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Emotional Lability Questionnaire: Relatives and Carers (ELQ-R and C)
Availability
Please email the author for information about obtaining the instrument: inewsomdavis@me.com
Classification
Supplemental:  Amyotrophic Lateral Sclerosis (ALS)
Short Description of Instrument
Background: The ELQ was developed to provide detailed information for experimental investigation of nature and extent of emotional lability in the ALS population.
 
Construct measured: This questionnaire assesses frequency, duration of episodes, relation to external events, degree of voluntary control, congruence with mood state and subsequent distress of patients with pathological laughter and crying and emotional lability.
 
Generic vs. disease specific: Disease specific
 
Means of administration: Administered as a structured interview
 
Intended respondent: Self-report by patient, proxy completion by caregiver in parallel version.
 
# of items: 33 in total, (includes 3 screening questions)
 
# of subscales and names of sub-scales: Laughing, Crying and Smiling
 
# of items per sub-scale: 11 items
 
Strengths: Since episodes of pathological laughing and crying may occur with varying frequency this measure asks about the previous four weeks. Includes a scale for abnormal smiling. A carer/proxy version is available to allow for the fact that patients and carers may disagree about the frequency with which such episodes occur. Has also been validated in an Italian version.
 
Weaknesses: No validation against clinical diagnosis.
Scoring

The ELQ is scored on a 4-point Likert scale with 0–3; proportional ratings, scale depending on question.

Psychometric Properties
Feasibility: Includes 3 screening questions which if answered negatively terminates the interview
 
Reliability: Cronbach's alpha for the Laughter scale= 0.8, Crying Scale =0.6. Test-retest reliability (4-6 week interval): intraclass correlation coefficients of 0.75 and 0.72 for Laughter and Crying Scales (Newsom-Davis 2004, Ph.D. Thesis)
 
Validity: Significant correlations between Crying and Total, Laughter and Total, Smiling and Total and Laughter and Smiling scores was significant at least p<0.05 (Newsom-Davis et al., 1999). Statistically significant between self and independent ratings for Total scores, Crying scores and Laughter scores at least p<0.05 and also for Crying (self-rated) and Total (Independent-rater) (Newson-Davis et al., 1999). Correlations between self- and independent rater versions for Total and Laughter scores significant at p<0.001(Palmieri et al., 2009). Some evidence of ability to differentiate between ALS subtypes in comparison to controls (Wicks et al., 2009).
 
Sensitivity to Change: No evidence of a significant change in scores over a six month period in ALS patients compared with controls (Abrahams et al., 2005).
 
Relationships to other variables: Self-rated Crying, Laughter and Total scores all correlated with bulbar impairment (p<0.01) (Newson-Davis et al., 1999), Total scores correlated with Total ALSFRS-R scores (p<.01); ALSFRS-Language (p<0.001); and ALSFRS-Swallowing (p<0.0001) scores. Laughing scores correlated with time since disease onset (p<0.001) (Palmieri et al, 2009); in addition, Total scores correlated with State anxiety (STAI Y1) scores (p<0.01); Crying correlated with Emotional Fragility (p<0.001) and Beck Depression inventory scores (p<0.001) STAI Y (p<0.01) and Trait anxiety (STAI Y2) scores ( p<0.01) (Palmieri et al, 2009). Total ELQ scores predictive of global measure of psychological distress in caregivers (Goldstein et al., 2006). No correlation with cognitive performance (Palmieri et al., 2009).
References
Newsom-Davis IC, Abrahams S., Goldstein LH, Leigh PN. (1999). The emotional lability questionnaire: a new measure of emotional lability in amyotrophic lateral sclerosis. J Neurol Sci, 169(1-2), 22–25.
 
Abrahams S, Leigh PN, Goldstein LH. Cognitive change in ALS: a prospective study. Neurology. 2005;64(7):1222–1226.
 
Goldstein LH, Atkins L, Landau S, Brown R, Leigh PN. (2006). Predictors of psychological distress in carers of people with amyotrophic lateral sclerosis: a longitudinal study. Psychol Med, 36(6), 865–875.
 
Palmieri A, Abrahams S, Soraru G, Mattiuzzi L, D'Ascenzo C, Pegoraro E, Angelini, C. (2009). Emotional Lability in MND: Relationship to cognition and psychopathology and impact on caregivers. J Neurol Sci, 278(1-2), 16–20.
 
Wicks P, Abrahams S, Papps B, Al-Chalabi A, Shaw CE, Leigh PN, Goldstein LH. (2009). SOD1 and cognitive dysfunction in familial amyotrophic lateral sclerosis. J Neurol, 256(2), 234–241.