Ten-year review of rating scales. VI: scales assessing externalizing behaviors

J Am Acad Child Adolesc Psychiatry. 2003 Oct;42(10):1143-70. doi: 10.1097/00004583-200310000-00006.


Objective: This is the sixth article in a series of 10-year reviews of rating scales. The current article reviews scales that assess externalizing behaviors such as disruptive behavior disorders and aggression.

Method: Relevant scales were found by searching popular electronic databases. The search was then broadened by a review of the references in selected articles. Due to the paucity of well-established scales, any such scales with potential utility for elucidating the functioning of youths with externalizing behaviors were selected.

Results: None of these scales is diagnosis-based, although some correlate with DSM-IV-defined disruptive behavior disorders. Most scales assessing disruptive behavior disorders have a solid normative base, good psychometric functioning, and high clinical utility. Scales assessing aggression comprise a bimodal group. Several have been adapted from the adult literature and are widely used in clinical practice, while others address theoretical aspects of aggression and are used predominantly in research. Empirical support for all of the scales assessing aggression varies widely, although several show potential for routine clinical practice.

Conclusions: Overall, these scales measure a variety of constructs with considerable utility for assessing youths' externalizing behaviors, predicting outcome, and evaluating treatment effects. Many need further validation with youth.

Publication types

  • Review

MeSH terms

  • Aggression / psychology*
  • Attention Deficit and Disruptive Behavior Disorders / diagnosis*
  • Child
  • Diagnosis, Differential
  • Diagnostic and Statistical Manual of Mental Disorders
  • Humans
  • Psychiatric Status Rating Scales / standards*
  • Psychometrics
  • Reproducibility of Results
  • Sensitivity and Specificity