Psychometric properties of the Japanese version of the Disruptive Behavior Disorders Rating Scale reported by parents and caregivers

doi:10.21203/rs.3.rs-4619661/v1

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Psychometric properties of the Japanese version of the Disruptive Behavior Disorders Rating Scale reported by parents and caregivers

https://doi.org/10.21203/rs.3.rs-4619661/v1

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The Disruptive Behavior Disorders Rating Scale (DBDRS) is widely used in many countries as a questionnaire to measure each symptom of Attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) in children and adolescents. This study’s objectives were (1) to examine the psychometric properties of the Japanese version of the DBDRS (J-DBDRS), measuring the symptoms of ADHD, ODD, and CD in children and adolescents reported by parents/caregivers, (2) to estimate the prevalence of ADHD, ODD, and CD in Japanese children and adolescents using the J-DBDRS, and (3) to examine the relationship between its symptoms, anxiety, depression, and irritability. A total of 2442 parents and caregivers who had children and adolescents aged 6–15 participated in the study. The results confirmed the structural validity for the four-factor structure, internal consistency, test-retest reliability, and convergent validity of the J-DBDRS. According to the results, the psychometric properties of the J-DBDRS; the characteristics of the estimated prevalence of ADHD, ODD, and CD in Japan; and the associations between each mental symptom were discussed.

Parents

Children and adolescents

DBDRS

Psychometric properties

Attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are highly prevalent among children and adolescents worldwide. The diagnostic criteria for ADHD include developmentally inappropriate symptoms of inattention and/or hyperactivity/impulsivity (APA, 2022). According to a meta-analysis (Polanczyk et al., 2015), the worldwide prevalence of ADHD in children and adolescents was 3.4% (CI 95% 2.6–4.5). The diagnostic criteria for ODD include three types of symptoms (angry-irritable mood, argumentative-defiant behavior, and vindictiveness), and those of CD include four types of symptoms (aggression toward people and animals, destruction of property, deceitfulness or theft, and serious violations of rules) (APA, 2022). The previous meta-analysis indicated that worldwide prevalence in children and adolescent was 3.6% (CI 95% 2.8–4.7) for ODD and 2.1% (CI 95% 1.6–2.9) for CD (Polanczyk et al., 2015).

Children and adolescents with ADHD, ODD, and CD experience various impairments and negative courses. For example, many children with ADHD experience academic failure and related problems (Frazier et al., 2007: Loe & Feldman, 2007). Besides, children with ADHD are more likely to have problems with peers and families than those without ADHD (Hoza, 2007; Johnston & Mash, 2001). A longitudinal study of 177 boys aged 7–12 with ODD indicated that the symptoms predicted impairment in peers, romantic relationships, paternal relationships, and job opportunities (Burke et al., 2014). Moreover, children with CD were at risk of being rejected by peers, being suspended, being expelled from school, and involvement with legal system (Frick et al., 2005; Frick, 2016). Furthermore, ADHD, ODD, and CD have very high comorbidities and are often comorbid with emotional problems, such as anxiety, depression, and irritability (Burke et al., 2010; Freeman et al., 2016; Larson et al., 2011; Newcorn et al., 2001). Therefore, it is crucial to develop assessment tools for ADHD, ODD, and CD in children and adolescents to provide appropriate prevention and treatment.

Several assessment tools for ADHD, ODD, and CD have been developed, such as semi-structured interviews and questionnaires. Semi-structured diagnostic interviews are used in many clinical trials for assessing ADHD, ODD, and CD (Murrihy et al., 2023; Ollendick et al., 2016; Sciberras et al., 2018). However, the implementation of semi-structured interviews requires intensive training for interviewers, which makes it impossible to screen children with ADHD, ODD, and CD from a large number of children and adolescents. Questionnaires have the advantage of screening a large number of children to detect those who show symptoms in a community, and a variety of questionnaires with reliability and validity have been developed, including child-, parent-, and teacher-reported questionnaires. For example, the ADHD Rating Scale (DuPaul et al., 1998), Conners 3 (Conners, 2008), and the Disruptive Behavior Disorder Rating Scale (DBDRS; Pelham et al., 1992) have been developed, and their reliability and validity have been evaluated worldwide. In Japan, the Oppositional Defiant Behavior Inventory (ODBI) was developed to assess the behavioral characteristics of Japanese children with ODD and has been confirmed to be valid and reliable (Harada et al., 2004; Harada et al., 2008). Furthermore, some subscales of general mental health measures are available to assess attention and conduct problems, such as the Achenbach System of Empirically Based Assessment (ASEBA; Achenbach & Rescorla, 2000) as well as Strengths and Difficulties Questionnaire (SDQ; Goodman, 2001).

The DBDRS was developed by Pelham et al. (1992) and can be used as a parent- and teacher-reported scales. Additionally, it has items that align with the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria and can estimate the prevalence of ADHD, ODD, and CD. The DBDRS has been translated into various languages in different countries, and its reliability and validity have been repeatedly confirmed in each country (e.g., Dutch version, Antrop et al., 2002; Korean version, Lee et al., 2022; Urdu version, Loona & Kamal, 2011; Yoruba version, Oke et al., 2019; Italian version, Zuddas et al., 2006). The Japanese version of the DBDRS (J-DBDRS) was also developed using data from 1867 children and adolescent aged 6–15 (Kishida et al., 2022). The results for the ODD subscale indicated high reliability (α = 0.82) as well as moderate and positive correlations between the subscale and the ODBI (r = 0.66). However, the validity and reliability of the other subscales (i.e., ADHD and CD) of the J-DBDRS have not been studied. Although the DBDRS can be used to estimate the prevalence of ADHD, ODD, and CD, its prevalence in Japanese children and adolescents has not been reported. If the psychometric properties of the J-DBDRS are revealed, early screening for at-risk and diagnosed children and adolescents can be provided, and more effective prevention and treatment for Japanese children and adolescents with ADHD, ODD, and CD can be implemented.

The objectives of this study were threefold: (1) to examine the reliability and validity of the J-DBDRS; (2) to estimate the prevalence of ADHD (inattentive, hyperactive, combined, and all types), ODD, and CD using the developed scale; and (3) to examine the relationship between its symptoms, anxiety, depression, and irritability.

Participants

This study used a dataset from the Mental Health Problems and Behavioral Factors in Children and Adolescents study (MBCA study), an online survey designed to examine the relationship between mental health and behavioral factors in Japanese children and adolescents. The MBCA study was conducted twice in Japan, targeting parents and caregivers nationwide. The first survey was conducted in February 2022 and the second in June 2022. A total of 2606 parents and caregivers who had children and adolescents from grades one (aged 6–7) to nine (aged 14–15) participated in the online survey. Participants were recruited through an internet survey company, the DO HOUSE (https://www.dohouse.co.jp/english/). Survey fees were paid to the participants through the company, based on their company policies. Data on parents’ gender, age, ethnicity, education level, employment status, and family income were obtained. Additionally, the children's gender, age, grade, parent-child relationship, ethnicity, and school status were obtained. The study was conducted with permission from the Institutional Review Board of the university to which the first author belonged (No. 21040). Informed consent was obtained from parents and caregivers who responded to the online survey.

Assessments

A) Disruptive Behavior Disorder Rating Scale (DBDRS)

The DBDRS is a parent- and teacher-reported scale developed by Pelham et al. (1992) that measures symptoms of ADHD, ODD, and CD in children and adolescents. The DBDRS is a 45-item questionnaire rated on a 4-point Likert scale (0 = “Not at all,” 1 = “Just a little,” 2 = “Pretty Much,” and 3 = “Very Much”), consisting of nine items for inattention of ADHD (ADHD-IA), nine items for hyperactivity/impulsivity of ADHD (ADHD-HI), eight items for ODD, and 15 items for CD, based on the DSM diagnostic criteria (APA, 2013). Except for the four items that were not related to DBD, 42 items were used in the analyses.

The J-DBDRS was developed by Kishida et al. (2022) through a back-translation procedure with permission from the original author (Professor Pelham). Two researchers independently translated the original English version of the DBDRS into Japanese. Another researcher reviewed and confirmed the forward-translated versions of these items. Then, two bilinguals independently conducted a back-translation of the forward translation into English. Finally, the original developer (Prof. Pelham) of the DBDRS confirmed the conceptual equivalence between the original and back-translated versions. The validity and reliability of ODD subscale of the J-DBDRS was examined in a previous study (Kishida et al., 2022).

B) Strengths and Difficulties Questionnaire

The parent version of the SDQ consists of 25 items rated on a 3-point Likert scale which measures a child's strengths and difficulties (Goodman, 2001). The subscales of the SDQ include emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. The total scores of the four subscales, excluding prosocial behavior, can be used as general difficulties. Expect for the prosocial behavior, higher scores indicated higher difficulties. Moriwaki and Kamio (2014) evaluated the reliability and validity of a Japanese version of the SDQ.

C) Spence Children’s Anxiety Scale (SCAS)

The parental version of the SCAS was used to measure anxiety symptoms in children and adolescents (Nauta et al., 2004). The parent version of the SCAS is a 38-item scale rated on a 4-point Likert scale, and the total scores were used to assess anxiety symptoms. The reliability and validity of the Japanese version of the SCAS were confirmed by Ishikawa et al. (2014).

D) Depression parent-rating scale for children (DPRS)

The DPRS was used to measure depressive symptoms in children and adolescents. The original items of the Depression Self-Rating Scale (DSRS; Birleson et al., 1987) were used in the DPRS. The DCRS and DPRS consist of 18 items rated on a 3-point Likert scale, and the total scores were used for depressive symptoms. The reliability and validity of the Japanese version of the DSRS, and Kishida et al. (2006), as well as the reliability and validity of the DPRS were confirmed by Kishida et al. (2021).

E) Affective reactivity index parent-report (ARI)

The parent-rated version of ARI has been used to measure irritability in children and adolescents (Stringaris et al., 2012). The ARI is a six-item scale rated on a 3-point Likert scale, and the total scores were used to measure irritability in children and adolescents. Takahashi and Kishida (2020) confirmed the reliability and validity of the Japanese version of the ARI.

Statistical plan

The first purpose of this study was to examine the reliability and validity of the J-DBDRS. Confirmatory factor analysis was conducted using the weighted least squares mean and variance adjusted (WLSMV) estimation. The four-factor model was evaluated based on the previous studies (Lee et al., 2022; Zuddas et al., 2006). The model was a four-factor structure with nine items of ADHD inattention of ADHD loaded on the first factor, nine items of ADHD hyperactive/impulsivity of ADHD loaded on the second factor, eight items of ODD loaded on the third factor, and fifteen items of CD loaded on the fourth factor. In the Model, the factors correlated with each other. The model was evaluated using goodness-of-fit indices. Specifically, we used the GFI, adjusted goodness-of-fit index (AGFI), Comparative Fit Index (CFI), Normed Fit Index (NFI), and Root Mean Square Error of Approximation (RMSEA). According to statistical handbooks on covariance structure analysis and structural equation modeling (Toyoda, 2007, 2014), for all four indices except RMSEA, a value of 0.95 or higher indicates a good fit, while lower values for RMSEA indicate a better fit. Additionally, the RMSEA was judged to indicate a good fit at 0.05 or less. Subsequently, internal consistency and test-retest reliability were calculated for the reliability of the DBDRS subscales. To examine differences by gender (boys and girls) and developmental stage (children and adolescents), a two-factor analysis of variance was conducted using the scores on each subscale of the DBDRS as the dependent variable, as well as gender and developmental stage as independent variables.

Then, the estimated prevalence of ADHD (inattention, hyperactivity/impulsivity, mixed, and any type), ODD, and CD was calculated based on the diagnostic algorithms of the DBDRS (https://ccf.fiu.edu/research/_assets/dbd-rating-scale.pdf) and DSM-5-TR (APA, 2022). If six or more items of the eight items for Inattention type of ADHD were endorsed as "pretty much" or "very much" to meet the criteria and the child did not have ADHD-HI, the child is diagnosed as Inattention type of ADHD. If six or more items of the eight items for Hyperactivity/impulsivity type of ADHD were endorsed as "pretty much" or "very much" to the meet criteria and the child did not have ADHD-IA, the child would be diagnosed as Hyperactivity/impulsivity type of ADHD. If a child matched both types of ADHD, the child was classified as having combined ADHD. If a child matched for Inattention, Hyperactivity/impulsivity, or a combined type of ADHD, the child was classified as having any type of ADHD. If four or more times of the nine items for ODD endorsed as "pretty much" or "very much" to the meet criteria, the child would be diagnosed as ODD. If three or more items of the 15 items for CD endorsed as "pretty much" or "very much" to meet the criteria, the child would be diagnosed as CD. Differences in prevalence were tested using the χ² test for gender and developmental stage.

Finally, hierarchical multiple regression analyses were performed to examine the relationship between ADHD, ODD, CD, and each symptom (anxiety, depression, and irritability). First, correlation coefficients were calculated for the DBDRS subscales of anxiety, depression, and irritability. Subsequently, a hierarchical multiple regression analysis was conducted using ADHD-IA (inattention of the ADHD) as the dependent variable. Gender (boys) and developmental stage (children) were entered in Step 1, other symptoms of the DBDRS (ADHD-HI, ODD, and CD) in Step 2, and SCAS, DPRS, and ARI in Step 3. If Steps 2 or 3 were significantly increased and the standardized regression coefficient from the symptoms was small (.20) or larger, the variable was considered to be the mental symptoms associated with ADHD-IH. The same analyses were conducted for ADHD-HI, ODD, and CD groups. Statistical analyses were performed using R version 4.3.1 (Package lavaan) for confirmatory factor analysis and IBM SPSS Statistics for Windows version 29 for the other analyses.

Participants

Among the 2606 participants in the survey, 2442 (93.70%) were included in the analyses after the missing data were excluded. Among these parents, 1343 were mothers/females and 1099 were males/fathers, and the mean age was 44.46 years (SD = 5.95). In addition, among these children and adolescents, 1168 were girls and 1274 were boys and the mean age was 11.20 years (SD = 2.54). Then, for the longitudinal survey used to examine the test-retest reliability of the J-DBDRS, 1566 participants were included in the analysis after the missing data were excluded.

Confirmatory factor analysis and reliability

Confirmatory factor analysis using WLSMV estimation were conducted to examine the four models of the J-DBDRS. The results showed the four-factor model was well fitted: χ² = 2854.232, df = 733, GFI = 0.963, AGFI = 0.959, CFI = 0.967, NFI = 0.955, and RMSEA = 0.033 (90% CI: 0.032 to 0.035). Subsequently, for the factor loadings of each factor, sufficient values were found: 0.67 to 0.73 for 18 items for ADHD-IA, 0.53 to 0.71 for ADHD-HA, 0.61 to 0.76 for eight items for ODD, and 0.37 to 0.74 for CD. Strong positive correlations were found between ADHD-IA and ADHD-HA (r = .83), strong positive correlations between ADHD-IA and ADHD-HA, and ODD (r = .76 and r = .74, respectively), and moderate to strong positive correlations between CD and ADHD-IA, ADHD-HI, and ODD (r = .52, r = .64, and r = .67, respectively). The factor loadings and correlations between the factors are presented in Table 1. Internal consistency was then examined, and results showed high reliability for all subscales (ADHD-IA was α = .90, ADHD-HI was α = .85, ODD was α = .88, and CD was α = .88). The test-retest reliability of each subscale was examined and showed high reliability for ADHD-IA (r = .71, ICC (1, 2) = .83), ADHD-HI (r = .68, ICC (1, 2) = .81), and ODD (r = .69, ICC (1, 2) = .81). However, moderate reliability was observed for CD (r = .48, ICC (1, 2) = .64). In summary, the structural validity, internal consistency, and test-retest reliability of the J-DBDRS were confirmed.

Descriptive statistics of the DBDRS

　To examine the differences according to gender and developmental stage, a two-factor analysis of variance was conducted. The results showed a significant main effect of gender on ADHD-IA and ADHD-HI scores (F (1, 2438) = 21.17, p < .001 and F (1, 2438) = 28.43, p < .001, respectively) and the symptoms of boys were higher than those of girls. Then, a significant main effect of stage on ADHD-IA, ADHD-HI, and ODD scores (F (1, 2438) = 33.44, p < .001; F (1, 2438) = 121.56, p < .001; and F (1, 2438) = 31.49, p < .001, respectively) and the symptoms of children were higher than those of adolescents. Besides, A significant interaction was found for AHHD-IA (F (1, 2438) = 4.00, p < .05), ADHD-HI (F (1, 2438) = 13.30, p < .01), and ODD (F (1, 2438) = 5.87, p < .05). The results of the post-hoc analyses indicated the symptoms were higher in children than in adolescents for boys and girls, and furthermore the symptoms were higher in boys than in girls among children (p < .05). The scores for each subscale and the results of the analysis of variance are presented in Table 2.

Estimated prevalence of ADHD, ODD, and CD

Then, the estimated prevalence of ADHD, ODD, and CD based on the DBDRS were calculated for six categories: ADHD-IA (inattention type), ADHD-HI (hyperactivity/impulsivity type), ADHD-COM (combined type), ADHD-ANY (any type), ODD, and CD. The results indicated that 2.70% for ADHD-IA, 0.37% for ADHD-HI, 1.06% for ADHD-COM, 4.14% for ADHD-ANY, 4.67% for ODD, and 1.68% for CD were shown, respectively. For ADHD-COM and ADHD-ANY, the estimated prevalence was higher in boys than in girls (p < .05; p < .01, respectively). For ODD, boys had a higher prevalence than girls (p < .01), and children had a higher prevalence than adolescents (p < .05). For CD, no significant differences in the estimated prevalence were observed between the genders and developmental stages. The prevalence of each diagnostic criterion and results of the χ² test are shown in Table 3.

Correlation coefficient for each variable

To examine the construct validity of the DBDRS, correlation coefficients were calculated using the subscale and total SDQ-P scores. The results showed that ADHD-IA and ADHD-HI showed moderate-to-high positive correlations with hyperactivity/inattention on the SDQ (r = .66 and r = .56). Additionally, ODD and CD showed moderate-to-high positive correlations with the SDQ conduct problems (r = .70 and r = .60). Furthermore, general difficulties showed moderate-to-high positive correlations with ADHD-IA, ADHD-HI, ODD, and CD (r = .66, r = .60, r = .60, and r = .54, respectively). Thus, the convergent validity of the J-DBDRS was confirmed.

Association between disruptive behavior symptoms, anxiety, depression, and irritability

Hierarchical multiple regression analyses were conducted to identify the association between its symptoms, anxiety, depression, and irritability after controlling for gender, stage, and each symptom. The results indicated that ADHD-HI was moderately and positively related to ADHD-IA (β = 0.50), and ODD was weakly and positively related to ADHD-IA (β = 0.37). The results for ADHD-HI indicated that ADHD-IA was moderately and positively related to ADHD-HI (β = 0.47), and CD was weakly and positively related to ADHD-HI (β = 0.24). The results indicated that ADHD-IA was weakly and positively related to ODD (β = 0.27), and irritability was moderately and positively related to ODD (β = 0.53). The CD results indicated that the ADHD-HI was weakly and positively related to CD (β = 0.35). In summary, ADHD-IA and ODD were related, while ADHD-HI and CD were related. Additionally, irritability was related with ODD, but anxiety and depression were not related to any symptom of DBD after controlling for gender, stage, or other symptoms. The results of the hierarchical multiple regression analyses are presented in Table 4.

The purposes of this study were to examine the reliability and validity of the J-DBDRS; to estimate the prevalence of ADHD, ODD, and CD in Japanese children and adolescents, and to examine the association between its symptoms, anxiety, depression, and irritability. Regarding the reliability and validity of the J-DBDRS, the results confirmed the structural validity for a four-factor structure, internal consistency, test-retest reliability, and convergent validity. For the estimated prevalence of ADHD, ODD, and CD in Japan, 4.14% for ADHD, 4.67% for ODD, and 1.68% for CD were shown. Finally, after controlling for gender, stage, and other symptoms, ADHD-IA (inattention) was associated with ODD and ADHD-HI (hyperactivity/impulsivity) with CD. After controlling for these variables, ODD was associated with irritability.

Confirmatory factor analysis revealed that the four-factor model consisting of ADHD-IA, ADHD-HI, ODD, and CD had good fit indicates. These results are consistent with those of previous studies of the DBDRS (Lee et al., 2022; Zuddas et al., 2006), which confirmed the same four-factor structure. Additionally, the internal consistencies for each subscale of the DBDRS were high (α = .85 ~ .90). However, although test-retest reliability was high for ADHD-IA, ADHD-HI, and ODD (r = .68–.71, ICC = .81–.83), that of the CD subscale was slightly lower (r = .48, ICC = .64). Similarly, a previous study (Zuddas et al., 2006) reported that the reliability for CD was lower (r = .70 for teachers and r = .40 for parents) than for ADHD-IA (r = .94 and r = .89), ADHD-HA (r = .93 and r = .82), and ODD (r = .91 and r = .84). Behavior characteristics of CD, such as lying down, stealing, and delinquent behavior, can occur without the awareness of teachers and parents. Therefore, the reliability of the CD subscale may be lower than that of the other subscales.

This study revealed that the estimated prevalence of ADHD in Japanese children and adolescents was 4.14%, which is within the confidence interval of the worldwide prevalence (Polanczyk et al., 2015). Similarly, the estimated prevalence was 4.67% for ODD and 1.68% for CD, which are also within the confidence interval of the worldwide prevalence (Polanczyk et al., 2015). However, there may be differences in the prevalence of the ADHD subtypes in Japan. Specifically, the prevalence of ADHD-HA (0.37%) was much lower compared to those of ADHD-IA (2.70%) and ADHD-COM (1.06%). Thus, when it comes to subtypes of ADHD, the hyperactivity/impulsivity type may be relatively lower in Japan compared to the inattention type. This study examined the estimated prevalence using a questionnaire survey, and therefore it will be essential to examine the prevalence using semi-structured diagnostic interviews in the future.

The results of hierarchical multiple regression analyses indicated that ADHD-IA and ADHD-HI were moderately and positively related to each symptom (β = .50 and β = .47). These subscales represent the two symptoms of ADHD, and their strong relationship is understandable. Second, ADHD-IA was weakly related with ODD (β = .27), while ADHD-HI was weakly related with CD (β = .35). Previous studies (Newcorn et al., 2001; Zoromski et al., 2015) also reported that inattentive children may have more emotional problems such as anxiety and irritability, while impulsive children might have more conduct and behavioral problems. Next, the results showed a moderate relationship between irritability and ODD (β = .53). Irritability is one of the three symptoms of ODD, and the high correlations between irritability and ODD symptoms are consistent with the previous study results (r = .49, Kishida et al., 2022). Also, a previous study reported that youths with DMDD, who had higher irritability, almost always had ODD (Freeman et al., 2016). Further research is needed on the discriminability of diagnoses and symptoms of ODD and DMDD in children and adolescents.

This study has several limitations. First, it was conducted on a community sample and did not include a clinical group. Further studies are required to determine the prevalence of ADHD, ODD, and CD in clinical groups in Japan. Second, convergent validity using diagnostic interviews was not used. Third, no teacher evaluations were conducted. The differences in symptoms of ADHD, ODD, and CD as viewed by parents and teachers can be crucial information, especially for school-aged children, because they spend much time not only at home, but also school. Finally, the age groups used in this study have some limitations; this study targeted children and adolescents aged 6–15 years old. The applicability of the DBDRS in younger children and older adolescents needs to be further explored.

Despite the above limitations, this study revealed the psychometric properties of the J-DBDRS; the estimated prevalence of ADHD, ODD, and CD; and the relationship between its symptoms, anxiety, depression, and irritability. In the future, it will be necessary to conduct basic research to clarify the psychosocial characteristics, risk factors, and protective factors of ADHD, ODD, and CD using the J-DBDRS. Furthermore, research on psychosocial treatment and prevention of ADHD, ODD, and CD should be conducted for Japanese children and adolescents.

Author Contribution

Each author made the following contributions to this manuscript.Kohei Kishida, PhD: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Investigation, Methodology, Writing – original draft, Writing – review & editingMasami Tsuda, MA: Conceptualization, Data curation, Writing – review & editingShin-ichi Ishikawa, PhD: Conceptualization, Supervision, Writing – review & editing

Acknowledgement

We would like to thank Professor William E. Pelham for approving the translation of the DBDRS into Japanese and validating the Japanese version of the DBDRS. We would like to thank the participants of this study.

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Tables 1 to 4 are available in the Supplementary Files section.

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Psychometric properties of the Japanese version of the Disruptive Behavior Disorders Rating Scale reported by parents and caregivers

Status:

Version 1

Abstract

Introduction

Methods

Participants

A) Disruptive Behavior Disorder Rating Scale (DBDRS)

B) Strengths and Difficulties Questionnaire

C) Spence Children’s Anxiety Scale (SCAS)

D) Depression parent-rating scale for children (DPRS)

E) Affective reactivity index parent-report (ARI)

Statistical plan

Results

Discussion

Declarations

Author Contribution

Acknowledgement

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1