The pediatric emotional distress scale: a brief screening measure for young children exposed to traumatic events

Introduced the Pediatric Emotional Distress Scale (PEDS), which was developed to quickly assess behaviors identified in empirical and theoretical literature as significantly elevated in children after experiencing traumatic events. The 21-item parent-report rating scale includes 17 general behavior items and 4 trauma-specific items. Factor analyses on the 17 items, with 475 two- to ten-year-olds (traumatic event exposure and nontraumatic event exposure), yielded 3 reliable factors labeled Anxious/Withdrawn, Fearful, and Acting Out. Factor and total scores were shown to have good internal consistency, and both test-retest and interrater reliability were at acceptable levels. Discriminant analyses demonstrated the PEDS could distinguish traumatic event exposure and nonexposure groups, although maternal education should be a significant consideration in interpretation. Future research with diverse populations who have documented trauma is needed to enhance the utility of the full PEDS scale.     

Format effects in two teacher rating scales of hyperactivity

The object of this study was to investigate the effect of differences in format on the precision of teacher ratings and thus on the reliability and validity of two teacher rating scales of children's hyperactive behavior. Teachers (N=242) rated a sample of children in their classrooms using rating scales assessing similar attributes with different formats. For a sub-sample the rating scales were readministered after 2 weeks. The results indicated that improvement can be made in the precision of teacher ratings that may be reflected in improved reliability and validity.This research was supported by grants from the Spencer Foundation and the National Institute of Mental Health (MH 29495). A somewhat different version of this paper was presented at the annual convention of the American Educational Research Association, Toronto, Canada, March 1978. The author thanks Nadine Lambert and Leonard Marascuilo for their assistance in the preparation of this paper.     

A behavioral observation method for differentiating hyperactive and aggressive boys

This study employed a playroom observation technique to examine the behavioral differences between hyperactive and aggressive boys. Subjects were clinic-referred boys assigned to Hyperactive, Aggressive, or Hyperactive plus Aggressive goups on the basis of behavior checklists and ratings of psychiatric chart information. While significant discrimination was obtained in all three settings (free play, restricted play, and restricted academic), behavioral differences among the subject groups were most pronounced during the restricted academic period. Discriminant function analysis for the restricted academic period resulted in accurate classification of 86% of the subjects as hyperactive, aggressive, or hyperactive plus aggressive. The present findings suggest that children with externalizing disorders can be distinguished in light of their observed clinic behavior in the restricted academic setting.This was conducted as part of the author's dissertation. The author wishes to express thanks to Jan Loney, Richard Milich, and Richard Roberts for their assistance in completion of this study and preparation of this article.     

Convergence between statistically derived behavior problem syndromes and child psychiatric diagnoses

The relations between scores on statistically derived behavior problem syndromes and DSM-III diagnoses were examined for 270 clinically referred children aged 6 through 16. Each child's parent completed the Child Behavior Checklist (CBCL) and was administered the NIMH Diagnostic Interview Schedule for Children (DISC)-a structured interview covering DSM-III diagnostic criteria. Numerous behavior problems scales scored from the CBCL were significantly related to one or more diagnoses. The strongest relations were between scores on the Hyperactive, Delinquent, and Depressed scales and diagnoses of Attention Deficit Disorder, Conduct Disorder, and Depression/Dysthymia, respectively. This convergence supports the validity of some syndromal constructs common to both assessment paradigms.This research was supported in part by NIMH grant no. MH37372 and by NIMH contract no. RFP-DB-81-0027. The first author is supported by a Faculty Scholar's Award from the William T. Grant Foundation. The authors wish to thank Tom Achenbach and Russ Barkley for their valuable comments on an earlier draft.     

Eighteen month test-retest stability of the youth self report in a sample of Catalonian adolescents

The aim of this study is to assess the test-retest stability of the Spanish version of Youth Self Report after 18 mo. for a sample of 357 Catalonian high school students (158 boys and 199 girls). At Time 2 the girls' scores increased on Delinquent and Aggressive Behavior scales and, therefore on Externalizing scores. At Time 2 the boys' scores increased on Attention Problems and Delinquent Behavior and decreased on Anxious/Depressed, Social Problems, and Internalizing scales. Significant differences in the remaining scales were not observed. The test-retest intraclass correlations for the broad-band scales ranged between .62 (Internalizing) and .68 (Externalizing) and for the narrow-band scales between .37 and .67. The correlations for girls and boys were similar but slightly higher for girls on Anxious/Depressed and Thought Problems.     

A study of genetic and environmental effects on the co-occurrence of problem behaviors in three-year-old twins

The authors examined the genetic and environmental causes of the co-occurrence of problem behaviors in children. The analyses involved mother and father ratings of Oppositional, Withdrawn/Depressed, Aggressive, Anxious, Overactive, and Sleep Problems in 446 monozygotic and 912 dizygotic pairs of 3-year-old twins. Genetic factors contributed on average .150 (37.3%), shared environment .206 (51.2%), and nonshared environment .046 (11.4%) to the phenotypic correlations between the syndromes. Genetic and environmental factors caused different groupings. Internalizing and Externalizing groupings were indicative of nonshared environmental factors; clusters of problem behaviors with either the Aggressive or Anxious symptoms were most suggestive of genetic factors, and high scores on all syndromes indicated shared environmental influences.     

Behavioral and emotional problems among Chinese and American children: Parent and teacher reports for ages 6 to 13

This study compared behavioral and emotional problems reported by parents and teachers in Chinese urban and rural samples and demographically similar American samples. Parents of 469 6-to-13-year-old children of each nationality completed the Child Behavior Checklist (CBCL). Teachers completed the Teacher's Report Form (TRF). Cross-cultural differences were generally modest in magnitude. Chinese children scored higher on TRF Delinquent Behavior and Anxious/Depressed syndromes, and on Internalizing. American children scored higher on CBCL Aggressive Behavior and TRF Attention Problems syndromes. Boys exhibited more externalizing behaviors across both cultures. The mean correlation between parent and teacher ratings was .36 in the Chinese sample and .29 in the American sample, a nonsignificant difference. Findings indicate considerable similarity between problems reported for children in very different societies.This work was supported by NIMH grant MH40305 and by University Associates in Psychiatry, a nonprofit health service and research corporation of the University of Vermont Department of Psychiatry.The authors are grateful to David Jacobowitz and Catherine Howell for their help in the analyses.     

Context effects in the behavioral ratings of hyperactivity

It was proposed that parents of hyperactive children would observe more problems at home in some but not all home contexts. To test this hypothesis, parents of teacher-identified hyperactive and nonhyperactive children were asked to complete a context-specific behavioral rating scale (Werry, 1968). Hyperactive children were rated by their parents as changing activities, talking, interrupting, and exhibiting dependency more than nonhyperactive children. Furthermore, those differences between hyperactive and control children were observed primarily in the play and homework contexts.This research was supported by a National Institute of Mental Health Grant MH(32282).     

Agreement of parent and teacher rating scales with comprehensive clinical assessments of attention deficit disorder with hyperactivity

Forty-one clinic-referred children were given the DSM-III diagnosis of attention deficit disorder with hyperactivity (ADD/H) based on structured diagnostic interviews of the child and mother and on two teacher and two parent rating scales. The degree of agreement between diagnostic classification of ADD/H based solely on criterion scores on each rating scale and classification based on the comprehensive clinical assessments that included use of the same rating scaleswas assessed by comparing the ratings of the 41 children with ADD/H to those of 47 clinic-referred children given other diagnoses or no diagnosis. The accuracy of classification was highly similar across scales. Increasing the cutoff score increased the acing true positives. Using the point of intersection of these two curves to choose the optimal cutoff scores resulted in 70–75% accurate classification and 25–30% misclassification of children given clinical diagnoses of ADD/H. This rate of misclassification suggests that rating scales alone should not be used to classify ADD/H for most clinical and research purposes, especially because the method of comparison used in this study favored finding a high degree of correspondence.     

Factor Structure and Criterion Validity of Secondary School Teacher Ratings of ADHD and ODD

Attention-Deficit Hyperactivity Disorder (ADHD) is currently viewed as a heterogeneous disorder with two factors: inattention and impulsivity–hyperactivity. This conceptualization of ADHD is based primarily on research with children or samples that mix children and adolescents. To examine if the 2-factor ADHD model is appropriate for adolescents and if the ADHD factors are distinct from Oppositional Defiant Disorder (ODD) in adolescents, teacher rating data were collected for 2 samples of adolescents. The results of a confirmatory factor analysis supported the convergent and divergent validity of a model with separate but correlated factors for inattention, impulsivity–hyperactivity, and defiant behavior. Further evidence of construct validity was found when factor scores were examined relative to the criterion variables of academic performance and rule-breaking behavior. The results support the utility of teacher ratings of ADHD and ODD in the assessment of adolescents, and the applicability of the DSM-IV conceptualization of these disorders to adolescents.     

Rorschach correlates of sexual abuse: trauma content and aggression indexes

This study compared Rorschach records of nondissociative outpatients with histories of (a) definite sexual abuse (n = 22), (b) suspected but unconfirmed sexual abuse (n = 13), or (c) no sexual abuse (n = 43) on selected variables hypothesized to be associated with sexual abuse. As predicted, clients with definite sexual abuse scored significantly higher than clients known not to be sexually abused on Armstrong and Loewenstein's (1990) Trauma Content index (TC/R), with an effect size greater than 1 SD. Contrary to prediction, there was no significant difference in the frequency of their Aggressive Past (AgPast; Gacono & Meloy, 1994) scores. AgPast scores, however, did positively correlate with sexual abuse that was violent or sadistic. As a test of discriminant validity, we hypothesized that 2 Rorschach variables (PER and Sc) would be unrelated to sexual abuse. This was supported by our data. Although TC/R was strongly associated with the presence and severity of sexual abuse, it could not discriminate sexually abused from nonsexually abused clients with great accuracy. The TC/R score is 1 factor among many that can be used to assess the validity of clients' claims of past sexual abuse.     

Kinesthetic Cues in the Development of Time Concepts

The intent of this study was to document general behavioral correlates of cognitive impulsivity. Fourth-grade children were individually administered the Matching Familiar Figures (MFF) test, and the resulting measures (latency and errors) were correlated with a group administered scale of impulsivity, the Impulsivity Scale for Children (ISC) and eight teacher ratings evaluating the child on a series of different behaviors. No relationships existed between MFF measures and the ISC; and only one teacher rating correlated significantly with either MFF variable. This teacher rating (tendency to respond) was found to be the only discriminating teacher rating, and the high correlation between it and the MFF latency was explained because of the high task similarity between MFF requirements and the behaviors rated on “tendency to respond.” Cognitive impulsivity was not predicted by classroom behavior, implying that an individual's preferred conceptual tempo is not a part of a global impulsive behavior pattern but rather a relatively independent dimension of cognitive style. The questionable validity of the ISC was discussed for children of this age group, as was the significant correlation between Primary Mental Abilities (PMA) scores and the ISC scores.     

Rating Scales for the Assessment of Empathic Communication in Medical Interviews (REM): Scale Development,Reliability, and Validity

Empathy has been shown to affect the quality of care by enhancing the physician–patient relationship and promoting effective communication. In this study, the newly developed Rating Scales for the Assessment of Empathic Communication in Medical Interviews (REM), designed to assess empathy and confrontation in physician–patient interactions, were subjected to preliminary psychometric testing. Particular attention was paid to face validity, reliability, sensitivity, and practicality. A total of 118 volunteers were asked to assess transcribed interactions between physicians and a standardized patient using the REM. In order to assess the convergent validity of the REM, the Motivational Interviewing Treatment Integrity Code (MITI) and the Behavior Change Counseling Index (BECCI) were used. Factor analysis identified two subscales, reflecting empathy and confrontation. Interrater reliability coefficients for items ranged from r = .82 to .97; Cronbach’s alphas for the two subscales were .89 and .88, respectively. The convergent validity was supported by substantial correlations between the REM scores and the MITI scores and by significant correlations between the REM scores and the BECCI score. The REM demonstrated good psychometric properties suggesting the rating scales might be useful in clinical practice, research endeavors, and medical education. Further research is necessary to assess the test-retest reliability as well as the predictive validity of this instrument.     

Observations and ratings of tics in school settings

This paper describes the findings of a school-based tic assessment procedure (direct observations, teacher rating scales) for hyperactive children with comorbid tic disorder. Rates of motor tic frequency were found to be moderately stable across both days and school settings. Correlations between direct observations of tics and clinician rating scales were generally in the low to moderate range as were correlations between teacher and clinician rating scales. Overall rates of hyperactive/disruptive behaviors were not associated with rates of motor tic occurrence, and the behavioral symptoms of both disorders were also independent for specific intervals of time.This study was supported, in part, by a research grant from the Tourette Syndrome Association, Inc., and P.H.S. grant MH 45358 from the National Institute of Mental Health. The authors wish to thank Joyce Sprafkin for providing valuable clinical services related to the conduct of the school-based medication evaluations and Joseph Schwartz for assisting with the data analyses. We are particularly indebted to the families and teachers who made this study possible.     

Continuities in maternal reports and child behaviors over time in hyperactive and comparison groups

Maternal reports, observations of nursery and elementary school behavior, and teacher ratings of problems were available for hyperactive and control children who had participated in a longitudinal study. This paper examines consistencies in maternal reports and child behaviors over time, and their relationship to teacher ratings in elementary school. Maternal reports of infant sleep difficulties were related to maternal ratings of hyperactivity at 41/2 and 61/2 years. Maternal ratings of activity at 41/2 were predictive of 61/2-year ratings of hyperactivity and conduct problems. In addition, behavior in a research nursery at 41/2 predicted teacher ratings of problems and classroom behavior in grade two. Hyperactive preschoolers who left the table most during structured activities were more often out-of-seat and off-task in school. Controls who were more aggressive in the nursery were more disruptive in the classroom. These data indicate continuities in both maternal reports and child behaviors.Collection of follow-up data were supported by Grant No. MA-4505 from the Medical Research Council of Canada to Dr. Campbell and were collected when she was at McGill University and the Montreal Children's Hospital. Portions of these data were presented at the American Psychological Association, Washington, D.C., September 1976.     

Validity of the miami structured interview-1 for assessing type a behavior,competitiveness, and aggression in children

The validity of the Miami Structured Interview-1 for measuring Type A behavior in children was examined in 122 boys 8 to 16 years old. We assessed the relationship between interview ratings and Type A and factor analytically derived Type A component scores from the Matthews Youth Test for Health (MYTH), a teacher rating scale. The validity of interview ratings was initially supported by significant correlations with MYTH Type A scores for preadolescents rated by English teachers and adolescents rated by English and mathematics teachers. Principal-components analyses of the MYTH items revealed components we labeled competitiveness-leadership and impatience-aggression. Interview ratings were related to the competitiveness-leadership component from English and mathematics teachers of both age groups but not the impatience-aggression component. The implications of these findings and the strengths and limitations of the Miami Structured Interview-1 for preadolscents and adolescents are discussed.An earlier version of this paper was presented at the American Psychological Association 91st Annual Meeting, Anaheim, California, 1983. This research was supported by National Heart, Lung and Blood Institute Grant R01 HL23356, Cross-Cultural Determinants of Coronary Heart Disease Risk Factors in Preadolescents and Adolescents. We gratefully acknowledge the confidence and support shown by Dr. George Christakis, Principal Investigator of Grant R01 HL23356.     

Aggressivity,inattention, hyperactivity,and impulsivity in boys at high and low risk for substance abuse

Aggressivity, inattention, hyperactivity, and impulsivity are cardinal dimensions of externalizing behavior problems of childhood. They are diagnostic and clinical features of childhood disorders, and are thought to be linked to the subsequent development of adult disorders such as substance abuse (SA). Little is known, however, about the convergent and discriminant validity of these four constructs. We used multiple measures to develop indices of aggressivity, inattention, hyperactivity, and impulsivity in a sample of 10- to 12-year-old boys (N=183) with and without a family history of SA. Data were taken from mother reports, child reports, teacher reports, and laboratory tasks. The study aims were (1) to test the convergent and discriminant validity of aggressivity, inattention, hyperactivity, and impulsivity; (2) to examine whether the data were consistent with a model specifying the four constructs as indicators of one superordinate factor; and (3) to differentiate boys with and without a family history of SA in construct scores. The results supported the convergent and discriminant validity of the four constructs. Although discriminable, the constructs covaried strongly and were consistent with a model specifying them as indicators of a single superordinate factor. Boys with a family history of substance abuse scored higher than control boys on aggressivity, inattention, and impulsivity scores, but the groups did not differ on hyperactivity scores. The results are discussed in terms of the role of childhood behavior problems in vulnerability to SA.This work was supported by the National Institute on Drug Abuse grant No. DA 05605.     

Psychometric properties of the children's atypical development scale

The Children's Atypical Development Scale (CADS) is a 53-item rating scale designed to measure unusual behaviors in children. Principal-factor analysis on a clinic-referred and pediatric sample of 474 children resulted in a four-factor solution: Communication Deficits, Lability, Social Relatedness Deficits, and Preoccupation. The CADS is internally consistent and has adequate temporal stability. CADS factor scores were differentially associated with parent and teacher rating scales, IQ, and Continuous Performance Test errors. The scale shows promise as a clinical and research tool for assessing atypical behaviors associated with pervasive developmental disorder and other neurobehavioral disorders.This research was supported in part by a grant from the Smart Family Foundation. The authors are grateful to James P. O'Donnell, Catherine Lord, and Frank A. Zelko for their comments on an earlier draft.     

Reliability and concurrent relations between the teacher version of the child behavior profile and the conners revised teacher rating scale

A total of 104 disturbed boys aged 6–11 were assessed with the teacher version of the Child Behavior Profile and the Conners Revised Teacher Rating Scale (TRS). A subsample of 55 boys were reassessed with both measures at an interval of 1 week. For the teacher Profile, test-retest correlations averaged r=87 for eight behavior problem scales and r=91 for four adaptive functioning scales. Reliabilities were slightly higher for Externalizing scales (average r=.91) than for Internalizing scales (r=.80). Reliabilities averaged .94 for the Revised TRS. Correlations between the two measures indicated a strong correspondence between the three Externalizing scales of the Profile and the factor-based TRS scales. Specifically, Profile scales labeled Inattentive, Nervous-Overactive, and Aggressive correlated highly (p < .001) with TRS scales labeled Inattentive-Passive, Hyperactivity, and Conduct Problem, respectively. The Conners Hyperkinesis Index correlated highly with all three Externalizing scales of the Profile, particularly Aggressive (r=.82). Overall, these results support the reliability and concurrent validity of both measures.This research was supported by an NIMH Research Scientist Development Award (MH00403) to the first author and by NIMH grant number MH37372. The support of the William T. Grant Foundation is gratefully acknowledged. The authors are indebted to the students, teachers, and staff of PACE School for their cooperation. Tom Achenbach provided valuable comments on an earlier draft.     

The relationship of young adolescent Children's Depression Inventory (CDI) scores to their social and cognitive functioning

The relationship of young adolescents' scores on the Children's Depression Inventory (CDI) to subjective and objective indices of their social and cognitive functioning was examined. Subjects were 89 young adolescents (11–15 years old), their parents, and their social studies teachers. The correlations of adolescents' CDI scores with recent school grades, objective ratings of overt social behavior, and measures of adolescent social and cognitive competence as perceived by the adolescent, both parents, and the teacher were examined. CDI scores were significantly and negatively correlated with school grades, behavioral ratings of positive social communication, and adolescent, mother, father, and teacher perceptions of the adolescents' social and cognitive competence. The relationship of these findings to those of other CDI validity studies is discussed.This research was supported, in part, by the William T. Grant Foundation and the University of Georgia's Institute for Behavioral Research.