Validation of a cross-cultural instrument for child behavior problems: the Disruptive Behavior International Scale – Nepal version

Abstract

BackgroundObtaining accurate and valid measurements of disruptive behavior disorders remains a challenge in non-Western settings due to variability in societal norms for child behavior and a lack of tools developed outside of Western contexts. This paper assesses the reliability and construct validity of the Disruptive Behavior International Scale – Nepal version (DBIS-N)—a scale developed using ethnographic research in Nepal—and compares it with a widely used Western-derived scale in assessing locally defined child behavior problems.MethodsWe assessed a population-based sample of 268 children ages 5–15 years old in Nepal for behavior problems with a pool of candidate items developed from ethnographic research. We selected final items for the DBIS-N using exploratory factor analysis in a randomly selected half of the sample and then evaluated the model fit using confirmatory factor analysis in the remaining half. We compared the classification accuracy and incremental validity of the DBIS-N and Eyberg Child Behavior Inventory (ECBI) using local defined behavior problems as criteria. Local criteria were assessed via parent report using: 1) local behavior problem terms, and 2) a locally developed vignette-based assessment.ResultsTen items were selected for the final scale. The DBIS-N had good internal consistency (Cronbach’s α: 0.84) and excellent test-retest reliability (intraclass correlation 0.93, r = .93). Classification accuracy and area under the curve (AUC) were similar and high for both the ECBI (AUC: 0.83 and 0.85) and DBIS-N (AUC: 0.83 and 0.85) on both local criteria. The DBIS-N added predictive value above the ECBI in logistic regression models, supporting its incremental validity.ConclusionsWhile both the DBIS-N and the ECBI had high classification accuracy for local idioms for behavior problems, the DBIS-N had a more coherent factor structure and added predictive value above the ECBI. Items from the DBIS-N were more consistent with cultural themes identified in qualitative research, whereas multiple items in the ECBI that did not fit with these themes performed poorly in factor analysis. In conjunction with practical considerations such as price and scale length, our results lend support for the utility of the DBIS-N for the assessment of locally prioritized behavior problems in Nepal.Electronic supplementary materialThe online version of this article (10.1186/s40359-018-0262-z) contains supplementary material, which is available to authorized users.

Role of Pediatricians, Pediatric Associations, and Academic Departments in Ensuring Optimal Early Childhood Development Globally: Position Paper of the International Pediatric Association

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Communication about distress and well-being: Epistemic and ethical considerations

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School-based group interpersonal therapy for adolescents with depression in rural Nepal: a mixed methods study exploring feasibility, acceptability, and cost

“…We adapted it for Sindhupalchowk using free listing to identify tasks that are important to adolescents in this setting. Secondary outcomes were anxiety, PTSD, and disruptive behaviour, measured with the Beck Anxiety Inventory (BAI, 21 items); Child PTSD Symptom Scale (CPSS) (17 items); and Disruptive Behaviour International Scale – Nepal (DBIS-N, 24 items) (Kohrt et al ., 2003 ; Jordans et al ., 2010 ; Burkey et al ., 2016 ; Burkey et al ., 2018 ). Tools were translated into Nepali and previously validated in Nepal.…”