A Test Review: Children’s Depression Rating Scale, Revised (CDRS-R)

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The instrument is considered a clinician-rating scale as opposed to self-reported instrument. When assessing for the depression in children that takes a specific tool created specifically for that …

The instrument is considered a clinician-rating scale as opposed to self-reported instrument. When assessing for the depression in children that takes a specific tool created specifically for that population and construct. All assessment instruments have a purpose and there are technical considerations an assessor must consider when using it. The assessor must be familiar with the tool, understand the purpose for which it is used, how reliable and valid it is, the way it is scored and items needed for assessment, whether the measure has generalizable results, and something about the population on which the instrument was normalized. The Children’s Depression Rating Scale, Revised (CDRS-R) is used to assess depression in children and adolescents ages 6-18 using 17 different areas of assessment. This paper will present a detailed overview of this instrument.

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  • 1. REVIEW CHILDREN’S DEPRESSION Test Review: Children’s Depression Rating Scale, Revised (CDRS-R) Sidney Gaskins Walden University 1
  • 2. REVIEW CHILDREN’S DEPRESSION 2 Abstract The Children’s Depression Rating Scale, Revised (CDRS-R) was modeled after the Hamilton Rating Scale for Depression. The instrument is considered a clinician-rating scale as opposed to self-reported instrument. When assessing for the depression in children that takes a specific tool created specifically for that population and construct. All assessment instruments have a purpose and there are technical considerations an assessor must consider when using it. The assessor must be familiar with the tool, understand the purpose for which it is used, how reliable and valid it is, the way it is scored and items needed for assessment, whether the measure has generalizable results, and something about the population on which the instrument was normalized. The Children’s Depression Rating Scale, Revised (CDRS-R) is used to assess depression in children and adolescents ages 6-18 using 17 different areas of assessment. This paper will present a detailed overview of this instrument.
  • 3. REVIEW CHILDREN’S DEPRESSION 3 Test Review: Children’s Depression Rating Scale, Revised (CDRS-R) The Children’s Depression Rating Scale, Revised (CDRS-R) has been developed to assess depression using 17 categories or areas of assessment. Assessing for depression in children and adolescents can be difficult. Differentiating between anxiety and depression requires tools able to separate the different symptoms and allow for appropriate care to be given. Stark, Kaslow, and Laurent (1993) found that in a group of children depressed, anxious, and comorbid depressed and anxious there was little differentiation between their responses on given measures. The Children’s Depression Rating Scale, Revised (CDRS-R) is able to those 17 categories to narrow the diagnosis. However, to understand whether the instrument is appropriate for a practitioner’s clientele they must conduct research to gather general information, understand the purpose and nature of the instrument, know the technical considerations involved in its use, and evaluate qualifications of users and understand the scoring system used. This paper presents each of the aforementioned as a review of the Children’s Depression Rating Scale, Revised (CDRS-R). I. General Information A. Title: Children’s Depression Rating Scale, Revised (CDRS-R) B. Author: Elva O. Poznanski and Hartmut Mokros C. Publisher: Western Psychological Services, 12031 Wilshire Blvd., Los Angeles, CA 900251251 D. Forms, groups to which applicable: Specifically used to assess depression in children ages 6 to 18 this assessment tool also monitors treatment responses. It can be applied in nonclinical setting such as schools and pediatric clinics (Western Psychological Services, n.d.). This assessment allows the interviewer to rate 17 symptoms: (1) Impaired Schoolwork, (2) Difficulty
  • 4. REVIEW CHILDREN’S DEPRESSION 4 Having Fun, (3) Social Withdrawal, (4) Appetite Disturbance, (5) Sleep Disturbance, (6) Excessive Fatigue, (7) Physical Complaints, (8) Irritablilty, (9) Excessive Guilt, (10) Low SelfEsteem, (11) Depressed Feelings, (12) Morbid Ideation, (13) Suicidal Ideation, (14) Excessive Weeping, (15) Depressed Facial Affect, (16) Listless Speech, and (17) Hypoactivity. (Western Psychological Services, n.d.). The CDRS-R has been successfully translated into German and Hebrew (Keller, Grieb, Ernst, Spröber, Fegert, & Kölch, 2011, Zalsman, Misgav, Sommerfeld, Kohn, Brinstein-Klomek, Diller, Sher, Schwartz, Ben-Dor, Wolovik, & Oquendo, 2005). E. Practical features: A nonclinical sample of children was used to derive norms. These children were directly interviewed. Though many self-report measures diagnose, the direct interview process gives the interviewer the opportunity to engage with the child, interact with them in a positive manner, and have treatment evaluation be immediate (Western Psychological Services, n.d.). Due to the client being young this instrument takes into consideration their sensitivity allowing for a semi-structured interview process. The interviewer is provided with a useful guide to conduct the interview with both the child and the parent(s) of the child. F. General type: The CDRS-R, is a diagnostic tool used to assess childhood depression of those aged six to twelve years old and monitor the treatment response. G. Date of publication: The CDRS-R was last revised and published in 1996. H. Costs, booklets, answer sheets, scoring: The CDRS-R price data for the materials necessary are: $99 per the kit including 25 administration booklets and 1 manual; $44 per 25 administration booklet; $60 per manual; and $22 per continuing education questionnaire and evaluation form (Western Psychological Services). Each area assessed is rated on a 7-point scale which makes it easy to observe symptoms. On the scale 7 represents severe clinical difficulties while 1 indicates the lack of difficulties. The assessment also integrates information from other sources such as
  • 5. REVIEW CHILDREN’S DEPRESSION 5 parents and school personnel. I. Time required to administer: The time needed to administer this assessment is between 15-30 minutes. This estimate includes both administration and scoring of the interview. Though there are no stated training requirements the detail required to administer and to score the instrument appropriately does call for an appropriately trained mental health professional (Nezu, Ronan, Meadows, & McClure, 2000). J. Purpose for which evaluated: For use with youth ages 6-18 years old who are placed in the custody of the department of children services or involved with juvenile justice and are in need of mental health services. II. Purpose and Nature of the Instrument A. Stated purpose: The Children’s Depression Rating Scale was modeled after the Hamilton Rating Scale for Depression and is used specifically to screen for and diagnose depression and as a way to monitor treatment responses in youth ages six to twelve years old. It can also detect slight, notable changes in and severity of symptoms (Western Psychological Services, n.d.; Wolfe, & Mash, 2006). B. Description of test, items, and scoring: The CDRS-R is a multi-report instrument. It has selfreport, parental interview, and teacher interview instruments to gain a well-rounded view of the youth. There are 17 symptom areas that are assessed 14 of which are rated on a 7-point scale and three rated on a 5-point scale. Those rated on a 7-point scale, a 2 indicates that there may be a problem but it is not clinically significant, ratings between 3-7 indicate clinically significant problems in the assessed area (Nezu, et al., 2000). Within the instrument, a clinician can add comments about the rated symptom below each item. All 17 items produce the Summary Score for this instrument. T-scores between 55-64 indicate further evaluation, any score > 65 indicates
  • 6. REVIEW CHILDREN’S DEPRESSION 6 a likely depressive disorder (Lam, Michalak, & Swinson, 2005). C. Use in counseling: The use of CDRS-R as a screening and diagnostic instrument is only one aspect of how it can be used for counseling. While it is a self-report instrument, the nature of the instrument is that the assessor interviews the client that allows for direct interaction and engagement. This can add to the development of the therapeutic alliance and provide positive interaction for a child who may be withdrawn (Western Psychological Services, n.d.). There is a manual and rating form available, each copy of the rating form contains information about scoring and interpretation, and the manual provides a guide for parent interviews (Verhulst & van der Ende, 2006). III. Technical Considerations A. Normative sample: Two hundred thirty-three school children were used to standardize the ratings for the CDRS-R. The T-scores for this derived from the Summary Score being converted (Verhulst & van der Ende, 2006). For the clinical sample, the mean T-score for depressive disorders as 71, the nonclinical sample was 53. Children who did not report suicidality, in the nonclinical sample, the range was from 1.2 (SD = 0.6) to 2.1 (SD = 1.0), and from 1.6 (SD = 0.9) to 3.2 (SD = 1.3). Disturbances in appetite were the least severe, and morbid ideation, the most. Child interviews in the sample of symptom area means ranged from 1/5 (SD = 1.0; appetite disturbance) to 3.7 (SD = 1.7; low self-esteem). The German translation was tested on 60 inpatients (26 female, 34 male) between the ages of 7.5 to 17.9 (M = 13.9, SD = 2.9) (Keller et al., 2011). B. Reliability: Verhulst and van der Ende (2006) reports that in a 2-week interval, test-retest for the Summary Scores there is .80, that in a group of school age that the instrument Summary score has a Cronbach’s alpha of .85, and between two clinician was .92. According to Nezu, et
  • 7. REVIEW CHILDREN’S DEPRESSION 7 al. (2000). In the clinical sample item-total correlations ranged from .28 (impaired schoolwork) to .78 (depressed feelings), and the range was from .26 (appetite disturbance) to .71 (depressed facial affect) in the nonclinical sample. Four psychiatrists who specialize in working with children conducted the initial interviews, two psychiatrists corated each interview. A clinical sample of children (N = 25) was used to establish interrater reliability. Interrater reliability was shown to be superior (r = .92). Test-retest reliability was established over a 2-week period and proved stability over that time (r = .80). Based on intake and 2-week postintake interviews done by two separate clinicians, clinical sample (N = 52) test-retest reliability was established. The second rater conducted their interviews blind to the initial ratings. C. Validity: Clinician-reported ratings of depression on the CDRS-R Summary score correlated . 87 and .48. The Summary Score on the CDRS-R and that of the Dexamethasone Suppression Test were significantly associated (Verhulst & van der Ende, 2006). D. Generalizability: This author was unable to find information directly pertaining to the generalizability of the instrument. It has been widely used and found to be reliable with children in schools, adolescents with depression, and when translated into German and Hebrew (Keller et al., 2011; Mayes, et al., 2010, Zalsman, et al., 2005) IV. Practical Evaluation A. Qualifications of examiners: Examiners using this tool are recommended to be a clinician educated at an accredited university, having completed a considerable amount of graduate or post-graduate coursework in test interpretation, psychometrics, measurement theory, educational statistics or a closely related area (Australian Council for Educational Research, 2011; Ontario Centre of Excellence for Child and Youth Mental Health, 2011). According to Australian
  • 8. REVIEW CHILDREN’S DEPRESSION 8 Council for Educational Research (2011) examiners should be involved with organizations that require experience in the “ethical and competent use of psychological tests”. B. Scoring provisions: There are 17 symptom areas that are assessed 14 of which are rates on a 7-point scale and three rated on a 5-point scale (Gaskins, 2012). Scoring for this instrument requires that all 17 scores are used to produce a Summary Score, which is a T-score. The score ranges between 17-119, scores between 55-64 indicate the need for further evaluation, those scores > 65 indicate the possibility of depressive disorder (Australian Council for Educational Research, 2012; Lam et al., 2005). If the examiner finds it useful scores from alternative sources such as parents interviews can be compared for each of the 17 areas Specific instructions about how the instrument is scored and interpreted is available in the instrument manual produced by the publisher. V. Evaluation A. Comments of reviewers: Dowd and Stovall (2001) consider the CDRS-R to be an instrument that is well-designed, reliable, and valid due to the studies conducted using the instrument. The use of multiple resources such as parent and teacher input is noted as a strength. In this review the fact that it is a semi-structured instrument was of concern, which as addressed through suggesting that standardize format be followed. Dowd and Stovall (2001) questioned the exclusion of Asian and Native American children from the sample population, caution practitioners working with these populations against its use, and consider this lack of national standardization a weakness. Overholser, Brinkman, Lehnert, and Ricciardi (1995) found that there are a number of symptoms of which can be identified in the interviewing and scoring process that are not specific to depression and proposed the development of a short form. The creation of a short form should include only those symptoms specific to a diagnosis of
  • 9. REVIEW CHILDREN’S DEPRESSION 9 depression. Both of these assessments suggest that there is a need to investigate and improve the norm sample to reflect the population and to address only those symptoms specific to depression in the assessment of a client. B. General evaluation: The CDRS-R is a comprehensive, easily administered instrument that allows the assessor to begin the therapeutic process during the assessment. The ability to interact with a client who is possibly isolated and withdrawn is a unique feature that supports the development of a therapeutic alliance immediately. Interviewing is not an exact science therefore this semi-structured instrument demands an interviewer who is trained, experienced in using this instrument, and is able to systematically follow the instructions outlined in the manual to elicit necessary participation by the client. Though it is considered a reliable and valid instrument in assessing depression in children, was norm sampled with two hundred thirty-three school children, the concern with this instrument is the relatively small norm sample and whether or not this sample was demographically representative of the U.S. population. To answer this question further investigation is necessary. Overall, CDRS-R is an efficient and useful instrument to engage children ages 6-18 in an assessment of the severity of their depression.
  • 10. REVIEW CHILDREN’S DEPRESSION 10 VI. References Australian Council for Educational Research. (2012). Children’s Depression Rating Scale – Revised (CDRS-R). In ACER Shop Online. Retrieved January 13, 2012, from https://shop.acer.edu.au/acershop/group/CDR/28;jsessionid=3B9EE0AB5DA3C63632CE871D95C77C55. Dowd, E. T., Stovall, D. E. (2001). [Review of the Children’s Depression Rating Scale, Revised]. In The fourteenth mental measurements yearbook available from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail? vid=3&hid=25&sid=37adb9bc-c1d6-4268-b256-06c609f0b2bd %40sessionmgr4&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=loh&AN =17073337 Gaskins, S. (2012). Assessing Depression in Youth: Researching the Children’s Depression Rating Scale, Revised (CDRS-R). Keller, F., Grieb, J., Ernst, M., Spröber, N., Fegert, J. M., Kölch, M. (2011). Children's Depression Rating Scale-Revised (CDRS-R): development of a German version and psychometric properties in a clinical sample. Z Kinder Jugendpsychiatr Psychother, 39(3),179-85 Lam, R. W., Michalak, E. E., Swinson, R. P. (2005). Assessment scales in depression, mania and anxiety. Abingdon, Oxfordshire, OX, UK: Taylor & Francis. Retrieved from http://books.google.com/books? id=nET5M3xyiZ0C&pg=PA243&dq=children's+depression+rating+scale&hl=en&sa=X &ei=aI0IT626Jea42wXp1Mm3Aw&ved=0CFwQ6AEwAw#v=onepage&q=children's %20depression%20rating%20scale&f=false
  • 11. REVIEW CHILDREN’S DEPRESSION 11 Mayes, T. L., Bernstein, I. H., Haley, C. L., Kennard, B. D., & Emslie, G. J. (2010). Psychometric properties of the Children's Depression Rating Scale-Revised in adolescents. Journal of Children and Adolescent Psychopharmacology. 20(6), 513-516. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21186970. Nezu, A. M, Ronan, G. F., Meadows, E. A., & McClure K. S. (2000). Practitioner’s guide to empirically based measures of depression. New York, NY: Kluwer Academic/Plenum Publishers. Retrieved from http://books.google.com/books? id=kckLDgTQ1kgC&pg=PA129&lpg=PA129&dq=Children’s+Depression+Rating+Scal e+revised+available+in+spanish&source=bl&ots=QwNY622DsP&sig=pxwoE3iUaKfFf YNPgxZK4IchvQ0&hl=en&sa=X&ei=vowlT9DgC-OysALA6yMAg&ved=0CDgQ6AEwAg#v=onepage&q=Children’s%20Depression%20Rating %20Scale%20revised%20available%20in%20spanish&f=false Ontario Centre of Excellence for Child and Youth Mental Health. (2011). Measure profile: Children's Depression Rating Scale (CDRS). In Ontario Centre of Excellence for Child and Youth Mental Health. . Retrieved January 13, 2011, from http://www.excellenceforchildandyouth.ca/about-learning-organizations/measure-profile? id=74Regents of the University of Colorado. (n.d.). Children's Depression Rating Scale, Revised (CDRS-R). In Center for the Study and Prevention of Violence. Retrieved February 6, 2012 from http://ibs.colorado.edu/cspv/infohouse/vioeval/vioevalDetails.php? recordnumber=609&vio_name=vioeval. Overholser, J. C., Brinkman, D. C., Lehnert, K. L., & Ricciardi, A. (1995). Children's Depression Rating Scale—Revised: Development of a short form. Journal Of Clinical Child
  • 12. REVIEW CHILDREN’S DEPRESSION 12 Psychology, 24(4), 443-452. Stark, K. D., Kaslow, N. J., & Laurent, J. (1993). The assessment of depression in children: Are we assessing depression or the broad-band construct of negative affectivity?. Journal Of Emotional And Behavioral Disorders, 1(3), 149-154. Verhulst, F. C., van der Ende, J. (2006). Assessment scales in child and adolescent psychiatry. Abingdon, Oxon, UK: Informa UK Ltd. Wolfe, D. A., & Mash, E. J. (2006). Behavioral and emotional disorders in adolescents: Nature, assessment, and treatment. New York, NY: Guilford Press. Retrieved from http://books.google.com/books?id=nRzMWqpjpcC&pg=PA324&lpg=PA324&dq=purpose+and+nature+of+children's+depression+ratin g+scale&source=bl&ots=5r2fOlfHwM&sig=7n2WLoBHiodwMFoJXXINnVCsDh4&hl =en&sa=X&ei=EHsIT9i8ENKu2gWZt7CVBg&ved=0CE8Q6AEwBQ#v=onepage&q=p urpose%20and%20nature%20of%20children's%20depression%20rating %20scale&f=false Western Psychological Services. (n.d.). Children's Depression Rating Scale, Revised (CDRS-R). In Western Psychological Services. Retrieved January 2, 2011, from http://portal.wpspublish.com/portal/page? _pageid=53%2C69676&_dad=portal&_schema=PORTAL. Zalsman, G., Misgav, S., Sommerfeld, E., Kohn, Y., Brinstein-Klomek, A., Diller, R., Sher, L., Schwartz, G. S., Ben-Dor, D. H., Wolovik, L., & Oquendo, M. (2005). Children's Depression Inventory (CDI) and the Children's Depression Rating Scale-Revised (CDRSR): Reliability of the Hebrew version. International Journal of Adolescent Medicine and Health. 17(3), 255-257. Retrieved from http://www.mendeley.com/research/childrens-
  • 13. REVIEW CHILDREN’S DEPRESSION 13 depression-inventory-cdi-childrens-depression-rating-scalerevised-cdrsr-reliabilityhebrew-version/. Western Psychological Services. (n.d.). Children's Depression Rating Scale, Revised (CDRS-R) . In Western Psychological Services. Retrieved January 2, 2011, from http://portal.wpspublish.com/portal/page? _pageid=53%2C69676&_dad=portal&_schema=PORTAL.