Professional Psychology: Research and Practice © 2012 American Psychological Association

2012, Vol. 43, No. 6, 641– 649 0735-7028/12/$12.00 DOI: 10.1037/a0027324

Assessment of Disruptive Behavior Disorders: Tools and Recommendations

Cliff McKinney and Melanie Morse

Mississippi State University

Distinguishing between disruptive and normative behavior is a challenging task. How to best assess for
disruptive behavior in children and adolescents is a significant question encountered by many profes-
sionals. The purpose of this review is to summarize the existing research regarding reliable and valid
tools for assessing disruptive behavior disorders. Following a summary of these various tools available
to clinicians, recommendations for the assessment of disruptive behavior disorders are suggested. These
recommendations include ideal situations where comprehensive assessments may be conducted as well
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

as situations where resources may be limited. Clinicians must conduct as thorough of an assessment as
This document is copyrighted by the American Psychological Association or one of its allied publishers.

feasible so that accurate diagnoses and recommendations may be made to inform treatment.

Keywords: disruptive behavior, assessment, etiology, children, adolescents

Most individuals have seen a child acting out or have heard of
a teenager in trouble with the law. After all, kids will be kids,
right? However, the distinction between normative behavior and
clinically disruptive behavior must be determined with a proper
assessment. What factors must a clinician take into account when
assessing for disruptive behavior disorders (DBDs), which include
oppositional defiant disorder (ODD), conduct disorder (CD), and
attention deficit/hyperactivity disorder (ADHD), and what tools
are available to assess those factors? To answer the question at
hand, the current review begins with an exploration of develop-
mental considerations and the issue of comorbidity. Then, assess-
ment methods are summarized and recommendations for a reliable
and valid assessment are made.
Developmental and Gender Considerations
Assessment of the core features of DBDs in children has proven
to be challenging for several reasons. No precise standard has been
accepted to accurately distinguish these common early childhood
behaviors from behaviors of clinical concern (Wakschlag et al.,
2007). For instance, developmental studies have found that tan-
trums lasting only a couple of minutes are considered normative
behavior for preschoolers (Potegal, Kosorok, & Davidson, 2003),
This article was published Online First March 5, 2012.
CLIFF MCKINNEY received his PhD in clinical psychology from the Uni-
versity of Central Florida. He is an assistant professor of psychology at
Mississippi State University. His research interests include etiology and
assessment of disruptive behavior disorders, parenting, and child adjust-
ment.
MELANIE MORSE received her BA in psychology from Hendrix College.
She is a graduate student in the MS in clinical psychology program at
Mississippi State University. Her research interests include social desir-
ability, self-report of substance use, and multicultural mental health service
delivery.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Cliff
McKinney, Mississippi State University, Department of Psychology, P.O.
Box 6161, MS State, MS 39762. E-mail: cmckinney@psychology
.msstate.edu
whereas prolonged tantrums are characteristic of a clinical disorder
(Wakschlag et al., 2007). Further, disruptive behaviors occur
across the ages and are present normally, to some extent, in
toddlerhood and throughout the teenage years (McKinney & Renk,
2007). Dispute also exists over whether preschool-aged children
are developmentally distinguished enough to receive a DBD diag-
nosis (Keenan & Wakschlag, 2002). Some researchers argue that
atypical behaviors in preschoolers are temporary developmental
disruptions related to the beginning of independence from care-
givers (Keenan & Wakschlag, 2002; Pelletier, Collett, Gimpel, &
Crowley, 2006). Other researchers argue that atypical behaviors
displayed by preschool-aged children should not be used to clas-
sify a behavior problem but to identify a disturbance within the
parent– child relationship (Zeanah, Boris, & Scheeringa, 1997).
To help address these concerns, Wakschlag, Tolan, and Lev-
enthal (2010) argue for a developmentally specific classification
for preschool disruptive behavior. For example, Diagnostic and
Statistical Manual of Mental Disorders (4th ed.; DSM–IV; Amer-
ican Psychiatric Association, 1994) criteria for DBDs are worded
in a way that may not necessarily reflect behavior in preschoolers
(e.g., a preschooler is unlikely to use a weapon but may hit others).
Wakschlag et al. (2010) further argue that types of aggression
frequently observed among preschoolers (e.g., reactive aggression
as a response to frustration) are developmentally appropriate and
suggest that atypical patterns of temper loss, aggression, noncom-
pliance, and low concern for others among preschoolers merits a
warning sign for parents and clinicians. Given the large debate
about the developmental appropriateness of DBD assessment, the
reader is referred to Wakschlag et al. (2010) for more details.
Despite the controversy, recent studies have found that problem
behavior patterns do begin during the first few years of life (Carter,
Briggs-Gowan, Jones, & Little, 2003). Research on preschool
disruptive behavior finds that early disruptiveness may be distin-
guished from normal childhood behavior as early as 3 years of age
(Moreland & Dumas, 2008). Research shows that parental char-
acteristics, such as psychopathology, stress, and inconsistent and
harsh parenting practices, play a role in the development of DBDs
(Capaldi, Conger, Hops, & Thornberry, 2003; Wakschlag &

641
 642 MCKINNEY AND MORSE
Keenan, 2001). Disruptive behavior problems among preschoolers
also are stable over extended periods of time. Roughly half of
children who exhibit significant behavior problems during the
preschool years continue to demonstrate problems in the future
(Moreland & Dumas, 2008; Pelletier et al., 2006). If left untreated,
disruptive behavior problems are likely to escalate over time and,
in turn, elevate the child’s risk of developing other psychiatric
disorders in adulthood (Pelletier et al., 2006).
Given that the course and symptoms of DBDs may be different
for males and females, gender also must be considered. Although
gender differences may be small, some trends have been identified.
For example, Kroneman, Loeber, Hipwell, and Koot (2009) state
that boys typically display more disruptive behavior than girls
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before puberty, whereas this difference levels off during puberty.
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From early to late adolescence, girls show a faster increase in
symptoms of disruptive behavior compared with boys. Overall,
girls display less disruptive behavior than boys, but girls who are
referred to clinics typically present with more severe behavioral
symptoms than boys. Kroneman et al. (2009) further state that
boys are more likely to show aggression aimed at harming others
physically (e.g., hitting, biting), whereas girls are more likely to
display aggression aimed at harming others socially (i.e., relational
aggression; e.g., spreading rumors or threatening to retract friend-
ship).
Comorbidity
Another complication with the diagnosis of DBDs in children
deals with the frequent overlap in symptoms among ODD, CD,
and ADHD (Pelletier et al., 2006). Research suggests that over half
of the children who meet criteria for ODD or CD also meet criteria
for ADHD (Pelletier et al., 2006). This finding poses a concern
about whether symptoms of ADHD, ODD, and CD should be
considered as separate constructs or as multiple dimensions of the
same construct (Pelletier et al., 2006). For example, research
suggests distinct differences in the expression of ODD and CD in
children with and without ADHD, where children with comorbid
diagnoses experience higher rates of ADHD symptom severity,
delinquent behavior, and overt aggression (Connor & Doerfler,
2008). Additionally, research indicates that ODD is predictive of
future CD, and that ADHD is predictive of future ODD and CD
(Pardini & Fite, 2010), suggesting that these disorders may be
related to developmental pathways or common etiologies (e.g.,
atypical brain development; Kaplan, Dewey, Crawford, & Wilson,
2001).
Research also suggests a relationship between DBDs and other
disorders. Research finds that children with ADHD in a commu-
nity sample often have one (44%) or more (43%) comorbid dis-
orders (Barkley, 2003). Community samples also suggest that
children with DBDs are more likely to be diagnosed with major
depressive disorder, learning disorders, and communication disor-
ders (McKinney & Renk, 2007). Further, approximately 25% of
clinic-referred children with ADHD also had an anxiety disorder.
Research on the comorbidity of ADHD and bipolar disorder is
inconclusive, although some studies have found comorbidity rates
between 10 –20%. DBDs also may present with associated devel-
opmental and social problems, including motor incoordination and
impaired intellectual and academic functioning (Barkley, 2003).
Assessment Methods
Despite the concerns noted here, clinicians must continue to
assess and diagnose to the best of their abilities. Thus, a discussion
of tools for the assessment of DBDs is presented, followed by
recommendations for their most effective use.
Interviewing Methods
Interviewing methods are a common tool used to assess for a
variety of disorders and include the Kiddie Schedule for Affective
Disorders and Schizophrenia: Present-Lifetime Version
(KSADS-PL) and the Diagnostic Interview Schedule for Children
(DISC). These diagnostic interviews may be administered in 1–2
hr to children and caregivers. In particular, the behavioral supple-
ment of the KSADS-PL is useful to assess for symptoms of
ADHD, ODD, and CD, whereas the other parts of the interview are
useful to assess for comorbid diagnoses. The KSADS-PL has
demonstrated strong psychometrics, including good interrater re-
liability and discriminant and predictive validity (Birmaher et al.,
2009). The DISC has demonstrated strong psychometrics as it is
sensitive to detecting DBDs and has cross-informant agreement
and concurrent and predictive validity (Jewell, Handwerk,
Almquist, & Lucas, 2004).
Rating Scales
Research has found that DBDs may be assessed reliably across
the age range with the use of parent rating scales (Task Force on
Research Diagnostic Criteria: Infancy and Preschool, 2003). Ad-
vantages to using parent report data include that it usually is easy
to obtain, administer, score, and interpret (Reedtz et al., 2008). The
use of parental report also makes it easy for clinicians to establish
a foundation for discussing with parents ways to manage and
reduce disruptive behavior in children (Reedtz et al., 2008). In
addition to parent report, many rating scales also rely on teachers.
Teacher ratings of disruptive behaviors in children are especially
important because teachers commonly give students referrals to
mental health services. Teachers are exposed to groups of children
on a daily basis; therefore, they easily can compare typical and
atypical behaviors among children (Pelletier et al., 2006).
One system that utilizes multiple informants is the Achenbach
System of Empirically Based Assessment (ASEBA). This system
includes the Child Behavior Checklist (CBCL; completed by care-
givers), the Teacher Report Form (TRF), and the Youth Self
Report (YSR). This system is used to assess for behavioral and
emotional problems, and has different forms for different age
groups ranging from preschool age to adulthood. It takes approx-
imately 10 –30 min to complete the various forms (Flanagan,
2005). The ASEBA has demonstrated strong psychometrics, in-
cluding content, criterion-related, and construct validity, and high
test–retest, interrater, and internal consistency reliability (Achen-
bach & Rescorla, 2001; Flanagan, 2005).
The Behavior Assessment System for Children (BASC) is an-
other system that relies on multiple informants and is similar to the
ASEBA. The BASC is designed to assess for emotional and
behavioral disorders among individuals ages 2–25 years and in-
cludes a Teacher Rating Scale (TRS), Parent Rating Scale (PRS),
and Self-Report of Personality (SRP). The BASC has demon-
 DISRUPTIVE BEHAVIOR ASSESSMENT
strated good psychometrics, including concurrent and construct
validity, and high internal consistency, test–retest, and interrater
reliability (Stein, 2007).
The Eyberg Child Behavior Inventory (ECBI) is another rating
scale available to detect the behaviors associated with DBDs in
children that relies on parent report. The ECBI consists of 36
specific problem behaviors and their frequency. The ECBI has
demonstrated concurrent and construct validity as well as good
test–retest and internal consistency reliability across gender, age,
and ethnic groups (Whiston & Bouwkamp, 2003).
The Strengths and Difficulties Questionnaire (SDQ) is a 25-item
measure that may be completed by parents and teachers for chil-
dren age 3–16 years and by children age 11–16 years. The SDQ
has five subscales that assess for emotional symptoms, conduct
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problems, hyperactivity-inattention, peer problems, and prosocial
behavior. An advantage of the SDQ is that it has been translated
into over 60 languages and is a good screening measure, as it is
short, includes positive items, and is easy to score (Stone, Otten,
Engels, Vermulst, & Janssens, 2010). The SDQ has shown good
psychometrics, including construct and concurrent validity, and
high internal consistency and adequate interrater reliability (Stone
et al., 2010).
Other rating scales that assess disruptive behavior and have
adequate psychometrics include the Disruptive Behavior Rating
Scale – Parent Version (Friedman-Weieneth, Doctoroff, Harvey, &
Goldstein, 2009), the Disruptive Behavior Disorders Rating Scale
(Pelletier et al., 2006), the Child and Adolescent Disruptive Be-
havior Inventory (Shipp, Burns, & Desmul, 2010), and the School
Situations Questionnaire (Pelletier et al., 2006). Overall, it is
important to note that discrepancies among informants may be
common and related to mental health issues, social characteristics,
or differences in the amount of time spent with the child (Bingham,
Loukas, Fitzgerald, & Zucker, 2003). Further, although rating
scales are certainly a useful tool in identifying DBDs among
children and adolescents, they should be used only as an aid rather
than a sole determinant in DBD diagnosis (Manning & Miller,
2001).
Observational Assessment
In addition to general behavioral observations that may be done
during testing, at home, or in the classroom, structured diagnostic
observations are an effective standardized tool for identifying
DBDs (Wakschlag et al., 2007). Observed behaviors within the
laboratory have been found to accurately reflect everyday behavior
(Wakschlag et al., 2005). Thus, observational measures of DBDs
function as valuable supplements to parental reports. Observa-
tional methods are particularly important in the assessment of
DBDs in children because they provide relevant information that
the child would not typically disclose on his or her own, enable the
discovery of salient behaviors, distinguish between a child’s typ-
ical and atypical behavior, and allow direct assessment of contex-
tual information (Wakschlag et al., 2007). For example, clinicians
may observe how parents enforce rules with their children, how
children respond to commands and consequences, and how parent–
child interactions contribute to positive and negative behaviors.
Wakschlag et al. (2005) developed the Disruptive Behavior
Diagnostic Observation Schedule (DB-DOS) to serve as a com-
panion to parent-interview methods in the assessment of DBDs in
643
preschoolers. The DB-DOS utilizes two types of observational
methods. The first is a laboratory-based method known as a
“performance-based” task, aimed at obtaining specific clinically
relevant processes in children. Performance tasks may include
simulations, tasks with the child alone, or tasks where the parental
behavior is scripted to systematically elicit the full range of be-
haviors relevant to a particular diagnosis. The DB-DOS also in-
cludes diagnostic observation, which is structured to allow for a
wide range of clinically relevant behaviors to be observed, and
clinical judgment may be used to rate behaviors on a continuum of
atypicality, ranging from normative variation to clinically con-
cerning. The DB-DOS demonstrates good interrater and test–retest
reliability as well as strong predictive and concurrent validity
(Wakschlag et al., 2005; 2007).
Intellectual and Achievement Assessment
Children with DBDs tend to have lower verbal intelligence and
achievement than other children, which may be related to reduced
communication and/or executive functioning skills (Pihl, Vant, &
Assaad, 2003). Deficits in these areas are found in children with
ADHD who frequently experience comorbid DBDs, whereas chil-
dren with only ODD or CD usually do not have these cognitive
deficits (Hogan, 1999). Additionally, learning disorders are comor-
bid with DBDs, as described previously. Due to the evidence
suggesting a link between DBDs and intelligence and achieve-
ment, clinicians may assess intellectual and achievement function-
ing as part of a comprehensive assessment.
The Wechsler series of intelligence tests includes the Wechsler
Preschool and Primary Scale of Intelligence–Third Edition
(WPPSI-III), the Wechsler Intelligence Scale for Children–Fourth
Edition (WISC-IV), and the Wechsler Adult Intelligence Scale–
Fourth Edition (WAIS-IV). The WPPSI-III may be used to assess
children ages 2 years 6 months to 7 years 3 months. The measure
yields scores for Verbal and Performance indices for all ages as
well as a Processing Speed Index for ages 4 years and up. The
Verbal Index and Performance Index scores factor into the Full
Scale IQ score, which has a mean of 100 and a standard deviation
of 15. The Wechsler Intelligence Scale for Children–Fourth Edi-
tion (WISC-IV) and Wechsler Adult Intelligence Scale–Fourth
Edition (WAIS-IV) are similar to the WPPSI-III but are for use
with children ages 6 years to 16 years 11 months, and 16 years and
older, respectively. Verbal Comprehension, Perceptual Reasoning,
Working Memory, and Processing Speed indices load onto the Full
Scale IQ score for both tests. These measures demonstrate excel-
lent psychometrics and are widely used to test the intelligence of
children (Madle, 2005; Maller, 2005).
The Stanford-Binet–Fifth Edition (SB5) is a test of intelligence
and may be used for ages 2 years to 89 years 11 months. The
measure yields a Full Scale IQ score as well as two domain scores
(Nonverbal IQ and Verbal IQ) and five factor indices (Fluid
Reasoning, Knowledge, Quantitative, Reasoning, Visual-Spatial
Processing, and Working Memory). The SB5 was normed on a
large sample and has good psychometrics (Johnson & D’Amato,
2005).
The Kaufman Brief Intelligence Test (KBIT) is another intelli-
gence test that may be used for ages 4 to 90 years. Similar to the
SB5, the KBIT yields Nonverbal and Verbal scores as well as a
Full Scale IQ score. The psychometrics of the Kaufman are good
 644 MCKINNEY AND MORSE
and the measure is a good option for assessing IQ in preschool and
primary schoolchildren (Madle, 2007).
The Woodcock-Johnson Tests of Achievement–Third Edition
(WJ-A-III) is a test of academic functioning for ages 2 to 90 years,
and helps to determine academic strengths and weaknesses. The
standard administration contains 12 subtests assessing reading,
writing, mathematics, and oral language, and provides information
on total achievement and equivalent age and grade levels. The
measure has shown excellent psychometrics and is a first-line
choice for achievement testing among children (Cizek, 2003).
The Wechsler Individual Achievement Test–Third Edition
(WIAT-III) is designed to measure listening, speaking, reading,
writing, and mathematics achievement in children ages 4 years
through 19 years 11 months. A total of 7 composite scores load
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onto the Total Achievement score. The WIAT-III helps inform
decisions regarding eligibility for services or placement for stu-
dents with learning disabilities and has strong psychometrics
(Miller, 2010).
Temperament and Personality Assessment
Some researchers have suggested that temperament in early
childhood forms the basis for personality disorders in adulthood
(Millon, 1996). Perhaps the greatest evidence for the development
of personality disorders is linked to DBDs in childhood (Coolidge,
Thede, Stewart, & Segal, 2002). Research suggests that negative
temperamental factors, including short attention span, are highly
correlated with disruptive behavior (Wakschlag & Keenan, 2001).
Other research suggests that it is the goodness of fit between parent
and child that influences the development of disruptive behavior
(McClowry, Rodriguez, & Koslowitz, 2008). For example, a child
with a negative temperament may not go on to develop disruptive
behavior if the parent has the abilities, supports, and resources to
care for such a child. Clinicians may assess for temperament with
the Dimensions of Temperament Survey–Revised (Canals,
Hernández-Martı́nez, & Fernández-Ballart, 2011).
The Minnesota Multiphasic Personality Inventory (MMPI) for
Adolescents (MMPI-A) is a comprehensive personality assessment
device used to assess psychological functioning in adolescents.
The MMPI-A is for use with adolescents aged 14 to 18 years. The
MMPI-A includes 478 total items from the MMPI and MMPI-2 as
well as items unique to adolescents (i.e., relationships with parents,
sexuality, identity formation). Completion time is about an hour
and the adolescent rates each item as true or false. The MMPI-A
contains seven validity scales, 10 clinical scales, 15 content scales,
clinical subscales, and supplementary scales. Psychometrics for
the MMPI-A is based on the MMPI-2, which shows strong psy-
chometrics (Lanyon, 1995).
The Personality Assessment Inventory for Adolescents (PAI-A)
is similar to the MMPI-A and is for use with ages 12 to 18 years.
The measure contains 264 items and typically takes adolescents
about 45 min to complete and examiners about 15 min to score.
Items are answered on a 4-point scale and load onto corresponding
validity and clinical scales. The PAI-A has strong psychometrics,
including criterion-related validity and good internal consistency
and test–retest reliability (Kade, 2010).
The Coolidge Personality and Neuropsychological Inventory for
Children (CPNI) is a 200-item questionnaire designed to aid par-
ents and clinicians in identifying problematic behaviors in chil-
dren. The CPNI is designed for parent, guardian, teacher, or
immediate-family-member responses and seeks to assess person-
ality disorders, neuropsychological dysfunction, and other clinical
syndromes, including DBDs. The CPNI is measured on a 4-point
Likert scale and has demonstrated high internal consistency and
predictive validity (Coolidge et al., 2002).
Additional Areas of Importance in Determining
Specific Etiologies of DBDs
Should the results of an assessment indicate the presence of a
DBD, the specific etiology must be considered. Environmental or
dispositional factors may contribute separately or simultaneously
to disruptive behavior (McKinney & Renk, 2006, 2007).
Callous-Unemotional Traits
Research has shown a pattern between the presence of callous-
unemotional (CU) traits and DBDs. CU traits are characterized by
a lack of guilt and empathy as well as the manipulative use of
others for personal gain. CU traits are related to conduct problems,
aggression, and delinquency (Frick & White, 2008), and predict
severe and persistent delinquency (Pardini & Fite, 2010). One
measure of CU traits is the Antisocial Process Screening Device
(APSD), which includes 20 items completed by parents, teachers,
or youth (Frick & Hare, 2001). Frick’s (2003) Inventory of
Callous-Unemotional Traits (ICU) is another measure of CU traits.
The ICU is a 24-item measure that can be completed by adoles-
cents, parents, or teachers. The measure consists of 12 positively
and 12 negatively worded questions about the adolescent. Factor
analyses suggest that the ICU evaluates callousness, uncaring, and
unemotional behavior. Hierarchical regression analyses support
the ICU’s ability to predict problematic behaviors and construct
validity was supported by the measurement’s association with the
Big Five personality dimensions (Essau, Sasagawa, & Frick,
2006).
Behavioral Disinhibition
Behavioral disinhibition is another characteristic that should be
assessed in the presence of a DBD. Behavioral disinhibition en-
compasses the tendency to demonstrate boldness, approach, and
spontaneity in unfamiliar situations. Research has identified a
relationship between childhood DBDs and behavioral disinhibi-
tion. For example, youth who are unable to inhibit their behaviors
may have a higher threshold for novelty and sensation-seeking
activities, thus leading to disruptive behavior (Hirshfeld-Becker et
al., 2007). The Brief Sensation Seeking Scale (BSSS) is an 8-item
questionnaire designed to assess sensation-seeking in children and
adolescents. The questionnaire contains four scales: Experience
Seeking, Boredom Susceptibility, Thrill and Adventure Seeking,
and Disinihbition. The validity of the BSSS is supported by the
strong correlation between scores on the measurement and mari-
juana use (Essau et al., 2006). The BSSS also may be helpful in
predicting CU traits in adolescents. The APSD also screens for
behavioral disinhibition.
Executive Functioning
Children with DBDs also often have difficulties in executive
functioning, which is defined as the initiation and regulation of
 DISRUPTIVE BEHAVIOR ASSESSMENT
goal-directed behavior, ability to perceive and encode cues in the
environment, and control over impulses. Children with lower
executive functioning are more likely to show disruptive behavior
symptoms compared with children with higher executive function-
ing, and this difference may be due to poor problem-solving and/or
communication skills (Pihl et al., 2003). Kaplan et al. (2001)
suggest that deficits in executive functioning are associated with
ADHD, which poses as a risk factor for the future development of
ODD and CD. Thus, determining if deficits in executive function-
ing are present may help differentiate among various developmen-
tal pathways associated with DBDs. Clinicians may use measures
such as the detour-reaching box (Hughes & Russell, 1993) and the
Tower of London (Shallice, 1982) to assess for executive func-
tioning. These devices assess a child’s ability to develop strategies,
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reach goals, and deal with frustration.
Social Cognition
Social cognition is also a relevant area to assess when a DBD
has been identified. Children with DBDS are likely to perceive
high threat in ambiguous or positive situations and are prone to
display disruptive behaviors when they view their environment as
threatening (Kempes, Matthys, de Vries, & van Engeland, 2005).
For instance, if a child accidentally spills milk on another child,
this child may believe that the action was intentional. This may
lead to a more aggressive response than if the child believed it
happened by accident. Clinicians may use the computer-based
Schedules for the Assessment of Social Intelligence (Skuse, Law-
rence, & Tang, 2005) or the DVD-based Schultz Test of Emotion
Processing–Preliminary Version (Schultz et al., 2010) to assess for
social cognition.
Discussion
The research reviewed in this article is particularly relevant to
clinicians who seek accurate identification of DBDs in children
and adolescents, the teachers responsible for the safety of their
classrooms and the well being of their students, and the parents
raising children with disruptive behavior. Given the large number
of tools available, clinicians must choose carefully in conducting
their assessments. To assist with this, an illustrative example of an
ideal assessment, as well as recommendations for a more practical,
real-world assessment, are provided.
Illustrative Example
Step 1: Obtain informed consent with the legal guardian(s)
and discuss the presenting problem. Obtain a detailed history
and complete a diagnostic interview. The KSADS-PL is recom-
mended, as it assesses for a range of disorders and has a behavioral
supplement that provides a thorough assessment for symptoms of
ADHD, ODD, and CD. Although it always is important to collect
a thorough history for any presenting problem, certain areas may
be especially important to assess when it comes to DBDs. In
particular, sleep patterns should be addressed thoroughly, as lack
of sleep may result in symptoms consistent with ADHD (e.g.,
inattentiveness, difficulty concentrating) and with ODD/CD (e.g.,
irritability, aggressiveness). In addition, the developmental path-
way, as well as course and onset of the disruptive behavior, should
645
be considered closely. For example, some children may develop
disruptive behavior as a child, related to a combination of both
biological and environmental factors, whereas others may develop
disruptive behavior as an adolescent, related to environmental
factors only. Following a thorough history and diagnostic inter-
view, a case conceptualization may be developed.
Step 2: In the first meeting with the guardians, age-
appropriate rating scales may be provided for parents, teach-
ers, and the child to complete. Informants should be instructed
to complete their scales independently so that other informants do
not bias their responses. The ASEBA is recommended, as it
assesses for a range of disorders; may be completed by parents,
teachers, and the child, depending on age; and provides an easy to
interpret cross-informant report. Alternatively, the SDQ may be
recommended, as it is a shorter measure that correlates with the
ASEBA. Results of rating scales may be used to provide confir-
mation of the results of diagnostic interviewing as well as provide
information about additional areas needing follow-up.
Step 3: Meet with the child. Establish rapport by asking
open-ended questions about the child’s interests and expectations
about testing. Engage in an age-appropriate game or activity and
establish age-appropriate rules as necessary, particularly if the
child presents with disruptive behavior. The use of a colorful,
simple rule chart that tracks the child’s progress and allows for
stickers and other relevant rewards to be earned may be particu-
larly useful in managing behavior. If the child is old enough,
developmentally appropriate questions may be asked regarding the
child’s perceptions of the presenting problem. If a rating scale is
completed by the child, it can be used to help structure an inter-
view with the child about his or her thoughts of the problem. This
also is an opportune time to gather behavioral observations of the
child. In meeting with the child, care should be taken in how the
environment is structured. It is not uncommon for individuals
working with children to have a play area, and the child may
behave very differently in an area intended for play compared with
an area that appears more professional. For example, a child may
have greater difficulty regulating behaviors when excitement or
interest in the environment around them is high. Given this, it may
be particularly important to gather behavioral observations of the
child in several different contexts (e.g., school during work and
recess, home during structured and free time, etc.).
Step 4: Complete individual testing with the child. Testing
may begin during the first meeting with the child. The child should
use any aids that are normally available (e.g., glasses, hearing
aids), and the examiner should question the child about his or her
hunger, fatigue, and other characteristics that may be related to the
child’s ability to respond to test items in a valid manner. Guardians
should be encouraged to ensure the child has had a healthy break-
fast or lunch prior to testing. Further, it may be recommended for
the child to be excused from school on testing days so that the
child is not subjected to extended hours of mental activity. At
times, the child also may be taking a medication. It is important
that potential side effects of a child’s medication, such as drows-
iness and difficulty concentrating, are not present during testing.
One major issue with medication and assessment is when the child
is taking medication for ADHD. Should the child be tested while
taking the medication or should the child stop the medication for
the assessment? Active consultation with the guardians and pre-
scribing doctor, along with clinical judgment, assist with this
 646 MCKINNEY AND MORSE
decision. For example, the guardians and the doctor may be
comfortable with continuing the medication, and so it would be
best to obtain information about the child’s abilities while taking
the medication. Alternatively, guardians and the doctor may be
considering reducing the medication or stopping the medication,
and so it would be best to conduct the assessment after the
medication has been discontinued.
After these background characteristics are thoroughly consid-
ered, age-appropriate intellectual and academic assessment may be
completed. It is encouraged to provide as many breaks as neces-
sary so that the child is able to provide his or her best effort, and
intellectual and achievement testing should be completed across
multiple sessions. For example, the child may complete intellec-
tual testing during one session if the child is able to sustain his or
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
her best effort, but, particularly with younger children, intellectual
testing will need to be completed across multiple sessions. Com-
pleting testing across multiple sessions provides the advantage of
gathering additional behavioral observations over time. The
Wechsler series is recommended for intellectual assessment and
the WJ-A-III is recommended for academic assessment. Together,
these tools provide a wealth of information on intellectual and
academic abilities.
Step 5: When a DBD is diagnosed, specific areas (e.g., CU
traits, behavioral disinhibition) should be assessed to help
determine the etiology of the disruptive behavior. Children
may present with DBDs for a variety of reasons, and the specific
areas described previously may all contribute to a particular child’s
presentation.
Step 6: Complete a comprehensive assessment report with
recommendations and meet with the guardians and, if appro-
priate, the child. The goals of most any assessment are to
provide an adequate description and explanation of the problem as
well as to provide as many relevant, specific recommendations to
help improve the child’s functioning in a variety of domains.
Recommendations should begin with the most important issue at
hand and should address areas of weakness as well as strength.
Anyone who receives the results of the assessment should be
provided with a thorough debriefing about the findings, recom-
mendations, and limitations of the assessment. This may be a good
time to complete any relevant release-of-information forms so that
other important individuals may consult about the results of the
report.
Various aspects of a comprehensive assessment may be com-
pleted by individuals with a range of training, including school,
educational, counseling, and clinical psychology. For example,
rating scales may be administered and scored by supervised tech-
nicians, behavioral observations and formal assessment methods
(e.g., intellectual assessment) may be conducted by supervised or
licensed master’s-level clinicians, and interpretation of results and
integrative report writing may be completed by supervised or
licensed doctorate level clinicians, although many settings allow
for this to be done by supervised or licensed master’s-level clini-
cians as well.
When Resources Are Limited
Although a comprehensive assessment accomplishes several
things, many clinicians are faced with making difficult choices
about which tools they are able to use when resources are limited.
For example, managed care may not allow for a costly and time-
consuming assessment, clients may be unable to afford or spend
the time necessary completing such an assessment, and clinicians
may be strapped for time in providing a comprehensive assess-
ment, depending on their caseloads. Thus, it may be necessary to
choose particular tools in an effort to save time and money.
Research investigating the predictive and incremental validity of
assessment methods may assist clinicians in choosing wisely.
In particular, rating scales appear to be an inexpensive and
timely method of assessing not only for DBDs but also for other
possible comorbid disorders. In fact, Granero, Ezpeleta, de la Osa,
and Doménech (2009) suggest that, compared with other methods,
the CBCL is most predictive of disruptive behavior. Further,
Granero et al. (2009) state that clinical interviews with family
members significantly increase predictive validity above using the
CBCL alone. Consistent with this, Odgers et al. (2007) state that
family history of externalizing disorders differentiates life-course
persistent conduct problems from childhood- or adolescent-limited
conduct problems and demonstrates incremental validity above
family and child risk factors. Odgers et al. (2007) suggest that brief
family history questions may assist clinicians in diagnosing chil-
dren with DBDs and identifying children who most need treat-
ment. Behavioral observations also demonstrate significant incre-
mental validity in predicting disruptive behavior above parent and
teacher ratings. In addition to research indicating that formal
observation systems add incremental validity to rating scales (i.e.,
DB-DOS; Wakschlag et al., 2008), informal behavioral observa-
tions also add incremental validity (McConaughy et al., 2010).
Although research suggests that intellectual and academic as-
sessments may help distinguish children with and without DBDs
(Hogan, 1999; Hooper & Evans, 1984; Lewin, Davis, & Hops,
1999; Semrud-Clikeman, Hynd, Lorys, & Lahey, 1993; Willcutt,
Pennington, Chhabildas, Friedman, & Alexander, 1999), less re-
search examines the incremental validity of these tools above
rating scales, interviews, and behavioral observations. Thus, it is
not known if intellectual and academic assessment allows for more
accurate diagnosis above other methods.
Overall, when a comprehensive assessment is not possible, a
briefer assessment including interviews, rating scales, and behav-
ioral observations may provide good clinical utility in diagnosing
DBDs, particularly given the research described here regarding the
effectiveness of ratings scales (Granero et al., 2009), and the
incremental validity of interviews (Granero et al., 2009; Odgers et
al., 2007) and behavioral observations (McConaughy et al., 2010).
It is important to note that even when resources are limited,
clinicians should screen for comorbid disorders (Willcutt et al.,
1999) as part of a DBD assessment. Failing to treat associated
mood and/or academic problems, among others, may severely
limit treatment. Further, clinicians must take into account devel-
opmental and gender considerations, as noted in this article. Cli-
nicians should understand that females may present with different
types of disruptive behavior than males and that some disruptive
behavior may be normative, particularly for toddlers and teenag-
ers. To assist in distinguishing between normative and clinical
disruptive behavior, clinicians are urged to consider degree of
impairment and persistence of the disruptive behavior. For exam-
ple, disruptive behavior that is associated with problems at home,
at school, and/or with peers and that persists beyond normal strives
for autonomy should be considered for clinical significance.
 DISRUPTIVE BEHAVIOR ASSESSMENT
In conclusion, clinicians, teachers, and parents should be aware
that the early identification and treatment of disruptive behavior
problems is likely to reduce, or even prevent, the development of
more serious psychiatric diagnoses in the future. Clinicians should
take care to note the developmental trajectory, gender consider-
ations, and comorbidity of DBDs and other disorders when com-
pleting an assessment. Honing in on these factors may help a
clinician to pick up on symptoms of DBDs that may have other-
wise gone unnoticed. Overall, professionals must conduct as thor-
ough of an assessment as feasible so accurate diagnoses and case
conceptualizations may be made to inform treatment. Once an
accurate assessment has been completed, specific interventions
tailored by the results of the assessment may be implemented.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
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Accepted December 13, 2011 䡲

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