Emotional/behavioral problems in clinic and nonclinic children: correspondence among child, parent and teacher reports

Parent-teacher disagreement regarding psychopathology in children: a risk factor for adverse outcome?

OBJECTIVE

To investigate if parent-teacher discrepancies in reports of behavioral/emotional problems in children predict poor outcome.

METHOD

A total of 1154 4- to 12-year-old children from the general population were followed up. At the first assessment, parent and teacher ratings were obtained with the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF). Fourteen years later, DSM-IV diagnoses were assessed, and ratings of self-reported and parent-rated behavioral and emotional problems were obtained.

RESULTS

CBCL and TRF scores predicted most of the outcomes, but in general, discrepancies between CBCL and TRF scores did not. There were some exceptions. For instance, higher parental vs. teacher ratings of aggressive behaviors increased the risk of suicide attempts/self-mutilation.

CONCLUSION

Risk factors for self-mutilating behaviors may be supplemented with parent-reported aggressive behaviors that are not observed by the teachers. In general, whereas CBCL and TRF scale scores were useful predictors of outcome, parent-teacher discrepancies were not.

Perceptions and congruence of symptoms and communication among second-generation Cambodian youth and parents: a matched-control design

This study examined the relationship between perception of communication and report of symptoms among second-generation Cambodian children and their parents using a matched-control design of clinic and community children. Children reported significantly higher symptoms than parents in both samples. Clinic parents reported more symptoms than community parents, but no differences were observed between children, and the mean level of child-reported symptoms was similar to past studies examining clinic populations. Parents reported better communication than children, and community respondents reported better communication than their clinic counterparts. Same-informant communication predicted symptom report. These data suggest that communication is a key factor in understanding symptoms in this group, provide evidence that child perception of communication is particularly important, and that the use of a matched control design might reveal high symptom levels in community samples that are otherwise undetected.

Who is best at predicting children's anxiety in response to a social evaluative task? A comparison of child, parent, and teacher reports

The purpose of this preliminary study was to examine the validity of child, parent, and teacher reports of child social anxiety in predicting the child's responses to a social evaluative task. Children, parents, and teachers each completed a measure of social anxiety, as well as a measure that asked them to predict the child's anxiety during a behavioral approach task (BAT) of reading aloud in front of a video camera. Consistent with previous literature, analyses revealed poor agreement across informants. Importantly, children's reports predicted their own anxious feelings and, to some degree, their behaviors during the task, whereas other informants' reports did not. We recommend that further research examine the relative validity of multiple informants' reports in predicting children's real-life behavior.

[Birth order, behavioural problems, and the mother-child relationship in siblings aged 4 to 11 years from a 2-child family]

Birth Order, Behavioural Problems, and the Mother-Child Relationship in Siblings Aged 4 to 11 Years From a 2-Child Family

OBJECTIVE

This study was designed to define the relation between some sibling characteristics (birth order, sex, and interval between successive births) and some behavioral problems in children, on the one hand, and certain dimensions of the mother-child relationship, on the other hand.

METHOD

The sample, from National Longitudinal Survey of Children and Youth, included 1,196 families with 2 biological children aged 4 to 11 years. Behavioural problems and dimensions of the mother-child relationship were assessed by mothers. Repeated-measures multivariate analyses of variance were conducted.

RESULTS

Analyses showed that first-born children have more internalized symptoms than second-born children. Second-born children also have more positive interactions with their mothers than first-born children. The interval between successive births does not affect these results.

CONCLUSION

Several differences emerged between siblings. Health professionals should take these findings into account in their clinical assessments.

The continuity of psychopathology from early childhood to preadolescence: a prospective cohort study of 3-12-year-old children

OBJECTIVE

To study the continuity of psychopathology from the age of 3-12 years.

METHODS

In a population-based birth cohort, children's emotional and behavioral problems were assessed at age 3 using the Child Behavior Checklist 2-3 (CBCL 2-3), and at age 12 by parents using the CBCL 11-18, and the Youth Self Report (YSR) completed by the children. Behavioral ratings were obtained from 800 subjects at both time points.

RESULTS

externalizing problems at age 3 predicted both externalizing and internalizing problems among both genders in preadolescence. In girls, internalizing behavior at age 3 predicted parent-reported internalizing behavior, and associated negatively with externalizing behavior in self-reports at age 12. Aggressive behavior was found to be remarkably stable, and both aggressive and destructive behavior independently predicted a wide range of later externalizing and internalizing problems. Parent ratings of withdrawal showed stability from early childhood to preadolescence in both genders. Somatic complaints of 3-year-old girls independently predicted both externalizing and internalizing problems.

CONCLUSIONS

The results show the complexity of pathways in psychopathology from early childhood to preadolescence. In particular, aggressive and destructive behaviors in very early childhood predict later problems and necessitate early recognition and possible intervention at an early age. An instrument like the CBCL 2-3 is valuable in the early detection of children at risk of long-term problems.

Modeling relations between hassles and internalizing and externalizing symptoms in adolescents: A four-year prospective study

This study examined the relations between hassles and internalizing and externalizing symptoms across 4 years in adolescents who varied with regard to their risk for psychopathology. The sample comprised 240 adolescents assessed in 6th, 7th, 8th, and 9th grades regarding their level of peer and academic hassles and internalizing and externalizing symptoms. Structural equation modeling was used to construct latent variables of hassles and internalizing and externalizing syndromes. Results varied by informant about the teens' symptoms. For adolescent report, the stress exposure model fit the data best for internalizing syndromes; that is, higher levels of stressors predicted significantly higher levels of self-reported symptoms 1 year later. For mother report of adolescents' symptoms, the stress generation model fit the data best for both internalizing and externalizing syndromes; that is, higher levels of adolescents' internalizing and externalizing symptoms, as reported by their mothers, significantly predicted higher levels of hassles 1 year later.

Reading the signs: impact of signed versus written questionnaires on the prevalence of psychopathology among deaf adolescents

OBJECTIVE

There are no empirically validated measures of psychopathology that can be easily understood by signing deaf children and little reliable data on the prevalence of psychiatric disturbance in this population. The aim was to meet this need by developing an Australian Sign Language (Auslan) version of a widely used measure (the Youth Self-Report; YSR) which could be administered in an interactive CD-ROM format, to assess its reliability, and to compare the prevalence of clinically significant psychopathology in deaf adolescents when using the Auslan questionnaire versus the standard written version. This would also allow examining the validity of written questionnaires in this population.

METHOD

Twenty-nine male and 25 female adolescents with severe or profound hearing loss from public and private schools in the Australian States of Tasmania (n = 11) and New South Wales (n = 43) agreed to participate and completed the written and the interactive Auslan versions of the YSR. Parallel forms were completed by parents (Child Behaviour Checklist) and teachers (Teacher's Report Form).

RESULTS

The Auslan version showed comparable reliability to that reported for the standard YSR: internal consistency (alpha) ranging from 0.77 to 0.97 and test-retest agreement (r) from 0.49 to 0.78. The interactive Auslan version yielded a prevalence of clinically significant emotional and behavioural problems in deaf adolescents of 42.6% compared with 21.4% when using the standard English version. Prevalence for the wider Australian adolescent population (18.9%) was similar to that obtained among deaf adolescents when using the standard YSR (21.4%). However, it was higher among deaf adolescents (42.6%) when using the Auslan version (OR = 3.2, 95% CI = 1.83-5.58). According to the Auslan version, the syndromes Withdrawn/Depressed (OR = 6.5, 95% CI = 2.96-14.25), Somatic Complaints (OR = 4.8, 95% CI = 2.53-9.22), Social Problems (OR = 8.3, 95% CI = 4.16-16.47) and Thought Problems (OR = 5.7, 95% CI = 2.50-12.80) were much more prevalent among deaf adolescents than in the wider adolescent population, while Attention Problems (OR = 1.1, 95% CI = 0.39-3.17) and Rule-Breaking Behaviour (OR = 1.5, 95% CI = 0.73-3.17) were not.

CONCLUSIONS

An interactive Auslan version of the YSR is reliable, better accepted and yields higher rates of disturbance than the standard written questionnaire. Clinicians should be aware that using written instruments to assess psychopathology in deaf adolescents may produce invalid results or may underestimate the level of disturbance, particularly emotional problems.

The development and maintenance of anxiety symptoms from infancy through adolescence in a longitudinal sample

This study examined the etiology and course of anxiety symptoms from infancy through adolescence in a longitudinal high-risk community sample. One hundred fifty-five subjects were assessed using a variety of observational, projective, and objective measures. Results of path analyses revealed the following: (a) anxiety symptoms showed moderate stability during childhood and adolescence; (b) heightened neonatal biobehavioral reactivity and poor regulation predicted emotion regulation difficulties in preschool, which predicted anxiety symptoms in childhood; (c) developmental incompetence in childhood predicted anxiety symptoms in preadolescence, and anxiety symptoms in preadolescence predicted incompetence in adolescence; (d) insecure attachment relationships in infancy predicted negative peer relationship representations in preadolescence, and these representations predicted anxiety symptoms in adolescence; (e) compared to males, females showed similar rates of anxiety symptoms in childhood but greater and more stable rates in adolescence; however, males and females showed similar patterns of association between risk factors and anxiety symptoms across childhood and adolescence; and (f) the model tested was specific in predicting anxiety symptoms and not psychopathology in general. The results support a developmental model of the etiology and maintenance of anxiety symptoms in childhood and highlight factors to consider in efforts to prevent and treat childhood anxiety.

Prognostic value of parent-adolescent disagreement in a referred sample

OBJECTIVE

To investigate whether parent-adolescent disagreement regarding reports on adolescents' psychopathology indicates a poor prognosis.

METHODS

A total of 151 11- to 18-year-olds who had been assessed with the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) at referral to an outpatient psychiatry clinic were followed up. At follow-up, 4.3 years later, signs of poor outcome were assessed.

FINDINGS

Discrepancies between CBCL and YSR scores predicted future disciplinary problems at school, police/judicial contacts, and drug use.

CONCLUSIONS

To determine the prognosis of psychopathology in adolescents who are referred to mental health services, discrepancies between parents and adolescents may be useful. Given the relatively large number of statistical comparisons (n = 16) that was needed to obtain these results, future studies are needed to test if the results are robust across different settings.

Teacher awareness of anxiety symptoms in children

The present study aimed to determine which anxiety symptoms in children are associated with teacher awareness and whether teacher awareness differs according to student age and gender. The Multidimensional Anxiety Scale for Children (MASC) was completed by 453 second through fifth grade students and teachers nominated the three most anxious students in their classrooms. A multivariate analysis of variance was conducted with MASC scale scores as the dependent variables. Children identified by teachers as anxious had significantly higher levels of overall anxiety, physiological anxiety, social anxiety, and separation anxiety. Overall, teacher awareness did not differ based on student age or gender.

Assessing violence exposure and trauma symptoms in young children: a critical review of measures

The acknowledgment of the existence of age-specific posttraumatic stress symptoms in infants, toddlers, and preschoolers points to the urgent need for standardized assessment tools for violence exposure and trauma symptoms in young children. The authors review the assessment measures currently available for the evaluation of potentially traumatic events (PTE) and posttraumatic stress disorder (PTSD) symptoms in children less than 6 years old. Each measure is described and its strengths and weaknesses discussed in a developmental context, while also considering the specific difficulties inherent to the assessment of young children. Recommendations for further test development are given.

Relationship between maternal clinical factors and mother-reported child problems

Maternal depression has been associated with mothers' elevated reports of child problems. However, it is unclear the extent to which elevations in mother ratings reflect having a depression diagnosis, having any mental illness diagnosis, or having a diagnosis vs. symptom levels. As part of a NIMH-funded, longitudinal study of mothers with serious mental illness (N=379), we examined the relationship between mother-reported adolescent behavior problems (N=78) and maternal depression vs. other diagnoses, as well as the effects of depression diagnosis vs. symptom levels. Mothers were recruited from the public mental health system in an urban area, and are primarily African-American and low income. We found that maternal psychiatric symptoms made a unique and significant contribution to explaining the variance in mother-reported child problems, independent of controls (e.g., teacher reports and child demographics), while maternal diagnosis did not. Implications of findings are discussed.

Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study

Discrepancies often exist among different informants' (e.g., parents, children, teachers) ratings of child psychopathology. Informant discrepancies have an impact on the assessment, classification, and treatment of childhood psychopathology. Empirical work has identified informant characteristics that may influence informant discrepancies. Limitations of previous work include inconsistent measurement of informant discrepancies and, perhaps most importantly, the absence of a theoretical framework to guide research. In this article, the authors present a theoretical framework (the Attribution Bias Context Model) to guide research and theory examining informant discrepancies in the clinic setting. Needed directions for future research and theory include theoretically driven attention to conceptualizing informant discrepancies across informant pairs (e.g., parent-teacher, mother-father, parent-child, teacher-child) as well as developing experimental approaches to decrease informant discrepancies in the clinic setting.

10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden

OBJECTIVE

To review recent progress in child and adolescent psychiatric epidemiology in the area of prevalence and burden.

METHOD

The literature published in the past decade was reviewed under two headings: methods and findings.

RESULTS

Methods for assessing the prevalence and community burden of child and adolescent psychiatric disorders have improved dramatically in the past decade. There are now available a broad range of interviews that generate DSM and ICD diagnoses with good reliability and validity. Clinicians and researchers can choose among interview styles (respondent based, interviewer based, best estimate) and methods of data collection (paper and pencil, computer assisted, interviewer or self-completion) that best meet their needs. Work is also in progress to develop brief screens to identify children in need of more detailed assessment, for use by teachers, pediatricians, and other professionals. The median prevalence estimate of functionally impairing child and adolescent psychiatric disorders is 12%, although the range of estimates is wide. Disorders that often appear first in childhood or adolescence are among those ranked highest in the World Health Organization's estimates of the global burden of disease.

CONCLUSIONS

There is mounting evidence that many, if not most, lifetime psychiatric disorders will first appear in childhood or adolescence. Methods are now available to monitor youths and to make early intervention feasible.

Disentangling the underlying dimensions of psychopathy and conduct problems in childhood: a community study

The psychometric and predictive validity of callous-unemotional (CU) traits as an early precursor of conduct disorder and antisocial behavior were assessed. A community sample of children (4-9 years of age) were tested 12 months apart with the Antisocial Process Screening Device (APSD; P. J. Frick & R. D. Hare, 2002), a measure of early signs of psychopathy in children. Factor analysis supported the structure of the APSD. Given controversy surrounding construct overlap between psychopathy and conduct problems, a factor analysis was conducted on pooled items from the Strengths and Difficulties Questionnaire and APSD. A 5-factor solution resulted: antisocial, hyperactivity, CU traits, anxiety, and peer problems. CU traits added small but significant improvements in the 12-month prediction of antisocial behavior for boys and older girls, after controlling for Time 1 measures. These results indicate that although the dimensions of the APSD overlap with dimensions of the disruptive behavior disorders, CU traits have unique predictive validity in childhood.

Concordance of reports of mental health functioning by adolescents and their caregivers: a comparison of European, African and Latino Americans

The purpose of this study was to examine the concordance of parental and adolescent reports of adolescents having emotional and behavioral problems. Data were collected from youths (age 11-17) and adult caregivers from a community-based sample of households. The sample consisted of 4175 youths and their caregivers (37.8% European, 35.0% African, 25.4% Latino, and 1.8% other American). Indicators of emotional and/or behavioral problems were global indicators: perceived mental health, life satisfaction, happiness, interpersonal problems at home, and problems at school. Overall, parent-child concordance on the indicators of mental health was low, with a mean kappa value of 0.12. In multivariate analyses, European American parent-youth dyads were significantly more likely to be concordant on reports of perceived mental health, problems at home, and problems at school than African American and Latino dyads. Our data suggest that ethnicity is a significant factor in parental labeling and awareness of adolescent mental health problems. Future research should examine whether the extent to which greater lack of concordance on the indicators of mental health by minority parent-child dyads plays a role in entry into and retention in mental health care.

What's in a name? A comparison of methods for classifying predominant type of maltreatment

OBJECTIVE

The primary aim of the study was to identify a classification scheme, for determining the predominant type of maltreatment in a child's history that best predicts differences in developmental outcomes.

METHOD

Three different predominant type classification schemes were examined in a sample of 519 children with a history of alleged maltreatment. Cases were classified into predominant maltreatment types according to three different schemes: Hierarchical regression analyses examined whether the HT, SFT, and EHT type classifications contributed to prediction of child behavior problems, trauma symptoms and adaptive functioning.

RESULTS

After controlling for demographic factors, the HT definitions predicted four outcomes, while the SFT definitions predicted three, and the EHT classifications contributed to the prediction of five child outcomes. The co-occurrence of multiple types of maltreatment was robustly related to outcomes. However, the HT and SFT classifications predicted outcomes even after accounting for the co-occurrence of multiple maltreatment subtypes.

CONCLUSION

A classification scheme that differentiates between type combinations and single maltreatment types may have the greatest predictive validity. Over and above knowing about co-occurrence of maltreatment sub-types, it is important to understand what type, or constellation of types, of maltreatment have been alleged in a child's history.

Youth-parent consistencies on ratings of difficulties and prosocial behavior: Exploration of an at-risk sample

Low informant agreement is of particular concern in clinical settings, since diagnoses and interventions are largely based on reports from parents and/or youths. This study explores youth-parent consistencies in an at-risk sample of youths (n = 42), several from immigrant and refugee families, all with stressful background experiences. Data from a community sample (n = 165) was used to contrast the clinical results. Results showed that correlations between clinical youths and parents were within the same range as those in the community sample. Consistencies concerning absolute level of behavior were higher in the clinical sample. However, interesting differences in informant consistencies were found on difficulties and resources between the two samples. This study adds to the picture that there is no simple relationship between severity of behavior deviance and informant agreement. Asking about behavioral resources as well as difficulties may provide valuable additional information regarding differences in the perspectives of at-risk youths and parents.

The Impact of the Big Five Personality Traits on Reports of Child Behavior Problems by Different Informants

The present study compared ratings of a standardized sample of child behavior problems across informants and examined the effects of informant personality traits on child behavior ratings by mothers, teachers, and group-care workers. Participants were 55 clinic-referred children, aged 6-12 years. All informants watched and rated the same 17-min videotaped behavior sample of a familiar target child. Independent trained observers rated the same videotapes to provide criterion ratings. Informants' personality traits were assessed using the NEO Five Factor Personality Inventory. Results showed that mothers reported fewer behavior problems than did the professionals, that the informants who were familiar with the child reported more behavior problems than did the independent observers, and that higher levels of informant neuroticism were related to higher ratings of child behavior problems in the case of the professionals, but not in the case of the mothers. In addition, group-care workers who were less extraverted and open were likely to report more child behavior problems than group-care workers with normal levels of extraversion and openness. Finally, no relations were found between agreeableness or conscientiousness and ratings of child behavior. Findings suggest that professionals who work with children are not immune to distortions based on their own personality.

Observations of Aggressive Children During Peer Provocation and With a Best Friend

Observational methods were used to examine aggressive children's peer relations in 2 contexts: when being teased by a peer and when interacting with a best friend. Because aggressive children may have more difficulty than nonaggressive children in both peer contexts, the authors also examined whether relations between behaviors across contexts varied as a function of aggression. Results indicated that aggression was related to children's behavior when provoked. Children's behavior when provoked was associated with fewer positive and more negative interactions with their best friend, particularly for aggressive children. Results are discussed with respect to social norms in middle childhood and informing interventions for aggressive children.

Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder

OBJECTIVE

The aim of treatment for attention-deficit/hyperactivity disorder (ADHD) is to decrease symptoms, enhance functionality, and improve well-being for the child and his or her close contacts. However, the measurement of treatment response is often limited to measuring symptoms using behavior rating scales and checklists completed by teachers and parents. Because so much of the focus has been on symptom reduction, less is known about other possible health problems, which can be measured easily using health-related quality-of-life (HRQL) questionnaires, which are designed to gather information across a range of health domains. The aim of our study was to measure HRQL in a clinic-based sample of children who had a diagnosis of ADHD and consider the impact of 2 clinical factors, symptom severity and comorbidity, on HRQL. Our specific hypotheses were that parent-reported HRQL would be poorer in children with ADHD than in normative US and Australian pediatric samples, in children with increasing severity of ADHD symptoms, and in children who had diagnoses of comorbid psychiatric disorders.

METHODS

Cross-sectional survey was conducted in British Columbia, Canada. The sample included 165 respondents of 259 eligible children (63.7% response rate) who were referred to the ADHD Clinic in British Columbia between November 2001 and October 2002. Children who are seen in this clinic come from all parts of the province and are diverse in terms of socioeconomic status and case mix. ADHD was diagnosed in 131 children, 68.7% of whom had a comorbid psychiatric disorder. Some children had >1 comorbidity: 23 had 2, 5 had 3, and 1 had 4. Fifty-one children had a comorbid learning disorder (LD), 45 had oppositional defiant disorder or conduct disorder (ODD/CD), and 27 had some other comorbid diagnosis. The mean age of children was 10 years (standard deviation: 2.8). Boys composed 80.9% (N = 106) of the sample. We used the 50-item parent version of the Child Health Questionnaire to measure physical and psychosocial health. Physical domains include the following: physical functioning (PF), role/social limitations as a result of physical health (RP), bodily pain/discomfort (BP), and general health perception (GH). Psychosocial domains include the following: role/social limitations as a result of emotional-behavioral problems (REB), self-esteem (SE), mental health (MH), general behavior (BE), emotional impact on parent (PTE), and time impact on parents (PTT). A separate domain measures limitations in family activities (FA). There is also a single-item measure of family cohesion (FC). Individual scale scores and summary scores for physical (PhS) and psychosocial health (PsS) can be computed. Symptom severity data (parent and teacher) came from the Child/Adolescent Symptom Inventory 4. These checklists provide information on symptoms for the 3 ADHD subtypes (inattentive, hyperactive, and combined). Each child underwent a comprehensive psychiatric assessment by 1 of 4 child psychiatrists. Documentation included a full 5-axis Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis on the basis of a comprehensive assessment. Clinical information for each child was extracted from hospital notes.

RESULTS

Compared with both population samples, children with ADHD had comparable physical health but clinically important deficits in HRQL in all psychosocial domains, FA, FC, and PsS, with effect sizes as follows: FC = -0.66, SE = -0.90, MH = -0.97, PTT = -1.07, REB = -1.60, BE = -1.73, PTE = -1.87, FA = -1.95, and PsS = -1.98. Poorer HRQL for all domains of psychosocial health, FA, and PsS correlated significantly with more parent-reported inattentive, hyperactive, and combined symptoms of ADHD. Children with > or =2 comorbid disorders differed significantly from those with no comorbidity in most areas, including RP, GH, REB, BE, MH, SE, PTT, FA, and PsS, and from those with 1 comorbid disorder in 3 domains, including BE, MH, and FA and the PsS. The mean PsS score for children in the ODD/CD group (mean difference: -12.9; effect size = -1.11) and children in the other comorbidity group (-9.0; effect size = -.77) but not children in the LD group were significantly lower than children with no comorbid disorder. Predictors of physical health in a multiple regression model included child's gender (beta = .177) and number of comorbid conditions (beta = -.197). These 2 variables explained very little variation in the PhS. Predictors of psychosocial health included the number of comorbid conditions (beta = -.374) and parent-rated combined ADHD symptoms (beta = -.362). These 2 variables explained 31% of the variation in the PsS.

CONCLUSIONS

Our study shows that ADHD has a significant impact on multiple domains of HRQL in children and adolescents. In support of our hypotheses, compared with normative data, children with ADHD had more parent-reported problems in terms of emotional-behavioral role function, behavior, mental health, and self-esteem. In addition, the problems of children with ADHD had a significant impact on the parents' emotional health and parents' time to meet their own needs, and they interfered with family activities and family cohesion. The differences that we found represent clinically important differences in HRQL. Our study adds new information about the HRQL of children with ADHD in relation to symptom severity and comorbidity. Children with more symptoms of ADHD had worse psychosocial HRQL. Children with multiple comorbid disorders had poorer psychosocial HRQL across a range of domains compared with children with none and 1 comorbid disorder. In addition, compared with children with no comorbidity, psychosocial HRQL was significantly lower in children with ODD/CD and children in the other comorbidity group but not in children with an LD. The demonstration of a differential impact of ADHD on health and well-being in relation to symptom severity and comorbidity has important implications for policies around eligibility for special educational and other supportive services. Because the impact of ADHD is not uniform, decisions about needed supports should incorporate a broader range of relevant indicators of outcome, including HRQL. Although many studies focus on measuring symptoms using rating scales and checklists, in our study, using a multidimensional questionnaire, we were able to show that many areas of health are affected in children with ADHD. We therefore argue that research studies of children with ADHD should include measurement of these broader domains of family impact and child health.

Parent and teacher agreement on child behavior checklist items in a sample of preschoolers from low-income and predominantly African American families

In this study we examined parent and teacher agreement at the item level of the newly revised Child Behavior Checklist/1 1/2-5 (CBCL/1 1/2-5) and Caregiver-Teacher Report Form/1 1/2-5 (CTRF/1 1/2-5) in 505 preschool children from low-income and predominantly African American families. Parents generally rated more children as having problem behaviors than did teachers. Lack of agreement between parents and teachers at the item level was indicated by low correlation coefficients, kappa values, and co-identification of children with specific behavior problems. High levels of parent-teacher agreement were obtained only when rank orders of problem behaviors were compared. No significant sex effect was found on parent and teacher agreement at the item level. Problem behaviors most often indicated by parents and teachers reflected the roles and responsibilities of parents and teachers in the home and school settings. Our findings suggest informant and setting specificity of parent- and teacher-identified problem behaviors in young children.

Parent-adolescent disagreement regarding psychopathology in adolescents from the general population as a risk factor for adverse outcome

This study investigated whether parent-adolescent disagreement regarding adolescents' behavioral and emotional problems predicted adverse outcome. A Dutch sample of 15- to 18-year-olds was prospectively followed across a 4-year interval. The Child Behavior Checklist (CBCL: T. M. Achenbach, 1997) and Youth Self-Report (YSR; T. M. Achenbach, 1991b) were administered at initial assessment, and the following signs of poor outcome were assessed 4 years later: police/judicial contacts, expulsion from school/job, suicidal ideation, unwanted pregnancy, suicide attempts, deliberate self-harm, referral to mental health services, report of having a behavioral or emotional problem, and feeling the need for professional help without actually receiving help. Twenty CBCL syndrome scores, 23 YSR syndrome scores, and 16 discrepancy scores were significant predictors of poor outcome. It was concluded that to determine the prognosis of psychopathology in adolescents, discrepancies between informants may be important.

Patterns of agreement between parent and child ratings of emotional and behavioral problems in an outpatient clinical setting: when children endorse more problems

This study examined clinically relevant patterns of agreement between parent and child ratings of child behavior problems and factors associated with these patterns. Subjects were 274 children, ages 11 to 18 years, and their parents. Overall agreement between parent-child ratings was modest. Twenty-five percent of parent-child pairs agreed children's behavior problems were clinically elevated ("both" group), 29% agreed problems were nonclinical ("neither" group), in 39% of pairs only parents reported clinically elevated problems ("parent only" group) and in 8% of pairs only children rated clinically elevated problems ("child only" group). Maternal stress and child age, but not child gender, were associated with parent-child agreement patterns. Children with depressive/mood disorders were more likely to be in the "child only" group than in any other group. This study discusses the importance of paying attention to child reports of elevated behavior problems, particularly when parents report that child behavior problems are not clinically elevated.

ThePreschool Feelings Checklist: a brief and sensitive screening measure for depression in young children

OBJECTIVE

Childhood depression is widely underrecognized in primary health care settings. This phenomenon appears to increase with younger age. Evidence has been provided for a valid depressive syndrome among preschool children. Based on the need for the earliest possible identification of depression, the development of a brief screening measure to capture young children with markers of depression from these community settings was developed and tested.

METHOD

A group of 174 preschool children underwent a comprehensive psychiatric assessment. The majority of this study group was ascertained from primary care settings using a 20-item checklist designed to capture depressive symptoms in young children. The assessment included the Diagnostic Interview Schedule for Children Version modified for young children and the Child Behavior Checklist. Ratings on the checklist were subsequently compared with these independent measures of psychopathology using several analytic strategies.

RESULTS

The Preschool Feelings Checklist demonstrated high internal consistency, and 16 items showed strong associations with independent diagnostic measures of internalizing symptoms and major depressive disorder. The Preschool Feelings Checklist demonstrated high specificity and sensitivity for the identification of major depressive disorder at a cutoff score 3 or more.

CONCLUSIONS

The Preschool Feelings Checklist is a brief and valid screening measure highly feasible for use in primary care settings. It demonstrated utility for the identification of preschoolers in need of formal mental health evaluation for depression.

Agreement between parents and teachers on behavioral/emotional problems in Japanese school children using the child behavior checklist

We investigated the agreement between Japanese parents' and teachers' ratings concerning their children's behavioral/emotional problems. Mothers (n = 276) and teachers (n = 19) assessed each child (n = 316; 6 to 12 years old ) using Japanese parent and teacher version of the Child Behavior Checklist. Parent-teacher agreement were examined through three indices; mean scores, correlations and D scores (generalized distance between item profile). Mean scores rated by parents were significantly higher than those by teachers. The differences of parents' ratings according to sex of the child or parents' occupational level, and those of teachers' ratings according to sex of the child were consistent with previous Western studies. Parent-teacher correlations were in the low to middle range (0.16-0.36). We obtained significant sets of independent variables accounting for the variance of D scores, but the effect size of these variables was small. These results indicated that, as seen in Western studies, Japanese parents and teachers would also assess their child's problems differently and the child's demographics affect their evaluation. For further research, parent and teacher characteristics which may influence on their perspective of the child's problems could be examined.

Perceptions of the Family Environment and Youth Behaviors: Alcohol-Abusing Runaway Adolescents and Their Primary Caretakers

Research suggests family disturbance is highly correlated to adolescents running away from home. However, given methodological challenges, few studies assess parent report of the family situation and instead, rely primarily on adolescent self-report. This article reports the findings of parents' and runaway adolescents' reports on several behavioral dimensions. Substance-using runaway adolescents completed measures about their family environment and adolescent problem behaviors. Of 119 adolescents, 49 of their parents also completed measures at intake. Adolescents perceived a more negative family environment than did their parents, and parents rated their youth as having more externalizing problems than did the youth themselves. Findings are consonant with prior research showing a relationship between parental distress and child problems. Contrary to prior findings, this sample of parents did not report significant alcohol use, and there was no relationship between their use and their child's use. Implications for future research and family therapy are discussed.

Friends as reporters of children's and adolescents' depressive symptoms

Obtaining information from multiple informants is important when assessing youth depression. Past studies have utilized adults' reports of youths' emotional functioning and aggregate reports from classmates but have not considered close friends as reporters of depressive symptoms. This is surprising given the important roles of friends as companions and confidants. This study investigated relations between friend-reported depressive symptoms and youths' self-reports. From a larger sample of fifth-, seventh-, and ninth-grade participants, self-reports and friend reports of depressive symptoms and friend reports of friendship quality were available for a subset of 367 participants. Significant positive relations emerged between friend reports and self-reports of affective depressive symptoms for girls and youth in high-quality friendships. Relations between friend reports and self-reports were stronger for conduct-related than affective depressive symptoms and reached significance for boys as well as for girls and for youth in low-quality friendships as well as for youth in high-quality friendships. Implications for identifying at-risk youth are discussed.

Parental cognitions and satisfaction: relationship to aggressive parental behavior in child physical abuse

There are limited data on cognitions and satisfaction with the child in parents who have physically abused their children. Therefore, we examined convergence among these constructs, and their relationships to parental aggression among participants in a treatment study for child physical abuse. Data were examined at two time points 12 weeks apart. The cognitions (unrealistic expectations of the child, perception of lack of control, and hostile attribution bias) and satisfaction with the child showed little convergence. Only parental satisfaction correlated significantly with aggressive parental behavior directed at the child, even after controlling for social desirability. Where there were significant correlations between externalizing child behavior and aggressive parental behavior and between parental depression and aggressive parental behavior, some limited support was found for an indirect path through parental satisfaction. If replicated, these findings suggest it may be useful to focus on parental satisfaction in research on child physical abuse.

Three informants' reports of child behavior: parents, teachers, and foster parents

OBJECTIVE

To evaluate whether disagreements in reporting child behavior problems between biological parents and foster parents and teachers are related to depressive symptoms in the biological parent.

METHOD

Child Behavior Checklists and Teacher's Report Forms were completed by parents, foster parents, and teachers on 95 foster children between ages 5 and 16 during 1990-1991. Depressive symptoms in biological parents were assessed using the Center for Epidemiologic Studies Depression Scale. Structural equation modeling was used to estimate the relation between parental depressive symptoms and the discrepancies between their reports and those of two other informants.

RESULTS

In both the internalizing and externalizing behavior models, a significant relation was found between parents' depressive symptoms and their discrepancies in reporting, but not with child behavior. This relation was stronger for internalizing than externalizing models.

CONCLUSIONS

Using foster parents (and teachers) as informants offered a unique opportunity to view the reports of biological parents in comparison to two independent reports. Foster parents have a similar observational situation as biological parents but bring a less emotionally invested perspective to behavior observation, even when they are relatives. It is likely that depressive symptoms in parents distort their reports of their children's behavior. Clinicians would be wise to supplement parental with other informant reports.

Bias in Parental Reports?

Summary: In clinical practice, child psychologists' case formulations are often based on parental reports. In this study, we examined whether mothers' reports of internalizing and externalizing behavior problems in their children might be biased by maternal psychopathology. The target child sample consisted of 68 boys aged 6-12 years who were receiving treatment. Mothers' reports were compared with the reports of both teachers and group care workers as criterion ratings. After controlling for variance shared with the independent raters, multiple regression analysis indicated substantial partial correlations between various types of maternal psychopathology and the reporting of internalizing child behavior problems. Only small to insignificant partial correlations were found in the case of externalizing behavior problems. This finding is consistent with the social attribution theory that predicts greater distortion when observing more ambiguous stimuli.

Race/Ethnicity and rates of self-reported maltreatment among high-risk youth in public sectors of care

This study examined rates of youth-reported maltreatment history and the association between youth-reported maltreatment and foster care history across four racial/ethnic groups in a public system of care. Interviews were conducted with 1,045 youth (European Americans, African Americans, Hispanic Americans, and Asian Pacific Islanders) and their primary caregivers, sampled from one of five service sectors (alcohol/drug services, child welfare, juvenilejustice, mental health, and special education) in San Diego. Overall, racial/ethnic differences in youth-reported maltreatment were minimal. However, in the child welfare sector, African American youth self-reported maltreatment less frequently than other youth. There were significant racial/ethnic differences in foster care history, with African Americans far more likely to have been placed, even after controlling for youth-reported maltreatment, income, age, and gender. Furthermore, maltreatment history was associated with placement for all youth except African Americans. These results suggest that the overrepresentation of minority children in child welfare does not stem from greater rates of maltreatment.

Are discrepancies among child, mother, and father reports on children's behavior related to parents' psychological symptoms and aspects of parent-child relationships?

Examined whether parents' symptoms and qualitative and quantitative aspects of parent-child relationships make unique contributions to mothers' and fathers' reports of, and mother-child, father-child, and father-mother discrepancies on, children's behavior. Participants were 100 children, aged 10-12, and their mothers and fathers. Parents' symptoms and parent-child relationships made unique contributions to both parents' ratings of externalizing behavior. Although parent-child relationship variables were related to both parents' ratings of internalizing behavior, only parents' symptoms made unique contributions. On mother-child and father-child discrepancies, differences emerged between mother and father, and internalizing and externalizing behaviors. Both fathers' and mothers' symptoms contributed to father-mother discrepancies on both behavior types, with parent-child relationships contributing unique variance to discrepancies on internalizing behavior. Results highlight the importance of each informant's symptoms and relationship variables in understanding informant discrepancies.

Stress and psychopathology in children and adolescents: is there evidence of specificity?

Research on the relations between specific stressors and specific psychological outcomes among children and adolescents is reviewed. Specificity, the notion that particular risk factors are uniquely related to particular outcomes is discussed from a theoretical perspective, and models of specificity are described. Several domains of stressors are examined from a specificity framework (e.g., exposure to violence, abuse, and divorce/marital conflict) in relation to broad-band outcomes of internalizing and externalizing symptoms. Studies that tested for specificity conducted within the past 15 years are examined, and definitional problems are highlighted. Little evidence for specificity was found. Methodological problems in the literature and the lack of theory-driven specificity research are discussed, and directions for future research are identified.

The Target Symptom Rating: a brief clinical measure of acute psychiatric symptoms in children and adolescents

Describes the development and psychometric properties of the Target Symptom Rating (TSR), a brief, multi-informant measure of commonly observed symptoms in child and adolescent clinical work. In a large sample of children and adolescents in inpatient and residential treatment, the 13 TSR items fell into 2 subscales: Emotional Problems and Behavior Problems, which were associated in expected ways with the Internalizing and Externalizing factors of the Achenbach scales and the Child and Adolescent Functional Assessment Scale (CAFAS). The measure was sensitive to change in brief and extended treatment, as rated by parents, patients, primary clinicians, and family therapists, and shows promise as a tool for outcome research in applied settings.

Threatened and attempted suicide by partner-violent male respondents petitioned to family violence court

The authors examined threatened and attempted suicide among partner-violent male respondents in a family court domestic violence intervention court based on the reports of 101 women petitioning the court for orders of protection. Suicidal behavior was prevalent; 45.5% of respondents had a history of threatened suicide and 12.9% had a history of suicide attempts. Most recent threats were clustered in the previous 6 months (70.5%) with one-fourth occurring within a week of the petition, potentially indicating a desperate response to a deteriorating relationship. Attempts were not clustered in recent months. Men with a history of threatened or attempted suicide were shown to have been more violent at the index offense and greater domestic violence severity overall, potentially indicating a subsample of more severely partner-violent men also at particularly heightened risk for suicide. The study of suicidal behavior in partner-violent men may inform the prevention of suicide and severe domestic violence.

Issues in parent-child agreement: the case of structured diagnostic interviews

There are three primary purposes of this review. First, the review distinguishes among three types of reliability and describes the importance of evaluating the reliability of child psychopathology assessment instruments for clinical practice and research. Second, parent-child reliability findings from 5 of the more carefully studied and frequently used Structured (semi and highly) diagnostic interviews (The Schedule for Affective Disorders and Schizophrenia for School-age Children, The Child Assessment Scale, The Anxiety Disorders Interview Schedule for Children. The Diagnostic Interview for Children and Adolescents, and the Diagnostic Interview Schedule for Children) are examined. Finally, this review explores factors that have been implicated in terms of their potential effect on parent-child agreement. In addition, future directions for research and clinical practice within this area are identified and potential resolutions to the conundrum of parent-child discordance are discussed.

The validity of proxy-based data in suicide research: a study of patients 50 years of age and older who attempted suicide. I. Psychiatric diagnoses

OBJECTIVE

To investigate the validity of best-estimate methodology for making psychiatric diagnoses among individuals who attempted suicide.

METHOD

Subjects were 80 patients admitted for treatment following a suicide attempt. Psychiatric diagnoses based on structured interviews with subjects were compared with diagnoses made based on interviews with proxy respondents. In both cases, interview information was supplemented with pre-admission psychiatric and medical records to inform diagnoses.

RESULTS

Diagnostic agreement, based on kappa coefficients, was substantial for major depression and bipolar disorders, and moderate for non-affective psychoses, organic mood and anxiety disorders. Agreement was substantial for substance dependence but poor for substance abuse disorders.

CONCLUSION

Results support best-estimate methodology for making mood and substance dependence diagnoses in research of suicidal behavior in this age group, with potential implications for interpreting postmortem research of completed suicide.

Selbst- und Fremdeinschätzung der Kinderängstlichkeit

Zusammenfassung: Die Dresdner Kinder-Angst-Studie (DKAS) untersuchte eine repräsentative Stichprobe von 826 Achtjährigen bezüglich Ängstlichkeit der Kinder mittels Selbsteinschätzung sowie mittels Fremdeinschätzung durch Eltern und Lehrerinnen. Mit 230 der Kinder fand zusätzlich eine diagnostische Einzeluntersuchung zur Feststellung klinischer und subklinischer Ängste statt. Die Urteilerübereinstimmung der Ängstlichkeitseinschätzung erwies sich als sehr gering (r = .08 bis r = .15). Mädchen schätzen sich als ängstlicher ein als Jungen und werden auch so eingeschätzt. Auf die Übereinstimmung zwischen Kind und Erwachsenen übt dies jedoch keinen Einfluss aus. Als Faktoren, welche die Übereinstimmung der Ängstlichkeitseinschätzung zwischen Kind und Eltern beeinflussen, konnten Depressivität der Mutter und State-Angst des Kindes in der Befragungssituation identifiziert werden. Angstbelastung oder Schulbildung der Eltern und die schulische Leistungsfähigkeit des Kindes üben keinen Einfluss aus. Die Elterneinschätzung steht in einem signifikanten Zusammenhang mit dem Angst-Diagnose-Status des Kindes. Dies trifft besonders bei der Trennungsangst und der Sozialphobie, nicht aber bei agoraphobischen Ängsten zu. Die Selbsteinschätzung des Kindes weist nur bezüglich Diagnosestatus in subklinischen agoraphobischen Ängsten einen Zusammenhang auf.

Behavioral and emotional problems in Chinese adolescents: parent and teacher reports

OBJECTIVE

This study examined behavioral and emotional problems in Chinese adolescents.

METHOD

A sample of 1,694 adolescents aged 12 to 16 years participated in this study in 1997. Parents completed the Child Behavior Checklist (CBCL), and teachers completed the Teacher's Report Form (TRF).

RESULTS

For both parent and teacher reports, internalizing syndromes were scored higher in girls and externalizing syndromes were scored higher in boys. Scores on most of the CBCL and TRF subscales were higher for the older adolescents. The overall prevalence rates of parent- and teacher-reported behavioral problems were 23.1% and 19.2%, respectively. The eight cross-informant syndromes were highly comorbid, with a significant association across syndromes (mean odds ratio = 16.1 for CBCL and 22.5 for TRF). Correlations between parent and teacher reports were 0.51 for eight subscales and 0.68 for Total Problems.

CONCLUSIONS

These findings demonstrate that behavioral and emotional problems tend to increase with age and cluster in the same individuals. The prevalence rates of behavioral problems in Chinese adolescents are comparable to those reported in Western countries. In contrast to findings for Western samples, parent reports of behavioral problems were highly correlated with teacher reports.

Child and Adolescent Empirical Psychotherapy Research

This paper reviews child and adolescent psychotherapy research, with a focus on two major theoretical classes of psychotherapies: cognitive-behavior and psychoanalytic psychotherapies. Our interest is particularly drawn to different issues: definition of psychotherapy and research on outcome and process. Specific attention is given developmental issues. We identify the major results and problems and propose methodological strategies for improving psychotherapeutic treatment research for child and adolescent disorders. Some areas that need to be addressed in the future are also discussed, such as the effects of specific techniques, the intensity and duration of treatment outcome and process, the effect of comorbidity, and the relationship between research and clinical practice.

Depressive symptoms as measured by the CDI in a population of northern Italian children

The aim of this study was to evaluate some Children's Depression Inventory (CDI) psychometric properties and the prevalence of depressive symptoms in an unselected Italian sample of two hundred and eighty-four children aged 8 years. The CDI internal consistency was adequate (Cronbach's alpha:.80). The mean and standard deviation of CDI and the percentage of children at risk of depression (10.6%) in this sample are consistent with the figures reported by other studies carried out in northern Europe and North America. There were differences in gender and socioeconomic level in that boys scored higher than girls, and in the lower socioeconomic level there were more children at risk of depression. Ten items best discriminated children at risk for depression with 94% of correct classification. Most of these items consisted of observable signs. It is suggested that the CDI has noteworthy consistency across samples of relatively different cultures, that it can reliably be employed in the assessment of young children, and that observable signs outnumber internalizing symptoms of depression among children at risk

Mother and child perceptions of child functioning: relationship to maternal distress

The relationship between maternal distress and mother's reports of psychosocial problems in their children has been well-documented. However, relatively little research has investigated the relationship between maternal and family distress and young children's perception of their own functioning. Using a brief questionnaire designed for use with children, data were collected from 166 mothers and their children aged 5-12 years. Children provided information about their own daily functioning, and mothers provided information about their own, their child's, and their family's psychosocial functioning. Findings indicated that while children generally agreed with the reports of their mothers, children of distressed mothers self-reported better daily functioning than their mothers did. Distressed mothers tended globally to report negatively about themselves, their child, and their family. The present findings suggest that when assessing mothers or children, the reports of children should be considered as well as the reports of mothers.

Patterns and correlates of agreement between parent, teacher, and male adolescent ratings of externalizing and internalizing problems

The authors examined how well 394 triads of male youths, caregivers, and teachers agreed about youth problems reported on the Achenbach checklists. Dyadic agreement was measured through difference scores (subtracting the raw score of youth self-report from the caregiver's or teacher's score for shared items), q correlations between pairs of raters across items, and D2 (generalized distance between item profiles) for both externalizing and internalizing items. Teachers reported fewer internalizing and externalizing problems than did caregivers or youths. Teacher-youth disagreement was higher for African American than European American males about externalizing criteria. Caregiver depression and stress (but not paternal antisocial behavior or maternal substance abuse) correlated with higher disagreement with other informants about all criteria. These factors appear to increase disagreement about the level of problems but not about specific symptom patterns.

Child-reported depression and anxiety in preadolescence: II. Preschool predictors

OBJECTIVE

To examine the predictive association of parent- and teacher-reported behaviors at age 2 to 3 years in relation to child-reported depression and anxiety at age 10 to 11 years.

METHOD

Subjects were participants in a longitudinal study of 420 children aged 2 to 3 years from the general population first assessed in 1989 and again in 1991 (n = 397) and 1997 (n = 358). For the present study, 249 children were included for whom all relevant measures were obtained. These measures include the Child Behavior Checklist (CBCL) for 2- to 3-year-olds at time 1, the CBCL for 4- to 18-year-olds and the Teacher's Report Form at time 2, and the Dimensions of Depression Profile for Children and the State-Trait Anxiety Inventory for Children at time 3.

RESULTS

Only 5 and 8 of 220 parent-reported preschool problem items were significantly related to later child-reported depression and anxiety, respectively, and only 3 of 120 teacher-reported problem items were related to later anxiety. Of 120 teacher-reported preschool problem items, 21 were significantly related to later depression, including items referring to early signs of depression and social and academic problems.

CONCLUSIONS

Teachers, but not parents, can provide valuable information regarding preschool signals of preadolescent depression, but not anxiety. These signals include early social and academic problems.

Child-reported depression and anxiety in preadolescence: I. Associations with parent- and teacher-reported problems

OBJECTIVE

To examine a wide range of parent- and teacher-reported behaviors in relation to child-reported depression and anxiety in preadolescence.

METHOD

Subjects were participants in a longitudinal study of 420 preschool children from the general population that started in 1989. At second follow-up 8 years later (ages 10-11 years), usable parent information was obtained for 358 children. For this study, 274 children for whom complete child, parent, and teacher reports were obtained at age 10 to 11 years were included. Measures included the Dimensions of Depression Profile for Children, the State-Trait Anxiety Inventory for Children, the Child Behavior Checklist/4-18, and the Teacher's Report Form.

RESULTS

Of 120 parent-reported problem items, only 11 and 9 were associated with child-reported depression and anxiety, respectively. For teachers, 33 and 20 items (of 120) were significantly associated with child-reported depression and anxiety, respectively, including items referring to withdrawal, anxiety, depression, social problems, and academic problems.

CONCLUSIONS

Teachers are more likely than parents to notice internalizing problems and related problems such as social and academic problems in children reporting depression or anxiety.