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.     

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.     

Child and parent evaluations of depression and aggression in psychiatric inpatient children

This investigation examined the agreement between children and their parents on measures of depression and aggression. A total of 120 inpatient children (ages 7–13) and their mothers and fathers independently completed self-report and interview measures that focused on the children's dysfunction. Children and their parents differed in their ratings of each symptom area, with children providing significantly less severe ratings than their parents. Children who met DSM III criteria for major depression or conduct disorder were significantly higher in their ratings of depression and aggression than children without these diagnoses, as reflected in both child and parent ratings. Child and parent ratings correlated in the low to moderate range on measures of children's symptoms, whereas mother and father ratings correlated in the moderate to high range. The correspondence between children and parents did not vary as a function of symptom area (depression and aggression) or assessment format (self-report and interviews). The results suggest that children are able to rate the severity of their dysfunction, although they tend to provide lowerbound estimates than do their parents.     

Methodological considerations in the evaluation of the convergence of psychiatric diagnoses and parent-informant checklists

Psychiatric diagnoses and objective parent checklists are alternative ways to describe child adjustment problems. There has recently been interest in evaluating the degree of agreement or convergence between these sources of information. This paper addresses three issues neglected by researchers in this area. The appropriateness of the use of indices of sensitivity and specificity to describe the correspondence of diagnoses and checklist scores is questioned. Implications of failure to consider the reliability of diagnoses in interpreting diagnosis-checklist agreement are discussed. Also, possible parameters of diagnosis-checklist agreement that should be identified by researchers are reviewed. Suggestions for improving research in this area are offered.     

Presenting problems and assigned diagnoses among young Latino children with disruptive behaviors

It is unclear whether the behaviors that alert families to the need for services are those that classify children for the diagnoses they receive. This study describes the behaviors that Latina mothers from Cuba, Puerto Rico, and the Dominican Republic report to have induced them to seek services for their young children. Both qualitative and quantitative analyses were used. Results indicated that mothers most frequently cited behaviors that fell in the categories of Hyperactivity, Aggression/Temper Tantrums, and School Complaints as reasons for help seeking. Whereas aggression and self-injurious acts were most alarming to mothers, School Complaints appeared to be a strong motivator for help seeking. Children whose mothers cited school behavior as a reason for help seeking had significantly poorer global functioning and presented significantly higher care giving demands than peers. In addition, their mothers reported significantly more disciplinary laxity than the mothers of peers without School Complaints. Maternal narratives of children's behaviors moderately concurred with assigned diagnoses. Mothers overlooked inattentive behaviors in children with ADHD and reported much more aggression and oppositionality than might be expected from the number of diagnoses of ODD that were assigned.     

Overt and covert antisocial behavior: Child and family characteristics among psychiatric inpatient children

The present study examined child and family characteristics associated with overt and covert antisocial child behaviors. Child psychiatric inpatients (N=258, ages 6–13) were identified as high in overt and/or covert antisocial behaviors (e.g., aggression and stealing, respectively) based on a structured parent interview measuring antisocial behavior. Children were classified into four groups derived from the factorial combination of level of overt (high vs. low) and covert (high vs. low) antisocial behaviors. Analyses were made of the children's reactions to hostile and anger-provoking situations, deviant and prosocial child behaviors at home and at school, and family structure and organization. Children higher in overt antisocial behaviors were more negative, resentful, and irritable in their reactions to hostile situations and more aggressive at school. They came from families with significantly greater conflict and less independence among family members. Children higher in covert antisocial behavior participated in fewer social activities and were higher in anxiety; their families showed significantly lower family cohesion and organization and less of an emphasis on moral-religious values. The results suggest reliable differences in child and family functioning as a function of patterns of overt and covert antisocial behavior.     

Social skill performance among normal and psychiatric inpatient children as a function of assessment conditions

The present investigation examined the effects of varying the standard assessment conditions on performance of social skills among normal and psychiatric inpatient children. Sixty children (30 normals, 30 patients), ages 6–12, completed behavioral and self-report measures of social skills on two separate occasions. During the second assessment, half of the children received feedback and incentives for performance; the other half did not. The testing conditions consistently altered social skill performance. Children who received the incentives during assessment showed significantly higher levels of social skills, as reflected in concrete behavior (e.g. eye contact, facial expressions), and molar responses (e.g. giving compliments, responding to provocation). The results suggest that social skills performance varies considerably as a function of the assessment conditions. Training programs should not assume that persons do not have the responses in their repertoires merely because of low pretest performance unless more extensive efforts are made to evoke appropriate responses.     

Derivation and implications of MMPI cluster groups in clinically depressed inpatient females.

The purpose of this study was to subclassify clinically depressed patients based on a cluster-analytic examination of the MMPI. Subjects were 79 female inpatients with major depression. A cluster analysis of the MMPI validity and clinical scales resulted in three clusters labeled psychotic (287 MMPI profile), hostile (24 MMPI profile), and histrionic (32 MMPI profile) depression. The psychotic group exhibited the greatest depression as measured by the Beck Depression Inventory (BDI). The psychotic and hostile groups, however, did not differ on other associated aspects of depression, such as negative cognitions, nonassertiveness, or personality style. The hostile group reported the fewest physical difficulties and the most excessive alcohol use. The groups, however, did not differ on other aspects of depression history or presentation such as family history of depression or previous hospitalizations. A repeated measures ANOVA for the three cluster groups on the BDI at admission, discharge, and 6 months after discharge indicated that all groups showed improvement at discharge but that only the hostile depressive group continued to show improvement at the 6-month follow-up.     

Associations between parent perceived social cognitive factors and child objectively measured physical activity behaviors among preschool-aged children

Grounded in social cognitive theory (SCT), this study sought to examine whether parents perceived social cognitive factors regarding children's physical activity (PA) behaviors were associated with preschool children's moderate-to-vigorous PA (MVPA) levels. A total of 142 Hong Kong parent-child pairs from five preschools/childcare centers completed all assessments in the cross-sectional study. Children’s (42% girls; mean age = 4.52 ± 0.67 years) PA was measured through accelerometers. Parents (74% mothers; mean age = 37.38 ± 4.63 years) completed a paper-based questionnaire assessing the social cognitive factors on their children’s PA participation. The data were analyzed using latent variable structural equation modeling. Findings revealed that the model showed acceptable fit with the data: χ² (23) = 38.14, p = .025, χ²/df = 1.66, CFI = 0.955, TLI = 0.929, RMSEA = 0.068, 90% CI [0.025, 0.106], and SRMR = 0.072. The model accounted for 39.1% of the variance in the PA behavior of preschool-aged children. Structural equation modelling revealed parental self-efficacy (β = 0.29, 95% CI [0.95, 0.49]) and goal setting (β = 0.25, 95% CI [0.06, 0.44]) were directly associated with children’s MVPA. Outcome expectations (β = 0.09, 95% CI [0.01, 0.03]) and goal setting (β = 0.18, 95% CI [0.05, 0.32]) mediated the association between parental self-efficacy and children’s MVPA. Indirect associations of parental self-efficacy from setting goals via parental support (β = 0.15, 95%CI [0.02, 0.30]) and perceived barriers (β = 0.15, 95% CI [0.05, 0.28]) were uncovered. Results supported the use of SCT in understanding how the parents perceived social cognitive factors predict the PA behaviors of young children. This study provides insight into whether these theoretical variables could be modified or promoted in future intervention programs. Enhancing parents’ abilities to ensure preschool-aged children are physically active is of great importance given the global decline in PA among children.     

Convergence among measures of interpersonal attraction

The purpose of this research was to determine whether Rubin's (1970) Liking and Love scales, the Interpersonal Jealousy scale of Mathes and Severa (1981), and a measure of sexual attraction, the Sexual Attraction scale, measure the same or independent dimensions of interpersonal attraction when applied to same- and opposite-sex friends rather than dating partner. It was found that the Liking and Love scales appeared to measure the same dimension of interpersonal attraction. However, this dimension was independent of the dimension measured by the Interpersonal Jealousy scale and the dimension measured by the Sexual Attraction scale. The latter two dimensions were also independent of each other.     

The influence of parent conflict style on children

Families constantly manage tension between autonomy from and connection to family members (T. C. Sabourin, 2003). Family conflict is an important maintenance behavior where this tension often plays out. Specifically, we hypothesized that the negotiation of family conflict between parents and children will be an important factor in the willingness of a young adult child to identify with family. Using a sample of young adults from 2 U.S. locations, regression analysis indicated that conflict styles mediated the association between family communication patterns and shared family identity. Specifically, the level of conformity orientation within the family emerged as moderator of the pattern of mediation. Additionally, findings suggested the avoiding conflict style may be particularly detrimental to shared family identity.     

The sleep patterns and problems of clinically anxious children

Childhood sleep problems have been associated with a range of adverse cognitive and academic outcomes, as well as increased impulsivity and emotional disorders such as anxiety and depression. The aim of the study was to examine subjective reports of sleep-related problems in children with anxiety disorders during school and weekend nights. Thirty-seven children with clinically-diagnosed anxiety disorders and 26 non-clinical children aged 7-12 years completed an on-line sleep diary to track sleep patterns across school nights and weekend nights. Anxious children reported going to bed significantly later (p = 0.03) and had significantly less sleep (p = 0.006) on school nights compared to non-anxious children. No significant differences in sleep onset latency, number of awakenings or time awake during the night, daytime sleepiness, or fatigue were found between the two groups. On the weekends, anxious children fell asleep quicker and were less awake during the night than on weeknights. School-aged anxiety disordered children showed a sleep pattern that differs from their non-anxious peers. Although the mean 30 min less sleep experienced by anxious children may initially seem small, the potential consequences on daytime performance from an accumulation of such a sleep deficit may be significant, and further investigation is warranted.     

Mental health policy and the psychiatric inpatient care of children

Recent changes in psychiatric inpatient treatment of children and youth are placed in the more general context of, first, the inpatient treatment of adults and, second, multiple public policies affecting children. For adults, the experimental evidence shows that the majority of psychiatric inpatients could be treated in programs outside the hospital more effectively and less expensively. For children, no such data base exists. Contrary to policy intent, between 1980 and 1985 inpatient care of children and youth increased substantially in residential treatment centers, private psychiatric hospitals, and scatter hospitals (general hospitals without any formal specialized units). Thus, psychiatric inpatient care of children and youth is increasing, dramatically so at largely uninvestigated and more expensive sites. The failure of children's mental health policy is placed in the context of the multiple policy failures for children regarding health, welfare, education, and housing. Recent positive efforts by federal agencies are described, but the need is great for data on efficacy and cost-effectiveness of inpatient treatment of children.     

MMPI and Rorschach indices of schizophrenic and depressive diagnoses among adolescent inpatients

Although adolescent norms have been developed for the MMPI (e.g., Marks, Seeman, & Haller, 1974) and Rorschach (e.g., Exner, 1986a), little is known regarding the discriminate diagnostic validity of these measures with adolescents. This study investigated the usefulness of these measures in the detection of depression and schizophrenia among adolescent inpatients. Subjects (mean age = 15.3) consisted of 134 adolescents who received Rorschach and MMPI administrations at hospital admission. Clinical diagnoses resulted in the following groupings for this sample: schizophrenia = 15, dysthymic disorder = 41, major depression = 26, conduct disorder = 28, personality disorder = 18. MMPI scale Sc elevation was found to be the most effective single predictor of schizophrenic diagnoses, with a hit rate of .76, sensitivity of .62, and specificity of .78. Neither MMPI scale D scores nor Rorschach DEPI scores were found to be significantly related to patients' diagnoses. Results were interpreted in terms of prior findings in adult psychiatric populations and in relation to implications for the clinical assessment of adolescents.     

Retest stability of DSM-III-R diagnoses among adolescents using the diagnostic interview schedule for children (DISC-2.1C)

Retest stability of DSM-III-R diagnoses was assessed using the DISC-2.1C with a sample of Anglo, African, and Hispanic American adolescent patients 12 to 17 years of age. Based on the kappa statistic, retest stability was fair for any disorder ( =.50), for any anxiety disorder ( =.44), for any affective disorder ( =.53), for any disruptive behavior disorder ( =.58), and for substance use disorders ( =.46). Although there was a trend for reliability to be somewhat higher for African Americans ( =.58) than for Anglos ( =.42) or Hispanics ( =.49), these differences were not statistically significant. In general, 15- to 17-year-olds had somewhat better reliability ( =.58) than did 12- to 14-year-olds ( =.44). Males had somewhat higher reliability ( =.63) than females ( =.43). These findings are congruent with those reported recently using the DISC-R (Schwab-Stone et al., 1993) and suggest that the DISC appears to be at least as reliable as other available child diagnostic instruments. In view of the fair-to-moderate levels of reliability of these instruments in general, future research should focus on the joint effects of instrument, subject, interviewer, and nomenclature on operating characteristics of diagnostic interview schedules, focusing in particular on factors affecting accurate recall and reporting of symptoms and episodes. This research was supported in part by grants MH44214 and MH44773 from the National Institute of Mental Health, and by the Hogg Foundation for Mental Health. The authors wish to acknowledge the participation and collaboration of A. J. Pumariega, J. W. Swanson, and C. E. Holzer III and staff of the Center for Cross-Cultural Research, directed by F. M. Treviño.     

Longitudinal relations among school context,school-based parent involvement,and academic achievement of Chinese American children in immigrant families

Immigrant families face multiple barriers to engaging with children's schools. Yet, school-based parent involvement has been associated with academic and behavioral benefits for children of immigrant families. Although past research has examined links between family contextual factors and parent involvement, less is known about the links between school contextual factors and parent involvement in immigrant families. Identifying socio-cultural barriers to parent involvement across home and school contexts can inform culturally competent family engagement interventions serving immigrant families. In a two-wave (1.5 years apart) longitudinal study of a community-based sample of Chinese American children (N = 210, beginning age = 5.8–9.1 years) attending over 80 schools in a metropolitan area, we assessed school-based parent involvement behaviors and parent involvement-related psychological processes (i.e., parent-teacher relationship quality, parents' endorsement of schools, teachers' perceptions of parents) using parent and teacher report. First, results indicated that significant positive associations were found between school-based parent involvement behaviors and parent involvement-related psychological processes (rs = 0.36–0.53). Next, multi-level modeling was conducted to test concurrent relations of Wave 1 school contextual factors to all four parent involvement constructs (controlling for family-level factors), as well as testing the prospective relations of parent involvement at Wave 1 to children's academic achievement at Wave 2. Student body diversity of schools was negatively associated with school-based parent involvement (rs = −0.18, −0.17), parent-rated parent-teacher relationship quality (r = −0.18), and parents' endorsement of schools (r = −0.36). The concentration of Asian students at schools and schoolwide achievement were negatively associated with teachers' perceptions of parents (rs = −0.18, −0.20). However, neither school contextual factors nor school-based parent involvement at Wave 1 uniquely predicted children's academic achievement at Wave 2. Implications of findings for understanding and addressing barriers to engaging Chinese American immigrant families in their children's schools are discussed.     

Predicting school performance of preschool children from parent reports

Parents of 391 preschool children ages 49 to 64 months completed a brief developmental inventory as part of a preschool screening program operated by an urban school district. The 28-item developmental inventory assessed adaptive behavior and language development. In addition, preschool children were administered the Minneapolis Preschool Screening Instrument. Teacher ratings of kindergarten performance the following year provided criterion data to validate the screening measures. Correlations with the overall teacher rating [the mean of nine ratings] were .40 for the adaptive behavior scale and .57 for the language scale. Validity figures for the developmental inventory were significantly higher for low SES than for high SES children, for older children [57 to 64 months] than for younger children [49 to 56 months], and for firstborn children than for younger siblings. No effects were found by sex. While a positive relationship between parent reports of developmental functioning and early school performance was clearly established, validity levels did not justify use of parent information as a sole source of preschool screening information.This research was supported in part by a grant from the Bureau of Education for the Handicapped.