Cultural contributions to adults' self-rated mental health problems and strengths: 7 culture clusters, 28 societies, 16 906 adults

BACKGROUND

It is unknown how much variation in adult mental health problems is associated with differences between societal/cultural groups, over and above differences between individuals.

METHODS

To test these relative contributions, a consortium of indigenous researchers collected Adult Self-Report (ASR) ratings from 16 906 18- to 59-year-olds in 28 societies that represented seven culture clusters identified in the Global Leadership and Organizational Behavioral Effectiveness study (e.g. Confucian, Anglo). The ASR is scored on 17 problem scales, plus a personal strengths scale. Hierarchical linear modeling estimated variance accounted for by individual differences (including measurement error), society, and culture cluster. Multi-level analyses of covariance tested age and gender effects.

RESULTS

Across the 17 problem scales, the variance accounted for by individual differences ranged from 80.3% for DSM-oriented anxiety problems to 95.2% for DSM-oriented avoidant personality (mean = 90.7%); by society: 3.2% for DSM-oriented somatic problems to 8.0% for DSM-oriented anxiety problems (mean = 6.3%); and by culture cluster: 0.0% for DSM-oriented avoidant personality to 11.6% for DSM-oriented anxiety problems (mean = 3.0%). For strengths, individual differences accounted for 80.8% of variance, societal differences 10.5%, and cultural differences 8.7%. Age and gender had very small effects.

CONCLUSIONS

Overall, adults' self-ratings of mental health problems and strengths were associated much more with individual differences than societal/cultural differences, although this varied across scales. These findings support cross-cultural use of standardized measures to assess mental health problems, but urge caution in assessment of personal strengths.

Co-developmental Trajectories of Defiant/Headstrong, Irritability, and Prosocial Emotions from Preschool Age to Early Adolescence

This study ascertains how the proposed subtypes and specifiers of oppositional defiant disorder (ODD) based on irritability and prosocial emotions co-develop and describes the clinical characteristics of the resultant classes. A sample of 488 community children was followed up from ages 3 to 12 years and assessed with categorical and dimensional measures answered by parents and teachers. Latent class growth analysis for three parallel processes [defiant/headstrong, irritability, and limited prosocial emotions (LPE)] identified a 4-class model with adequate entropy (.912) and posterior probabilities of class membership (≥ .921). Class 1 (n = 38, 7.9%) was made up of children with defiant/headstrong with chronic irritability and LPE. Class 2 (n = 128, 26.3%) was comprised of children with defiant/headstrong with chronic irritability and typical prosocial emotions. Class 3 (n = 101, 20.7%) clustered children with LPE without defiant/headstrong and without irritability. Class 4 (n = 220, 45.1%) included children with the lowest scores in all the processes. The classes were distinguishable and showed different clinical characteristics through development. These findings support the validity of ICD-11 ODD subtypes based on chronic irritability and may help to guide clinicians' decision-making regarding treating oppositionality in children.

Reciprocal relations between dimensions of Oppositional defiant problems and callous-unemotional traits

Although irritability, headstrong/defiant behavior, and callous-unemotional traits (CU traits) often co-occur, the prospective associations between them are not well known. A general population sample of 622 children was followed up yearly from ages 3 to 12 years and assessed using dimensional measures of irritability, headstrong/defiant, and CU traits with teacher provided information. A random intercept cross-lagged panel model, accounting for all unmeasured time-invariant confounding using the children as their own controls, revealed cross-lagged reciprocal associations between increased headstrong/defiant and increased CU traits at all ages and a unidirectional association from headstrong/defiant to irritability. The findings are consistent with headstrong/defiant behavior and CU traits mutually influencing each other over time and headstrong/defiant behavior enhancing irritability. School-based intervention and prevention programs should take these findings into consideration. They also suggest that irritability acts as a distinct developmental dimension of headstrong/defiant and callous-unemotional behaviors and needs to be addressed independently.

Describing Callous Unemotional Traits and Stressful Life Event Trajectories: Differences on Risk Factors and Mental Health Outcomes from the Age of 3 to 10

Callous Unemotional (CU) traits are associated with different environmental risk factors, such as negative stressful life events (SLE). The most common studied SLE associated with CU trait has been childhood maltreatment, but less is known about how other SLE impact the development of CU traits. Therefore, this work examines risk factors, personal factors (executive functioning), and mental health outcomes associated with the trajectories of Callous Unemotional (CU) traits and Stressful Life Events (SLE) in a community sample of children. A cohort of 377 preschoolers were followed up between ages 3 and 10. Several risk factors and outcomes for three trajectory groups (high CU/SLE; high CU/low SLE; and the reference group with low CU/SLE) were analyzed by using multiple post-hoc comparisons. We hypothesized that children with high CU/SLE would face more contextual risk factors, more executive functioning difficulties and more mental health problems than children with high CU/low SLE or the reference group. At the age of 3, children who showed high CU/SLE faced more early contextual adversity, including socioeconomic difficulties and maternal antisocial behavior than the other groups of children. At the age of 10, children with high CU/SLE presented more peer problems and higher psychopathology symptoms than the reference group, but no differences on mental health outcomes in comparison to the high CU/low SLE group. These results have potential implications for clinical practice and studies attempting to identify different CU subtypes in children.

Age and sex-specific cutoff scores for the teacher-report inventory of callous-unemotional traits on children

This longitudinal study aims to provide meaningful cutoff scores for total score of the teacher-rated Inventory of Callous-Unemotional Traits (ICU) from the preschool age until early adolescence, separately by age and sex. The ICU cutoff scores were determined by using low/high trajectories of oppositional defiant problems (ODP) and conduct problems in a Spanish community sample of 620 children that were followed up between the ages of 3 and 13. Receiver operating characteristic (ROC) curves with the two trajectories as criteria and ICU total score at each age as a predictor were estimated by sex separately, and the area under the ROC curve (AUC) was obtained. Average ICU cutoff scores of 26 for boys and 22 for girls were found to be of moderate utility for the prediction of high trajectories of each of ODP and conduct problems. They identified cases with an average sensitivity of 66% and specificity of 70% for boys and an average sensitivity of 69% and specificity of 72% for girls. The obtained cutoff scores might help clinical practitioners in their decision-making process when identifying low and high-risk groups of children. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Source-Specific Information on Social Cognition: A Matter of Context or Concept?

This work tackles the measurement invariance of the social cognition construct when different observers, age and participant's age are considered. This is a prior question that needs to be answered before attributing discrepancies in information coming from diverse sources just to the varying behavior occurring across setting, and mainly interpret the discrepancies as indicative of cross-contextual variability. The article also studies the link between discrepancies and source-specific information and the validity of that information to predict several outcomes. The measurement invariance across sex, time and informant of a social cognition measure applied to children's parents and teachers was longitudinally tested in a Spanish general population sample, at ages 5 (N = 581) and 10 (N = 438). Full or partial metric and scalar equivalence were found across sex and over time within informants. Partial scalar invariance was not obtained across informants. Latent class analysis identified 2 classes of difficulties in social cognition for both informants at both ages: low social cognition and high social cognition. Comparison of classes resulting predicting outcomes yielded differential predictions due not only to varying context but also to a different concept of social cognition across informants. In general, significant differences between raters were informant dependent. We conclude that it is important to consider both teachers' and parents' observations to fully understand the construct of social cognition.

Diagnostic classification of irritability and oppositionality in youth: a global field study comparing ICD-11 with ICD-10 and DSM-5

BACKGROUND

Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD-11, a solution markedly different from DSM-5's (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD-10's (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD-11 classification of chronic irritability and oppositionality as compared to the ICD-10 and DSM-5 approaches.

METHODS

Clinicians (N = 196) from 48 countries participated in an Internet-based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability.

RESULTS

Compared to ICD-10 and DSM-5, ICD-11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM-5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability.

CONCLUSIONS

The formulation of irritability and oppositionality put forth in ICD-11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability.

Prospective association of parental and child internalizing symptoms: Mediation of parenting practices and irritability

Maternal internalizing symptoms have been linked with child internalizing symptoms, but paternal internalizing difficulties have received little attention. Our aims were to prospectively analyse the simultaneous effect of maternal and paternal internalizing symptoms on child internalizing difficulties, examining gender differences, and to verify the mediating effect of parenting practices and child irritability. The sample included 470 families assessed at child ages 3, 6, 8, and 11. Multi-group structural equation modelling was performed with Mplus8.2. Complete equivalence was found between boys and girls for all paths. Maternal internalizing symptoms at age 3 had an indirect effect on child internalizing symptoms at age 11, via irritability at age 8. Paternal internalizing symptoms at age 3 were not associated with any of the variables under study. Maternal internalizing symptoms and child irritability are targets for intervention in order to prevent child internalizing difficulties.

Validation of BGaze method supporting ADHD diagnosis

Introduction

Eye movement recordings can provide information about higher-level processing of visual information. Recent evidence shows a novel role for eye vergence in orienting attention (Solé Puig et al., 2013). Based on such eye tracking data, the BGaze method (Braingaze; Spain) detects visual attention. The outcomes of the BGaze method have been applied to classify ADHD patients from healthy controls.

Aim

In this study, we validated the BGaze method.

Objective

We therefore recorded eye movements in children while performing a visual detection task.

Methods

We evaluated the BGaze method using 4 types of supervised machine learning algorithms. In total, 138 different trained models were tested. Nineteen ADHD diagnosed patients (children 7–14 years of age) and 19 healthy age matched controls were used to build the 138 models. We performed 30 times repeated random sub-sampling validation. In each repeated random split, training set consisted of 80% of the data and test set of the remaining 20%. Finally, all the 138 models were tested with a validation set consisting of 232 children, including 22 ADHD patients.

Results

Across all the 138 models, BGaze method showed an average accuracy of 90.84% (minimum 86.21%; maximum, 95.26%) and an average AUC of 0.95 (minimum 0.90; maximum, 0.97). Best models gave accuracies of 92%, AUCs of 0.96 and FN and FP rates of 4.3% and 7.5%, respectively. Mean scores during the training-testing phase averaged 99.63%.

Conclusion

The BGaze method is robust, accurate, and can provide an objective tool supporting the clinical diagnosis of ADHD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

How the Affective Reactivity Index (ARI) works for teachers as informants

BACKGROUND

The Affective Reactivity Index (ARI) is a brief instrument originally designed as a self- and parent report. However, the view of teachers, who can observe social situations that may give rise to irritability, is relevant. The goal is to provide the measurement qualities of the ARI score as reported by teachers.

METHOD

Children formed part of a longitudinal study on behavior problems in Barcelona (Spain) and they were assessed when they were 7 (N = 471) and 11 years old (N = 454) with questionnaires about psychopathology, anger and aggressive behavior, and a diagnostic interview answered by the parents, youths and teachers. Confirmatory factor analysis, measurement invariance, reliability and validity were studied for the ARI answered by teachers.

RESULTS

The 6-item, 1-factor model fitted well. Almost full metric invariance and partial scalar invariance was obtained across sex and over age. The ARI scores largely converged with other teacher-reported measures of anger and irritability, and with other measures of psychopathology, aggressive behavior, and callous-unemotional traits at a medium level. The associations with parent's measures were medium to low, and very low for child self-reported measures. The ARI scores significantly differentiated children with and without psychopathology and functional impairment, both cross-sectionally and longitudinally.

LIMITATIONS

Only one child self-report measure of irritability included. Limited internal consistency of some scale scores. Findings are mostly generalizable to Spanish children.

CONCLUSIONS

ARI could be a suitable instrument for measuring irritability as reported by teachers. The teacher's view can be useful when planning treatment by helping to identify treatment targets.

Irritability and parenting practices as mediational variables between temperament and affective, anxiety, and oppositional defiant problems

Irritability and parenting are potential targets for transdiagnostic studies to identify the common and core dysfunctional characteristics underlying several diagnostic pictures with the goal of addressing these issues in treatment. Our objective was to investigate the different paths from temperament to child psychopathology (affective, anxiety, and oppositional problems) through irritability and parenting using a prospective design from ages 3 to 7. A sample of 614 3-year-old preschoolers was followed at ages 4, 6, and 7. Parents answered questionnaires about temperament (age 3), irritability (age 4), parenting practices (age 6), and psychopathology (age 7). Statistical analyses were carried out through structural equation modeling (SEM) to test the mediation effect of irritability and parenting practices from temperament (negative affectivity and effortful control) through to affective, anxious, and oppositional problems. The proposed model fit the data well. SEM showed (a) an indirect effect from temperament to affective problems, via irritability and positive parenting; (b) a direct effect from negative affectivity to anxiety, plus an indirect effect from both temperament dimensions, via irritability and autonomy parenting practices; and (c) an indirect effect from temperament to oppositional problems, via irritability and punitive parenting. Irritability and parenting are transdiagnostic mediational variables that should be focused on in intervention programs for affective, anxiety, and oppositional problems.

Clinical Validation of Eye Vergence as an Objective Marker for Diagnosis of ADHD in Children

OBJECTIVE

ADHD youth show poor oculomotor control. Recent research shows that attention-related eye vergence is weak in ADHD children.

METHOD

To validate vergence as a marker to classify ADHD, we assessed the modulation in the angle of vergence of children ( n = 43) previously diagnosed with ADHD while performing an attention task and compared the results with age-matched clinical controls ( n = 19) and healthy peers ( n = 30).

RESULTS

We observed strong vergence responses in healthy participants and weak vergence in the clinical controls. ADHD children showed no significant vergence responses. Machine-learning models classified ADHD patients ( n = 21) from healthy controls ( n = 21) with an accuracy of 96.3% (false positive [FP]: 5.12%; false negative [FN]: 0%; area under the curve [AUC]: 0.99) and ADHD children ( n = 11) from clinical controls ( n = 14) with an accuracy of 85.7% (FP: 4.5%; FN: 19.2%, AUC: 0.90).

CONCLUSION

In combination with an attention task, vergence responses can be used as an objective marker to detect ADHD in children.

First incidence, age of onset outcomes and risk factors of onset of DSM-5 oppositional defiant disorder: a cohort study of Spanish children from ages 3 to 9

OBJECTIVE

To examine the 1-year first incidence and prevalence of oppositional defiant disorder (ODD), the outcomes on psychopathology and functioning by age of onset and the risk factors of onset of ODD from ages 3 to 9 in children from the Spanish general population.

DESIGN

Longitudinal with seven follow-ups and double cohort (ODD and non-ODD children).

SETTING

General population of preschool and elementary school children in Barcelona (Spain).

PARTICIPANTS

On a first phase, the parent-rated Strengths and Difficulties Questionnaire conduct problems scale plus ODD Diagnostic and Statistical Manual of Mental Disorders, fourth version, symptoms were used to screen for behavioural problems. The second phase sample size contained 622 cases at age 3 and, at age 9, 418 remained in the study.

RESULTS

The probability of the onset of ODD showed increasing values at ages 4 (R=2.7%) and 5 years (R=4.4%). These values decreased until age 7 (R=1.9%) and increased again until age 9 (R=3.6%). Up to 9 years old, the cumulative risk of new cases of ODD was 21.9%. Early onset was associated with a higher risk of depression comorbidity and later onset with higher functional impairment and symptomatology. Subthreshold ODD, high scores in irritability and headstrong dimensions, attention deficit/hyperactivity disorder and other comorbidity, negative affectivity until age 7, difficulties in inhibit and emotional control, punitive parenting and maternal internalising problems were risk factors of a first episode of ODD during this 7-year period.

CONCLUSIONS

The risk of new cases of ODD in the general population at preschool age and during childhood is high. Preschool age is a target period for preventive interventions. Identified risk factors are objectives for targeted and indicated interventions.

Oppositional Defiant Disorder dimensions and aggression: The moderating role of hostile bias and sex

BACKGROUND

Hostile Attributional Bias (HAB) has been related to conduct problems. The common and unique associations between the different dimensions of Oppositional Defiant Disorder (ODD) symptoms, specific components of HAB, sex and types of aggression (overt and relational) in a community sample of 491 7-year-old children are investigated.

METHOD

Teachers rated the children's ODD symptoms and aggression and the children self-reported about HAB. Multiple linear regressions showed that ODD dimensions were directly associated with both types of aggression.

RESULTS

Boys were more overtly aggressive and girls more relational. Emotional distress was directly associated with relational aggression. The relational component of HAB uniquely moderated the influence of the oppositional dimension on relational aggressive behaviour.

CONCLUSIONS

The assessment of social cognition variables is necessary to approach specific interventions in the presence of ODD symptoms, as this may help to identify a subset of children prone to aggressive reactions.

Nonsuicidal self-injury in community adolescents: A systematic review of prospective predictors, mediators and moderators

Nonsuicidal self-injury (NSSI) usually starts during adolescence and is associated with an array of psychological and psychiatric symptoms and future suicide attempts. The aim of this study is to determine prospective predictors, mediators and moderators of NSSI in adolescent community samples in order to target prevention and treatment strategies. Two team members searched online databases independently. Thirty-nine studies were included in the review. Several variables were seen to prospectively predict NSSI: female gender, family-related variables, peer victimisation, depression, previous NSSI and self-concept. Few studies analysed mediators and moderators. Low self-concept was highlighted as a relevant moderator in the relationship between intra/interpersonal variables and NSSI. Implications of these findings are discussed. The considerable heterogeneity between studies posed a limitation to determine robust predictors of NSSI. Further prospective studies using standardised measures of predictors and outcomes are needed to ascertain the most at risk individuals and develop prevention strategies.

Explaining the relationship between temperament and symptoms of psychiatric disorders from preschool to middle childhood: hybrid fixed and random effects models of Norwegian and Spanish children

BACKGROUND

Four explanations for the concurrent and prospective associations between temperament and psychopathology in children have been suggested: predisposition, complication/scar, common cause/continuity, and pathoplasty/exacerbation. Because the confounding effects of common causes have not been ruled out in prior work, the support for the various explanations is uncertain.

METHODS

Screen-stratified community samples of 4-year olds in Trondheim, Norway (n = 1,042), and 3-year olds in Barcelona, Spain (n = 622), were assessed biennially for symptoms of attention-deficit/hyperactivity (ADHD), oppositional defiant (ODD), conduct (CD), anxiety, and depressive disorders through interviewer-based psychiatric interviews across four waves of data collection. The parents completed child temperament ratings. The data were analyzed with random and fixed effects regression adjusted for all time-invariant unmeasured confounders (e.g., genetics, common methods bias, item overlap).

RESULTS

In both Norway and Spain and across ages, negative affect predisposed children to symptoms of all disorders except CD, low effortful control predisposed children to ADHD and ODD-symptoms, and surgency predisposed children to increased ADHD-symptoms. Complication effects were observed in the Spanish children for ADHD-symptoms, which increased surgency and diminished effortful control, and for ODD-symptoms, which decreased surgency. The common cause and pathoplasty/exacerbation explanations were not supported.

CONCLUSIONS

The present results are consistent with the view that temperament plays a causal role in the development of symptoms of psychiatric disorders in children. Because temperament is malleable, interventions targeting the affective, attentional, and behavioral regulatory components of temperament may reduce psychopathology in children.

The Brief Problem Monitor-Parent form (BPM-P), a short version of the Child Behavior Checklist: Psychometric properties in Spanish 6- to 8-year-old children

We provide the first validation data on the Spanish version of the Brief Problem Monitor-Parent form (BPM-P), a recently developed abbreviated version of the 120-item Child Behavior Checklist for Ages 6 to 18 (CBCL/6-18) in young schoolchildren. Parents of a community sample of 521 children aged 6-8 answered the CBCL/6-18 yearly, and the 19 BPM-P items were examined; parents also provided different measures of psychopathology. Confirmatory factor analysis of the expected 3-factor model (attention, externalizing, and internalizing) showed adequate fit (root mean square error of approximation, RMSEA ≤ .057), and measurement invariance across sex and age was observed. Internal consistency for the derived scores was satisfactory (ω ≥ .83). Concurrent validity with the equivalent scale scores of the original full CBCL/6-18 (r ≥ .84) and convergent validity with parents' ratings of the Strengths and Difficulties Questionnaire scores (r ≥ .52) were good. BPM-P scores at age 7 showed good predictive accuracy for discriminating the use of mental health services (OR ≥ 1.12), functional impairment (B ≤ -1.25), and the presence of the corresponding disorders diagnosed with an independent clinical interview, both cross-sectionally at age 7 and longitudinally at age 8 (OR ≥ 1.24). The BPM-P provides reliable and valid scores as a very brief follow-up and screening tool for assessing behavioral and emotional problems in young schoolchildren. (PsycINFO Database Record

Development of a screening tool enabling identification of infants and toddlers at risk of family abuse and neglect: a feasibility study from three South European countries

BACKGROUND

Child abuse is a health and social problem, and few screening instruments are available for the detection of risk in primary health care. The aim was to develop a screening instrument to be used by professionals in the public health care sector, thus enabling the detection of infants and toddlers at risk of emotional and physical abuse and neglect, and to provide evidence for the feasibility of the instrument in Cyprus, Greece and Spain.

METHOD

A total of 50 health professionals from paediatric public health-care centres in the three countries were involved in a three-step process for guiding the development of the screening tool and its application.

RESULTS

A nine-item screening tool, consisting of items assessing relational emotional abuse, physical abuse and other risk factors, was developed. The screening tool was applied on a total of 219 families with 0 to 3-year-old children attending public health centres in the three countries. Clinicians reported that they agreed on the inclusion of the questions (86.4-100%) and that they found the questions to be useful for the clinical evaluation of the family (63.2-100%).

CONCLUSION

The screening tool shows considerable face validity and was reported feasible by an international set of clinicians.

Parenting practices as mediating variables between parents' psychopathology and oppositional defiant disorder in preschoolers

BACKGROUND

Oppositional defiant disorder (ODD) is very frequent in preschoolers. The severity and the long-term negative outcomes make the understanding of this disorder a priority. The goal in this study was to assess the mediating role of parenting practices in the relationship between parents' psychopathology and ODD in preschoolers.

METHOD

A community sample of 622 children was assessed longitudinally at age 3 and age 5. Parents reported on children's psychopathology through a diagnostic interview, and on their own psychological state and parenting style through questionnaires.

RESULTS

At ages 3 and 5, corporal punishment mediated the relationships between mothers' anxiety-depression and ODD (in girls), between mothers' aggressive behavior and ODD (in boys), and between parents' rule-breaking and ODD both in boys and girls. For both sexes, there was a direct association between mothers' aggressive behavior score and ODD. The association between fathers' psychopathology and ODD was not mediated by the fathers' parenting practices. Fathers' anxiety-depression and aggressive behavior scores were directly associated with ODD.

CONCLUSIONS

Parents' psychopathology must be explored and, in families where such psychopathology is a relevant variable, parenting practices must be addressed with a view to the prevention and treatment of children's ODD in the preschool years.

Trajectories of Oppositional Defiant Disorder Irritability Symptoms in Preschool Children

This study traces the developmental course of irritability symptoms in oppositional defiant disorder (ODD) from ages 3-5 and examines the psychopathological outcomes of the different trajectories at age 6.

METHOD

A sample of 622 3-year-old preschoolers (311 were boys), followed up until age 6, was assessed yearly with a semi-structured diagnostic interview with parents and at age 6 with questionnaires answered by parents, teachers and children.

RESULTS

Growth-Mixture-Modeling yielded five trajectories of irritability levels for the whole sample (high-persistent 3.5%, decreasing 3.8%, increasing 2.6%, low-persistent 44.1% and null 46.0%). Among the children who presented with ODD during preschool age, three trajectories of irritability symptoms resulted (high-persistent 31.9%, decreasing 34.9% and increasing 33.2%). Null, low-persistent and decreasing irritability courses in the sample as a whole gave very similar discriminative capacity for children's psychopathological state at age 6, while the increasing and high-persistent categories involved poorer clinical outcomes than the null course. For ODD children, the high-persistent and increasing trajectories of irritability predicted disruptive behavior disorders, comorbidity, high level of functional impairment, internalizing and externalizing problems and low anger control at age 6.

CONCLUSIONS

Irritability identifies a subset of ODD children at high risk of poorer longitudinal psychopathological and functional outcomes. It might be clinically relevant to identify this subset of ODD children with a high number of irritability symptoms throughout development with a view to preventing comorbid and future adverse longitudinal outcomes.

USING THE PARENT-INFANT RELATIONSHIP GLOBAL ASSESSMENT SCALE TO IDENTIFY CAREGIVER-INFANT/TODDLER DYADS WITH ABUSIVE RELATIONSHIP PATTERNS IN SIX EUROPEAN COUNTRIES

The study examined whether the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised Edition (DC: 0-3R; ZERO TO THREE, 2005) Parent-Infant Relationship Global Assessment Scale (PIR-GAS) is applicable to six European countries and contributes to the identification of caregiver-infant/toddler dyads with abusive relationship patterns. The sample consisted of 115 dyads with children's ages ranging from 1 to 47 months. Sixty-four dyads were recruited from community settings without known violence problems, and 51 dyads were recruited from clinical settings and already had been identified with violence problems or as being at risk for violence problems. To classify the dyads on the PIR-GAS categories, caregiver-child interactions were video-recorded and coded with observational scales appropriate for child age. To test whether the PIR-GAS allows for reliable identification of dyads with abusive relationship patterns, PIR-GAS ratings were compared with scores on the the International Society for the Prevention of Child Abuse and Neglect's (ISPCAN) Child Abuse Screening Tool-Parental Version (ICAST-P; D.K. Runyan et al., ), a questionnaire measuring abusive parental disciplinary practices. It was found that PIR-GAS ratings differentiated between the general and the clinical sample, and the dyads with abusive patterns of relationship were identified by both the PIR-GAS and the ICAST-P. Interrater reliability for the PIR-GAS ranged from moderate to excellent. The value of a broader use of tools such as the DC: 0-3R to promote early identification of families at risk for infant and toddler abuse and neglect is discussed.

The discriminative capacity of CBCL/1½-5-DSM5 scales to identify disruptive and internalizing disorders in preschool children

This paper studies the discriminative capacity of CBCL/1½-5 (Manual for the ASEBA Preschool-Age Forms & Profiles, University of Vermont, Research Center for Children, Youth, & Families, Burlington, 2000) DSM5 scales attention deficit and hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), anxiety and depressive problems for detecting the presence of DSM5 (DSM5 diagnostic and statistical manual of mental disorders, APA, Arlington, 2013) disorders, ADHD, ODD, Anxiety and Mood disorders, assessed through diagnostic interview, in children aged 3-5. Additionally, we compare the clinical utility of the CBCL/1½-5-DSM5 scales with respect to analogous CBCL/1½-5 syndrome scales. A large community sample of 616 preschool children was longitudinally assessed for the stated age group. Statistical analysis was based on ROC procedures and binary logistic regressions. ADHD and ODD CBCL/1½-5-DSM5 scales achieved good discriminative ability to identify ADHD and ODD interview's diagnoses, at any age. CBCL/1½-5-DSM5 Anxiety scale discriminative capacity was fair for unspecific anxiety disorders in all age groups. CBCL/1½-5-DSM5 depressive problems' scale showed the poorest discriminative capacity for mood disorders (including depressive episode with insufficient symptoms), oscillating into the poor-to-fair range. As a whole, DSM5-oriented scales generally did not provide evidence better for discriminative capacity than syndrome scales in identifying DSM5 diagnoses. CBCL/1½-5-DSM5 scales discriminate externalizing disorders better than internalizing disorders for ages 3-5. Scores on the ADHD and ODD CBCL/1½-5-DSM5 scales can be used to screen for DSM5 ADHD and ODD disorders in general populations of preschool children.

Socioeconomic status and oppositional defiant disorder in preschoolers: parenting practices and executive functioning as mediating variables

OBJECTIVES

To investigate the mediating mechanisms of oppositional defiant disorder (ODD) in preschoolers through pathways analysis, considering the family socioeconomic status (SES) as the independent variable and the parenting style and the children's executive functioning (EF) as the mediating factors.

METHOD

The sample included 622 three-year-old children from the general population. Multi-informant reports from parents and teachers were analyzed.

RESULTS

Structural Equation Modeling showed that the associations between SES, EF, parenting style and ODD levels differed by children's gender: (a) for girls, the association of low SES and high ODD scores was partially mediated by difficulties in EF inhibition, and parenting practices defined by corporal punishment and inconsistent discipline obtained a quasi-significant indirect effect into the association between SES and ODD; (b) for boys, SES and EF (inhibition and emotional control) had a direct effect on ODD with no mediation.

CONCLUSION

SES seems a good indicator to identify children at high-risk for prevention and intervention programs for ODD. Girls with ODD in families of low SES may particularly benefit from parent training practices and training in inhibition control.

Measurement Invariance of Oppositional Defiant Disorder Dimensions in 3-Year-Old Preschoolers

Measurement invariance (metric/scalar) of oppositional defiant disorder (ODD) dimensions (negative affect, oppositional behavior, and antagonistic behavior) across sex and informants is tested. Parents and teachers of 622 preschool children from the general population answered a dimensional measure of ODD. ODD dimensions function similarly in boys and girls. Some differences were found by informant, indicating that the equivalence of the ratings of parents and teachers is not complete and that given the same underlying level of the latent trait, some parents’ item scores were higher than those of teachers. Metric invariance was complete but scalar invariance was not attained. The results contribute evidence on the conceptualization of ODD as a source-specific disorder. The simultaneous use of ODD dimensions reported by parents and teachers must be considered in the context of a lack of complete measurement invariance, which implies that comparisons of observed means from parents and teachers are not readily interpretable.

Behavior Rating Inventory of Executive Functioning-Preschool (BRIEF-P) Applied to Teachers: Psychometric Properties and Usefulness for Disruptive Disorders in 3-Year-Old Preschoolers

OBJECTIVE

We provide validation data on the Behavior Rating Inventory of Executive Functioning-Preschool version (BRIEF-P) in preschool children.

METHOD

Teachers of a community sample of six hundred and twenty 3-year-olds, who were followed up at age 4, responded to the BRIEF-P, and parents and children answered different psychological measures.

RESULTS

Confirmatory factor analysis achieved adequate fit of the original structure (five-first-order-factor plus three-second-order-factor model) after excluding four items. The derived dimensions obtained satisfactory internal consistency, moderate convergent validity with psychopathology and temperament, and good ability to discriminate between children with ADHD. BRIEF-P scales were not associated with a performance-based measure of attention. The teacher's BRIEF-P adds significant clinical information for the diagnosis of ADHD (ΔR(2) from 5.3 to 15.3) when used with other instruments for the assessment of psychopathology, functional impairment, or performance-based attention.

CONCLUSION

The BRIEF-P may be useful in the identification of preschool children, specifically those with ADHD, who might have a dysfunction in executive functioning.

The relationship between weight status and emotional and behavioral problems in Spanish preschool children

OBJECTIVE

To examine cross-sectional and longitudinal associations between behavioral problems and weight status, considering body mass index (BMI) z-scores and overweight status, in a community sample of preschoolers.

METHODS

The Strengths and Difficulties Questionnaire and the Diagnostic Interview for Children and Adolescents were administered to 611 parents. Adjusted general linear models and binary logistic regressions were used.

RESULTS

Children who were overweight and had a higher BMI were at increased risk of peer problems and attention-deficit/hyperactivity disorder (ADHD) symptoms. Prospective analyses showed that a higher BMI at the age of 3 years was predictive of peer problems at ages 4 and 5 years and hyperactivity and ADHD symptoms at the age of 4 years.

CONCLUSION

This is the first study using a diagnostic-based instrument that shows a relationship between weight status and ADHD symptoms in preschoolers. Overweight children might benefit from screening for behavioral disorders and peer relationship problems.

Syndromes of Self-Reported Psychopathology for Ages 18-59 in 29 Societies

This study tested the multi-society generalizability of an eight-syndrome assessment model derived from factor analyses of American adults' self-ratings of 120 behavioral, emotional, and social problems. The Adult Self-Report (ASR; Achenbach and Rescorla 2003) was completed by 17,152 18-59-year-olds in 29 societies. Confirmatory factor analyses tested the fit of self-ratings in each sample to the eight-syndrome model. The primary model fit index (Root Mean Square Error of Approximation) showed good model fit for all samples, while secondary indices showed acceptable to good fit. Only 5 (0.06%) of the 8,598 estimated parameters were outside the admissible parameter space. Confidence intervals indicated that sampling fluctuations could account for the deviant parameters. Results thus supported the tested model in societies differing widely in social, political, and economic systems, languages, ethnicities, religions, and geographical regions. Although other items, societies, and analytic methods might yield different results, the findings indicate that adults in very diverse societies were willing and able to rate themselves on the same standardized set of 120 problem items. Moreover, their self-ratings fit an eight-syndrome model previously derived from self-ratings by American adults. The support for the statistically derived syndrome model is consistent with previous findings for parent, teacher, and self-ratings of 1½-18-year-olds in many societies. The ASR and its parallel collateral-report instrument, the Adult Behavior Checklist (ABCL), may offer mental health professionals practical tools for the multi-informant assessment of clinical constructs of adult psychopathology that appear to be meaningful across diverse societies.

Tracing developmental trajectories of oppositional defiant behaviors in preschool children

Objective Previous studies on developmental trajectories have used ad hoc definitions of oppositional defiant behaviors (ODB), which makes it difficult to compare results. This article defines developmental trajectories of ODB from ages 3–5 based on five different standard measurements derived from three separate instruments.

Method

A sample of 622 three-year-old preschoolers, followed up at ages 4, 5, and 6, was assessed with the five measures of oppositionality answered by parents and teachers. Growth-Mixture-Modeling (GMM) estimated separate developmental trajectories for each ODB measure for ages 3 to 5.

Results

The number of classes-trajectories obtained in each GMM depended on the ODB measure, but two clear patterns emerged: four trajectories (persistent low, decreasers, increasers/high increasers, persistent moderate/persistent high) or three trajectories (persistent low, decreasers, increasers/high increasers). Persistent high trajectories accounted for 4.4%–9.5% of the children. The trajectories emerging from the different ODB measures at ages 3 to 5 discriminated disruptive disorders, comorbidity, use of services, and impairment at age 6, and globally showed a similar pattern, summarizing longitudinal information on oppositionality in preschool children in a similar way.

Conclusions

Trajectories resulting from standard scales of the questionnaires have predictive validity for identifying relevant clinical outcomes, but are measure-specific. The results contribute to knowledge about the development of ODB in preschool children.

Executive functions in preschoolers with ADHD, ODD, and comorbid ADHD-ODD: Evidence from ecological and performance-based measures

Executive functioning in 3-year-old preschoolers with attention-deficit hyperactivity disorder (ADHD), oppositional-defiant disorder (ODD), comorbid ADHD+ODD, and children without any of these conditions (control group) was examined. A community sample including 622 children was diagnosed using a diagnostic interview following DSM-IV criteria, and assessed using the Behavior Rating Inventory of Executive Function Preschool version (BRIEF-P) and the Kiddie-Conners' Continuous Performance Test. The children diagnosed with ADHD showed the poorest executive function (EF) profile in comparison with controls, and were closely followed up in this respect by the comorbid ADHD+ODD children. The ADHD and comorbid groups presented similar executive difficulties. The ODD group obtained mean scores statistically equal to those of controls in EF. These findings suggest that, in preschoolers, executive functioning deficits assessed with a performance-based measure or with behavioural descriptions are specific to children with ADHD, in comparison with those with ODD. This study contributes knowledge about EFs in two prevalent and comorbid disorders in preschool children, ADHD and ODD, knowledge that can help our understanding of specific deficits and the design of specific early intervention initiatives.

Comorbidity of oppositional defiant disorder and anxiety disorders in preschoolers

BACKGROUND

The aim was to study the comorbidity of oppositional defiant disorder (ODD) and anxiety disorders (AD) among preschool children of the general population, and to assess the contribution of comorbidity to the child's functional impairment.

METHOD

622 children were assessed at the ages of 3 and 5, through a diagnostic interview. They were clustered into three diagnostic groups: only ODD, only AD and comorbid ODD+AD.

RESULTS

At age 3, ODD was associated with specific phobia, OR = 4.7, 95% CI [1.4, 14.1], and at age 5, with any anxiety disorder, OR=3.9; 95% CI [1.8, 8.4]. ODD at age 3 was predictive of separation anxiety at age 5, OR=4.1; 95% CI [1.2, 14.3]. Comorbid ODD+AD cases showed a higher risk of functional impairment at school and in behavior toward others. Sex and socioeconomic status were not related to the diagnostic group.

CONCLUSIONS

ODD+AD comorbidity can be identified in preschool children. Early identification of this association is needed to adequately treat the affected children.

Usefulness of the Social and Communication Disorders Checklist (SCDC) for the Assessment of Social Cognition in Preschoolers

This study provides data on the usefulness of the Spanish version of the Social and Communication Disorders Checklist (SCDC; Skuse et al., 1997 ), in terms of the validity and reliability of derived scores. Data were obtained from parents’ interviews and parents’ and teachers’ questionnaires that measured different psychological variables from a community sample of 579 (291 boys and 288 girls), 5-year-old children. These children were tested to assess their intellectual capacity. Confirmatory factor analyses yield a one-dimensional structure invariant across sex within each informant (parents or teachers), with negligible latent mean differences between boys and girls for both informants (parents-teachers). The internal consistency was satisfactory (alpha values ≥ .85 for teacher version and ≥ .75 for parent version). SCDC scores correlated with specific scales related to developmental problems, aggressive behavior, executive functioning, and uncaring behavior toward others. SCDC scores were unrelated to intelligence quotient, whereas SCDC scores were associated with the presence of disruptive disorders, measured with diagnostic interview. Results provide evidence on reliability and validity of SCDC scores, which is potentially a useful measure for the study of social cognition and its relationship with preschool adjustment.

Prevalence of DSM-IV disorders, comorbidity and impairment in 3-year-old Spanish preschoolers

PURPOSE

The goal is to examine the prevalence, comorbidity and impairment of DSM-IV disorders in 3-year-old children from the Spanish general population.

METHOD

A sample of 1,341 3-year-old preschoolers were randomly selected and screened for a double-phase design. In total, 622 families were assessed with a diagnostic semi-structured interview and functional impairment measures.

RESULTS

Prevalence of any diagnosis was 29.9%, the most prevalent disorders being primary insomnia (11.7%) and oppositional defiant disorder (ODD) (6.9%). There were no sex differences in the prevalence. One-third of the families had sought professional help for the child's symptoms, and 9.4% received treatment (4.4% psychological and 2.1% pharmacological). After controlling for other comorbidities, ADHD was significantly associated with ODD, CD, insomnia and social phobia; ODD was associated with CD, separation anxiety, specific phobia and major depression. Diagnostic categories were associated with impairment, family burden, seeking professional help and receiving treatment. A diagnosis was more frequent in children of low socioeconomic status, born outside Spain, from one-parent families, with younger parents and with parents of lower educational level.

CONCLUSIONS

Psychopathology, comorbidity and associated factors are very frequent from age three, suggesting a need for efforts of detection, prevention and treatment in the different societies.

The short and very short forms of the Children's Behavior Questionnaire in a community sample of preschoolers

The aim was to test the internal structure of scores on the short and very short forms of the Children's Behavior Questionnaire (CBQ) scale and to study the relationship between the dimensions derived and external variables previously related to extreme temperament in a Spanish community sample. The sample comprised of 622 three-year-old children participating in a longitudinal study. Data were obtained from parents and teachers through a semistructured diagnostic interview and questionnaires evaluating children's characteristics and psychological states. Results showed a three-factor structure and moderate reliability of the scale scores for both the short and very short forms. Associations were found between the Surgency/Extraversion dimension and attention-deficit/hyperactivity disorder and externalizing problems, between Negative Affect and internalizing and emotional problems, and between Effortful Control and attention, externalizing, and social problems and other executive function measures. Salient temperamental characteristics predicted psychopathological disorders and impairment at ages 3 and 4. The short forms of the CBQ provide reliable and valid scores for assessing temperamental characteristics in the preschool years.

Multiple mediators of the relationships among maternal childhood abuse, intimate partner violence, and offspring psychopathology

The aim of the study was to examine whether maternal depression, mothers' and fathers' parenting, child physical punishment and negative life events (NLE) mediate the effect of maternal childhood abuse (CA), intimate partner violence (IPV) and cumulative violence (both CA and IPV) on Spanish children's and adolescents' psychopathology. Furthermore, multiple mediator models examine whether IPV mediates the effect of CA on the contextual and family factors mentioned above. Three hundred and eighteen Spanish outpatients aged 7 to 18 and their parents were assessed using a structured interview and other instruments for measuring the study variables. Structural equation models (SEMs) showed multiple pathways explaining psychopathological problems among offspring of mothers who suffered CA, IPV and both of these violent experiences. In particular, mothers' depression mediated the link between maternal CA, IPV, cumulative violence and children's externalizing, and total behavior problems. Child NLE was an important pathway between maternal CA and total behavior problems, as well as between cumulative violence and both externalizing and total problems. IPV contributed to explaining the link between maternal CA and contextual and family factors, such as child physical punishment and NLE, which were in turn, associated with children's behavior problems. Findings show the complex interconnections between different types of violence and their harmful effects on the mental health of women and their offspring, as well as the need to extend our knowledge on this subject.

Comorbidity and phenomenology of bipolar disorder in children with ADHD

OBJECTIVE

To assess the comorbidity of bipolar disorder (BPD) in children with ADHD and to study the psychopathological profile of ADHD children with and without mania.

METHOD

A total of 100 children with ADHD were assessed with a semistructured diagnostic interview and questionnaires of mania, ADHD, and general psychopathology.

RESULTS

8% of children met criteria for BPD and 6% for BPD-not specified. ADHD children with bipolar spectrum disorder had greater comorbidity with disruptive behavior disorders and scored higher on the Young Mania Rating Scales and on the Child Behavior Checklist (CBCL) Scales of rule-breaking behavior, externalizing problems, and total problems; however, significance on the CBCL Scales was lost when controlling for disruptive behavior disorders.

CONCLUSION

BPD is frequently associated with ADHD; it has important implications for prognosis and choice of treatment. Differences on the CBCL Scales could be explained by the comorbidity with disruptive behavior disorders rather than by a specific manic profile.

Psychometric properties of the Strengths and Difficulties Questionnaire(3-4) in 3-year-old preschoolers

We provide the first validation data on the Strengths and Difficulties Questionnaire (SDQ(3-4)), a brief screening tool for behavioral and emotional problems, in preschool children. Parents of a community sample of 1341 Spanish 3-year-olds and teachers of a sample of 622 children responded to the SDQ(3-4) and different measures of psychopathology. Confirmatory factor analysis yielded adequate fit of the model to the original structure. Internal consistency (omega coefficient) for total scores was .87 for parents and .91 for teachers. Convergent validity of SDQ(3-4)-parents' reports with Achenbach's taxonomy and diagnostic interview was good, but low for SDQ(3-4)-teachers' reports. The SDQ(3-4) showed predictive accuracy for discriminating use of mental health services and functional impairment. This is the first work presenting empirical evidence of the reliability and validity of the parents' and teachers' SDQ(3-4) for preschoolers. The SDQ(3-4) presents acceptable psychometric properties for use in the identification of preschool children who might have behavioral or emotional problems.

Maternal childhood abuse, intimate partner violence, and child psychopathology: the mediator role of mothers' mental health

This study examined the mediator role of mothers' mental health in the relationship among maternal childhood abuse (CA), intimate partner violence (IPV), and offspring's psychopathology, and explored whether mediational pathways were moderated by children's sex. Participants were 327 Spanish outpatient children, 8 to 17 years old, and their mothers. Mothers' global psychological distress and depressive symptoms mediated the associations between mothers' violence history and children's externalizing problems. However, only depressive symptoms fully mediated these relationships. Children's sex did not have a moderating role in adjusted paths. Mothers' depressive symptoms are an important mechanism by which maternal violence experiences could affect externalizing problems in Spanish children.

Dimensions of oppositional defiant disorder in 3-year-old preschoolers

BACKGROUND

To test the factor structure of oppositional defiant disorder (ODD) symptoms and to study the relationships between the proposed dimensions and external variables in a community sample of preschool children.

METHOD

A sample of 1,341 3-year-old preschoolers was randomly selected and screened for a double-phase design. In total, 622 families were assessed with a diagnostic semi-structured interview and questionnaires on psychopathology, temperament and executive functioning completed by parents and teachers.

RESULTS

Using categorical and dimensional symptoms of ODD it was possible to confirm, cross-informant and cross-method, distinct dimensions for defining the structure of ODD: one made up of irritable and headstrong and the other of negative affect, oppositional behaviour and antagonistic behaviour. Specific associations with DSM-IV disorders were found, and irritable was associated with anxiety disorders, whereas headstrong was associated with disruptive disorders, including aggressive and non-aggressive CD symptoms. Also, negative affect was associated with anxiety disorders and non-aggressive CD symptoms, oppositional behaviour with disruptive disorders and aggressive CD symptoms, and antagonistic behaviours with disruptive disorders and, in boys, with mood disorders. The dimensions correlated with specific scales of psychopathology, temperament and executive functioning.

CONCLUSIONS

Oppositional defiant disorder is a heterogeneous disorder from preschool age. Different dimensions, with moderate to acceptable reliability and convergent and discriminant validity with other psychological constructs, can be identified early in life.

Inventory of callous-unemotional traits in a community sample of preschoolers

The purpose of this study was to test the factor structure of the Inventory of Callous-Unemotional Traits (ICU; Frick, 2004 ) and to study the relation between the derived dimensions and external variables in a community sample of preschool children. A total of 622 children 3 and 4 years of age were assessed with a semistructured diagnostic interview, the ICU, and other questionnaires on psychopathology, temperament, and executive functioning, completed by parents and teachers. Confirmatory factor analysis derived from teachers' ICU responses yielded three dimensions: Callousness, Uncaring, and Unemotional. Callousness and Uncaring subscale scores correlated with the specific scales related to aggressive behavior, temperament, executive functioning, and conduct problems. The ICU scale scores discriminated cross-sectionally oppositional defiant disorder (ODD) and conduct disorder (CD) diagnoses, aggressive and nonaggressive symptoms of CD, use of services, and ODD/CD-related family burden. Longitudinally, Callousness subscale score at age 3 predicted ODD or CD diagnosis at age 4. Unemotional was not associated with aggressive measures, but it was linked to anxiety disorders cross-sectionally and longitudinally. Callous-Unemotional traits contributed significantly to predicting disruptive behavior disorders controlling for sex, temperament, and executive functioning (predictive accuracy between 3 and 5%). The ICU is a promising questionnaire for identifying early Callous and Uncaring traits in preschool years that may help in the identification of a subset of preschool children who might have severe behavioral problems.

DSM-Oriented Scales of the Child Behavior Checklist and Youth Self-Report in clinically referred Spanish children

The Achenbach System of Empirically Based Assessment (ASEBA) is an example of the efforts to integrate categorical and dimensional assessment methods. The latest editions of the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR) included the DSM-Oriented Scales, constructed in rational manner based on the items making up these inventories.

OBJECTIVE

To analyze the psychometric properties of the DSM-Oriented Scales of the CBCL and YSR.

METHOD

A clinical sample of 420 children and adolescents (aged 8-17 years) was assessed with the CBCL and YSR, with a structured diagnostic interview and with measures of functional impairment to study the reliability and validity of the DSM-Oriented Scales.

RESULTS

Internal consistency ranged from moderate to good for all the scales except the DSM-Anxiety Problems Scale. Agreement between parents and children ranged between moderate and low values. Kappa coefficients showed moderate agreement in the different symptoms. The DSM-Oriented Scales presented acceptable diagnostic power for DSM-IV disorders and a significant relationship with measures of functional impairment.

CONCLUSION

The DSM-Oriented Scales constitute a useful approach from the dimensional model to the DSM-IV disorders in Spanish clinical population.

The Diagnostic Interview of Children and Adolescents for Parents of Preschool and Young Children: psychometric properties in the general population

There is a need for reliable and well-validated diagnostic measures for studying psychopathology in preschool and young children. The goal is to study the psychometric properties of the Diagnostic Interview for Children and Adolescents for Parents of Preschool and Young Children (DICA-PPYC) in the general population. A sample of 852 Spanish school children, aged 3 to 7 years, were randomly selected and screened for a double phase design. A total of 251 families were interviewed with the DICA-PPYC and 244 participated in a test-retest design. Different measures of psychopathology and functional impairment were also administered. Test-retest agreement with a mean interval of 8.8 days ranged from excellent to slight (kappa from 1 to 0.39) for DSM-IV-TR and from good to fair (kappa from 0.77 to 0.49) for Research Diagnostic Criteria-Preschool Age diagnoses. Attenuation between test and retest was not significant for the prevalence of diagnoses, although it was significant for the number of externalising and total symptoms in the interview. The diagnoses converged moderately with the CBCL and Dominic scores. The presence of diagnoses in the DICA-PPYC significantly differentiated preschoolers and young children who had used mental health services, were more impaired, and presented more severe psychopathology measured by dimensional scales. The DICA-PPYC is a reliable and valid semi-structured interview schedule for preschool and young children, and can serve to advance the knowledge and mental health care of this population.

Diagnostic value of the Dominic Interactive Assessment with children exposed to intimate partner violence

This article reports on the diagnostic validity of the Dominic Interactive Assessment (DIA) in a sample of Spanish children exposed to intimate partner violence (IPV). The study participants included 55 children aged between 6 and 11 years whose mothers visited an IPV counselling centre. Psychopathology and functional impairment were used as the main criteria for assessing predictive and discriminative accuracy, as well as incremental validity, of DIA. The results indicate that DIA permits obtaining useful information from children. This information improves the prediction and validity of the process of clinical assessment of children exposed to IPV. Children's self-reports could prove effective in identifying cases in this high-risk population when developmentally adequate instruments and functional criteria are used.

Sex differences in oppositional defiant disorder

The goal was to analyze the sex differences in symptoms, comorbidity and functional impairment in outpatient children with Oppositional Defiant Disorder (ODD). A sample of 343 children, aged 8 to 17 years and diagnosed with ODD, were assessed with a semi-structured diagnostic interview and dimensional measures of psychopathology and functional impairment. Boys with ODD more frequently displayed the symptoms "deliberately annoys" and "blames others", presented comorbid ADHD, and had greater functional impairment in school and community contexts; girls presented higher comorbidity with internalizing symptomatology (anxiety, depression and somatic complaints). Given that some clinical differences are apparent in ODD between boys and girls, it is necessary to consider the sex of the patient in order to identify and treat this disorder efficiently and effectively in boys and in girls.

Maternal experiences of childhood abuse and intimate partner violence: Psychopathology and functional impairment in clinical children and adolescents

OBJECTIVES

The current study examined the independent effects of mothers' childhood abuse (CA) and intimate partner violence (IPV) on psychopathology and functional impairment in children; and the potential moderating and mediating role of individual and family factors in these relationships. Additionally, this study explored the potential cumulative effects of both maternal CA and IPV on children's outcomes.

METHOD

The sample included 547 Spanish children and adolescents aged between 8 and 17 years, and their parents, who had accessed mental health services. The assessment was based on structured interviews with the children and their parents. Statistical analyses were carried out through hierarchical multiple, negative-binomial and logistic regressions, and Structural Equation Models.

RESULTS

Children whose mothers experienced CA and those whose mothers suffered physical IPV showed increased DSM-IV disruptive disorders and externalizing behavior problems, respectively. Children who directly observed physical IPV and also suffered physical punishment by parents showed increased internalizing problems. IPV had effects, either direct or indirect by physical punishment, on children's externalizing problems. Cumulative effect analyses indicated that the prevalence of disruptive disorders was highest in children whose mothers had suffered both CA and IPV.

CONCLUSION

Spanish children whose mothers have suffered CA, IPV or both, are at high risk of serious conduct problems, whereas children exposed to IPV and who were also physically abused are at greater risk of internalizing problems. Physical punishment of children contributes in part to explain externalizing problems of IPV-exposed children. These findings indicate potential targets of assessment and intervention for families seeking help in mental health services.

International comparisons of behavioral and emotional problems in preschool children: parents' reports from 24 societies

International comparisons were conducted of preschool children's behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½-5 by parents in 24 societies (N = 19,850). Item ratings were aggregated into scores on syndromes; Diagnostic and Statistical Manual of Mental Disorders-oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3-12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0-198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes < 1%). Across all pairs of societies, correlations between mean item ratings averaged .78, and correlations between internal consistency alphas for the scales averaged .92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies.

Differential effects of psychological maltreatment on children of mothers exposed to intimate partner violence

OBJECTIVE

Psychological maltreatment (PM) is the most prevalent form of child abuse, and is the core component of most of what is considered as child maltreatment. The aim of this work was to explore differential adverse outcomes of the different types of PM in the mental health and functioning of children living in homes in which they are exposed to intimate partner violence (IPV).

METHOD

Participants were 168 children, aged between 4 and 17, whose mothers experienced IPV. They were assessed using different measures of psychopathology and functioning: Diagnostic Interview for Children and Adolescents-IV, Child Behavior Checklists and Child and Adolescent Functioning Assessment Scale. Furthermore, IPV was assessed with the Schedule for Assessment of Intimate Partner Violence Exposure in Children and the Index of Spouse Abuse. Statistical analyses were carried out with regression models adjusted by means of Generalized Estimating Equations.

RESULTS

Spurning was the PM subtype with the greatest global effect on the children, as it was significantly associated with internalizing and externalizing problems. Denying emotional responsiveness specifically increased the risk of internalizing psychopathology and impairment in the emotional area. Terrorizing was not significantly associated with a greater number of negative outcomes in children's psychopathology or functioning in this population.

IMPLICATIONS

The results suggest the importance of taking PM types into account in order to fully understand the problems of children exposed to IPV at home, and for the design of effective treatment and prevention programs.