Modified Overt Aggression Scale: Difference between revisions

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{{Short description|Assessment tool for aggressive behavior}}

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| name = Modified Overt Aggression Scale

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| purpose =evaluate frequency of aggressive episodes

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The '''Modified Overt Aggression Scale''' ('''MOAS''') is a four-part behavior rating scale used to evaluate and document the “frequency and severity” of aggressive episodes.<ref name=":0">Huang, H. C., Wang, Y.-T., Chen, K. C., Yeh, T. L., Lee, I. H., Chen, P. S., … Lu, R. B. (2009). The reliability and validity of the Chinese version of the Modified Overt Aggression Scale. ''International Journal of Psychiatry in Clinical Practice'', ''13''(4), 303–306.</ref>  The rating scale is made up of four categories; verbal [[aggression]], aggression against objects, aggression against self, and aggression against others.<ref name=":0" /> Each category consists of five responses, which over time can track the patient's aggressive behavior. The MOAS is one of the most widely used measures for violence and aggression.<ref name=":1">Harris, S. T., Oakley, C., & Picchioni, M. (2013). Quantifying violence in mental health research. ''Aggression and Violent Behavior,'' ''18''(6), 695-701. {{doi|10.1016/j.avb.2013.07.022}}</ref>

The MOASscale was originally intended for use by physicians in a clinical setting, but parents may also use it to track aggressive behaviors in their children over time. It is particularly helpful in assessing aggressive behaviors in patients with [[traumatic brain injury]] (TBIs). The scores of the scale have shown good [[reliability (research methods)|reliability]] and [[test validity|validity]] across multiple different study samples<ref name="MOAS1"/><ref name="ReferenceA"/>

The '''Modified Overt Aggression Scale (MOAS)''' is a four-part behavior rating scale designed to measure four types of aggressive behavior as witnessed in the past week.<ref name=MOAS1>{{cite journal|last1=Alderman|first1=N|last2=Knight|first2=C|last3=Morgan|first3=C|title=Use of a modified version of the Overt Aggression Scale in the measurement and assessment of aggressive behaviours following brain injury.|journal=Brain injury|date=July 1997|volume=11|issue=7|pages=503–23|pmid=9210987|doi=10.1080/bij.11.7.503.523}}</ref> Each section consists of five questions, with the first section regarding verbal aggression, the second section focusing on aggression against property, the third section measuring autoaggression, and the fourth section concerning physical aggression. Respondents are asked to check whether each statement describes the child’s behavior over the previous week.<ref name="ReferenceA">{{cite journal|last1=Yudofsky|first1=SC|last2=Silver|first2=JM|last3=Jackson|first3=W|last4=Endicott|first4=J|last5=Williams|first5=D|title=The Overt Aggression Scale for the objective rating of verbal and physical aggression.|journal=The American Journal of Psychiatry|date=January 1986|volume=143|issue=1|pages=35–9|pmid=3942284|doi=10.1176/ajp.143.1.35}}</ref>

== Development and history ==

The MOAS was originally intended for use by physicians in a clinical setting, but parents may also use it to track aggressive behaviors in their children over time. It is particularly helpful in assessing aggressive behaviors in patients with [[traumatic brain injury]] (TBIs). The scores of the scale have shown good [[reliability (research methods)|reliability]] and [[test validity|validity]] across multiple different study samples<ref name="MOAS1"/><ref name="ReferenceA"/>

The test was originally designed to measure aggression in psychiatric inpatients, specifically those with [[autism]] and other intellectual disabilities.<ref>Ratey, J. J., & Gutheil, C. M. (1991). The measurement of aggressive behavior: Reflections on the use of the Overt Aggression Scale and the modified Overt Aggression Scale. ''The Journal of Neuropsychiatry and Clinical Neurosciences, 3''(2), S57-S60.</ref> The scale is generally used to track aggression and aggressive acts over time, typically at one week intervals.<ref name=":1" /> It has since been used to measure the efficacy of therapy and drug treatments on aggressive behavior in clinical settings.<ref>Oliver, P. C., Crawford, M. J., Rao, B., Reece, B., & Tyrer, P. (2007). Modified Overt Aggression Scale (MOAS) for People with Intellectual Disability and Aggressive Challenging Behaviour: A Reliability Study. ''Journal of Applied Research in Intellectual Disabilities,'' ''20'', 368-372. {{doi|10.1111/j.1468-3148.2006.00346.x}}</ref> The test has since been translated into Italian,<ref>Margari, F., Matarazzo, R., Casacchia, M., Roncone, R., Dieci, M., Safran, S., . . . Simoni, L. (2005). Italian validation of MOAS and NOSIE: A useful package for psychiatric assessment and monitoring of aggressive behaviours. ''International Journal of Methods in Psychiatric Research,,14''(2), 109-118. {{doi|10.1002/mpr.22}}</ref> Chinese,<ref name=":0" /> and French.<ref>DE BENEDICTIS, L., DUMAIS, A., STAFFORD, M., CÔTÉ, G. and LESAGE, A. (2012), Factor analysis of the French version of the shorter 12‐item Perception of Aggression Scale (POAS) and of a new modified version of the Overt Aggression Scale (MOAS). Journal of Psychiatric and Mental Health Nursing, 19: 875-880. doi:10.1111/j.1365-2850.2011.01870.x</ref> The scores of the scale have reported good [[Reliability (statistics)|reliability]] and [[Validity (statistics)|validity]] across multiple study samples.<ref name=":0" />

In a study conducted by Chinese researchers in 2009, the Modified Overt Aggression Scale was found to be both reliable and valid.<ref name=":0" />  The results from the study concluded there was high reliability,<ref name=":0" /> meaning the scale consistently measures the levels of aggression in each category. The MOAS is also confirmed to be valid,<ref name=":0" /> meaning the scale truly measures what it is supposed to.

== Scoring/interpretation ==

Total scores on the MOAS range from 0-40, with a higher score indicating more aggressive behavior. Each checked statement receives 1 point, then points from each section are summed.

In 2009, a study conducted by Ira L. Cohen and her associates studied characteristics, such as aggressiveness, in people with [[Intellectual disability|intellectual disabilities]] (IDs). The MOAS was used and researchers reported it being "a reliable and valid measure of aggressiveness in this population."<ref name=":2">Cohen, I. L., Tsiouris, J. A., Flory, M. J., Kim, S.-Y., Freedland, R., Heaney, G., … Ted Brown, W. (2010). A large scale study of the psychometric characteristics of the IBR Modified Overt Aggression Scale: Findings and evidence for increased self-destructive behaviors in adult females with autism spectrum disorder. ''Journal of Autism and Developmental Disorders'', ''40''(5), 599–609. {{doi|10.1007/s10803-009-0908-z}}</ref>

Section scores are weighted as follows:

It is also found to be valid for measuring aggression in [[Developing country|developing countries]], in addition to the developed world, where it was originally validated.<ref>Chukwujekwu, D. C., & Stanley, P. C. (2008). The Modified Overt Aggression Scale: How valid in this environment? ''Nigerian Journal Of Medicine,'' ''17''(2), 153-155. Retrieved October 29, 2018.</ref>

*Scores from the "Aggression Against Property" section multiplied by 2;

*Scores from the "Autoaggression" section multiplied by 3;

*Scores from the "physical aggression" section multiplied by 4.

== Limitations ==

Weighted score are then added together to yield the total score. A scoring summary can be found at the bottom of the measure to aid in interpretation of responses.

The original version of scale was found to have problems with its scoring methods, leading some psychologists to see it as not reliable.<ref>Mattes, J. A. (2010). Suggested Improvements to the Overt Aggression Scale-Modified. ''The Journal of Neuropsychiatry and Clinical Neurosciences,'' ''22''(1), 123-123. {{doi|10.1176/jnp.2010.22.1.123.e1}}</ref>  Such suggestions led to revisions of the scale.

There were a few problems with the study conducted in China to test reliability and validity. The participants were psychiatrists familiar with the scale, so their pre-existing knowledge could have skewed the results. The study was conducted on a small number of people, meaning its results cannot be generalized to the whole population.<ref name=":0" /> These factors contributed to a limited and specific [[Sampling (statistics)|sample size]] that may have altered the results of this study, questioning the accuracy of the reliability and validity.

== See also ==

*[https://depts.washington.edu/dbpeds/Screening%20Tools/Modified-Overt-Aggression-Scale-MOAS.pdf Modified Overt Aggression Scale]

The study conducted about people with IDs had minor limitations. Their standards of autistic traits were based on clinical information, instead of standard measures set by the [[Autism Diagnostic Interview|Autism Diagnostic Interview-Revised]].<ref name=":2" /> Based on the large sample size of over 2,000 people though, it is not considered a major complication.

*[http://www.jaacap.com/article/S0890-8567(09)60552-9/pdf AACAP practice parameter for aggressive behavior], designed for psychiatric institutions

*[[Oppositional defiant disorder]]

*[[Conduct disorder]]

== References ==

{{Reflist}}

== Further reading ==

{{Psychology}}

* {{cite journal |last1=Masters |first1=Kim J. |last2=Bellonci |first2=Christopher |author3=Work Group on Quality Issues |date=February 2002 |title=Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=41 |issue=2 Suppl |pages=4S–25S |doi=10.1097/00004583-200202001-00002 |doi-access= |pmid=11833634 |url=http://www.jaacap.com/article/S0890-8567(09)60552-9/fulltext |url-access=subscription }}

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== External links ==

{{Wikiversity|Modified Overt Aggression Scale}}

*[https://depts.washington.edu/dbpeds/Screening%20Tools/Modified-Overt-Aggression-Scale-MOAS.pdf Modified Overt Aggression Scale]

*[https://sccap53.org Society of Clinical Child and Adolescent Psychology]

*[http://effectivechildtherapy.org/concerns-symptoms-disorders/disorders/self-injurious-thoughts-and-behaviors/ EffectiveChildTherapy.Org information on rule-breaking, defiance, and acting out]

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