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Research ArticleRegular Article

Brief Rating of Aggression by Children and Adolescents (BRACHA): A Reliability Study

Drew Barzman, Douglas Mossman, Loretta Sonnier and Michael Sorter
Journal of the American Academy of Psychiatry and the Law Online September 2012, 40 (3) 374-382;
Drew Barzman
Dr. Barzman is Assistant Professor of Psychiatry and Pediatrics and Director of the Child and Adolescent Forensic Psychiatry Service, and Dr. Sorter is Professor of Clinical Psychiatry and Clinical Director of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Dr. Sonnier is a Forensic Psychiatry Fellow, University of Cincinnati, Cincinnati, OH. Dr. Mossman is Director, Glenn M. Weaver Institute of Law and Psychiatry, University of Cincinnati College of Law, and Professor of Psychiatry, Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati College of Medicine, Cincinnati, OH.
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Douglas Mossman
Dr. Barzman is Assistant Professor of Psychiatry and Pediatrics and Director of the Child and Adolescent Forensic Psychiatry Service, and Dr. Sorter is Professor of Clinical Psychiatry and Clinical Director of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Dr. Sonnier is a Forensic Psychiatry Fellow, University of Cincinnati, Cincinnati, OH. Dr. Mossman is Director, Glenn M. Weaver Institute of Law and Psychiatry, University of Cincinnati College of Law, and Professor of Psychiatry, Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati College of Medicine, Cincinnati, OH.
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Loretta Sonnier
Dr. Barzman is Assistant Professor of Psychiatry and Pediatrics and Director of the Child and Adolescent Forensic Psychiatry Service, and Dr. Sorter is Professor of Clinical Psychiatry and Clinical Director of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Dr. Sonnier is a Forensic Psychiatry Fellow, University of Cincinnati, Cincinnati, OH. Dr. Mossman is Director, Glenn M. Weaver Institute of Law and Psychiatry, University of Cincinnati College of Law, and Professor of Psychiatry, Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati College of Medicine, Cincinnati, OH.
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Michael Sorter
Dr. Barzman is Assistant Professor of Psychiatry and Pediatrics and Director of the Child and Adolescent Forensic Psychiatry Service, and Dr. Sorter is Professor of Clinical Psychiatry and Clinical Director of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Dr. Sonnier is a Forensic Psychiatry Fellow, University of Cincinnati, Cincinnati, OH. Dr. Mossman is Director, Glenn M. Weaver Institute of Law and Psychiatry, University of Cincinnati College of Law, and Professor of Psychiatry, Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati College of Medicine, Cincinnati, OH.
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  • Figure 1
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    Figure 1

    The 10 raters' prorated total BRACHA 0.9 scores for the 24 videos. The scores were a summary of five numbers: smallest score, lower quartile, median score, upper quartile, and largest score.

  • Figure 2
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    Figure 2

    Plots of scores assigned by each rater show that Raters 1 and 6 tended to score videos lower than the others.

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Tables

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    Table 1

    Abbreviated BRACHA 0.9 Items and Response Options*

    ItemAbbreviated BRACHA ItemsResponse Options
    1Previous psychiatric hospitalization or day treatment placement□ Yes□ No
    2School suspension or expulsion□ Yes□ No
    3Trouble accepting adult authority at home or at school□ Little or none
    □ Some□ A lot
    4Frequency of physical aggression toward others (e.g., hitting, kicking punching, biting, slapping, fights at school, throwing objects at others)□ Never
    □ Occasionally
    □ Often
    5Impulsiveness in the emergency department (e.g., often needing redirection, throwing objects, running out of the room, yelling at the interviewer, extremely talkative, etc.)□ No Incidents
    □ One or more incidents
    6Intrusiveness in the emergency department (e.g., invading personal space, asking personal questions, etc.)□ No incidents
    □ One or more incidents
    7Attempts to harm others or violent acts with intent to seriously harm others (includes all weapons use, even without injury, if used with harmful intent)□ Never
    □ Once
    □ More than once
    8Violent ideation towards others (i.e., thoughts, wishes, or desires to harm other people)□ Never
    □ Occasionally
    □ Often
    9Actual expressions of violent intentions or plans to hurt others (includes text messages and e-mails)□ Never
    □ Occasionally
    □ Often
    10Acts that intentionally destroyed property (e.g., breaking objects, vandalism, fire setting, making holes in the walls; does not include accidents or throwing things)□ Never
    □ Occasionally
    □ Often
    11Threats or physical aggression towards self or others in the past 24 hours□ Yes□ No
    12Pattern of either verbal or physical aggression towards self or others□ Yes□ No
    13Aggressive behavior before age 10 years (e.g. firesetting, destruction of property, stealing, trying to seriously hurt a person or animal, bullying, frequent fights; does not include lying)□ Never
    □ Occasionally
    □ Often
    14Signs of remorse (such as responsibility, shame, and/or guilt) after violence or aggressive acts□ Not aggressive, or if aggressive, displays remorse, guilt, shame, or responsibility
    □ If aggressive, displays no remorse, guilt, shame, or sense of responsibility
    • ↵* A full version of the BRACHA 0.9 and scoring instructions may be obtained by contacting the first author.

    • View popup
    Table 2

    Inter-rater Reliability for Individual BRACHA Items

    ItemKendall's WFleiss' κ + SE†Gwet's AC + SE‡
    Wχ2 (df = 23)*
    10.932213.40.905 ± 0.0510.937 ± 0.034
    20.885194.00.851 ± 0.0650.917 ± 0.040
    30.794182.60.698 ± 0.0530.683 ± 0.050
    40.818188.10.780 ± 0.0450.782 ± 0.047
    50.814146.80.585 ± 0.0750.729 ± 0.076
    60.773127.90.492 ± 0.1530.886 ± 0.036
    70.48490.60.349 ± 0.1410.844 ± 0.057
    80.661152.00.568 ± 0.1080.743 ± 0.070
    90.802180.60.671 ± 0.0870.884 ± 0.038
    100.621117.20.385 ± 0.0950.849 ± 0.038
    110.616141.60.565 ± 0.0840.565 ± 0.083
    120.671154.30.625 ± 0.0950.627 ± 0.094
    130.754171.90.536 ± 0.1350.840 ± 0.046
    140.763168.40.703 ± 0.0910.826 ± 0.051
    • ↵* All values are significant (p < 0.0001).

    • ↵† All 95% confidence intervals lie above the critical value of 0.033.14

    • ↵‡ AC1 for two-category items (3, 4, 7–10, 13); AC2 for three-category items (1, 2, 5, 6, 11, 12, 14). All 95% confidence intervals lie above the critical value of 0.160.14

    • View popup
    Table 3

    Calculation of the ICC, Conventional Method

    dfSum of SquaresMean SquareF
    Between raters92,030.67225.635.62
    Between cases23112,035.204,871.09121.41
    Within cases21610,335.6947.85
    Residual2078,305.0240.12
    Total239122,370.80
    • ICC = 0.9099

    • View popup
    Table 4

    Bayesian Calculation of the ICC

    A. Model 1: Embedded Image

    NodeMeanSD2.5%Median97.5%
    ICC0.90970.025770.85300.91190.9533
    σa210.33.4145.6559.73318.78
    σw20.94610.09194−0.78280.94021.142
    • Deviance: D¯ = 666.619; DIC = 691.498.

  • B. Model 2: Embedded Image

    ICC=σ2aσ2a+σ2b+σ2ω

    NodeMeanSD2.5%Median97.5%
    b1−0.51250.2166−0.9567−0.5054−0.1074
    b20.14870.21−0.25770.1460.5705
    b30.34130.2131−0.066050.33680.7739
    b40.42720.21530.020440.42130.8669
    b50.19980.2106−0.20770.19730.6226
    b6−0.51220.2172−0.9586−0.505−0.1055
    b70.06720.2094−0.34210.066450.4842
    b80.02670.2092−0.38560.02630.4399
    b9−0.39720.2136−0.8346−0.39190.006401
    b100.21630.2102−0.18860.21310.6413
    ICC0.90620.028690.84160.90930.9526
    σa210.393.4095.6909.76618.74
    σb20.19520.14540.050850.15850.5565
    σw20.79530.079010.65580.79010.9643
    • Deviance: D¯ = 624.948; DIC=657.596.

  • C. Model 3: Embedded Image

    NodeMeanSD2.5%Median97.5%
    b1−0.51560.2222−0.9651−0.5113−0.09033
    b20.16590.2191−0.25920.16290.607
    b30.36560.2216−0.05630.36030.8178
    b40.45290.22320.030950.4470.9103
    b50.21840.2199−0.20490.21430.6642
    b6−0.51570.2222−0.9666−0.5109−0.08992
    b70.082110.219−0.34480.080110.5194
    b80.039790.2188−0.38720.03790.477
    b9−0.39650.2203−0.8403−0.39330.02854
    b100.2360.2196−0.18730.23210.6808
    c−0.51560.2222−0.9651−0.5113−0.09033
    ICCModel 2 0.90350.029760.83670.90660.952
    ICCModel 3 0.89010.034560.81250.89390.9462
    Diff3−2−0.013350.01244−0.04756−0.009631−0.001874
    σa29.043.1544.7678.42716.87
    σb20.2260.15680.067140.18610.6212
    σw2 1.351.775 0.31540.93074.887
    σw20.79420.078860.65430.7890.9631
    • Deviance: D¯ = 624.572; DIC=657.308.

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Journal of the American Academy of Psychiatry and the Law Online: 40 (3)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 40, Issue 3
1 Sep 2012
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Brief Rating of Aggression by Children and Adolescents (BRACHA): A Reliability Study
Drew Barzman, Douglas Mossman, Loretta Sonnier, Michael Sorter
Journal of the American Academy of Psychiatry and the Law Online Sep 2012, 40 (3) 374-382;

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Brief Rating of Aggression by Children and Adolescents (BRACHA): A Reliability Study
Drew Barzman, Douglas Mossman, Loretta Sonnier, Michael Sorter
Journal of the American Academy of Psychiatry and the Law Online Sep 2012, 40 (3) 374-382;
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