardless of the healthcare setting. With the demographic imperative of a rapidly aging society, much greater attention is now being devoted to the problem of geriatric pain, with new initiatives in healthcare planning, calls for better professional education in geriatrics and pain management as well as new directions and funding resources for research into this important problem. Of course, this increased awareness must still be translated into action, not just because better pain relief for older adults is an ethically desirable outcome, but out of the sheer necessity of dealing with the millions of older persons who will suffer from persistent and bothersome pain in the years to come.

Multidimensionality of the Alcohol Withdrawal Symptom Checklist: A Factor Analysis of the Alcohol Withdrawal Symptom Checklist and CIWA‐Ar

This study evaluated the factor structure of 2 scales for measuring the severity of the alcohol withdrawal syndrome (AWS): a self-rated scale, the Alcohol Withdrawal Symptoms Checklist (AWSC), and an observer-rated scale, the Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar). Alcohol-dependent male inpatients [n=127, age: 43.0+/-9.7 (mean+/-SD) years] were recruited from an inpatient treatment unit. Both measures of AWS were assessed repeatedly during the initial week of sobriety in these patients. An exploratory factor analysis was applied to the data collected on the first study day. Five independent factors accounted for 64% of total variance in the AWSC: autonomic arousal, depression, nausea and vomiting, alcohol craving, and tension/anxiety. Three items (abdominal pain, hallucinations, confusion) could not be included in the analysis due to insufficient variance. Three dimensions identified for the CIWA-Ar (autonomic arousal, nausea and vomiting, tension/anxiety) were also captured by the ASWC. Total AWSC scores correlated well with total CIWA-Ar scores (r=0.72), supporting validity of the AWSC. Lower correlations between total CIWA-Ar and the 5 factors (r=0.32-0.52) suggested that the CIWA-Ar and AWSC factors had discriminative value. Self-rated measures of AWS could play an important role in complementing observer-rated measures in clinical and research settings. In this sample, the AWSC appeared to identify multiple dimensions of AWS with face validity for clinical relevance.

Panic disorder subtypes: further clinical differences

Panic disorder (PD) is a heterogeneous phenomenon with respect to symptom profile. Most studies agree that a group of patients with prominent respiratory symptoms emerged as a distinct PD subtype. In this study we compared a range of clinical features associated with PD and agoraphobia in patients with respiratory (RS) and nonrespiratory (NRS) subtypes of PD. The participants were 124 patients with PD (79 women and 45 men), with or without agoraphobia, diagnosed by DSM-IV criteria. Following the observer-rated Panic Disorder Severity Scale assessment, subjects completed self-report measures, including the Anxiety Sensitivity Index (ASI), Panic-Agoraphobia Scale; the Beck Anxiety Inventory; and the Panic-Agoraphobic Spectrum Scale (PAS-SR). Multivariate analysis of variance (MANOVA) showed significant group differences [Pillai's trace = 0.95, F (5, 118)(=)2.48, P = .036]. Patients in RS group had higher mean total scores on the ASI (F = 5.00, df = 1, P = .027) and PAS-SR (F = 11.23, df = 1, P = .001) than patients in NRS group. Also, patients with RS attained higher scores than patients with NRS on four domains of PAS-SR (panic-like symptoms, agoraphobia, separation sensitivity, and reassurance seeking). A descriptive discriminant analysis of the data correctly identified 69.4% of the patient group in general and 86.1% of RS group (Wilks's lambda = 0.87, df = 8, P = .048). The significant discriminating factors of the RS and NRS groups were domains of panic-like symptoms, agoraphobia, separation sensitivity, and reassurance seeking. Our findings suggest that anxiety sensitivity and panic-agoraphobic spectrum symptoms might be particularly relevant to understanding subtypes of PD.

Single voxel proton magnetic resonance spectroscopy in post-stroke depression

Mood disorders are associated with structural, metabolic and spectroscopic changes in prefrontal regions. In the case of depression associated with stroke, there is little information about the biochemical profile of these regions, as assessed by proton magnetic resonance spectroscopy ( 1H-MRS). In a group of first-ever stroke patients, we studied the association between post-stroke depression and 1H-MRS measurements in unaffected frontal lobes. Twenty-six patients with a first ischemic stroke located outside the frontal lobes were included in the study. Single voxel proton magnetic resonance spectroscopy ( 1H-MRS) was performed to assess N-acetylaspartate/creatine (NAA)/Cr, glutamate + glutamine (Glx)/Cr, choline (Cho)/Cr and myo-inositol (mI)/Cr ratios. Patients were assessed within the first 10 days after stroke and again four months later. The diagnosis of depression was made on the basis of clinical observation, interview and Hamilton Depression Rating Scale scores. In a group of 26 patients, eight (31%) met criteria for depression at the first assessment, and nine (35%) met criteria for depression at follow-up. Patients with depression in the immediate post-stroke phase had significantly higher Glx/Cr ratios in the contralesional hemisphere than non-depressive patients. No biochemical differences were found between the groups at 4-month follow-up. These findings suggest that post-stroke depression is accompanied by changes in frontal lobe glutamate/glutamine levels, perhaps reflecting abnormalities in glutamatergic transmission in the immediate post-stroke period.

Potential screening measures for depression and anxiety after stroke

Depression and anxiety are common problems after stroke. The National Clinical Guidelines for stroke (Royal College Physicians, 2004) recommend that all patients are screened for low mood. The aim of the review was to identify measures which could be used for this purpose and to review the evidence for their sensitivity and specificity with stroke patients. A literature search was conducted using electronic databases, including Medline, Embase, PsycInfo and CINAHL, to identify articles published in peer reviewed journals on mood assessment after stroke. Questionnaire measures were identified which were appropriate only for those able to communicate verbally. In addition visual analogue and observer rating scales were identified which were considered appropriate for all stroke patients. The hospital anxiety and depression scale (HADS) and general health questionnaire (GHQ) had most evidence to support their use as screening measures for people without communication problems. The stroke aphasic depression questionnaire–hospital version (SADQ-H) had best support for use as a screening measure for those with communication problems. No measures were identified that had been validated as screening measures for anxiety after stroke. The HADS, GHQ12 and SADQ-H10 were recommended as short screening measures suitable for detecting depression after stroke. However the cut-offs giving good sensitivity and specificity were not well established for stroke patients and measures need to be developed for detecting anxiety.

Analysis of an Observational Rating Scale for Repetition, Posture, and Force in Selected Manufacturing Settings

The aim of this work was to quantify the interrater reliability of a set of scales that assess repetition, posture, and force as used on site when examining industrial work. Interrater reliability of observational assessment methods can vary depending on the definition of the methods and situations in which they are used. In several industries, 846 jobs were assessed using pairs of analysts to rate the repetition, force, and posture of the upper limbs. Twelve analysts with varying experience levels participated. Using an interclass correlation coefficient (ICC), force and repetition had reliability values of .60 and .71 before and .82 and .87 after discussion, respectively. After discussion, peak posture ratings had ICCs of .60 to .83. ICCs for average posture ratings ranged from .31 to .51 initially to .55 to .67 in final ratings. Less experienced analysts changed their initial ratings more than did the senior investigators. The high interrater reliability of the repetition and force metrics indicates that a single analyst is appropriate for basic job assessment. Posture ratings benefit greatly from a two-analyst system. Average postures should be assessed across a full range of the scale for interrater reliability assessment. Analyst pairs should be rotated to avoid forming biases. For basic assessments of forceful exertions and repetitive motions, a single analyst can be used, reducing the resource requirements for both industry and large epidemiological studies.

Pain in Severe Dementia: Self‐Assessment or Observational Scales?

To assess the performance of self-assessment scales in severely demented hospitalized patients and to compare it with observational data. Prospective clinical study. Geriatrics hospital and a geriatric psychiatry service. All patients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for dementia, with a Mini-Mental State Examination score less than 11 and a Clinical Dementia Rating score of 3. Three self-assessment tools--the verbal, horizontal visual, and faces pain scales--were administered in randomized order. A nursing team independently completed an observational pain rating scale. Main outcomes were comprehension (ability to explain scale use and correctly indicate positions for no pain and extreme pain, on two separate occasions), inter- and intrarater reliability, and comparison of pain intensities measured by the different scales. Sixty-one percent of 129 severely demented patients (mean age 83.7, 69% women) demonstrated comprehension of at least one scale. Comprehension rates were significantly better for the verbal and the faces pain scales. For patients who demonstrated good comprehension, the inter- and intrarater reliability of the three self-assessment scales was high (intraclass correlation coefficient=0.88-0.98). Correlation between the three self-assessment scales was moderate to strong (Spearman correlation coefficient (r)=0.45-0.94; P<.001). Observational rating correlated at least moderately with self-assessment (r=0.25-0.63), although for patients reporting pain, the observational rating scale underestimated severity compared with all three self-assessment scales. Clinicians should not apply observational scales routinely in severely demented patients, because many are capable of reliably reporting their own pain.

Detection of Depression in Acute Schizophrenia: Sensitivity and Specificity of 2 Standard Observer Rating Scales

To compare the psychometric properties of the Calgary Depression Rating Scale (CDRS) and the Hamilton Depression Rating Scale (HDRS) for severity assessment of depression in acute schizophrenia. During clinical routine treatment, we investigated 119 inpatients with acute schizophrenia, using the CDRS, the HDRS, and a global 4-point Depression Severity Scale (DEP-SEV). We compared CDRS and HDRS sum scores regarding their diagnostic accuracy, with global severity of depression as the criterion. We estimated sensitivity and specificity on the basis of receiver operating characteristic curves. According to global clinical ratings (DEP-SEV), 31% of patients had no depression, 19% had mild, 31% had moderate, and 19% had severe depression. Sensitivity was significantly higher (P < 0.05) for the CDRS than for the HDRS to assess mild (0.94 vs 0.76, cut-off 3 vs 10 points) or severe depression (1.00 vs 0.78, cut-off 11 vs 22 points); specificity was comparably high (> or = 0.88) for both scales. Despite the fact that both scales were effective in separating mild, moderate, and severe depression, significant advantages emerged for the CDRS to detect mild or severe depression in schizophrenia.

Dimensions of Disordered Attention in Traumatic Brain Injury: Further Validation of the Moss Attention Rating Scale

Hart T, Whyte J, Millis S, Bode R, Malec J, Richardson RN, Hammond F. Dimensions of disordered attention in traumatic brain injury: further validation of the Moss Attention Rating Scale. Objectives To investigate the factor structure of disordered attention in moderate to severe, acute traumatic brain injury (TBI) and to use factor analysis and item response theory to further validate and refine an observational rating scale of attention for clinical and research purposes. Design Multicenter inception cohort. Setting Inpatient rehabilitation units. Participants Patients with TBI (N=372) consecutively admitted to 8 Traumatic Brain Injury Model System centers within 2 weeks prior to observation, who consistently followed commands and who were on stable doses of all psychotropic medications for a 3-day rating period. Interventions Not applicable. Main Outcome Measure Participants were rated independently by treating occupational and physical therapists at an average of 1 month postinjury on the Moss Attention Rating Scale (MARS), a 45-item, Likert-type scale of attention-related behavior. Results Exploratory and confirmatory factor analyses revealed 3 correlated factors of disordered attention, interpreted as restlessness/distractibility, initiation, and sustained/consistent attention. Item response (Rasch) analysis was used to eliminate redundant items and to fill gaps in item difficulty. The resulting MARS consists of 22 items that can produce 3 factor scores and a total score that covers the broad construct of disordered attention. Conclusions The factor-scored MARS has potential utility as a quantitative observational method with which to assess and study different dimensions of disordered attention in acute TBI, and to monitor change over time and treatment response within these dimensions.

Administering the MADRS by telephone or face-to-face: a validity study

BackgroundThe Montgomery Åsberg Depression Rating Scale (MADRS) is a frequently used observer-rated depression scale. In the present study, a telephonic rating was compared with a face-to-face rating in 66 primary care patients with minor or mild-major depression. The aim of the present study was to assess the validity of the administration by telephone. Additional objective was to study the validity of the first item, 'apparent sadness', the only item purely based on observation.MethodsThe present study was a validity study. During an in-person interview at the patient's home a trained interviewer administered the MADRS. A few days later the MADRS was administered again, but now by telephone and by a different interviewer. The validity of the telephone rating was calculated through the appropriate intraclass correlation coefficient (ICC).ResultsMean total score on the in-person administration was 24.0 (SD = 11.1), and on the telephone administration 23.5 (SD = 10.4). The ICC for the full scale was 0.65. Homogeneity analysis showed that the observation item 'apparent sadness' fitted well into the scale.ConclusionThe full MADRS, including the observation item 'apparent sadness', can be administered reliably by telephone.

Feasibility and Reliability of Four Pain Self-Assessment Scales and Correlation With an Observational Rating Scale in Hospitalized Elderly Demented Patients

Acute and chronic pain is common in hospitalized demented elderly people, yet there are limited data about the performance of pain assessment tools in this population. The aim of this study was to evaluate the feasibility and reliability of four pain self-assessment scales in this population and compare their performance to an observational pain rating scale. Our prospective clinical study was conducted in an acute-care and intermediate-care geriatric hospital on 160 consecutive inpatient referrals to the dementia consultation who met Diagnostic and Statistical Manual of Mental Disorders-IV criteria for dementia. Exclusion criteria were delirium, terminal care, and severe sensory impairment. Four unidimensional self-assessment tools--the verbal, horizontal visual, vertical visual, and faces pain scales--were administered in randomized order to mild, moderate, and severely demented patients. An observational pain rating scale was independently completed by the nursing team. Only 12% of the 160 patients (mean age 85 years, 71% women) understood no scale. Respectively, 97%, 90%, and 40% of patients with mild, moderate, and severe dementia understood at least one scale (p <.05). There was a nonsignificant trend toward poorer comprehension of the faces scale. Test-retest reliability was high for all four self-assessment scales, and the correlation between these scales was very strong (Spearman's r(s) = 0.81-0.95; p <.001). Observational rating correlated moderately with self-assessment and tended to underestimate pain intensity (r(s) = 0.31-0.40; p <.05). Self-assessment pain scales can be used reliably in the vast majority of older hospitalized patients with mild to moderate dementia and in nearly half of those with severe dementia. Observational pain rating scales correlate only moderately with self-assessment and should be reserved for those few patients who have demonstrated that they cannot complete a self-assessment.

Early Predictors of Attention-Deficit/ Hyperactivity Disorder and School Difficulties in Low-Birthweight, Premature Children

This study investigated whether specific behaviors observed in 30 month-old lowbirthweight children are predictive of diagnosis of attention-deficit/hyperactivity disorder (ADHD) and school difficulties at age 8. Videotapes of 571 participants were coded using the Attention-Deficit Hyperactivity Disorder Observational Rating Scale (ADHD-ORS). Logistic and discriminant analyses were conducted using the three scale factors. High scores on one factor, Inattentiveness, predicted physician diagnosis and/or school difficulties 51 2 years later. The Inattentiveness factor also discriminated a linear sequence of diagnostic groups, two of which were statistically significant. These findings suggest that certain behaviors can be identified before the age of 3 by trained observers and that this identification that make a future ADHD diagnosis and/or school difficulties more likely.