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Shortform Assessment for Children (SAC)

Overview

The SAC is a brief, 48-item questionnaire that is completed by parents/caregivers and/or teachers. The SAC provides observational ratings of a child’s psychosocial behaviors. It takes about five minutes to complete. Standardized scores are compared to both a national normative sample of youth from the general population and a normative sample of “at-risk” youth from child welfare and juvenile justice systems. The SAC can be quickly scored on the SAC scoring website.

The SAC includes 24 externalizing behavior items and 24 internalizing behavior items randomly arranged in two columns on a single page. The instrument provides three response categories, asking the informant (parent/caregiver or teacher) to describe each item as either “not true = 0,” “somewhat or sometimes true = 1,” or “very true or often true = 2” of the child. For comparison purposes, it is helpful to have a SAC completed on the child from both the home and school settings.

Externalizing Behavior Problems

Externalizing behavior refers to a group of problems characterized by noncompliance, aggression, destructiveness, attention problems, impulsiveness, hyperactivity, and/or delinquency (McMahon, 1994). Externalizing behaviors are the most common problem behaviors found in children and adolescents and are diagnosed frequently as oppositional defiant, conduct, and attention-deficit hyperactivity disorders. Externalizing behaviors are highly stable over time, although there is evidence that there are differences between those who are “early” starters and those who are “late” starters (McMahon, 1994). Externalizing behavior for early starters begins in preschool or the early school years and for late starters in adolescence. Although the latter pathway is more common, it is less likely to persist into adulthood than the former. The SAC provides a single broadband measure of externalizing behavior problems. Broadband measures of externalizing behaviors are more stable than more narrow disorders over time and across gender, age, and geographical location.

Internalizing Behavior Problems

Internalizing behavior in childhood and adolescence include problems related to anxiety, fear, shyness, low self-esteem, sadness, and depression (Ollendick & King, 1994). This cluster of internalizing behaviors is the second most common group of problem behaviors, after externalizing behaviors, found in children and adolescents. There are a number of symptoms that are included in multiple narrow disorders (eg, anxiety disorders) that can result in children being diagnosed with multiple types of internalizing disorders.

As with externalizing behavior, broadband measures of internalizing behavior are more stable over time and across samples defined by age, gender, and geographical location than measures of more narrow disorders. The SAC provides a single broadband measure of internalizing problems.

The Origins of the SAC and Other Behavioral Rating Scales

A number of scales reference similar behaviors (eg, bullying, boasting, cruelty, crying, destructiveness, fearfulness, fighting, stealing, swearing, teasing, temper tantrums, worrying, etc.) to rate children’s mental health or psychosocial functioning. These scales have a common origin. The original items describing more than 200 of these behaviors were first identified and collected into scales in the middle of the last century to classify either children (eg, Hewitt and Jenkins, 1946) or adults (eg, Guertin, 1952; Wittenborn and Holzberg, 1951). In the 1950s and early 1960s, several studies identified factors or dimensions around which these behaviors clustered (Guertin, 1952; Hewitt & Jenkins, 1946; Lorr, 1957; Peterson, 1961; Quay & Peterson, 1960; Wittenborn & Holzberg, 1951). Common dimensions identified by Hewitt and Jenkins (1946) and others included a distinction between children with overinhibited, anxious or internalizing behaviors and children with aggressive, antisocial, or externalizing behaviors (Bennett, 1960; Ross, 1959).

In the 1960s, the National Institute of Mental Health (NIMH) funded efforts to develop a systematic classification of children’s emotional disorders using behavioral items from many of these scales. One early and well-known effort funded by NIMH (MH5117 and MH6316), the Behavioral Classification Project, factor analyzed 142 behavioral items from several existing scales. The Behavioral Classification Project used the items to build an improved classification system for children using parents’ ratings of their children’s behaviors (Dreger et al, 1964). Among other dimensions identified in this study were the overinhibited, anxious or internalizing behaviors and aggressive, antisocial, or externalizing behaviors identified by Hewitt and Jenkins (1946) more than a decade earlier.

Following a 1964 study by Dreger et al, additional NIMH-funded research under the direction of Norman Garmezy (MH06170) and Edward Zigler (MH06809) supported another set of factor analyses of the behavioral items first listed by Hewitt and Jenkins (1946), Wittenborn and Holzberg (1951), and others. This series of analyses supported by NIMH also classified behaviors into externalizing and internalizing categories which were used later in the Child Behavior Checklist (Achenbach, 1966) and other behavioral rating scales. These categories again were consistent with two of the categories identified earlier by Hewitt and Jenkins (1946) and others.

A half-century later, NIMH funded another effort (MH56502) under the direction of Anthony Hemmelgarn to determine whether a short list of these behaviors, labeled the Shortform Assessment for Children (SAC), could be used to screen children for mental health problems in child welfare and juvenile justice systems. NIMH also funded Hemmelgarn’s efforts to determine if the same short list of behaviors could be used with equal validity by both parents and teachers. Previously, distinct items were collected into separate scales for parents and teachers. The project found that the same short list of behaviors (the SAC) provided a valid measure of externalizing and internalizing problems when using either parents or teachers as informants (Hemmelgarn, Glisson & Sharp, 2003).

Sequential tests of item wording resulted in the current forty-eight items of the SAC. While none of the forty-eight items are identical to the items in the CBCL and other scales mentioned above, many of the items reference the same behaviors (eg, cruelty, crying, destructiveness, fearfulness, fighting, stealing, swearing, teasing, temper tantrums, worrying, etc.) that were first identified by Hewitt and Jenkins (1946), Wittenborn and Holzberg (1951), and others in the middle of the twentieth century. The psychometric properties of the SAC have been established in a number of different studies and samples, confirming its validity and reliability across gender, age, and race (Glisson & Green, 2006; Glisson, Hemmelgarn & Post, 2002; Hemmelgarn, Glisson & Sharp, 2003; Tyson & Glisson, 2005).

If you would like to know more about the SAC or would like a 30-day free trial of the SAC website, please contact us.

SELECTED PUBLICATIONS

Achenbach, T.M. (1966). The classification of children’s psychiatric symptoms: A factor-analytic study. Psychological Monographs: General and Applied, 80(7), 1-37.

Bennett, I. (1960). Delinquent and neurotic children. New York: Basic Books.

Dreger, R.M., Reid, M.P., Lewis, P.M., Overlade, D.C., Rich, T.A., Taffel, C. et al. (1964). Behavioral classification project. Journal of Consulting Psychology, 28(1), 1-13.

Glisson, C., & Green, P. (2006). The role of specialty mental health care in predicting child welfare and juvenile justice out-of-home placements. Research on Social Work Practice, 16(5), 480-490.

Glisson, C., Hemmelgarn, A., & Post, J.A. (2002). The Shortform Assessment for Children (SAC): An assessment and outcome measure for child welfare and juvenile justice. Research on Social Work Practice 12, 82-106.

Guertin, W.H. (1952). A factor-analytic study of schizophrenic symptoms. Journal of Consulting Psychology, 16, 308-312.

Hemmelgarn, A.L., Glisson, C., & Sharp, S.R. (2003). The validity of the Shortform Assessment for Children (SAC). Research on Social Work Practice, 13(4), 510-530.

Hewitt, L.E., & Jenkins, R. (1946). Fundamental patterns of maladjustment: The dynamics of their origin. Springfield, IL: State of Illinois.

Lorr, M. (1957). The Wittenborn psychiatric syndromes: An oblique rotation. Journal of Consulting Psychology, 21, 439-444.

McMahon, R.J. (1994). Diagnosis, assessment, and treatment of externalizing problems in children: The role of longitudinal data. Journal of Consulting and Clinical Psychology 62, 901-917.

Ollendick, T.H., & King, N.J. (1994). Diagnosis, assessment, and treatment of internalizing problems in children: The role of longitudinal data. Journal of Clinical and Consulting Psychology 62, 918-927.

Peterson, D.R. (1961). Behavior problems of middle childhood. Journal of Consulting Psychology, 25, 205-209.

Quay, H.C., & Peterson, D.R. (1960). Personality factors in the study of juvenile delinquency. Exceptional Children, 26, 472-476.

Ross, A.O. (1959). The practice of clinical child psychology. New York: Grune & Stratton.

Tyson, E.H., & Glisson, C. (2005). A cross-ethnic validity study of the Shortform Assessment for Children (SAC). Research on Social Work Practice, 15, 97-109.

Wittenborn, J.R., & Holzberg, J.D. (1951). The generality of psychiatric syndrome Journal of Consulting Psychology, 15, 372-380.

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