The Child Behavior Profile: An Empirically Based System for Assessing Children’s Behavioral Problems and Competencies

Parent-Child Attachment Security and Depressive Symptoms in Early Adolescence: The Mediating Roles of Gratitude and Forgiveness

Although greater parent-child attachment security is linked with children's lower levels of depressive symptoms, little research has evaluated potential explanatory mechanisms. We investigated whether dispositional gratitude and interpersonal forgiveness explain the relation between attachment security with parents and early adolescents' depressive symptoms. Early adolescents (N = 105; M age = 12.3 years; 51% girls) completed questionnaires assessing their attachment security to mother and father figures, depressive symptoms, and dispositional gratitude, and an interview assessing interpersonal forgiveness. Results revealed that greater attachment security to mothers and fathers was associated with fewer depressive symptoms and greater levels of dispositional gratitude and interpersonal forgiveness. Further, dispositional gratitude and interpersonal forgiveness were negatively associated with depressive symptoms. Dispositional gratitude emerged as a mediator between attachment security with each parent and depressive symptoms. Our findings suggest that greater parent-child security may promote early adolescents' appreciation of positive events, which in turn may relate to fewer depressive symptoms.

Parental Nurturance Moderates the Etiology of Youth Resilience

Parenting behaviors are among the most robust predictors of youth resilience to adversity. Critically, however, very few studies examining these effects have been genetically-informed, and none have considered parenting as an etiologic moderator of resilience. What's more, despite the multidimensionality of resilience, extant etiologic literature has largely focused on a single domain. The current study sought to fill these respective gaps in the literature by examining whether and how parental nurturance shapes the etiology of academic, social, and psychological resilience, respectively. We employed a unique sample of twins (N = 426 pairs; ages 6-11) exposed to moderate-to-severe levels of environmental adversity (i.e., family poverty, neighborhood poverty, community violence) from the Twin Study of Behavioral and Emotional Development in Children. As expected, parental nurturance was positively correlated with all forms of resilience. Extended univariate genotype-by-environment interaction models revealed that parental nurturance significantly moderated genetic influences on all three domains of resilience (academic resilience A1= -0.53, psychological resilience A1= -1.22, social resilience A1= -0.63; all p < .05), such that as parental nurturance increased, genetic influences on youth resilience decreased. Put another way, children experiencing high levels of parental nurturance were more resilient to disadvantage, regardless of their genetic predisposition towards resilience. In the absence of nurturing parenting, however, genetic influences played an outsized role in the origins of resilience. Such findings indicate that parental nurturance may serve as a malleable protective factor that increases youth resilience regardless of genetic influences.

Parent-Child Play and the Emergence of Externalizing and Internalizing Behavior Problems in Childhood: A Systematic Review

It has widely been accepted that play has a major role in human development. The play situation is considered a save and controlled space in which children can learn to express their problems and to regulate their emotions, thus promoting emotional and behavioral adjustment. In early childhood, this process is thought to emerge in close interaction with caregivers. Parent-child play is thus viewed as an ideal window for parents to connect with their children and to support them in their social-emotional development. In this preregistered systematic review, we sought to integrate evidence from developmental and clinical psychology to shed more light on the role of parents in the relationship between parent-child play and children's behavioral adjustment as expressed in internalizing or externalizing behavior. Our review revealed that increased harsh control during play interactions as well as a lack of parental responsiveness, warmth and sensitivity were found to be associated with increased behavioral problems. Yet, no protective effect of warmth or responsiveness could be found in the context of risk groups. Moreover, the included studies indicated that positive affect expressed by parents during parent-child play was associated with fewer behavior problems in children, while negative affect was associated with more behavior problems. In general, this review revealed that quality and quantity of playful parent-child interactions were reduced in children with behavioral problems of both domains compared to children without behavioral problems. These findings illustrate the important role of parental characteristics during play interactions and their possible impact on children's behavioral adjustment.

Trust and general risk-taking in externalizing adolescent inpatients versus non-externalizing psychiatric controls

Background

Interpersonal trust is an important target for the conceptualization, identification, and treatment of psychiatric disorders marked by interpersonal difficulties. A core feature of adolescent externalising disorders is interpersonal impairment. However, research investigating trust is scarce. A relatively novel approach for studying trust in psychopathology is through examination of social decision making using behavioural economic games.

Objective

To employ a modified trust game in order to determine whether externalising adolescents exhibit perturbed decision making in social and/or nonsocial contexts.

Methods

Externalising inpatient adolescents (n = 141) and non-externalising psychiatric controls (n = 122) completed self-report measures of psychopathology and invested in an iterative trust game played under two conditions: social (trust) and nonsocial (lottery condition), each consisting of five consecutive trials.

Results

Externalising adolescents showed a limited increase in trust investments, compared to a significant increase in lottery investments, across early game trials relative to psychiatric controls. This significant three-way interaction between experimental group, game condition, and trials became most evident at the second trial of games. Between-group differences on trust investments were non-significant. However, externalising adolescents invested significantly less in the trust relative to lottery condition, an effect unobserved in psychiatric controls.

Conclusions

This study tentatively suggests that adolescent externalising disorders may be associated with an insensitivity to normative social exchange which may arise, in part, from a lack of anticipated co-player reciprocity. It is not the level of trust that may distinguish externalising adolescents but perhaps the form of which the trust exchange takes shape. Conclusions are tempered by the fact that the employed trust game did not include feedback in the form of co-player repayments.

Is neighborhood poverty harmful to every child? Neighborhood poverty, family poverty, and behavioral problems among young children

This longitudinal study investigates the association between neighborhood poverty and behavioral problems among young children. This study also examines whether social environments mediate the relationship between neighborhood poverty and behavioral problems. We used data from the third and fourth waves of the Fragile Families and Child Wellbeing study to assess behavioral problems separately for children who experienced no family poverty, moved out of family poverty, moved into family poverty, and experienced long-term family poverty. Regression models assessed the effect of neighborhood poverty on behavioral problem outcomes among children aged 5 years, after controlling for sociodemographic characteristics and earlier behavioral problems. Results showed an association between neighborhood poverty and lower social cohesion and safety, which lead to greater externalizing problems among children with long-term family poverty living in high-poverty neighborhoods compared with those in low-poverty neighborhoods. Policies and community resources need to be allocated to improve neighborhood social environments, particularly for poor children in high-poverty neighborhoods.

Predicting risky health behaviors 35 years later: Are parents or teacher's reports of childhood behavior problems a better judge of outcomes?

OBJECTIVES

This study sought to understand (1) whether parents and teachers reports of childhood behavioral problems could predict smoking and alcohol consumption 35 years later, and (2) whether propensity for smoking and alcohol consumption differed on the basis of informant agreement in their classification of behavioral syndromes.

METHODS

Participants included those from the Aberdeen Children of the 1950s study (ACONF) with full childhood information as well as self-reports in adulthood (n = 1342). Latent Class Analysis was conducted to identify patterns of childhood problem behaviors as rated by teachers and parents. Regression models were then conducted predicting adulthood smoking and alcohol consumption. Informant agreement categories were constructed and differences across categories in both smoking and alcohol consumption were tested.

RESULTS

Three subtypes of childhood behavior problems were identified by both teachers and parents: "Normative," "Externalizing," and "Internalizing,". Parents also identified a distinct fourth group "Mixed". Teacher's classification of the child as externalizing significantly predicted greater likelihood of being a current smoker, and parents' classification as internalizing predicted lower likelihood of being an ex-smoker. Parents' ratings as externalizing and mixed also predicted lower levels of alcohol consumption, which was opposite to the predicted effect. Additionally, informant agreement of externalizing indicated a greater propensity of smoking in adulthood, but did not indicate differences in alcohol consumption.

CONCLUSIONS

This study suggests that it is important to consider additive information from multiple informants when examining the life-course effects of childhood behavioral problems on risky health behaviors in adulthood.

Exposure to Alcohol Content in Movies and Initiation of Early Drinking Milestones

BACKGROUND

Exposure to alcohol content in movies has been shown to be associated with adolescent use of alcohol, including earlier onset. This study examined the influence of movie alcohol exposure on subsequent alcohol onset, considering the social context (whether the movie was viewed with a friend or parent). We examined whether media's influence holds across a spectrum of early drinking milestones: sipping (but not consuming a full drink of) alcohol, consuming a full drink of alcohol, and engaging in heavy episodic drinking (HED).

METHODS

Data were taken from a sample of 882 middle school youth (52% female; 24% non-White) enrolled in an ongoing study on alcohol initiation and progression. Exposure to alcohol content in films was measured using a method that combines content analysis and random assignment of movie titles to youth surveys. The hazard of initiating alcohol use (sip, full drink, HED) as a function of exposure was estimated using survival analysis. Associations were adjusted for demographic, personality, and social influence factors known to be associated with both movie exposure and alcohol use.

RESULTS

Exposure to alcohol content was common. Hours of exposure prospectively predicted earlier onset of alcohol involvement across all outcomes. Viewing movies with friends appeared to augment the media exposure effect, in contrast to viewing movies with parents, which was not a significant predictor of initiation.

CONCLUSIONS

Exposure to alcohol in films is involved in the entry into early stages of alcohol involvement. Findings support further investigation into the role of the media in underage drinking, especially in the context of consuming media with friends and peers. Limiting media exposure and/or stronger Federal Trade Commission oversight of movie ratings should be a priority for preventing underage drinking.

Anorexia and Depression: Depressive Comorbidity in Anorexic Adolescents

Frequently, depression is a concomitant pathology in anorexia nervosa. To verify this, we carried out a comparative case/control study with 50 anorexic patients, restricting-type (ANP), 50 depressed patients (DP) and 50 non-patients (NP), aged between 13 and 16. We used the Rorschach Test and the Minnesota Multiphasic Personality Inventory (MMPI) and compared the results to parent's observations collected from the Achenbach Child Behavior Checklist (CBCL). Results showed two clearly different groups among participants: ANP with depression (36%) and ANP without depression (64%). This seems to indicate that depression is not a core element in anorexic disorders. However, we also observed a significant increase in the MMPI scale 2, which was probably related to starvation and weight loss. We confirmed the absence of general anxiety in the ANP group and obtained differences between depressive symptoms and those derived from coping deficit disorders. The discussion emphasizes the importance of using several tests to reduce bias in results and conclusions.

Depressive symptoms among children and adolescents in Iran: a confirmatory factor analytic study of the centre for epidemiological studies depression scale for children

This study investigated the psychometric properties of the Iranian translation of the Centre for Epidemiological Studies Depression Scale for Children (CES-DC) in school children and adolescents in Iran. The CES-DC is a 20-item self-report scale designed to measure depressive symptoms in children and adolescents. A total of 1,984 children and adolescents, aged 12-17 years, participated in this research. In addition to the CES-DC, all participants completed the Spence Children's Anxiety Scale (SCAS) and the Strength and Difficulties Questionnaire (SDQ). The CES-DC demonstrated high internal consistency (Cronbach Alpha = .87). Confirmatory factor analyses revealed the same four factor structure as proposed by Radloff. Invariance tests showed an equivalent structure among boys and girls and younger and older adolescents. The CES-DC total scores correlated significantly with the SCAS total scores and the SDQ emotional symptoms subscale, providing support of its convergent validity. To conclude, the CES-DC proved to be a reliable and valid measure of depressive symptoms in the Iranian context.

Neurodevelopmental and psychological assessment of adolescents born to drug-addicted parents: effects of SES and adoption

OBJECTIVES

Prenatal exposure to heroin may have long-term consequences for development during early and middle childhood. The present research studied the cognitive, social, and emotional functioning of adolescents exposed to drugs prenatally, and investigated the extent to which the early adoption of children exposed prenatally to drugs would alleviate the possible effects of exposure.

METHODS

The study included 191 adolescents (12-16 years of age) and their parents in Israel, who had or had not been exposed prenatally to drugs and differing in socio-economic status (SES), and in adoptive status. They were administered five subtests of the Wechsler Intelligence Scale for Children (WISC-III), and the Youth Self-Report Form for assessing behavior problems that measures problems associated with attention deficit, self-esteem and risk-taking. Parents were administered the Child Behavior Checklist (CBCL) for assessing behavior problems, the Conners Rating Scale (CRS) for assessing attention deficit problems in their children and the Wender Utah Rating Scale (WURS), a self-report measure of ADHD-related problems.

RESULTS

Adolescents exposed to at least one risk factor (exposure to drugs, low SES, or adoption) performed more poorly than those exposed to none of these risk factors on the WISC-III subtests, the CBCL and the CRS. The effects of risk factors did not cumulate. Contrary to our hypothesis, adoption did not mitigate the effects of prenatal exposure to drugs: for cognitive functioning exposure to drugs was associated with poorer performance among the exposed High SES Adopted versus non-exposed High SES non-adopted children on three of the WISC-III subtests. Exposed low SES children living with their parents performed at the same relatively low level as non-exposed low SES controls. Exposure to drugs was associated with adult ADHD-related problems assessed by the WURS. There were no direct or interaction effects of exposure on neurological functioning, self-competence, behavior problems on the CBCL or risk-taking.

CONCLUSIONS

Children exposed to drugs of abuse prenatally, including those adopted away, and children who grow up in low SES backgrounds, may be at risk of relatively reduced cognitive functioning (though still within the normal range) in adolescence. Children exposed to drugs, who are from low SES backgrounds, or who are adopted, may be at risk for lower cognitive or social functioning than children who have not experienced such risks.

PRACTICE IMPLICATIONS

There is a need for implementing early monitoring and long-term intervention programs featuring encouragement of cognitive and social skills for children prenatally exposed to drugs in order to alleviate the possible long-term effects of exposure to risk.

Sex differences in the behavior of children with the 22q11 deletion syndrome

High rates of psychiatric impairment in adults with 22q11 deletion syndrome (22q11DS, also referred to as DiGeorge or velocardiofacial syndrome) suggest that behavioral trajectories of children with 22q11DS may provide critical etiologic insights. Past findings that report Diagnostic and Statistical Manual (DSM) diagnoses are extremely variable; moreover, sex differences in behavior have not yet been examined. Child Behavior Checklist (CBCL) ratings from 82 children, including 51 with the 22q11DS and 31 control siblings, were analyzed. Strikingly consistent with rates of psychiatric impairment among affected adults, 25% of children with 22q11DS had high CBCL scores for Total Impairment, and 20% had high CBCL Internalizing Scale scores. Males accounted for 90% of high Internalizing scores and 67% of high Total Impairment scores. Attention and Social Problems were ubiquitous; more affected males than females (23% vs. 4%) scored high on Thought Problems. With regard to CBCL/DSM overlap, 20% of affected males as compared with 0 affected females had one or more high CBCL ratings in the absence of a DSM diagnosis. Behaviors of children with 22q11DS are characterized by marked sex differences when rated dimensionally, with significantly more males experiencing Internalizing and Thought Problems. Categorical diagnoses do not reflect behavioral differences between male and female children with 22q11DS, and may miss significant behavior problems in 20% of affected males.

Immediate and sustained effects of parenting on physical aggression in Canadian children aged 6 years and younger

OBJECTIVE

To determine whether the effects of factors associated with the development of childhood (aged 6 years or younger) physical aggression were immediate (cross-sectional), sustained (longitudinal), or both.

METHODS

A longitudinal subsample (n = 975) of children born between December 1994 and April 1995 was drawn from the Canadian National Longitudinal Survey of Children and Youth and followed from birth to 6 years of age. Using random- and fixed-effects logistic panel regression models, child (sex and preterm birth), maternal (education, employment, and positive or hostile/ineffective parenting), and family (lone-parent, older and younger siblings, and income) indicators were regressed on childhood physical aggression.

RESULTS

Hostile/ineffective parenting contributed significantly to explaining the variance in aggression. At each measurement time point (birth, 2, 4, and 6 years of age), a change in hostile/ineffective parenting had an effect on aggression, and this effect carried forward across time up to 6 years. Being a boy, having a mother with less education, and living in a lone-parent family with siblings also contributed significantly to aggression. Preterm birth, maternal employment, depressive symptoms, positive interaction, and income failed to contribute significantly to aggression.

CONCLUSIONS

These results support the hypothesis that hostile/ineffective parenting has an immediate effect on aggression. Contrary to predictions that it would have an immediate effect only at the time it was occurring, hostile/ineffective parenting had a sustained effect on aggression that carried forward in time up to 6 years of age. The results suggest that hostile/ineffective parenting has an effect on aggression prior to any evidence of aggressive behaviour in the child.

The German version of the Centre for Epidemiological Studies Depression Scale for Children: psychometric evaluation in a population-based survey of 7 to 17 years old children and adolescents--results of the BELLA study

OBJECTIVES

To examine the psychometric properties and test the theoretical quality of the German version of the Centre for Epidemiological Studies depression scale for children (CES-DC), a 20-item screening instrument measuring the frequency of parent- and self-reported depressive symptoms in children and adolescents.

METHODS

Using a population-based, representative sample of n=2,863 7 to 17-year-old German children and adolescents, factorial validity were determined by means of linear structural equation modelling. Cross-sectional coefficients of reliability, inter-rater agreement as well as descriptive statistics of the scales were calculated.

RESULTS

In a population-based German sample, the four-factor version of the CES-DC following Radloff (Appl Psychol Meas 1:385-401, 1977) is considered to have good factorial validity and stability across age and informant versions. The main problems of the questionnaire are the high item difficulties, strong floor effects of the scales and low cross-sectional reliability, which are acceptable only for screening purposes. The low inter-rater agreement indicates that parental assessment can replace self-assessment only to a limited degree.

CONCLUSION

The strengths and weaknesses of the CES-DC are discussed taking previous data and comparable tests into consideration. Particular advantages are the existence of the parent-report form and the adult version, as well as its multifactorial structure. Parental assessment should be supplemented by self-report data whenever possible.

Behavioral/emotional profiles of preschool language-impaired children

Previous research has suggested that language-impaired (LI) children have a high prevalence of psychiatric disorders, and conversely, that children being treated for psychiatric disorders have a high incidence of language impairment. To investigate the relationship between developmental language and psychiatric disorders further, the behavioral and emotional status of a large, well-defined group of preschool-age LI and matched control children were evaluated using the Achenbach Child Behavior Checklist (CBCL). Based on parent report, data were analyzed for broad- as well as narrow-band syndromes. For the broad-band syndromes, results demonstrated significant between-group differences for boys, but not girls. However, for the narrow-band syndromes, unexpectedly few significant between-group differences were found for boys or girls. Only the Immaturity scale for boys and Social Withdrawal scale for girls proved significantly different between groups. Inspection of the items that comprised these two scales revealed a high prevalence of items which relate to attention, perception, and motor functions. As previous research with LI children has demonstrated that highly significant perceptual/motor disorders characterize this population, additional analyses were performed to determine the extent to which attention, perception, and motor items on the CBCL contributed to the significant group differences found. When items classified as assessing attention, perception, or motor functioning were excluded, few significant between-group differences remained. Subsequent analyses demonstrated a high correlation between the CBCL items classified as assessing attention, perception, or motor functions and the performance of LI and normal children on a battery of non-verbal attention, perception, and motor tasks. These results suggest that psychiatric disorders previously identified in LI children may be related primarily to specific neurodevelopmental delay in perceptual/motor functioning.

Risk and protective factors for urban African-American youth

The present study investigated risk and resilience processes in a sample of urban African-American youth. Risk and protective factors were assessed across ecological levels including individual, family and community. Both externalizing and internalizing symptomatology were included as measures of child adjustment. Youth and parental reports as well as various methods, such as the Experience Sampling Method, were used to capture the daily experiences of the adolescents from different perspectives. Poverty, hassles, and exposure to violence predicted higher rates of externalizing and internalizing symptoms. Individual and family protective variables emerged as powerful sources of resilience. An inner sense of confidence and helpful family support were associated with reductions in the deleterious effects of community poverty. Two main patterns, protective-stabilizing and overwhelming-risk, seemed to characterize most of the risk by protective factor interactions. The present findings are important for understanding the complex experiences of urban youth and furthering the literature on sources of risk and protection for African-Americans.

Parenting stress, marital quality, and child behavior problems at age 7 years

The study examined the relationship of early family environment and infant characteristics with childhood behavior problems at age 7 years. Sixty-two mothers and 56 fathers of preterm (30-36 weeks gestation and greater than 1500 g) and full-term boys and girls completed the Parenting Stress Index, Dyadic Adjustment Scale, and a measure of socioeconomic status during the child's first year. When their child was age 7 years, parents completed the Eyberg Child Behavior Inventory Intensity (frequency of behavior) and Problem (impact of behavior) scales. Hierarchical regression analyses showed that parenting stress because of their child's distractibility during infancy predicted the frequency of childhood behavior problems at age 7 years for mothers and of the impact of behaviors on the mother and the father. The quality of the marital relationship during infancy predicted the frequency of behavior problems reported by fathers. Public health nurses are well positioned to assess parenting stress and marital quality and to provide support to families during the early stages of parenthood.

Quality of life in children and adolescents with cystic fibrosis: implications for optimizing treatments and clinical trial design

Health related quality of life (QOL) as an outcome measure in clinical trials is becoming increasingly important. Trials should not only be able to demonstrate the pharmacologic activity of a therapy, but of equal importance, they should demonstrate clinical effectiveness that is of significant benefit to the patient. QOL measurement provides a way of incorporating the child/parent's perspective of how cystic fibrosis (CF) and its therapies impact on their lives. Several validated generic instruments have been employed to measure QOL in adolescents and adults. QOL assessment is more difficult in children and, therefore, has been employed less often in children with CF. Difficulties arise with the issue of whether children can report their own experiences directly, or whether a parent or clinician should report on behalf of the child. A child-centered approach is imperative since the literature indicates that children are able to report on their own QOL. An additional complication has been the use of adult measures with children. These are often inappropriate in their complexity, use of language, response scales, and time frame. The evaluation of pharmacologic therapies can profit from QOL measurement. The effectiveness of a drug and any adverse effects that impact on daily life can be assessed from the child/parent's viewpoint. Home therapy versus hospital therapy and drug delivery systems, are additional areas where QOL as an outcome measure is valuable. There have been relatively few appropriately powered trials in CF, and only a minority of these have evaluated QOL as an outcome measure. This review highlights areas where QOL measurement is appropriate. It focuses on the pharmacologic trials that have employed QOL assessment for antibiotic, mucociliary clearance, anti-inflammatory, and nutritional therapies. Methodological issues of incorporating QOL assessment into trials center on cross-cultural and data interpretation issues. QOL measurement in CF has been patchy and largely unreliable. The notion that improved symptoms equate with improved QOL is erroneous. Measurement of how symptoms impact on QOL is essential. Currently, the development and validation of CF specific measures (across the CF age range) provides optimism for appropriate QOL measurement in clinical trials, and for future meta-analysis and systematic reviews.

Home-based management can achieve intensification cost-effectively in type I diabetes

BACKGROUND

Newly diagnosed insulin-dependent diabetic children are most often admitted to hospital for education and insulin management and subsequently followed in outpatient clinics or office settings. However, most could be managed at home, given adequate family and health care team support and subsequent follow-up facilitated by home-based nursing intervention. We conducted a randomized trial of clinical, psychosocial, and cost effects of home-based management in a 2-year follow-up study of newly diagnosed diabetic children.

METHODS

Sixty three patients were randomly assigned to traditional hospitalization and outpatient follow-up (hospital-based group) or home management (home-based group). Treatment differences between the two groups consisted of duration of initial hospital stay, site and timing of initial teaching, and nature and extent of subsequent nursing follow-up. Metabolic control was assessed by means of quarterly glycosylated hemoglobin measurements for 24 months and then at 36 months. Diabetes-related adverse events, knowledge of diabetes, adherence to the diabetes regimen, psychosocial impact, and social (total) costs incurred were assessed for 24 months.

FINDINGS

Glycosylated hemoglobin concentrations were significantly lower in the home-based group at 12 to 24 months and at 36 months. Both groups had comparable numbers of diabetes-related adverse events. There were no significant group differences in psychosocial impact. Parents in the home-based group spent significantly fewer hours on diabetes care and incurred significantly lower out-of-pocket expenses during the 1st month. Health care sector costs were significantly higher. Hospital costs were $889 higher, and government costs $890 higher per child. Social (total) costs were only $48 higher per case (NS) with home care when parents' time was valued at $11.88 per hour.

INTERPRETATION

Home-based management for newly diagnosed diabetic children can result in better metabolic control and similar psychosocial outcomes compared with traditional hospital- and clinic-based care without notable effects on social (total) costs.

Impact of marital quality and parent-infant interaction on preschool behavior problems

This study examined the relationships between parent interactions with healthy term and preterm infants at 12 months of age, marital quality, family socioeconomic status, and preschool behavior problems. Eighty mothers and 74 fathers were observed in the home during an interaction with their child (Nursing Child Assessment Teaching Scale), and this group of parents completed the Dyadic Adjustment Scale questionnaire (marital quality) 12 months after the child was discharged from the hospital. Each parent completed the Eyberg Child Behavior Inventory when their child was four years of age. The parent and infant interaction scores were not predictive of later child behavior problems. Maternal perceptions of marital quality at 12 months predicted the frequency (Eyberg Intensity score) and impact (Eyberg Problem score) of the child's problematic behaviors reported by mothers. Marital quality and family socioeconomic status predicted the impact of behavior problems for fathers. There were no significant differences between preterm and term children or between boys and girls in the frequency or impact of problematic behaviors. Mothers reported a significantly greater frequency of behavior problems than fathers of the same children. The implications of these findings for nurses who work with families and young children are discussed.

Measuring problem behaviors in children with mental retardation: dimensions and predictors

Scores from the Child Behavior Checklist (CBCL; Achenbach, 1991a) and the Client Development Evaluation Report (CDER; California Department of Developmental Services, 1980) for 67 children and adolescents with mental retardation were examined to evaluate the factorial validity of the instruments. Four factor analyses were conducted. The initial factor analysis of CBCL data failed to confirm the presence of the five first-order factors previously reported for the CBCL standardization sample (Achenbach, 1991b). Second, the higher-order factors of Externalizing and Internalizing behaviors, similar to the structure reported for the CBCL standardization sample (Achenbach, 1991b), were confirmed on the present sample. Third, the two CDER factors of Personal Maladaption and Social Maladaption, previously identified by Widaman, Gibbs, and Geary (1987), were also confirmed. Finally, a higher-order factor analysis of the two factor scores from the CBCL and two factor scores from the CDER was conducted to study the congruence between the CBCL Externalizing and CDER Social Maladaption dimensions, and between the CBCL Internalizing and CDER Personal Maladaption factors. Moderate levels of congruence were found. Next, child characteristics, including level of mental retardation, age, and four dimensions of adaptive behavior, were used as predictors of problem behavior. No child characteristics were significantly related to the CBCL Externalizing dimension, but child age and level of mental retardation were significant predictors of the CBCL Internalizing dimension. CDER Cognitive Competence predicted CDER Social Maladaption, and child age predicted CDER Personal Maladaption. The findings are discussed in relation to previous studies of problem behaviors of children and adolescents with mental retardation.

Measuring treatment outcome for adults and adolescents: reliability and validity of BASIS-32

This article examines the reliability and validity for adults and adolescents of Behavioral and Symptom Identification Scale (BASIS-32), a 32-item patient-report instrument designed to facilitate psychiatric outcome assessment of adult inpatient populations. This study extends the original analysis of the psychometric properties of BASIS-32 to a different site, using a self-report rather than interview format and samples of both adult and adolescent patients. Responses to the BASIS-32 are reported for two groups of patients consecutively admitted between 1991 and 1994: adults over 18 years old (n = 462) and adolescents between 12 and 18 (n = 244). Results of this investigation confirm the utility of BASIS-32 as an easily administered and scored self-report outcome assessment tool for adult psychiatric patients. Its utility for adolescent patients was not as clearly demonstrated.

Children and Death: New Horizons in Theory and Measurement

Recent research in the area of children and death is reviewed in this article, focusing on the two broad domains of childrens' death concept development and children and bereavement. The kinds of psychometric instrumentation used in current projects within these areas is then reviewed. These instruments can be broadly classified as structured interview formats (standardized and unstandardized), paper and pencil formats (standardized and unstandardized), and phenomenographic methodology. The bulk of research in the field has relied upon structured interview formats. The Development of Death Concept Questionnaire and the Derry Death Concept Scale are the two standardized structured interview formats that are reviewed, along with a number of unstandardized structured interview formats. The Mourning Behavior Checklist and the Child Behavior Checklist are the two standardized paper and pencil formats that are reviewed, along with a number of unstandardized paper and pencil formats. A relatively new phenomenographic approach developed by Wenestam and Wass is also reviewed. This discussion is then used as a background for the secondary purpose of this article, which is to bring attention to the area of children and death anxiety as a new frontier for theoretical and psychometric investigation.

The Response of Children to the Dying and Death of a Sibling

This study investigated the behavioral adjustment of sixty-one children ages four to sixteen years during the terminal illness and first year following a sibling's death from cancer. Using the Child Behavior Checklist, data on behavior problems and competence were collected from parents and teachers. Data collection occurred before death during the terminal phase, and two weeks, four months, and one year post death. The results of data analysis by t-test comparisons generally indicated that the bereaved siblings demonstrated significantly higher levels of behavior problems and significantly lower social competence in comparison to normal children. The implications for practice are discussed.

Cross-cultural validity of a parent's version of the Dental Fear Survey Schedule for children in Chinese

The cross-cultural validity of a parent's version of the Dental Fear Survey Schedule (DFSS) for children was assessed by examining the relationship between the parent's report of child fear in Chinese (DFSS) and actual child behavior (CB) in the dental environment for two samples: 70 Chinese children ages 5-15 yr, residing in Canada, and 99 mainland Chinese children ages 2.5-7.0 yr residing in Kunming, Yunnan, PRC Canadian DFSS score M = 31.9 (SD = 9.5) with no differences by age or sex. PRC DFSS score M = 35.7 (SD = 8.9) with girls reported more fearful than boys. No age difference was detected. Higher DFSS scores were associated with more CB in both samples. Factor analyses yielded similar solutions and internal consistency was high. Control and potential victimization were identified as important constructs. The results suggest the Chinese version of the DFSS is a reliable and valid parental measure of child dental fear.

The Diagnostic Interview Schedule for Children-Revised Version (DISC-R): I. Preparation, field testing, interrater reliability, and acceptability

OBJECTIVE

To describe the history and assessment strategies used to investigate and revise the Diagnostic Interview Schedule for Children (DISC), a highly structured interview form used by lay interviewers to elicit diagnostic criteria for the common psychiatric disorders of childhood and adolescence.

METHOD

Revision was based on clinical and community data that identified unreliable and undiscriminating items in an earlier version of the instrument (DISC-1). A field study was carried out with 74 parent-child pairs. Interrater reliability and acceptability to patients was high. Accompanying papers describe the test-retest and construct validity of the instrument.

CONCLUSIONS

Taken together, the findings suggest that the DISC is an acceptable, brief, inexpensive, and convenient instrument for ascertaining a comprehensive range of child and adolescent diagnoses whose methodological properties are comparable with other child diagnostic instruments.

Lead exposure and child behavior

OBJECTIVES

Unlike cognitive impairments associated with lead exposure, lead-associated child behavior problems have been difficult to specify, particularly in young children.

METHODS

The Child Behavior Checklist (CBCL) and the Center for Epidemiologic Studies Depression Scale were used as the outcome and confounding variables, respectively, of major interest. These measures were examined with respect to blood lead levels of 201 African-American children aged 2 through 5 years.

RESULTS

In comparison with the low exposed group, the high exposed group (two consecutive blood lead levels greater than or equal to 15 micrograms/dL) had a significantly higher mean CBCL Total Behavior Problem Score (TBPS) and Internalizing and Externalizing scores; when other factors, including maternal depressive symptomatology, were controlled for, regression procedures indicated a .18-point TBPS increase for each unit increase in lead and a 5.1-point higher TBPS in the high exposed group; children in this group were 2.7 times more likely to have a TBPS in the clinical range.

CONCLUSIONS

Through its use of a standardized parent-report measure of behavior and its consideration of maternal morale in multiple linear and logistic regression procedures, this study provides further evidence of lead's detrimental effect on child behavior at levels typical of present-day exposure.

Family stress and functioning in children: the moderating effects of children's beliefs about their control over parental conflict

While factors such as gender and SES have been studied as moderators of stress for children, their perceptions of control have received little attention. In the current study, children's domain-specific perceptions of their control during marital conflict were investigated as potential moderators of the impact of family stress on children's behavior problems, and perceptions of competence. Ninety-four children aged 6-12 years and mothers from families ranging in level of parental conflict from nondiscordant to discordant to physically violent were interviewed. Multiple regression analyses revealed that higher levels of conflict control beliefs acted as compensatory moderators of stress, being associated with lower levels of problem behaviors across stress levels. However, higher conflict control beliefs acted as vulnerability moderators with regard to children's perceptions of competence.

Children in the public eye: The functioning of Pastors' children

Pastors' children have been thought to have more behavioral problems than other children since they face high expectations and are part of families that are often under public scrutiny. The purpose of this study was to describe the social competencies and behavioral problems of a national sample of pastors' children, aged 4-16, and to compare them to age and sex standardized norms. Data were obtained on 98 children from a random sample of 62 families, using the Child Behavior Checklist. Results indicate that scores for both boys and girls at each age grouping fell within the acceptable norms for both social competencies and behavioral problems.

HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth

In this article, we present data obtained with the psychosocial interview instrument, HEADSS (Home, Education, Activities, Drug use and abuse, Sexual behavior, Suicidality and depression) that was administered to High Risk Youth Clinic clients at their initial visits during a 1-year period. Of the 1,015 new patients, 63% were homeless/runaway youths and 37% were living with their families. Utilizing the HEADSS interview instrument, we compared homeless/runaway youths to nonhomeless youths in a number of areas, including risks for human immunodeficiency virus (HIV) infection. Our results showed that homeless teens tended to be younger, female, and white compared to their nonhomeless counterparts. They were more likely to have dropped out of school and were far more likely to be depressed and actively suicidal. They demonstrated all forms of drug abuse. They engaged in first sexual intercourse at an earlier age, and experienced a higher incidence of sexual abuse and prostitution. They were 6 times more likely to be at risk for HIV infection.

Psychological impact of significantly short stature

These baseline data confirm that many children with significantly short stature are vulnerable to diverse developmental, social and educational problems, and substantiate the importance of a multidisciplinary treatment approach that includes a comprehensive psychological and medical assessment. The psychological assessment should focus on the early detection of problems in academic achievement and psychosocial development, in order that appropriate educational and counselling interventions can be provided. The paediatrician can also foster a positive relationship with patients and their families to facilitate treatment compliance and improve overall outcome in several ways. These include a simple explanation of the aetiology of the child's short stature and how the diagnosis was made, a review of the treatment protocol that includes information about potential side-effects and suggestions for minimizing conflicts about injections, and an open discussion of prognosis to help families develop realistic expectations. It is further suggested that paediatricians stress that treatment outcome should be assessed in psychological terms, such as increased responsibility, as well as physical growth. These anticipatory interventions will help to ensure that the eventual outcome of comprehensive treatment is an optimally functioning young adult.

Temperament characteristics of mentally retarded children

In a comparative study of temperament and intelligence in groups of mentally retarded and normal children, it was found that mentally retarded children who also had excess of psychopathology in them, showed greater signs of 'difficult' child temperament. Relationship between intelligence and emotionality variable of temperament was linear and positive in the mentally retarded children. This study generates the hypothesis that negative mood may be temperamental correlated with mental retardation.

Diagnosis of attention deficit disorder with hyperactivity in Chinese boys

Parental and teacher ratings of adjustment on the Achenbach Child Behavior Checklist and Teacher Rating Form were obtained on 39 subjects diagnosed as having attention deficit disorder with hyperactivity (ADDH), 31 subjects with ADDH plus learning disability (ADDH-LD), and 29 controls. Subjects were all males between the ages of 9 and 11 years and resided in Changsha, People's Republic of China. Significant group differences were found between the two clinical groups and the control group. Ratings by parents and teachers of the ADDH and ADDH-LD groups indicated more behavior problems and poorer social adjustment than controls. ADDH and ADDH-LD groups were not significantly different from one another except on ratings of school and learning problems.

Lateralized brain injury and behavior problems in children

This study investigated the types of behavior problems found in children with lateralized brain lesions. Children referred for neuropsychological assessment were assigned to dominant (DH) or nondominant (NDH) groups on the basis of history of neurological disease or injury, findings on neurological examination, functional and structural laboratory findings, and neuropsychological assessment. Over two-thirds fell into the clinical range of behavior problems by parental report on the Achenbach Child Behavior Checklist. Degrees of pathology were nearly equal. DH children showed more externalizing than internalizing symptomatology. NDH children showed more internalizing than externalizing behavior problems. Results are discussed in terms of symptom formation based on lateralization of lesion.

Improvements in self-concept after treatment of nocturnal enuresis: randomized controlled trial

To determine whether changes in attitude and behavior occur after treatment of nocturnal enuresis, we randomly assigned 121 children aged 8 to 14 years to receive conditioning therapy (n = 66) or a 3-month waiting period (n = 55). All children completed the Piers-Harris Self-Concept Scale (P-H), the State-Trait Anxiety Scale (STAIC), and the Nowicki-Strickland Locus of Control test (NSLC) at entry and after treatment or delay. Parents completed the Achenbach Child Behavior Checklist (CBCL). There were no significant group differences in background demographic variables. Significant improvements in the P-H Scale (P = 0.04) and three of its subscales occurred in children in the treatment group compared with those in whom treatment was delayed. The changes were greatest for those who had the largest decreases in wetting frequency. Changes in CBCL, STAIC, and NSLC scores were not statistically significant. We conclude that there may be mental health benefits in children helped to master the symptom of enuresis, which in this age group is probably a chronic stressor.