DAt-Kon – et verktøy for differensiering av atferds- og konsentrasjonsvansker hos barn

Abstract

DAt-Kon is a Norwegian assessment tool for behavioral and concentration problems in children as described by parents and close guardians in the home and school setting. The term ‘DAt-Kon’ is an acronym for ‘Differentiation of behavioral and concentration problems’. The tool, which has been developed by the present author, was designed for primary use within the municipality based Educational and Psychological Service (PPT). The most important task for the PPT is to provide educational support for children who present problems with learning or with adjustment to the various rules and expectations of the school system. DAt-Kon as a theoretical model is based on a humanistic/hermeneutical philosophical tradition. The fundamental idea is that the meaning of behavior is conveyed and decoded in the same manner as literal texts and can only be grasped through interpretation of communication. Another central assumption is that problem behavior in children is reflected not in the behavior itself, but in the concern and worry that the behavior evokes in the child’s surroundings. The “core” or primary source of a problem may be linked to the individual child as a “disorder”, “dysfunction”, “disability”, emotional state or temperamental “bias”, but problem behavior may be best understood as negative transactional cycles that develop when the child for some reason do not meet the expectations of its surroundings. What is perceived as problem behavior in one social or educational context may be seen as normal or even resourceful and positive behavior in other contexts. The social acceptance or rejection of the child’s individual solutions and adaptation to the expectations and reactions of its surroundings will in turn be decisive in the development of transactional cycles leading either to social acceptance or to further environmental concern and rejection. Problems with concentration or with adjustment to social rules are increasingly reported as a major concern in school. Many, perhaps most of these problems may be understood as general discipline or motivational problems related to pedagogical or system issues. In many cases though, more severe and individually related problems occur which cannot be easily addressed with general disciplinary or systems oriented approaches. DAt-Kon is a theoretical model for understanding and differentiation of the many individual paths and trajectories leading to concentration and behavior problems in children. It is also an assessment and reflection tool designed for use by the PPT in collaboration with teachers and parents in order to find appropriate and individually adapted measures of support for the child in school or in the home or peer setting.

The assessment tool, DAt-Kon IV, consists of a set of questionnaires, answered by the parents and the class teacher or other professionals at school who know the child well. These questionnaires investigate important issues in the evaluation and differentiation of the many pathways leading to behavioral or concentration problems. The assessment consists of a behavior checklist consisting of 160 items in a parallel home and school version with pair wise almost identical items. In addition information involving the child’s resources, health status and important socioecological aspects of the home and school environment is gathered from both arenas. A developmental history of the child is provided by a separate form divided into 13 developmental themes. Scoring, analysis and presentation of the results is performed by the DAt-Kon Analysis, a specially designed computer program. The DAt-Kon model defines 16 core dimensions describing different trajectories of problem behavior associated with different developmental and contextual patterns. The computer analysis generates an individual problem profile, providing the best supported “working hypothesis” of the child’s problems, as described within the conceptual framework of the DAt-Kon model. The suggested hypotheses are used as a basis for team discussion and reflection within the Educational and Psychological Service (PPT), and collaboration with home and school, eventually with the social and health care services. A ‘hypothesis’ as presented by the DAt-Kon analysis is a tentative working formulation that may be challenged and modified in the subsequent discussion and reflection between assessment leader, parents and teachers, eventually leading to a new and more differentiated understanding of the child by all involved parts. The term ’hypothesis’ is used not in a strictly hypothetical- deductive sense, but as a hermeneutical tool in the elaboration and structuring of the information presented by parents and teachers. The goal of the assessment process is not diagnostic, but to support parents and teachers in the restructuring and reframing of their preconceptions of the child. The possible new frames of understanding obtained through collaborative reflections on the hypotheses suggested by the DAt-Kon analysis, will in turn provide teachers and parents with new ideas and ways to support and stimulate the child in its social and academic learning process. This dissertation investigates DAt-Kon as a theoretical model and as an assessment tool based on this model. While much research has been done on previous versions of the assessment instrument, none of the results has been published. The main purpose of this dissertation has been to give a preliminary empirical evaluation of DAt-Kon IV both as a psychometric instrument, and as a practical tool in the assessment and consulting tasks of the Educational and Psychological Service involving children referred for conduct and concentration problems in school. Another important aim has been to present the instrument as a theoretical model in a rather detailed way to provide a solid basis for the evaluation of the instrument, and to document the work lying behind the development. The empirical evaluation consists of three studies performed over a six year period. Two of these studies investigate the psychometric status of the instrument. The third study is based on a questionnaire answered by experienced users of DAt-Kon, evaluating to what extent the instrument fulfill the purpose and aims stated in the DAt-Kon model, and the ecological validity of the hypotheses derived from the DAt-Kon Analysis. The results of the first study, based on 742 case protocol sets received from 28 PPTs in the period 2002 – 2006, indicated that most of the 16 primary scales, and the 28 content scales included in the DAt-Kon IV, had an acceptable internal consistency, with Cronbach’s alpha values typically in the range of 0.75 to 0.85. Factor analyses of the primary scales showed a high agreement between the defined conceptual components of each of the 16 dimensions in the DAt-Kon model and the factor structure of the corresponding primary scale, suggesting a satisfactory construct validity of most of the primary scales. The results of the item analyses indicated a need to revise the structure of the content scales primarily to obtain a better coherence between the content structure of the primary scales and the corresponding content scales. Factor- and alpha analyses of the item set of the current content scales resulted in nine discarded scales, 18 scales with minor revisions of the item structure, and 11 new scales (30 in all). The reorganization resulted in a cleaner item structure with a substantial increase in internal consistency in most of the revised and new scales, compared to the old and discarded ones. No major changes were made to the item structure of the primary scales, nor in the phrasing of any of the items in any part of the assessment forms. The second study was performed on the same protocol set, and on the revised content scale structure. The primary aim of this study was to identify possible empirically derived profile patterns associated with the 16 dimensions of the DAt-Kon model. This was done by assigning case profiles generated by the DAt-Kon analysis into separate hypothesis groups based on the core problem hypotheses suggested by the program. The analyses resulted in 20 identified hypothesis groups, each with a distinct profile pattern. Each profile consisted of a core scale representing the hypothesis, together with characteristic associated and secondary problem patterns, as well as typical developmental histories. Four of the profile patterns consisted of combined hypotheses, typically describing sub patterns within a given core dimension. Kruskal-Wallis analyses showed that 13 of the hypothesis groups were significantly different when the core scale scores of each group were compared. For three very low frequency hypothesis groups (N<5), primarily in the problem area D: Relational disorders, differences between hypothesis groups were not possible to evaluate statistically. The results of the study suggest that the empirically identified profile patterns of most of the hypothesis groups have high construct validity as indicators of the corresponding hypothesized profile patterns of the DAt-Kon model. There is a need, though, for a further evaluation of the content validity of the profile patterns comparing the DAt-Kon results with concurrent results of other relevant assessment methods on a new and more representative protocol set. In a second part of the same study, central tendencies of the empirically derived profile patterns were used in the evaluation of the current norms applied by the DAt-Kon analysis. Highly significant differences were found between the mean core scale scores of the 16 “single” hypothesis groups – and the primary scale means of a control group without attention or behavior problems. The results showed that most of the core scales of each profile pattern had a normal distribution, and that the central tendencies within these scales were close to the critical cut off values adapted in the DAt-Kon IV scale norms (i.e. lying in the area between the scale Mean and -1½ SD). The results indicate no urgent need for a major revision of the current norms. There is little doubt however that a new study based on a more “clinically” representative sample and a more balanced gender and age distribution, would have contributed to a more accurate set of critical values, especially within the low frequency problem areas of the DAt-Kon circle. The third study was an evaluation study investigating the experienced usefulness and relevance of DAt-Kon IV among 88 trained users of the instrument within the PPT. The scoring patterns on the various questions and items in the questionnaire suggest that DAt-Kon IV is perceived as a highly relevant instrument for the PPT. The agreement between the user’s own evaluation of the core problems in each case and the corresponding hypotheses suggested by the DAt-Kon analysis was generally very high. These results indicate ecological validity of the instrument as measured by the subjective experiences of users operating within the target area that DAt-Kon was designed for. In the last part of the dissertation, the current status of DAt-Kon is discussed in the light of the presented theoretical framework and research findings, with special emphasis on ecological validity and the practical value of DAt-Kon as a tool for the Educational and Psychological Service. Possible limitations in the current model and assessment instrument are discussed. Recent changes in the organization and staffing of the PPT, and the heavy use of DAt-Kon as a referral tool for assessment and psychiatric evaluation at mental health institutions, may seem to undermine the intended role of DAt-Kon as an educationally oriented model and assessment tool. Different measures and strategies that might contribute to address this challenge are presented in the closing section of the dissertation.