(PS3-A13) The Transdiagnostic Youth-adapted Sheehan Disability Scale: A Psychometric Evaluation

Assessment of functional impairment in psychiatric disorders is critical, as symptom reduction may not automatically translate to functional improvement.  The need for effective and efficient measures of functional impairment is particularly acute for youth, where few validated measures exist.  Limited research has explored the youth-adapted Sheehan Disability Scale (SDS) in clinical settings. This scale (Whiting & Tolin, 2008) measures 1) child self-report of their own impairment (SDS-C), 2) parent report of child impairment (SDS-PC), and 3) parent report of parent impairment due to the child’s symptoms (SDS-PP).  The present study aimed 1) to further evaluate the psychometric properties of the youth-adapted SDS in a large treatment-seeking sample with primary fear-based disorders, 2) to explore potential age-related differences in these psychometric properties, and 3) to examine the measure’s sensitivity to treatment between baseline and session 15 of cognitive behavioral therapy. The sample included 594 child (M age = 13.6 years, SD = 2.68) and parent (M age= 47.1 years, SD = 5.67) dyads presenting to treatment at a specialty outpatient clinic in a psychiatric hospital. Participants completed measures about functional impairment and child symptom severity, while clinicians provided ratings of illness severity over the course of treatment. On the SDS-C, youth reported mild family interference and moderate social and school impairment. Parents reported that their child experienced moderate impairment across domains on the SDS-PC, while they reported mild impairment in their own functioning on the SDS-PP. Cronbach’s α was acceptable for all three scales (SDS-C = .72, SDS-PC = .74, SDS-PP = .85). Further, when accounting for child’s age, reliability remained in the acceptable range for youth aged younger than 14 years (SDS-C = .73, SDS-PC = .73, SDS-PP = .84), and for youth aged 14 years or older (SDS-C = .69, SDS-PC = .74, SDS-PP = .85). Parent and child reports were moderately positively correlated across functional domains for both age groups, indicating fair inter-rater agreement. When compared to overall clinician-rated illness severity, parent and child ratings of functional impairment were moderately positively correlated (rs: 0.44-0.57). Low to moderate positive correlations were found between the parent and child SDS scores and the youth’s report of anxiety and depressive symptoms at baseline (rs: 0.23-0.57). Paired-sample t-tests found significant reductions in functional impairment ratings from baseline to session 15, demonstrating sensitivity to treatment. Similarly, treatment-related changes in clinician-rated illness severity were significantly moderately correlated with changes in both SDS-C and SDS-PC (rs: 0.48-0.53). Overall, this suggests that the youth adapted SDS is a reliable and valid transdiagnostic measure of youth and parent functional impairment. Additionally, findings suggest that youth can provide reliable reports of their functioning regardless of age. Finally, the adapted SDS scales appeared sensitive to treatment and thus can be a useful outcome measure for clinicians and researchers.