Stability and change in types of behavioral disturbance of children and adolescents

Behavioral Approaches to the Treatment of Aggressive Disorders

Behavioral approaches to the treatment of aggression and hostility in children, adolescents, and adults are reviewed. The major theoretical approaches and definitions are presented, and a number -of classification variables that may facilitate the research in the area are recommended. It is suggested that the three major theoretical approaches emphasize reinforcement processes, social learning, or cognitive-emotional factors, and that each theory has different implications for assessment and treatment. Studies relevant to each paradigm are reviewed. The need for theory-based assessment and treatment strategies as a guide in future research is emphasized.

Understanding the Mechanisms Through Which an Influential Early Childhood Program Boosted Adult Outcomes

A growing literature establishes that high quality early childhood interventions targeted toward disadvantaged children have substantial impacts on later life outcomes. Little is known about the mechanisms producing these impacts. This paper uses longitudinal data on cognitive and personality traits from an experimental evaluation of the influential Perry Preschool program to analyze the channels through which the program boosted both male and female participant outcomes. Experimentally induced changes in personality traits explain a sizable portion of adult treatment effects.

Continuity and desistance in disruptive boys' early fighting at school

Disruptive boys in kindergarten, selected from teacher ratings in a large study, were each followed up for four successive years. There was considerable continuity of the boys' fighting, despite a declining prevalence in fighting over the years. High oppositional behavior in one year did not consistently predict fighting in the next year. A history of fighting was associated with being held back in grade. Boys were assigned to fighting evolution status on the basis of their fighting scores over the four years: stable high fighters, desisting high fighters, and variable/initiating high fighters. Stable high fighters, unlike desisting high fighters, scored high on nonaggressive antisocial acts at the end of the four years. For some boys, cessation of fighting was associated with later nonaggressive antisocial behavior. Fighting evolution status was examined further in relationship to anxiety, hyperactivity/inattentiveness, and prosocial behaviors. At age 9, stable high fighters, and to a lesser extent variable/initiating high fighters, were more likely to come from single parent families than desisting high fighters. The results are discussed in the context of the development of conduct problems in children.

A 30-year prospective follow-up study of hyperactive boys with conduct problems: adult criminality

OBJECTIVE

To compare the official arrest records for a large number of hyperactive boys (N = 179), most with conduct problems, and 75 control boys; to examine childhood IQ, socioeconomic status, and parent reports of childhood hyperactivity and conduct problems for their contribution to criminal behavior in adulthood; and to compare adult outcome for multimodality-treated (MMT) and drug-treated-only (DTO) hyperactives.

METHOD

We report on the official arrest history from early to mid- (18 to 38 years of age) adulthood in these 254 white subjects.

RESULTS

Ninety one percent of subjects were followed up. California official arrest records were obtained on all of these subjects. Hyperactive subjects had significantly higher arrest, conviction, and incarceration rates compared with controls. Childhood antisocial behaviors, socioeconomic status, and IQ predicted adult criminality. Multimodality-treated boys with Hyperactive/ADHD (attention-deficit/hyperactivity disorder) did not fare better than DTO boys with ADHD.

CONCLUSIONS

Hyperactive/ADHD boys with conduct problems are at increased risk for adult criminality. Hyperactive boys without childhood conduct problems are not at increased risk for later criminality. An intensive 3-year MMT treatment of 6- to 12-year-old hyperactive boys is insufficient to prevent later adult criminality.

Gender differences in changes in and stability of conduct problems from early adolescence to early adulthood

The present paper examines whether there are gender differences in changes in the aggregate level and individual stability of conduct problems from early adolescence to early adulthood. We analysed self-reported data collected as part of a longitudinal general population study of Norwegian adolescents (n = 1,234). The analyses showed that involvement in conduct problems for both genders peaked in mid-adolescence. The extent to which this peak reflected changes in the number of participants or differences in the frequency of problems among the participants varied according to gender. In most cases, the individual stability of involvement in conduct problems was similar for girls and boys. However, in the long term, relative involvement was more stable for boys than for girls. Moreover, the proportion of boys who showed a high level of involvement both during adolescence and early adulthood was greater than for girls.

Predictors of cross-informant syndromes among children and youths referred for mental health services

This study sought to identify which syndromes of initial problems predicted later syndromes among children and youths referred for mental health services. Standardized parent reports on the Child Behavior Checklist obtained at intake were compared to standardized parent, teacher, and self-reports obtained at follow-up. There were 1,103 subjects (774 males and 329 females) 4 to 18 years old, followed up an average of 6 years after referral. High quantitative and categorical stability was found for cross-informant syndromes within samples of younger and older subjects. Throughout childhood and into young adulthood, parent ratings of most syndromes at the time of referral predicted the counterpart cross-informant syndrome construct at follow-up, controlling for other types of problems at referral. There were multiple additional independent predictors of many syndromes, including Delinquent Behavior, Aggressive Behavior, and Shows Off for young adult males. Time 1 Social Problems and Attention Problems independently predicted diverse problems at Time 2 for younger males. A wide variety of problems also predicted younger males' self-ratings of withdrawal, anxiety, and depression. The stability of problems for the referred sample was similar to that found for demographically matched nonreferred subjects drawn from a national sample.

Risk factors for violent behavior in elementary school boys: have you hugged your child today?

Seventeen Hispanic elementary schoolboys with violent behavior problems were compared with 27 matched control students who were not overtly violent at school. Violent boys were significantly more likely to not live with their fathers, to have unmarried parents, to have more siblings, and to have fathers who never show them affection. Parents of violent boys were more likely than those of matched control students to use spanking for discipline and to admit that they rarely express affection for their sons.

The stability of dimensions of behavior in ADHD and normal children over an 8-year followup

The present study reports on standardized behavioral ratings received by a large sample of hyperactive children meeting research diagnostic criteria (n = 108) and a community control sample of normal children (n = 61) who were followed prospectively over 8 years into adolescence. On some parent-report measures both groups declined in the severity of their behavior problems across time, while on other measures only the hyperactive group declined, but the hyperactives always remained more deviant than the controls at followup. The hyperactives and controls also differed on most teacher and self-report ratings at followup. The greatest degree of agreement between raters at adolescence was between parent and youth ratings. These results are consistent with previous research demonstrating more deviant scores for hyperactive children than controls on various rating scales at adolescent followup. They also are consistent with research showing significant longitudinal continuity of both internalizing and externalizing behavioral pathology.

Six-year stability of parent-reported problem behavior in an epidemiological sample

An epidemiological sample of 936 Dutch children originally aged 4-11 years was assessed at 2-year intervals over a 6-year period. Parents completed the Child Behavior Checklist (CBCL) on all four occasions. Stability coefficients computed for eight CBCL syndromes, Internalizing and Externalizing dimensions, and total problems revealed considerable long-term stability. There was no significant difference in the 6-year stability of internalizing vs. externalizing scores. This finding was at odds with reports of considerably lower stability of internalizing behavior, and was consistent with findings suggesting that the stability of internalizing problems should not be underestimated. The magnitude and specificity of the long-term stability of internalizing and externalizing scores lends support to the validity of these behavioral dimensions as tapped by the CBCL. No significant sex or age differences in the stability of problem behaviors were found.

Prediction of children's referral to mental health and special education services from earlier adjustment

The 4-year stability in problem behaviors assessed with the Child Behavior Checklist (CBCL), and their predictive validity with regard to poor outcome variables was studied in 1052 4-12-year old children from a general population sample. Irrespective of sex and age, the scores on the CBCL of some 44% of the children remained above the 90th percentile over the 4-year time interval. Externalizing problem behavior tended to show somewhat greater stability than internalizing problem behavior. High initial levels of both internalizing and externalizing problems, and persistence of problems were predictive of referral to mental health services. Referral to special education was higher for younger boys with high initial attention problems and school problems. Police contacts occurred more often in older boys with high initial aggression scores.

Longitudinal research in child and adolescent psychiatry

An indispensable approach to the study of variations in individual development and of causal mechanisms and processes underlying the course of psychopathology is the longitudinal method. In this introductory review, the strengths and weaknesses of longitudinal research are discussed, and factors hampering progress in this field are outlined. The many advantages of this approach warrant continuing efforts to develop strategies that minimize its drawbacks.

Ontario Child Health Study follow-up: evaluation of sample loss

This article presents an analysis of sample loss in a 4-year follow-up of children aged 4 to 12 who participated in the Ontario Child Health Study in 1983. Of the 1,617 children participating in the original Ontario Child Health Study, 1,172 (72.5%) were located and enlisted at follow-up in 1987. Based on wave-one assessments, nonparticipants at follow-up tended to have higher levels of psychopathology and family risk variables. Respondents were matched with nonparticipants and differentially weighted to compensate for selective loss. In comparing estimates based on actual (observed) and weighted responses in the follow-up sample, it was found that the effects of sample loss depended on the analytical focus. Evaluations of outcome of disorder and risk for disorder were not affected by sample loss. Evaluation of variables that predict persistence of disorder (prognosis) was affected by a bias toward the null.

Reducing early childhood aggression: results of a primary prevention program

Teacher-rated antisocial behavior in early elementary grades has been shown to be a precursor of adolescent delinquency and drug use. The combined effects of parent and teacher training on the teacher-rated antisocial behavior of a panel of subjects assigned to experimental and control classrooms at entry into the first grade was assessed at the end of the second grade. Lower rates of aggressiveness were found for white boys in the experimental classrooms and lower rates of self-destructive behavior were found for white girls in the experimental classrooms when compared with controls on the Teacher Form of the Child Behavior Checklist. No significant condition differences were found for black subjects. The interventions are described and limits and implications of the study are discussed.

Four-year follow-up of an epidemiological sample

In this 4-year follow-up of behavioral/emotional problems in an epidemiological sample of 1,200 children originally aged 4 to 12 years assessed with the Achenbach Child Behavior Checklist (CBCL), high stability in the level of CBCL total problem scores was found. Stability of problem behavior was equally substantial for ages 4 to 12 and both sexes. Aggressive and other externalizing behaviors showed the highest stability. Even in children as young as 4 to 5 years, aggressive and attentional problems showed considerable stability. The results of the present study were informative with respect to methodology in indicating clearly that employing a mailing survey for obtaining parent reports on behavioral/emotional problems resulted in the selective exclusion of a group of especially problematic children who were recovered when parents were interviewed at home.

Sociability and social withdrawal in childhood: stability and outcomes

The stability and long-term correlates of both social withdrawal and sociability were investigated in a longitudinal study of normal children in kindergarten through the fifth grade. Both observational and peer assessment indices of withdrawal and sociability were considered; furthermore, a distinction was made between observed active versus passive solitude. Of particular interest was whether social withdrawal in early childhood was predictive of subsequent internalizing problems, as assessed by self-reports of social competence, overall self-worth, loneliness, and depression as well as teacher ratings of shy/anxious behavior, in later childhood. Results indicated a modest degree of stability for observed social withdrawal but not for observed sociability, nor for active or passive forms of solitude. Somewhat higher stability correlations were obtained for peer assessments of both sociability and withdrawal. In terms of predictive outcomes, significant relations were found between early social withdrawal in kindergarten and Grade 2 and subsequent internalizing problems in Grades 4 and 5, although the pattern of results was mixed. These data suggest that social withdrawal in early childhood may be predictive of risk for internalizing difficulties in later childhood.

Childhood and adolescent depression. I. Epidemiological and aetiological aspects

Depression in childhood and adolescence has become a topic of considerable research interest in the last decade. A number of studies ranging over the last half-century provide information about the prevalence of depressive symptoms and syndromes in non-referred populations. These studies are critically reviewed in the light of an analysis of the various meanings that the term 'depression' may carry, and a variety of methodological issues. The sparse evidence for the involvement of a number of potential risk factors for depressive disorders is then considered and suggestions for future work in this area are outlined.

Persistence and change in behavioral/emotional problems reported by parents of children aged 4-14: an epidemiological study

Crucial to our understanding of psychopathology in children is information on the stability and change of behavioral/emotional problems and competencies across time. Existing studies, reviewed in this article, provide only limited answers due to one or more of the following factors: restriction of the sample to a single locality, the use of selected samples, large sample attrition, the use of different assessment instruments at different times, the small number of specific behavioral/emotional problems or the use of very broad categories of functioning. The present study was designed to test the persistence and change of behavioral/emotional problems and competencies as reported by parents of 1,412 children aged 4-14 over a two-year period in a representative sample of the general population. At both points, standardized parents' reports were obtained using the Achenbach Child Behavior Checklist (CBCL). A recovery rate of 80.2% was obtained. Our study is the only one, as far as we known, to present follow-up data separately for ages covering the preschool period to adolescence, making it possible to compare stabilities in the occurence of behavioral/emotional problems across various developmental levels. Over the two-year follow-up period, there was a significant decrease in problem scores. Although possible, it is unlikely that the mental health of children in our sample increased very much. A decrease in problem scores over time has been demonstrated for clinical as well as general population samples in other studies as well. No satisfactory explanations are available for this phenomenon. It is important, however, that studies employing a retest design take account of this phenomenon. Irrespective of changes in the magnitude of group scores over time, stability coefficients can tell us whether individual children tend to preserve their rank orders. The stability coefficients between Time 1 and Time 2 total problem scores ranged from .62 (girls, aged 4-5) to .71 (boys, aged 6-11). No significant differences between stability coefficients for different age-groups and for both sexes could be demonstrated. The changes in scores across time for individual items were consistent with the cross-sectional data of our earlier study (Verhulst et al. Acta Psychiatrica Scandinavica, 1985, 72, suppl. 323). Stability coefficients for social competence scores at both times of assessment were generally somewhat weaker than those found for problem scores.(ABSTRACT TRUNCATED AT 400 WORDS)

Some determinants of individual differences in the behaviour of children of parentally deprived parents

Parents who had been placed in an orphanage as children rated the behaviour of all their children who were between the ages of 6-18 years on a children's behaviour survey instrument. All families were intact and the parents had not requested professional help for marital problems. A significant number of relationships were found between parental background variables and higher reported levels of conflict with siblings and with parents, dependent-unassertive behaviour, and undemandingness in the children. Although sampling difficulties preclude generalization, the results suggest that repercussion of events in the lives of the first and second generation that are usually pathogenic may be seen in the third generation, even when the second generation may not be grossly adversely affected. These events most frequently related to individual differences in the third generation in the area of undercontrol of aggression directed toward parents and siblings.

A family study of patients with temper outbursts

To evaluate the heritability of a personality trait, "having temper outbursts," and of associated diagnoses, we obtained histories of first degree relatives on two groups: (1) patients with temper outbursts (N = 33), and (2) diverse psychiatric patients without temper outbursts (N = 12). Family interviews were conducted blind to patient (temper or not) status, using a modified version of the Family History RDC. Though Ns are relatively small, and results therefore require confirmation, the data indicate familial transmission of temper problems; an average of 18.2% of Group 1 relatives had temper problems, compared to 4.3% for Group 2. The trait of having temper outbursts was more strongly transmitted than were specific diagnoses (e.g. Intermittent Explosive Disorder, Antisocial Personality Disorder or Residual Attention Deficit Disorder) associated with temper outbursts. Patients with neurological conditions apparently related to their temper outbursts were less likely to have positive family histories.

Early Precursors and Concurrent Correlates of Patterns of Illicit Drug Use in Adolescence

This study examines social, familial and child behavior antecedents of adolescent illicit drug use. The sample studied is a subsample of a follow-up sample of Manhattan children, whose mothers were interviewed at two points in time, with a 5 year interval. The subsample constitutes those study children age 14 to 22 at Time II, who were interviewed directly 6 months following the second interview with the mother. The findings indicate that early predictors have a significant and substantial influence on later illicit drug use. Importantly, differential patterns of illicit drug use exhibit relatively distinct antecedents. The use of marijuana-only is related to socioeconomic background and early child behaviors; the use of drugs other than marijuana is related to parental-marital behaviors, the quality of the bond between parents and children and early adjustment problems (with peers and at home); heroin use is strongly associated with parental-marital behaviors indicative of familial disorganization and parental antisocial behaviors.

Psychological disturbance in children with physical disabilities: continuity and change in a 5-year follow-up

This study measures continuity in behavioral disturbance over a 5-year period among 255 children with physical disabilities who were 6 to 18 years old at first assessment. The pattern of the results differed from that reported previously for a sample of the general population of children. Disabled children showed little stability in aggression, an area in which stability over time had been consistently reported for the general child population. Furthermore, important differences were observed between children with cystic fibrosis and children with cerebral palsy, myelodysplasia, or multiple physical handicaps, all conditions involving brain abnormality. Children with cystic fibrosis followed the trend toward better adjustment seen among the general population of children. In contrast, among children with conditions involving the brain, the majority of those who had been classified as psychologically severely impaired remained at this level of impairment 5 years later. In two behavioral domains, Mentation Problems and Isolation, children with conditions involving the brain maintained, on the average, the same markedly high score they had initially. Among children with physical conditions involving the brain, Mentation Problems and Isolation signify persistent problems that do not subside as the children mature.

Cross-sectional and longitudinal observations of activity level and sustained attention in a normative sample

This study examined developmental changes in playroom observations of activity level and sustained attention among 47 elementary school-age boys. The boys were observed at two different times, approximately 2 years apart. The playroom observations consisted of two 15-minute periods, a relatively unstructured freeplay period and a structured restricted academic period. In general, both cross-sectional and longitudinal analyses suggested developmental improvements in the observed behaviors. Both gross and fine motor activity decreased with increasing age, while the time spent on task increased. Consistent with the selective attention literature, there appeared to be a dramatic increase in the boys' ability of focus attention at around age 11. Finally, most of the behaviors in the restricted academic period showed significant stability over time, whereas few of the free-play behaviors did so.

Epidemiological Study of Psychiatric Disorder in Adolescent Girls: Preliminary Communication

A two-stage general population study of affective disorder and problems of eating control in 15–19-year-old girls is in progress, the sample being identified by the use of general practitioners' age-sex registers. So far, 244 girls and their mothers have been interviewed and have independently completed questionnaires relating to mood and appetite control. The girls completed questionnaires both on themselves and on their mothers, and their mothers on themselves and on their daughters. Significant correlations between self-rating and rating of the other person were obtained in all cases, with agreement on the daughters' mood being higher in non-manual couples.

A 3-year follow-up of aggressive and withdrawn behavior in childhood: preliminary findings

The school placement of 122 aggressive, 150 withdrawn, 182 aggressive-withdrawn, and 299 control children was determined 3 years following their original selection. Children identified by peers as aggressive-withdrawn or aggressive were more likely to have failed a grade or to be in a special class than were withdrawn children or controls. Older aggressive-withdrawn subjects and controls, but not aggressive subjects or withdrawn subjects, had higher rates of school failure and special class placement. Fewer boys than girls were in a regular class at the expected grade level. The results underline the importance of childhood aggression as a predictor of later academic adjustment. Implications of these findings for the interpretation of measures of behavioral stability are discussed.

Aggressive conduct disorder: the influence of social class, sex and age on the clinical picture

Past studies have shown that aggressive conduct disorder is more common in boys and in families of low socioeconomic status, and that affected children are usually seen in child psychiatry clinics before the age of 10. In this work we aimed to find how socioeconomic status, sex and age at admission influence the clinical picture of this disorder. We divided a series of 58 affected children into two groups on each of the three factors and compared the groups on 175 variables. We found little evidence that the children's difficulties varied with social class, sex or age. This apparent constancy of the clinical picture reinforces the idea that aggressive conduct disorder is a valid, though broadly defined, psychiatric syndrome.

Subtypes of aggressive conduct disorder

The subjects were 46 boys with aggressive conduct disorder who were admitted to a psychiatric ward. We divided them according to level of activity and number of antisocial "symptoms"; then compared the resulting groups on clinical and social variables. Seventy-four per cent of the boys were observed to be hyperactive. Compared to those with a normal level of activity, this group developed their problems earlier, had more frequent speech and language deficits and came from more disrupted homes. Thirty boys were classed as antisocial and 16 as not. The former differed from the latter chiefly in their failure to respond to treatment. At follow-up significantly more non-antisocial boys were improved than antisocial. The results suggest that antisocial behavior affects outcome, while the variations in activity level are related to different origins of the disorder.