The Development of the Obsessive-Compulsive Disorder School Impact Scale: An Investigation Using the Accuracy-Reliability Paradigm for Scale Validation

Obsessive-compulsive disorder (OCD), once thought to be rare in children and adolescents, is now believed to be 20 to 40 times more common than previously reported. Students with OCD commonly experience poor peer relations, higher absentee rates, and a decline in scholastic aptitude and overall school functioning. They have increased risk for drug and alcohol abuse. Because approximately one-third to one-half of adults with OCD report that their OCD symptoms developed in childhood or adolescence, school staff need to be able to identify and monitor OCD. Some students who are diagnosed with OCD remain in the regular education setting while others are placed in special education due to their inability to function in regular classrooms.

In many cases, early detection of OCD plays a vital role in children's recovery. To that end, Kratochwill and Racine are completing a new rating scale and observation system designed to help school staff record their observations and judgments of students' behavior and to refer them to specialists when appropriate.

A new OCD assessment scale is needed because current assessment devices are inappropriate downward extensions of adult scales and lack reliability and validity. Additionally, while clinicians and researchers can detect when treatment leads to improvement, they often fail to indicate what behaviors have changed. The Racine-Kratochwill scale provides a way to measure such changes, thus helping professionals determine what behaviors have improved.

Among the many observable symptoms of OCD are counting rituals (for example, the student persistently counts the number of steps taken or the number of times a door is opened or closed); grooming rituals (excessive concern with dirt and germs and excessive hand washing; excessive checking (homework over and over); and excessive need for symmetry and order (doing things in a certain way, conducting ordered rituals before starting work or throughout the school day).

A teacher or other school staff person uses the Racine-Kratochwill scale to measure a student's behavior, in particular, the frequency and duration of observable OCD behaviors; the teacher's level of confidence that the behavior being rated is OCD; how much the observed behavior interferes with the student's performance; how much the student seems distressed when not allowed to engage in the behavior; and how much the observed behavior bothers the teacher.

The measurement tools and the process of developing them will serve as a template for developing future instruments to measure other specific childhood behavior disorders (for example, attention deficit/hyperactivity disorder, selective mutism, and depression).