Validation of a cross-cultural instrument for child behavior problems: the Disruptive Behavior International Scale – Nepal version
Matthew D. Burkey, Ramesh P. Adhikari, Lajina Ghimire, Brandon A. Kohrt, Lawrence S. Wissow, Nagendra P. Luitel, Emily E. Haroz and Mark J. D. Jordans
Published on: 3 November 2018
Background: Obtaining accurate and valid measurements of disruptive behavior disorders remains a challenge in non-Western settings due to variability in societal norms for child behavior and a lack of tools developed outside of Western contexts. This paper assesses the reliability and construct validity of the Disruptive Behavior International Scale – Nepal version (DBIS-N)—a scale developed using ethnographic research in Nepal—and compares it with a widely used Western-derived scale in assessing locally defined child behavior problems.
Methods: We assessed a population-based sample of 268 children ages 5–15 years old in Nepal for behavior problems with a pool of candidate items developed from ethnographic research. We selected final items for the DBIS-N using exploratory factor analysis in a randomly selected half of the sample and then evaluated the model fit using confirmatory factor analysis in the remaining half. We compared the classification accuracy and incremental validity of the DBIS-N and Eyberg Child Behavior Inventory (ECBI) using local defined behavior problems as criteria. Local criteria were assessed via parent report using: 1) local behavior problem terms, and 2) a locally developed vignette-based assessment.
Results: Ten items were selected for the final scale. The DBIS-N had good internal consistency (Cronbach’s α: 0.84) and excellent test-retest reliability (intraclass correlation 0.93, r = .93). Classification accuracy and area under the curve (AUC) were similar and high for both the ECBI (AUC: 0.83 and 0.85) and DBIS-N (AUC: 0.83 and 0.85) on both local criteria. The DBIS-N added predictive value above the ECBI in logistic regression models, supporting its incremental validity.
Conclusions: While both the DBIS-N and the ECBI had high classification accuracy for local idioms for behavior problems, the DBIS-N had a more coherent factor structure and added predictive value above the ECBI. Items from the DBIS-N were more consistent with cultural themes identified in qualitative research, whereas multiple items in the ECBI that did not fit with these themes performed poorly in factor analysis. In conjunction with practical considerations such as price and scale length, our results lend support for the utility of the DBIS-N for the assessment of locally prioritized behavior problems in Nepal.
Keywords: Disruptive behavior disorders, Oppositional defiant disorder, Conduct disorder, Child behavior problems, Externalizing disorders, Scale, Validation, Low-income countries, Nepal