Journal of Child and Adolescent Behavior
Open Access

Abstract

Objective: Previous studies found oppositional defiant disorder to be primarily a problem of irritability/emotional dysregulation when studied using symptoms of ADHD, ODD, conduct, and affective disorders. This study analysed items which were found to load on emotional dysregulation, with the objective of developing a reliable and valid rating scale for measuring emotional dysregulation in children and youth. Method: Two random samples of 360 were drawn from 3,374 SNAP-IV 90-item rating scales which were then used as calibration and validation samples for Rasch modelling. Each of 18 symptoms of emotional dysregulation was examined for fit with the Rasch model and evaluated for local independence and differential item performance. Items that violated Rasch assumptions were eliminated and the internal reliability and person separation index of the remaining items were studied. The resulting scale was validated using the Conners’ Emotional Lability scale as a standard. We then analysed the items on the 3,374 SNAP-IV scales to calculate the rates of current emotional dysregulation in those meeting criteria for ADHD using both our scale, the CEER-9, and the Conners. Results: A nine-item scale for emotional regulation has been developed that satisfies the Rasch model, a form of item response theory. This scale reliably separates emotionally dysregulated / irritable children and adolescents from healthy ones and is invariant with respect to child sex and age and rater type (parent or teacher). Area under the curve analysis showed that a threshold score of 4 in our scale has optimal accuracy for identifying children and adolescents with current significant dysfunction in emotional regulation. Among youth with ADHD inattentive, hyperactive-impulsive, and combined types, 78 percent, 85 percent, and 88 percent met the cut-off score for Conners emotional lability index. By comparison, the rates were 60 percent, 67 percent, and 71 percent using the CEER-9. Conclusion: This study reports a nine-item rating scale, the Clinical Evaluation of Emotional Regulation-9 (CEER-9), an observer rating scale developed in children and adolescents, whose sum is a measure of emotional regulation, with a score of 4 or more out of 9 indicating current emotional dysregulation/irritability. Having the properties of good measurement, the CEER-9 is a valuable tool for clinical and research applications. Within children and youth with ADHD, current emotional dysregulation/irritability is highly prevalent.

Biography

Jenna Pylypow is pursuing her Residency in Psychiatry, and fellowship in Child and Adolescent Psychiatry at University of Saskatchewan. She previously completed her Medical degree at University of Alberta, as well as Honours degree in Psychology at University of Calgary.