Diagnostic Testing 1. Beck Anxiety Inventory 3 Description: 4 Rationale: 4 Personnel, Training, Administration, and Scoring Requirements: 5 Population Used to Develop Measure 5 What Are The Symptoms Of An Anxiety Attack? 5 The Beck Anxiety Inventory of the 21 most common symptoms: 5 Scoring: 6 Interpretation of score 6 Psychometric Properties: 7 Reliability: 7 Validity 7 Advantages: 8 Disadvantages: 9 Suggested Uses: 9 Beck Anxiety Inventory used in Pakistani Settings 10 2. Hamilton Anxiety Scale (HAS) 11 Rating: 11 Purpose 11 Use in the field 12 Scale 12 Scoring 12 Criteria for interpretation 12 Versions 12 Psychometric Properties 13 Applied in different researches 14 3. Hamilton Depression Scale 15 Description/Purpose 15 Use in the field 15 Scale 16 Criteria for interpretation 16 Psychometric properties 16 Applied in different researches 18  Correlations among Depression Rating Scales and A Self-Rating Anxiety Scale In Depressive Outpatients 18 Limitations 19 4. Adaptive Behavior Assessment System Second Edition 19 Rationale: 20 What’s New in ABAS–II 20 ABAS–II Rating Forms 21 Scores Reported 22 Sample Items: 22 Psychometric Properties: 23 Standardization 23 Validity 25 Advantages of Using ABAS–II 25 Adaptive behaviour assessment system in Pakistan: 26 5. Symptom Assessment-45 26 Purpose: 26 Description: 26 SA-45 Scales: 27 Psychometric properties: 28 Reliability and Validity: 28 Norms: 29 Research in Pakistani context: 30

Diagnostic Testing
Diagnosis is the identification of the nature and cause of anything.
Diagnostic describes a procedure or test, which is performed to determine what is wrong with a patient, or what illness they have. Diagnostic procedures do not attempt to treat or cure anything, but are more informational and exploratory in nature. 1. Beck Anxiety Inventory

* Measure Name: Beck Anxiety Inventory (1993) (*Annexure 1) * Acronym: BAI * Authors: Aaron T. Beck and Robert A. Steer * Publisher: The Psychological Corporation. * * Type of Assessment: Self-report * Age Range: 12 to 80 years * Number of items: 21 * Response Format: 4-point Likert-type scale: Not All (0), Mildly (1), Moderately (2), Severely (3) * Measure Type: Screening * Measure Format: Questionnaire

All of us have had time of stress and anxiety. When the symptoms of anxiety gets out of hand, and affect our everyday life continuously, we may need to take steps to improve our mental state. Sometimes, prolonged symptoms of extreme anxiety may be an indicator of other mental health issues such as depression. The BAI is commonly used psychometric tool to test the level of anxiety of an individual. The BAI scoring can be used as a basis for further tests as well. The result of the inventory gives an indication of the severity of anxiety in a person who took it.

Description:
The BAI is the gold standard self-report measure of general anxiety symptoms. The Beck Anxiety Inventory (BAI) is a widely used 21-item self-report inventory used to assess anxiety levels in adults and adolescents. It has been used in multiple studies, including in treatment-outcome studies for individuals who have experienced traumas. Although the age range for the measure is from 17 to 80, the measure has been used in peer-reviewed studies with younger adolescents aged 12 and older. Each of the items on the BAI is a simple description of a symptom of anxiety in one of its four expressed aspects: (1) subjective (e.g., "unable to relax"), (2) neurophysiologic (e.g., "numbness or tingling"), (3) autonomic (e.g., "feeling hot") or (4) panic-related (e.g., "fear of losing control"). In a comparative analysis of the research output on clinical measures of anxiety (PsychInfo citation analysis for 1991-1998), the "BAI ranks third, behind the State-Trait Anxiety Inventory and the Fear Survey Schedule, in terms of use in research" (Piotrowski, 1999).
This assessment tool is a self-report inventory, which means that a person can answer the questions in the assessment test for himself or herself, without the assistance of a psychiatric professional. While health assistants or paraprofessionals can supervise the test, only trained psychiatric doctors can use it for diagnosis and treatment purposes.

Rationale:
The Beck Anxiety Inventory was specifically designed to reduce the overlap between depression and anxiety scales by measuring anxiety symptoms shared minimally with those of depression.
Such an instrument would offer advantages for clinical and research purposes over existing self-report measures, which have not been shown to differentiate anxiety from depression adequately.

Personnel, Training, Administration, and Scoring Requirements:
The BAI may be administered and scored by paraprofessionals, but it should be used and interpreted only by professionals with appropriate clinical training and experience. The BAI requires 5 to 10 minutes to complete when it is self-administered and 10 minutes when it is orally administered.
Scoring takes 5 minutes.
Population Used to Develop Measure
Beck, A.T., Epstein, N., Brown, G., & Steer, R.A. (1988) drew three successive samples of psychiatric outpatients. A total of 1,086 patients included 456 men (42%, mean age = 36.4 years, SD=12.4) and 630 women (58%, mean age = 35.7 years, SD=12.1). The patients were predominantly diagnosed with mood and anxiety disorders, but other nonspecific disorders were also represented. Less than 1% of the sample was diagnosed as psychotic. The ethnic composition of the sample is unknown.

The symptoms of anxiety used in BAI, features of BAI, and how the inventory is used in assessing anxiety disorder as well as its reliability and validity are mentioned below.

What Are The Symptoms Of An Anxiety Attack?
The Beck Anxiety Inventory of the 21 most common symptoms:

* Numbness or tingling * Feeling hot * Wobbliness in legs * Unable to relax * Fear of worst happening * Dizzy or lightheaded * Heart pounding/racing * Unsteady * Terrified or afraid * Nervous * Feeling of choking * Hands trembling * Shaky / unsteady * Fear of losing control * Difficulty in breathing * Fear of dying * Scared * Indigestion * Faint / lightheaded * Face flushed * Hot/cold sweats

Theoretical Orientation Summary:
Items were selected based upon their consistency with DSM-III-R criteria for anxiety disorders, with an emphasis on panic disorder and generalized anxiety disorder.
Scoring:
The respondent is asked to rate how much he or she had been bothered by each symptom over the past week on a 4 point scale ranging from 1 to 3. The items are summed to obtain a total score that can range from 0 to 63.
The scoring works this way: For each of the 21 symptoms listed above, rate yourself with a score of 0, 1, 2 or 3.

0 = I do not have this symptom at all.
1 = I do have this symptom, but does not affect me very much (Mild)
2 = I do have this symptom, and it does affect me fairly often (Moderate)
3 = I do have this symptom, and it affects me greatly and often (Severe)

Interpretation of score is (cut off scores) as follow:
A grand total score between: 0 - 7 indicates minimal anxiety.
A grand total score between: 8-15 indicates mild anxiety.
A grand total score between: 16-25 indicates moderate anxiety.
A grand total score between: 16-63 indicates severe anxiety
Every individual will be different and the symptoms experienced can vary. Only you can know if your quality of life is being affected by your condition and the symptoms you are experiencing. If you do feel you need help it is certainly best to seek advice and/or treatment before you become completely overwhelmed with either general, constant anxiety or anxiety/panic attacks that can put you into a never ending pattern of fear.

Psychometric Properties:
The BAI is psychometrically sound.
Reliability:
1. Internal consistency (Cronbach’s alpha) ranged from .92 to .94 for adults (With their diagnostically mixed sample of 160 outpatients, Beck, Epstein, Brown, & Steer [1988]) 2. The alphas for the Diagnostic and Statistical Manual of Mental Disorders, Third Edition—Revised (DSM-III-R) anxiety disorder groups ranged from .85 to .93. (Fydrich, Dowdall, & Chambless [1992]) 3. Test-retest reliability: A subsample of patients (n=83) completed the BAI after 1 week, and the correlation between intake and 1-week BAI scores was .75. * Subsequent researches have also shown adequate 5 week test-retest reliability among individuals diagnosed with panic disorder and agoraphobia at .83. 4. Reliability of the BAI for adolescents has not been directly tested 5. The scale obtained high internal consistency and item-total correlations ranging from .30 to .71 (median=.60)
Validity
(1) Concurrent validity: the correlation with the Hamilton Anxiety Rating Scale—Revised was .51. * The correlation with the anxiety subscale of the Cognition Check List, which measures the frequency of dysfunctional cognitions related to anxiety, was also .51. * The BAI is also significantly correlated with the Trait (.58) and State (.47) subscales of the State-Trait Anxiety Inventory (Form Y) and with the mean 7-day anxiety rating (.54) of the Weekly Record of Anxiety and Depression. (2) Content Validity: Items were selected based upon their consistency with DSM-III-R criteria for anxiety disorders, with emphasis on panic disorder and generalized anxiety disorder. (3) Validity of the BAI for adolescents has not been directly tested. (4) Numerous studies have examined the BAI’s relationship to other measures and have found evidence for its convergent and discriminant validity.
The BAI has been found to correlate moderately with the Hamilton Anxiety Rating scale (Beck et al., 1988) and the State-Trait Anxiety Inventory (STAI), with no difference between correlations with Trait and State scales (Creamer et al., 1995).
In addition, BAI has demonstrated good convergent validity by significantly correlating with other measures of anxiety (r=0.48) among clinical samples.
The BAI typically shows lower correlations with the BDI than does the STAI or other measures of anxiety, suggesting it has better discriminant validity (Creamer et al., 1995; Fydrich, Dowdall, & Chambless, 1992).
The BAI also has shown good discriminant validity with respect to measures of depression as compared to other anxiety-specific measures such as State-trait Anxiety depression scale.
However, factor analysis combining both the BAI and STAI-State scale showed that the two scales load on different factors, suggesting that they tap different constructs (Creamer et al., 1995).
Advantages:
1. This measure is a quick screening measure used to identify anxiety symptoms in individuals.
2. The measure can either be self-reported or orally administered.
3. The 21 questions are accurate predictors of anxiety disorders, which makes this screening tool useful in diagnosing clients.
4. The BAI is a useful tool to determine client baselines. Throughout the course of therapy, the BAI can be helpful for ongoing assessment of the client's symptomatology.
5. Compared to other measures of anxiety, the BAI better discriminates anxiety symptoms from depression.
6. The measure has been validated in other countries, with studies suggesting that the measure is reliable and valid in numerous cultures.
Disadvantages:
1. While many items tap the somatic symptoms of anxiety, this measure fails to assess other anxiety symptoms that commonly appear in trauma-exposed individuals.
2. A number of researchers have suggested that the BAI may be tapping more physiological aspects of anxiety such as panic. The physiological aspect of anxiety is, however, an important aspect to assess in PTSD, given the high comorbidity of PTSD and panic and research studies showing that many individuals experience panic symptoms during trauma exposure and that such symptoms are related to later symptomatology. (Bryant & Panasetis, 2001; Nixon & Bryant, 2003).
3. BAI symptoms have been found to be associated with measures of health status
(Wetherell & Gatz, 2005), suggesting that in samples with health problems (e.g., medical trauma) an anxiety measure that taps cognitive rather than somatic aspects of anxiety may be important.
4. Given the research suggesting that females score higher than males, separate norms are needed by gender.
5. Psychometric studies involving U.S. adolescents have involved predominantly White samples. More research is needed involving samples with greater ethnic and socioeconomic diversity.
Suggested Uses: Recommended for use in assessing anxiety in clinical and research settings.
Clinical and Research Uses
The BAI can be used to assess and establish a baseline anxiety level, as a diagnostic aid, to detect the effectiveness of treatment as it progresses, and as a post-treatment outcome measure.
Other advantages of the BAI include its fast and easy administration, repeatability, discrimination between symptoms of anxiety and depression, ability to highlight the connection between mind and body for those seeking help to reduce their anxiety, and proven validity across languages, cultures, and age ranges.
Some researchers have suggested that the BAI may be less sensitive to symptoms secondary to medical or other trauma, more sensitive to panic disorder than it is to the symptoms of other anxiety disorders, and may need separate norms for males, females, and more ethnically/socioeconomically diverse samples.

Beck Anxiety Inventory used in Pakistani Settings
“FREQUENCY OF ANXIETY IN PATIENTS REPORTING FOR PRE-ANAESTHESIA ASSESSMENT” * (Annexure 2) Issue Year : 2010, Issue Number : 1, Issue Month : March | Written By : Shoaib Ahmed*, Saleem Ahmed, Abdul Qayyum Ghauri, Shakeel Ahmed | Belongs To : *Combined Military Hospital Multan, Combined Military Hospital Malir |

Objective: To study the frequency of anxiety in patients who reported for pre-anaesthesia assessment pre-operatively in Combined Military Hospital (CMH) Malir Cantt and to establish any association of anxiety with demographic characteristics.
Study Design: A cross-sectional study
Patients and Method: One hundred consecutive patients who reported for pre-anaesthesia prior to planned surgeries were included in the study. Inclusion and exclusion criteria were setup. Each patient filled up a questionnaire in Urdu language based on Beck Anxiety Inventory. Results were summed and statistically analyzed using SPSS 11.0.
Result: A total of 100 patients took part in the study ranging from 18 years to 60 years of age. Twenty-nine (29%) were males and 71 (71%) were females. Fifty-five (55%) were up to 30 years of age and forty-five (45%) above 30 years of age. Forty-two percent had no anxiety while 58% had varying grades of anxiety; 35% had mild, 17% moderate and 6% had severe anxiety. The frequency of anxiety in males was 48% as compared to 62% in females (P>0.118). Moreover 40% of patients up to 30 years of age had anxiety as compared to 80% in patients above 30 years of age (P<0.001).
Conclusion: Anxiety was a common problem in patients who were assessed pre-operatively during pre-anaesthesia. Association of anxiety with gender was insignificant while there was a significant association of anxiety with different age groups.

2. Hamilton Anxiety Scale (HAS) *(Annexure 3)
The HAS was originally developed to assess the severity of anxiety symptoms in patients diagnosed with ‘neurotic anxiety states’ (Hamilton 1959), and it provides an overall measure of global anxiety that is weighted towards somatic and autonomic features of anxiety, but also includes emotional and cognitive symptoms. it was developed by Max Hamilton in 1959.
Hamilton developed the scale by utilizing the statistical technique of factor analysis. Using this method, he was able to generate a set of symptoms related to anxiety and further determine which symptoms were related to psychic anxiety and which were related to somatic anxiety.
Rating:
* Clinical rated * Publically domain anxiety rating scale
Administration time: 10–15 minutes
Purpose
The HAS is used to assess the severity of anxiety symptoms present in children and adults. It is also used as an outcome measure when assessing the impact of anti-anxiety medications, therapies, and treatments and is a standard measure of anxiety used in evaluations of psychotropic drugs. The HAS can be administered prior to medication being started and then again during follow-up visits, so that medication dosage can be changed in part based on the patient's test score.
It provides measures of overall anxiety, psychic anxiety (mental agitation and psychological distress), and somatic anxiety (physical complaints related to anxiety). Hamilton developed the HAS to be appropriate for adults and children; although it is most often used for younger adults, there has been support for the test's use with older adults as well. Hamilton also developed the widely used Hamilton Depression Scale (HDS) to measure symptoms of depression.
Use in the field
Since its introduction by Max Hamilton in 1959, it has become a widely used and accepted outcome measure for the evaluation of anxiety in clinical trials. It was included in the National Institute of Mental Health's Early Clinical Drug Evaluation Program Assessment Manual, designed to provide a standard battery of assessments for use in psychotropic drug evaluation.
Scale
The scale consists of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to anxiety).
Scoring
Each item is scored on a scale of 0 (not present) to 4 (severe).
0 = Not present, 1 =Mild, 2= Moderate, 3 =Severe, 4= Very severe.
Criteria for interpretation
Mild: Below 18
Mild to Moderate: 18 to 24
Moderate to Severe: 25 +

Versions
The scale has been translated into: Cantonese for China, French, and Spanish.

Psychometric Properties

* The Hamilton Anxiety Scale was tested for reliability and validity in two different samples, one sample (n=97) defined by anxiety disorders, the other sample (n=101) defined by depressive disorders. The reliability and the concurrent validity of the HAS and its subscales proved to be sufficient. Internal validity tested by latent structure analysis was insufficient.

* A number of validation studies of the clinician HAS document its psychometric properties. Several validation studies have also been conducted of the computer HAS. In the first, 292 adults were administered both a desktop and clinician HAS in counterbalanced order. Internal scale consistency (coefficient alpha) was high (.92) and the mean item-to-total scale correlation was .65. The test-retest reliability was .96. The correlation between the computer and clinician HAS scores was .92, providing support for the concurrent validity of the computer HAS. The mean score difference between the computer and clinician HAS scores for the total sample was small (1.37 points) but significant. However, for subjects with an anxiety disorder the difference in scores between HAS versions was not significant.

* A version of the HAS was developed using slight modification of the desktop version. In a validation study 72 subjects were given the clinician and HAS in counterbalanced order. Subjects were retested 24 hours later with both versions. Internal scale consistency reliability was .93 and the mean item-to-total scale correlation was .67, indicating a high level of internal consistency reliability. Test-retest reliability was .97, and mean score differences (.23 of a point) between test and retest were not significant. Correlation of both versions was .65 and the HAS was correlated with the Beck Anxiety Inventory (r = .52). The mean score difference between the two versions (0.60 of a point) was not statistically significant providing further evidence of concurrent validity.

Applied in different researches * Pattern of Somatic symptoms in anxiety and depression Objective Issue Year: 2011
Issue Month: September
Written By: Mubashar Shah, Wahid Bukhsh Sajid, Dr. Fazaila Sabih, Muhammad Shoaib Hanif
Belongs To: Combined military Hospital Abbottabad, Islamic international Medical College Rawalpindi, CMH Rawalpindi
Research topic: To determine the pattern of somatic symptoms in anxiety and depressive disorders.
Place of Study: Department of Psychiatry Military Hospital Rawalpindi.
Duration of Study: From May to November 2002.

* Reliability and Validity of the Hamilton Anxiety Rating Scale in an Adolescent Sample
Researchers: Duncan Clark John E. Donovan
From: Pittsburgh Adolescent Alcohol Research Center, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA , Accepted 4 August 1993.

* Herbal and Dietary Supplements for Treatment of Anxiety Disorders
Researchers: Atezaz Saeed, Richard M. Bloch, and Diana J. Antonacci, East Carolina University, Greenville, North Carolina. Accepted in 2007.

Limitations
The test has been criticized on the grounds that it does not always discriminate between people with anxiety symptoms and those with depressive symptoms (people with depression also score fairly high on the HAS).
Because the HAS is an interviewer-administered and rated measure, there is some subjectivity when it comes to interpretation and scoring. Interviewer bias can impact the results. For this reason, some people prefer self-report measures where scores are completely based on the interviewee's responses.

3. Hamilton Depression Scale *(Annexure 4)
It was first introduced by Max Hamilton in 1960.The Hamilton Rating Scale for Depression has been the Gold standard for assessment of depression for more than 40 years.
Description/Purpose
The Hamilton Depression Rating Scale is a 17-item scale that evaluates depressed mood, vegetative and cognitive symptoms of depression, and co morbid anxiety symptoms. It provides ratings on current DSM-IV symptoms of depression, with the exceptions of hypersomnia, increased appetite, and concentration/indecision. The HDS was originally designed to be administered by a trained clinician using a semi-structured clinical interview.
Use in the field
The HDS was one of the first rating scales developed to quantify the severity of depressive symptomatology., it has since become the most widely used and accepted outcome measure for evaluating depression severity. It was included in the National Institute of Mental Health's Early Clinical Drug Evaluation Program Assessment Manual, designed to provide a uniform battery of assessments for use in evaluating pharmacologic drug treatment of depression. The HDS has since become the standard depression outcome measure used in clinical trials presented to the Food and Drug Administration by pharmaceutical companies for approval of New Drug Applications. It was also the primary outcome measure in the National Institute of Mental Health collaborative studies comparing pharmacotherapy with psychotherapy for the treatment of depression. The HDS is the usual standard against which other depression rating scales are validated. The scale has been translated into many European and Asian languages. A computerized version of the HDS implemented over Touch-Tone telephones using Interactive Voice Response has been used in over 18 multi-site clinical trials to date.
Scale
The 17-items are rated:
In general, the 5-point scale items use a rating of
0 = absent
1 = doubtful to mild
2 = mild to moderate
3 = moderate to severe
4 = very severe.
A rating of 4 is usually reserved for extreme symptoms.
The 3-point scale items used a rating of
0 = absent
1 = probable or mild
2 = definite
Criteria for interpretation
Normal: 0-7
Mild Depression: 8-13
Moderate Depression: 14-18
Severe Depression: 19-22
Very Severe Depression: above 23

Psychometric properties
The Psychometric properties like reliability and validity of the scale has been examined explicitly since 1979. Hamilton's scale has been found to exhibit high internal consistency and support for its 'Construct Validity' has been demonstrated by correlations with other measures of depression, anxiety and depression related cognition(Dozois, 2003). The majority of Hamilton scale items show adequate reliability with six items meeting the reliability criteria in every sample during studies including guilt; middle insomnia, psychic anxiety, somatic anxiety gastrointestinal and general somatic The internal, interrater and retest reliability are good ( Bagby et.al,2004). A study to compare the psychometric properties of the Hamilton Rating Scale for Depression (HDS) in patients with stroke, Alzheimer's dementia (AD), and Parkinson's disease (PD), has shown that the concurrent validity of the HDS with the DSM-IV criteria for major depressivedisorder is high in each of these groups (Naarding et.al,2002). Thus, the psychometric properties of the HDS scale are excellent and adequate

The psychometric properties of the original clinician-administered scale have been well documented. * Several validation studies of the computer HDS have been conducted in the past decade. In a validation study of a desktop PC version with 97 subjects, a correlation of .96 was found between the computer- and clinician-obtained HDS scores. Mean score difference between the computer and the clinician were not significantly different. Both the computer and clinician demonstrated high and similar levels of internal consistency reliability. Both versions differentiated patients with major depression from patients with minor depression and controls, with significant mean score differences between the three groups. Both forms of administration demonstrated similar levels of convergent validity, correlating highly with the Beck Depression Inventory, providing further evidence for the equivalence of the two measures. * A second study of the desktop HDS involved 390 subjects participating in clinical drug trials between 1989 and 1992 at the Department of Psychiatry, University of Wisconsin-Madison. Subjects were administered computer and clinician versions of the HDS in counterbalanced order prior to receiving treatment. Internal scale consistency and the mean item-to-total scale correlation indicated adequate psychometric properties. Test-retest reliability on a subsample of 41 subjects was .95. The correlation between computer and clinician HDS scores was .90. The mean score difference between the computer and clinician HDS scores was again very small and not statistically significant. * Studies have proved that the Hamilton depression scale actually is better than the Montgomery-Åsberg Depression Rating Scale in sensitivity to change and in detecting early change with treatment.

Applied in different researches * Department of Psychology, University of Western Ontario, London, Canada.
In this study, the psychometric properties of the Hamilton Depression Scale were examined in a sample of 249 undergraduate participants. The HDS exhibited high internal consistency and support for its construct validity was demonstrated by the HDS’s patterns of correlations with other measures of depression, anxiety, and depression-relevant cognition. Moreover, the operating characteristics of the standard HDS outperformed the simplified HDS in the prediction of the Beck Depression Inventory-II (Beck, Steer, & Brown, 1996) classification. The results provide strong support for the HDS as a reliable and valid instrument for the assessment of depressive severity. * ------------------------------------------------- Correlations among Depression Rating Scales and A Self-Rating Anxiety Scale In Depressive Outpatients
Researchers:
Toru Uehara
Tetsuya Sato
Kaoru Sakado

We investigated relationships among the Hamilton Rating Scale for Depression (HRSD), the Beck Depression Inventory (BDI), the Inventory to Diagnose Depression (IDD), and the Self-rating Anxiety Scale (SAS) for 44 outpatients with major depression. The IDD showed significant correlation with the HRSD (r=.58), the BDI (r=.42), and the SAS (r=.39). The BDI showed significant correlation with the HRSD (r=.39) and the SAS (r=.40). Results from multiple regression analysis showed that the BDI and age were selected as the significant variables to correlate with the SAS (P<.05). Although self-rating depression scales, such as the BDI and IDD, are typically more influenced by anxiety than the objective rating(HRSD), the IDD may prove to be as useful and reliable as the HRSD for evaluating, relatively independent of anxiety, the severity of depressive symptoms. * Trial for Postnatal Depression
Sponsor: Pakistan Institute of Learning and Living
Collaborators: Dow University of Health Sciences
University of Manchester
Two scales used
Edinburgh Postnatal Depression Scale (EPDS) and Hamilton Depression Rating Scale (HDRS).
Limitations
Hamilton provided only general guidelines for the administration and scoring of the scale. No standardized probe questions were provided to elicit information from patients and no behaviorally specific guidelines were developed for determining each item's rating.

4. Adaptive Behavior Assessment System Second Edition
The Adaptive Behavior Assessment System–Second Edition (ABAS–II) provides a comprehensive norm-referenced assessment of the adaptive skills of individuals ages birth to 89 years. The clinician can use the ABAS–II to diagnose and classify disabilities and disorders; identify an individual’s strengths and limitations; and to document and monitor the individual’s performance over time. The ABAS–II provides for the assessment of an individual by multiple respondents (e.g., parents, teachers, family members, the individual), evaluates function across multiple environments, and contributes to a complete assessment of the daily functional skills of an individual. The ABAS–II is very useful tool in the assessment of individuals who may be experiencing difficulties with the daily adaptive skills necessary for functioning effectively in their environments.
Rationale:
When the goal of treatment is improving daily functioning and quality of life for an individual whose adaptive skill limitations are of concern; a comprehensive diagnostic assessment such as ABAS–II is essential because it provides the analysis of strengths and weaknesses in adaptive functioning the clinician needs to develop the appropriate intervention plan.

What’s New in ABAS–II
ABAS–II includes new features such as the infant–preschool Parent/Primary Caregiver and Teacher/ Daycare Provider rating forms, normative data for children ages birth to five years, and an expanded structure that incorporates the current American Association of Mental Retardation (AAMR) guidelines for diagnosis of mental retardation. In addition to including younger age ranges and the AAMR guidelines, ABAS–II retains all of the features of the first edition of ABAS. These include an assessment of overall adaptive functioning (the General Adaptive Composite) and an assessment of the 10 adaptive skill areas specified by the DSM–IV–TR, ABAS–II also retains the Parent and Teacher Forms for ages 5–21 years and the Adult Form for ages 16–89 years. The AAMR (2002) emphasizes the importance of evaluating conceptual, social, and practical skills when assessing adaptive behavior for diagnostic and intervention purposes. Significant limitations in adaptive behavior are defined as performance at least two standard deviations below the mean on either (a) conceptual, social, or practical adaptive functioning, or (b) an overall score on a standardized measure that assesses these three adaptive domains. In the table below, the 10 skill areas of the original ABAS have been conceptually grouped into the three broad domains according to AAMR guidelines. Adaptive Domains | Conceptual | Social | Practical | CommunicationFunctional AcademicsSelf-Direction | LeisureSocial | Community UseHome/School LivingSelf-CareHealth and SafetyWork |

Because federal and state governments and other professional associations (e.g., American Psychiatric Association) have not yet revised their policies to reflect AAMR policy recommendations (i.e., the use of conceptual, social, and practical skills in diagnosis, classification, and program planning), ABAS–II retains the 10 skill areas and the General Adaptive Composite (GAC) from the first edition in order to provide standardized norm-referenced assessment of these skill areas, in addition to addressing the three broad domains of behavior advocated by the AAMR.

ABAS–II Rating Forms
The multidimensional quality of ABAS–II is derived from five rating forms that can be used in combination with one another or separately. Each rating form comprises 193 to 241 items and can be completed independently by a respondent in about 20 minutes. The instructions and items can be read aloud to a respondent if he or she does not have the necessary reading skills to complete the form independently. The rating scale for the ABAS–II items requires a respondent to indicate if the individual being assessed is able to perform an activity independently, and if so, how frequently (always, sometimes, or never) he or she performs the activity. Rating Form | Ages | Setting | Respondents | Parent/PrimaryCaregiver Form | 0-5 | home and community | parents or others responsible for the child’s primary care | Teacher/DaycareProvider Form | 2-5 | school or daycare | teachers, teacher’s aides, preschool instructors, daycare or other childcare providers | Parent Form | 5-21 | home and community | parents or others responsible for the child’s primary care | Teacher Form | 5-21 | school | teachers, teacher’s aides, or other school professionals | Adult Form | 16-89 | home and community | Family members, professional caregivers, supervisors, or the individual |

Scores Reported
The ABAS–II normative data enable the clinician to obtain a normative comparison between an individual’s adaptive behavior and the typical adaptive behavior of same-age individuals from a representative national sample. Optional analyses provide for the identification of strengths and weaknesses in skill areas and comparison of scores for the adaptive domains. ABAS–II provides:
• norm-referenced scaled scores for the 10 skill areas (M = 10, SD = 3)
• norm-referenced standard scores for the Conceptual, Social, and Practical Adaptive Domains and for the GAC, including standard scores (M = 100, SD = 15), 90% and 95% confidence intervals and percentile ranks
• adaptive skill classifications of Extremely Low, Borderline, Below Average, Average, Above Average, Superior, and Very Superior which may be used for the skill areas, adaptive domains, and the GAC.
Sample Items: Skill area | Sample Items | | Infant-Preschool Forms | School-Age And Adult Forms | Communication | Speaks in sentences of six or more words. | Ends conversations appropriately. | Community Use | Asks to go to a park or other favorite place. | Finds and uses a pay phone. | Functional Academics | Sings the alphabet song. | Makes reminder notes or lists. | Home/School Living | Turns TV on and off. | Wipes up spills at home/school. | Leisure | Shows interest in mobiles or other moving toys. | Plays alone with toys, games or other fun activities. | Health and Safety | Refrains from putting dirt or sand in mouth. | Carries scissors safely. | Self-Care | Holds and drinks from a sipping cup. | Uses public restroom alone. | Self-Direction | Resists pushing or hitting another child when angry or upset. | Completes large home or school projects on time. | Social | Smiles when he/she sees a parent. | Laughs in response to funny comments or jokes. | Motor*/Work | Shakes rattle or toy. | Cares properly for work supplies and equipment. |
*Motor replaces the Work skill area on the infant-preschool forms.

Psychometric Properties:
Standardization
The five ABAS–II forms were developed based on information gathered over eight years of research. Data collected during pilot and national tryout phases were analyzed to select items for the national standardization editions. The standardization samples for the Parent/Primary Caregiver and Teacher/Daycare Provider Forms for children ages birth to five years comprised 2100 individuals; the standardization samples for the Parent and Teacher Forms, and Adult Form comprised 5270 individuals.
The composition of the standardization samples were representative of the U.S. population in terms of the following variables: sex, race/ethnicity, geographic region, and parent education level These samples represented a continuum of development, including people with typically developing skills and people identified with a disability, in proportions representative of the general U.S. population (U.S. Bureau of the Census, 1999, 2000). * Evidence of Reliability
Reliability studies provide confidence and support for many application of the ABAS-II and are summarized as follows:
• All Forms
• Internal Consistency: Reliability coefficients for the GAC are in the high .90s for all age groups, ranging from .97 to .99. Reliability coefficients for the adaptive domains are in the .90s, ranging from .91 to .98. Average reliability coeffi-cients of the skill areas across age groups are typically in the .90s, ranging from .85 to .97.
• Parent and Teacher Forms and Adult Form
• Test-Retest Reliability: Test-retest reliability coefficients of the GAC are all in the .90s. The mean GAC scores of the two testings (in a 1–2 week period) are very consistent, with the mean retest scores slightly higher. As expected, the test-retest reliability coefficients of the 10 skill areas are slightly lower, mainly in .80s to .90s.
• Inter-Rater Reliability: (Teacher Form [ages 5–21] ratings by two teachers) Inter-rater reliability coefficients on the GAC scores are .91 for students between ages 5 and 9, .87 for students between ages 10 and 21, and .89 for students of all ages. The inter-rater reliability coeffi-cients for the skill areas generally are in the .60s and .70s. (Correlations corrected for variability in sample.)
• Inter-Rater Reliability: (Parent Form [ages 5–21] ratings by both parents) The inter-rater reliability coefficients on the GAC scores are .83–.85 for both age groups (ages 5–11 and 12–21). The inter-rater reliability coefficients for the skill areas generally are in the .60s and .70s. (Correlations corrected for variability in sample.)
• Inter-Rater Reliability: (Adult Form—ratings by two adult respondents) The inter-rater reliability coefficients on the GAC scores are .90 without Work and .93 with Work. The inter-rater reliability coefficients for the skill areas generally are in the .80s. (Correlations corrected for variability in sample.)
Validity
The correlation between the school-age Teacher Form GAC and the Vineland Adaptive Behavior Scales–Classroom Edition (VABS) Adaptive Behavior Composite is .82. Furthermore, all scores from nine ABAS skill areas and the three VABS subdomains correlate significantly (p < .01). For example, the two scales that assess communication correlate .76. ABAS–II includes additional validity studies with the Vineland Adaptive Behavior Scales–Interview Edition and with other adaptive behavior assessment instruments designed for children younger than 5 years.

Advantages of Using ABAS–II
• Provides current norms, provides norms that include a proportionate sample of Hispanics.
• Provides norms that include a proportionate sample by socioeconomic status.
• Follows AAMR recommendations for the diagnosis and treatment of mental retardation by providing an assessment of the three domains as specified in the 2002 definition of mental retardation.
• Provides scores for the 10 skill areas critical to the assessment of mental retardation as specified by the DSM–IV–TR.
• Provides for a rapid yet comprehensive assessment of adaptive behaviours using a questionnaire format.
• Does not require a parent or teacher interview.
• Provides a guessing score to help evaluate whether or not a respondent has sufficient information needed to complete the form.
• Provides broader coverage of children and youth by including norms for parent and teacher forms for clients ages birth to 21 years.
• Offers Scoring Assistant software that enables scoring and profiling in minutes.
• Includes Spanish-language Parent and Teacher Forms.
• Provides correlation studies with Wechsler.
Adaptive behaviour assessment system in Pakistan:
Ma Ayesha Memorial Centre has a special education school on its premises since 1998. The school is dedicated to children with cognitive problems (mild to moderate retardation). The admission criteria for this school is that the child has to be evaluated independently by the experts along with an adaptive behaviour assessment by the school management prior to admission. 5. Symptom Assessment-45
Purpose:
Designated to evaluate a broad range of psychological problems and symptoms of psychopathology. It is often used as a screening tool, to help formulate diagnoses, to develop treatment plans, and to measure outcomes. Its brevity makes it ideal for use in managed-care settings.
Description:
The SA-45, published by MHS, (MHS publishes an extensive line of clinical products that are specially designed to help clinicians and mental health professionals assess children, adolescents, and adults for the possible presence and severity of psychological disorders.) is a quick (taking about 10 minutes) and comprehensive measure of psychiatric symptomatology, particularly useful in primary care settings. It uses the proven items and structure of the SCL–90–R® to create a brief, yet thorough, measure of psychiatric issues
Using a 5-point likert scale, the SA-45 measures Anxiety, Depression, Hostility, Interpersonal Sensitivity, Obsessive-Compulsivity, Paranoid Ideation, Phobic Anxiety, Psychoticism and Somatisation. A score for the Global Severity and Positive Symptom indexes, helpful when assessing overall symptomatology, are also produced. The SA-45 is scored relative to a normative database of over 18,000 individuals.
SA-45 Scales:
Following is a summary of content of each of the 9 scales
Depression (DEP) - Items related to asking about recent experiences of feeling lonely, hopeless, and worthless. Other symptoms tested are a loss of interest in things and feeling blue Interpersonal Sensitivity (INT) - The respondents' feelings about himself or herself are assessed here. These include feeling inferior or self-conscious around others, feeling that others are unsympathetic or unfriendly and feeling uneasy when others are talking with or watching the respondent
Hostility (HOS) - Measuring uncontrollable temper outbursts, getting into frequest arguements, shouting, and urges to harm others or break things.
Obsessive-Compulsive (OC) - Difficulty concentrating or making decisions, repetitive checking or doing tasks slowly to ensure correctness, and problems with one's mind "going blank" are symptoms presented on this scale
Psychoticism (PSY) - Auditory hallucinations, feelings that others know or are controlling one's thinking, and ideas that one should be punished for his or her sins
Paranoid Ideation (PAR) - Subtler forms of paranoid thinking are assessed on this scale, such as feeling that others take advantage of the respondent; that they cannot be trusted and are responsible for his or her troubles; a failure to give credit for his or her achievements, and watching or talking about him or her.
Somatization (SOM) - The presence of vague physical symptoms are presented here. Including; hot / cold spells and feeling of numbness, soreness, tingling, and heaviness in various parts of the body.
Phobic Anxiety (PHO) - Rating experiences of fear or uneasiness when being in open spaces or crowds, using public transportation, and leaving home alone. Avoidance of specific places, things, and activities is also covered in this scale
Global Severity Index (GSI) - Represents the total of the item response values (1-5) for all items on the SA-45 providing a more meaningful overview of the level of symptomology.
Positive Symptom Index (PST) - Indicates the total number of symptoms reported to be present (i.e., item yielding a response other that "Not at all")
Psychometric properties:
The two principal psychometric properties of a rating scale are reliability and validity. To be useful, rating scales should be reliable (i.e., consistent and repeatable even if performed at different times or under different conditions) and valid (i.e., represent the true state of nature). No scale is totally reliable and/ valid
Reliability and Validity:
Numerous studies have validated the reliability of the SA-45 (Davison, M L, et. al. 1997; Maruish, M E 1999).
To investigate the psychometric properties of SA-45 a project was designed to demonstrate the benefits of integrating behavioral healthcare services in primary medical care settings using data from a sample of 126 adults seeking medical services in a family practice setting. Specifically, the appropriateness of the SA45's adult non-patient norms, as well as cross-validation of its test-retest reliability and construct validity, was investigated from the first set of data gathered for this project. The results suggested that use of the SA-45 non-patient norms with primary care populations is appropriate. Three-month test-retest correlations between Depression scale scores and SA-45 and SA-24-predicted GSI (Global Severity Index) scores were found to be moderate but highly significant. In addition, correlations among the SA-45 scales and indices and their correlations with the SF-12 Mental and Physical Component Summary scales added further support for the psychometric integrity of the SA-45. Finally, only partial indirect support was obtained for the SA-45's ability to accurately classify patients as requiring further evaluation for behavioral health problems.
Another study examined the validity of the Symptom Assessment-45 Questionnaire (SA-45) in the Mentally Disordered Offender (MDO) population. The SA-45 is increasingly administered as a tool for screening, assessment and treatment monitoring, even though its psychometric properties have not been adequately examined. The subjects for this study were 424 MDOs admitted to the Detroit Wayne County Mentally Ill/Substance Abuse - Corrections Outpatient Intensive Treatment Continuum (M-COIT) Bridge program. Inter-scale relationships were calculated for the SA-45s of 383 male MDOs and compared to those reported in the SA-45 manual. The resulting correlations in the study sample were consistently higher than those reported in the SA-45 manual. The criterion validity of the SA-45 was also examined employing the Millon Clinical Multiaxial Inventory 3rd edition (MCMI-III) as the criterion measure. Overall minimal criterion related validity was found for each of the separate subscales when measured against the MCMI-III. In light of the findings, a principal component analysis was conducted to examine the structure of the SA-45. The best solution for the SA-45's primary symptom scales was a single factor structure, which is similar to findings of the parent measure, the Symptom Checklist-90 Revised, where the single factor is thought to measure general psychiatric distress. These findings suggest that clinicians working with MDOs should exercise caution when employing the SA-45 subscales to measure ongoing dynamic factors as they may relate to predictions of impending recidivism. The subscales are not sensitive enough and do not measure the constructs purported in the SA-45manual. However, the SA-45 in its current form may be a useful, dynamic measure of overall psychological and psychiatric distress.
Norms:
Norms have been developed on the basis of a database of over 18,000 individuals, with group-specific data for males and females, inpatients and non-patients, and adolescents and adults (ages 13 years and older).

Research in Pakistani context:
A research was conducted in Pakistan by Arshi Ali in 2006 to investigate the psychological problems of adults who were abused in childhood because child abuse occurs in all geographic locations including both urban and rural areas. It cuts across socio-economic groups, races and religions as well. Child abuse is not an isolated problem; it is an issue of national concern.
Methodology
In order to measure abused childhood a checklist questionnaire was prepared after conducting two pilot studies. One was to form an assessment tool for identifying abused childhood of adults in reference to Pakistani society and to explore the types of physical as well as verbal abused childhood of adults. The second pilot study was aimed to explore whether the sexually abused childhood exists in non-clinical Pakistani adults. Symptoms Assessment - 45 scales was selected for measuring psychological problems of adults. The sample of the present research comprised of two hundred and forty eight (248) adults, 135 males and 113 females. Their ages range between 18 to 26 years. Checklist questionnaire and SA-45 scale were applied on a large population than on the basis of cut off scores non abused and abused groups were identified. ANOVA and other descriptive statistics were performed for analyzing the data. For interpreting the results, α 0.05 level of significance was set.

Results:
The results revealed that the adults who have been abused specifically in terms of verbal, physical and sexual tend to have anxiety, depression, OCD, phobia, somatization, hostility, interpersonal sensitivity, paranoid ideation and psychotic features as compared to those adults who have not been abused in childhood, on the other hand adults who have been abused specifically in terms of verbal and physical tended to reveal no significant difference in phobia and somatization scores in the comparison of those adults who have not been abused in childhood. However, comparison of verbally, physically and sexually severe abused and non-abused group on phobia scores depicted no significant differences.

References:
Beck, A. T., & Steer, R. A. (1990). Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation.
Steer, R. A., Ranieri, W. F., Beck, A. T., & Clark, D. A. (1993). Further evidence for the validity of the Beck Anxiety Inventory with psychiatric outpatients. Journal of Anxiety Disorders, 7, 195–205.
Beck, A.T., Epstein, N., Brown, G., & Steer, R.A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56,
893-897.
Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959: 32:50-55

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