Behaviour Assessment System for Children, BASC - a discussion

Hutan

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Behavior Assessment System for Children, Parent Rating Scales (BASC- PRS) is being used by a current study investigating omics in young people with ME/CFS.

I thought it would be useful to have a closer look at it. It is a 173 item survey that parents fill out about their child.

It costs over $100 to buy, so I have only found a few clues about its contents.

The report the survey produces covers 14 aspects of the child's behaviour, grouped into 4 categories:

Externalising problems
Hyperactivity
Aggression
Conduct Problems​
Internalising problems
Anxiety
Depression
Somatization​
Behavioural symptoms Index
Attention problems
Atypicality
Withdrawal​
Adaptive skills
Adaptability
Social skills
Leadership
Functional communications
Activities of Daily Living​
 
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And how do you answer those questions when your child is now ill? Perhaps the child was a joyful energetic social young person before becoming ill. And now they are slumped in their bed, refusing to go to school, often feeling upset and complaining about aches and pains and feeling exhausted even though the doctor says that there is nothing wrong with them.

Surely how you answer the questions will have much more to do with how you interpret the illness (biological or psychosomatic) than what the child's natural personality set point is?

And, does an assessment like that, with all of its bias and inaccuracy and potential to cause harm to the child and their relationship with their parents, contribute anything useful to, for example, an omics study?
 
This obviously has nothing to do with ME/CFS.

It's also not surprising that someone is using it for ME/CFS.

The incompetence is never surprising, but remains shocking.

I am absolutely serious that questionnaires like this should be banned. I can't see how this would even happen but it's clearly being misused on an industrial scale. Even though when dealing with behavioral problems, what else are they going to use? But this is a classic case of "yes, your power tool that you use for X is super duper but it has literally destroyed my yard, killed my dogs, injured my kid and polluted most of my house so you should not be using power tools until you learn to use them in a safe manner, or preferably never at all".
 
I agree questionnaires designed to elicit data on the listed psychological and behavioural characteristics of a child are totally inappropriate and intrusive for pwME.
We haven't seen the questions, just the aspects they expect to elicit from them. It seems likely they were not designed to be used for physically sick children, so answers will be highly misleading.
 
I found some slides with example items from the BASC-3 PRS. The bullet-pointed items are assessed by the parent, about their child. I think there is a scale to record the degree to which each item is true.

Anxiety: The tendency to be nervous, fearful or worried
  • Is fearful
  • Has trouble making decisions
Depression: Feeling soft unhappiness, sadness and stress that may result in an ability to carry out everyday activities or may bring on thoughts of suicide
  • Is negative about things
  • Says "I can't do anything right"
  • getting easily upset
Somatization: The tendency to be overly sensitive to and complain about relatively minor physical problems and discomforts
  • Is afraid of getting sick
  • Complains of physical problems

Attention problems:
  • Has short attention span
  • Has trouble concentrating
Atypicality: The tendency to behave in ways that are considered "odd" or commonly associated with psychosis
  • Seems out of touch with reality
  • Acts as if other children are not there
Withdrawal: the tendency to evade other to avoid social contact
  • Is fearful
  • Has trouble making decisions
  • Isolates self from others
  • Quickly joins group activities
  • Has trouble making new friends
  • Prefers to play alone
Adaptability
  • Adjusts well to changes in plans
  • Accepts things as they are
 
Thanks @Nightsong
Yes. Here are some items from BASC-PRS A (A is for adolescent; C is for child)

Complains of being sick when nothing is wrong
Says "I think I'm sick"
Avoids exercise or other physical activity
Gets sick
Isolates self from other
Complains about health
Complains of pain
Expresses fear of getting sick
Complains of stomach pain
Has headaches
Seems lonely
Misses deadlines
Complains of physical problems
Has trouble concentrating
Has seizures
Is suspicious of others
Is irritable
Is afraid of getting sick
 
The blindingly obvious problem being, of course, that this kind of list of 'symptoms' is exactly what you would expect to see in a child who has a serious physical problem that is undiagnosed, and being misdiagnosed and mistreated as a mental health problem.

The appropriate safety factor, the margin of error, in these type of clinical tools is simply not there. The causal assumptions and inferences invoked are way too arbitrary and unexamined, and remain too stubbornly so.

I find it difficult to believe that in the 21st century this is unwitting ignorance of these issues and risks.
 
The blindingly obvious problem being, of course, that this kind of list of 'symptoms' is exactly what you would expect to see in a child who has a serious physical problem that is undiagnosed, and being misdiagnosed and mistreated as a mental health problem.

I’m not a child and I’m correctly diagnosed. My parents would still classify me as severly mentally ill according to this form. You don’t need the last part for this form to make no sense at all, even though it would make this even worse.
 
There are surveys that could be used in ME/CFS instead of the BASC, with its aim of identifying psychopathologies, in order to identify symptoms and mood issues, both for research and for clinical care. You would probably still want to add on questions for ME/CFS specific symptoms and something like FUNCAP for assessing function.

For example;

The Measurement of Symptoms in Children with Cancer
The purpose of this study was to determine symptom prevalence, characteristics, and distress in children with cancer. The Memorial Symptom Assessment Scale (MSAS) 10–18, a 30-item patient-rated instrument adapted from a previously validated adult version, provided multidimensional information about the symptoms experienced by children with cancer.

Patients could easily complete the scale in a mean of 11 minutes.

The analyses supported the reliability and validity of the MSAS 10–18 subscale scores as measures of physical, psychological, and global symptom distress, respectively. Symptom prevalence ranged from 49.7% for lack of energy to 6.3% for problems with urination. The most common symptoms (prevalence > 35%) were lack of energy, pain, drowsiness, nausea, cough, lack of appetite, and psychological symptoms (feeling sad, feeling nervous, worrying, feeling irritable).

Subscale scores demonstrated large variability in symptom distress and could identify subgroups with high distress.

See how the Memorial Symptom Assessment Scale doesn't put psychopathology labels on psychological symptoms? 'Feeling sad, feeling nervous, worrying, feeling irritable'. All perfectly normal and largely reasonable reactions to being sick, not being able to do what you did before and being uncertain when or if you will be well again.

It's not the use of surveys that is necessarily wrong, it is the use of surveys that record a young person's natural responses to being sick (e.g. reporting pain, feeling sad) and automatically assume that those reports and feelings are wrong and indicative of mental illness.
 
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I see schools of undifferentiated behavioural interpretation

I've searched, not very hard admittedly, but I could find no warning saying to use the BASC survey with care in populations of children with medical conditions.

Unqualified behavioural "assessment" is not assessment. Interpretation is not assessment

This "Assessment System" is not even an interpetation. It pretends to interpret. It misinterprets instead

It translates all a target may think, say and do into some model of aberration

It churns out new models of aberration so often its like Sainsburies bringing out a host of new convenience foods every month. Whatever sells well

Eg its not an eating disorder. Then its an avoidant disorder. Thats a new one. Gotcha

These people obviously grew up playing tag inbetween playing mummies and daddies, or best of all playing teacher. A ready made workforce ripe for recruitment. No discernment required. Just must modify the people according to the model

Unregulated behavioural "assessment" may translate all of your communication, all of your ways, all of your thoughts, every look on your face, every mask and all of your body language. All those bodily signs and symptoms. It all translates into some aberration

Everything and anything can be mapped onto these models, which can also be enforced

It is even more pernicious once contending that any targets' health and safety criteria are pathological. A danger to all concerned. To be "modified". Modify all contra-indications

It will so contend. Because it can. It knows no bounds.

Health & Safety criteria remain prohibitive, nevertheless. This is necessarily legitimised

So the maverick science fixates on the signs of fear. It probes and prompts for fear. It will challenge you. It will push you onto the slippery slope so you must opt out. Bingo. Proof

When enforcement is implied (threatened) then do not agree to comply. Because that is a legal agreement. Breaking the legal agreement is the grounds for the enforcement. Neat heh

At that stage, if its not all a bluff, then you might need an independent assessment, instead. And you would be entitled to one. In the hands of a real practitioner who has standards. For example, this survey designed to recognise some extra distress and maybe attend to it, but not necessarily to modify the mind:
There are surveys that could be used in ME/CFS instead of the BASC, with its aim of identifying psychopathologies, in order to identify symptoms and mood issues, both for research and for clinical care.

You would probably still want to add on questions for ME/CFS specific symptoms and something like FUNCAP for assessing function. For example;

The Measurement of Symptoms in Children with Cancer

See how the Memorial Symptom Assessment Scale doesn't put psychopathology labels on psychological symptoms? 'Feeling sad, feeling nervous, worrying, feeling irritable'. All perfectly normal and largely reasonable reactions to being sick, not being able to do what you did before and being uncertain when or if you will be well again.

It's not the use of surveys that is necessarily wrong, it is the use of surveys that record a young person's natural responses to being sick (e.g. reporting pain, feeling sad) and automatically assume that those reports and feelings are wrong and indicative of mental illness.

However one should not be subjected to any demand for proof of illness, while ill or nursing an ill child. By the time there is such a dispute, such assessments cannot be posed as therapy

Of course there are cases where co-operation with a zealous reformer works. Its just not predictable, so it is a vagary. In other cases co-operation will never work. That was pre-determined. In some cases the co-operation required is designed to be impossible

Please do check me if and where my posts are not accurate observation, but just my opinion, and/or ignorant of the exceptions to my rules

I am not sure there is any science of behaviour that is not intent upon modifying other people's behaviour. As if for their own good. Selling them something that must be good for them so they must have it

Behavioural science. Behavioural analysis. Behavioural assessment. Behavioural evaluation. Behavioural modification

The expertise of pure science, applied by an adept in the applied science of behaviour

The expert "scientific" analysis, assessment, evaluation and modification of behaviour

Steered by competent cost-effective research. Market research. Social research. Political research. Psychological research. Neuroscience research. The advertising alone is worth a treasure
 
It's not the use of surveys that is necessarily wrong, it is the use of surveys that record a young person's natural responses to being sick (e.g. reporting pain, feeling sad) and automatically assume that those reports and feelings are wrong and indicative of mental illness.
Unfortunately, that's the whole problem and it's not the questionnaires themselves, but their interpretation without context. Because the context is disputed, making the interpretation completely wrong. Which means that no questionnaire is truly safe, there is simply no way for a safe questionnaire to be interpreted safely because the people doing the interpretation have decided that there is no illness. So much that they literally argue that having symptoms means no illness. That's how insane this all is.

And there is no way to fix this without fixing the system. Which is about as feasible as moving the moon closer to Earth.

So, really, no one should answer questionnaires is about the only rational solution. A solution that is just as insane as the problem. Yay!
 
:) The BASC-3 people talk about patterns. I guess the lines help them see the patterns.

No doubt an experienced BASC-3 practitioner can identify a psychopathology complex with a glance.
Trouble is, they are descriptive categories not measurements. And the order they are placed in is arbitrary. So the pattern seen by joining the dots is also arbitrary. Change the order the descriptive categories are placed in and what looked like an elephant turns into a snake, metaphorically speaking. The patterns are meaningless.
 
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