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Information was presented on the psychometric characteristics of the Aberrant Behavior Checklist. The internal consistency and test-retest reliability of the Checklist appeared to be very good. Interrater reliability tended to vary across raters and subscales and ranged from mediocre to good but was generally in the moderate range and acceptable for research purposes. Validity was assessed by comparing Checklist scores for residents presenting with attributes thought to reflect varying degrees of social adaptation. Validity was also evaluated by comparing Aberrant Behavior Checklist scores with ratings on adaptive behavior scales and with objective observations of behavior. In general, validity was established for most Aberrant Behavior Checklist subscales. Preliminary data from drug investigations suggested that the Checklist may provide a useful adjunct for the assessment of psychotropic drug effects.

Studies of thioridazine (Mellaril) use for treating childhood behavior disorders were reviewed with a special emphasis on methodology, In general, we found that the caliber of these studies has been unsatisfactory and, furthermore, that measures of drug effect have tended to stress global rather than specific changes, resulting in little qualitative information being available. Examination of subgroups of children treated with thioridazine failed to reveal different levels of drug responsiveness. Few investigators have attempted to assess cognitive effects, but the evidence suggests that cognitive dulling may be an unwanted effect of treatment. Further research of sufficient quality is needed.

Interrater and test-retest reliabilities of the Aberrant Behavior Checklist were compared on the basis of type of instructions to raters. Three nurses in each of three residential units twice rated 28 mentally retarded residents, using one type of rating system, and the ratings were repeated 4 weeks later. The frequency-based instructions resulted in both higher interrater and test-retest reliability coefficients than did the other instructional types. Frequency-based ratings were performed again in another residential unit, but the higher reliabilities were not replicated. Interrater and test-retest reliability correlations varied markedly both across subscales and raters but were comparable to levels derived with other symptom checklists. We concluded that rater characteristics (e.g., motivation) are more powerful variables than are scoring systems.

The Aberrant Behavior Checklist was used to collect data from a large United States institution for comparison with ratings previously obtained in New Zealand. A total of 531 subjects within the American facility and 937 residents of New Zealand institutions were studied. The United States data were factor analyzed using the same procedures that were employed to develop the scale in New Zealand. In addition, subscales of the Checklist were analyzed as a function of sex, age, country, and level of mental retardation. Finally, the effects of various medical conditions were analyzed. The original factor structure of the Checklist was validated for the United States sample, with a mean coefficient of congruence of .93 averaged across the five factors. Sex failed to influence subscale scores, whereas age, country, and severity of retardation significantly affected ratings. Deafness was unrelated to Checklist scores whereas cerebral palsy, epilepsy, psychosis, and psychoactive drug treatment were related.

The development of a scale to assess drug and other treatment effects on severely mentally retarded individuals was described. In the first stage of the project, an initial scale encompassing a large number of behavior problems was used to rate 418 residents. The scale was then reduced to an intermediate version, and in the second stage, 509 moderately to profoundly retarded individuals were rated. Separate factor analyses of the data from the two samples resulted in a five-factor scale comprising 58 items. The factors of the Aberrant Behavior Checklist have been labeled as follows: (I) Irritability, Agitation, Crying; (II) Lethargy, Social Withdrawal; (III) Stereotypic Behavior; (IV) Hyperactivity, Noncompliance; and (V) Inappropriate Speech. Average subscale scores were presented for the instrument, and the results were compared with empirically derived rating scales of childhood psychopathology and with factor analytic work in the field of mental retardation.

A double-blind, placebo-controlled trial of thioridazine (Mellaril) was conducted with severely retarded patients. Subjects were assessed on a relatively low standardized dose as well as on the individual dosage that had previously been determined clinically as most effective. Both active drug conditions caused a reduction in hyperactivity, bizarre behavior, and self-stimulation. The standardized dose, which was less than half the mean titrated level, resulted in an equivalent therapeutic response. The need for more attention to dosage levels in future investigations was emphasized.

Anticonvulsant drug concentrations in retarded individuals (117 hospital residents, 58 community-based) were surveyed. Concentrations of carbamazepine (CBZ, Tegretol) and phenytoin (Dilantin) were determined in salivary samples collected before morning medication (premedication sample) and 4 hours later (postmedication sample). Of 146 individuals receiving CBZ, 16% had salivary concentrations above the therapeutic range on at least one sample, whereas 2% exceeded the range on both samples. Of the 54 subjects prescribed phenytoin, 28% had at least one salivary concentration exceeding the therapeutic range, and 15% surpassed the therapeutic range on both samples. These data suggest the desirability of using regular therapeutic drug monitoring and neurological assessments to avoid the possibility of toxic drug levels in this population. A variety of subject and pharmacological variables (sex, severity of retardation, number of seizures in the last year, and dose) were also examined for their relationship to drug concentrations.