Differential predictive value of parents' and teachers' reports of children's problem behaviors: A longitudinal study

This study investigated the prediction of signs of disturbance in 946 children originally aged 4 to 11 years from the general population across a 6-year period. Parents' and teachers' ratings obtained via the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) were tested as predictors of (a) academic problems, (b) school behavior problems, (c) receipt of mental health services, (d) child's need for professional help, (e) suicidal behavior, and (f) police contacts. Total problem scores in the deviant range on the CBCL or TRF were significantly associated with poor outcomes 6 years later. The combination of deviant scores on both the CBCL and TRF was a powerful predictor of poor outcomes with 56% of the girls, and 36% of the boys with total problem scores in the deviant range on both instruments maladjusted 6 years later. The CBCL syndromes Attention Problems and Delinquent Behavior, and the TRF syndromes Delinquent Behavior, Somatic Complaints, and Social Problems significantly predicted poor outcomes. Teachers' reports predicted poor outcomes equally well or even somewhat better than parents' reports. It is important to include teacher information in the diagnostic assessment of children.We wish to thank Dr. Thomas Achenbach for his helpful advice. This research was supported by grants from the Sophia Foundation for Medical Research, and the Health Research Promotion Program.     

School competence and emotional/behavioral problems among Norwegian school children as rated by teachers on the Teacher Report Form

Of 1,409 eligible children aged 6-13 years in grades 1 to 7 who were randomly selected from a national sample of Norwegian schools, 858 participated in the present study (60.9%). The sample was stratified by school centrality, region and size of grade cohort. The teachers assessed their children's academic performance, adaptive school functioning, and levels of emotional/behavioral problems using the 2001 version of the Teacher Report Form (TRF). Only one child was randomly selected from each grade cohort. Girls had significantly higher scores than boys in the Working Hard, Appropriate Behavior, Learning, and Total Adaptive Functioning domains. For girls, only the Working Hard domain was of medium effect size. While boys had significantly higher scores than girls on Attention, Thought Problems, Rule-Breaking, Aggression, Externalizing Problems and Total problems, only Attention Problems showed a medium effect size. Significant sex by age interaction effects were also found for Rule-Breaking, Externalizing, Internalizing, Anxious-Depressed and Total Problems. In all these comparisons, 10-13-year-old boys had significantly higher scores than 6-9-year olds, while girls had similar problem levels across age groups. Our mean Total Problems score (17.2) was lower than the grand mean (21.6) reported in a multi-country comparison but higher than in another Norwegian large-scale survey. Overall, our findings indicate that teachers in Scandinavia report, just as do parents, relatively low levels of emotional/behavioral problems among school-aged children.     

The Autism Detection in Early Childhood Tool: Level 2 autism spectrum disorder screening in a NICU Follow-up program

ObjectiveChildren born preterm are at increased risk for autism spectrum disorder (ASD). However, early diagnosis of ASD is challenging because conventional screening Level 1 tools are less reliable in this population. We sought to determine whether the Autism Detection in Early Childhood (ADEC) and Child Behavior Checklist (CBCL) could accurately identify children at risk for ASD in a NICU Follow-up setting and thus facilitate referral for formal ASD evaluation.MethodChildren aged 18–36 months were recruited from a NICU Follow-up program. All children received presumptive diagnoses based on DSM-5 criteria and were screened for ASD risk with the ADEC and CBCL. Children scoring in the “at risk” range on either tool were referred for a full diagnostic ASD evaluation.ResultsSixty-nine patients (median birth weight 1140 g; median gestational age 28 weeks) were included with 18 designated “at risk” for ASD. Nine (13 %) scored “at risk” on the ADEC and 12 (17 %) on the CBCL. Thirteen children underwent diagnostic ASD evaluation with 9 receiving a formal diagnosis of ASD. The ADEC demonstrated the best performance (sensitivity 89 %, specificity 98 %). The CBCL was less sensitive (sensitivity 50 %, specificity 90 %). Requiring elevated scores on both the CBCL and ADEC was specific but not sensitive (sensitivity 33 %, specificity 100 %).ConclusionThe ADEC performed well in identifying children at risk for ASD within this high-risk NICU cohort, adding benefit as an autism-specific screening tool over the CBCL alone.     

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.     

Psychopathological Profile in Children with Chronic Tic Disorder and Co-existing ADHD: Additive Effects

The nature of the co-occurrence of chronic tic disorders (CTD) and attention deficit hyperactivity disorder (ADHD) is unclear. Especially in the field of psychopathology, the relationship of CTD and ADHD remains to be clarified. Thus, the aim of the present chart review study was to specify the contribution of CTD and/or ADHD to the psychopathological profile of the comorbid group (CTD+ADHD). The psychopathological profiles of four large groups (CTD-only (n=112), CTD+ADHD (n=82), ADHD-only (n=129), controls (n=144)) were measured by the eight subscales of the Child Behavior Checklist (CBCL) and analyzed by a 2×2 factorial design followed by contrasts. There were main effects of ADHD diagnosis on all but one subscale of the CBCL (Somatic Complaints). For CTD diagnosis, main effects were found for Attention Problems, Anxious/Depressed, Thought Problems, Social Problems and Somatic Complaints. The only interaction effect was seen for Somatic Complaints. While CTD and ADHD were both related to internalizing psychopathology of children in the CTD+ADHD group, ADHD had the largest effect on externalizing psychopathology in the comorbid group. At the level of psychopathology, an additive model for the co-occurrence of CTD and ADHD is strongly supported. In the comorbid group (CTD+ADHD), the ADHD diagnosis shows the strongest relation to externalizing psychopathology.     

Empirically based assessment of the behavioral/emotional problems of 2- and 3- year-old children

The aim was to determine whether ratings of 2- and 3-year-olds could yield more differentiation among their behavioral/emotional problems than the internalizing-externalizing dichotomy found in previous studies. The 99-item Child Behavior Checklist for Ages 2–3 (CBCL/2–3) was designed to extend previously developed empirically based assessment procedures to 2-and 3-year-olds. Factor analyses of the CBCL/2–3 completed by parents of 398 2- and 3-year-olds yielded six syndromes having at least eight items loading 30 and designated as Social Withdrawal, Depressed, Sleep Problems, Somatic Problems, Aggressive, and Destructive. Second-order analyses showed that the first two were related to a broad-band internalizing grouping, whereas the last two were related to a broad-band externalizing grouping. Scales for the six syndromes, two broad-band groupings, and total problem score were constructed from scores obtained by 273 children in a general population sample. Mean test-retest reliability r was 87, 1-year stability r was 69, 1-year predictive r with CBCL/4–16 scales at age 4 was 63, 2-year predictive r was 55, and 3-year predictive r was 49. Children referred for mental health services scored significantly higher than nonreferred children on all scales. A lack of significant r's with the Minnesota Child Development Inventory, Bayley, and McCarthy indicate that the CBCL/2–3 taps behavioral/emotional problems independently of the developmental variance tapped by these measures.This research was supported by March of Dimes Birth Defects Foundation Grants 12–88 and 12–186, a Faculty Scholars Award from the W.T. Grant Foundation, and a Biomedical Research Support Grant from the University of Vermont College of Medicine.     

Effects of a Peer Engagement Program on Socially Withdrawn Children with a History of Maltreatment

Children with a history of child maltreatment often have limited social interactions with other children and adults. This study examined the effects of a Peer Engagement Program, consisting of peer mentoring and social skills training with positive reinforcement, in three children with low levels of oral and social interaction. A multiple baseline, single-subject research design was used to test whether introduction of the intervention was associated with increased, directly observed oral interaction and engagement in social activities with peers and adults. The Child Behavior Checklist (CBCL) and the Social Skills Rating Scale (SSRS) were administered before and after intervention. All children showed increased levels of oral and social interaction and improved scores on the SSRS and the CBCL.     

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.     

The Children's Social Vulnerability Questionnaire (CSVQ): Validation,relationship with psychosocial functioning,and age-related differences

Background/Objective: Social vulnerability refers to difficulties detecting potentially harmful interpersonal situations. Although it is an important predictor of psychosocial and interpersonal difficulties in clinical samples, research investigating this construct is scarce. We aimed to (a) develop a brief measure for assessing social vulnerability in typically developing children, the Children's Social Vulnerability Questionnaire (CSVQ) (b) examine the relationship between social vulnerability and psychosocial functioning, (c) explore age-related differences, and (d) explore levels of social vulnerability amongst children with clinical needs. Method: Data were gathered on two samples. Participants were parents (n = 790) of elementary school-aged children (3-12 years), and parents and teachers of a second sample (n = 96). Results: Results provide strong reliability and validity evidence. Social vulnerability showed moderate relationships with emotional and behavioural problems, and only a weak relationship with social skills. Parents perceived greater social vulnerability in younger than older children, and amongst children with clinical needs. Parents’ and teachers’ scores were correlated. Conclusions: Social vulnerability is not simply a lack of social skill; rather, it is a valuable construct for understanding psychosocial risk, especially for young and clinical samples of children.     

Development of a Unified Protocol for the Treatment of Emotional Disorders in Youth

This study evaluated the efficacy of the Mind Reading interactive computer software to remediate emotion recognition deficits in children with autism spectrum disorders (ASD). Six unmedicated children with ASD and 11 unmedicated non-clinical control subjects participated in the study. The clinical sample used the software for five sessions. The control sample was evaluated only on pre- and post-test performance to assess practice effects. Results showed that participants with ASD scored significantly higher on the posttest than on the pretest. As level of emotion difficulty increased, mean scores on the pretest decreased, indicating that difficulty level had a valid effect. The Mind Reading computer software appears to significantly improve the emotion recognition abilities in children with ASD.     

Mutual eye gaze facilitates person categorization for typically developing children, but not for children with autism

Previous investigations of gaze processing in autism have demonstrated a pattern of intact and impaired performance. Although individuals with autism are capable of discriminating another’s gaze, they fail to interpret gaze direction, especially within the context of sociocommunicative (i.e., mentalistic) interactions. Extending this general line of inquiry, we explored whether typical children and children with autism spectrum disorder (ASD) were influenced by gaze direction in a task that demanded a core person-related judgment—namely, sex categorization. The results revealed that typically developing school-aged children were faster to classify faces by sex when targets displayed direct rather than averted gaze, or when the eyes were closed. This was not the case, however, for children with ASD, whose responses were unaffected by gaze direction. These findings suggest that difficulties in gaze processing in autism extend beyond sociocommunicative inferences to include basic person-perception judgments.     

An Abbreviated Screening Instrument for Autism Spectrum Disorders

The reliability and validity of the Parent's Observations of Social Interactions (POSI), a new, seven‐item screening instrument for autism spectrum disorders (ASD), is examined in two substudies. In Study 1, parents of 217 children (18–48 months) evaluated at a developmental clinic completed intake questionnaires that included the POSI and the Modified Checklist for Autism in Toddlers (M‐CHAT) checklist. POSI and M‐CHAT scores were compared to clinical evaluation results to assess reliability and validity. In Study 2, parents of 232 children (16–36 months) from both primary care and subspecialty settings completed the POSI, the M‐CHAT, and a report of their child's diagnoses. POSI and M‐CHAT scores were compared to reported diagnoses to assess reliability and validity. In both studies, the POSI demonstrated adequate internal reliability (Cronbach α = 0.83 and 0.86, respectively). In Study 1, POSI sensitivity (89%) was higher than that for the M‐CHAT (71%; p < .05); specificities were not significantly different (POSI: 54%, M‐CHAT: 62%). In Study 2, sensitivity (83%) compared favorably to that for the M‐CHAT (50%), although specificity was lower (75 vs. 84%). Despite its brevity, the POSI demonstrated good internal reliability and comparable sensitivity/specificity to the M‐CHAT checklist in two independent populations. If results are reproduced in larger, more diverse samples, the POSI may provide an efficient method for ASD screening in young children.     

Quantitative autism traits in first degree relatives: evidence for the broader autism phenotype in fathers, but not in mothers and siblings

Autism spectrum disorder (ASD) symptoms are present in unaffected relatives and individuals from the general population. Results are inconclusive, however, on whether unaffected relatives have higher levels of quantitative autism traits (QAT) or not. This might be due to differences in research populations, because behavioral data and molecular genetic research suggest that the genetic etiology of ASD is different in multiplex and simplex families. We compared 117 unaffected siblings and 276 parents of at least one child with ASD with 280 children and 595 adults from the general population on the presence of QAT using the Social Responsiveness Scale (SRS). Mean SRS scores for siblings, control children, parents and control adults were 25.4, 26.6, 33.7 and 32.9. Fathers of children with ASD showed significantly higher levels of QAT than controls, but siblings and mothers did not. We could not detect a statistically significant difference in SRS scores between relatives from simplex and multiplex families. These results do not support the theory of differential (genetic) etiology in multiplex and simplex families and suggest that a carried genetic risk is generally not expressed phenotypically in most relatives, except in fathers.     

Measurement Structure of the Turkish Translation of the Child Behavior Checklist Using Confirmatory Factor Analytic Approaches to Validation of Syndromal Constructs

The new correlated 8-factor measurement structure of the Child Behavior Checklist for ages 6-18 (CBCL/6-18; T. M. Achenbach & L. A. Rescorla, 2001) derived from an American sample was used as a benchmark to evaluate its generalizability to Turkish general population (N = 5,195) and clinical (N = 963) samples. Item-level confirmatory factor analysis (CFA) was used to evaluate the adequacy of the correlated 8-factor model across 3 sample conditions (general population, clinical, and combined sample whose Total Problems scores were above the Turkish national median). The results supported the generalizability of the overall measurement structure of the CBCL to the Turkish population.     

Children with autism spectrum disorder are more trusting than typically developing children

The current study examined whether children with autism spectrum disorder (ASD) had an indiscriminate trust bias whereby they would believe any information provided by an unfamiliar adult with whom they had no interactive history. Young school-aged children with ASD and their age- and ability-matched typically developing (TD) peers participated in a simple hide-and-seek game. In the game, an experimenter with whom the children had no previous interactive history pointed to or left a marker on a box to indicate the whereabouts of a hidden reward. Results showed that although young school-aged ASD children did not blindly trust any information provided by the unfamiliar adult, they appeared to be more trusting in the adult informant than did their age- and ability-matched TD children.     

The Child Behavior Checklist for Group Care Workers: A Study Regarding the Factor Structure

In this study we examined the factor structure of the Child Behavior Checklist (CBCL) filled out by group care workers. Group care workers' judgements were collected on 846 children and adolescents treated in various residential settings in The Netherlands. Using confirmatory factor analysis, we were able to show that the original CBCL factor model based on parental judgments of child behavior also fits for the judgments of group care workers. This means that the well known 8 narrow-band syndromes (Withdrawn, Somatic Complaints, etc.) as well as the 2 broad-band syndromes (Internalizing and Externalizing) can be used to interpret the CBCL scores of group care workers. This confirmation of the CBCL factor structure is a first step to add a group care worker version to the CBCL family. However, as a second step, normative data need to be gathered to further enhance the use of the CBCL for group care workers.     

Assessing ADHD and comorbid disorders in children: the Child Behavior Checklist and the Devereux Scales of Mental Disorders

Evaluated discriminant validity and clinical utility of selected subscales of the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) and the Child Behavior Checklist (CBCL; Achenbach, 1991a) in 228 children referred to a clinic for the evaluation and treatment of attention deficit hyperactivity disorder (ADHD). The DSMD is a multiaxial behavior rating scale that measures symptomatology for a broad range of child psychopathology as described in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-R-III] and 4th ed. [DSM-IV]; American Psychiatric Association, 1987, 1994). Discriminant function analyses as well as sensitivity, specificity, and predictive power analyses were computed to evaluate the discriminant validity and clinical utility of selected DSMD and CBCL subscales for assessing ADHD, oppositional defiant disorder (ODD), and anxiety disorders. Results indicated that the DSMD compared very favorably with the CBCL in the ability to discriminate between children with ADHD and those without ADHD and between children with comorbid ODD and anxiety disorders and children who did not meet criteria for these disorders. The DSMD Attention subscale may be somewhat better at ruling in ADHD combined subtype (ADHD-C) and ADHD inattentive subtype (ADHD-I) than the CBCL Attention Problems subscale, but the CBCL Attention Problems subscale may have slightly better utility than the DSMD Attention subscale in ruling out these subtypes. Both the CBCL and DSMD were more useful for ruling out than for ruling in ODD and anxiety disorders.     

The Lexical Stroop Sort (LSS) picture-word task: a computerized task for assessing the relationship between language and executive functioning in school-aged children

The relationship between language development and executive function (EF) in children is not well understood. The Lexical Stroop Sort (LSS) task is a computerized EF task created for the purpose of examining the relationship between school-aged children’s oral language development and EF. To validate this new measure, a diverse sample of school-aged children completed standardized oral language assessments, the LSS task, and the widely used Dimensional Change Card Sort (DCCS; Zelazo, 2006) task. Both EF tasks require children to sort stimuli into categories based on predetermined rules. While the DCCS largely relies on visual stimuli, the LSS employs children’s phonological loop to access their semantic knowledge base. Accuracy and reaction times were recorded for both tasks. Children’s scores on the LSS task were correlated with their scores on the DCCS task, and a similar pattern of relationships emerged between children’s vocabulary and the two EF tasks, thus providing convergent validity for the LSS. However, children’s phonological awareness was associated with their scores on the LSS, but not with those on the DCCS. In addition, a mediation model was used to elucidate the predictive relationship between phonological awareness and children’s performance on the LSS task, with children’s vocabulary fully mediating this relationship. The use of this newly created and validated LSS task with different populations, such as preschoolers and bilinguals, is also discussed.     

Harmonized Phenotypes for Anxiety,Depression, and Attention-Deficit Hyperactivity Disorder (ADHD)

In multi-cohort consortia, the problem often arises that a phenotype is measured using different questionnaires. This study aimed to harmonize scores based on the Child Behaviour Check List (CBCL) and the Strength and Difficulties Questionnaire (SDQ) for anxiety/depression and ADHD. To link the scales, we used parent reports on 1330 children aged 10–11.5 years from the Raine study on both SDQ and CBCL. Harmonization was done based on Item Response Theory. We started from existing CBCL and SDQ scales related to anxiety/depression and ADHD (theoretical approach). Next, we conducted a data-driven approach using factor analysis to validate the theoretical approach. Both approaches yielded similar scales, validating the combination of existing scales. In addition, we studied the impact of harmonized (IRT-based) scores on the statistical power of the results in meta-analytic gene-finding studies. The results showed that the IRT-based harmonized scores increased the statistical power of the results compared to sum scores, even with an equal sample size. These findings can help future researchers to harmonize data from different samples and/or different questionnaires that measure anxiety, depression, and ADHD, in order to obtain the larger sample sizes, to compare research results across subpopulations or to increase generalizability, the validity or statistical power of research results. We recommend using our item parameters to estimate harmonized scores that represent commensurate phenotypes across cohorts, and we explained in detail how other researchers can use our results to harmonize data in their studies.

     

Development of behavioural problems in children adopted from Romania to the Netherlands,after a period of deprivation

A longitudinal study was conducted among 72 Romanian adoptive children (41 boys, 31 girls) in the Netherlands, who, according to the parents and medical records, had all experienced a period of some degree of deprivation before their adoption. The children were on average 2 years and 9 months old at adoption. Parents filled out the Child Behavioural Checklist twice. On average there was little change in scores between the two measurements, and correlations were high. Some children displayed a marked improvement, or worsening of problems. The change in CBCL scores was not related to age or health on arrival into the adoptive family. Children who received special education at the first measurement (31%) improved significantly more on Total Problems than children who didn't. The same applied to professional help, the 46 children (64%) for whom professional help was engaged improved significantly more than the other 26 children. It appears to be effective to engage educational and psychological help for these (severely) deprived children at an early stage.