Laboratory and performance-based measures of childhood disorders: introduction to the special section

Serves as an introduction to a special section of the journal on laboratory and performance-based measures of childhood disorders. The articles in the special section were part of the work of a task force established by Division 12 of the American Psychological Association on "Upgrading the Science and Technology of Assessment and Diagnosis." In this introduction, I raise a number of issues involved in the use of laboratory and performance-based measures for the assessment of childhood psychopathology that cut across the different disorders covered in the special section. Some of these issues are common to most techniques used in the assessment of childhood psychopathology; others are more specific to this particular method of assessment. However, by focusing on these issues related to the use of laboratory and performance-based measures, it will hopefully encourage a critical examination of all techniques currently being used in the assessment of psychopathology and highlight important issues involved in translating measures that were developed primarily for use in research into forms that are useful in clinical practice.     

Considering the clinical utility of performance-based measures of childhood anxiety

Examines general issues regarding the clinical utility of performance-based measures and specifically considers the utility of performance measures relevant to childhood anxiety and fear. First, we discuss the limitations of questionnaire and interview measures of childhood anxiety and the ways in which performance-based measures may compensate for or augment the use of such measures. Second, we review the major groups of performance-based measures that are potentially relevant to childhood anxiety and discuss evidence regarding their reliability and validity. Third, in the context of a general discussion of the various ways in which an assessment procedure may have clinical utility, we discuss the extent to which the performance-based techniques reviewed possess utility. Although many of these measures show promise of one or more types of clinical utility, none currently possess sufficient documented utility to warrant their dissemination for clinical use. We conclude by recommending directions for future research to demonstrate and improve the utility of such measures.     

Complementary assessments of executive function in preterm and full-term preschoolers

Executive functions (EFs) are interrelated cognitive processes that have been studied in relation to behavior, attention, academic achievement, and developmental disorders. Studies of EF skills assessed through parent report and performance-based measures show correlations between them ranging from none to modest. Few studies have examined the relationship between EF skills measured through parent report and performance-based measures in relation to adaptive function. The present study included preschool children born preterm as a population at high risk for EF impairments. Preschool children (N = 149) completed a battery of EF tasks that assess working memory, response inhibition, idea generation, and attention shifting or cognitive flexibility. Parents reported on children’s EF and adaptive skills. Preterm children showed more parent-rated and performance-based EF impairments than did full-term children. The combined use of either parent report or performance-based measures resulted in the identification of a large number of children at risk for EF impairment, especially in the preterm group. Both parent report and performance-based EF measures were associated with children’s adaptive function. EF skills are measurable in young child'ren, and we suggest that EF skills may serve as targets for intervention to improve functional outcomes. We recommend the use of both parent report and performance-based measures to characterize children’s EF profiles and to customize treatment.     

Assessing the Verbal Behavior of Conduct Problem Children During Mother-Child Interactions:

In this study we compared the verbal behavior of 4 to 8-year-old conduct problem and normal children in interactions with their mothers in the Child-Directed Interaction phase of the Dyadic Parent-Child Interaction Coding System (Eyberg & Robinson, 1983). It was predicted that conduct problem children would use less praise, ask fewer questions, make more critical statements, and give more commands during interactions with their mothers than normal children. Results support two of these four predictions, with conduct problem children using fewer questions and less praise. Implications for the assessment and treatment of conduct problems as well as how these verbal behaviors may develop from problem parent-child interactions are discussed.     

Assessing social dysfunction: the contributions of laboratory and performance-based measures

Reviewed research studies in which laboratory and performance-based measures were used with success to identify problematic social interaction patterns and social skills deficits associated with poor peer relationships. However, the clinical utility of these measures remains an empirical question. In this article, social competence is conceptualized as an organizational construct, reflecting the child's capacity to integrate behavioral, cognitive, and affective skills to adapt flexibly to diverse social contexts and demands. Correspondingly, performance-based measures of social functioning that include complex social interaction stimuli and require integrative responses appear more likely to demonstrate social validity than measures focused on isolated behaviors or cognitions. Research studies are reviewed that involve observations of children in three types of analogue social situations: play groups, friendship pairs, and social-challenge situations. In addition, studies that have utilized performance-based measures to screen and evaluate children for social skills training programs are reviewed. We conclude that performance-based measures are unlikely to be useful in determining whether a child is experiencing social dysfunction but may enhance the clinical analysis of the nature of the child's social difficulties. We identify gaps in the current knowledge regarding the clinical utility of performance-based measures of social dysfunction, along with directions for future research.     

Assessment of Attention in Preschoolers

In the past two decades, there has been an increased interest in the assessment and treatment of preschool children presenting with concerns about attention problems. This article reviews the research and clinical literature involving assessment of attention and related skills in the preschool years. While inattention among preschoolers is common, symptoms alone do not necessarily indicate a disorder, and most often represent a normal variation in typical preschool child development. Thus, accurate identification of ??disordered?? attention in preschoolers can be challenging, and development of appropriate, norm-referenced tests of attention for preschoolers is also difficult. The current review suggests that comprehensive assessment of attention and related functions in the preschool child should include thorough review of the child??s history, planned observations, and formal psychometric testing. The three primary methods of psychometric assessment that have been used to characterize attentional functioning in preschool children include performance-based tests, structured caregiver interviews, and rating scales (parent, teacher, and clinician). Among performance-based methods for measurement of attention in the preschool years, tests have been developed to assess sustained attention, selective (focused) attention, span of attention (encoding/manipulation), and (top-down) controlled attention??including freedom from distractibility and set shifting. Many of these tests remain experimental in nature, and review of published methods yields relatively few commercially available, nationally normed tests of attention for preschoolers, and an overall dearth of reliability and validity studies on the available measures.     

Development and Implementation of a Function-Based Clinical Interview to Evaluate Childhood Behavior Problems

The most common reason that children are referred to mental health providers relates to behavior and emotional problems. Without intervention, children with maladaptive behaviors are at risk for poor school performance, interpersonal difficulties, and significant conduct problems later in life. Previous research on the assessment of these problems has focused primarily on caregiver self-report questionnaires, observational coding, and/or diagnostic classification. The behavior literature has far fewer examples of best-practice interview strategies to solicit meaningful clinical information from primary stakeholders. Since caregiver report is essential during initial interviews to better understand his or her child’s presenting issues and given the primary role of assessment is to integrate information into the design of an evidence-based intervention (Barlow et al., 2005), additional published guidance on the content of these clinical interactions is warranted. The following paper outlines an approach to gathering pertinent information from caregivers about their children’s behavior in a way that is germane to treatment planning. In addition, the authors include validity and reliability data to substantiate the interview’s continued use in the clinical setting.     

Laboratory and performance-based measures of depression in children and adolescents

Reviews laboratory and performance-based measures for the assessment of symptoms and correlates of depression in children and adolescents. First, we briefly review limitations of self-report and other report measures of depression. Next, we describe four laboratory methods, including social interaction tasks, information-processing tasks, measures of psychological deficits and laboratory analogue designs, and sleep studies. We then summarize the specific depressive symptoms measured by each of these methods. Finally, we discuss issues of the validity and utility of these methods.     

Associations between Maternal Attention-Deficit/Hyperactivity Disorder Symptoms and Parenting

Mothers of children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for an ADHD diagnosis themselves, which is likely associated with impairments in parenting. The present study utilized a multi-method assessment of maternal ADHD and parenting to examine the extent to which maternal ADHD symptoms are associated with maladaptive parenting. Participants included 70 6–10 year old children with DSM-IV ADHD and their biological mothers. Results suggested that mothers with higher levels of ADHD symptoms reported lower levels of involvement and positive parenting and higher levels of inconsistent discipline. During observed parent–child interactions, maternal ADHD symptoms were negatively associated with positive parenting, and positively associated with negative parenting and repeated commands before giving the child an opportunity to comply. Given prior research suggesting that maladaptive parenting behaviors are risk factors for the later development of conduct problems among children with ADHD, these findings have important clinical implications for family-based assessment and treatment of ADHD.     

Callous-unemotional traits and developmental pathways to severe conduct problems

One method for defining pathways through which children develop severe conduct problems is based on the presence or absence of callous-unemotional (CU) traits. This study investigated potential differences between nonreferred children (mean age = 12.36 years; SD = 1.73) with and without CU traits (n = 98). Children with conduct problems, irrespective of the presence of CU traits, tended to have significant problems in emotional and behavioral regulation. In contrast, CU traits, irespective of the presence of conduct problems, were associated with a lack of behavioral inhibition. Hostile attributional biases were associated with conduct problems but only in boys and in the absence of CU traits. These findings suggest that the processes underlying deficits in emotional and behavioral regulation in children with conduct problems may be different for children with CU traits.     

Revisiting the accuracy hypothesis in families of young children with conduct problems

Revisited the accuracy hypothesis in an examination of the relation between maternal depressive symptomatology and child conduct problems. All data were gathered as part of the pretreatment assessment in an outcome study of families with clinic-referred children with conduct problems (age 3 to 6). The mothers varied in their depressive symptomatology, from not at all symptomatic to severely symptomatic. Correlations indicated that with increasing depressive symptomatology, mothers (N = 97) displayed a higher rate of physical negative behaviors towards their child and reported more child conduct problems. Regression analyses revealed that at the lowest levels of maternal depressive symptomatology there was a discrepancy between mothers' reports of child behavior problems and child deviant behaviors observed during mother-child interaction. In contrast, at higher levels of depression, mothers' reports of child behavior were consistent with laboratory observations of their child's behavior. These findings provide evidence to support the accuracy hypothesis in reference to mothers who display a high degree of depressive symptomatology, but the results also call into question the validity of maternal report in families with children with conduct problems.     

Little Children with Big Worries: Addressing the Needs of Young,Anxious Children and the Problem of Parent Engagement

Anxiety disorders in preschool-age children represent an important clinical problem due to high prevalence, substantial impairment, persistence, and associated risk for later emotional problems. Early intervention may mitigate these problems by capitalizing on a strategic developmental period. Elevated neuroplasticity, availability of screening tools, and the potential to modify parenting practices position anxiety as a good candidate for early intervention and preventive efforts. While some novel interventions show promise, the broad success of such programs will largely depend on parent engagement. Since parents are less likely to identify and seek help for anxiety problems compared to other childhood behavior problems, especially in a preventive manner, methods for understanding parents’ decisions to participate and enhancing levels of engagement are central to the success of early childhood anxiety prevention and intervention. Understanding these processes is particularly important for families characterized by sociodemographic adversity, which have been underrepresented in anxiety treatment research. This review summarizes the developmental phenomenology of early emerging anxiety symptoms, the rationale for early intervention, and the current state of research on interventions for young, anxious children. The roles of parent engagement and help-seeking processes are emphasized, especially among economically disadvantaged and ethnic minority communities who are acutely at risk. Evidence-based strategies to enhance parent engagement to facilitate the development and dissemination of efficacious programs are offered.     

Assessing normal and abnormal personality functioning: strengths and weaknesses of self-report, observer, and performance-based methods

Assessing personality characteristics; distinguishing the boundaries between normal and abnormal functioning; identifying impairment in the domains of work, interpersonal relationships, and emotional state due to maladaptive personality traits; and translating these findings into effective, appropriate treatment interventions is a complicated endeavor. Valid, reliable conclusions about an individual's personality functioning and adjustment cannot be reached unless one has accurate information about that person's patterns of behavior, cognitions, emotions, and interpersonal relationships. I discuss strengths and weaknesses of assessment approaches utilizing explicit assessment methods, such as self-report measures and clinical interviews; information obtained from knowledgeable observers; and performance-based, implicit assessment methods such as the Rorschach Comprehensive System (Exner, 2003). In contrast to explicit methods of assessment, implicit methods can provide salient information about a personality construct whether or not individuals have accurately conceptualized that construct, have weighed how the construct describes them, are self-aware, and are willing to openly provide information relevant to that construct. I propose that the accuracy of conclusions about an individual's personality style, problems in adjustment, and treatment needs may be improved if conclusion are based on a multimethod assessment approach that incorporates information gathered using explicit assessment methods, information provided by significant others, and data from performance-based or implicit measures of personality.     

Assessment of Behavioral and Emotional Problems in Infancy: A Systematic Review

Behavioral and emotional problems are highly prevalent in early childhood and represent an important focus of practice for clinical child and pediatric psychologists. Although psychological or psychiatric disorders are not typically diagnosed in children under the age of 2 years, recent research has demonstrated the appropriateness of assessing behavioral and emotional problems during the first 2 years of life (defined throughout as “infancy”). The current paper provides a systematic review of assessment procedures used to identify behavioral and emotional problems during infancy. Existing assessment procedures for infants take the form of parent- or caregiver-report questionnaires, observational coding procedures, and diagnostic classification systems. The questionnaires and observational coding procedures both had substantial psychometric evidence for use with infants, although observational coding may have limited utility in clinical practice. The classification systems have less empirical support for use with infants, and further research is necessary to demonstrate the appropriateness of these procedures with infants. Utilizing the reviewed procedures to assess behavioral and emotional problems in infants can have a substantial impact in research and practice settings, and further research is needed to determine the usefulness of these procedures in developing, testing, and implementing preventive and early intervention programs for infants and their families.     

Callous-unemotional traits and conduct problems in the prediction of conduct problem severity,aggression, and self-report of delinquency

The role of callous-unemotional (CU) traits and conduct problems in predicting conduct problem severity, severity and type of aggression, and self-reported delinquency at a 1-year follow-up was investigated in a sample of 98 children (mean age 12.43; SD = 1.72) recruited from a community-wide screening. Children with both CU traits and conduct problems had a greater number and variety of conduct problems at follow-up than children who at the screening had high levels of conduct problems alone. However, this poorer outcome for children with CU traits could largely be accounted for by differences in initial level of conduct problem severity. Children with CU traits and conduct problems were also at risk for showing higher levels of aggression, especially proactive aggression, and self-reported delinquency. Importantly, these outcomes could not be solely explained by initial level of conduct problem severity. Finally, CU traits predicted self-reported delinquency in some children who did not initially show high levels of conduct problems and this predictive relationship seemed to be strongest for girls in the sample who were high on CU traits but who did not show significant conduct problems.     

Examining the relationship between performance-based and questionnaire assessments of executive function in young preterm children: Implications for clinical practice

The aim of this study was to determine whether specific performance-based executive function assessment tools were associated with executive functioning in everyday life as reported by parents and teachers of four- to five-year-old preterm and term children. At the age of 4 years, 141 preterm children born <33 weeks’ gestation and 77 term children were assessed using performance-based intelligence (WPPSI-III) and executive function (EF) assessment tools (NEPSY-II, Day-Night and Shape School tasks). The assessment results were compared with the parent and teacher completed questionnaires of EF (BRIEF-P) when the children started kindergarten at the age of 4 to 5 years. The performance-based intelligence and EF assessment results were not consistently associated with the parent and teacher reports of EF in everyday life for either preterm or term groups. Clinical implications of using and interpreting performance-based EF assessment tools and EF questionnaires are discussed with a particular focus on young preterm children at the commencement of formal schooling.     

Sidney Blatt's Contributions to Personality Assessment

Over a long, distinguished career, Sidney Blatt contributed to theory and research in personality development, personality assessment, and psychotherapy. Best known for his 2-configurations model of personality and author or co-author of more than 250 articles and 18 books and monographs, Blatt was also a master clinician, a psychoanalyst who was awarded the 1989 Bruno J. Klopfer Award by the Society for Personality Assessment (SPA) for his contributions to both self-report and performance-based assessment. He was also the president of SPA from 1984 to 1986. This special series contains papers by writers who participated in all aspects of Blatt's contributions to personality assessment, both self-report and performance-based. Topics covered include Blatt's 2-configurations model of personality, development, and psychopathology; boundary disturbance and psychosis in performance-based assessment; the interaction of gender and personality on narrative assessments; and the Object Relations Inventory and differentiation relatedness, especially as these relate to therapeutic outcome.     

Measuring Parenting in Community and Public Health Research Using Brief Child and Parent Reports

The use of multi-method, multi-informant assessment is a hallmark of research in child development and mental health; however, many research strategies such as population surveys require brief assessment tools. The Alabama Parenting Questionnaire (APQ) is a popular measure of empirically identified aspects of positive and negative parenting styles important to conduct problems in children. A brief version exists, however it does not measure all relevant parenting domains, and it has not been validated for child reports. We evaluated validity of the brief parent and child report version of the complete five subscale version of the APQ in a sample of 208 children aged between 9 and 17, at risk for conduct problems and antisocial behaviour. The results showed that all five dimensions of parenting can be measured using a brief 15 item version; specifically child and parent reports converged as expected and discriminated high from low conduct problem children using parent and teacher reports. Only child reports converged with independent observations of parenting behaviour, supporting previous research showing that child reports of parenting are particularly important. Finally, results did not support the typical methods used for combining child and parent reports into one index.     

Thinking around the corner: the development of planning abilities

The ability to plan and search ahead is essential for problem solving in most situations in everyday life. To investigate the development of planning and related processes, a sample of four- and five-year-old children was examined in a variant of the Tower of London, a frequently used neuropsychological assessment tool of planning abilities. The applied problems either required searching ahead for optimal solution or were solvable by pure step-by-step forward processing. Furthermore, the ambiguity of subgoal ordering was varied.Results revealed an age-related effect of search depth: the four-year olds’ planning accuracy was particularly decreased in problems demanding search ahead, while five-year olds mastered both problem types equally well. Interestingly, this interaction between age and search depth could not be accounted for by measures of working memory and inhibition. Differential effects of age were also found for subgoal ordering with respect to initial planning and movement execution times. In sum, planning abilities showed considerable development during late kindergarten age that appeared to be specifically associated with the integration and back-validation of the anticipated consequences of internally modeled actions. The present study demonstrates that a careful consideration of problem structure may greatly enhance the insights gained from the application of a routinely used assessment tool, the Tower of London. This may be especially advantageous when addressing specific subpopulations such as children or clinical samples.