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.     

Distribution of DSM-II diagnoses in a child psychiatric setting

While DSM-II contains more diagnostic categories related specifically to children than did the earlier DSM-I, clinical utilization studies of the various categories have not been extensive. The present study reports data on the distribution of diagnoses of childhood disorders and analyzes relationships among several diagnostic categories and subject variables. Results indicate that clinicians are using a wide range of DSM-II diagnoses for childhood disorders, including some which were intended for use with adults as well as those which were designed specifically for children. Transient Situational Disorders and Behavior Disorders are assigned almost equally to two-thirds of the sample. Chi-square analyses revealed a relationship between diagnostic categories and subject variables of age and sex. These data suggest that boys, particularly between the ages of 6 and 13, are more frequently than girls categorized as Behavior Disorder, and that the Transient Situational Disorder category is overutilized for adolescents, both male and female.The authors are indebted to James H. Johnson for his valuable contributions in all phases of this study and to Peggy Louro for her assistance in data collection.     

Convergence of parent checklists and child psychiatric diagnoses

This study examined the correlation between the Childrens' Behavior Questionnaire by Rutter, Tizard, and Whitmore (1970) and clinical diagnoses in a total of 1,468 in-and outpatients. The following diagnoses were considered: conduct disorder, emotional disorder, mixed disorder of conduct and emotions, and the hyperkinetic syndrome. In general, correlations were low, but subscores indicating conduct or neurotic disorders had somewhat higher correlation with these respective disorders than the hyperactivity subscore. Sensitivity figures (i.e., percentage of true positives) were moderate to low, while specificity figures (i.e., percentage of true negatives) were high. It is concluded that convergence of parent checklists and child psychiatric diagnoses in unselected samples is only moderate.     

Marital discord and child behavior problems in a nonclinic sample

Mothers' evaluations of their marital relationship and of their children's behavior at home and teachers' ratings of the children's behavior in school were obtained using well-established measures. While an association was found between ratings of marital discord and children's problematic behavior, the relation was a fairly weak one. The present findings are discussed in comparison to the results of other research that has relied upon clinic samples and nonindependent ratings in examining the relation between marital and child problems. In general, it appears that different methodological procedures lead to quite different conclusions about the strength of the association between interparental conflict and child behavior problems.This work was supported in part by a grant from the Sigma Xi Scientific Society.     

Neurocognitive influences on health behavior in a community sample.

CONTEXT: Dominant models of individual health behavior omit biological variables entirely and are composed almost exclusively of social-cognitive and conative variables. Research from the neurosciences suggests a role for brain function in explaining behaviors that require active self-regulation for consistent performance. However, the association between brain function and health behavior is underexplored. OBJECTIVE: To examine the predictive power of executive function for 2 health risk behaviors and 2 health protective behaviors in healthy adults. DESIGN: A cross-sectional community sample (N = 216) of adults 20-100 years of age were administered a battery of neuropsychological tests and completed self-report questionnaires regarding their health practices. It was hypothesized that poor performance on neuropsychological tests tapping executive function would be associated with poor health behavior tendencies. RESULTS: Errors on the Stroop task were positively associated with health risk behavior and negatively associated with health protective behavior after controlling for demographics, education, and IQ. CONCLUSION: Executive function is associated with health behavior tendencies. If the association is causal, explanatory models of individual health behavior should be revised to account for individual differences in biologically imbued self-regulatory abilities.     

The relationship between acculturation and problem behavior proneness in a Hispanic youth sample: a longitudinal mediation model

This study, using secondary data analysis, examined prospectively a mediation model of the relationship between acculturation and problem behavior proneness among 330 Hispanic children and adolescents from an urban school district in the southwest region of the United States. Acculturation was predicted to have an indirect, but positive, relationship to problem behavior proneness through parental involvement and self-esteem. The results partially supported the model and indicated that parental involvement, but not self-esteem, played a significant mediational role in children's problem behavior proneness. The individual indicators of problem behavior proneness among Hispanic youth were significantly interrelated, which is consistent with problem behavior theory as conceptualized by R. Jessor (1984) and R. Jessor and S. L. Jessor (1977). Findings from this study provide implications for future research and intervention designs.     

The relationship of the Rorschach Schizophrenia Index to psychotic features in a child psychiatric sample

In this study we investigated the reliability and validity of the Rorschach Schizophrenia Index (SCZI) from Exner's (1978, 1993) Comprehensive System for a sample of 413 child psychiatric inpatients by examining relationships with the Personality Inventory for Children-Revised (PIC-R) and chart diagnoses. Interscorer reliability and internal consistency were acceptable. Multivariate analyses of variance results revealed significantly different PIC-R profiles for those with and without elevated SCZI scores, with significant differences emerging on the PIC-R Psychosis (PSY) scale and 2 cognitive triad scales (Intellectual Screening and Development), which have been reported to be more frequently elevated in PIC-R profiles of children with psychotic disorders. Significant differences were found across SCZI groups for the PSY scale, Reality Distortion scale, reality testing critical items and chart diagnoses of psychotic disorder. Implications for clinical interpretation of the SCZI with children and issues for further research with this population are discussed.     

Relations between child temperament and adolescent negative urgency in a high-risk sample

Negative urgency, rash action during negative mood states, is a strong predictor of risky behavior. However, its developmental antecedents remain largely unstudied. The current study tested whether childhood temperament served as a developmental antecedent to adolescent negative urgency. Participants (N = 239) were from a longitudinal study oversampled for a family history of alcohol use disorder (AUD). Negative emotionality (anger and sadness reactivity) and effortful control were measured in childhood (5–8) and negative urgency in adolescence (13–18). Childhood anger reactivity was uniquely related to later negative urgency above and beyond sadness reactivity. Effortful control was not related to later negative urgency; however, a latent variable capturing the shared variance between childhood effortful control and anger reactivity was related to later negative urgency.     

Sex differences in the reciprocal relationships between mild and severe corporal punishment and children's internalizing problem behavior in a Chinese sample

The study aimed to investigate the sex differences in the reciprocal relations between parental corporal punishment and child internalizing problem behavior in China. Four hundred fifty-four Chinese elementary school-age children completed measures of their parental corporal punishment toward them and their own internalizing problem behavior at two time points, 6 months apart. Structural equation modeling revealed that both parental mild and severe corporal punishment significantly predicted child internalizing problem behavior for girls, but only parental severe corporal punishment marginally predicted child internalizing problem behavior for boys; child internalizing problem behavior predicted both mild and severe corporal punishment for boys but not for girls. The findings highlight the important role of severity of corporal punishment and child sex in understanding the relations between parental corporal punishment and child internalizing problem behavior and have implications for the intervention efforts aimed at reducing child internalizing symptoms or parental corporal punishment in China.     

The normative development of child and adolescent problem behavior

The aim of this study was to identify normative developmental trajectories of parent-reported problems assessed with the Child Behavior Checklist (CBCL; T. M. Achenbach, 1991) in a representative sample of 2,076 children aged 4 to 18 years from the general population. The trajectories were determined by multilevel growth curve analyses on the CBCL syndromes in a Longitudinal multiple birth-cohort sample that was assessed 5 times with 2-year intervals. Most syndromes showed a linear increase or decrease with age or a curvilinear trajectory, except for thought problems. Trajectories for most syndromes differed for boys versus girls, except those for withdrawn, social problems, and thought problems. These normative developmental trajectories provide information against which developmental deviance in childhood and adolescence can be detected.     

Replication of empirically derived syndromes as a basis for taxonomy of child/adolescent psychopathology

To advance the empirical identification of child/adolescent syndromes, principal components analyses were performed on four sets of parents' ratings of 8,194 6- to 16-year-olds referred to American and Dutch mental health services. The following syndromes replicated well for both sexes at ages 6-16: Aggressive, Anxious/Depressed, Attention Problems, Delinquent, Somatic Complaints, and Withdrawn. For both age ranges, a syndrome designated as Socially Inept replicated well among boys, and one designated as Mean replicated well among girls. Evidence was also found for a Schizoid syndrome in all sex/age groups and a Sex Problems syndrome among girls at ages 6-11. Syndrome scores discriminated well between nationwide normative and clinical samples. The replicated syndromes contribute to the empirical basis for a taxonomy of the kinds of disorders commonly seen between the ages of 6 and 16.     

Six-year stability of parent-reported problem behavior in an epidemiological sample

An epidemiological sample of 936 Dutch children originally aged 4–11 years was assessed at 2-year intervals over a 6-year period. Parents completed the Child Behavior Checklist (CBCL) on all four occasions. Stability coefficients computed for eight CBCL syndromes, Internalizing and Externalizing dimensions, and total problems revealed considerable long-term stability. There was no significant difference in the 6-year stability of internalizing vs. externalizing scores. This finding was at odds with reports of considerably lower stability of internalizing behavior, and was consistent with findings suggesting that the stability of internalizing problems should not be underestimated. The magnitude and specificity of the long-term stability of internalizing and externalizing scores lends support to the validity of these behavioral dimensions as tapped by the CBCL. No significant sex or age differences in the stability of problem behaviors were found.     

Correspondence of teacher ratings and direct observations of classroom behavior of psychiatric inpatient children

The present investigation examined the correspondence of teacher ratings and direct observations of classroom behavior. Techers, extraclass raters, and observers completed standard rating scales and/or measures of overt classroom behaviors of psychiatric inpatient children (N=32). The study assessed if the correspondence between ratings and direct observations was influenced by who evaluates the child (teachers, raters) and the assessment format (general ratings, discrete behaviors). The results indicated that (1) measures from different assessors correlated in the low to moderate range, (2) data from extraclass raters corresponded more closely with direct observations than with data from teachers, (3) teacher and rater estimates of overt child behavior did not correlate more highly with direct observations than did standard rating scales, and (4) teachers and raters viewed child behavior as more appropriate than direct observations indicated. Measures from teachers, raters, and observers readily distinguished attention deficit disorder children with hyperactivity from their peers. However, teacher evaluations delineated these children more sharply than other assessors.Completion of this paper was facilitated by a Research Scientist Development Award (MH00353) to the first author from the National Institute of Mental Health.     

The relationship between personality organization and sexual life in a community sample of men

Contemporary object-relation theory of personality postulates that the level of severity of personality organization parallels the nature and extent of problems in the patient’s sexual life. The study aims at exploring the relationship between dimensions of Borderline Personality Organization (BPO) (as assessed according to Otto Kernberg’s model), sexual functioning, quality of sexual life and paraphilias in a community sample of men. One-hundred and thirty-six healthy men were asked to complete a set of questionnaires including the Inventory of Personality Organization (IPO), the International Index of Erectile Function, the Sexual Quality of Life Questionnaire, and a checklist to assess the prevalence of paraphilias. High scores on IPO subscales were significantly associated with low overall satisfaction in sexual functioning, low quality of sexual life, and the presence of paraphilias. Results expand previous findings on the relationship between features of BPO and core components of sexual life and support the need for an assessment of personality functioning in subjects reporting sexual problems.     

Prospective relationships between drug problems and work adjustment in a community sample of adults

The prospective relationships between drug problems and work adjustment (e.g., job instability, job satisfaction) were examined in a community sample of 470 adults. Polydrug problems (alcohol, marijuana, and cocaine problem drug use) were both predictors and consequences of work adjustment. In partial support of the impaired functioning theory, polydrug problems predicted reduced job satisfaction 4 years later. Supporting the work-related strain theory, early job instability predicted polydrug problems 4 years later. In support of the theory of general deviance, low social conformity predicted later job instability. Finally, supporting social support theory, early support for drug problems reduced polydrug problems and increased job satisfaction 4 years later.     

Family interaction and child outcome in a high-risk sample

This study hypothesized that the quality of family interaction would predict longitudinally children's follow-up functioning. The subjects were 97 boys, functioning on the average within the normal range but considered to be at risk for psychopathology because one parent had previously been hospitalized for psychiatric illness. Family measures of deviant and healthy communication and of activity, balance, and warmth related significantly to children's competent social/emotional/cognitive functioning at a 3-yr. follow-up. The findings suggest the importance of considering multiple predictors of outcome for children and of employing clinical interventions that attend to more than one aspect of family functioning.     

WASI profile variability in a sample of psychiatric inpatients

This study examined the variability of Wechsler Abbreviated Scale of Intelligence profiles using the subtest range and profile variability index in a sample of 70 psychiatric inpatients. The subtest range and profile variability index were correlated .93 (p<.001), indicating that either measure may be used to assess profile variance. Comparison of profile variability on this abbreviated scale with other Wechsler intelligence scales in similar populations suggests that variability measures are not comparable across the tests.     

Assessment of the influence of background noise on escape-maintained problem behavior and pain behavior in a child with Williams syndrome

We examined the influence of background noise on levels of problem behavior and pain behavior under functional analysis conditions for a child with a diagnosis of Williams syndrome and hyperacusis. Background noise was associated with increases in escape-maintained problem behavior and increases in pain behavior such as clasping ears and crying. When the child was fitted with earplugs, there were substantial reductions in both problem and pain behavior under the background noise condition.     

Exposure to community violence and trauma symptoms in late adolescence: comparison of a college sample and a noncollege community sample

This paper presents a comparison for two samples (college and noncollege) of older, urban African-American adolescents of correlations between two measures of exposure to community violence (victim and witness) and four types of psychological trauma symptoms (anger, anxiety, depression, and dissociation). The central issue is the generalizability of previous findings about these relationships obtained from beginning college students of traditional age. The two samples did not differ in the magnitude of either the zero-order correlations or the multiple correlations between the two types of exposure to community violence and the four types of symptoms of trauma. The conclusion is that findings regarding the relationship of exposure to community violence with psychological symptoms of trauma obtained from college students may tentatively be generalized to older adolescents who are not in college.