A cross cultural comparison of French and Dutch disturbed children using the Child Behaviour Checklist (CBCL)

Dutch Norms for the Eyberg Child Behavior Inventory: Comparisons with other Western Countries

The Eyberg Child Behavior Inventory (ECBI) is one of the most widely used and well-validated parent rating scales for children's disruptive behavior. This screening instrument is a short, targetted and easy to implement inventory with good psychometric properties and is normed for different countries, among which the United States, Spain, Sweden and Norway. The ECBI has been successfully used for research and clinical purposes, in several countries including The Netherlands. To date, Dutch studies have relied on Scandinavian or US norm scores. However, this may be problematic because of cross-cultural differences in the degree to which certain behaviors are seen as problematic by parents. The main goal of this paper therefore was to obtain norm scores for The Netherlands among 6462 Dutch children aged 4 to 8 years (Mage = 6.37 years; SD = 1.32; 50.6% boys). In line with previous research, we found small differences on the mean sum scores across children of different ages (intensity scale) and gender (intensity and problem scale). Therefore, Dutch norm scores were provided age- and gender specific. Our results showed that disruptive behavior of children in the most rural areas was reported as occurring less frequently and was seen as less problematic by parents compared to the disruptive behavior of children in less rural areas. Finally, we found that Dutch norm scores on the ECBI were significantly lower than US norm scores, and significantly higher on the intensity scale (but not the problem scale) than Norwegian and Swedish norm scores.

Measurement invariance of internalizing and externalizing behavioral syndrome factors in a non-Western sample

This study examined the measurement structure of Child Behavior Checklist internalizing and externalizing syndrome scales in 1,146 eleven-year-old children from a birth cohort in Mauritius. We tested for measurement invariance at configural, metric, and scalar levels by gender and religioethnicity (Creole, Hindu, Muslim). A pared-down model representing five primary factors and two secondary factors met all three forms of invariance, supporting the validity of their use for group comparisons among Mauritian children. As rated by their parents, girls were higher than boys on Somatic Complaints and lower on Aggressive Behavior, Attention Problems, and Externalizing. Creoles were higher than Muslims and Hindus on all seven factors. Hindus were higher than Muslims on Somatic Complaints and lower on Aggressive Behavior. To our knowledge, this is the first study to demonstrate strict invariance of a Child Behavior Checklist-based internalizing and externalizing factor structure among subgroups within a society.

The Role of Socialization, Effortful Control, and Ego Resiliency in French Adolescents' Social Functioning

The relations among effortful control, ego resiliency, socialization, and social functioning were examined with a sample of 182 French adolescents (14-20 years old). Adolescents, their parents, and/or teachers completed questionnaires on these constructs. Effortful control and ego resiliency were correlated with adolescents' social functioning, especially with low externalizing and internalizing behaviors and sometimes with high peer competence. Furthermore, aspects of socialization (parenting practices more than family expressiveness) were associated with adolescents' effortful control, ego resiliency, and social functioning. Effortful control and ego resiliency mediated the relations between parental socialization and adolescents' peer competence and internalizing problems. Furthermore, effortful control mediated the relations between socialization and adolescents' externalizing behavior. Findings are discussed in terms of cultural and developmental variation.

Eyberg Child Behavior Inventory (ECBI): Norwegian norms to identify conduct problems in children

This article presents the first Norwegian standardization of an assessment tool specifically designed to measure childhood conduct problems. Norwegian norms for the Eyberg Child Behavior Inventory (ECBI) based on data obtained from a random population sample (N= 4063) of children in the age range of 4 to 12 years are presented. The sample was drawn from rural and urban areas within three Norwegian town districts. Clinical and research advantages of having a properly standardized assessment tool for this specific subclass of childhood psychiatric problems in Norway are discussed.

Testing the 8-syndrome structure of the child behavior checklist in 30 societies

There is a growing need for multicultural collaboration in child mental health services, training, and research. To facilitate such collaboration, this study tested the 8-syndrome structure of the Child Behavior Checklist (CBCL) in 30 societies. Parents' CBCL ratings of 58,051 6- to 18-year-olds were subjected to confirmatory factor analyses, which were conducted separately for each society. Societies represented Asia; Africa; Australia; the Caribbean; Eastern, Western, Southern, and Northern Europe; the Middle East; and North America. Fit indices strongly supported the correlated 8-syndrome structure in each of 30 societies. The results support use of the syndromes in diverse societies.

Psychometric properties of the Child Behavior Checklist/2-3 in an Arab population

Child Behavior Checklist 2-3 is a parents' report questionnaire whose psychometric properties are known in the Western setting, but no studies have investigated this in an Arabic culture. In this study, the psychometric properties of the Arabic translation were studied using a sample of 694 children age 3 yr., ascertained as part of a community-based epidemiological study in the United Arab Emirates. The item-total correlations for items were satisfactory, ranging from .16 to .58. Cronbach alpha values for reliability ranged from .70 to .88 for the subscales and .93 for the Total score. The test-retest reliability coefficient for the Total score was .83. The validity was also high as 94.1% of those who scored above the cut-off point were classified correctly by a blind clinical interview. The results suggest that Child Behavior Checklist 2-3 is a reliable and valid checklist for use in the Arabic culture.

Multidimensional scaling of pediatric sleep breathing problems and bio-behavioral correlates

STUDY OBJECTIVES

Complex relationships exist between pediatric sleep disorders and daytime behavior. Using a multidimensional scaling model, we investigated these relationships in 126 children with sleep breathing disorders (SBD).

METHOD

Validated questionnaires on nighttime behavior, daytime behavior, and respiratory health were administered to a large number of school children in Belgium. Children who met the criterion of having at least one sleep-related breathing problem (three or more times per week during the past six months) were selected for further analyses. A total of 26 indicators were defined and modeled, including sleep problems, sleep efficiency, sleep environment, sleep enuresis, internalised and externalised behavioral problems, respiratory health of the child and relatives, smoking exposure, and caffeine consumption.

RESULTS

From 3,045 questionnaire responses 4.1% of the children were reported to have a SBD symptom. SBD children differed on sleep and health domains from non-SBD children. Furthermore, through scaling of the (dis)similarities among the 26 indicators the SBD child was able to be modeled. By way of an internal analysis of the data-matrix the following indicators were eliminated: sleep correlates, health of the family, and behavior rated by teachers, followed by caffeine intake, drugs, and behavior rated by the parents. This revealed a two-dimensional model, consisting of primary SBD and secondary SBD.

CONCLUSION

Children with SBD differ on many domains from children without such disorders and an underlying two-fold SBD concept was found. Firstly, the SBD-indicator positioned in between investigated correlates with disorders of initiating and maintaining sleep and sleep hyperhydrosis on one hand and with respiratory-related illnesses on the other; this was labeled primary SBD. Secondly, the SDB-indicator not closely associated with any of the investigated correlates can be interpreted as secondary SBD.

Problem behaviors in 3-year-old children in the United Arab Emirates

INTRODUCTION

The purpose of this study was to examine the prevalence of behavioral disorders among 3-year-old children in the United Arab Emirates (UAE). Although this type of study exists in the industrialized countries, very few studies have been undertaken in the developing countries.

METHOD

Six hundred ninety-four randomly selected 3-year-old UAE nationals were screened using the Child Behaviour Checklist for Ages 2-3.

RESULTS

Of the children in the study, 10.5% had scores in the clinical range. By using clinical interviews in stage 2 of high-scoring children and random samples of children with normal scores, the weighted prevalence for a clinically significant disorder in behavior was estimated to be 9.94%. A number of putative risk factors were identified, including perinatal factors, adverse family factors, and a positive family history of mental health problems.

DISCUSSION

The prevalence of disordered behavior in this Arab culture and its risk factors are similar to those in developed countries. However, certain unique sociocultural determinants were also identified that have implications for the early detection of disordered behavior and care of children with disordered behavior.

Juvenile bipolar disorder in Brazil: clinical and treatment findings

BACKGROUND

Because few studies were conducted to evaluate bipolar disorder in children and adolescents outside North America, this investigation aims to describe clinical features, pattern of comorbidities, and response to pharmacologic treatment in a sample of youths with bipolar disorder (BD) from a pediatric psychopharmacology outpatient clinic in Brazil.

METHODS

We performed a retrospective chart review of all patients under age 15 with BD diagnoses who were evaluated and treated in our clinic from 1998-2001. A comparison sample of subjects with attention-deficit/hyperactivity disorder (ADHD) without BD (n = 362) was also evaluated.

RESULTS

The prevalence of juvenile BD in our sample was 7.2% (36/500) (95% confidence interval = 5.2-9.9). Irritable mood was detected in 91.7% of the bipolar patients. The main comorbidity found was ADHD (58.3%). Children with BD had significantly higher rates of abnormally elevated CBCL scores in the externalizing dimension, anxiety and depression, delinquent behavior, and aggressive behavior scales than ADHD subjects (p <.05). Most BD patients (78%) needed combination drug therapy to achieve symptomatic control.

CONCLUSIONS

Our results replicate clinical and treatment findings from U.S. investigations in a different culture demonstrating that juvenile BD is not a rare disorder in clinical samples.

Validity of the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe)

The Strengths and Difficulties Questionnaire (SDQ) is an internationally widely used, brief screening instrument for mental health problems in children and teenagers. The SDQ probes behaviours and psychological attributes reflecting the child's difficulties as well as strengths, and targets hyperactivity/inattention, emotional symptoms, conduct problems, peer problems and prosocial behaviour. Also, the instrument taps the impact aspect, i.e. whether the child is judged to suffer from emotional or behavioural problems severe enough to cause distress or social impairment. Studies of the original English SDQ, as well as of translations into several other languages, attest to a compelling usefulness and validity of the instrument. In this investigation, the adequacy of the Swedish adaptation of the SDQ (SDQ-Swe) was tested in comparisons between parent reports on 5-15-year-old children drawn from a community sample (n=263) and from a child psychiatric sample (n=230). Results showed that the instrument differentiated well between the community and the psychiatric samples, the latter displaying more symptoms, fewer strengths and more social impairment. Moreover, ROC analyses showed satisfactory sensitivity and specificity of the principal scales of the SDQ-Swe at proposed cut-offs. Hence, results showed adequate validity of the SDQ-Swe, suggesting that this new instrument, an instrument in tune with the ideas of contemporary child psychiatry and psychology, is a useful tool for mental health screening in children and adolescents.

Cross-cultural generalizability of CBCL syndromes across three continents: from the USA and Holland to Australia

The study asked how well Achenbach's 8-factor cross-informant model for the Child Behavior Check-list (Achenbach, 1991a, 1991b, 1991c) fits clinic data in the USA, Holland, and Australia. DeGroot et al.'s Dutch 8-factor model (DeGroot, Koot, & Verhulst 1994) was also tested for its cross-cultural generalizability. Achenbach's matched clinical sample data (N = 2110) were analyzed and contrasted with the previously reported Dutch findings (N = 2335), as well as a new data set collected on clinic referred children and adolescents in Australia (N = 2237). Confirmatory factor analyses supported the Dutch as much as the American model in the USA, Holland, and Australia. Although about 90% of items showed convergent validity across models and countries, the attention and especially the social problems factor found least support. Most double loadings in the current models were not upheld. Instead, additional analyses discovered a number of unmodelled loadings including many cross-loadings. This led to the redefinition of the social problems factor as a mean aggression factor (with associated social problems) whereas the original aggression factor focuses on emotional acting out and the delinquent factor describes an evasive, covert type of antisocial behavior. Overall most support was obtained for the withdrawn, somatic, anxious/depressed, thought problems, and aggressive factors.

The Child Behavior Checklist (CBCL) and related material: standardization and validation in Danish population based and clinically based samples

The Child Behavior Checklist (CBCL) and related material, developed by Achenbach and Edelbrock in Vermont, was validated in a mailed survey. A population based sample of 779 children between the age of four and 17 years was compared to a sample of 146 children referred for child psychiatric service. Danish children scored very much like our Scandinavian and German neighbours, but low compared to most others. The CBCL mean 'total behavior problem score' in the population was 17.7. The checklists, especially the parent and teacher versions, provided good construct validity. Youths generally reported more emotional problem behavior than their parents and teachers did about them. In general, parents and youths agree more, reporting emotional problems, and parents and teachers agree more, when scattering externalizing behavior. Short screening constructs are introduced, and by the use of latent trait analysis, four clinically relevant sub-scales were generated. Predictive value, sensitivity, specificity and clinical validity must be undertaken in a future two-phase study.

Competence and behavioral/emotional problems among Taiwanese adolescents as reported by parents and teachers

OBJECTIVE

To investigate competence and behavioral/emotional problems among nonreferred adolescents in Taiwan, using a Chinese version of the Child Behavior Checklist (CBCL-C) and the Teacher's Report Form (TRF-C). The psychometric properties of these instruments and cross-cultural differences were also examined.

METHOD

Parents of 854 junior high school students aged 12 to 16 years in Taipei, Taiwan, were asked to complete the CBCL-C. Among these students, 162 had their teachers' ratings of the TRF-C.

RESULTS

The internal consistency and 1-month test-retest reliability were satisfactory for both the CBCL-C and TRF-C, which were moderately correlated. Both exploratory and confirmatory factor analysis provided some support for the validity of Achenbach's cross-informant model. Parents' reports showed that compared with their American counterparts, Taiwanese adolescents tended to have lower scores on most competence scales, higher scores on scales that reflect covert behavior problems, and lower scores on scales that reflect more overt behavior problems. However, teachers' reports showed no significant differences on most competence and behavior problem scales.

CONCLUSION

The CBCL-C and TRF-C are useful tools for assessing the mental health status of Taiwanese adolescents. The cross-cultural differences in adolescent behavior problems are discussed.

Prepubertal and young adolescent bipolarity versus ADHD: assessment and validity using the WASH-U-KSADS, CBCL and TRF

BACKGROUND

This addendum to 'Prepubertal and early adolescent bipolarity differentiate from ADHD by mania criteria; grandiose delusions; ultra-rapid or ultradian cycling' (in this volume) provides (1) a description of Washington University at St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) with sample sections (hypersexuality, rapid cycling); (2) a comparison of WASH-U-KSADS to KSADS-P/L and KSADS-1986 and (3) a comparison of WASH-U-KSADS to Child Behavior Checklist (CBCL) and Teachers Report Form (TRF) data.

METHODS

Data were from the first 60 bipolar (BP) and first 60 ADHD subjects of 270 consecutively ascertained cases (90 BP, 90 ADHD and 90 community controls) in the NIMH funded 'Phenomenology and Course of Pediatric Bipolarity' study. Comprehensive assessments included the WASH-U-KSADS (administered blindly to mothers and separately to children), CBCL and TRF.

RESULTS

As reported elsewhere in this volume, WASH-U-KSADS data significantly differentiated BP and ADHD groups. Significant differences were also found with the parent-rated CBCL and the teacher-rated TRF, thereby providing cross-modality and cross-informant validation of the WASH-U-KSADS. Because of the close agreement with published CBCL data from another investigator, cross-site validation also occurred.

LIMITATIONS

Venues for consecutive ascertainment from the lowest socioeconomic status classes were unavailable due to current health care policies.

CLINICAL RELEVANCE

CBCL and TRF data separated BP from ADHD groups, largely by non-specific externalizing dimensions (e.g., hyperactivity, aggressivity). Clinically relevant differentiation by categorical mania-specific criteria (e.g., elated mood, grandiosity, racing thoughts) occurred with WASH-U-KSADS data. Both types of data are crucial for genetic and neurobiological studies.