The use of laboratory and performance-based measures in the assessment of children and adolescents with conduct disorders

Provides a review of laboratory and performance-based assessment techniques that have been used in research with children who have severe conduct problems. Many of these techniques have proven useful for monitoring the effects of interventions, which seems to be their most immediate clinical use. With further development, several of these techniques have the potential for assessing clinically important processes that may be involved in the development and maintenance of conduct problems in youth, especially processes that may differ across subgroups of children with conduct disorders (CDs). The assessment of such processes could contribute to the development of individualized treatment plans for children and adolescents with CDs. However, a number of theoretical, methodological, and ethical issues limit the clinical utility of these laboratory and performance-based techniques in their current stages of development, especially in their contribution to making initial diagnoses of CDs. These limitations lead to very cautious recommendations for their clinical use.     

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.     

Assessment of depression in adolescents: objective and projective measures

This study is a multimethod assessment of depressive features in a sample of 60 adolescent inpatients. The purpose of the study was to examine the relationship between self-report measures of depression and Rorschach variables commonly associated with depression. Patients represented a variety of diagnostic categories in order to determine whether information gathered through assessment instruments was related to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III], American Psychiatric Association, 1980) diagnoses of depression. Findings indicated that this sample of adolescents was highly defensive and emotionally constricted. There were several significant relationships between self-report measures and Rorschach indicators of depression. However, in general, the Rorschach variables were not strongly related to depression. The self-report measures were more accurate than Rorschach variables in discriminating between depressed and nondepressed subjects.     

Medication treatment for depression in children and adolescents

Depression in children and adolescents is relatively common and associated with significant morbidity and mortality-thus, it is strongly deserving of treatment. To date, there have been a number of randomized, controlled trials of both tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) in the acute treatment of depression in youths. Surprisingly, the available data do not demonstrate TCA superiority over placebo for this disorder in this age group. There is, however, evidence of SSRI superiority to placebo, and longer-term treatment with SSRIs may help prevent recurrence. There is almost no data on other pharmacologic approaches. Effective use of the efficacious treatments also depends on effective case-finding and providing treatment, which families and youths will take in adequate quantity and duration. The right approaches to these aspects of effective treatment are greatly understudied.     

Comorbidity of anxiety and depression in children and adolescents.

Anxiety and depression in children and adolescents are reviewed, including differential diagnosis, assessment of symptoms, family history data, developmental features, and clinical correlates. Findings indicate that 15.9% to 61.9% of children identified as anxious or depressed have comorbid anxiety and depressive disorders and that measures of anxiety and depression are highly correlated. Family history data are inconclusive. Differences emerged among children with anxiety, depression, or both disorders. Anxious children were distinguishable from the other 2 groups in that they showed less depressive symptomatology and tended to be younger. The concurrently depressed and anxious group tended to be older and more symptomatic. In this group, the anxiety symptoms tended to predate the depressive symptoms. Findings are discussed in the context of a proposed developmental sequence.     

Sex differences in symptoms of depression among American children and adolescents

The Arabic Children's Depression Inventory in its English version was administered to a sample of 535 U.S. school students (11 to 18 years old). By sex, differences on total score and on 19 of 27 items (70.4%) were not statistically significant. Nevertheless, differences were significant for 8 (29.6%) items on which girls had higher mean scores. Half of the items were positive indicators of depression (I am sad, I feel lonely, I feel miserable, and I hate myself), while the other half were negative (I feel happy, Life is rosy, A lot of people like me, and I am optimistic).     

Facets of loneliness and depression among Chinese children and adolescents

The authors examined the relation among different facets of loneliness and depression in a sample of 6,356 Chinese children and adolescents from Grades 4-9. Loneliness and depression were closely related among the primary (Grades 4-6) and secondary (Grades 7-9) students, both boys and girls. Although the different facets of loneliness were predictive of the various facets of depression, peer-related loneliness and aloneness were more predictive of depression in both groups than was parent-related loneliness. The students in Grades 5 and 6 scored lower for loneliness but a little higher for depression than did the students in Grade 4. The students in Grades 8 and 9 scored higher than the students in Grade 7 for loneliness and depression. The primary boys scored higher than the primary girls for both loneliness and depression. Among the secondary students, there was no difference between the scores of the boys and those of the girls for loneliness, but the boys scored lower than the girls for depression.     

Personality and performance-based measures in the prediction of alcohol use

Research has demonstrated a variable relationship between alcohol consumption and self-report personality measures of novelty seeking and harm avoidance. Research has also demonstrated a relationship between performance-based measures of risk taking and substance use. The current study compared the utility of personality measures and performance-based measures in the prediction of alcohol use. The authors hypothesized that the domains would contribute uniquely and would also interact in the prediction of alcohol consumption. Data on alcohol consumption were collected on a daily basis for 2 weeks. Performance-based measures included the Bechara Gambling Task and the Balloon Analogue Risk Task. The Tridimensional Personality Questionnaire was the primary personality measure. Results partially supported hypotheses, in that personality measures showed strong relationships with alcohol use and interacted with performance-based measures in predicting alcohol consumption. Thus, both behavioral and personality measures contributed to prediction of alcohol consumption, and performance-based measures played a moderating role. Results suggest that a combination of behavioral and self-report personality measures may be useful for those screening groups for risk factors for excessive alcohol consumption.     

Effects of psychotherapy for depression in children and adolescents: a meta-analysis

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability.     

Association between anxiety and depression in children and adolescents with anxiety disorders

The relationship between anxiety and depression was examined in a sample of 106 children and adolescents referred to an outpatient anxiety disorder clinic for children. Twenty-eight percent of patients with DSM-III diagnoses of anxiety disorders displayed a concurrent major depression. Children with anxiety disorders plus major depression were found (1) to be older, (2) to demonstrate more severe anxiety symptomatology, and (3) to be diagnosed with different rates of certain anxiety-disorder subtypes, when compared to anxious patients without major depression. Nondepressed anxious children and adolescents did not differ from a psychopathological control group in severity of either anxiety or depression symptoms.     

Concordance of teacher-rated and performance-based measures of executive functioning in preschoolers

The most common method used to evaluate child behavior and functioning is rating scales completed by parents and/or teachers. Given that executive functioning (EF) plays a fundamental role in the developing child’s cognitive, behavioral, and social-emotional development, it would be ideal if ratings of EF and performance-based EF measures assess the same construct. However, most studies report a small to negligible association between performance-based measures and ratings of EF. There are few studies investigating this association for preschoolers, and most only include parent ratings. Teachers may be more reliable reporters of EF behaviors due to the higher demand for EF skills in the preschool setting than at home and because teachers may have a better sense of what behaviors are normative. In this study, we reviewed the associations between three EF rating scales completed by teachers on 243 preschool children. Results showed small to moderate correlations with EF measures of inhibition and cognitive flexibility/switching for all three scales, with the strongest associations observed between Child Behavior Rating Scale (CBRS) Behavioral Regulation subscale and child EF measures. Exploratory multivariate path analyses showed that, after controlling for age, sex, and socioeconomic status (SES), Behavioral Regulation significantly predicted performance-based measures of EF and accounted for incrementally more variance in the models. We conclude that in ideal situations, it is best to measure EF using both rating scales and performance-based measures of EF. The CBRS seems to be a sensitive measure of EF in preschoolers and may be a helpful brief screening tool for use with teachers.     

Religiosity,subjective well-being,and depression in Saudi children and adolescents

To explore the associations between religiosity and both subjective well-being (SW-B) and depression, a sample of 7211 Saudi school children and adolescents was recruited (2159 boys, 5052 girls). Their ages ranged from 11 to 18 years (M _age = 16.1, SD = 1.5 for boys; M _age = 15.6, SD = 1.9 for girls). They responded to five self-rating-scales of religiosity and SW-B, that is, happiness, satisfaction, mental health, and physical health, as well as the Multidimensional Child and Adolescent Depression Scale. It was found that males obtained significantly higher mean scores than their female counterparts on the religiosity and the SW-B self-rating-scales, whereas females obtained a significantly higher mean score on depression than their male peers. All the correlations among males and female were significant between religiosity and both SW-B rating scales (positive) and depression (negative). A principle components analysis was conducted. A high-loaded and bipolar factor was disclosed and labelled “Religiosity and well-being vs. depression.” In the stepwise multiple regression, the main predictor of religiosity in both sexes was satisfaction. In the light of the high mean score on religiosity, it was concluded that religiosity is an important element in the lives of the present sample of Saudi Muslim children and adolescents. Based on the correlations and factor analysis, it was also concluded that religious persons (in this sample) are happier, healthier, and less depressed.     

Monitoring psychotherapy with performance-based measures of personality functioning

In this commentary, I review a meta-analysis and three original research reports concerning the Rorschach (Exner, 2003; Rorschach, 1921/1942) and the Thematic Apperception Test (TAT; Murray, 1943) assessment in psychological treatment planning and outcome evaluation. The information in these four articles bears witness to the potential utility of performance-based personality assessment measures for this purpose. The strengths and limitations of the articles suggest several guidelines for future research designed to examine this Rorschach and TAT application including an emphasis on effectiveness studies, longitudinal data, integrated independent variables, observable dependent variables, sophisticated data analysis combining nomothetic and idiographic presentation, and the incremental contribution of performance-based measures to psychotherapy-related personality assessment.     

Parent-report and performance-based measures of executive function assess different constructs

A total of 405 children of 5–18 years of age were administered performance-based and parent-report measures of executive function (EF), and measures of motor, attention, reading, and mathematics performance. Attention, reading, and mathematics abilities were associated with a parent-report measure of EF. Reading and mathematics abilities were also associated with performance-based measures of EF, including the Animal Sorting, Inhibition, and Response Set subtests of the Developmental NEuroPSYchological Assessment-II. In contrast, motor functioning was only associated with performance-based measures of EF. Findings suggest that different constructs of EF are measured by parent-report versus performance-based measures, and that these different constructs of EF are associated with different neurodevelopmental processes.     

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.     

Development of handedness: comparison of questionnaire and performance-based measures of preference

Hand preference has been assessed primarily using questionnaires. This approach is difficult to use with children so researchers have frequently used observation of hand choice when children pick up and use tools. Recently we developed such a performance-based measure, the WatHand Box Test (WBT). Participants ranging in age from 2 to 24 years each completed the WBT and the Revised Waterloo Handedness Questionnaire. Analyses revealed a strong preference for the right hand across all age groups on both tests with no significant differences across age and a significant correlation between the two measures. These findings do not concur with other work showing children younger than six years exhibited a much smaller right-hand preference. The concordance between these two preference measures is consistent with our previous findings. However, the relatively small common variance explained in this relationship suggests that these two tests may reflect somewhat different components of preference.     

Evaluation of subclinical depression in children using self-, peer-, and teacher-report measures

This study reports on several classification issues utilizing the Children's Depression Inventory (CDI), the Child Behavior Checklist-Teacher Form (CBCL-T), and the Peer Nomination Inventory of Depression (PNID). The first sample contained 752 public school children in grades 5, 6, and 9. A second sample of 142 fifth-graders was included to have an additional PNID comparison group. Results revealed moderate correlations between the CDI and the CBCL-T and PNID. Use of multiple criteria for selecting children as depressed was discussed, and selection rates using multiple measures with either strict or lenient cutoff scores were given. Normative data on the PNID were evaluated, and it was suggested that norms for the PNID may not be generalizable to other samples. Finally, race and gender analyses showed that CDI scores for females were significantly higher than for males, whereas CDI scores for Hispanics were significantly higher than for non-Hispanic whites. However, Omega-squared analyses for these two variables showed this to be of little practical significance.     

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.