Relationship of asthma severity and psychological problems in children

OBJECTIVE: To determine whether physiological severity of asthma is associated with increased psychological symptoms in children. METHOD: Participants were 337 children, aged 7 to 19 years (mean 11.9, SE 0.13), and a parent of each child. Children's asthma severity was rated by experienced pediatric asthma specialists using current guidelines from the National Heart, Lung, and Blood Institute. Children filled out the Children's Manifest Anxiety Scale and the Weinberger Adjustment Inventory. Parents reported on their child's medical history, completed the Child Behavior Checklist (CBCL) about their child, and completed the Pennebaker Inventory of Linguid Languidness as a measure of their own physical symptoms. RESULTS: Child-rated anxiety symptoms were unrelated to asthma severity or to markers of asthma functional morbidity. Parental ratings of internalizing symptoms in their children were related to severity. Parent physical symptoms explained 10.2% of the variance in CBCL Internalizing symptoms, and asthma severity added an additional 6.7% to the variance. CONCLUSIONS: Asthma severity may be a more salient stressor to parents, who in turn report higher levels of child internalizing symptoms for children with severe asthma, than to children themselves. Contrary to prior hypotheses, children with severe asthma did not rate themselves as having higher levels of anxiety than those with mild or moderate asthma or than standardized norms.     

Behavioral changes after closed head injury in children.

This study provides a longitudinal follow-up of the behavioral adjustment of 45 children with mild, moderate, and severe closed head injuries. Two measures of behavioral adjustment, the Child Behavior Checklist (CBCL) and the Vineland Adaptive Behavior Scales (VABS), were obtained from a parent at the time of injury and at 6 and 12 months postinjury. The severely injured children obtained significantly poorer VABS scores than children with mild and moderate injuries over the year-long follow-up. In addition, on the CBCL, severely injured children had more school problems and engaged in fewer social activities than mild and moderately injured children. These results show that severe head injury in children was associated with declines in adaptive functioning, whereas scores for children with mild and moderate injuries did not differ, nor did they deviate from average levels at any follow-up interval. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal stress and emotional status during the perinatal period and childhood adjustment.

An emerging literature suggests that maternal distress during the prenatal and perinatal period may adversely affect offspring development. The association between maternal stress and emotional status in the perinatal period (defined as 1 month after birth) and adjustment of first-grade children was examined in 948 mother-child dyads from the NICHD Study of Early Child Care using hierarchical multiple regression. Maternal demographic characteristics, including maternal education and income, accounted for 4% of the variance in Child Behavior Checklist (CBCL) externalizing scores when children were in first grade. Maternal stress and emotional status at 1 month accounted for an additional 4% of the variance in CBCL externalizing t scores; statistically significant contributions were made by maternal depression and perceived social support. Maternal depression and parenting stress at 1 month made statistically significant contributions to CBCL internalizing scores at first grade. These findings contribute to a growing body of literature indicating that perinatal maternal adjustment is associated with children's emotional and behavioral functioning years later. Implications for school psychologists' involvement in prevention, assessment, and intervention practices are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of dysregulated children using the Child Behavior Checklist: A receiver operating characteristic curve analysis.

Disorders of self-regulatory behavior are common reasons for referral to child and adolescent clinicians. Here, the authors sought to compare 2 methods of empirically based assessment of children with problems in self-regulatory behavior. Using parental reports on 2,028 children (53% boys) from a U.S. national probability sample of the Child Behavior Checklist (CBCL; T. M. Achenbach & L. A. Rescorla, 2001), the receiver operating characteristic curve analysis was applied to compare scores on the Posttraumatic Stress Problems Scale (PTSP) of the CBCL with the CBCL Dysregulation Profile (DP), identified using latent class analysis of the Attention Problems, Aggressive Behavior, and Anxious/Depressed scales of the CBCL. The CBCL–PTSP score demonstrated an area under the curve of between .88 and .91 for predicting membership in the CBCL–DP profile for boys and for girls. These findings suggest that the CBCL–PTSP, which others have shown does not uniquely identify children who have been traumatized, does identify the same profile of behavior as the CBCL–DP. Therefore, the authors recommend renaming the CBCL–PTSP the Dysregulation Short Scale and provide some guidelines for the use of the CBCL–DP scale and the CBCL–PTSP in clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cross-cultural generalizability of the Child Behavior Checklist cross-informant syndromes.

Principal factor analysis followed by promax rotations were performed on Child Behavior Checklist (CBCL) scores of 2,339 children randomly drawn from a sample of 4,674 clinically referred Dutch children, aged 4–18 years. Dutch syndromes were very similar in item composition to the 8 CBCL cross-informant syndromes derived by T. M. Achenbach (1991), except for the Social Problems syndrome. Cross-national correlations ranged from .82 for the Social Problems syndrome to .99 for the Somatic Complaints and Anxious/Depressed syndromes. Confirmatory factor analysis of the Dutch and American syndromes in a cross-validation sample of the remaining 2,335 Dutch children supported both the Dutch and the American scales to the same degree. Exploratory and confirmatory results both strongly supported the cross-cultural generalizability of the CBCL cross-informant syndromes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is It Prudent to Administer All Items for Each Child Behavior Checklist Cross-Informant Syndrome? Evaluating the Psychometric Properties of the Youth Self-Report Dimensions With Confirmatory Factor Analysis and Item Response Theory.

Through surveying of children in 10 nations with parent, teacher, and Youth Self-Report (YSR) forms of the Child Behavior Checklist (CBCL), cross-informant syndromes (CISs) were derived and cross-validated by sample-dependent methodology. Generalizing CBCL syndromes and norms to nations excluded from its normative sample is problematic. This study used confirmatory factor analyses (CFAs) to test factor model fit for CISs on the YSR responses of 625 Jamaican children ages 11 to 18 years. Item response theory (IRT), a sample independent methodology, was used to estimate the psychometric properties of individual items on each dimension. CFAs indicated poor to moderate model-to-data fit. Across all syndromes, IRT analyses revealed that more than 3/4 of the cross-informant items yielded little information. Eliminating such items could be cost effective in terms of administration time yet improve the measure's discrimination across syndrome severity levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of epidemiologic, histologic, and virologic studies on Hodgkin''s disease in western Kenya and Nagasaki, Japan

AIMS: The aim of the present study was to determine which medical variables were predictors of long-term behavioural/emotional outcome after surgical correction for congenital heart disease in infancy and childhood. METHODS: The Child Behavior Checklist (CBCL) was used to predict parent-reported behavioural/emotional problems in 125 10-15 year-old congenital heart disease children from: (1) biographical status (2) medical history (3) heart surgery (4) short-term post-operative course and (5) number of heart operations and (6) extra cardiac concomitant anomalies. RESULTS: Higher CBCL total problem scores at follow-up were associated with a greater number of heart operations and deep hypothermic circulatory arrest (< 22 degrees). 'Internalizing problems' were associated with a greater number of heart operations, deep hypothermic circulatory arrest, a short gestational age, low systemic oxygen saturation, and older age at surgical repair. 'Externalizing problems' were associated with a greater number of heart operations only. CONCLUSION: Several medical variables were significant predictors and can be used to identify those congenital heart disease children who are at risk of long-term behavioural/emotional maladjustment.     

Problem behavior in early and middle childhood: an initial behavior genetic analysis

Twin samples were used to estimate the relative importance of genetic and environmental influences on problem behavior in children, assessed by the Child Behavior Checklist (CBCL). For the younger cohort, mothers completed the CBCL/2-3, while for the older cohort the CBCL/4-18 was used. Nearly half of the older sample had also been assessed with the questionnaire for younger children at a prior date, providing tentative answers regarding continuity and change in the etiology of problem behavior. Results suggested that shared environmental influences may be more important in early childhood than in middle childhood, while the reverse holds for genetic influences.     

Concurrent validity of the internalizing and externalizing profile patterns of the Achenbach Child Behavior Checklist.

Explored the concurrent validity of the Child Behavior Checklist (CBCL), using 163 6–11 yr old consecutive referrals to a child psychiatry outpatient department. Ss were administered a battery of psychological tests aimed at measuring cognitive (short form of the WISC—R and the Wide Range Achievement Test), personality (the Nowicki-Strickland Locus of Control Scale for Children and a measure of egocentrism), and social functioning (Piers-Harris Self-Concept Scale and a measure of coping). Using the computerized classification of the CBCL, Ss in the optimal range and those with mixed profiles and high and low scores were determined. Parent and teacher ratings of pathology and competence were also obtained. Results indicate that CBCL internalizers were favored on a number of measures of adaptation when compared with CBCL externalizers, which is consistent with a wider literature on internalizing–externalizing syndrome types indicating that internalizers are generally more competent than are externalizers. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The equivalence of the Child Behavior Checklist/1 1/2-5 across parent race/ethnicity, income level, and language.

This study examined the equivalence of the Child Behavior Checklist/1 1/2-5 (CBCL/1 1/2-5) in 682 parents of 2- to 4-year-old children stratified by parent race/ethnicity (African American, Latino, and non-Latino White), family income (low vs. middle-upper), and language version (Spanish vs. English). Externalizing Scale means differed by income and child gender. Internalizing Scale means differed by income and parent race/ethnicity. Differential item analyses showed that few items functioned differently by racial/ethnic, language, and income group. A confirmatory factor analysis demonstrated that the Externalizing Scale provided a good fit with the data across racial/ethnic and income groups. However, model fit was improved for the Internalizing Scale when factor weights were allowed to vary. Findings support the equivalence of the CBCL/1 1/2-5 when used with parents of low-income preschool children from African American and Latino backgrounds, although further study of the factor structure for the Internalizing Scale is recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing coparenting in families of school-age children: Validation of the Coparenting and Family Rating System.

Studied (1) the psychometric properties of an observational co-parenting measure and (2) the relationship between co-parenting and the adjustment of school-age children. Ss were 67 couples in the US with a 1st-born, 7-11 yr old child. Family interactions during unstructured family play in a laboratory setting were coded with the Coparenting and Family Rating System (CFRS; J. P. McHale et al, 2000). Three self-report measures of marital adjustment, the Child Behavior Checklist (CBCL), and the Revised Children's Manifest Anxiety Scale were administered. For boys, the CFRS measure Hostility-Competitiveness correlated with anxiety (Revised Children's Manifest Anxiety Scale) and with mother-reported internalizing, externalizing, and overall problems (CBCL). For girls, the CFRS measure Parenting Discrepancy correlated with mother-reported internalizing (CBCL). The possibility of sex differences in co-parenting-adjustment links is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral and emotional problems of students with learning disabilities, serious emotional disturbance, or both conditions

This study investigates the behavioral and emotional problems of children with learning disabilities (LD), serious emotional disturbance (SED), and LD/SED, using the Teacher Report Form (TRF) and Child Behavior Checklist (CBCL). The sample consisted of 217 students with LD, 72 with SED, and 68 with SED/LD, ages 6 to 18 (mean age = 11.5). The students with SED were rated more impaired than the students with LD on all TRF scales except Attention Problems, and on three of the eight CBCL syndrome scales. The children with LD differed from those with SED mainly in terms of severity of problems, not with respect to type of problem. It is concluded that students with co-morbid LD and SED are underidentified and underserved in special education systems.     

Diagnostic accuracy of the Child Behavior Checklist scales for attention-deficit hyperactivity disorder: A receiver-operating characteristic analysis.

The diagnostic accuracy of the Child Behavior Checklist (CBCL) scales for attention deficit hyperactivity disorder (ADHD) were examined using receiver-operating characteristic (ROC) analysis. Three logistic regression models were estimated in an initial sample of 121 children (aged 6–18 yrs) with and without ADHD. These models were then tested in a cross-validation sample (N?=?122) and among the 111 brothers and 108 sisters of the initial and cross-validation samples. In all 4 groups, the CBCL Attention Problems scale had the highest discriminating power for ADHD. Adding other scales did not increase the area under the curve of the ROC significantly. Findings suggest that the CBCL Attention Problems scale could serve as a rapid and useful screening instrument not only to help identify cases likely to meet criteria for ADHD in clinical settings, but also to identify cases of ADHD among the siblings of children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A dimensional approach to the assessment of social competence in boys.

Mothers of 93 7–11 yr old boys seeking treatment for their sons' peer relationship problems completed the Child Behavior Checklist (CBCL). Factor analysis was used to identify subscales that tap social competence within the CBCL, the Social Skills Rating System for parents, and the Pupil Evaluation Inventory for teachers. Among the CBCL scales, only the Social Withdrawal scale and 1 Social Competence subscale tapped a Social Competence factor in common with Social Competence subscales from the other instruments. Combinations of CBCL scales resulted in improved classification of social competence over base rates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parent and child discrepancies in reporting severity of problem behaviors in three out-of-home settings.

This study compared scores on the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) for samples of youths in 3 out-of-home placements with varying levels of restrictiveness. Mean CBCL T scores were more than a standard deviation higher than mean YSR T scores on the broadband scales and about 2/3 of a standard deviation higher on the syndrome scales. The magnitude of the discrepancy varied between placements for several scales, with the least restrictive placements having the largest difference between CBCL and YSR ratings for the Externalizing scale. For the Internalizing scale, the discrepancy was larger for older youths (ages 15–18) than for younger youths (ages 11–14). These results support previous findings that in clinical samples, adults rate children's behavioral and emotional problems as more severe than do children themselves. This study extends prior research by demonstrating the occurrence of this discrepancy across a continuum of care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral adjustment in children of diabetic mothers

The aim of this study was to evaluate whether maternal diabetes in pregnancy may adversely affect the children's behavioral adjustment, in a sample of 201 mothers (68 with pre-gestational diabetes, 50 with gestational diabetes, and 83 with non-diabetic pregnancies) and their singleton offspring. After accounting for socioeconomic status, ethnicity and maternal attitudes, none of the Child Behavior Checklist ratings correlated significantly with maternal patient group or several indices of antepartum maternal metabolism. Child obesity, a common sequela of diabetic pregnancies, correlated positively with Internalizing Behavior problems and three narrow-band sub-scales: Somatic Complaints, Anxious/Depressed, and Social Problems. Results suggest that children of diabetic mothers are at increased risk for a variety of developmental disturbances. Screening for learning and behavioral difficulties should be made at regular pediatric visits, with follow-up evaluations warranted by positive indications, excessive weight gain, or other evolving medical concerns.     

Behavioral symptoms of children and adolescents in Germany, the Netherlands and USA. A cross-cultural study with the Child Behavior Checklist

The goal of the study was a cross-cultural comparison of the parent ratings of behavior problems of children and adolescents aged 4-18 years in Germany, The Netherlands and the United States using the Child Behavior Checklist (CBCL). The analyses were undertaken in a German community sample (n = 1622) and a Dutch community sample (n = 2076). The results were compared with the data published by Achenbach for the national US sample. The analyses were based on the scales of the 1991 CBCL version and were performed for four age and sex groups (4- to 11-year-old boys/girls and 12- to 18-year-old boys/girls). In general, relatively minor differences could be detected between the three random samples. The range in the different samples was between -0.04 and 0.35, which is in line with other cross-cultural analyses using the CBCL. As long as no representative norms for Germany are available, the American norms can serve as an orientation for German studies using the CBCL.     

Rationally and empirically derived dimensions of children's symptomatology: Expert ratings and confirmatory factor analyses of the CBCL.

Expert ratings and confirmatory factor analyses were used to develop an alternative system for scoring the Child Behavior Checklist (CBCL; T. M. Achenbach, 1991) to measure specific dimensions corresponding to current conceptualizations of child symptomatology. Data were from a nonclinic and 2 independent clinic samples. Subscales measuring Anxiety, Attention Problems/Hyperactivity, Conduct Problems, Depression, Oppositional Defiant, Social Problems/Immaturity, and Somatization were created. Logistic regressions were conducted to evaluate the diagnostic efficiency and discrimination of the new and original approaches to scoring the CBCL. Some of the new subscales demonstrated better sensitivity, positive predictive power, and discriminant validity than the original CBCL subscales; however, subscales from both approaches demonstrated low sensitivity. Results support the use of the new subscales for specific research purposes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The socioemotional behaviors of children with SLI: Social Adaptation or Social Deviance?

Two models of the relationship between socioemotional behavior and verbal abilities are compared: Social Adaptation and Social Deviance. The socioemotional integrity of 17 children with specific language impairment (SLI) and 20 unaffected children who were age-matched (AM) was examined using the Child Behavior Checklist (CBCL) and the Teacher's Report Form (TRF) at kindergarten and first grade. All CBCL and TRF syndrome scale means for both groups were within normal limits. Significant group x respondent interaction effects were observed; teachers, and not parents, rated the children with SLI as having more social and internalizing behavioral problems than their AM peers. Significant differences between groups were restricted to internalizing, social, and attention problems. Very little congruence or stability over time was observed in the clinical ratings. The outcomes support a Social Adaptation Model of socioemotional behavior and language impairment. Implications for the clinical management of children with SLI are discussed.     

Evaluation of the Brief Problem Checklist: Child and caregiver interviews to measure clinical progress.

Objective: To support ongoing monitoring of child response during treatment, we sought to develop a brief, easily administered, clinically relevant, and psychometrically sound measure. Method: We first developed child and caregiver forms of a 12-item Brief Problem Checklist (BPC) interview by applying item response theory and factor analysis to Youth Self-Report (YSR; Achenbach & Rescorla, 2001) and Child Behavior Checklist (CBCL;Achenbach & Rescorla, 2001) data for a sample of 2,332 youths. These interviews were then administered weekly via telephone to an ethnically diverse clinical sample of 184 boys and girls 7–13 years of age and their caregivers participating in outpatient treatment, to examine psychometric properties and feasibility. Results: Internal consistency and test–retest reliability were excellent, and factor analysis yielded 1 internalizing and 1 externalizing factor. Validity tests showed large and significant correlations with corresponding scales on paper-and-pencil administrations of the CBCL and YSR as well as with diagnoses obtained from a structured diagnostic interview. Discriminant validity of the BPC interviews was supported by low correlations with divergent criteria. Longitudinal data for the initial 6 months of treatment demonstrated that the BPC significantly predicted change on related measures of child symptoms. Estimates obtained from random coefficient growth models showed generally higher slope reliabilities for the BPC given weekly relative to the CBCL and YSR given every 3 months. Conclusions: Given their combination of brevity and psychometric strength, the child and caregiver BPC interviews appear to be a promising strategy for efficient, ongoing assessment of clinical progress during the course of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)