Helping Give Away Psychological Science/Measure OS-CBS

Challenging Behavior Scale (OS-CBS)

General description

History and Development

Competitive Comparison

**GBI tables for comparison

Teenager or young adult filling out a version of GBI about themselves

Target Diagnosis:	Bipolar	Bipolar	Bipolar	Any Mood
Scale	MDQ	GBI-10M	7 Up	GBI-10Da
Shortest	12	10	7	10
Reading Levela	7.3	11.1	11.1	11.1
Languages	13+	25+	4+	25+
Projected d	.40	.43	.36
Projected AUC (95% CI)	.61 (.54 to .67)	.62 (.58 to .67)	.60 (.56 to .65)	.66 (.62 to .70)
Sensitivity at Specificity=.9	.20	.22	.20	.23
DiLR+	2.0 raw 9+	2.2 raw 19+	2.0 raw 11+	2.3 raw 16+
Time Frame	Lifetime	Past year	Past year	Past year

Scoring and Interpretation[edit | edit source]

Computer Administration and Scoring[edit | edit source]

[Here we will put in links to the Assessment center measures once they are cleaned and fixed. I need to ask Eric about what code for the GBI is currently updated and open source online., I will also add some info on the pros and cons of computer vs. paper administration.]

The HGAPS Assessment Center offers online versions of the GBI (both self- and parent-report).

Online Versions of the GBI

Assessment	Language	For Parent/Child/Adult	Link
7 Up-7 Down	English	Adult and Adolescent	7up-7down
General Behavior Inventory	English	Parent	GBI
General Behavior Inventory	Spanish	Parent	GBI
General Behavior Inventory	English	Adult/Adolescent	GBI
General Behavior Inventory 10M	English	Parent	GBI 10M
General Behavior Inventory Da	English	Parent	GBI Da
General Behavior Inventory Da	Spanish	Parent	GBI Da
General Behavior Inventory Db	English	Parent	GBI Db

Scoring Instructions[edit | edit source]

General Behavior Inventory/Parent-General Behavior Inventory[edit | edit source]

In Depue's anchor paper, the original 73 item version of the GBI used case scoring, where items were given values ranging from 1-4. Symptoms that were rated as 1 or 2 were considered to be absent and symptoms rated as 3 or 4 were considered to be present. However, as the GBI was developed over time, the authors of the measure decided to use Likert scaling instead of the dichotomous “case scoring,” to increase the sensitivity of the measure while remaining reliable. The items on the GBI and PGBI are now scaled from 0-3 rated as 0 (never or hardly ever present), 1 (sometimes present), 2 (often present), and 3 (very often or almost constantly present).This same scale is used for all of the GBI short forms as well.

When Depue factor analyzed the GBI, he found that GBI could be spilt into either two or three factors, which became the scales of the GBI. In both factor models, one of the factors, the depression scale, stayed consistent. The depression scale of the full length GBI/PGBI consists of a sum score of the following 46 items: 01, 03, 05, 06, 09, 10, 12, 13, 14, 16, 18, 20, 21, 23, 25, 26, 28, 29, 32, 33, 34, 36, 37, 39, 41, 44, 45, 47, 49, 50, 52, 55, 56, 58, 59, 60, 62, 63, 65, 67, 68, 69, 70, 71, 72, 73.

In the two factor model, the other factor was the hypomanic/biphasic scale of the full length GBI/PGBI, which consists of a sum score of the following 28 items: 02, 04, 07, 08, 11, 15, 17, 19, 22, 24, 27, 30, 31, 35, 38, 40, 42, 43, 44, 46, 48, 51, 53, 54, 57, 61, 64, 66. (Note that item 44 was included in both the depression and the hypomanic/biphasic scale of Depue's scoring due to factor cross-loading.) This two factor model with the depression scale and the hypomanic/biphasic scale is recommend by Depue for scoring and is used in most research on the full-length GBI.

In the three factor model, the items in the hypomanic/biphasic scale above loaded into two separate factors that Depue labeled the hypomania scale and the mixed scale. The hypomania scale of the full-length GBI consists of a sum score of the following 21 items: 04, 07, 08, 11, 15, 17, 22, 27, 30, 31, 38, 42, 43, 44, 46, 51, 54, 57, 61, 64, 66. The mixed scale of the full-length GBI consists of a sum score of the 7 following items: 02, 19, 24, 35, 40, 48, 53. (Note that in the 3 factor model, item 44 was still included in both the depression and the hypomania scale of Depue's scoring.)

Research by Youngstrom et al. further supports using the depression and biphasic/hypomanic scales for scoring and analysis. As part of that analysis, they grouped the 73 items into twenty parcels with three or four similar items each, 8 parcels containing items with hypomanic/biphasic content and 12 parcels with depressive items. Those 20 parcels are listed both in the figures on the short forms above and in the table below.

Missing Data[edit | edit source]

If the client/research participant did not answer every question, the GBI/PGBI can still be scored as long as they filled out 80% of the measure or scale being scored. If at least 80% of the items are present, prorate the summed score of the items they rated to the full length of the scale (equivalent to mean imputation). To do this, find the mean of the answered items by dividing the sum score of the answered items by the number of answered items. Then, multiply this average item score by the total number of items in the measure to find the prorated score. For the full length GBI/PGBI, this should be done for both the depression and hypomanic/biphasic scales as both are used for interpretation of the measure.

GBI/PGBI Short Forms[edit | edit source]

Like the current version of the full length GBI/PGBI, the GBI/PGBI 10 Item Short Forms: Mania, Depression A, Depression B, GBI 7 Up 7 Down Inventory, and PGBI Sleep Sub-Scale are scored on a Likert scale ranging from 0-3 with 0 as "never or hardly ever present", 1 as "sometimes present", 2 "often present", and 3 "very often or almost constantly present". If given as a standalone measure, the short forms are scored as a sum of all of the items.

The items to extract from the full GBI for each short form are as follows:

• 10 item Mania: 53, 54, 4, 11, 22, 40, 27, 19, 64, 31.
• 10 item Depression Form A: 3, 45, 68, 16, 56, 13, 5, 20, 50, 59.
• 10 item Depression Form B: 34, 14, 63, 72, 62, 9, 23, 6, 32, 18.
• 7 Up: 22, 31, 30, 64, 43, 46, 38.
• 7 Down: 23, 34, 63, 47, 56, 62, 73.
• Sleep Subscale (7 items): 5, 15, 18, 25, 31, 37, 52.

The expandable and sortable table below of all items in the full length GBI shows the overlap of items across the different short forms, along with the item content, Depue subscale designation, and parcel classification. Please note that the content column includes the text from the parent-report version of the GBI. For the self-report version, the content of items are the same except the language of "your child," "he/she," or "him/her" is written as "you" and "your child's" or "his/her" as "your."

Item #	10 Item Mania	10 Item DepA	10 Item DepB	Sleep Subscale	7Up-7Down	Depue's 2 factor model	Depue's 3 factor model	Parcel	Parcel Label	ExpandContent

Interpretation of Scores[edit | edit source]

General Behavior Inventory/Parent-General Behavior Inventory[edit | edit source]

Along with the raw score, the percent of max possible (POMP) score can be used for interpretation. To find this score, divide the raw sum score by the maximum possible score for the measure/scale and multiply that decimal by 100. For the full length GBI/PGBI if the 0-3 scale is used, the maximum possible score for the total measure is 219, the maximum possible score for the depression scale is 138, and the maximum possible score for the hypomanic/biphasic scale is 84. The raw scores and the POMP are both meaningful: the higher the raw score/POMP on the depression scale, the higher the likelihood of a mood disorder; the higher the raw score/POMP on the hypomanic/biphasic scale, the higher the likelihood of BSDs. While clinicians can look at the score of the whole measure to get a sense of the overall intensity of symptoms, looking at the individual depression vs. hypomanic/biphasic scales will give clinicians more accurate information on if the client is likely dealing with a BSD or other mood disorders like depression. There are currently not normed scores or published Diagnostic Likelihood Ratios for the full length GBI/PGBI.

GBI/PGBI Short Forms[edit | edit source]

Nomogram for combining likelihood ratios and probabilities Like with the full length GBI/PGBI, both the raw score and the percent of max possible (POMP) score can be used for interpretation. The method to calculate the POMP is described above. For the 10 item short forms (10 item Mania, Depression 10A, and Depression 10B), the maximum possible score is 30. For the 7 Up, 7 Down short forms, the maximum possible score is 42 for the measure overall and 21 for individual up and down scales. The higher the raw score or POMP score of the Depression 10A, Depression 10 B, and 7 Down scale, the higher the likelihood of a mood disorder. The higher the raw score or POMP score of the 10 item Mania form or the 7 Up scale, the higher the likelihood of BSDs. For the sleep subscale, the maximum possible score is 21. Research suggests that the higher the raw/POMP score on the sleep subscale, the higher the likelihood of not only mood-related sleep problems but also BSDs. However, more research is needed to confirm this finding.

In addition to the raw scores and POMP scores, clinicians can also use Diagnostic Likelihood Ratios (DiLRs) to help them interpret GBI/PGBI short form scores. DiLRs are the ratio in a given score range of the percentages of cases of people with versus without the target condition. This makes DiLRs a helpful and practical guideline for calculating the odds of a client having a certain disorder. The DiLRs can also be combined with previous information to update the probabilities of diagnoses for individual cases, either mathematically using Bayes' Theorem or visually using a probability nomogram as shown to the left.

Parent-Report GBI/PGBI Short Forms Multilevel diagnostic likelihood ratios (DiLR)
Measure Title	Risk Change Label	Very Low	Low	Neutral	High	Very High
PGBI 10M for Bipolar	Score Range	0 to 2.59	2.6 to 6.99	7 to 10.99	11 to 17.99	18+
	DiLR	.07	.41	1.44	2.39	5.38
PGBI 10DepA for Any Mood	Score Range	0 to 1.99	2 to 5.99	6 to 9.99	10 to 14.99	15+
	DiLR	.25	.71	1.85	4.52	8.80
PGBI 10DepB for Any Mood	Score Range	0 to 1.99	2 to 5.99	6 to 10.99	11 to 14.99	21+
	DiLR	.22	.71	2.69	5.64	8.09

*DiLRs based on a sample of 617 youth, 5 to 18 years of age, seeking outpatient mental health services at an academic medical clinic. The 10M DiLR predict the probability of a bipolar spectrum disorder (bipolar I, II, cyclothymic disorder, or Other Specified Bipolar and Related Disorder. The 10DepA and 10DepB DiLR predict any mood disorder (including major depression, dysthymic/persistent depressive disorder, and Other Specified Depressive Disorder as well as bipolar disorders).

Self-Report GBI short forms Multilevel diagnostic likelihood ratios (DiLR)
Measure Title	Risk Change Label	Low	Neutral	High	Very High
GBI 10M for Bipolar	Score Range	0 to 9.99	10 to 14.99	15+	N/A
	DiLR	0.71	1.04	2.05
GBI 7-Up for Bipolar Score	Score Range	0 to 1.99	2 to 13.99	14+	N/A
	DiLR	0.55	1.02	2.68
GBI 10DepA for Any Mood	Score Range	0 to 5.99	6 to 15.99	16 to 21.99	22+
	DiLR	0.54	1.23	1.76	4.74
GBI 10DepB for Any Mood	Score Range	0 to 5.99	6 to 16.99	17 to 20.99	21+
	DiLR	0.52	1.19	2.55	5.33
GBI 7-Down for Any Mood	Score Range	0 to 2.99	3 to 11.99	12 to 15.99	16+
	DiLR	0.51	1.22	2.20	6.5

*DiLRs based on a sample of 427 youth, 11 to 18 years of age, seeking outpatient mental health services at an academic medical clinic. The 10M and 7-Up DiLRs predict bipolar I, II, cyclothymic disorder, or Other Specified Bipolar and Related Disorder. The 10DepA, 10DepB, and 7-Down DiLRs predict any mood disorder (including major depression, dysthymic/persistent depressive disorder, and Other Specified Depressive Disorder as well as bipolar disorders).

Using the GBI to measure treatment response[edit | edit source]

The GBI has been used in several treatment studies, and it shows good sensitivity to treatment effects. The 10 item versions in particular are brief enough to be repeated during the course of treatment, but show similar effect sizes to interview-based ratings in research studies. The 7 Up-7 Down scales have not been tested in an extracted, standalone format in treatment studies yet.

Here are benchmarks for evaluating change during treatment:

	Benchmarks*			Critical Change (Raw Scores)			Minimal Important Difference
Measure	Away	Back	Closer	95%	90%	SEdifference	(MID) d ~.5
PGBI-10Ma	1	9	6	6	5	3.2	3
PGBI-10Daa	--	7	4	6	5	3.0	3
PGBI-10Dba	--	7	4	6	5	2.9	3
AGBI-10Mc	--	14	7	6	5	3.1	3
AGBI-10Dac	--	18	7	6	5	3.2	3
AGBI-10Dbc	--	16	7	6	5	2.9	4
7 Upc	--	8	4	4	4	2.2	3
7 Downc	--	12	5	5	4	2.3	3

*The benchmarks are based on clinical and nonclinical norms, following the "clinically significant change" model by Jacobson and colleagues.

Reliability and Validity

Reliability

Reliability

			Challenging Behavior	Property Desctruction	Aggression	Conduct	Self-Injury	Elopement
ASD only Sample	Alpha	Projected	.848	.846	.846	.846	.866	.886
		Actual	.914	.901	.912	.899	.913	.923
	Correlation	Projected	.893	.902	.902	.891	.891	.928
		Actual	.949	.954	.941	.952	.952	.961
Population Sample	Alpha	Projected	.848	.846	.846	.846	.866	.886
		Actual	.881	.875	.879	.851	.856	.883
	Correlation	Projected	.893	.902	.902	.891	.891	.928
		Actual	.944	.948	.932	.943	.953	.944

Validity

The validity of the GBI has been heavily researched. When the GBI was first validated, researchers found that the GBI kept false positives low and was especially good at finding non-cases of depression, hypomania, or biphasic behavior. Additionally, the GBI was found to weed out neurotic patients or simply unhappy patients from depressed, hypomanic, or biphasic patients. Further studies support the GBI’s discriminative validity. One such study found that the GBI discriminated well between cyclothymes, dysthymes, non chronic major depressives, and patients with nonaffective disorders. The GBI correctly identified 88% of total cases. More specifically, the GBI correctly identified “All of the cyclothymes, 92% of dysthymes, 75% of the non chronic major depressives, and 87% of the patients with nonaffective disorders” (Outpatient study). Furthermore, the GBI was found to have good sensitivity and reliability when evaluating children and adolescents. Both the depression scale and the hypomanic/biphasic scale produced an AUC of .82 when discriminating between bipolar spectrum disorder and all others

Validity in special populations

N = 951 ASD individuals (see suplement in draft)

Links

• PubMed Search -- A current search of the GBI on PubMed, a free database that covers medicine (so some articles published in psychology journals might be missing). The entries will usually include abstracts, and sometimes will include a version of full text (especially if the project was grant funded). The search is designed to be highly specific (i.e., not including lots of irrelevant articles), but it might miss some articles.
• The Open Translations Project (TOpTraP) -- an effort to gather the translated versions of the best free measures in one place. The GBI 10 item mania and depression scales are available in more than two dozen languages; the full length version is available in several.
• EffectiveChildTherapy.Org information on Bipolar Disorder -- a website built for families to learn more about ways to improve social, emotional, and academic life for youths
• Society of Clinical Child and Adolescent Psychology -- the professional society for psychologists focusing on helping youths and families dealing with emotional and behavioral challenges

Appendices

Suggested Citation for Measures[edit | edit source]

Self report GBI, full length version

Depue, R. A., Slater, J. F., Wolfstetter-Kausch, H., Klein, D. N., Goplerud, E., & Farr, D. A. (1981). A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: A conceptual framework and five validation studies. Journal of Abnormal Psychology, 90, 381-437. https://doi.org/10.1037/0021-843X.90.5.381

and if using specifically in teens:

Danielson, C. K., Youngstrom, E. A., Findling, R. L., & Calabrese, J. R. (2003). Discriminative validity of the General Behavior Inventory using youth report. Journal of Abnormal Child Psychology, 31, 29-39.

Parent-report full-length GBI (full length version)

Youngstrom, E. A., Findling, R. L., Danielson, C. K., & Calabrese, J. R. (2001). Discriminative validity of parent report of hypomanic and depressive symptoms on the General Behavior Inventory. Psychological Assessment, 13, 267-276.

10 Item Mania and Depression forms

Parent-report

Youngstrom, E. A., Van Meter, A. R., Frazier, T. W., Youngstrom, J. K., & Findling, R. L. (2018). Developing and validating short forms of the Parent General Behavior Inventory Mania and Depression Scales for rating youth mood symptoms. Journal of Clinical Child & Adolescent Psychology. https://doi.org/https://doi.org/10.1080/15374416.2018.1491006

Self report

Youngstrom, E. A., Perez Algorta, G., Youngstrom, J. K., Frazier, T. W., & Findling, R. L. (2020). Evaluating and Validating GBI Mania and Depression Short Forms for Self-Report of Mood Symptoms. Journal of Clinical Child & Adolescent Psychology, 1-17.

7 Up-7 Down

Youngstrom, E. A., Murray, G., Johnson, S. L., & Findling, R. L. (2013). The 7 Up 7 Down Inventory: A 14-item measure of manic and depressive tendencies carved from the General Behavior Inventory. Psychological Assessment, 25, 1377-1383. https://doi.org/10.1037/a0033975

Sleep scale

Meyers, O. I., & Youngstrom, E. A. (2008). A Parent General Behavior Inventory subscale to measure sleep disturbance in pediatric bipolar disorder. Journal of Clinical Psychiatry, 69, 840-843. https://doi.org/ej07m03594

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