A newly developed assessment scale for attentional disturbance based on behavioral problems: Behavioral Assessment of Attentional Disturbance (BAAD).

Attentional disturbance following brain damage has been commonly evaluated by having the patients perform neuropsychological tasks. In rehabilitation settings, however, the primary concern is not task performance, but functional real-world behaviors. The aim of this study was to investigate the reliability and validity of a newly developed system for rating attentional behavior (Behavior Assessment of Attentional Disturbance, BAAD). The subjects included 183 patients with various types of brain damage. The initial form of BAAD consisted of 12 items to be completed by each patient's occupational therapist. Each item was rated based on the frequency with which the problem behaviors appeared during daily sessions of occupational therapy in the course of a week. A principle component analysis (factor analysis) with varimax rotation identified three principle factors which together explained 69.2% of the total variance. These components were regarded as related to "arousal", "sustained attention", and "selective attention". A final version of the BAAD scale with six items was developed by excluding all items with no significant relation to the aforementioned factors. The scale had a Cronbach's alpha coefficient of 0.81. The intraclass correlations for intra- and inter-rater reliability were 0.94 and 0.84, respectively. The BAAD score was significantly correlated with the patients' performance on the neuropsychological tests. The results indicate that the BAAD has good reliability and validity.