Exploring Child and Parent Factors in the Diagnostic Agreement on the Anxiety Disorders Interview Schedule

Worryingly low levels of parent–child agreement on child psychiatric diagnosis are reported. This study examined parent–child agreement on diagnostic categories and severity ratings with the Anxiety Disorders Interview Schedule, Child and Parents versions (ADIS-C/P). Children’s age, gender, motivation and self-concept and parent’s general psychopathology and diagnoses were examined. Participants were 110 children (aged 8–14 years) with a principal specific phobia diagnosis, and their parents. Findings revealed excellent parent–child agreement on principal specific phobia diagnosis (97.3%), and fair levels of concordance on most co-occurring secondary diagnoses. As expected, children with high motivation had generally stronger parent–child agreement on diagnoses and severity ratings (for ADHD p?p?p?相似文献   

Do Parents and Overweight,Treatment-Seeking Youth Provide Similar Ratings of Youths’ Psychosocial Functioning and Fatigue?

Patterns of agreement between parent and child ratings of psychosocial functioning and fatigue in children with obesity were examined. Analyses demonstrated moderate agreement for social anxiety in elementary children and small agreement for social anxiety in adolescents. Results of analyses of overall quality of life revealed small agreement in children under the age of 8, large agreement in children ages 8–12, and moderate agreement in adolescents ages 13–18. Overall ratings of fatigue demonstrated moderate agreement both in elementary children and in adolescents. A meaningful relationship was found between each factor measured by a parent and a child. Patterns which were unexpected given the existing literature were found; possible hypotheses explaining these patterns are presented; and the need for further research is highlighted.     

Parent and child agreement on anxiety disorder symptoms using the DISC predictive scales

Growing recognition of the negative impact of anxiety disorders in the lives of youth has made their identification an important clinical task. Multiple perspective assessment (e.g., parents, children) is generally considered a preferred method in the assessment of anxiety disorder symptoms, although it has been generally thought that disagreement between parent and youth ratings of the child's emotions is common. This study examined parent and child reports of the child's anxiety disorder symptoms using the Diagnostic Interview Schedule for Children-Predictive Scales (DISC-PS) in a clinic-referred sample of substance using adolescents. Parents and adolescents (N = 480) who were referred for substance abuse treatment were screened for anxiety disorder symptoms using the DISC-PS at pretreatment. Results suggest similar (low) levels of agreement between the parent report and child report versions as found with other anxiety symptom and anxiety disorder measures. Findings provide data on multi-informant agreement and highlight issues in the use of the DISC-PS to identify anxiety problems in youth.     

Perfectionistic self-presentation in children and adolescents: development and validation of the Perfectionistic Self-Presentation Scale--Junior Form

Research on adults indicates that perfectionistic self-presentation, the interpersonal expression of one's perfection, is associated with a variety of psychopathological outcomes independent of trait perfectionism and Big Five traits. The current article reports on the development and evidence for the validity of the subtest score interpretations of an 18-item self-report measure of perfectionistic self-presentation for children and adolescents. Analyses conducted on data from two clinical samples and one nonclinical sample of children and adolescents found that the Perfectionistic Self-Presentation Scale--Junior Form (PSPS-Jr) reflected a multidimensional model of perfectionistic self-presentation with three subscales: Perfectionistic Self Promotion, Nondisplay of Imperfection, and Nondisclosure of Imperfection. The subscale scores were found to demonstrate internal consistency, and there was good evidence supporting the validity of the interpretation of subscale scores based on this new measure. The subscales were associated with maladaptive outcomes, but were not influenced unduly by biases that included social desirability and differential item functioning by gender. Overall, the PSPS-Jr appears to be a useful measure of the expression of perfection among youths and an important tool in attempting to understand the nature and the consequences of perfectionistic self-presentation in children and adolescents.     

Don’t be afraid of the General Factor of Personality (GFP): Its relationship with behavioral inhibition and anxiety symptoms in children

Two studies examined the relationship between the General Factor of Personality (GFP) and behavioral inhibition and anxiety symptoms in primary school children. The GFP is assumed to reflect effectiveness in interaction with others. In Study 1, using self-reports and parent ratings of 226 non-clinical children, we found GFP scores to be negatively related to behavioral inhibition and anxiety symptoms. In Study 2 we compared non-clinical children (N = 81) with children with anxiety disorders (N = 45). In both groups we obtained child and parent ratings. The clinically referred children scored significantly lower on the GFP than the non-clinical children. Moreover, as in Study 1, higher GFP scores were associated with lower levels of behavioral inhibition and anxiety symptoms. The two studies support the view that the GFP is a relevant construct in anxiety proneness and anxiety problems.     

Mother–Child Agreement on Reports of Internalizing Symptoms Among Children Referred for Evaluation of ADHD

The effects of maternal (bias), child (age, severity of behavior problems), and measurement characteristics (similarity of parent and child measures; types of internalizing symptoms) on mother–child agreement on reports of children's internalizing symptoms were examined for 65 children referred for evaluation of ADHD. Agreement was low and did not improve when parents and children completed parallel measures. Mothers and children were more likely to agree on severity of internalizing symptoms rated as behavioral than those rated as ideational. The majority of discordant reports were of the type that mothers, but not children, reported clinically elevated symptoms. This type of discordance appeared to be a function of maternal negative bias rather than underreporting of symptoms by children.     

A preliminary investigation of reaction time variability in relation to social functioning in children evaluated for ADHD

Reaction time variability (RTV) is a ubiquitous phenomenon in Attention-Deficit/Hyperactivity Disorder (ADHD). Few studies have examined RTV in relation to functional outcomes such as social impairment in children with ADHD. In this exploratory study, we investigated whether RTV is associated with social functioning in children at risk for ADHD. Specifically, we explored the association between RTV (tau derived from correct go trials of a Stop-Signal task) and social functioning in 198 children ages 7–12 years referred for an ADHD evaluation. Social functioning measures included child and/or parent ratings of social competence, aggression, social problems, and impairment in relationships. In regression analyses that also included Oppositional Defiant Disorder symptoms and sex, higher RTV was significantly associated with lower ratings of social competence, and higher proactive/reactive aggression ratings on the child self-report measures. RTV was not significantly associated with parent report of social functioning or relationship impairment. This study provides preliminary evidence that RTV may be associated with social functioning in children at risk for ADHD. We propose that lapses of attention affecting cognitive control may also negatively impact social information processing thereby affecting social functioning. Replication is warranted and longitudinal studies are needed to investigate whether RTV predicts social dysfunction in ADHD.     

A Multi-Informant Approach to Assessing Safety Behaviors among Adolescents: Psychometric Properties of the Subtle Avoidance Frequency Examination

Safety behaviors are subtle avoidance strategies for minimizing distress within social situations (e.g., avoidance of eye contact). These behaviors factor prominently in the development and maintenance of social anxiety concerns, and when patients use these behaviors within psychosocial treatments for social anxiety, this may impede treatment response. Prior work supports the need to include measures of safety behaviors within evidence-based assessments of social anxiety. Along these lines, researchers developed the Subtle Avoidance Frequency Examination (SAFE) to assess safety behaviors among adults. However, we know relatively little about the SAFE’s psychometric properties when administered to adolescents. We tested the SAFE’s psychometric properties using adolescent self-reports and parallel parent reports in a mixed-clinical/community sample of 96 14 to 15 year-old adolescents and their parents (33 clinic-referred; 63 community control; 59.4% African American). Adolescent and parent SAFE reports displayed moderate correspondence with each other. Both adolescent and parent SAFE reports related positively to well-established measures of adolescent social anxiety and depressive symptoms. Both reports distinguished adolescents on referral status as well as cut scores on well-established measures of adolescent social anxiety. Further, both adolescent and parent SAFE reports displayed incremental validity in relation to survey reports of adolescent social anxiety, over-and-above survey reports of adolescent depressive symptoms, which commonly co-occur with social anxiety. However, adolescent (but not parent) SAFE reports predicted adolescents’ social anxiety and state arousal as displayed within social interactions with unfamiliar peer confederates. These findings have important implications for leveraging multi-informant approaches to assessing safety behaviors among adolescents.     

Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5

The relationships between severity, chronicity, and timing of maternal depressive symptoms and child outcomes were examined in a cohort of 4,953 children. Mothers provided self-reports of depressive symptoms during pregnancy, immediately postpartum, and when the child was 6 months old and 5 years old. At the age 5 follow-up, mothers reported on children's behavior and children completed a receptive vocabulary test. Results suggest that both the severity and the chronicity of maternal depressive symptoms are related to more behavior problems and lower vocabulary scores in children. The interaction of severity and chronicity of maternal depressive symptoms was significantly related to higher levels of child behavior problems. Timing of maternal symptoms was not significantly related to child vocabulary scores, but more recent reports of maternal depressive symptoms were associated with higher rates of child behavior problems.     

Asthma severity, child security, and child internalizing: using story stem techniques to assess the meaning children give to family and disease-specific events

Children with persistent asthma are at increased risk for mental health problems. Although mechanisms of effect are not yet known, it may be that children are less trusting of the family as a source of support and security when they have more severe asthma. This study tested whether asthma severity is related to children's perceptions of insecurity in the family, and whether insecurity is in turn associated with child adjustment. Children (N = 168; mean age = 8 years) completed story stems pertaining to routine family events (e.g., mealtimes) and ambiguous but potentially threatening asthma events such as tightness in the chest. Responses were evaluated for the extent to which appraisals portrayed the family as responding in cohesive, security-provoking ways. Asthma severity was assessed by both objective lung function testing and primary caregiver report. Caregivers reported child symptomatology. Beyond medication adherence, caregiver education, and child age and gender, greater asthma severity predicted more internalizing and externalizing symptoms. Greater asthma severity, assessed using spirometry (but not parent report), was related to less secure child narratives of the family, which in turn related to more child internalizing symptoms. Results suggest that asthma can take a considerable toll on children's feelings of security and mental health. Furthermore, given the difficulty in assessing young children's perceptions, this study helps demonstrate the potential of story stem techniques in assessing children's appraisals of illness threat and management in the family.     

Psychometric properties of the screen for child anxiety related emotional disorders (SCARED) among elementary school children in Finland

Anxiety disorders are the most common mental disorders in children and youth. Effective screening methods are needed to identify children in need of treatment. The Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire is a widely used tool to assess childhood anxiety. We aim toevaluate the psychometric properties of the SCARED questionnaire, test the SCARED factor structure, and evaluate the prevalence of anxiety symptoms in a community sample of Finnish elementary school children, based on both a child and parent report. The sample included all pupils (n = 1,165) in grades 2 through 6 (ages 8–13) in four elementary schools in the city of Turku, Finland. Children completed a Finnish translation of the SCARED questionnaire at school, with one parent report questionnaire per child completed at home. In total, 663 child‐parent dyads (56.9%) completed the questionnaire. Internal consistency was high for both child and parent reports on all subscales (0.71–0.92), except for school avoidance (0.57 child, 0.63 parent report). Inter‐rater reliability ranged from poor to fair across subscales (intraclass correlation 0.27–0.47). Self‐reported anxiety scores were higher than the parent reported scores. Females had significantly higher total scores than males based on the child reports (p = 0.003), but not the parent reports. In the confirmatory factor analysis, hypothesized models did not have a good fit with the data, and modification was needed. The Finnish SCARED questionnaire has good internal consistency. Low child‐parent agreement calls for the importance of including both child and parental reports in the assessment of anxiety symptoms.     

Maternal and Paternal Perceptions of Social Competence in Children and Adolescents

We examined maternal and paternal perceptions of social competence in children and adolescents. One hundred forty-seven parents rated scenarios depicting children who varied in age, gender, and social competence. Parents also completed questionnaires assessing the amount of time they spend with their own children, their gender identity, their psychological symptoms, and their affectivity. Results indicated that the amount of time parents spend with their own children was related to maternal and paternal ratings, whereas affectivity was related to paternal ratings. In contrast, parents’ gender identity and psychological symptoms were unrelated to their ratings of social competence. Finally, there was an interaction between parent gender and the level of social competence depicted in the scenarios they rated, suggesting that there were differences in maternal and paternal ratings. These findings emphasize the importance of examining the perceptions of both mothers and fathers when assessing social competence in children and adolescents.     

Cultural differences in the relationship between parenting and children's behavior

Parent and teacher data for 14,990 children from the National Longitudinal Survey of Children and Youth were used in multilevel analyses to examine the relationship between ethnicity, children's aggression and emotional problems, and parenting. Using parent and teacher report, relationships between ethnicity and child behavior were present but modest. The association between parental harshness and child aggression differed between ethnic groups and across informants. Using teacher report of outcomes, parental harshness was positively related to child aggression in European Canadian families but negatively related in South Asian Canadian families. For all ethnic groups, parental harshness was positively related to children's aggression when parent report of outcomes was used, but relationships varied in strength across ethnic groups. The relationship of parental harshness with child emotional problems did not differ across groups, irrespective of informant. The results are discussed within the context of an ecological model of parenting.     

Anxiety symptoms in Japanese and in German children

The purpose of this study was to compare the frequency of anxiety symptoms and their association with gender and age in Japanese and German children using the Spence Children's Anxiety Scale (SCAS). A total of 1837 children (862 from Germany and 975 from Japan) between the age of 8 and 12 years were investigated. Results revealed that German children reported significantly higher symptoms of separation anxiety, social phobia, obsessive compulsive disorder, and generalized anxiety disorder than Japanese children. Conversely, Japanese children reported significantly higher scores on symptoms related to physical injury fear. In both countries, girls scored higher than boys on all the scales of the SCAS. Symptoms of separation anxiety and panic decreased with age, whereas social phobia increased with age. The findings underscore the impact of culture on children's anxiety.     

Anxious Solitude and Clinical Disorder in Middle Childhood: Bridging Developmental and Clinical Approaches to Childhood Social Anxiety

It was hypothesized that children identified by their peers at school as anxious solitary would report more symptoms of social anxiety disorder on a self report questionnaire and, on the basis of child and parent clinical interviews, receive more diagnoses of social anxiety disorder and additional anxiety and mood disorders. Participants were 192 children drawn from a community sample of 688 children attending public elementary schools. Half of these children were selected because they were identified as anxious solitary by peers and the other half were demographically-matched controls. 192 children provided self reports of social anxiety disorder symptoms on a questionnaire, and 76 of these children and their parent participated in clinical interviews. Results indicate that children identified by their peers as anxious solitary in the fall of 4th grade, compared to control children, were significantly more likely to receive diagnoses of social anxiety disorder, specific phobia, and selective mutism based on parent clinical interviews. Additionally, there was a tendency for these children to be diagnosed with generalized anxiety disorder and post traumatic stress disorder based on parent clinical interviews. Furthermore, children who had been identified as anxious solitary at any time in the 3rd or 4th grades were more likely than control children to report symptoms of social anxiety disorder that fell in the clinical range and to receive diagnoses of social anxiety disorder and dysthymia (both trends) and major depression (a significant effect) according to parental clinical interview.     

Social Anxiety in Children with Anxiety Disorders: Relation with Social and Emotional Functioning

Investigated the psychometric properties of the Social Anxiety Scale for children-Revised (SASC-R) as well as relations between social anxiety and children's social and emotional functioning. Participants were a clinic sample of children, ages 6–11 with anxiety disorders (N = 154) who completed the SASC-R. For a subset of these children, parent ratings of social skills, and self-ratings of perceived competence and peer interactions were also obtained. Factor analysis of the SASC-R supported the original three-factor solution and internal consistencies were in the acceptable range. Among children with simple phobia, scores on the SASC-R differentiated those with and without a comorbid social-based anxiety disorder. Social anxiety was also associated with impairments in social and emotional functioning. Specifically, highly socially anxious children reported low levels of social acceptance and global self-esteem and more negative peer interactions. Girls with high levels of social anxiety were also rated by parents as having poor social skills, particularly in the areas of assertive and responsible social behavior.     

Familial Aggregation of ADHD Characteristics

Patterns of familial aggregation of ADHD symptoms in parents of ADHD and non-ADHD children were examined. Within the ADHD sample, symptom aggregation was examined as a function of biological relationship, parent and child gender, and children's comorbid diagnoses. Participants consisted of parents of 579 children with ADHD, Combined Type participating in the multimodal treatment study of children with ADHD and parents of 288 normal control participants. Adult symptoms of ADHD were measured by both self-report and report of a significant other. Results indicated that the parents of children with ADHD had higher ratings of inattention/cognitive problems, hyperactivity/restlessness, impulsivity/emotional lability, and lower self-concept than parents of children without ADHD on both self-report and other-report ratings. Within the ADHD sample of children, other-report ratings of inattention/cognitive problems and impulsivity/emotional lability were higher for biological parents compared to nonbiological parents whereas self-ratings were not related to biological status. These findings support previous research documenting familial aggregation of ADHD and appear to strengthen the hypothesis that there is a genetic contribution to ADHD.     

Modification of Cognitive-Behavioral Techniques in the Treatment of a Five Year-Old Girl with Social Phobia

Social phobia is a debilitating anxiety disorder that often goes undetected in young children, but can be effectively treated with cognitive-behavioral interventions. For children and adolescents, treatment usually includes education, social skills training, cognitive restructuring, relaxation training, and exposure. However, for very young children who present with social phobia, it is necessary to adapt treatment to the developmental level of the child. A case illustration demonstrates the way in which cognitive behavioral treatment (CBT) was modified for the treatment of a five year-old girl with social phobia. Several modifications were made, including utilizing novel exposure techniques and emphasizing parent management training in order to promote generalization of treatment gains outside of session.     

Child,mother, and father evaluations of depression in psychiatric inpatient children

The agreement among children and their parents in evaluating the children's depression was examined in 48 families. Newly admitted inpatient children (ages 6–13) and their mothers and fathers independently completed selfreport and interview measures to assess severity and duration of the children's depression. The results indicated that different measures of depression completed by the same rater (child, mother, or father) were highly intercorrelated. Yet there was little or no relationship between childmother and child-father ratings of the children's depression for the same or related measures of depression. Children independently diagnosed (DSM III) as depressed rated themselves and were rated by their parents as more depressed than nondepressed children. Even so, children consistently rated themselves as less depressed across the measures than did their parents. Parent ratings of the children's depression and the correspondence of child-parent ratings varied as a function of several child and family variables, including child IQ, gender, race, and family welfare status.This investigation was supported in part by a Research Scientist Development Award (1 K02 MH00353) to the first author from the National Institute of Mental Health and by a Clinical Research Center Grant for the Study of Affective Disorders (5 P50 MH30915-05) from the National Institute of Mental Health. The authors are grateful to the clinical research team of the Child Psychiatric Treatment Service.