The Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) Training Center
Program on Developmental Mechanisms of Psychopathology
Institute for Juvenile Research, University of Illinois at Chicago

WHAT IS THE DB-DOS?

Rationale: Disruptive behavior is the most common reason for referral of preschool children to mental health clinics but, until recently, developmentally validated instruments for this age group were not available. The Disruptive Behavior Diagnostic Observation Schedule (DB-DOS, Wakschlag et al., 2007) is a semi-structured diagnostic observation that was designed to provide a direct assessment tool for distinguishing the normative misbehavior of early childhood from clinically significant disruptive behavior syndromes and disorders (DBDs) in preschool children (ages 3-5 years old). The DB-DOS was specifically designed to be relatively brief (50 minutes) for feasibility of clinical administration.

Description of DB-DOS Paradigm: The DB-DOS paradigm is comprised of three interactional contexts that vary by partner and demand characteristics. The tasks are designed to examine the child's capacity to regulate their behavior, both with and without structure, with their parent and with an unfamiliar adult, and during both challenging and fun activities. Each interactional context includes parallel sets of "presses" designed to elicit a range of clinically salient behaviors. The Examiner Contexts provide an opportunity to assess child disruptive behavior in a manner that is comparable across examiners by applying a set of guidelines for examiner responses to child disruptive behavior. In addition, the inclusion of two separate Examiner Contexts ("Examiner-Engaged"and "Examiner-Busy") enables assessment of the child's ability to regulate emotions and behavior across contexts that systematically vary in terms of the level of support provided to the child. The Examiner-Engaged Context includes the examiner with the child with the examiner sitting in close proximity to the child and actively interacting and providing support. The Examiner-Busy context is a "withdrawal of attention task" designed to have the child work independently with the examiner in the room but sitting off to the side and offering only minimal support. Examiner behavior is low-key and natural, with some scripting based on the context. Thus, the Examiner responds naturally in the Engaged context but keeps interactions to a minimum in the Busy context. Flexible clinical guidelines are also provided, in order to provide the examiner with a response hierarchy for responding to child disruptive behavior. These are designed to enable the behavior to unfold naturally (without the examiner stepping in too quickly to modulate it) while ensuring that it is also not "out of control' or "unsafe"for the child. The Parent Context enables assessment of child behavior within the parent-child relationship, with tasks that are parallel to those used by the examiner. The parent's behavior during the DB-DOS is not scripted. Examination of patterns of behavior across these three DB-DOS interactional contexts enables assessment of the pervasiveness of child disruptive behavior.

DB-DOS Coding System: The DB-DOS coding system was specially designed to distinguish the normative misbehavior of the preschool period from clinically concerning behavior, through an emphasis on behavioral quality. There are two broad domains conceptualized as core facets of disruptive behavior: (1) Behavioral Regulation: This latent construct encompasses a range of DBD symptoms reflecting: (a) a resistant, inflexible style in response to environmental demands; (b) blatant disregard of rules; and, (c) destructive and provocative behavior. (2) Anger Modulation: This latent construct incorporates DBD symptoms reflecting: (a) irritable, sullen mood (e.g., angry/resentful); and, (b) dysregulated expressions of anger (e.g. loses temper).

See Wakschlag et al, in 2008a for a full listing of DB-DOS codes. (see current research section for full references)

Global behavioral ratings are based on the child's behavior within each context. Behaviors are coded along a clinical continuum with scores of 2-3 considered in the clinical range: 0 = normative behavior 1 = normative misbehavior 2 = of concern 3 = clearly atypical. Ancillary ratings of child competence are also coded. A companion coding system for assessing parenting behavior, The Parenting Clinical Observation Schedule (P-COS; Hill, in press) is also available. Reliability and validity of the DB-DOS and P-COS have been reported (for details see Wakschlag et al., 2007, 2008a-b and Hill et al (2008))