Concurrent Validity of the Child Behavior Checklist DSM-Oriented Scales: Correspondence with DSM Diagnoses and Comparison to Syndrome Scales

This study used receiver operating characteristic (ROC) methodology and discriminative analyses to examine the correspondence of the Child Behavior Checklist (CBCL) rationally-derived DSM-oriented scales and empirically-derived syndrome scales with clinical diagnoses in a clinic-referred sample of children and adolescents (N = 476). Although results demonstrated that the CBCL Anxiety, Affective, Attention Deficit/Hyperactivity, Oppositional and Conduct Problems DSM-oriented scales corresponded significantly with related clinical diagnoses derived from parent-based structured interviews, these DSM-oriented scales did not evidence significantly greater correspondence with clinical diagnoses than the syndrome scales in all cases but one. The DSM-oriented Anxiety Problems scale was the only scale that evidenced significantly greater correspondence with diagnoses above its syndrome scale counterpart —the Anxious/Depressed scale. The recently developed and rationally-derived DSM-oriented scales thus generally do not add incremental clinical utility above that already afforded by the syndrome scales with respect to corresponding with diagnoses. Implications of these findings are discussed.     

Maternal Depression,Maternal Expressed Emotion,and Youth Psychopathology

Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two predictors–maternal depression within the child’s lifetime and maternal EE–in a study of children at risk for depression. One hundred and seventy-one youth, ages 8–12, and their mothers participated. To assess maternal and youth psychopathology, dyads were administered structured diagnostic assessments, and mothers and children completed self-report measures of their own depressive symptoms. In addition, mothers completed the Achenbach Child Behavior Checklist–Parent Report Version (CBCL) for their children. Maternal EE was assessed based on the Five Minute Speech Sample. History of maternal depression was associated with high maternal EE, and the combination of maternal depression history and maternal EE was associated with children’s own reports of higher depressive symptoms. Current maternal depressive symptoms were associated with mothers’ reports of children’s Internalizing scores on the CBCL, and maternal depression history, current maternal depressive symptoms, and maternal EE were strongly associated with mothers’ reports of children’s Externalizing and Total Problem scores on the CBCL. History of maternal depression and a rating of high or borderline Critical EE (characterized by maternal critical comments and/or reports of a negative relationship) were independently associated with children’s depression diagnoses.     

The reliability and validity of the Turkish version of the brief infant–toddler social emotional assessment (BITSEA)

In this study the reliability and validity of the Turkish version of the brief infant–toddler social emotional assessment (BITSEA) were investigated in a community sample. The sample consisted of 462 children (mean age: 24.60 ± 7.93 [12–42] months) who had applied to Turkish health centers for immunization. Both parents completed the BITSEA; mothers completed the child behavior checklist 2/3 (CBCL). Internal consistencies of the BITSEA–problem (P) and competence (C) scales were good to excellent (Cronbach's α = 0.82 and 0.72, respectively). Interrater reliability between parents and test–retest reliability were good. BITSEA/P scores were significantly correlated with CBCL internalizing, externalizing and total problem scores (p < 0.001). Maternal BITSEA/P cutpoint scores revealed that 30.6% of male toddlers and 28.6% of females were in the subclinical range and 13.1% of males and 17.6% of females were in clinical range. Results reveal that the Turkish version of BITSEA is a reliable, valid and simply applicable instrument for screening social, emotional and behavioral problems among toddlers. Clinical validation of the BITSEA/C and BITSEA/P is warranted.     

Measurement Equivalence of the Child Behavior Checklist among Parents of African American Adolescents

The Child Behavior Checklist (CBCL/6-18) is a widely used parent-report measure of youth internalizing and externalizing problems. Accumulating evidence, however, suggests that the CBCL may not adequately assess clinical problems in diverse populations. We investigated the measurement equivalence (ME) of the CBCL in an African American adolescent sample (N = 145). Confirmatory factor analysis indicated poor factor model fit; however, modification indices and an alternative two-factor model produced improved fit statistics. Internal consistency coefficients of CBCL scales ranged from α = .65 to .88 and were generally lower than those reported for the normative sample. The CBCL exhibited convergent validity with conceptually similar scales on the Parent Report Scale of the Behavior Assessment System for Children; however, the correlations were weaker than those reported for the normative sample. The CBCL Internalizing composite failed to predict clinician-rated Emotional problems, however, the Externalizing composite predicted clinician-rated behavior problems. In summary, the CBCL did not exhibit unequivocal evidence of ME, as it both possesses and lacks a number of statistical attributes that would demonstrate its equivalence with African Americans. Future empirical and theoretical work is discussed.     

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.     

Do Historical Changes in Parent–Child Relationships Explain Increases in Youth Conduct Problems?

The coincidence of historical trends in youth antisocial behavior and change in family demographics has led to speculation of a causal link, possibly mediated by declining quality of parenting and parent–child relationships. No study to date has directly assessed whether and how parenting and parent–child relationships have changed. Two national samples of English adolescents aged 16–17 years in 1986 (N = 4,524 adolescents, 7,120 parents) and 2006 (N = 716 adolescents, 734 parents) were compared using identical questionnaire assessments. Youth-reported parental monitoring, expectations, and parent–child quality time increased between 1986 and 2006. Ratings of parental interest did not change. Parenting differences between affluent and disadvantaged families narrowed over time. There was thus little evidence of a decline in quality of parenting for the population as a whole or for disadvantaged subgroups. Parent-reported youth conduct problems showed a modest increase between 1986 and 2006. Findings suggested that the increase in youth conduct problems was largely unrelated to observed change in parent–child relationships.     

The 10-Item Positive and Negative Affect Schedule for Children, Child and Parent Shortened Versions: Application of Item Response Theory for More Efficient Assessment

The Positive and Negative Affect Schedule for Children (PANAS-C/P; child and parent versions) yield positive affect (PA) and negative affect (NA) scales that are clinically useful for identifying youth with anxiety and mood problems. Despite the advantages that item response theory (IRT) offers relative to classical test theory with respect to shortening test instruments, no studies to date have applied IRT methodology to the PANAS-C/P scales. In the present study, we thus applied IRT methodology using a school-based development sample (child sample: N = 799; parent sample: N = 553) and developed a shortened 5-item PA scale (joyful, cheerful, happy, lively, proud) and a 5-item NA scale (miserable, mad, afraid, scared, sad) for the sake of simultaneously increasing the assessment efficiency of the PANAS-C/P scales while improving the psychometric properties of the scales. The reduced PA and NA child scales classified relevant diagnostic groups in a separate clinic-referred validation sample (N = 662) just as well as the original PANAS-C child scales and may be used to help identify youth with internalizing disorders in need of mental health services.     

A Meta-analytic Review of the Role of Child Anxiety Sensitivity in Child Anxiety

Conflicting findings exist regarding (1) whether anxiety sensitivity (AS) is a construct distinct from anxiety in children and (2) the specific nature of the role of AS in child anxiety. This study uses meta-analytic techniques to (1) determine whether youth (ages 6–18 years) have been reported to experience AS, (2) examine whether AS differentiates anxiety disordered youth from youth without diagnoses, and (3) ascertain whether AS distinguishes youth with panic disorder from those with other anxiety disorders. The weighted mean effect size analyses included 15 studies and 6,579 participants. Results suggested positive correlational relationships between AS and anxiety for children (r = 0.26) and adolescents (r = 0.36) and higher levels of AS for anxiety disordered youth than non-clinical youth (d = 0.64). Findings tentatively suggested higher levels of AS for youth with panic disorder than youth diagnosed with other anxiety disorders. Implications and future directions in the research of child AS are discussed.     

Inter-Parent Agreement on the Syndrome Scales of the Child Behavior Checklist (CBCL): Correspondence and Discrepancies

Using multiple informants from a clinical setting, potential associations between inter-parental agreement and age, gender, and child diagnosis were explored in the current study. Archival data from psychological evaluations conducted on 174 children ages 5–18 through a hospital-affiliated outpatient psychology clinic were analyzed, focusing on mothers’ and fathers’ scores on the syndrome and index scales of the Child Behavior Checklist (CBCL). Although inter-parent correspondence levels on each of the subscales were found to be moderately high (averaging r = .50), significant discrepancies between the severity levels of parent reports were found on nine of 11 subscales, with mothers’ ratings consistently being slightly higher. Data from this clinical sample suggest that although single-informant ratings of child behavior may be generally representative of reports from both parents on many of the CBCL narrow-band scales, age, gender, and child diagnosis were related to several patterns of agreement on specific syndrome scales. Therefore, it is important to include fathers, because they provide a unique perspective on social problems, delinquency, and attention problems, in particular. Both correspondence and discrepancies between parent reports of specific child problems can provide valuable clinical information that is useful for child assessment and treatment.     

Youth Developmental Assets and Perceived Life Satisfaction: Is There a Relationship?

This study explored associations between youth developmental assets (i.e., support by parents/other adults; accountability to adults; empowerment; school support; values regarding risk behaviors; quantity of other adult support; empathetic relationships) and adolescents’ perceptions of overall life satisfaction. Public high school students (N = 3,477) completed a self-report questionnaire. Analyses were conducted to examine relationships between developmental assets and perceived life satisfaction while controlling for socioeconomic status. Results indicated that significant (p ≤ .05) associations were established for perceived support by parents/other adults for all four race/gender groups, self and peer values regarding risk behavior for black females, quality of other adult support for black males and white females and life satisfaction for adolescents. Significant (p ≤ .05) associations were also established for perceived support by parents/other adults for White males and Black males, accountability to parents/other adults for White females, quality of other adult support for White males and Black females and for empathetic relationships for all four race/gender groups. Results suggest that perceived life satisfaction is related to youth developmental assets, although moderated by gender and race differences. Further research is necessary to identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with youth developmental assets in order to develop gender appropriate and culturally sensitive health promotion programs.     

Comparing the Strengths and Difficulties Questionnaire and the Child Behavior Checklist: Is Small Beautiful?

The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioral screening questionnaire that can be completed in 5 minutes by the parents or teachers of children aged 4 to 16; there is a self-report version for 11- to 16-year-olds. In this study, mothers completed the SDQ and the Child Behavior Checklist (CBCL) on 132 children aged 4 through 7 and drawn from psychiatric and dental clinics. Scores from the SDQ and CBCL were highly correlated and equally able to discriminate psychiatric from dental cases. As judged against a semistructured interview, the SDQ was significantly better than the CBCL at detecting inattention and hyperactivity, and at least as good at detecting internalizing and externalizing problems. Mothers of low-risk children were twice as likely to prefer the SDQ.     

Behavioral and emotional problems among Italian international adoptees and non-adopted children: father's and mother's reports

This study intends to fill the gap in empirical research carried out in Italy regarding international adoptees' behavioral and emotional problems. Assuming a multi-informant approach, it aims to compare parents' reports of behavioral problems of adopted and non-adopted children and to examine parental agreement. The sample was composed of 186 adoptive couples and 195 biological couples with the target child between ages 7 and 11 years. The mother and father filled in the Child Behavior Checklist (CBCL) separately. Analysis of the CBCL revealed that adopted children are perceived by their parents as having more Total and Externalizing Problems than are their non-adopted counterparts. Moreover, they are more likely to demonstrate attention difficulties and aggressive behavior. The agreement between parents turned out to be moderate for adoptive parents and slightly lower for the biological ones. Consistent with most adoption research, the results confirm the higher risk of behavioral problems among adopted children. They also shed light on the significant perceptual discrepancy between mothers and fathers, underlining the importance of considering both parents' reports in the study of adopted children's adjustment.     

Using the ASEBA to Screen for Callous Unemotional Traits in Early Childhood: Factor Structure,Temporal Stability,and Utility

This study evaluated a five-item screening measure of Callous Unemotional (CU) traits using items drawn from the Preschool Form of the Achenbach System of Empirically Based Assessment (ASEBA). Using data from the Durham Child Health and Development study (N = 178), confirmatory factor analyses demonstrated that CU items could be distinguished from Attention Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant (ODD) items. The two-year stability (N = 137) of CU (ϕ = .84) was comparable to that of ADHD (ϕ = .79) and ODD (ϕ = .69). Three groups of children were selected based on parent-rated ODD and CU behaviors at the 36-month assessment (N = 37; ODD+CU, N = 7; ODD-only, N = 12; non-ODD, N = 18). Multiple measures of infant temperament predicted group membership with 84% accuracy. Consistent with Frick and Morris’ (Journal of Clinical Child and Adolescent Psychology 33(1):54–68, 2004) hypotheses, ODD+CU and ODD-only children exhibited temperamental profiles in infancy that were consistent with low fear and emotionally dysregulated pathways into conduct problems, respectively.     

A Psychometric Analysis of the Child Behavior Checklist DSM-Oriented Scales

The Child Behavior Checklist for Ages 6–18 (CBCL/6-18) possesses newly developed DSM-Oriented Scales, constructed through expert clinical judgment to match selected categories for behavioral/emotional problems as described in the DSM-IV. The present investigation examined the basic psychometric properties for all six DSM-Oriented Scales (i.e., Affective, Anxiety, Somatic, Attention-Deficit/Hyperactivity, Oppositional, and Conduct Scales) in a large clinical sample of children and adolescents (N = 673). Findings from the present study provide strong evidence for the reliability, as well as convergent and discriminative validity, of these scales. It appears that the DSM-Oriented Scales may provide accurate supplementary information that may be considered when formulating clinical diagnoses.

Autism Spectrum Symptomatology in Children: The Impact of Family and Peer Relationships

This study examines the potential impact of family conflict and cohesion, and peer support/bullying on children with autism spectrum disorder (ASD). While such impacts have been established for a range of non-ASD childhood disorders, these findings may not generalize to children with ASD because of unique problems in perspective-taking, understanding others’ emotion, cognitive rigidity, and social reasoning. A structural model-building approach was used to test the extent to which family and peer variables directly or indirectly affected ASD via child anxiety/depression. The sample (N = 322) consisted of parents of children with ASD referred to two specialist clinics. The sample contained parents of children with Autistic Disorder (n = 76), Asperger Disorder (n = 188), Pervasive Disorder Not Otherwise Specified (n = 21), and children with a non-ASD or no diagnosis (n = 37). Parents completed questionnaires on-line via a secure website. The key findings were that anxiety/depression and ASD symptomatology were significantly related, and family conflict was more predictive of ASD symptomatology than positive family/peer influences. The results point to the utility of expanding interventions to include conflict management for couples, even when conflict and family distress is low. Further research is needed on the potentially different meanings of family cohesion and conflict for children with ASD relative to children without ASD.     

Reward and Punishment Sensitivity in Children with ADHD: Validating the Sensitivity to Punishment and Sensitivity to Reward Questionnaire for Children (SPSRQ-C)

This study validates the Sensitivity to Punishment and Sensitivity to Reward Questionnaire for children (SPSRQ-C), using a Dutch sample of 1234 children between 6–13 years old. Factor analysis determined that a 4-factor and a 5-factor solution were best fitting, explaining 41% and 50% of the variance respectively. The 4-factor model was highly similar to the original SPSRQ factors found in adults (Punishment Sensitivity, Reward Responsivity, Impulsivity/Fun-Seeking, and Drive). The 5-factor model was similar to the 4-factor model, with the exception of a subdivision of the Punishment Sensitivity factor into a factor with ‘social-fear’ items and a factor with ‘anxiety’ items. To determine external validity, scores of three groups of children with attention deficit hyperactivity disorder (ADHD) were compared on the EFA models: ADHD-only (n = 34), ADHD and autism spectrum disorder (ADHD+ASD; n = 22), ADHD and oppositional defiant disorder (ADHD+ODD; n = 22). All ADHD groups scored higher than typical controls on Reward Responsivity and on the ‘anxiety’ factor (n = 75). The ADHD-only and ADHD+ODD group scored higher than other groups on Impulsivity/Fun-Seeking and Drive, while the ADHD+ASD group scored higher on Punishment Sensitivity. The findings emphasize the value of the SPSRQ-C to quickly and reliably assess a child’s sensitivity to reinforcement, with the aim to provide individually-tailored behavioral interventions that utilize reward and reprimands.     

Unidimensionality and Developmental Trajectory of Aggressive Behavior in Clinically-Referred Boys: A Rasch Analysis

A majority of research investigating aggression and its development in children relies on rating scales such as the Child Behavior Checklist (CBCL). These scales typically are developed using a conventional factor analytic approach for the selection and retention of scale items, but may contain insufficient items to assess the unidimensionality and developmental trajectory of youths’ aggressive behavior. Rasch analysis was employed to determine the extent to which CBCL Aggressive and Delinquent clinical syndrome scale items reflect the unidimensionality and expected developmental trajectory of aggressive behavior based on parent endorsements of 455, 6 to 16 year old boys referred to community mental health centers. The two scales showed considerable promise as a unidimensional aggression scale and mimic the expected developmental pattern of aggressive behavior in extant literature. Future development of an aggressive CBCL dimensional subscale, however, must eliminate redundant and non-contributing items, and include severe aggressive behavior items exhibited by persistently aggressive youths.     

Ethnic Differences in Perceived Impairment and Need for Care

Latino children in the U.S. have high rates of unmet need for mental health services, perhaps due to biased perceptions of impairment and need for care by parents and providers. We tested this argument using an experimental vignette design. Vignettes described children with problems that varied on severity (mild vs. serious), nature of the problem (internalizing vs. externalizing), as well as gender and ethnicity (Latino vs. Anglo). Raters were Latino and Anglo parents (N = 185) and providers (N = 189). Vignettes with Latino names were viewed as more impaired by both parents and providers, and this effect was significantly stronger in Latino vignettes with less severe problems. Severity and Latino features of vignettes also interacted with judgments of need for service. At higher severity, vignettes with Anglo names were judged to need service more than vignettes with Latino names, despite the same judged levels of impairment. Results are discussed in the light of the unmet need for Latinos.     

Few Preschool Boys and Girls with ADHD are Well-Adjusted During Adolescence

To estimate the prevalence of being well-adjusted in adolescence, boys and girls with (n = 96) and without (n = 126) attention-deficit/hyperactivity disorder (ADHD) were assessed seven times in eight years starting when they were 4–6 years of age. Symptoms of ADHD, ODD/CD, and depression/anxiety in addition to social skills and social preference were gathered using multiple methods and informants. Being well-adjusted was defined by surpassing thresholds in at least four of the five domains. At the 7- and 8-year follow-up, when youth were 11–14 years old, probands were significantly less likely to be well-adjusted relative to age- and ethnicity-matched control children. Only a minority of children with ADHD was well-adjusted in adolescence when emotional, behavioral, and social domains were considered simultaneously. Even when their ADHD symptoms improved over time, most probands exhibited significant impairment 7–8 years after their initial assessment.