Behavioral and emotional problems among Chinese and American children: parent and teacher reports for ages 6 to 13

Unintentional injury and its associated factors among left-behind children: a cross-sectional study

BACKGROUND

Unintentional injuries among children and adolescents are a major public health problem worldwide. These injuries not only have negative effects on children's physiology and psychology, but also bring huge economic losses and social burdens to families and society. Unintentional injuries are the leading cause of disability and death among Chinese adolescents, and left-behind children (LBC) are more prone to experience unintentional injury. The purpose of this study was to evaluate the type and incidence of unintentional injury among Chinese children and adolescents and explore the influences of personal and environmental factors by comparing the differences between LBC and not left-behind children (NLBC).

METHODS

This cross-sectional study was conducted in January and February 2019. Additionally, 2786 children and adolescents from 10 to 19 years old in Liaoning Province in China were collected in the form of self-filled questionnaires, including Unintentional Injury Investigation, Unintentional Injury Perception Questionnaire, Multidimensional Subhealth Questionnaire of Adolescent (MSQA), Negative life events, "My Class" questionnaire and Bullying/victim Questionnaire. Multiple logistic regression analysis was used to explore the factors associated with unintentional injury among children and adolescents. Binary logistic regression analysis was used to explore the factors affecting unintentional injuries between LBC and NLBC.

RESULTS

The top three unintentional injuries were falling injuries (29.7%), sprains (27.2%) and burns and scalds (20.3%) in our study population. The incidence of unintentional injuries in LBC was higher than that in NLBC. Burn and scalds, cutting injury and animal bites in LBC were higher than those in NLBC. The results show that junior high school students (odds ratio (OR) = 1.296, CI = 1.066-1.574) were more likely to report multiple unintentional injuries than primary school students. Girls (OR = 1.252, CI = 1.042-1.504) had higher odds of reporting multiple unintentional injuries. The odds of multiple injuries in children and adolescents with low levels of unintentional injury perception were higher than those in children and adolescents with high levels of unintentional injury perception (OR = 1.321, C = 1.013-1.568). Children and adolescents with a higher levels of mental health symptoms (OR = 1.442, CI = 1.193-1.744) had higher odds of reporting multiple unintentional injuries. Compared with teenagers who had never experienced negative life events, teenagers who had experienced negative life events many times (OR = 2.724, CI = 2.121-3.499) were more likely to suffer unintentional injuries many times. Low-level discipline and order (OR = 1.277, CI = 1.036-1.574) had higher odds of reporting multiple unintentional injuries. In-school adolescents who were bullied were more likely to report being injured multiple times than their counterparts who were not bullied (OR = 2.340, CI = 1.925-2.845). Low levels of unintentional injury perception, experienced negative life events and bullying had greater impacts on LBC than on NLBC.

CONCLUSION

The survey found that the incidence of at least one unintentional injury was 64.8%. School level, sex, unintentional injury perception, subhealth, negative life events, discipline and order and bullying were associated with incidents of unintentional injury. Compared with NLBC, LBC had a higher incidence of unintentional injury, and special attention should be given to this group.

Life events and parent style for mental health in children: a cross-sectional study

BACKGROUND

Life events and parenting styles might play an important role in children's mental health.

AIMS

This study aims to explore how life events and parenting styles influence children's mental health based on a Chinese sample.

METHODS

A total of 3535 participants had at least one mental disorder (positive group), while a total of 3561 participants had no mental disorders (negative group). The Child Behavior Checklist (CBCL), Adolescent Self-Rating Life Events Check List (ASLEC) and Egna Minnen Beträffande Uppfostran (EMBU) were used for screening these two groups.

RESULTS

CBCL total scores differed significantly by sex in the Positive group according to the Mann-Whitney tests (Z = -5.40, p < 0.001). Multiple regression analyses showed that the dimensions of punishment (p = 0.014) and other (p = 0.048) in the ASLEC scale can significantly predict CBCL total scores in the Positive group. Sex, age and overprotection from the father were risk factors (p < 0.001) according to binary logistic regression.

CONCLUSIONS

Life events and parenting styles may have impacts on mental health. Fathers play a very important role in children's growth. Punitive education and fathers' overprotection might be risk factors for children's mental health.

IMPACT

It is a large sample (3535) study of Chinese children and adolescents It provides evidence that life events and parenting styles have impacts on mental health and that fathers play a very important role in children's growth. It is conducive to the development of interventions for the mental health of children and adolescents.

Mother-Child Reminiscing About Emotionally Negative Events and Children's Long-Term Mental Health

The present study examined the longitudinal relation between mother-child reminiscing of emotionally negative events and children's mental health. European-American and Chinese-American mothers discussed with their 4.5-year-old children an event that was emotionally negative to the child. At age 7, children's mental health was assessed, including measures for externalizing problems, internalizing problems, negative social self (an Asian-salient dimension of depression), behavioral problems, and socially adaptive behavior. Independent of culture, maternal reference to negative emotional terms was related to fewer externalizing, internalizing, and behavior problems in children. Maternal attribution of emotions to children was associated with lower negative social self in children. Maternal explanation of children's emotions was linked to fewer externalizing problems and lower negative social self in children, and maternal reconfirmation of the explanations was related to fewer externalizing and behavioral problems in children. In contrast, maternal attribution of emotions to other people was associated with more externalizing problems and higher negative social self in children of both cultures. Some important cultural differences emerged. Chinese-American mothers' mention of negative emotional terms was linked to lower negative social self in children, and Chinese-American mothers' reconfirmation of explanation was related to more socially adaptive behaviors in children. No such relations were found in the European-American sample. The findings underscore the importance of family emotional reminiscing for children's long-term well-being and the role of culture in shaping the process.

Affective modulation of executive control in early childhood: Evidence from ERPs and a Go/Nogo task

Modulation of adaptive executive control is particularly demanded in a pre- and early-school period. Therefore, in the present study, we investigated whether affective information can influence executive control in preschool children. We have recorded EEG during a Go/Nogo task where gender of a face served as a Go/Nogo cue and emotional expressions (positive, negative, neutral) were task irrelevant. Negative emotions modulated the magnitude of the conflict effect (Nogo vs. Go) in the N200 relative to neutral control, indicating enhanced cognitive control for negative emotions. Moreover, interpersonal characteristics (e.g., aggressive behavior) correlated with the emotion facilitated inhibitory control as indicated by N200. In addition, Go/Nogo conflict modulated neural responses in children already 100 ms after stimulus onset when paired with socially relevant emotional stimuli. These results show that emotions affect cognitive control in this age group in a valence specific manner.

A longitudinal study of the role of children's altruism and forgiveness in the relation between parental aggressive discipline and anxiety of preschoolers in China

Using data collected over a 1-year period on a stratified random sample of 368 parents with children studying in nurseries (mean age=3.97years), this study assessed the predictive effects of parental corporal punishment, parental psychological aggression, preschoolers' altruism, and preschoolers' forgiveness on preschoolers' anxiety symptoms in Hong Kong, China. Results of hierarchical regression analyses showed that parental psychological aggression, preschoolers' altruism and preschoolers' forgiveness at Time 1 significantly predicted preschoolers' anxiety at Time 2, when controlling for the initial level of preschoolers' anxiety and important demographic variables that co-vary with preschoolers' anxiety. Moreover, preschoolers' altruism moderated the predictive effect of parental psychological aggression on preschoolers' anxiety symptoms. The study has several significant contributions. First, the study supports the predictive effect of parental aggressive discipline on preschoolers' anxiety. Second, we provide evidence that preschoolers' altruism and forgiveness negatively predict preschoolers' anxiety symptoms. Third, preschoolers' altruism and forgiveness are shown to protect them against parental psychological aggression. A dual-focus approach to intervention and prevention is proposed to reduce aggressive discipline by parents as well as to enhance altruism and forgiveness in children. Parent training programs could be provided to teach parents positive discipline strategies. Home-based or school-based interventions could be designed for preschool children to foster and enhance their altruism and forgiveness.

Behavior and Emotional Problems of Clinic-Referred Children of the African Diaspora: A Cross-National Study of African American and Jamaican Children Ages 4 to 18

Societal factors influence the types of problems children of African descent exhibit and the steps adults take to ameliorate them. Cross-national research on children of African descent living in different nations can identify the societal issues associated with problems these children present, but few specifically focus on children of African descent. This article addresses these issues by surveying presenting problems in clinic records of 2,078 children of African descent in the United States and Jamaica. Recorders coded and categorized problems according to eight Child Behavior Checklist syndromes and internalizing (e.g., shyness) and externalizing (e.g., fighting) problems. ANCOVAs revealed significantly more problems for African American than Jamaican youth but the converse was true for severe problems. The findings suggest the need for further studies that test whether lower parental thresholds, a U.S. society that encourages more family openness, widely available treatment services within the United States, and stress associated with minority group membership may cause African American parents to report more child problems than Jamaican parents.

Comparing Judgements of Social, Behavioural, Emotional and School Adjustment Functioning for Korean, Korean American and Caucasian American Children

Social, emotional, behavioural and school adjustment functioning among Korean, Korean American and Caucasian American children was examined with the Behavior Assessment System for Children (BASC) Self-Report of Personality (SRP) and the Parent Rating Scale (PRS). One hundred and twenty Korean, Korean-American and Caucasian-American children, ages 8 to 11, and their parents participated in this study. Generally, the Korean children were perceived as behaving in a more controlled, less self-reliant and internalizing manner than were the American children. The Korean American children were rated to have more adjustment difficulties. The notion of Korean family collectivism versus western individualism and the inherent conflict in these cultural values was used to discuss the results. Practitioners should be aware that ratings with the BASC PRS and SRP scales of Korean and Korean American children can be influenced by culture to a significant degree. Also it appears that the BASC SRP and PRS are sensitive to conflict created in children and families caught between cultures, particularly related to demands for rapid Americanization.

Anxiety disorder symptoms in Chinese preschool children

The present study investigated anxiety disorder symptoms in Chinese preschool children. A total of 1,854 mothers of children aged 3-6 years completed the 28-item Chinese version of Spence Preschool Anxiety Scale (PAS). Results demonstrated that the structure of anxiety in Chinese preschool children included five factors, and this five-factor structure applied to different age and gender groups. Inconsistent with the study by Edwards et al. (J Clin Child Adolesc Psychol 39:400-409, 2010) suggesting that obsessive-compulsive disorder did not comprise an independent factor in Australian preschoolers, this symptom can be viewed as an independent factor in Chinese preschoolers. Younger children displayed higher anxiety levels than older children. Anxiety symptoms of Chinese preschoolers were found at a high level compared to other studies. Substantial differences were found with regard to the content of prevalent anxiety symptoms among Chinese and Australian preschool children. The applicability of the five-factor structure of PAS and research implications are discussed.

Prevalence of psychiatric disorders among children and adolescents in northeast China

BACKGROUND

To describe the prevalence of DSM-IV disorders and comorbidity in a large school-based sample of 6-17 year old children and adolescents in northeast China.

METHODS

A two-phase cross-sectional study was conducted on 9,806 children. During the screening phase, 8848 children (90.23%) and their mothers and teachers were interviewed using the Strengths and Difficulties Questionnaire (SDQ). During the diagnostic phase, 1129 children with a positive SDQ and 804 randomly selected children with a negative SDQ (11%), and their mothers and teachers, were interviewed using the Development and Well-Being Assessment (DAWBA).

RESULTS

The overall prevalence of DSM-IV disorders was 9.49% (95% CI = 8.10-11.10%). Anxiety disorders were the most common (6.06%, 95% CI = 4.92-7.40), followed by depression (1.32%, 95% CI = 0.91-1.92%), oppositional defiant disorder (1.21%, 95%CI = 0.77-1.87) and attention-deficit hyperactivity disorder (0.84%, 95% CI = 0.52-1.36%). Of the 805 children with a psychiatric disorder, 15.2% had two or more comorbid disorders.

CONCLUSIONS

Approximately one in ten Chinese school children has psychiatric disorders involving a level of distress or social impairment likely to warrant treatment. Prevention, early identification and treatment of these disorders are urgently needed and pose a serious challenge in China.

Prevalence and associated factors of emotional and behavioural problems in Chinese school adolescents: a cross-sectional survey

BACKGROUND

Emotional and behavioural problems are key health issues in adolescence. The aim of this study was to evaluate the prevalence of emotional and behavioural problems in Chinese school adolescents and to explore associated factors.

METHODS

This cross-sectional study was conducted during the period of November/December 2009. A questionnaire including the Strengths and Difficulties Questionnaire (SDQ) self-reported version, and the characteristics of child (age, gender, only child and study pressure), parents (parent-adolescent relationship and parental expectations) and families (living area, family structure, socio-economic status and negative life events) was distributed to our study population. A total of 5220 Chinese adolescents (aged 11-18) from 30 public schools in Liaoning province completed the questionnaire. Multivariate logistic analysis was used to explore the factors associated with emotional and behavioural problems.

RESULTS

The average problem score was 11.28 (SD = 5.86) and the 10.7% scored above the cut-off for emotional and behavioural problems. Factors that increased the risk of having emotional and behavioural problems were: poor parent-adolescent relationship, experiencing more negative life events, older age, having study pressure, living in rural areas, boys and lower parental expectations.

CONCLUSIONS

The prevalence of emotional and behavioural problems among Chinese adolescents was lower level compared with those reported in other countries. We found parent-adolescent relationship, negative life events and age to be the strongest contributing factors of emotional and behavioural problems.

Parenting stress and child behavior problems among clinic-referred youth: cross-cultural differences across the US and Korea

Due to increased multiculturalism in the US and abroad, there is a need for increased understanding of the different ways in which parenting stress is related to child problems across cultures. In the present study, we investigated (a) differences in reported parenting stress and childhood problem behaviors across a Korean (n = 71) and US (n = 71) sample, as well as (b) differences in the ways in which parenting stress and childhood problems were related across Korean and US children based on mothers' reports. Results revealed that Korean mothers reported significantly higher parenting stress yet significantly lower childhood problem behaviors compared to US mothers. In addition, mother-based reports of child problems were significantly associated with parenting stress in the US sample, but not in the Korean sample. Clinical implications and culturally-relevant issues relevant to these findings are addressed, including a potential under-reporting bias of child problems among Asian parents.

Cognition and behavioural development in early childhood: the role of birth weight and postnatal growth

BACKGROUND

We evaluate the relative importance of birth weight and postnatal growth for cognition and behavioural development in 8389 Chinese children, 4-7 years of age. Method Weight was the only size measure available at birth. Weight, height, head circumference and intelligence quotient (IQ) were measured between 4 and 7 years of age. Z-scores of birth weight and postnatal conditional weight gain to 4-7 years, as well as height and head circumference at 4-7 years of age, were the exposure variables. Z-scores of weight at 4-7 years were regressed on birth weight Z-scores, and the residual was used as the measure of postnatal conditional weight gain. The outcomes were child's IQ, measured by the Chinese Wechsler Young Children Scale of Intelligence, as well as internalizing behavioural problems, externalizing behavioural problems and other behavioural problems, evaluated by the Child Behavior Checklist 4-18. Multivariate regressions were conducted to investigate the relationship of birth weight and postnatal growth variables with the outcomes, separately for preterm children and term children.

RESULTS

Both birth weight and postnatal weight gain were associated with IQ among term children; 1 unit increment in Z-score of birth weight (∼450 g) was associated with an increase of 1.60 [Confidence interval (CI): 1.18-2.02; P < 0.001] points in IQ, and 1 unit increment in conditional postnatal weight was associated with an increase of 0.46 (CI: 0.06-0.86; P = 0.02) points in IQ, after adjustment for confounders; similar patterns were observed when Z-scores of postnatal height and head circumference at age 4-7 years were used as alternative measurements of postnatal growth. Effect sizes of relationships with IQ were smaller than 0.1 of a standard deviation in all cases. Neither birth weight nor postnatal growth indicators were associated with behavioural outcomes among term children. In preterm children, neither birth weight nor postnatal growth measures were associated with IQ or behavioural outcomes.

CONCLUSIONS

Both birth weight and postnatal growth were associated with IQ but not behavioural outcomes for Chinese term children aged 4-7 years, but the effect sizes were small. No relation between either birth weight or postnatal growth and cognition or behavioural outcomes was observed among preterm children aged 4-7 years.

Symptoms of anxiety and associated risk and protective factors in young Asian American children

Anxiety is one of the most prevalent mental health problems in young children but there has been a dearth of studies focusing on Asian American children. This study examines the patterns and the predictors of childhood anxiety and related symptoms in young children in a diverse Asian American (ASA) sample (n = 101). Findings indicate that ASA children are at higher risk for anxiety, somatization, and depressive problems than their peers. Parents' level of acculturation (i.e., American identity, English competence), parental negative emotion socialization, conflicted parent-child relationship, child emotional knowledge and adaptive skills, as well as teachers' ethnic background and school class types were all associated with ASA children's anxiety. A combination of cultural, family, and school factors explained from 17 to 39 % of the variance in anxiety symptoms. Findings inform prevention services for young ASA children.

The genetics of attention deficit/hyperactivity disorder in adults, a review

The adult form of attention deficit/hyperactivity disorder (aADHD) has a prevalence of up to 5% and is the most severe long-term outcome of this common neurodevelopmental disorder. Family studies in clinical samples suggest an increased familial liability for aADHD compared with childhood ADHD (cADHD), whereas twin studies based on self-rated symptoms in adult population samples show moderate heritability estimates of 30-40%. However, using multiple sources of information, the heritability of clinically diagnosed aADHD and cADHD is very similar. Results of candidate gene as well as genome-wide molecular genetic studies in aADHD samples implicate some of the same genes involved in ADHD in children, although in some cases different alleles and different genes may be responsible for adult versus childhood ADHD. Linkage studies have been successful in identifying loci for aADHD and led to the identification of LPHN3 and CDH13 as novel genes associated with ADHD across the lifespan. In addition, studies of rare genetic variants have identified probable causative mutations for aADHD. Use of endophenotypes based on neuropsychology and neuroimaging, as well as next-generation genome analysis and improved statistical and bioinformatic analysis methods hold the promise of identifying additional genetic variants involved in disease etiology. Large, international collaborations have paved the way for well-powered studies. Progress in identifying aADHD risk genes may provide us with tools for the prediction of disease progression in the clinic and better treatment, and ultimately may help to prevent persistence of ADHD into adulthood.

Community-based mental health counseling for children orphaned by AIDS in China

There is an urgent need to develop scalable approaches to community-based mental health services for children in rural China and other developing countries involving task shifting from clinicians to trained community workers. Evidence is needed about the effectiveness of interventions for children affected by AIDS in rural areas. This article describes an intervention study aimed at developing, implementing, and evaluating a community-based counseling program for the AIDS orphans of Fuyang, Anhui Province, an area of central China where a tainted blood donation scheme infected countless farmers and left many children orphaned by AIDS. In China these children live in rural settings with no access to mental health services. The authors trained a group of community-based counselors to provide group counseling sessions focusing on self-awareness and communication and to provide a basic therapeutic approach for depression and anxiety. The authors conducted a baseline and two follow-up surveys of 39 children who met the clinical diagnostic criteria for anxiety and depression. There was a statistically significant improvement for the children on anxiety, but there was no statistically significant improvement on depression, with greatest gains immediately following the intervention. We demonstrated the feasibility of task shifting for mental health services in this setting.

Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence

PURPOSE

To examine whether the widely used Strengths and Difficulties Questionnaire (SDQ) can validly be used to compare the prevalence of child mental health problems cross nationally.

METHODS

We used data on 29,225 5- to 16-year olds in eight population-based studies from seven countries: Bangladesh, Brazil, Britain, India, Norway, Russia and Yemen. Parents completed the SDQ in all eight studies, teachers in seven studies and youth in five studies. We used these SDQ data to calculate three different sorts of "caseness indicators" based on (1) SDQ symptoms, (2) SDQ symptoms plus impact and (3) an overall respondent judgement of 'definite' or 'severe' difficulties. Respondents also completed structured diagnostic interviews including extensive open-ended questions (the Development and Well-Being Assessment, DAWBA). Diagnostic ratings were all carried out or supervised by the DAWBA's creator, working in conjunction with experienced local professionals.

RESULTS

As judged by the DAWBA, the prevalence of any mental disorder ranged from 2.2% in India to 17.1% in Russia. The nine SDQ caseness indicators (three indicators times three informants) explained 8-56% of the cross-national variation in disorder prevalence. This was insufficient to make meaningful prevalence estimates since populations with a similar measured prevalence of disorder on the DAWBA showed large variations across the various SDQ caseness indicators.

CONCLUSIONS

The relationship between SDQ caseness indicators and disorder rates varies substantially between populations: cross-national differences in SDQ indicators do not necessarily reflect comparable differences in disorder rates. More generally, considerable caution is required when interpreting cross-cultural comparisons of mental health, particularly when these rely on brief questionnaires.

Association between a marker for prenatal testosterone exposure and externalizing behavior problems in children

Prenatal androgen exposure has been associated with aggressive behavior in adults. It is less clear whether this association holds for childhood externalizing behavior. This study tests the hypothesis that increased prenatal androgen exposure is associated with aggressive behavior and attention problems in childhood. The ratio of the length of the second finger digit relative to the fourth digit, which is a marker for prenatal testosterone exposure, was assessed in 239 male and female fifth grade schoolchildren from Jintan, China, together with parent and teacher ratings of aggression and attention problems. Increased aggression and attention problems were both significantly associated with a lower ratio of the length of the second finger digit relative to the fourth digit ratios in boys but not girls. The effects remained significant after controlling for early adversity. These findings are the first to establish a relationship between an indirect indicator of fetal androgen exposure and any child psychopathology in Chinese children, and the observed effect size in boys was stronger than in male adults in Western studies. The results provide limited cross-cultural support for the importance of prenatal androgen exposure in contributing to the development of externalizing behavior problems in children, and they suggest that such effects may be specific to boys who may be relatively more vulnerable to early prenatal influences.

Epidemiological fallacies of modern psychiatric research

BACKGROUND

Psychiatric epidemiology is an important cornerstone of research in psychiatry and integral for the treatment and care of people suffering from psychiatric disorders. However, psychiatric epidemiology is a difficult science, which is often beset with methodological problems.

AIMS

In light of this, the current review sought to explore 13 of the common methodological issues in psychiatric epidemiology.

METHODS

Many methodological problems result from misunderstandings. As such, we sought to highlight these problems, provide evidence to counteract the myths surrounding these problems and subsequently provide recommendations to overcome these problems. To highlight and clarify these issues, examples are provided from current psychiatric literature.

RESULTS

Areas discussed in the review include problems with: taxonometry of disorders, sole reliance on self-reports, single-question diagnoses, baseline participation rates, measurement of lifetime prevalence, inconsistency of multiple informants, selection of covariates, testing of interactions, correction for multiple testing, the intermittent measurement of disorders during follow-up, evaluation of causal associations, data invalidation related to loss from follow-up and the publication of negative findings.

CONCLUSION

Many methodological myths prevail in the area of epidemiology and this review endeavoured to elucidate and clarify these. This review was developed as a teaching tool for students, clinicians and researchers.

The application of the preschool Child Behavior Checklist and the caregiver-teacher report form to Mainland Chinese children: syndrome structure, gender differences, country effects, and inter-informant agreement

Preschool children have long been a neglected population in the study of psychopathology. The Achenbach System of Empirically Based Assessment (ASEBA), which includes the Child Behavior Checklist/1.5-5 (CBCL/1.5-5) and the Caregiver-Teacher Report Form (C-TRF), constitutes the few available measures to assess preschoolers with an empirically derived taxonomy of preschool psychopathology. However, the utility of the measures and their taxonomy of preschool psychopathology to the Chinese is largely unknown and has not been studied. The present study aimed at testing the cross-cultural factorial validity of the CBCL/1.5-5 and C-TRF, as well as the applicability of the taxonomy of preschool psychopathology they embody, to Mainland Chinese preschoolers. Country effects between our Chinese sample and the original U.S. sample, gender differences, and cross-informant agreement between teachers and parents were also to be examined. A Chinese version of the CBCL/1.5-5 and C-TRF was completed by parents and teachers respectively on 876 preschoolers in Mainland China. Confirmatory factor analysis (CFA) confirmed the original, U.S.-derived second order, multi-factor model best fit the Chinese preschool data of the CBCL/1.5-5 and C-TRF. Rates of total behavior problems in Chinese preschoolers were largely similar to those in American preschoolers. Specifically, Chinese preschoolers scored higher on internalizing problems while American preschoolers scored higher on externalizing problems. Chinese preschool boys had significantly higher rates of externalizing problems than Chinese preschool girls. Cross-informant agreement between Chinese teachers and parents was relatively low compared to agreement in the original U.S. sample. Results support the generalizability of the taxonomic structure of preschool psychopathology derived in the U.S. to the Chinese, as well as the applicability of the Chinese version of the CBCL/1.5-5 and C-TRF.

Preventing behavior problems among elementary schoolchildren: impact of a universal school-based program in China

BACKGROUND

To evaluate the effect on problem behaviors of a universal school-based prevention curriculum of third grade students.

METHODS

Six regular classes in 1 elementary school were randomly assigned to an intervention (n = 208) or control (n = 209) group. A 13-session program was offered to students in the intervention group. The Achenbach Child Behavior Checklist (CBCL), parent report, was used to assess problem behaviors at baseline, at the conclusion of the curriculum, and again at 6-month follow up.

RESULTS

The unadjusted mean estimates of behavioral problems were significantly lower in the intervention group posttest (at the conclusion of the curriculum), -3.53 (95% confidence interval [CI] = -6.59 to -0.48; p = .023) and at the 6-month follow up, -5.22 (95% CI: -8.27 to -2.16; p = .001). After adjusting for potential confounders, gender (female), father's educational status (high school), family relationships (good and average), and child's age in months, intervention groups (intervention posttest and intervention after 6-month follow up) showed significantly lower total behavioral scores.

CONCLUSIONS

A universal school-based prevention program for Chinese elementary school-age children resulted in a significant positive change in behavioral problems. This is an important finding in the context of the Chinese 1-child policy that places great value on the achievement of the child.

CBCL behavior problems of post-institutionalized international adoptees

With the increase in international adoptions during the last decade, many researchers have investigated the developmental outcomes of these adoptees, including their extreme behaviors. Collectively, these results have not always appeared consistent across studies, perhaps because studies have used children reared in institutions or not, the institutional environments vary in severity, children spend different lengths of time in the institution and are assessed at different ages, and studies use different outcome measures. In an attempt to discern more order in the literature, this review focuses on 18 studies, each of which used the Child Behavior Checklist, and their outcomes are viewed with respect to these parameters. Results suggest that the major factor contributing to extreme behaviors is age at adoption, with those adopted after 6/18 months having more behavior problems, especially Internalizing, Externalizing, and Attention problems. Generally, samples of post-institutional children have more problems than samples of mixed or non-institutional internationally adopted children, and some problems are more likely to be manifest in adolescence, suggesting the effects of deficient early experiences are not simply the persistence of learned behavior but more general dispositions that become more noticeable or severe during adolescence. Findings are discussed in terms of early deficient social-emotional caregiver-child interactions that characterize most institutional environments as a possible major cause of later difficulties in post-institutionalized children.

The application of the preschool Child Behavior Checklist and the caregiver-teacher report form to Mainland Chinese children: syndrome structure, gender differences, country effects, and inter-informant agreement

Preschool children have long been a neglected population in the study of psychopathology. The Achenbach System of Empirically Based Assessment (ASEBA), which includes the Child Behavior Checklist/1.5-5 (CBCL/1.5-5) and the Caregiver-Teacher Report Form (C-TRF), constitutes the few available measures to assess preschoolers with an empirically derived taxonomy of preschool psychopathology. However, the utility of the measures and their taxonomy of preschool psychopathology to the Chinese is largely unknown and has not been studied. The present study aimed at testing the cross-cultural factorial validity of the CBCL/1.5-5 and C-TRF, as well as the applicability of the taxonomy of preschool psychopathology they embody, to Mainland Chinese preschoolers. Country effects between our Chinese sample and the original U.S. sample, gender differences, and cross-informant agreement between teachers and parents were also to be examined. A Chinese version of the CBCL/1.5-5 and C-TRF was completed by parents and teachers respectively on 876 preschoolers in Mainland China. Confirmatory factor analysis (CFA) confirmed the original, U.S.-derived second order, multi-factor model best fit the Chinese preschool data of the CBCL/1.5-5 and C-TRF. Rates of total behavior problems in Chinese preschoolers were largely similar to those in American preschoolers. Specifically, Chinese preschoolers scored higher on internalizing problems while American preschoolers scored higher on externalizing problems. Chinese preschool boys had significantly higher rates of externalizing problems than Chinese preschool girls. Cross-informant agreement between Chinese teachers and parents was relatively low compared to agreement in the original U.S. sample. Results support the generalizability of the taxonomic structure of preschool psychopathology derived in the U.S. to the Chinese, as well as the applicability of the Chinese version of the CBCL/1.5-5 and C-TRF.

Relations of parenting style to Chinese children's effortful control, ego resilience, and maladjustment

The purpose of the study was to examine the relations of authoritative parenting and corporal punishment to Chinese first and second graders' effortful control (EC), impulsivity, ego resilience, and maladjustment, as well as mediating relations. A parent and teacher reported on children's EC, impulsivity, and ego resilience; parents reported on children's internalizing symptoms and their own parenting, and teachers and peers reported on children's externalizing symptoms. Authoritative parenting and low corporal punishment predicted high EC, and EC mediated the relation between parenting and externalizing problems. In addition, impulsivity mediated the relation of corporal punishment to externalizing problems. The relation of parenting to children's ego resilience was mediated by EC and/or impulsivity, and ego resilience mediated the relations of EC and impulsivity to internalizing problems.

Comparison of self-reported emotional and behavioural problems in adolescents from Greece and Finland

AIM

To compare self-reported emotional and behavioural problems among Greek and Finnish adolescents.

METHODS

Youth Self-Report scores were analysed for 3373 Greek adolescents aged 18 years and 7039 Finnish adolescents aged 15-16 years from the general population in both countries. The impact of country, gender, place of residence, socioeconomic status (SES) and family stability on the scores was evaluated.

RESULTS

Only country and gender yielded small to medium effect on the scores. Greek boys scored significantly higher than Finns on 10 of the 11 YSR syndromes, particularly on the anxious/depressed scale. Greek girls scored significantly lower than Finnish girls on the somatic complaints and delinquent behaviour scales. In general, girls scored higher than boys on both internalising and externalising problems. The gender by country interaction revealed that Finnish girls reported more externalising problems.

CONCLUSION

The main differences marked in this comparison were the higher level of anxiety and depression in Greeks than Finns and the higher level of externalising problems in Finnish girls than boys. Cultural standards could play an important role in explaining these differences. Overall, it seems that only a small number of differences exist between a northern and southern European region.

Relationship between DHA status at birth and child problem behaviour at 7 years of age

Animal studies have demonstrated behavioural effects of long-chain polyunsaturated fatty acid (LC-PUFA) deficiencies and in humans, several psychiatric disorders have been linked to abnormal essential fatty acid metabolism. The aim of this study was to examine the relationship between LC-PUFA status at birth and the later development of problem behaviour. In a sample of 393 children, higher levels of docosahexaenoic acid (DHA) at birth were associated with lower levels of internalising problem behaviour at age 7 years. The association was markedly present in the infants fed with artificial formula (n=215, Beta=-0.32, P=0.000), but absent in the infants fed with human milk (n=170, Beta=0.11, P=0.325). The associations between arachidonic acid and internalising or externalising behaviour were neither large nor significant. The results suggest that perinatal DHA status may have long-term behavioural consequences. Therefore, we suggest to include measures of problem behaviour in future trials of LC-PUFA supplementation of mothers and/or infants.

Relations of effortful control, reactive undercontrol, and anger to Chinese children's adjustment

The purpose of the study was to examine the zero-order and unique relations of effortful attentional and behavioral regulation, reactive impulsivity, and anger/frustration to Chinese first and second graders' internalizing and externalizing symptoms, as well as the prediction of adjustment from the interaction of anger/frustration and effortful control or impulsivity. A parent and teacher reported on children's anger/frustration, effortful control, and impulsivity. Parents reported on children's internalizing symptoms, and teachers and peers reported on children's externalizing symptoms. Children were classified as relatively high on externalizing (or comorbid), internalizing, or nondisordered. High impulsivity and teacher-reported anger/frustration, and low effortful control, were associated with externalizing problems, whereas low effortful control and high parent-reported anger were predictive of internalizing problems. Unique prediction from effortful and reactive control was obtained and these predictors (especially when reported by teachers) often interacted with anger/frustration when predicting problem behavior classification.

Ethnic and generational influences on emotional distress and risk behaviors among Chinese and Filipino American adolescents

The purpose of this study was to explore ethnic and generational influences among Chinese, Filipino, and Euro American adolescents on emotional distress and risk behaviors. Hierarchical multiple regression analyses were conducted with 216 Chinese, 387 Filipino, and 400 Euro American adolescents from the National Longitudinal Study on Adolescent Health to investigate the influence of ethnicity on depression, somatic symptoms, delinquency, and substance use; and to examine the influence of generation on the outcome variables among Chinese and Filipino American adolescents. Ethnicity predicted depression and delinquency scores, while generation within ethnic groups predicted somatic symptoms and substance use. The findings diverge from theories using acculturation as an explanatory mechanism for distress and risk behaviors and underscore the importance of examining sub-groups and generations of Asian American youth.

Filial Therapy for Children's Behavioral and Emotional Problems in Mainland China

TOPIC

Filial therapy as a therapeutic intervention to promote parent-child interaction and improve child's behavior across culture.

PURPOSE

To review the state of the science of filial therapy and explore whether filial therapy would be an effective parenting program in China.

SOURCES

Four research articles related to the impact of filial therapy, used with Chinese immigrants, Koreans, and Native Americans, were located in a search of nursing, medical, psychological, and social science literature.

CONCLUSIONS

The findings indicated that filial therapy is a culturally sensitive and effective intervention. The overall limitations, some recommendations for future research, and the discussion of efficacy of filial therapy in China were provided.

Agreement between parent and teacher reports on behavioral problems among chinese children

Research has consistently shown low to moderate correlations between parent and teacher reports on children's behavioral problems in Western samples. Little is known about the agreement between parent and teacher reports on behavioral problems among Chinese children. The authors examined the agreement on behavioral and emotional problems in a community sample of 2836 Chinese children aged 6 to 11 years from Mainland China. Children's behavioral problems were assessed by the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF). Consistent with most previous studies in Western samples, our results indicated that parent-teacher agreement was low to moderate for attention, externalizing, and internalizing problems. Parent-teacher agreement was higher for attention and externalizing problems than for internalizing problems and decreased with increased behavioral problems. Child's gender, age, and academic performance and father's age were correlated with parent-teacher agreement on ratings of behavioral problems.

The symptom experience of hospitalised Chinese children and adolescents and relationship to pre-hospital factors and behaviour problems

PURPOSE

To describe the symptom experience of hospitalised Chinese children and adolescents and examine the relationship of symptoms to pre-hospital factors and child behaviour.

METHODS

Data were collected at two hospital sites in Hong Kong (HK) and at five hospitals in the Chinese Mainland (CM). A total of 307 hospitalised children and adolescents (ages 2-18) and their primary caregiver (e.g., mother, father or grandparent) participated in the study. Children and adolescents completed an age-appropriate symptom diary on one evening and subsequent morning early in their hospital stay. Parents completed the diary for the children less than 6 years of age. Parents also completed an age-appropriate Chinese version of the Child Behaviour Checklist.

RESULTS

Over 50% of the children and adolescents reported some degree of pain, 75% of them reported evening tiredness, and 21% reported gastrointestinal symptoms. The intensity of symptoms varied by age and region and symptoms often co-occurred. Greater symptom burden was predicted by previous surgery, higher level of worst pain prior to hospitalisation, parent report of child behaviour problems, and co-occurrence of other symptoms.

CONCLUSIONS

Hospitalised Chinese children manifest symptoms of pain, tiredness, and gastrointestinal distress that vary based on pre-hospital factors and are associated with child behaviour problems. Further research is needed to identify causes and treatments for children's symptoms.

Behavioural, emotional and family functioning of hospitalized children in China and Hong Kong

PURPOSE

This study examined behavioural and emotional problems, social competence and family functioning of hospitalized Chinese children in Hong Kong and the Chinese Mainland.

METHOD

A sample of 210 hospitalized children (ages 2-11 years) and their families participated in the study. The families were from a cross-section of geographical areas in Hong Kong (two hospitals) and the Chinese Mainland (five hospitals). Parents completed an age-appropriate Chinese version of the Child Behaviour Checklist and the Family Assessment Device. Multiple regression models were used to examine predictors of children's behaviour problems.

RESULTS

Behavioural patterns appeared to be specific to the developmental stage. Children had greater problems when their families demonstrated poorer affective involvement. Hospitalized children on the Chinese Mainland experienced more internalizing and externalizing behaviour problems than those in Hong Kong. Sick children, according to their parents, however, demonstrate some resiliency based on social and academic competency factors.

CONCLUSIONS

Hospitalized Chinese children manifest behavioural, emotional and family problems that vary by region, the child's development and gender. Problems predominantly of an internalizing nature characterized this group. The findings support the need for culturally appropriate behavioural assessments and interventions with hospitalized children.

Psychosocial functioning of hospitalized Chinese adolescents and their families

The purpose of this study was to describe behavioral and emotional problems, social competence, and family functioning of hospitalized Chinese adolescents and to compare their psychosocial functioning with normative samples of Chinese adolescents and their families. A convenience sample of 103 hospitalized adolescent patients and their families participated. Families came from geographical areas in the Chinese Mainland (5 hospitals) and Hong Kong (2 hospitals). Parents completed a Chinese version of the Child Behavior Checklist for ages 4 to 18 years and the Family Assessment Device. Adolescents responded to a Chinese version of the Youth Self-Report. Youth in the Chinese Mainland and Hong Kong appear to be quite similar in many domains of behavioral functioning. Hospitalized adolescents in Hong Kong and the Chinese Mainland exhibited behavioral and emotional profiles that were qualitatively similar to the norms reported in community samples of Chinese and Chinese-American adolescents, albeit significantly lower than their healthy counterparts. This study examined, for the first time, the psychosocial functioning of hospitalized Chinese adolescents and their families. Our findings contribute to the cultural relevance of measuring adolescent and family responses to a known stressor and are useful for international comparisons by health care providers and researchers.

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.

Emotional autonomy and problem behavior among Chinese adolescents

The author examined the association between emotional autonomy and problem behavior among Chinese adolescents living in Hong Kong. The respondents were 512 adolescents, 16 to 18 years of age, who were interviewed for a cross-sectional study. Three dimensions of emotional autonomy including individuation, nondependency on parents, and de-idealization of parents were significantly and positively correlated with the amount of problem behavior the participants engaged in during the past 6 months. Using a simple linear multiple regression model, the author found that problem behavior was associated with only one aspect of emotional autonomy-individuation. Results indicated that the relationship between problem behavior and three aspects of emotional autonomy was similar in both individualistic and collectivistic societies.

Behavioral and Emotional Problems Among Italian Children and Adolescents Aged 4 to 18 Years as Reported by Parents and Teachers

The aims of this study were the Italian standardization of the Child Behavior Checklist (CBCL/4-18) and the Teacher's Report Form (TRF), the analysis of the internal consistency of the two instruments, and the evaluation of the agreement between parents' and teachers' ratings. A group of 1423 parents and 1464 teachers of children and adolescents aged 4 to 18 years, from three different provinces of Northern Italy, were randomly recruited. Boys scored higher than girls on the Externalizing scales on both CBCL and TRF, while there were no significant differences between the two sexes on the Internalizing scales. In general, internalizing problems increased with age, whereas externalizing behaviors decreased, mainly through a reduction of aggressive problems in older subjects. For most scales, low socioeconomic status was associated with high problem scores. Most scales of the CBCL and the TRF showed a satisfactory internal consistency, with higher α coefficients for overt behaviors. A low - to - moderate parents' and teachers' agreement was found, with the higher correlation found for the Attention Problems scale. Overall, the figures of this first standardization are in line with the results of most studies carried out in Western and Eastern countries, evidencing a good applicability of Achenbach's instruments in Italy.

Culturally Appropriate Family Assessment: Analysis of the Family Assessment Device in a Pediatric Chinese Population

As part of a larger study, we investigated the adaptation of the Family Assessment Device (FAD) to a Chinese population of hospitalized children (N = 313) compared to a sample of families with healthy children (N = 29) in Hong Kong and Chinese Mainland. Confirmatory factor analysis and exploratory factor analysis (EFA) were performed to examine the FAD structure. The results supported the notion of cultural variations in measuring family functioning. Eight factors were found to explain 30.34% of the variance in family functioning. The Cronbach’s alphas of families with hospitalized children ranged from 0.29 to 0.74. Similar reliability scores were found in nonhospitalized families. This study indicates that the Chinese FAD has a different factor structure, reliabilities, and mean scores in several subscales compared to U.S. studies. The psychometric properties of the Chinese FAD may be influenced by the fact that the sample was focused on children rather than adults.