RSI™ Overview CDN

Product Overview

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Goldstein & Naglieri Exce ence I n A s s elsls m e n t s

MHS.com/RSI

Measuring Impairment With the increased awareness regarding the importance of understanding functional impairment during the diagnostic process, the need for a comprehensive measure of impairment is felt now more than ever.

Since impairment can play a large role in the lives of individuals, impairment could be just as critical as diagnosis in arranging and planning treatments. Although the precise definition of the term impairment varies across and within medical, mental health, and educational fields, we propose that the essence of this concept 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 self-care needs, family and social interaction expectations, domestic commitments, and school or work obligations.

The Rating Scale of Impairment (RSI™) is designed to meet the need for a measure of impairment that can be used with other symptom-based diagnostic tools when forming diagnoses and can assist in planning and monitoring treatments. The RSI can be completed by parents or teachers and measures impairment across a range of life areas for any child or youth aged 5 through 18 years. In close alignment with the framework of the World Health Organization (WHO) identified in the International Classification of Functioning, Disability and Health (ICF; WHO, 2001),1 the RSI yields scales that measure level of impairment in the areas of School/Work, Social, Mobility, Domestic, Family, and Self-Care.

Overview of the RSI Age Range: As illustrated in Figure 1, the RSI can be used by parents and teachers of children and youth aged 5 to 18 years.

RSI Forms: For children, the RSI (5–12 Years) Parent Form includes 41 items and the RSI (5–12 Years) Teacher Form includes 29 items. For youth, the RSI (13–18 Years) Parent Form includes 49 items and the RSI (13–18 Years) Teacher Form includes 29 items.

Scales: The RSI provides a number of RSI Scales that indicate levels of impairment across different life areas: School/Work, Social, Mobility, Domestic, Family, and Self-Care (RSI Scales included on each form vary based on the applicability of the content area to the rater and the age of the rated child or youth; see Figure 1). In addition to the RSI Scale scores, a Total Score is also provided. The RSI Total Score provides an indication of the child’s/youth’s overall level of impairment. While this score provides a global look at impairment for the individual, the RSI Scale scores are the best indication of impairment in the specific domains of functioning. As such the Total Score should be used along with the individual RSI Scale scores to provide a more comprehensive picture of the child’s/youth’s impairment. For a full description of the RSI Scales and the Total Score, refer to Table 1.

Reading Level: The RSI’s items and instructions are approximately at a sixth-grade reading level (i.e., can be read by the average sixth-grade student).

Administration Time: The RSI Parent Forms can be completed in under 10 minutes and the RSI Teacher Forms can be completed in under 5 minutes.

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The ICF domains of Major Life Areas as well as Learning and Applying Knowledge are aligned with the RSI School/Work scale. The ICF domains of Communication, Interpersonal Interactions and Relationships, and Community, Social and Civic Life are aligned with the RSI Social and Family scales. The ICF domains of Mobility, Self-­‐Care, and Domestic are aligned with the RSI Mobility, Self-­‐Care, and Domestic scales, respectively.

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Figure 1. Overview of the RSI Forms Note. Reading Level determined by the Flesch-Kincaid Grade Level.

Table 1. Description of the RSI Scales Scale School

(School/Work) 1

Scale Descriptions 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.

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.

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.

Total Score

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

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School scale for the RSI (5–12 Years) Parent Form, the RSI (5–12 Years) Teacher Form, and the RSI (13–18 Years) Teacher Form; School/Work scale for the RSI (13–18 Years) Parent Form.

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Administration and Scoring Options The RSI can be administered and scored via paper-and-pencil or by using the MHS Online Assessment Center (Figure 2).

RSI Report Options The following three RSI report types can be obtained when using the MHS Online Assessment Center:

1. The Interpretive Report provides detailed results from one administration.

PARENT

SELF

TEACHER

2. The Comparative Report provides a multi-rater perspective by combining results from up to five different raters.

3. The Progress Monitoring and Treatment Effectiveness Report provides an overview of change over time by combining results of up to four administrations from the same rater.

Figure 2. Overview of the RSI Administration and Scoring Options

Administration and Scoring Options

Paper-and-Pencil Administration Rater completes a paper-and-pencil QuikScore™ form or a Response Form printed from the MHS Online Assessment Center.

Paper-and-Pencil Scoring Examiner calculates scores directly on the QuikScore form.

Online Administration Rater completes the RSI online in the MHS Online Assessment Center.

Online Scoring

Online Scoring

Examiner enters responses into the MHS Online Assessment Center for automatic scoring and report generation.

RSI is scored automatically and reports are generated online.

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Normative and Clinical Samples Data collection took place from September 2012 to August 2014. Over 8,000 ratings were completed across the four RSI Forms, which included normative data, clinical data, as well as reliability and validity data. Of these ratings, 2,800 were included in the normative samples.

The RSI normative samples were evenly balanced in terms of age and gender. Specifically, ratings of 50 male children/youth and 50 female children/youth were collected for each year of age, resulting in 800 rated children for each of the RSI (5–12 Years) Forms (both with age M = 8.5 years, SD = 2.3 years), and 600 rated youth for each of the RSI (13–18 Years) Forms (both with age M = 15.5 years, SD = 1.7 years).

These normative samples were collected so that the distributions of race/ethnicity were stratified by geographic region and parental education, and so that the overall proportions of these demographic variables matched within 1% the 2010 U.S. Census targets (see Table 2). To 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.

The clinical data included in the normative samples were selected from over 1,300 ratings of children/youth with a clinical diagnosis. See Table 3 for the diagnostic makeup of the clinical samples collected for each RSI Form.

Table 2. Race/Ethnicity, Region, and Parental Education Level: RSI Normative Samples Race/Ethnicity RSI (5–12 Years) Forms RSI (13–18 Years) Forms U.S. U.S. Parent Teacher Parent Teacher Population Population (%) (%) (%) (%) (%) (%) Hispanic 23.5 23.6 23.0 21.7 21.7 21.0 Asian 4.3 4.5 4.5 4.0 4.0 4.4 Black 13.6 13.8 13.7 14.3 14.3 14.8 White 53.9 53.8 53.8 56.0 56.0 55.8 Other 4.8 4.4 4.9 4.0 4.0 4.1 Region RSI (5–12 Years) Forms RSI (13–18 Years) Forms U.S. U.S. Parent Teacher Parent Teacher Population Population (%) (%) (%) (%) (%) (%) Northeast 16.1 16.4 16.5 18.0 18.0 17.5 Midwest 21.6 21.9 21.8 22.0 22.0 21.9 South 38.0 37.8 37.6 36.0 36.0 36.7 West 24.3 24.0 24.0 24.0 24.0 24.0 Parental Education Level RSI Parent Forms U.S. 5–12 13–18 Population Years (%) Years (%) (%) No high school diploma 15.2 15.7 15.3 High school diploma/GED 29.3 30.0 29.3 Some college or associate's degree 30.4 30.0 30.0 Bachelor's degree 16.1 16.0 16.4 Graduate or professional degree 8.5 8.3 9.0

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Table 3. Primary Diagnosis and Number of Diagnoses: RSI Clinical Samples Primary Diagnosis RSI (5–12 Years) Forms RSI (13–18 Years) Forms Parent Teacher Parent Teacher N % N % N % N % Attention Deficit/Hyperactivity Disorder 156 33.3 112 33.1 84 23.5 55 25.7 Autism Spectrum Disorder 46 9.8 32 9.5 29 8.1 19 8.9 Depression or Anxiety Disorder 57 12.2 41 12.1 63 17.6 31 14.5 Intellectual Developmental Disorder 31 6.6 28 8.3 31 8.7 16 7.5 Learning Disability 44 9.4 40 11.8 33 9.2 38 17.8 Physical Disability 33 7.1 9 2.7 52 14.6 17 7.9 Other 101 21.6 76 22.5 65 18.3 38 17.8 Total N 468 338 357 214 Number of Diagnoses RSI (5–12 Years) Forms RSI (13–18 Years) Forms Parent Teacher Parent Teacher N % N % N % N % 1 Diagnosis 159 34.0 93 27.5 111 31.1 59 27.6 2 to 3 Diagnoses 241 51.5 180 53.2 165 46.2 118 55.1 4+ Diagnoses 68 14.5 65 19.2 81 22.7 37 17.3 Total N 468 338 357 214

Gender, Age, and Race/Ethnicity Effects To examine gender and age effects, ANOVAs were conducted to compare RSI scores on each form across gender and each year of age. Results indicated several significant main effects of gender with at least small effect sizes (median Cohen’s d = 0.25) for the majority of RSI scores, with boys scoring higher on impairment than girls. In order to retain these gender differences in the RSI Scale T-scores, the Tscores are computed using combined gender norms. Results also indicated that the relationship between RSI scores and age tended to be non-significant with negligible effect sizes between ages (median Cohen’s d = -0.07). No significant interaction was found between gender and age across any of the four RSI rater forms. Figures 6.1 and 6.2 show that although the level of impairment expressed by the RSI Total Score was typically higher for boys than for girls, impairment was fairly equal across age groups on each RSI Form.

Figure 3. Mean Total Score by Gender and Age: RSI Parent Forms

RSI Total Score

Series3

Series6

Series7

Series8

Male

Female

85 75 65 55 45 35 25 5

6

7

8

9

10

11

12

RSI (5-­‐12 Years)

13

14

15

16

17

18

RSI (13-­‐18 Years) Age Group

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Figure 4. Mean Total Score by Gender and Age: RSI Teacher Forms

RSI Total Score

Male

Female

85 75 65 55 45 35 25 5

6

7

8

9

10

11

12

RSI (5-­‐12 Years)

13

14

15

16

17

18

RSI (13-­‐18 Years) Age Group

To examine effects of race/ethnicity, ANCOVAs were conducted to compare RSI scores on each form between three race/ethnic groups (i.e., Black, Hispanic, and White) controlling for age, gender, region, and parental education level. Very few statistically significant main effects of race/ethnicity were observed. Moreover, effect sizes were negligible when comparing ratings of Black children/youth to ratings of White children/youth (median Cohen’s d = 0.06) and when comparing ratings of Hispanic children/youth to ratings of White children/youth (median Cohen’s d = 0.07).

To further explore the effects of race/ethnicity, disparate impact was assessed using the four-fifths rule (Fassold, 2000). Disparate impact is considered substantial when the ratio of the percentage of Black or Hispanic children/youth who received a desirable outcome (i.e., “No Impairment” classification) is less than four-fifths of the percentage of White children/youth who received the same outcome (i.e., ratio < .80). Results show that across the scores for each form, the ratios when comparing ratings of Black or Hispanic children/youth to White children/youth never fall below the four-fifth cut-off (ratios range from 0.87 to 1.14). Taken together, these results provide evidence for the generalizability of RSI scores across race/ethnic groups on all four RSI Forms.

Reliability Internal Consistency refers to the extent to which all items on the same scale consistently measure the same content. Cronbach’s alpha was used to estimate the internal consistency of the RSI Scales, whereas the composite score method described by Tellegen and Briggs (1967) was used to estimate the internal consistency of the RSI Total Score. As shown in Table 4, the RSI Scales and the Total Score were found to demonstrate strong levels of internal consistency.

Test-Retest Reliability refers to the stability of test scores when an assessment is administered on two or more occasions. Partial correlations were conducted to assess the test-retest reliability of the RSI Scales and Total Score over a 2- to 4-week interval (controlling for age and gender). As shown in Table 5, the results indicate excellent test-retest reliability.

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Table 4. Internal Consistency Coefficients: Cronbach's Alpha (RSI Scales) and Composite Score Reliability (Total Score) RSI (5–12 Years) Forms RSI (13–18 Years) Forms Number Score Parent Teacher Parent Teacher of Items School (School/Work) Social RSI Mobility Scale Domestic Family Self-Care Total Score 1

10 10 9 7 5 8 1 29–49

N = 776–794

N = 794–798

N = 584–596

N = 597–599

.90 .88 .79 .85 .76 -.94

.94 .89 .87 ---.95

.90 .86 .85 .85 .82 .75 .95

.93 .89 .91 ---.95

There are 29 items on the RSI Teacher Forms, 41 on the RSI (5–12 Years) Parent Form, and 49 on the RSI (13–18 Years) Parent Form.

Table 5. Test-Retest Reliability Coefficients: Partial Correlations RSI (5–12 Years) Forms RSI (13–18 Years) Forms Score Parent Teacher Parent Teacher N = 138-147 N = 154-162 N =182-190 N = 179-186 School (School/Work) .97 .94 .93 .90 Social .93 .85 .91 .87 Mobility .95 .87 .94 .95 RSI Scale Domestic .89 -.91 -Family .91 -.92 -Self-Care --.95 -Total Score .96 .96 .91 .89 Note. Correlations were computed using Thorndike’s (1949) case 2 correction method to adjust for variability. All correlations are significant, p < .001.

Validity Discriminative Validity. Discriminative validity pertains to an instrument’s ability to distinguish between relevant participant groups. Assuming that functional impairment should increase as the number of diagnoses increases, the RSI should be able to distinguish individuals with a greater number of diagnoses from individuals with fewer or no diagnoses. ANCOVAs were conducted to compare the RSI scores of children/youth from the general population with clinical cases categorized according to their number of diagnosed disorders (i.e., one diagnosis, two to three diagnoses, and four or more diagnoses).

Figures 5 to 8 illustrate the mean RSI Scale and Total Score comparisons between the general population sample and each clinical sample (controlling for age, gender, race/ethnicity, region, and parental education level where available). Significant main effects of number of diagnoses were observed for all scores (p < .01) except for Mobility on the RSI (5–12 Years) Teacher Form and the RSI (13–18 Years) Teacher Form (p = .036 and .017, respectively). An examination of Cohen’s d effect size ratios indicate that differences from the general population became progressively larger as the number of diagnoses increased. Specifically, across scores on all RSI Forms, effect sizes were generally small when comparing the general population to clinical cases with one diagnosis (median Cohen’s d = 0.45), medium when comparing the general population to clinical cases with two to three diagnoses (median Cohen’s d = 0.61), and strong when comparing the general population to clinical cases with four or more diagnoses (median Cohen’s d = 1.02). These results confirm the expectation that as the number of diagnoses increases, the level of impairment as assessed by the RSI also increases.

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Figure 5. Mean T-scores by General Population and Number of Diagnoses: RSI (5–12) Parent Form 70.0 65.0 Gen. Pop.

60.0

1 Diagnosis

55.0

2-­‐3 Diagnoses

50.0

4+ Diagnoses

45.0 40.0 School

Social

Mobility

DomesYc

Family

Total Score

Figure 6. Mean T-scores by General Population and Number of Diagnoses: RSI (5–12) Teacher Form 70.0 65.0 60.0

Gen. Pop.

55.0

1 Diagnosis 2-­‐3 Diagnoses

50.0

4+ Diagnoses

45.0 40.0 School

Social

Mobility

Total Score

Figure 7. Mean T-scores by General Population and Number of Diagnoses: RSI (13–18) Parent Form 70.0 65.0 60.0

Gen. Pop.

55.0

1 Diagnosis

50.0

2-­‐3 Diagnoses 4+ Diagnoses

45.0 40.0 School/Work

Social

Mobility

DomesYc

Family

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Self-­‐Care

Total Score

8

Figure 8. Mean T-scores by General Population and Number of Diagnoses: RSI (13–18) Teacher Form 70.0 65.0 60.0

Gen. Pop.

55.0

1 Diagnosis

50.0

2-­‐3 Diagnoses 4+ Diagnoses

45.0 40.0 School

Social

Mobility

Total Score

Relationship with Other Psychological Measures. The relationships of the RSI with several other psychological measures were explored. These other measures include the Barkley Functional Impairment Scale for Children and Adolescents (BFIS–CA; Barkley, 2012), the Adaptive Behavior Assessment System, Second Edition (ABAS–II; Harrison & Oakland, 2003), the Conners Comprehensive Behavior Rating Scales (Conners CBRS; Conners, 2008), and the Wechsler Intelligence Scale for Children (WISCIV; Wechsler, 2004). See Figure 9 for the median correlation across forms of the RSI Total Scores with the total scores of each of the other psychological measures.2 Figure 9. Relationships Between the RSI Total Score and Other Measures of Impairment, Adaptive Behavior, Symptoms, and Intelligence

RSI Total Score Impairment .59

Barkley Functional Impairment Scale

Symptoms .29

Adaptive Behavior -.54

Adaptive Behavior Assessment System-II

Conners CBRS – Symptom Scales

Intelligence -.05

Wechsler Intelligence Scale for Children - IV

2

Because a total score is not computed for the Conners CBRS, the median of the correlations between the RSI Total Score and all of the Conners CBRS Symptom Scales is presented.

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The correlations between the RSI Total Score and the BFIS–CA 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 correlations between the RSI Total Score and the ABAS–II 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. Indeed, the main 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).

The correlations between the RSI Total Score and the Conners CBRS Symptom Scales 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). In fact, a number of studies show that symptoms and impairment do not necessarily co-occur as individuals may meet the symptom criteria for a diagnosis without showing impairment or may show severe impairment without meeting the symptom criteria (Angold, Costello, Farmer, Burns, & Erkanli, 1999; Costello, Angold, & Keeler, 1999).

The correlations between the RSI Total Score and the WISC-IV 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.

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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. (2012). Barkley Functional Impairment Scale – Children and Adolescents. New York, NY: Guilford.

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.

Conners, C. K. (2008). Conners Comprehensive Behavior Rating Scales. Toronto, CA: Multi-Health Systems.

Costello, E., Angold, A., & Keeler, G. P. (1999). Adolescent outcomes of childhood disorders: The consequences of severity and impairment. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 121–128.

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.

Fassold, M. A. J. (2000). Disparate Impact Analyses of TAAS Scores and School Quality, Hispanic Journal of Behavioral Sciences, 22, 460–480.

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.

Harrison, P. L., & Oakland, T. (2003). Adaptive Behavior Assessment System (2nd ed.). San Antonio, TX: Western Psychological Services.

Naglieri, J. A., Goldstein, S., & LeBuffee, P. (2010). Resilience and impairment: An exploratory study of resilience factors and situational impairment. Journal of Psychoeducational Assessment, 28(4), 349–356.

Tellegen, A., & Briggs, P. F. (1967). Old wine in new skins: Grouping Wechsler subtests into new scales.

Journal of Consulting Psychology, 31, 499–506.

Wechsler, D. (2004). The Wechsler Intelligence Scale for Children (4th ed.). London, UK: Pearson Assessment.

World Health Organization (2001). International Classification of Functioning, Disability and Health (ICF).

Geneva: World Health Organization. Retrieved from http://www.who.int/classifications/icf/en/

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