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Learning to use the dawba online rating screens (page 1)

What is the dawba online?
To train you in the clinical rating of the DAWBA, we will be using a set of practice cases from the dawba online system. For those of you who are not familiar with the dawba online system, we need to give you a little bit of background information so that the rating screens make sense to you.

Woody - an invented case
We have created a fictitious teenager, Woody, to demonstrate to the full the dawba online rating screens. The cases in the training manual are real children whose anonymity has been preserved by changing names and minor details. By contrast Woody is totally invented. He has an unbelievable combination of problems, involving difficulties in practically every area of his life. We have made him like this because it was the only way to get answers to every question. The DAWBA interview has a lot of skip rules that ensure that the interview is kept as brief as possible. When the respondent's initial answers suggest that there aren't any serious problems in any given domain (such as depression or hyperactivity), the interview skips the rest of the questions in that domain. So the only way we could show you rating screens with every question answered was by giving Woody problems in all areas.

Getting started
When you click on the link below, your computer will take a few seconds to open a rating screen in a different window of your web browser (Internet Explorer, Netscape, Firefox, Opera, or whatever). Unless you have already got a second browser window open, this will automatically shift you to the rating screen. If the window is less than full sized, you may then want to maximise it. For the rest of this session, you will then be switching backwards and forwards between two windows - this one that has the instructions and explanations, and the other one that has the rating screens. After clicking on the link, come back to this window for the next instruction (which will probably involve clicking on the relevant tab or buton at the top or bottom of the screen).

Click here to open a report screen

Welcome back!
We're assuming that you have opened the rater screen and come back. Please note that once you have opened the rater screen, then clicking on the link on this page will reload the rater screen, but probably won't automatically shift you to that screen. Try it and see. To get back to the rating screen, you probably need to select the other window (probably via a tab or button at the top or bottom of your screen).

We will now take you on a guided tour of the dawba online rating screens. The instructions and explanations are here, and you will need to read them and then switch to the rating screens, and then come back again. The guided tour starts with the bar at the top of the rating screen:

The navigation bar
This is the top bar with little labels such as ALL and ADHD. Clicking on these labels allows you to select which rating screen you will go to next. They are your gateway to many different reports, a notepad, listings of diagnostic criteria, and the forms for entering your clinical diagnoses.

The informant list
Immediately under the left-hand side of the navigation bar on this first page is a table listing all the informants. In this case, there are three: Woody's mother, Woody's teacher, and Woody himself. Fortunately, everyone agrees he is a 14-year-old boy called Woody or Woodrow. If there had been disagreement about age, gender or name, you'd suspect that the clinic or research study had handed out the wrong ID and password to at least one of the respondents. This is one purpose of the informant list - to check that the respondents seem to be reporting on the same child. If you have access to the clinic or research study records, you can also use these details to check that the identity is correct. Finally, knowing the child's age and gender will come in useful to you as you interpret the symptoms.

Process monitoring
Just to the right of the informant list is some additional information: the child's ID number and three variables that help clinical raters monitor three aspects of the rating process. Firstly, raters can see if the case is in their in-tray, pending tray and out-tray. Secondly, raters can see at a glance whether the clinical ratings have been done (I+D rated means both ICD and DSM ratings have been done). Thirdly, the flag variable identifies cases that the rater needs to come back to or discuss with someone else.

The identity line
The informant list is not repeated on all screens - for all other reports, you see only a single identity line that combines the key information from the informant list with the three variables for process monitoring.

The ALL report
You are already in the ALL report because whenever you first open the rating screens, you always get taken to the ALL report first. This is the screen that gives you an overview of the child's symptoms as well as resultant impact and likely diagnoses. It is based on a summary of information from all available informants, which may include parent reports, teacher reports and self-reports. A computer algorithm uses the answers to the structured questions to predict the likelihood of DSM and ICD diagnoses. There are two parts to the ALL report: the Level message and the Overview table.

Probability of one or more diagnoses
Under the title that says 'Overview of Development and Well-Being Assessment', there is a coloured message that gives you a rough idea of how likely it is that the child warrants a clinical diagnosis. There are four possible levels:

very low probability refers to children who have few if any symptoms according to any informant, and where a brief review of the Open report is usually all that is required. In a community sample, the probability of a 'very low risk' child getting a clinical diagnosis is under 1%.

low probability refers to children whose symptoms and impact would put them at less than a 5% risk of having a psychiatric disorder in a community sample. Nevertheless, a review of the Open report is vital since this sometimes makes it clear that the difficulties are more severe than is apparent from the structured answers. In addition, even when a child appears to be at low risk, it is important to consider the following three points:

moderate probability refers to children whose likelihood of warranting a clinical diagnosis is around 20% in a comunity sample, and generally higher in a clinical sample. You need to review all the evidence carefully, but in most cases you will not feel that the child does reach the threshold for a clinical diagnosis (though this doesn't necessarily mean that they don't need help for sub-threshold difficulties).

high probability refers to children whose likelihood of warranting a clinical diagnosis is around 75% in a comunity sample, and generally higher in a clinical sample. After reviewing all the evidence, you will probably make one or more diagnoses, though these will not necessarily be the same ones that the computer suggests. However, in roughly 25% of high risk children, you will decide that they don't warrant a diagnosis after all.

Woody has a high overall probability of a psychiatric disorder. You can find out more about the meaning of the overall probability by clicking on this line in the report.

The 'Overview' table
Below the Level message is a green table that summarises the child's symptoms, resultant impact, and the computer-generated diagnoses. Each row in the table represents one domain - the name of the domain is the first column, e.g. Autistic Spectrum. The next two columns cover parent-reported symptoms and impact. As a rule of thumb, only ++ or +++ are likely to turn out to be important, but you may need to check lower levels of symptoms or impact at times. The next two columns are teacher-reported symptoms and impact, and after these are a further two columns for self-reported symptoms and impact.

The last two columns show the computer predictions of diagnostic probabilities, based on the answers to the fully structured questions - the first column is for DSM (IV & 5) and the second for ICD-10. Diagnostic predictions are at one of 6 levels:

Probability of disorder
- -less than 0.1%
-around 0.5%
-/+around 3%
+around 15%
+ +around 50%
  + + +  70%+

As far as possible, all the symptoms related to one diagnosis are presented on one line. This is generally possible for parent and self-report, but is not possible for the teacher reports of emotional symptoms. Teachers are not asked in detail about all emotional problems because early work with the DAWBA showed that most teachers had fairly limited knowledge of their students' emotional symptoms. Teachers are only asked about ten emotional symptoms, along with resultant impact. This information is presented in a separate line called 'Emotions at school' - this line comes after the lines based on parent and self reports of emotional difficulties.

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Last modified : 05/09/09