The Brief Impairment Scale (BIS): A Multidimensional Scale of Functional Impairment for Children and Adolescents

doi:10.1097/01.chi.0000163281.41383.94

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 44, Issue 7, July 2005, Pages 699-707

https://doi.org/10.1097/01.chi.0000163281.41383.94 Get rights and content

ABSTRACT

Objective

This article provides the results of the psychometric testing of the Brief Impairment Scale (BIS). The BIS is a 23-item instrument that evaluates three domains of functioning: interpersonal relations, school/work functioning, and self-care/self-fulfilment. It capitalizes on the strengths of existing global measures while addressing some of their limitations.

Method

Cross-sectional parent respondent data from one clinical (N = 757) and two community samples (N = 1,888 and 1,132) of children ranging in age from 4 to 17 years is employed to test the reliability and validity of the BIS. Receiver operating characteristic analyses are employed to assess useful cutoff scores on the scale.

Results

The total scale's internal consistency ranged from 0.81 to 0.88 and from 0.56 to 0.81 on the three subscales. Test-retest reliability for individual items ranged from fair to substantial in all but six items. The BIS has high convergent and concurrent validity. Receiver operator characteristic analyses suggest possible thresholds for different uses.

Conclusions

The BIS is psychometrically sound, useful in assessments and as an outcome measure in clinical practice and research. Its advantages over other global impairment instruments are that it is respondent based, short in administration time, and multidimensional.

Section snippets

Description of the BIS

The BIS is administered to an adult informant about his or her child. Previous research suggests that the more reliable and valid assessments of child impairment are provided by adult caretakers (Bird, 1999; Bird and Gould, 1995; Bird et al., 1996). The BIS consists of 23 items scored along three functioning domains: interpersonal relations (parents, siblings, peers, teachers and other adults), school/work (attendance, performance, responsibility), and self-fulfillment (sports participation,

Internal Consistency

High internal consistency in the total scale (Cronbach's α ≥.80) replicated across the four samples (Table 1). With the exception of the self dimension in sample 2, the remaining α on the scales of the three impairment dimensions were ≥.60 in each of the samples.

Test-Retest Reliability

A respondent-based instrument does not require the interviewer to interpret the respondent's rating. Therefore, the instrument's test-retest reliability is not influenced by rater bias. Only sample 1C (N = 68) provided test-retest

DISCUSSION

The BIS provides a global measure of impairment, scored along three dimensions of functioning: interpersonal relations, functioning at school/work, and functioning in areas of self-care and self-fulfillment. It shows high internal consistency and test-retest reliability, overall, and in most of its individual items. Its items have face validity and the scale shows good convergent and concurrent validity. ROC analyses confirm the instrument's validity against two external validators: a CGAS

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Measures assessed caregiver and youth-reported symptoms, functional impairment, and core underlying dysfunctions addressed by the UP-C/A (e.g., emotional reactivity, regulation, distress tolerance). Table 4 presents changes in several of these key outcome measures at posttreatment and 1-month follow-up for each case example, including the PROMIS® Emotional Distress–Anxiety Short Form-8a and Depressive Symptoms Short Form-6a, Pediatric and Pediatric Proxy (Quinn et al., 2014; Irwin et al., 2012), the caregiver-reported Emotion Dysregulation Inventory–Reactivity Short Form (EDI; Mazefsky et al., 2018), and the caregiver-reported Brief Impairment Scale (BIS; Bird et al., 2005). “Paul” was a 10-year-old White male who was self-referred to PHP for disruptive behavior and emotion dysregulation.
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Data were obtained through NIMH grants MH54827 (Dr. Canino, PI), MH56401 (Dr. Bird, PI), MH54827 (Dr. Canino, PI), and P01-MH 59876-02 (M. Alegria, PI), and from the National Center for Minority Health Disparities grant P20 MD000537-01 (Dr. Canino, PI). The authors acknowledge Dr. Adrian Angold's valuable comments and suggestions.

Article Plus (online only) materials for this article appear on the Journal's Web site: www.jaacap.com.

Disclosure: The authors have no financial relationships to disclose.

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ARTICLESThe Brief Impairment Scale (BIS): A Multidimensional Scale of Functional Impairment for Children and Adolescents

ABSTRACT

Objective

Method

Results

Conclusions

Section snippets

Description of the BIS

Internal Consistency

Test-Retest Reliability

DISCUSSION

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition-Revised (DSM-III R)

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV)

The Child and Adolescent Functional Assessment Scale (CAFAS): review and current status

Clin Child Fam Psychol Rev

Comparative outcomes of emotionally disturbed children and adolescents in a system of services and usual care

Psychiatr Serv

The Assessment of Functional Impairment

The use of diagnostic instruments and global measures of functioning in child psychiatry epidemiological studies

Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico

Arch Gen Psychiatry

The Columbia Impairment Scale (CIS): pilot findings on a measure of global impairment for children and adolescents

Int J Methods Psychiatr Res

Global measures of impairment for epidemiologic and clinical use with children and adolescents

Int J Methods Psychiatr Res

The Spanish translation and cultural adaptation of the Diagnostic Interview Schedule for Children (DISC) in Puerto Rico

Cult Med Psychiatry

ARTICLES
The Brief Impairment Scale (BIS): A Multidimensional Scale of Functional Impairment for Children and Adolescents