Adolescent depression: relationships of self-report to intellectual and adaptive functioning

A systematic review of the psychometric properties of tools for measuring depression in youths with intellectual disability

While youths with intellectual disability (ID) have increased vulnerability for depressive disorders, cognitive problems and combined functional barriers make them less prone to receive adequate treatments. A systematic review of the literature was conducted (PROSPERO Registration number: CRD42022347703) based on several databases from 1980 to 2022 to examine the quality of tools for measuring depression in children and adolescents with ID. The COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments) checklist was used to assess several psychometric domains. Twelve studies evaluated the properties of six tools for measuring depression in youths with ID. The Center for Epidemiologic Studies Depression Scale-Intellectual Disability (CESD-ID) was the only scale with at least five domains of psychometric properties assessed to have strong or moderate evidence. Based on the reviewed findings, tools specifically developed for populations with developmental disabilities should be considered first in order to screen depression in youths with ID. Much work is required to confirm their validity in clinical samples with patients with a complex form of developmental disabilities. As a complement to self- and caregivers-report questionnaires, clinician rating scales were considered useful to catch the full picture of depression in youths with ID, in particular associated behavioral expressions. Their validity received little scrutiny and certainly deserve more attention to improve care practice of youths with ID.

Anxiety and Depression Correlates at Age 10 in Children Born Extremely Preterm

Objective  Anxiety and depression rates are known to be elevated in prematurely-born children and adolescents. This prospective study examines demographic, academic, and physical health correlates of anxiety and depression symptoms in a sample of 10-year-old children who were born extremely preterm. Methods  Participants were 889 (51.2% male; 62.3% White) children who were born <28 weeks gestation. Child and family demographic data were collected at birth. When the children were 10, parents (n = 871) and teachers (n = 640) rated the level of anxiety and depression in children through the Child Symptom Inventory-4. Child academic functioning was assessed via the Wechsler Individual Achievement Test-III. Parents completed questionnaires about child academic functioning and physical health issues. Data analyses were conducted with multivariate linear modeling. Results  Level of prematurity was significantly related to both parent and teacher reports of anxiety. Public health insurance and individualized education program (IEP) status were associated with both parent and teacher reports of depression. Hispanic ethnicity, public insurance, IEP status, and asthma were significantly associated with both parent-reported anxiety and depression. Gross motor impairment was associated with parent-reported anxiety and teacher-reported depression. Child obesity was associated with teacher reports of anxiety, while male sex was significantly related to teacher reports of depression. Conclusion  This pattern of findings may suggest hypotheses for future research on models of the development and persistence of anxiety and depression within this particularly vulnerable group of children.

Associations of Anger and Fear to Later Self-Regulation and Problem Behavior Symptoms

The mediating and moderating roles of self-regulation in the associations of dispositional anger and fear to later conduct and anxiety symptoms were tested. Mothers and teachers rated children's anger and fear at 54 months (N = 191), and mothers reported on children's symptoms of anxiety and conduct disorders at 72 and 84 months (Ns = 169 and 144). Children's self-regulatory ability was assessed using the Tower of Hanoi task at 72 months. Children's self-regulation mediated the association between early dispositional fear and 84-month mother-reported anxiety disorder symptoms above and beyond the effects of earlier generalized anxiety symptoms. Children's anger directly predicted relatively high mother-reported conduct and anxiety disorder symptoms. Findings are discussed in terms of the importance of considering self-regulation as potential mechanism relating early childhood dispositional reactivity to later psychopathology symptoms.

Neuropsychological and behavioral profiles in attention-deficit hyperactivity disorder children of parents with a history of mood disorders: a pilot study

OBJECTIVE

We aimed to investigate the neurocognitive and behavioral endophenotypes of premorbid mood disorder. We compared intelligence, neuropsychological functioning, and behavioral problems among three groups: 1) a high-risk group [attention-deficit hyperactivity disorder (ADHD) children of parents with a history of a mood disorder], 2) a low-risk group (ADHD children of parents without a history of a mood disorder), and 3) normal comparison subjects.

METHODS

We used the Korean Educational Development Institute Wechsler Intelligence Scale for Children-Revised (KEDI-WISC-R), the Stroop Color Word Interference Test (Stroop), the Wisconsin Card Sorting Test (WCST), and the Rey-Osterrieth Complex Figure Test (RCFT) as neurocognitive measures, and we used the Child Behavior Checklist (CBCL) as a behavioral measure. Performance on these neuropsychological tests and score on the CBCL of 18 high-risk children were compared to those of 20 low-risk children and 24 healthy children. We also assessed the children's current mood state and familial functioning to control for the confounding effects of these variables.

RESULTS

Compared to low-risk and healthy children, high-risk children were impaired on the Picture Completion and Stroop Word subtest and showed higher scores on the CBCL subscales representing internalizing symptoms. These significant group differences persisted even after adjustment for the children's current mood state and familial functioning.

CONCLUSION

Neuropsychological deficits in the offspring of parents with a mood disorder may be associated with the current mood state rather than with innate characteristics, while their internalizing symptoms may partially stem from innate characteristics that are endophenotypes of a premorbid mood disorder.

Demystifying moderators and mediators in intellectual and developmental disabilities research: a primer and review of the literature

BACKGROUND

Intellectual and developmental disability (IDD) researchers have been relatively slow to adopt the search for moderators and mediators, although these variables are key in understanding how and why relationships exist between variables. Although the traditional method of causal steps is useful for describing and understanding moderators and mediators, it is not sufficient for statistical analysis.

METHODS

The theoretical and statistical processes of evaluating moderators and mediators are explained in terms familiar to IDD psychologists, using examples from IDD literature. Moderator and mediator analyses in five leading IDD journals are assessed for patterns of usage.

RESULTS

Although the number of publications in the past decade exceeds previous years, the field is still behind others in both the quantity and quality of the use of moderators and mediators.

CONCLUSION

The field as a whole will advance if the recent theoretical and technical advances outlined in this paper are employed.

A reliability generalization meta-analysis of coefficient alpha for the Reynolds Adolescent Depression Scale

The purpose of this study was to use a meta-analytic method known as reliability generalization to investigate the score reliability for a popular depression measure: The Reynolds Adolescent Depression Scale. We used the technique to provide an aggregate estimate of coefficient alpha across empirical studies that have employed the measure over time and across populations. Furthermore, we identified sample and demographic characteristics associated with variance in coefficient alpha. We discuss conditions associated with variability in coefficient alpha and alert researchers and practitioners to appropriate uses of the scale based on common reliability benchmarks.

A Prospective Twin Registry in Southwestern China (TRiSC): Exploring the Effects of Genetic and Environmental Factors on Cognitive and Behavioral Development and Mental Health Wellbeing in Children and Adolescents

The goals, prospects and methods of the Prospective Twin Registry in Southwestern China (TRiSC) are described. The aim of this study is to measure children's behavioral development and psychopathology from phenotypic, genetic and environmental perspectives. It focuses on measuring children's behavior and psychopathology from child self-reports, as well as parental and teacher informant reports, and relating it to the children's general cognitive abilities, and to the parenting style in the family. Other variables of interest such as children's temperament and parental health status are discussed, as well as plans for further research.

The Center for Epidemiologic Studies Depression Scale: factor validity and reliability in a French sample of adolescents with Intellectual Disability

The purpose of this study was to test the factor validity and reliability of the Center for Epidemiologic Studies Depression Scale (CES-D) within a sample of adolescents with mild to moderate Intellectual Disability (ID). A total sample of 189 adolescents (121 boys and 68 girls), aged between 12 and 18 years old, with mild to moderate ID were involved in two studies. In study 1, the content, phrasing and answering format of the CES-D were adapted for adolescents with ID. This instrument was renamed CES-D for ID (CES-D-ID) and two different versions based on two alternative answer scales (Likert and Likert-graphical) were developed and their psychometric properties were verified in study 2. The results provided support for the factor validity, reliability and invariance across gender and age of a 14-item version of the CES-D-ID based on a Likert-graphical answer scale.

Parent report of attention problems predicts later adaptive functioning in children with brain tumors

Children with brain tumors are at risk for psychological and behavioral difficulties. This study examined the ability of parent report of attention problems, withdrawal, anxiety, and depression, as well as IQ, to predict later adaptive functioning in 42 children treated for brain tumors. Age at diagnosis, SES, gender, and scores on the Neurological Predictor Scale (NPS) also were examined as predictors. Parent report of attention problems, SES, and NPS were significant predictors of later adaptive functioning across domains. This finding highlights the ability of parent report of attention problems to predict later adaptive functioning in children treated for brain tumors.

Self-reports on mental health problems of youth with moderate to borderline intellectual disabilities

OBJECTIVE

To determine the extent to which the Youth Self-Report (YSR) can be used to assess emotional and behavioral problems in adolescents with intellectual disabilities (IDs).

METHOD

In 2003, 281 11- to 18-year-olds with IDs (IQ > or =48) completed the YSR in an interview, and in 1993, 1,047 non-ID adolescents completed the YSR themselves. Parents completed the Child Behavior Checklist (CBCL). The ID sample was split into lower (IQ 48-69) and higher (IQ > or =70) IQ groups. Cronbach's alpha values of the YSR scales and (intraclass) correlation coefficients between and within YSR and CBCL scale scores were calculated to determine parent-adolescent agreement and YSR construct validity, which were compared between samples. Mean YSR scale scores were compared between adolescents with ID with and without psychiatric symptoms.

RESULTS

Cronbach's alpha, parent-adolescent agreement, and indications of construct validity were about similar in all samples, although discriminant validity was somewhat weaker in the lower IQ group. Mean scale scores were 1.5 to 2.0 times higher for ID adolescents with psychiatric symptoms.

CONCLUSIONS

The YSR seems applicable in youth with an IQ > or =48. Further research is needed to refine and confirm these findings and the factor structure of the YSR in adolescents with ID and to differentiate between adolescents with moderate and mild IDs.

Child psychopathology and lower cognitive ability: a general population twin study of the causes of association

Previous work has demonstrated associations between lower cognitive ability and childhood and adult non-psychotic psychopathology. As both cognitive ability (CA) and child psychopathology (CP) are influenced by genetic factors, one explanation for the association is that they are the pleiotropic manifestations of the same underlying genetic factors. The present paper examines three possible causes of the association: additive genetic factors, common environmental factors and individual-specific environmental factors. Three hundred and seventy-six twin pairs from the East Flanders Prospective Twin Survey were examined with the Child Behaviour Checklist and the Wechsler Intelligence Scale for Children-Revised. The cross-twin within-variable, within-twin cross-variable and cross-twin cross-variable correlations were calculated. Using structural equation modelling, bivariate models were fitted. The best fitting model was chosen, based on likelihood and parsimony. The observed phenotypic correlation between CP and CA was -0.19 (95% CI: -0.09, -0.27), with genetic factors accounting for about 84% of the observed correlation. Bivariate model fitting quantified the genetic correlation between CP and CA at -0.27 (95% CI: -0.12, -0.42) and the individual-specific environmental correlation at -0.17 (95% CI: -0.03, -0.31). In children, three different genetic factors may exist: one that solely affects the liability to CP, one that has only an effect on CA and one that influences both CP and CA. While individual-specific environmental factors can influence the liability to both traits, our results suggest that most of the environmental factors that increase the risk of CP do not influence CA and vice versa.

Depressive mood in students with mild intellectual disability: students' reports and teachers' evaluations

The present study examined 310 students with mild intellectual disability (ID) who attended special schools and self-contained classes in mainstream schools with regard to their reports of depressive mood, and loneliness and social skills, and teachers' perception of the students' academic, social and behavioural competencies. A multivariate analysis of variance (MANOVA) revealed that: students in special schools reported higher levels of depression and felt lonelier than mainstream school students; girls exhibited a greater sense of depressive mood than boys; teachers assessed boys as having higher academic competencies than girls; and boys were considered more easily distracted and less independent. However, teachers considered girls to have more adequate social adjustment, and be more task-oriented and more independent. For both groups, depressive mood can be predicted by distractibility and loneliness; by gender and lower academic competencies for special school students; or mainly by difficulties in social adjustment in the case of mainstream school students.

Methodological issues in interviewing and using self-report questionnaires with people with mental retardation

In this article the authors review methodological issues that arise when interviews and self-report questionnaires are used with people with mental retardation and offer suggestions for overcoming some of the difficulties described. Examples are drawn from studies that use qualitative methodology, quantitative studies assessing different question types, and studies reporting on the development of instruments measuring psychiatric symptoms, self-concept, and quality of life. Specific problems that arise with respect to item content (e.g., quantitative judgments, generalizations), question phrasing (e.g., modifiers), response format (e.g., acquiescence, multiple-choice questions), and psychometric properties (factor structure and validity) are discussed. It is argued that because many self-report questionnaires include questions that have been found to be problematic in this population, more attention needs to be paid to establishing the validity of such measures and to clearly defining the population for which the instrument is designed.

Screening adolescents with mental retardation for depression

This study investigated the reliability and validity of the Children's Depression Inventory (CDI) using 27 adolescents with mild mental retardation attending schools in a large metropolitan area. Cronbach's alpha was 0.79 and the test/retest correlation was 0.90 at 10 days to 2 weeks, indicating adequate reliability. Scores on the self-report CDI were compared with scores on an observer-completed inventory of psychopathology filled out by teachers and other staff, the Reiss Scales for Children's Dual Diagnosis. For female students, statistically significant negative associations were found between scores on the CDI and scores on the Reiss Scales and its depression subscale. Screening adolescents with mental retardation for depression should be an important part of Individualized Educational Plans for school nurses. School staff report should not be the only method of screening for depression in adolescents with mild mental retardation. School nurses may find the CDI useful as a self-report screening tool for depression.