The relationship between mutual family relations and child psychopathology

The associations of the mutual mother-child, father-child, and mother-father relationship and various patterns of family relations with child psychopathology were investigated in a sample of 137 families referred to outpatient mental health services. Assessment of the relative association of the different family dyads showed that both the mother-child and the mother-father relationship were related to child problem behaviour. However, whereas the mother-child relationship was consistently more related to externalising behaviour, the mother-father relationship was particularly related to internalising behaviour. Our findings gave clear support for the cumulative risk model: having more negatively qualified relationships was associated with more problem behaviour. Furthermore, our results suggested a protective influence of the parent-child relationship: having one or two positive parent-child relationships was associated with less problem behaviour. No support was found for the cross-generational coalition hypothesis. Implications for future research are discussed.

Quantitative genetic analysis of internalising and externalising problems in a large sample of 3-year-old twins

For a quantitative genetic study of pre-school problem behaviours, we have collected data with the Child Behavior Checklist for 2 and 3-year-old children (CBCL 2/3). Questionnaires were completed by mothers of 3620 twin pairs: 633 monozygotic males, 581 dizygotic males, 695 monozygotic females, 519 dizygotic females and 1192 dizygotic opposite sex twin pairs. The genetic and environmental influences on the Externalising and Internalising Problem scales were estimated, simultaneously with sex differences and sibling interaction effects. Genetic factors explained most of the observed variance for both Externalising and Internalising Problems. Cooperative sibling interactions were found for Externalising Problems, indicating that twins reinforce each other's behaviour. Sex differences in genetic architecture were found for Externalising Problems. Genetic factors explained 75% of the variance in girls and 50% in boys. Shared environmental influences were only of importance in boys. For both problem scales, non-shared environmental factors accounted for 25 to 32% of the variance. The observed variances of Internalising Problems could be adequately explained by genetic and nonshared environmental factors, with genetic factors accounting for 68% of the variance.

Frequency of parental report of problem behavior in children decreases with increasing maternal age at delivery

Child behavior problems were assessed in 1377 3-yr.-old twin pairs with the Child Behavior Check List from Achenbach (translated into Dutch language by Verhulst). The association between problem scores and maternal age at delivery of the twins was analyzed with statistical control for several potential confounding variables: birth weight of twins, maternal smoking during pregnancy, being breast or bottle fed and socioeconomic status. After controlling for all available confounding covariates, a significant linear effect for maternal age was left. Especially Externalizing behavior problems as well as the separate categories that constitute Externalizing, i.e., Aggressive, Oppositional, and Overactive, appeared to decrease continuously with increasing maternal age. This was true for both boys and girls as well as for first and secondborn twins. Evidence in support of a biological explanation of the association between maternal age and child behavior problems, is presented.

Psychopathology in young adults with congenital heart disease. Follow-up results

AIMS

The aim of the present study was to assess the occurrence of a wide range of behavioural and emotional problems long-term (> 9 years) after surgical correction for congenital heart disease in infancy and childhood.

METHODS

The problem scores on the Young Adult Self-Report of 166 19-25-year-old adults with congenital heart disease were compared with those of subjects of similar age from the general population.

RESULTS

On most Young Adult Self-Report scales no differences were found between the mean problem scores of the congenital heart disease-adults and reference peers. On only two Young Adult Self-Report scales (i.e. Somatic Complaints and Strange) and the total problem score were significant though small differences found between the mean problem scores of the congenital heart disease adults and reference peers. No significant relationship was found between cardiac diagnosis and problem behaviours in congenital heart disease adults. No relationship was found between IQ scores and problem behaviours in congenital heart disease adults.

CONCLUSION

Overall, it can be concluded that the results of the congenital heart disease adults were not unfavourable, since the differences in mean (total) problem scores between the congenital heart disease sample and reference group were small and limited to only two specific problem areas.

Understanding childhood (problem) behaviors from a cultural perspective: comparison of problem behaviors and competencies in Turkish immigrant, Turkish and Dutch children

Parents' reports of problem behaviors in 2,081 Dutch children, 3,127 Turkish children in Ankara and 833 Turkish immigrant children living in The Netherlands, aged 4-18 years, were compared. Dutch and Turkish versions of the Child Behavior Checklist (CBCL) were used. Immigrant children were scored higher than Dutch children on 6 of the 11 CBCL scales, most markedly on the Anxious/Depressed scale. Immigrant children were scored higher than Ankara children on five CBCL scales. However, these differences were much smaller than those found between immigrant and Dutch children. Furthermore, immigrant children's Total Problem scores did not differ from those for Ankara children. Turkish immigrant children have very similar patterns of parent-reported problem behaviors to children living in Turkey, although both groups of Turkish children showed higher levels of parent-reported problem behaviors than Dutch children. The higher scores for Turkish children on the Anxious/Depressed scale compared with their Dutch peers may be explained by cultural differences in parental perception of children's problem behaviors, as well as the threshold for reporting them, or by cultural differences in the prevalence of problems, for instance as the result of cross-cultural differences in child-rearing practice. More research is needed to test the degree to which Turkish immigrant parents tend to preserve their cultural characteristics and child-rearing practices in Dutch society.

Associations between different diagnostic approaches for child and adolescent psychopathology

OBJECTIVE

To test the convergence between the empirical-quantitative approach of the Child Behavior Checklist (CBCL) and the clinical-diagnostic approach of the DSM.

METHOD

The parent version of the NIMH Diagnostic Interview Schedule for Children (DISC), version 2.3, was administered after completion of the CBCL for 231 children and adolescents consecutively referred to an outpatient mental health clinic.

RESULTS

Of the subjects with a DSM-III-R diagnosis, 60% scored in the clinical range of the CBCL total problem score. The Withdrawn scale predicted affective and anxiety disorders. The Somatic Complaints scale predicted anxiety and mood disorders and Attention Deficit Hyperactivity Disorder. The Anxious/Depressed scale predicted anxiety and mood disorders and, to a lesser extent, disruptive behavior disorders. The Social Problems scale predicted Oppositional Defiant Disorder. The Attention Problems scale was the only significant predictor of "pure" Attention Deficit Hyperactivity Disorder (ADHD). The Aggressive Behavior scale predicted several disruptive behavior disorders, and Major Depression. The Delinquent Behavior scale was strongly associated with Conduct Disorder.

CONCLUSIONS

Empirically based CBCL scale scores and DISC-P based DSM-III-R diagnoses converged. However, both approaches do not converge to a degree that one approach can replace the other. Instead, combining both approaches may be valuable by adding information from one approach that is not captured by the other.

Comparisons of problems reported by parents of children in 12 cultures: total problems, externalizing, and internalizing

OBJECTIVE

To compare parent-reported problems for children in 12 cultures.

METHOD

Child Behavior Checklists were analyzed for 13,697 children and adolescents, aged 6 through 17 years, from general population samples in Australia, Belgium, China, Germany, Greece, Israel, Jamaica, the Netherlands, Puerto Rico, Sweden, Thailand, and the United States.

RESULTS

Comparisons of 12 cultures across ages 6 through 11 and 9 cultures across ages 6 through 17 yielded medium effect sizes for cross-cultural variations in Total Problem, Externalizing, and Internalizing scores. Puerto Rican scores were the highest, while Swedish scores were the lowest. With great cross-cultural consistency, Total and Externalizing scores declined with age, while Internalizing scores increased; boys obtained higher Total and Externalizing scores but lower Internalizing scores than girls. Cross-cultural correlations were high among the mean item scores.

CONCLUSIONS

Empirically based assessment provides a robust methodology for assessing and comparing problems reported for children from diverse cultures. Age and gender variations are cross-culturally consistent. Although clinical cutoff points should not necessarily be uniform across all cultures, empirically based assessment offers a cost-effective way to identify problems for which children from diverse cultural backgrounds may need help.

Cranial irradiation is the major cause of learning problems in children treated for leukemia and lymphoma: a comparative study

Prophylactic treatment of the central nervous system (CNS) in childhood leukemia and non-Hodgkin lymphoma (NHL) has negative effects on intelligence. We investigated the clinical significance of this finding by comparing the effect of different types of CNS prophylaxis on the survivor's learning capabilities. To isolate the effect of different types of CNS prophylaxis from other treatment and disease variables on learning problems, children treated for leukemia or NHL who received CNS prophylaxis with cranial irradiation (n = 30) or without cranial irradiation (n = 36) were compared with children treated for solid tumors who received systemic chemotherapy without any CNS treatment (n = 30) and with matched healthy controls (n = 265). The identification of learning problems was based on the school system's assessment. Parents and teachers reported on the child's educational status in a standardized way. Learning problems were found in 80% of children who received CNS prophylaxis with cranial irradiation. This was significantly higher than the 14% found in children treated with CNS prophylaxis without cranial irradiation (P < 0.000). The prevalence of learning problems in this latter group did not differ significantly from that in childhood cancer survivors without any form of CNS prophylaxis (20%) and in healthy matched controls (17%). We conclude that the high prevalence of learning problems in survivors of childhood leukemia and NHL is directly related to CNS prophylaxis with cranial irradiation and not to CNS prophylaxis per se or to other treatment and disease variables.

Increase in child behavior problems resulting from maternal smoking during pregnancy

In this article, the authors investigated the effect of maternal smoking during pregnancy on behavioral problems, which were not mediated by lower birth weight, in offspring at 3 y of age. The authors used the Child Behavior Checklist for ages 2-3 y (CBCL/2-3; Achenbach, Edelbrock and Howell) to assess behavioral problems in 1,377 2- to 3-y-old healthy twin pairs. Soon after the birth of twins, the authors collected pre- and perinatal information, including smoking habits of the mother during pregnancy. The question "Did you smoke during pregnancy?" could be answered by choosing one of three possible options: (1) never, (2) sometimes, or (3) regularly. The authors analyzed the effect of maternal smoking on the Child Behavioral Checklist total score and on several subscale scores for first- and second-born twins separately, and they adjusted for the possible confounding effects of birth weight, socioeconomic status, maternal age, and having been breast- or bottle-fed. There was a significant effect of maternal smoking on so-called externalizing behavior problems (oppositional, aggressive, overactive), but not on internalizing behavior problems (withdrawn, depressed, anxious), in both first- and second-born twins. The authors primarily attributed the enhanced externalizing problems to increased aggression. Although boys had higher externalizing (and aggression) scores than girls, the effect of maternal smoking was the same for boys and girls. The authors also discuss whether maternal smoking causes externalizing behavior problems.

Factors associated with child mental health service use in the community

OBJECTIVE

To determine the association of parent, family, and child factors with mental health services need and utilization.

METHOD

Possible determinants of services need and utilization were assessed in a general population sample of 2,227 children aged 4 to 18 years.

RESULTS

3.5% of the total sample had been referred for mental health services within the past year. The most potent factors associated with service need and utilization were the child's problem behaviors (both internalizing and externalizing) and academic problems and family stress. Socioeconomic factors and the child's sex were not in itself associated with help-seeking factors. Parental psychopathology, life events, and family psychopathology lowered the parents' threshold for evaluating the child's behavior as problematic but did not increase the likelihood of referral.

CONCLUSION

Referred children are more likely to live in families under stress than are children with the same level of problems who live in well-functioning families. Clinicians and researchers who make inferences from findings in clinical samples should realize, therefore, that children from problem families are overrepresented in their samples.

Parent, teacher and self-reports as predictors of signs of disturbance in adolescents: whose information carries the most weight?

We evaluated the ability of parents, teachers and self-reports to predict signs of maladjustment in 353 11- to 14-year-olds from the general population, over a 4-year time interval. Odds ratios were computed in order to test the ability of problem scales to predict later mental health referral and measures of parents' and children's own perceptions of the existence of major problems. Each informant made its own unique and indispensable contribution to the prediction of signs of maladjustment. Although teachers are often perceived as less able to assess internalizing problems than mothers and the children themselves, the present study showed that teachers' evaluations of internalizing problems are highly relevant if we take their ability to predict the subject's own perceptions of having problems as the criterion.

Ten-year time trends of psychopathology in Dutch children and adolescents: no evidence for strong trends

The 10-year time trends in competencies and problem scores in children and adolescents were assessed. Children and adolescents randomly selected from the Dutch general population in 1983 were assessed with the Child Behavior Checklist and the Teacher's Report Form. Their problem scores and competence scores were compared with those obtained by the same method 10 years later. No significant differences were found between the 1983 and 1993 total problem scores obtained from parents or teachers. On the level of problem items and scales, a few differences indicating an increase in problems were found. However, the magnitude of these differences was very small. Our results did not provide evidence for a clear secular increase in malfunctioning of Dutch children and adolescents.

Psychosocial functioning of children, adolescents, and adults following hypospadias surgery: a comparative study

Used standardized questionnaires to compare psychosocial functioning of 116 children and adolescents (9 to 18 years) and 73 adults (18 to 38 years) operated on for hypospadias, a congenital penile anomaly, with that of 88 and 50 age-matched comparison males, respectively, treated for an inguinal hernia. The relationships of coping with penile appearance, subject age, severity of hypospadias, number of operations, age at final surgery, and type of surgical procedure with psychosocial functioning were also investigated. Hypospadias patients did not exhibit a poorer psychosocial functioning and no significant relationships of various medical characteristics with psychosocial functioning could be discerned. Genital/body perception of hypospadias patients ages 9 to 18 years correlated positively with psychosocial functioning, albeit with low values. These findings are important for psychologists and specialists in the counseling process of hypospadias patients and their parents.

Behavioral and emotional problems in young preschoolers: cross-cultural testing of the validity of the Child Behavior Checklist/2-3

The cross-cultural validity of the Child Behavior Checklist for Ages 2-3 (CBCL/2-3) was tested in three Dutch samples of children referred to mental health services, from the general population, and from a twin study. Six scales were derived from factor analyses and labeled Oppositional, Aggressive, and Overactive, which constituted a broadband Externalizing grouping; Withdrawn/Depressed and Anxious, which constituted a broadband Internalizing grouping; and Sleep Problems. Internal consistencies of the scales, their test-retest reliabilities, interparent agreement, discriminative power, predictive relations with problem ratings 2 years later, and relations to other instruments designed to measure general development and behavior problems were adequate, and highly comparable to psychometric properties in American samples. It was concluded that across languages and cultures behavioral/emotional problems of young preschoolers may be adequately assessed with the CBCL/2-3.

The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents

BACKGROUND

We estimated the 6-month prevalence of psychiatric disorders among Dutch adolescents, using standardized, internationally available, and replicable assessment procedures, and assessed sex differences and comorbidity of diagnoses.

METHODS

In phase 1, the parent, self-report, and teacher versions of the Child Behavior Checklist screened a sample representative of 13- to 18-year-olds from the Dutch general population. In phase 2, the parent (P) and child (C) versions of the Diagnostic Interview Schedule for Children (DISC) provided DSM-III-R diagnoses for a selected subsample of 780 subjects.

RESULTS

The prevalence of any disorder was 21.5% for the DISC-C and 21.8% for the DISC-P. There was little overlap between subjects identified as having a disorder by the DISC-P and the DISC-C; only 4% met the criteria for any disorder on both. The most common disorders were simple phobia, social phobia, and conduct disorder. The most frequent comorbid diagnoses were anxiety and mood disorders.

CONCLUSIONS

Although prevalences of more than 21% for DISC-C- and DISC-P-derived diagnoses seem high, many adolescents with DSM-III-R diagnoses functioned quite well. The prevalence of any DSM-III-R diagnosis based on the DISC-C or DISC-P, in combination with the criterion for a definite case, was 7.9%.

[Being raised by lesbian parents or in a single-parent family is no risk factor for problem behavior, however being raised as an adopted child is]

Modern reproductive techniques and alternative family structures (with single or homosexual parents and adoption situations) raise questions about the consequences for the growing children involved. Genetic links appear to be less important for the functioning of a family than a strong wish for parenthood; parents who have become parents only through great efforts display a better quality of parenthood than average natural parents. Characteristics of the parent/parents, such as paedagogic qualities, and the quality of the parent-child relationship appear more important than the type of family. Published results of research reveal no reason why lesbian families should be judged differently from heterosexual ones as family types for the raising of children. The main negative factor for the functioning of the child growing up in a single-parent family is the marriage conflicts that have led to the single-parent situation; being raised by a single parent in itself has no adverse effect. Raising adopted children from other countries makes far greater demands on the adoptive parents than parents of biological children have to meet. The raising of a foreign adopted child by a single parent entails additional risks for the child's development. Data on the development of children in alternative family structures frequently concern exceptionally competent parents, which may have biased the findings.

Evaluation of attention before and after 2 years of growth hormone treatment in intrauterine growth retarded children

The objective of this study was to assess attention in children with short stature following intrauterine growth retardation (IUGR), at baseline and after 2 years of growth hormone (hGH) treatment. At baseline, all of the children had a birth height and a current height below the third centile. The attention measures (Sonneville Visual Attention Tasks: SVAT) of the IUGR group were compared with those of a comparison sample. In the baseline analyses, 48 children with IUGR and 119 comparison children were included; the 2-year follow-up analyses involved 41 children with IUGR and 68 comparison children. At baseline, children with IUGR showed deficits in divided, focused, and sustained attention. They were less accurate, exhibited more variability in reaction time, and performed more slowly and more impulsively than did the children in the comparison sample. After 2 years of hGH treatment, the IUGR group exhibited deficits in divided and sustained attention. They were still less accurate and showed more variability in reaction time and more impulsiveness. Current head circumference, the type of delivery, and global intelligence of children with IUGR were significantly correlated with attention measures. We hypothesize that short stature following IUGR and attention deficits are related, and that hGH treatment seems to have some beneficial effect on attentional capacity.

Accelerated longitudinal comparisons of aggressive versus delinquent syndromes

Accelerated longitudinal analyses revealed both similarities and differences between the developmental trajectories of empirically based aggressive versus delinquent syndromes in childhood and adolescence. Syndromes were scored from standardized ratings obtained from parents five times at 2-year intervals for seven birth cohorts of Dutch children initially assessed at ages 4 to 10 years. Scores for both the aggressive and delinquent syndromes declined from ages 4 to 10. After about age 10 years, scores for the aggressive syndrome continued to decline, but scores for the delinquent syndrome increased until about age 17. The aggressive syndrome was significantly more stable than the delinquent syndrome. Long-term predictive correlations between matched subjects from different cohorts were as high as predictive correlations between scores obtained by the same subjects, thus supporting the validity of accelerated longitudinal analyses. The results highlight important developmental distinctions between aggressive versus delinquent conduct problems. Failure to distinguish between aggressive and delinquent conduct problems could generate misleading conclusions about their respective developmental courses and limit the generalizability of results.

Cross-cultural generalizability of the Youth Self-Report and Teacher's Report Form cross-informant syndromes

Exploratory factor analyses on 569 Youth Self-Reports and 1,221 Teacher's Report Forms of clinically referred Dutch children revealed six and eight factors respectively, very similar to the eight YSR and TRF cross-informant syndromes derived by Achenbach (1991c, 1991d). Mean cross-cultural correlations were .89 for YSR syndromes and .95 for TRF syndromes. In confirmatory factor analyses of the Dutch and American YSR and TRF factor models in cross-validation samples of 570 YSRs and 1,221 TRFs, goodness-of-fit indices were only slightly better for Dutch factor models. The American cross-informant Social Problems and Attention Problems syndromes had the poorest fit. The application of the eight American cross-informant syndromes to Dutch self- and teacher reports was supported.

A genetic study of maternal and paternal ratings of problem behaviors in 3-year-old twins

Genetic and environmental influences on problem behaviors were studied in 3-year-old twins. Fathers' and mothers' ratings of problem behaviors in twins-236 monozygotic (MZ) girls, 210 MZ boys, 238 dizygotic (DZ) girls, 265 DZ boys, and 409 DZ opposite sex pairs- were obtained with the Child Behavior Checklist for Ages 2-3 (T.M. Achenbach, 1992). Twin correlations and results from a model fitting approach showed that genetic, shared environmental, and nonshared environmental influences accounted on average for about 64%, 9%, and 27% of the variance. Although shared environmental influences were small for most scales, they were important for Total Problems and somewhat larger for Externalizing than for Internalizing behaviors. Significant sex differences in genetic and environmental influences and evidence for sibling contrast effects were found for the Overactive scale.

Satisfaction with penile appearance after hypospadias surgery: the patient and surgeon view

PURPOSE

We studied the degree of agreement between hypospadias patient and surgeon satisfaction with the cosmetic surgical result, and the relation between penile length, meatal position and patient satisfaction.

MATERIALS AND METHODS

Cosmetic and functional results in 35 boys with hypospadias were assessed, and a standardized questionnaire was completed by patients and surgeon.

RESULTS

There was hardly any agreement between patient and surgeon satisfaction with patient penile appearance. Patients were less satisfied than the surgeon. No significant correlation was noted between penile satisfaction and penile length. Patients with a retracted meatus were less satisfied with the meatal position than those with a glanular meatus. Of the 35 patients 4 underwent repeat surgery after our study.

CONCLUSIONS

Hypospadias surgeons should explicitly asked if patients are satisfied and they should follow patients through adolescence.

The prevalence of self-reported problems in young adults from the general population

This study assessed the prevalence of a wide range of behavioral and emotional problems in 706 19- to 24-year-olds from the Dutch general population using the Young Adult Self-Report (YASR). The prevalence rates found can be used to make comparisons with data from individuals or other samples. Large or medium (variance > 5.9%) sex effects were found for alcohol use, for the items 'Brags' and 'Swears' (males > females), and for the items 'Cries a lot' and 'Fears' (females > males). With respect to socially desirable items, females more often reported attitudes or behaviors pertaining to helping other people, while males more often reported competitive behaviors or attitudes. For YASR syndromes, higher mean scores for females than males were found for the Withdrawn, Somatic Complaints, and Anxious/Depressed syndromes, while mean scores on the Delinquent Behavior syndrome were higher for males than females. No age effects were found, indicating that normative data were similar across the 19- to 24-year age span. Compared to other problem areas, thought problems and delinquent behavior in males, and social problems and delinquent behavior in females were least likely to be associated with other types of problems. Hence, instruments for the assessment of psychopathology in young adults should include these areas to provide a comprehensive picture of behavioral and emotional problems.

Self-concept before and after two years of growth hormone treatment in intrauterine growth-retarded children

The objective of this study was to assess self-concept in children with short stature after intrauterine growth retardation (IUGR), before and after 2 years of growth hormone (hGH) treatment. We assessed 25 children before treatment, and 40 children after a 2-year treatment period. Seventeen of the 25 children of whom we had pretreatment data, were reassessed after 2 years of hGH treatment. All children had a birth length below the 3rd percentile, and did not show catch-up growth (current height < P3). We compared the self-concept measures (Self-Perception Profile for Children; SPPC) of the IUGR group with similar measures of a Dutch school sample. Four of the six SPPC mean scale scores of the IUGR group prior to treatment were significantly lower than mean scores of the school sample. Mean-scale scores of the group children, assessed after 2 years of hGH treatment, did not differ significantly from those of the school sample. In the group of 17 children who were assessed before as well as after 2 years of treatment, the mean scale scores of 'social acceptance' and 'general self-worth' were significantly higher at the second assessment (t = -5.93, p < 0.001 and t = -4.36, p < 0.001, respectively). From the present study we can hypothesize that short stature after IUGR and a low self-concept are related.

Siblings of childhood cancer survivors: how does this "forgotten" group of children adjust after cessation of successful cancer treatment?

Siblings of childhood cancer patients are labelled the "forgotten children" because they experience significant psychosocial distress and are isolated from support systems inside and outside the family. This study investigates the late consequences of the cancer experience for siblings. 60 siblings of cancer survivors were compared with control subjects on measures of psychosocial adjustment. No differences were found between siblings of cancer survivors and controls on emotional and behavioural problems and competence, suggesting that siblings adjust well to the period after cessation of treatment. The effect of demographic, family and disease-related characteristics on the siblings' psychosocial adjustment was limited. Whereas during treatment many psychosocial problems for siblings have been reported, this does not result in a heightened risk of psychological disturbance for siblings as a late effect. The implications for patient care are discussed.

Psychopathology from adolescence into young adulthood: an 8-year follow-up study

OBJECTIVE

This study investigated the stability of behavioral and emotional problems from adolescence into young adulthood.

METHOD

Subjects from the general population (N = 459), aged 13-16 years, were evaluated initially with the Child Behavior Checklist (completed by parents) and 8 years later with the Young Adult Self-Report. The scoring format and factor structure of the two assessment instruments are similar; syndromes constructed from the two instruments are based on parents', teachers', and self-report information derived from large clinical samples. Signs of maladjustment also were assessed at follow-up through interviews.

RESULTS

Of the individuals with total problem scores in the deviant range on the Child Behavior Checklist, 27.3% had total problem scores in the deviant range on the Young Adult Self-Report at follow-up. The probability of having a total problem score in the deviant range at follow-up was raised 7.4-fold by having deviant-range scores on the Child Behavior Checklist somatic complaints and anxious/depressed syndromes (simultaneously) at the initial assessment. Referral to mental health services was predicted by deviant-range scores on the anxious/depressed syndrome, while suicide attempts were predicted by deviance on the withdrawn syndrome.

CONCLUSIONS

Adolescent problems tended to persist into young adulthood to a moderate degree. High rates of withdrawal from social contacts, anxiety or depression, somatic complaints without known medical origin, social problems, attention problems, delinquent behavior, and aggressive behavior during adolescence were risk factors for specific types of psychopathology and maladjustment at 8-year follow-up. The presence of psychopathology in adolescence should not be regarded as normative.

Psychosexual adjustment of children and adolescents after different types of hypospadias surgery: a norm-related study

PURPOSE

We studied the psychosexual adjustment, sexual behavior and genital appraisal of 9 to 18-year-old hypospadias patients.

MATERIALS AND METHODS

We interviewed 116 hypospadias patients and 88 comparison subjects in a semi-structured manner.

RESULTS

Hypospadias patients had a more negative genital appraisal and anticipated more ridicule by a partner because of penile appearance than comparison subjects but they did not have a different sexual adjustment. No significant impact of medical treatment (surgical procedures, number of operations or age at final surgery) was noted. Many hypospadias patients (38.8%) desired functional or cosmetic penile improvement.

CONCLUSIONS

In addition to procedures that bring the meatus to a more terminal position, those that bring it more ventral can be performed without negatively affecting psychosexual adjustment. Hypospadias patients were reluctant to seek advice for problems and, therefore, they should be followed through adolescence.

Self-reported and parent reported problems in adolescent international adoptees

Self-reported and parent reported problem behaviors of 1,538 intercountry adopted adolescents aged 14-18 years were compared with those from general population samples; 22% of the adopted boys, and 18% of the adopted girls could be regarded deviant according to self-reports, compared with about 10% of the subjects from the general population. Parents' reports showed a slightly greater difference between adopted versus nonadopted boys. Childhood deprivation was weakly associated with later parent reported, but not with self-reported problems. Racial antagonism was not related to problem behaviors. Adolescence may constitute a period of increased vulnerability for adopted children.

The eight-year stability of problem behavior in an epidemiologic sample

This study assessed the 8-y stability and change of parent-reported problem behaviors in 791 children from the general population assessed at 2-y intervals with the same standardized procedure, the child behavior checklist (CBCL). Problem behaviors were rather stable across even the relatively long time interval of 8 y. The 8-y stability coefficient for total problem score was 0.48, with somewhat higher stability for externalizing than internalizing problems. Despite stability, problem behaviors also changed considerably across time. These changes do not only reflect the increase in chronologic age. The present study showed that there are changes in children's problem levels that result from historical time influences. These secular trends seemed of even greater importance than aging effects, and reflect a slight increase of the norm of children's problem behaviors.

Late psychosocial consequences for parents of children who survived cancer

Investigated late psychosocial sequelae in 133 parents of children who survived cancer, using questionnaires developed to measure the specific impact of the disease. Childhood cancer had distinct and persistent late psychosocial effects on parents of survivors. Uncertainty and loneliness were the most reported problems. Demographic and situational characteristics such as being a mother, low SES, no religious affiliation, chronic disease in a family member other than the child surviving cancer, and concurrent stresses increased the risk of reporting late problems. Treatment itself had little or no effect on reported problems. However, when treatment led to long-term sequelae in the child, a significant and specific effect on parental problems was observed. No decline of problems over time was found, which has implications for patient care.

Psychosexual adjustment of men who underwent hypospadias repair: a norm-related study

PURPOSE

Psychosexual adjustment, sexual functioning and genital appraisal were studied in adult hypospadias patients.

MATERIALS AND METHODS

A total of 73 hypospadias patients and 50 comparison subjects received a semi-structured interview.

RESULTS

More hypospadias patients (32.8%) than comparison subjects (12.8%) had been inhibited in seeking sexual contacts. Hypospadias patients reported a more negative genital appraisal than comparison subjects but did not have a different sexual adjustment. The severity of hypospadias negatively affected genital appraisal. Patient age at final operation positively correlated with sociosexual development. Many patients (37%) desired functional or cosmetic penile improvement.

CONCLUSIONS

The majority of hypospadias patients experienced a normal adult sex life. They were reluctant to seek advice for problems. We recommend followup of patients through adolescence.

Recent Developments in the Assessment and Diagnosis of Child Psychopathology

In this article, recent developments in the assessment and diagnosis of child psychopathology are discussed with an emphasis on standardized methodologies that provide data that can be scored on empirically derived groupings of problems that tend to co-occur. Assessment methodologies are highlighted that especially take account of the following three basic characteristics of child psychopathology: (1) the quantitative nature of child psychopathology; (2) the role of developmental differences in the occurrence of problem behaviors, and (3) the need for multiple informants. Cross-cultural research is needed to test the applicability of assessment procedures across different settings as well as the generalizability of taxonomic constructs. Assessments of children in different cultures can be compared or pooled to arrive at a multicultural knowledge base which may be much stronger than knowledge based on only one culture. It is essential to avoid assuming that data from any single source reveal the significance of particular problems. Instead, comprehensive assessment of psychopathology requires coordination of multisource data using a multiaxial assessment approach.

Continuity and change of self-reported problem behaviors from adolescence into young adulthood

OBJECTIVE

To investigate the 4-year course of behavioral and emotional problems from adolescence into young adulthood in a general population sample.

METHOD

The population consisted of 364 individuals, aged 15 to 18 years at the beginning of the study. Subjects filled out the Youth Self-Report at the first time of assessment. At follow-up, 2 and 4 years later, subjects aged 19 or older completed the Young Adult Self-Report, which was derived from the Youth Self-Report.

RESULTS

Almost 40% of the adolescents who were classified as deviant initially were still deviant 4 years later. There was no significant difference in the continuity of internalizing problems versus externalizing problems in this sample.

CONCLUSIONS

All types of problems tended to persist to a similar degree. This holds also for problems that are often regarded as typical childhood problems, such as attention problems and hyperactivity. Because adolescent problems are likely to continue, we need more knowledge on the efficacy of interventions.

Assessment of the prevalence of psychiatric disorder in young adults

BACKGROUND

The effectiveness of different assessment procedures for determining prevalence rates of psychiatric disorder in young adults was investigated.

METHOD

In a two-stage multi-method procedure, the Young Adult Self-Report, the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), the Structured Interview for Personality Disorders (Revised), and the Global Assessment of Functioning (GAF) Scale were used to assess prevalence rates in 706 19-24-year-olds from the general population. Furthermore, individuals' subjective perception of distress and referral to mental health services were assessed.

RESULTS

The prevalence of any SCAN/DSM-III-R disorder was 19.3% (95% confidence interval: 11.2-27.4%). Most subjects who received a SCAN/DSM-III-R diagnosis were only mildly impaired. The highest prevalence rates of dysfunctioning (GAF score below 61) without referral to mental health services were for dissociative disorder (2.3%), sleep disorder (2.1%), alcohol dependence (1.3%) and affective disorder (1.8%).

CONCLUSION

Instruments that assess functional impairment in addition to DSM-III-R diagnoses are indispensable in prevalence studies.

Empirically based assessment and taxonomy of psychopathology: cross-cultural applications. A review

This paper provides an overview of empirically based assessment and taxonomy, as illustrated by cross-cultural research on psychopathology. The empirically based approach uses standardized assessment procedures to score behavioral and emotional problems from which syndromes are derived by multivariate analyses. Items and syndromes are scored quantitatively to reflect the degree to which individuals manifest them, as reported by particular informants. Although the approach to assessing problems and to constructing taxonomic groupings differs from the ICD/DSM approach, there are no inherent contradictions between either their models for disorders nor the criterial features used to define disorders. Cross-cultural comparisons have yielded relatively small differences in problem rates and syndrome structure, plus considerable similarity in associations of problems with sex and SES, as well as similar correlations between reports by different types of informants. Research on variations in problems in relation to culture, sex, age, SES, and type of informant can contribute to improving both the ICD/DSM and empirically based approaches and to a more effective synthesis between them.

Psychopathology in Dutch young adults: enduring or changeable?

This study reports on stability and change in emotional and behavioral problems in young adults over a 2-year time span. A sample of 528 18- to 22-year-olds from the general population was assessed using the Young Adult Self-Report (YASR) on two occasions. Stability coefficients for the total problem score of the YASR were 0.63 for males and 0.75 for females. Forty-nine percent of the subjects who were initially classified as deviant were still deviant at follow-up. Of all YASR syndromes, the highest stability was for the Anxious/Depressed scale.

Impact of childhood leukemia on family planning

Clinical experiences have indicated that family planning is affected by childhood leukemia. To investigate this issue, 130 mothers and fathers of 68 families with a long-term disease-free survivor were studied using interviews and questionnaires concerning the effects of childhood cancer on family planning. In one third of the families, either one or both partners reported that their child's disease affected their reproductive planning in various ways. The most extreme variations included having completed the family before diagnosis but still having another child versus not having completed the family before diagnosis but refraining from further progeny. More than half of the affected families refrained from having further offspring, delineating psychological motives for their decision. For parents whose family planning is affected by their experiences with childhood leukemia, the decision-making process is an extra burden. Therefore we advocate that support for the parents of a child with cancer should include counseling on progeny, in which both genetic and psychological information should be provided.

A twin-singleton comparison of problem behaviour in 2-3-year-olds

Twin-singleton differences in problem behaviours in 2-3-year-olds were studied. Maternal ratings of children's problem behaviours were obtained with the CBCL/2-3. The twin sample consisted of 1363 twin pairs (456 MZ, 907 DZ), the sample of singletons consisted of 420 children from the general population. Results indicated that the general level of problem behaviours in twins was broadly comparable to that in singletons. Four of the seven syndromes showed lower scores for twins. These differences, however, were small and mainly caused by lower scores for DZ twins in comparison to MZ twins and singletons. Part of the difference could be attributed to the higher maternal age in the twin groups. Higher means for boys were found for the total problem score, and the Aggressive and Overactive syndromes.

Developmental course of problem behaviors in adolescent adoptees

OBJECTIVE

To determine the 3-year developmental course of problem behaviors and competencies in intercountry adoptees in adolescence and to determine the role of ethnicity and early adverse environmental influences on the development of problem behaviors.

METHOD

In this prospective study, a sample of 1,538 intercountry adoptees, aged 11 to 14 years at initial assessment and 14 to 17 years at follow-up, were assessed with the Child Behavior Checklist (CBCL) at both occasions.

RESULTS

Across the follow-up interval there was an increase in problem behaviors and a decrease in competencies. Increases in problem scores were greatest for the CBCL scales Withdrawn and Delinquent Behavior. These findings contrasted with the results from a longitudinal study of an epidemiological sample of children from the general population. The increase in problem scores could not be attributed to the age of the child at placement, the medical condition at placement, early neglect or abuse, or racial antagonism.

CONCLUSION

In contrast with their agemates from the general population, intercountry adoptees showed an increase in maladaptive functioning in adolescence. Because early adverse influences were not responsible for the increase of problems, it was concluded that other factors pertaining to adolescent development interact negatively with adoption-specific factors that render individuals vulnerable to deviation from the normal developmental pathway.

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.

Psychosocial functioning of young adults after surgical correction for congenital heart disease in childhood: a follow-up study

To investigate the long-term psychosocial outcome of congenital heart disease, the emotional, intellectual and social functioning of 288 (young) adult patients was assessed with standardized assessment procedures 9-23 years (mean follow-up interval: 16 years) after surgical correction for congenital heart disease in childhood, and compared with that of reference groups. With respect to emotional functioning, the patients reported significantly fewer feelings of hostility, fewer neurotic complaints and a better self-esteem than reference subjects. Overall, the results concerning social functioning showed favourable outcomes on daily activities (school, employment) and leisure-time activities for (young) adults with congenital heart disease. No significant differences were found between scores of different cardiac diagnostic groups on hostility, neuroticism, self-esteem and leisure-time activities. The possibility whether the 'denial'-mechanism might have contributed to the positive outcomes is discussed.

The prediction of poor outcome in young adults: comparison of the Young Adult Self-Report, the General Health Questionnaire and the Symptom Checklist

The ability of the Young Adult Self-Report (YASR), the Symptom Checklist (SCL-90) and the General Health Questionnaire (GHQ-28) to predict maladjustment across a 2-year time-span was assessed in a general population sample of 528 18- to 22-year-olds. Referral for mental health services and need for professional help were predicted by total problem scores of the YASR, the GHQ-28 and the SCL-90 and by the internalizing scale of the YASR. Furthermore, the internalizing scale predicted suicide attempts or suicidal ideation, whereas the externalizing scale predicted police contacts. The YASR delinquent behavior syndrome was the only significant predictor of alcohol abuse. The findings supported the validity of the YASR as an instrument for the assessment of psychopathology in young adults.

A study of problem behaviors in 10- to 15-year-old biologically related and unrelated international adoptees

Genetic and environmental influences on problem behaviors were studied in a sample of international adoptees. Parental ratings of childrens' problem behaviors were obtained with the Child Behavior Checklist (CBCL). The sample (mean age, 12.4 years) comprised a group of biological siblings (111 pairs), a group of nonbiological siblings (221 pairs), and a group of singletons (94). Nonshared environmental influences were most important for problem behaviors studied in this paper. Genetic influences were substantial for Externalizing behaviors but unimportant for Internalizing behaviors. For the CBCL total problem score, Attention Problems, and Externalizing behaviors, the results of the present study were in agreement with findings from twin studies. The lack of genetic influences on Internalizing behaviors contrasts with results from twin studies. For the total problem score, the Externalizing grouping, Delinquent Behavior, and Aggressive Behavior, variances for singletons were significantly smaller than for siblings. Model fit indices indicated that these differences in variances are better attributed to smaller effects of factors associated with sibship size than to active influences of siblings on each other. Significant sex differences were found for 8 of the 10 scales. The larger variances for boys on the Externalizing grouping and Aggressive Behavior could be explained by genetic influences.

International adoption of children with siblings: behavioral outcomes

In a study of internationally adopted children in the Netherlands 399 children placed with one or more siblings were followed up approximately ten years after placement. A comparison of problem behavior in this group with that of 1,749 children placed alone shows that the adoption of sibling groups is relatively successful.