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ASSESS FUNCTIONAL IMPAIRMENT ACROSS 6 IMPORTANT LIFE AREAS.

SCHOOL/ WORK

MOBILITY

FAMILY

SOCIAL

DOMESTIC

SELF-CARE


What is Functional Impairment? Functional Impairment is a limitation resulting from a psychological, physical, or cognitive disorder that manifests as a reduced capability to meet the demands of life, such as physical mobility and selfcare needs, family and social interaction expectations, domestic commitments, and school or work obligations. Impairment is increasingly becoming an important component of diagnosis and treatment planning, and the need for a reliable and comprehensive measure is felt now more than ever. In fact, the majority of disorders in the DSM-5 include significant impairment as a diagnostic requirement. Since the goal of treatment is to reduce impairment, measuring its impact is an important step in the evaluation process.

Relationship Between the RSI and other Measures Measures of impairment are sometimes confused with measures of symptoms, adaptive behavior, and intelligence, however, as demonstrated below, significant differences exist, and each measure better suits a different purpose.

RSI and Symptoms

SYMPTOMS ARE PHYSICAL, COGNITIVE, OR BEHAVIORAL,

MANIFESTATIONS OF A DISORDER

IMPAIRMENTS ARE THE

CONSEQUENCES

Correlation: .29

IMPAIRMENT CAN EXIST

14%

WITHOUT A FORMAL DIAGNOSIS.

OF PEOPLE HAVE SIGNIFICANT

IMPAIRMENT WITHOUT A FORMAL DIAGNOSIS

(Angold etal., 1999)

The correlations between the RSI Total Score and the Conners Comprehensive Behavior Rating Scales (Conners CBRS; Conners, 2008) suggest that impairment and symptoms are not strongly related. Such findings support the notion that symptoms and impairment are different constructs and need to be considered separately in making diagnoses (Barkley et al., 2006; Eriksen & Kress, 2005).


RSI and Adaptive Behavior

Correlation: -.54

Adaptive behavior reflects the presence of skills learned to function in daily living. Impairment reflects a deficit in using those skills.

Holding a fork Not using a fork to eat The correlations between the RSI Total Score and the Adaptive Behavior Assessment System, Second Edition (ABAS–II; Harrison & Oakland, 2003) suggest that the two measures are related (given that they assess behavior within similar domains). However, the strength of the relationship is moderate enough to suggest that the two are capturing different constructs. This finding supports the evidence in the research demonstrating important differences between the two constructs. The essential difference between impairment and adaptive behavior is that the latter concept has been applied to those situations where limited intellectual ability is suspected. In contrast, the concept of impairment, applies to all levels of intellectual ability as well as variations in mental health and physical capability. Another difference between adaptive behavior and impairment lies in the distinction between skills and performance (Ditterline & Oakland, 2009). Whereas adaptive behavior reflects the presence of skills learned to function in daily living, impairment reflects a deficit in using those skills. Thus, measures of impairment focus on the outcome of a behavior rather than presence or absence of skills (Dumas et al.,2010; Gleason & Coster, 2012).

RSI and Intelligence

Correlation: -.05

The correlations between the RSI Total Score and the Wechsler Intelligence Scale for Children (WISCIV; Wechsler, 2004) suggest that these measures are not related. These findings, which are in line with past research (Naglieri, Goldstein, & LeBuffe, 2010), indicate that children/youth who are diagnosed with psychological disorders can exhibit significant impairment in their overall functioning regardless of their level of intellectual ability.

The RSI and Other Measures of Impairment

Correlation: .59

The correlations between the RSI Total Score and the Barkley Functional Impairment Scale for Children and Adolescents (BFIS–CA; Barkley, 2012) provide evidence of convergent validity in that the RSI is related to other measures of impairment. However, as expected given differences in item content, the correlations are not so strong as to suggest redundancy between the two measures. The RSI also differs from the BFIS-CA in terms of additional item content, and the inclusion of a teacher form. All prices are subject to change without notice.


The Most Representative Impairment Rating Scale The RSI has a large normative sample with approximately 2,800 ratings collected, closely matching 2010 U.S. Census target numbers (800 ratings for each of the RSI [5–12 Years] Parent and Teacher Forms, and 600 ratings for each of the RSI [13–18 Years] Parent and Teacher Forms). Normative samples were evenly balanced in terms of age and gender and distributions of race/ethnicity were stratified by geographic region and parental education, so that the overall proportions of these demographic variables matched within 1% the 2010 U.S. Census targets. Additionally, to better reflect the U.S. general population, between 11.6 to 11.8% of the normative samples included ratings of children/youth who had a clinical diagnosis or were eligible to receive special educational services according to the Individuals with Disabilities Education Act (IDEA) criteria.

Reliable and Valid Internal Consistency Reliability

Test-Retest Reliability

Chronbach’s alpha values for the Total Score and 6 RSI scales were strong:

• Excellent test-retest reliability was found. • Interval between test administrations: 2 to 4 weeks

Parent Total Score (5–12): α =.94 (RSI Scales median = .85) Parent Total Score (13–18): α =.95 (RSI Scales median = .85) Teacher Total Score (5–12): α =.95 (RSI Scales median = .89) Teacher Total Score (13–18): α =.95 (RSI Scales median = .91)

Parent full scale (5–12): r =.96 (RSI Scales median =.93) Parent full scale (13–18): r =.96 (RSI Scales median = .92) Teacher full scale (5–12): r =.91 (RSI Scales median = .87) Teacher full scale (13–18): r =.89 (RSI Scales median = .90)

The RSI also demonstrated strong discriminative validity, the ability to distinguish between different groups. Analyses were conducted to compare RSI scores of children/youth from the general population with clinical cases categorized according to their number of diagnosed disorders. As expected, when the number of diagnosis increased, the level of impairment as assessed by the RSI increased as well.

Interpret, Compare, and Monitor

Scales and Forms

Interpretive Reports provide detailed results from one administration.

Comparative Reports provide

PARENT

SELF

TEACHER

Progress Monitoring and Treatment Effectiveness Reports provide an

a multi-rater perspective by combining results from up to five different raters.

overview of change over time by combining results of up to four administrations from the same rater.

Rating Scale of Impairment (RSI)

RSI (5–12 Years)

Parent Form

Teacher Form

RSI (13–18 Years)

Parent Form

Teacher Form

Number of items: 41 Reading Level: 5.8 Admin Time: 10 mins.

Number of items: 29 Reading Level: 6.6 Admin Time: 5 mins.

Number of items: 49 Reading Level: 5.9 Admin Time: 10 mins.

Number of items: 29 Reading Level: 6.6 Admin Time: 5 mins .

RSI Scales: School Social Mobility Domestic Family

RSI Scales: School Social Mobility

RSI Scales: School/Work Social Mobility Domestic Family Self-Care

RSI Scales: School Social Mobility

Total Score

Total Score

Total Score

Total Score


About the RSI

Watch the

RSI Webinar

Authored by Sam Goldstein, Ph.D., and Jack. A. Naglieri, Ph.D., the Rating Scale of Impairment™ (RSI™) is a multiYouTube.com/MHSclinical informant behavior rating scale that measures functional impairment across six life areas in children/youth. When used in combination with symptom-based measures, the RSI adds impairment information that can help complete the diagnostic picture. It also helps to highlight where functional impairment is most prominent so that interventions can be more effectively targeted. When used in group settings, the RSI can help identify those who require additional assessment, or measure the effectiveness of intervention programs.

Determine if DSM-5/ICD-10 impairment criteria for a diagnosis are met by identifying specific areas where functioning is impacted Develop targeted treatment plans and monitor progress by focusing on areas with the greatest impairment Determine if service eligibility requirements are met with IDEA compatibility Assess impairment more clearly by separating functional limitations from symptoms Align with the World Health Organization’s (WHO) functional impairment framework with scales that represent domains identified in the WHO’s International Classification of Functioning, Disability, and Health (ICF)

Quick

Reference

Scale

Scale Descriptions

School/ Work

Measures the child’s/youth’s level of impairment when acquiring and applying knowledge at school and/or work; for example, being organized, completing work, remembering things, and learning at school and/or work.

Social

Measures how impaired the child/youth is when interacting and communicating with others; for example, talking in a group, expressing needs, and enjoying being with others.

Mobility

Measures the extent of the child’s/youth’s impairment when physically moving; for example, running and kneeling.

ADMINISTRATION TIME 5-10 minutes

Domestic

Describes the child’s/youth’s level of impairment when completing household tasks; for example, cleaning his/her room and putting away clean clothes.

FORMATS Online Paper-and-pencil (QuikScore™)

Family

Measures how impaired the child/youth is when interacting with his/her family; for example, communicating with family and taking part in family activities.

Self-Care

Measures the extent of child’s/youth’s impairment when caring for himself/herself; for example, feeding, dressing, and maintaining personal hygiene, including bathing and cleaning up when dirty.

AGE 5–18 years ADMINISTRATION TYPE Parent Form (5-12) & (13-18) Teacher Form (5-12) & (13-18)

TRANSLATIONS Spanish QUALIFICATION LEVEL B-level

Total Score

Reflects the child’s/youth’s overall level of impairment.


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Quikscore

RSI Complete Handscored Kit, 5-12 years & 13-18 years (RSI Manual, 25 RSI [5 -12 Years] Parent & Teacher QuikScore Forms, and 25 RSI [13 - 18 Years] Parent & Teacher QuikScore Forms) $315.00 RSI [5-12 Years] Handscored Kit RSI Manual, 25 RSI [5 -12 Years] Parent & Teacher QuikScore Forms $199.00 RSI [13-18 Years] Handscored Kit RSI Manual, 25 RSI [13-18 Years] Parent & Teacher QuikScore Forms $199.00 Spanish RSI Complete Handscored Kit, 5-12 years & 13-18 years (RSI Manual,25 RSI [5 -12 Years] Spanish Parent & Spanish Teacher QuikScore Forms, and 25 RSI [13 - 18 Years] Spanish Parent & Spanish Teacher Forms) $315.00 Spanish RSI [5-12 Years] Handscored Kit RSI Manual, 25 RSI [5 -12 Years] Spanish Parent & Spanish Teacher $199.00 QuikScore Forms Spanish RSI [13-18 Years] Handscored Kit RSI Manual, 25 RSI [13-18 Years] Spanish Parent & Spanish Teacher $199.00 QuikScore Forms $60.00 RSI Parent QuikScore Form (5-12 Years) (25/pkg) RSI Teacher QuikScore Form (5-12 Years) (25/pkg) $60.00 RSI Parent QuikScore Form (13-18 Years) (25/pkg) $60.00 RSI Teacher QuikScore Form (13-18 Years) (25/pkg) $60.00 Spanish RSI Parent QuikScore Form (5-12 Years) (25/pkg) $60.00 Spanish RSI Teacher QuikScore Form (5-12 Years) (25/pkg) $60.00 Spanish RSI Parent QuikScore Form (13-18 Years) (25/pkg)$60.00

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RSI CE Online Manual Quiz (3 CE Credits)

45.00

$

B-level All prices are subject to change without notice.

Also Available from Sam Goldstein, Ph.D., & Jack. A. Naglieri, Ph.D Leading scholars and clinicians offer a robust evidence base for a much-needed reconceptualization of impairment within the context of diagnosis and disability. This contextual approach to assessment goes beyond mere symptom counting, resulting in more accurate diagnosis, targeted interventions, and improved patient functioning. AIMPHC $

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References Angold, A., Costello, E. J., Farmer, E. M, Burns, B. J., & Erkanli, A. (1999). Impaired but undiagnosed. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 129–137. Barkley, R. A., Cunningham, C. E., Gordon, M., Faraone, S. V., Lewandowski , L., & Murphy, K. R. (2006). ADHD symptoms vs. impairment: Revisited. The ADHD Report, 14(2), 1–9. Ditterline, J., & Oakland, T. (2009). Relationship between adaptive behavior and impairment. In S.Goldstein & J. Naglieri (Eds.), Assessing impairment: From theory to practice (pp. 31–48). New York, NY: Springer. Dumas, H., Fragala-Pinkham, M., Haley, S., Coster, W., Kramer, J., Ying-Chia, K., & Moed, R. (2010). Item bank development for a revised Pediatric Evaluation of Disability Inventory (PEDI). Physical and Occupational Therapy in Pediatrics, 30, 168–184. Eriksen, K., & Kress, V. E. (2005). Beyond the DSM story: Ethical quandaries, challenges, and best practices. Thousand Oaks, CA: Sage. Gleason, K., & Coster, W. (2012). An ICF-CY-based content analysis of the Vineland Adaptive Behavior Scales–II. Journal of Intellectual & Developmental Disability, 37, 285–293. Naglieri, J. A., Goldstein, S., & LeBuffe, P. (2010). Resilience and impairment: An exploratory study of resilience factors and situational impairment. Journal of Psychoeducational Assessment, 28(4), 349–356.

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