Because the determination of an accurate diagnosis requires not only information about current status, but also developmental history, environmental stressors, medical history, physical health, family history of psychopathology, and cognitive functioning, scoring results must be interpreted in the context of these additional sources of information.  Scores obtained from the Symptom Inventories are not intended to provide a diagnosis. Only qualified professionals can render diagnoses after a thorough evaluation.

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With the above caveats in mind, Checkmate Plus Symptom Inventories can be scored to derive different scores, several of which are described here:

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• Symptom Count score (ordinal measure) is the total number of symptoms rated often and very often for a specific disorder (see Symptom Count Cutoff Score Sheets and Manuals for exceptions).

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• Symptom Count Cutoff score (yes/no; categorical model) indicates whether a youth has the prerequisite number of symptoms necessary for a DSM-5 diagnosis.

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• Symptom Severity score is based on a dimensional model that uses normative data to generate T scores.

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• Impairment Cutoff score (yes/no; categorical model) indicates whether the youth is impaired by the symptoms of a particular disorder (rating of often or very often) regardless of the number or severity of symptoms.

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• Impairment Severity score is based on a dimensional model, but scores for specific disorders are best conceptualized as ordinal.

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• Clinical Cutoff score (yes/no; categorical model) is a combination of the Symptom Count Cutoff score and the Impairment Cutoff score.

 

It is important to emphasize the fact that these parameters of mental health do not measure the exact same thing. Although they are clearly interrelated, research shows they are not redundant (Gadow, Kaat, & Lecavalier, 2013; Kaat, Gadow, & Lecavalier, 2013).  In other words, they measure different aspects of the mental health. For this and other reasons, it is prudent to carefully evaluate their relative merits in specific research and clinical applications.

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For the Symptom Count Score method, each item (i.e., symptom) is recoded as either present (1) or absent (0), which requires a modification of item weights as follows: Never=0, Sometimes=0, Often=1, Very often=1, and No=0 and Yes=1. There are a some exceptions, which are noted on Symptom Count Cutoff Score Sheets. For example, whereas for the majority of symptoms, a frequency of occurrence rating of sometimes is not considered clinically significant, some items are deemed serious and therefore significant if they occur sometimes (e.g., deliberately starting fires). The Symptom Count score is simply the number of symptoms rated as being problematic according to DSM criteria.

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DSM specifies the minimum number of symptoms necessary for making a diagnosis.  The minimum number of symptoms is the Criterion Score.  If an individual exhibits the minimum number of symptoms necessary for a diagnosis of a disorder, they receive a Symptom Count Cutoff Score of yes, which indicates that a more in-depth clinical evaluation may be warranted. Symptom Count Cutoff scores are categorical.

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The Symptom Severity Score is consistent with the dimensional model of assessment, and it uses the full range of frequency of occurrence ratings, where Never=0, Sometimes=1, Often=2, and Very often=3. The only exception is for No/Yes items, where No=0.5 and Yes=2.5. The Symptom Severity score is simply the sum of the item ratings for a specific disorder.

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Symptom Severity T Scores measure the degree of behavioral deviance compared with a normative sample.  To determine the severity of symptoms, individual scores are compared with the scores for a large group of similar-age people (normative sample).  A widely adopted standard deviation approach was applied for T scores, where symptom severity scores between one and two standard deviations above the mean (i.e., T scores from 60 to 69) denote symptoms of moderate severity, and scores of two or more standard deviations above the mean (T scores of 70 and above) indicate high symptom severity. The calculation of Symptom Severity scores is facilitated with the use of Symptom Severity Profile Score Sheets. Normative distributions are presented for symptom categories containing at least three items.

The incorporation of a dimensional model into Checkmate Plus Symptom Inventories (with appropriate caveats about score interpretation) was a radical departure from conventional diagnostic practice. There were a number of clinical scenarios where such information might prove helpful, not the least of which was DSM-IV’s Not Otherwise Specified and DSM-5’s, Other Specified categories. For example, the person being evaluated may not meet conventional symptom count criteria for a specific disorder but nevertheless receive a T score of 70 and be clinically impaired. To achieve this end, normative data were collected. These data permitted the generation of T scores and cutoffs based on standard deviations. Review of these data indicated important gender differences in symptom severity for some (but certainly not all) disorders, thus revealing yet another application of a dimensional model of symptom severity. In other words, exclusive reliance on gender- and age-neutral diagnostic algorithms could introduce bias in clinical decision making.

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DSM specifies the number of symptoms that must be problematic (criterion score) to warrant a diagnosis. However, this is not sufficient for a diagnosis as there are other criteria as well, one of the more important being impairment. The symptoms of the disorder must interfere with the individual’s social, school, or work functioning or cause significant personal distress. Most Checkmate Plus Symptom Inventories therefore include an impairment question for each multi-item disorder. The last item in each symptom category askes the informant to assesses the degree to which the symptoms of a specific disorder interfere with school (work) or social functioning. Responses are scored Never=0, Sometimes=0, Often=1, Very often=1. If an individual receives a score of “1”, they receive an Impairment Cutoff Score (yes). As was the case for symptom severity and symptom cutoff scores, the person being evaluated may not meet full symptom count criteria for a specific disorder but nevertheless be impaired (possibly Other Specified), or vice versa (i.e., symptomatic but not impaired; potentially at risk). The number of Impairment Cutoff scores can be summed to generate a Global Impairment Count Score.

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The Impairment Severity Score uses the full range of frequency of occurrence ratings, where Never=0, Sometimes=1, Often=2, and Very often=3. The Impairment Severity scores for all symptom categories can be summed to generate a Global Impairment Severity Score.

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Individuals who meet criteria for both Symptom Count Cutoff (yes) and Impairment Cutoff (yes) for the same symptom category receive a Clinical Cutoff Score (yes). In other words, a Clinical Cutoff score indicates an individual has the prerequisite symptoms of the disorder and is impaired by these symptoms.  Of all the Checkmate Plus Symptom Inventory scores, it could be argued the Clinical Cutoff score most closely approximates a diagnosis, especially when the evaluator considers age, gender, and rule-out diagnoses based on ratings for other disorders; nevertheless, it is not a diagnosis.  There are often other DSM criteria to be considered, as well as Other Specified status and information from other relevant informants.

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References

 

Gadow, K.D., Kaat, A.J., & Lecavalier, L. (2013). Relation of symptom-induced impairment with other illness parameters in clinic-referred youth. Journal of Child Psychology and Psychiatry, 54, 1198-1207. DOI: 10.1111/jcpp.12077.

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Kaat, A.J., Gadow, K.D., & Lecavalier, L. (2013). Psychiatric symptom impairment in children with autism spectrum disorders. Journal of Abnormal Child Psychology, 41, 959-969. DOI: 10.1007/s10802-013-9739-7.

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