Development of the Reactive Aggression Assessment (RAGA-16) Part II: Clinical Validation

Reactive aggression (RA) is a transdiagnostic symptom associated with more severe illness and worse clinical course. Despite the clinical importance of RA, few validated screening measures or outcome assessments exist for use with children under 12. The 16-item Reactive Aggression Assessment (RAGA-16) is a novel parent-report instrument with promising evidence of psychometric reliability. The current work presents clinical validation evidence for RAGA-16.

A retrospective chart review examined the records of children seeking inpatient and outpatient services. Parents completed the RAGA-16 and additional questionnaires assessing depression, hypomania, ADHD symptoms, and aggression at intake. The chart review also included clinical diagnoses, demographic information, and treatment details. Graded response models (GRMs) evaluated the RAGA-16 factor structure and associations with criterion variables evaluated the scores' validity as a screening measure assessing RA.

Confirmatory models showed good fit to the hypothesized two-factor structure with high marginal reliability (ωt = .98). RAGA-16 scores showed large significant positive associations with measures of aggression, impulsivity, and oppositionality (rs > .70, ps < .001), lower associations with hypomanic symptoms (r = .40, p < .01), and no significant association with depression (p > .05). RAGA-16 scores statistically discriminated diagnoses associated with severely externalizing symptoms from other diagnoses. Endorsement of RA in more contexts (home, school, or elsewhere) was associated with higher aggression symptoms.

Overall, RAGA-16 scores showed a pattern of criterion associations consistent with the construct of interest along with high score reliability. The addition of inpatient and outpatient clinical score characteristics to the existing epidemiological norms makes RAGA-16 a promising new tool for assessing youth RA.