The validity of the multi-informant approach to assessing child and adolescent mental health

Accuracy of Achenbach Scales in the Screening of Attention-Deficit/Hyperactivity Disorder in a Community Mental Health Clinic

OBJECTIVE

To use receiver-operating characteristics analysis to identify multilevel diagnostic likelihood ratios and provide a framework for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in children (5-10 years old) and adolescents (11-18 years old) in an outpatient setting.

METHOD

Caregiver, teacher, and youth reports from the Achenbach System of Empirically Based Assessment (ASEBA) were obtained for 299 children and 321 adolescents with multiple imputation of missing data. The reference standard was diagnosis of ADHD based on case history and a semistructured diagnostic interview masked to the ASEBA measurements.

RESULTS

In children, caregiver-reported Attention Problems (area under the curve [AUC] = 0.74) outperformed all other subscales of the caregiver and teacher measures (AUCs ≤ 0.72). In the older sample, caregiver- and teacher-reported Attention Problems (caregiver AUC = 0.73; teacher AUC = 0.61) were best at identifying ADHD. Inclusion of caregiver and teacher reports significantly (p < .001 for all comparisons) increased prediction of ADHD diagnosis, whereas youth self-report did not.

CONCLUSION

Caregiver-reported Attention Problems were more useful than teacher-reports and self-report in identifying ADHD. Combining caregiver and teacher reports improved identification. Multilevel likelihood ratios are provided to facilitate routine clinical use.

The contribution of parent and youth information to identify mental health disorders or problems in adolescents

BACKGROUND

Discrepancies between multiple informants often create considerable uncertainties in delivering services to youth. The present study assessed the ability of the parent and youth scales of the Strength and Difficulties Questionnaire (SDQ) to predict mental health problems/disorders across several mental health domains as validated against two contrasting indices of validity for psychopathology derived from the Development and Well Being Assessment (DAWBA): (1) an empirically derived computer algorithm and (2) expert based ICD-10 diagnoses.

METHODS

Ordinal and logistic regressions were used to predict any problems/disorders, emotional problems/disorders and behavioural problems/disorders in a community sample (n = 252) and in a clinic sample (n = 95).

RESULTS

The findings were strikingly similar in both samples. Parent and youth SDQ scales were related to any problem/disorder. Youth SDQ symptom and impact had the strongest association with emotional problems/disorder and parent SDQ symptom score were most strongly related to behavioural problems/disorders. Both the SDQ total and the impact scores significantly predicted emotional problems/disorders in males whereas this was the case only for the total SDQ score in females.

CONCLUSION

The present study confirms and expands previous findings on parent and youth informant validity. Clinicians should include both parent and youth for identifying any mental health problems/disorders, youth information for detecting emotional problems/disorders, and parent information to detect behavioural problems/disorders. Not only symptom scores but also impact measures may be useful to detect emotional problems/disorders, particularly in male youth.

How reliable and valid is the teacher version of the Strengths and Difficulties Questionnaire in primary school children?

INTRODUCTION

The Strengths and Difficulties Questionnaire (SDQ) is validated for parents, but not yet for teachers in a broad age range of children. We conducted a cross-sectional study with 4-10 years old school children to investigate if the SDQ-T can be used instead of the validated but lengthy Teacher's Report Form (TRF) to acquire information about emotional and behavioral problems in the school community.

METHODS

Teachers of 453 children from primary schools were approached. Teachers of 394 children (response rate 86.9%) with a mean age of 7.1 years filled in the SDQ-T (n = 387), the TRF (n = 349) or both (n = 342). We assessed reliability by calculating internal consistency and concurrent validity (using correlation coefficients, sensitivity, specificity) of the SDQ-T compared with the TRF.

RESULTS

Internal consistency of the SDQ-T Total Difficulties Score (SDQ-T TDS; Cronbach α = 0.80), hyperactivity/ inattention- (α = 0.86) and prosocial behavior (α = 0.81) was very good. Concurrent validity demonstrated a strong correlation of all subscales of the SDQ-T with the corresponding scale on the TRF (range 0.54-0.73), except for peer problems (0.46). Using a SDQ-T TDS cut-off score > 14, the SDQ-T had a good sensitivity (90%) and specificity (94%).

DISCUSSION

The good reliability, validity and brevity of the SDQ-T make it an easily applicable questionnaire for obtaining information about emotional and behavioral problems from teachers in primary school children.

Bullying and Being Bullied in Childhood Are Associated With Different Psychosocial Risk Factors for Poor Physical Health in Men

Bullying and being bullied in childhood are both linked with later adjustment problems. The impact of childhood bullying on risk for poor physical health in adulthood is understudied. Black and White men ( n = 305; mean age = 32.3 years) enrolled in the Pittsburgh Youth Study since the first grade underwent a comprehensive assessment of psychosocial, behavioral, and biological risk factors for poor health. Indices of bullying and being bullied were created by averaging annual ratings collected from participants and their caregivers when the participants were 10 to 12 years old. Results showed that being a bully in childhood was associated with greater stress and aggression and poorer health behaviors in adulthood, whereas being a victim of bullies in childhood was associated with lower socioeconomic resources, less optimism, and greater unfair treatment in adulthood. Unexpectedly, neither bullying nor being bullied in childhood was related to inflammation or metabolic syndrome. Bullying and being bullied in childhood were associated with distinct domains of psychosocial risk in adulthood that may later lead to poor physical health.

Measuring Anxiety in Children: The Importance of Separate Mother and Father Reports

Background

Previous research suggests that it is important to use parental reports when assessing children’s anxiety, but it remains unclear to what extent there are differences between mothers’ and fathers’ scores and whether these potential differences have any repercussions for the psychometric properties of the scale being used.

Objective

This study was conducted to investigate parental differences on the Parent version of the Screen for Child Anxiety Related Emotional Disorders-Revised (SCARED-RP), a rating scale for measuring child anxiety symptoms. The second aim was to re-examine the reliability and validity of the SCARED-RP, in light of these possible differences.

Methods

The SCARED-RP and the Child Behaviour Checklist (CBCL) were administered to parents of clinically anxious children (n = 81), and control children (n = 108). All children (n = 189) completed the SCARED-R.

Results

Significant correlations between mother and father reports were found within the clinically anxious sample. Mothers showed significantly more correspondence with their children in the control group than fathers. The SCARED-RP internal consistency on total scale was excellent (mothers: .94; fathers: .94) and moderate to good for all subscales (from .66 Situational-Environmental Phobia to .93 Animal Phobia). The SCARED-RP differentiated well between clinically anxious and control children (mother and father data). The concurrent validity was supported by strong correlations with the CBCL anxious-depressed scale.

Conclusion

Differences between mother and father reports suggest the importance of obtaining information from both parents separately. Furthermore, the SCARED-RP is a useful instrument for assessing children’s anxiety disorder symptoms in clinical and research settings.

Inflexible Youngsters: Psychological and Psychopathological Correlates of the Avoidance and Fusion Questionnaire for Youths in Nonclinical Dutch Adolescents

The present study examined psychological and psychopathological correlates of psychological inflexibility as measured by the Avoidance and Fusion Questionnaire for Youth (AFQ-Y) in two independent samples of nonclinical Dutch adolescents aged between 12 and 18 years (Ns being 184 and 157). Participants completed a survey containing the AFQ-Y and scales assessing mindfulness, thought suppression, self-compassion, self-worth, self-efficacy, and internalizing/externalizing symptoms. In both samples, the AFQ-Y was found to be a reliable measure of psychological inflexibility that correlated in a theoretically meaningful way with other psychological constructs. Most importantly, AFQ-Y scores correlated positively with internalizing and externalizing symptoms, and in most cases, these associations remained significant when controlling for other measures. These findings suggest that psychological inflexibility is an important factor in youth psychopathology that needs to be further investigated in future research.

The Malevolent Side of Human Nature

The term dark triad refers to the constellation of narcissism, Machiavellianism, and psychopathy. Over the past few years, the concept has gained momentum, with many researchers assuming that the dark triad is a prominent antecedent of transgressive and norm-violating behavior. Our purpose in this meta-analytic review was to evaluate (a) interrelations among narcissism, Machiavellianism, and psychopathy; (b) gender differences in these traits; (c) how these traits are linked to normal personality factors; and (d) the psychosocial correlates of the dark triad. Our findings show that dark triad traits are substantially intercorrelated, somewhat more prevalent among men than women, predominantly related to the Big Five personality factor of agreeableness and the HEXACO factor of honesty-humility, and generally associated with various types of negative psychosocial outcomes. We question whether dark triad traits are sufficiently distinct and argue that the way they are currently measured is too simple to capture the malevolent sides of personality. Because most research in this domain is cross-sectional and based on self-reports, we recommend using a cross-informant approach and prospective, longitudinal research designs for studying the predictive value of dark triad features.

Parent-Adolescent Discrepancies Regarding Adolescents' Peer-Related Loneliness: Associations with Adolescent Adjustment

Because loneliness is a subjective experience, it is often examined using self-reports. Yet, researchers have started to use other-reports to examine loneliness. As previous research suggests that discrepancies between self- and other views might have important implications for adolescents' mental health, the current study examines discrepancies in multi-informant reports on adolescents' loneliness in relation with prosocial behavior, aggression, and adolescents' parent-related loneliness. The sample consisted of 374 mother-adolescent dyads and 318 father-adolescent dyads (41.80% male, M _age  = 15.67 years, SD = 1.25). Results indicated that informants used different reference points to assess adolescents' peer-related loneliness, but were otherwise comparable. Moreover, informant discrepancies were associated with greater adolescents' reported parent-related loneliness. The current study did not provide evidence that discrepancies were related to prosocial or aggressive behavior. The current study adds to the notion that other-reports on loneliness show substantial convergence with self-reports. In addition, this study indicates that the discrepancy between other- and self-reports on loneliness holds valuable information for adolescent socio-emotional adjustment.

Father- and Youth-Reported Family Affective Expression Differentially Predicts Youth Internalizing and Externalizing Symptoms

Temperamental approach is associated with adolescent internalizing and externalizing symptoms. Negative family affective expression, or problematic communication about emotions, is also associated with youth's risk for symptoms. However, it is unclear whether negative family affective expression differentially predicts symptoms based on (a) youth's temperamental approach and (b) informants' perceptions of negative family affective expression. To address these issues, we explored whether mother-, father-, and youth-reported negative family affective expression moderated the relation between youth temperamental approach and symptoms. Participants were 775 youths (71% male, 76% Caucasian) assessed at ages 10-12 (Time 1) and 12-14 (Time 2). Mothers, fathers, and youths reported on negative family affective expression and youths reported on temperamental approach at Time 1. Teachers reported on youth symptoms at Times 1 and 2. Youth- and father-reported, but not mother-reported, negative family affective expression moderated the relation between youth approach and symptoms. When youths reported higher negative family affective expression, youths lower in approach exhibited higher internalizing symptoms than youths higher in approach. In contrast, when fathers reported lower negative family affective expression, youths lower in approach exhibited higher internalizing and externalizing symptoms than youths higher in approach. Assessments and interventions for youth symptoms should include not only temperamental features, but also multiple informants' perspectives of family affective expression. Such efforts could promote greater family communication, address problematic family dynamics, and potentially attenuate risk for youth symptoms.

Community Violence Exposure and Generalized Anxiety Symptoms: Does Executive Functioning Serve a Moderating Role Among Low Income, Urban Youth?

Although community violence exposure (CVE) confers risk for generalized anxiety symptoms, not all youth who are exposed to violence exhibit such symptoms, suggesting that other factors moderate this relation. One candidate for moderation is executive functioning (EF), which is linked to both CVE and generalized anxiety symptoms. Nevertheless, little research has examined whether EF moderates the CVE-anxiety relation. To address this gap, we examined associations among CVE (i.e., direct victimization and witnessed violence), EF abilities (i.e., emotional control and shifting), and parent- and child-reported generalized anxiety disorder (GAD) symptoms among low income, urban youth (N = 104, 50 % male, M = 9.93 ± 1.22 years). In terms of main effects, lower levels of emotional control were associated with increased parent-reported GAD symptoms, whereas lower levels of shifting abilities were associated with increased parent- and child-reported GAD symptoms across both subtypes of CVE. EF abilities moderated the relation between direct victimization and both parent- and child-reported GAD symptoms, but did not moderate the relation between witnessed violence and GAD symptoms. Post-hoc probing indicated that when youth were exposed to higher levels of direct victimization, those with lower EF abilities exhibited elevated GAD symptoms. However, the level of direct victimization did not impact the level of GAD symptoms among youth with higher EF abilities. Findings have implications for prevention and intervention programs among at-risk youth who are exposed to community violence.

Diagnostic Efficiency of the Child and Adolescent Symptom Inventory (CASI-4R) Depression Subscale for Identifying Youth Mood Disorders

This study examined the diagnostic and clinical utility of the Child and Adolescent Symptom Inventory-4 R (CASI-4 R) Depressive and Dysthymia subscale for detecting mood disorders in youth (ages 6-12; M = 9.37) visiting outpatient mental health clinics. Secondary analyses (N = 700) utilized baseline data from the Longitudinal Assessment of Manic Symptoms study. Semistructured interviews with youth participants and their parents/caregivers determined psychiatric diagnoses. Caregivers and teachers completed the CASI-4 R. CASI-4 R depressive symptom severity and symptom count scores each predicted mood disorder diagnoses. Both caregiver scores (symptom severity and symptom count) of the CASI-4 R subscale significantly identified youth mood disorders (areas under the curve [AUCs] = .78-.79, ps < .001). The symptom severity version showed a small but significant advantage. Teacher symptom severity report did not significantly predict mood disorder diagnosis (AUC = .56, p > .05), whereas the teacher symptom count report corresponded to a small effect size (AUC = .61, p < .05). The CASI-4 R Depression scale showed strong incrememental validity even controlling for the other CASI-4 R scales. Caregiver subscale cutoff scores were calculated to assist in ruling in (diagnostic likelihood ratio [DLR] = 3.73) or ruling out (DLR = 0.18) presence of a mood disorder. The CASI-4 R Depressive subscale caregiver report can help identify youth mood disorders, and using DLRs may help improve diagnostic accuracy.

Predictors of discrepancies between fathers and mothers in rating behaviors of preschool children with and without ADHD

To examine child factors and parental characteristics as predictors of discrepancies between parents' ratings of externalizing and internalizing behavior problems in a sample of preschool children with ADHD and behavior problems and in a nonclinical sample. We investigated correspondence and discrepancies between parents' ratings on the externalizing and internalizing behavior problems broadband scales of the Child Behavior Checklist version for preschool children (CBCL/1.5-5). Parents of 152 preschool children, with ADHD and behavior problems (n = 72) and nonclinical children (n = 80), aged between 28 and 72 months (M = 47.26, SD = 12.7), completed the CBCL/1.5-5. Candidate predictors of discrepancy included the child's age and sex, and parents' levels of parenting stress, depressive mood, attention-deficit and disruptive behavior. Hierarchical multiple regression analyses were conducted. Correspondence between parents, both for ratings on internalizing and externalizing behavior problems, was high (r = .63-.77). In the clinical sample, mothers rated the severity of externalizing behavior problems significantly higher than did fathers (p = < .001). Discrepancy between fathers and mothers on externalizing behavior problems was not predicted by child factors or interparental differences in psychopathology, but it was predicted by interparental differences in parenting stress (R 2 = .25, p < .001). This effect was significantly larger in the nonclinical sample (ΔR 2 = .06, p < .001). When parents disagree on the severity level of preschool children's externalizing behavior problems, the clinician should take into consideration that differences in parenting stress might be involved.

Efficacy of group social skills interventions for youth with autism spectrum disorder: A systematic review and meta-analysis

Group-based social skills interventions (GSSIs) are widely used for treating social competence among youth with autism spectrum disorder (ASD), but their efficacy is unclear. Previous meta-analysis of the literature on well-designed trials of GSSIs is limited in size and scope, collapsing across highly heterogeneous sources (parents; youths; teachers; observers; behavioral tasks). The current meta-analysis of randomized control trials (RCTs) was conducted to ascertain overall effectiveness of GSSIs and differences by reporting sources. Nineteen RCTs met inclusion criteria. Results show that overall positive aggregate effects were medium (g=0.51, p<0.001). Effects were large for self-report (g=0.92, p<0.001), medium for task-based measures (g=0.58, p<0.001), small for parent- and observer-report (g=0.47 and 0.40, respectively, p<0.001), and nonsignificant for teacher-report (p=0.11). Moderation analyses of self-report revealed the effect was wholly attributable to youth reporting that they learned about skilled social behaviors (social knowledge; g=1.15, p<0.01), but not that they enacted them (social performance; g=0.28, p=0.31). Social skills interventions presently appear modestly effective for youth with ASD, but may not generalize to school settings or self-reported social behavior.

Contextual influences on concordance between maternal report and laboratory observation of toddler fear

Emotion and temperament researchers have faced an enduring issue of how to best measure children's tendencies to express specific emotions. Inconsistencies between laboratory observation and parental report have made it challenging for researchers to determine the utility of these different forms of measurement. The current study examined the effect of laboratory episode characteristics (i.e., threat level of the episode, maternal involvement) on concordance between maternal report and laboratory observation of toddler fear. The sample included 111 mother-toddler dyads who participated in a laboratory assessment when toddlers were approximately 24 months old. Toddler fear was assessed both via maternal report and observation from a number of laboratory episodes that varied in their level of threat and whether mothers were free or constrained in their involvement in the task. Results indicated that maternal report related to the observed fear composites for low threat, but not high threat episodes. On the contrary, maternal involvement in the laboratory episodes did not moderate the relation between maternal report and laboratory observation of fear. These results suggest that the threat level of laboratory episodes designed to elicit fear, but not maternal involvement in these episodes, may be important to take into consideration when assessing their relation to maternal report of fear and fearful temperament. (PsycINFO Database Record

Design of a Multisite Study Assessing the Impact of Tic Disorders on Individuals, Families, and Communities

BACKGROUND

Tic disorders, including Tourette syndrome, are complex, multisymptom diseases, yet the impact of these disorders on affected children, families, and communities is not well understood.

METHODS

To improve the understanding of the impacts of Tourette syndrome, two research groups conducted independent cross-sectional studies using qualitative and quantitative measures. They focused on similar themes, but distinct scientific objectives, and the sites collaborated to align methods of independent research proposals with the aim of increasing the analyzable sample size.

RESULTS

Site 1 (University of Rochester) was a Pediatric Neurology referral center. Site 2 (University of South Florida) was a Child Psychiatry referral center. A total of 205 children with tic disorders were enrolled from both studies. The University of Rochester also enrolled 100 control children in order to clearly isolate impacts of Tourette syndrome distinct from those occurring in the general population. The majority of children with tic disorders (n = 191, 93.1%) had Tourette syndrome, the primary population targeted for these studies. Children with Tourette syndrome were similar across sites in terms of tic severity and the occurrence of comorbid conditions. The occurrence of psychiatric comorbidities in the control group was comparable with that in the general pediatric population of the United States, making this a well-justified comparison group.

CONCLUSIONS

Through collaboration, two sites conducting independent research developed convergent research methods to enable pooling of data, and by extension increased power, for future analyses. This method of collaboration is a novel model for future epidemiological research of tic disorders.

Child Conduct Problems across Home and School Contexts: A Person-Centered Approach

To examine patterns of conduct problems across the home and school context, we used latent class analysis to analyze primary caregivers' and teachers' ratings on the conduct problems subscale of the Strengths and Difficulties Questionnaire (R. Goodman, 1997) in the Family Life Project (N = 1,292), a prospective study of child development in rural and small town contexts. We found a similar four-class solution at five and seven years of age. In decreasing prevalence, the following classes were identified: (1) low symptoms reported by both informants (low cross-context); (2) high parent-reported symptoms, low teacher-reported symptoms (home context); (3) low parent-reported symptoms, moderate teacher-reported symptoms (school context); and (4) high symptoms reported by both informants (high cross-context). Classes exhibited stability from age five to age seven: children were more likely to remain in the same class than to transition to a different class, and longitudinal stability was especially high for children in the low cross-context class at age 5. A number of child and family characteristics measured in early childhood (executive function, verbal ability, poverty-related risk, sensitive parenting, and parental depressive symptoms) were associated with class membership at age five and age seven, but were generally not associated with longitudinal transitions between classes.

Transactional Associations Among Maternal Depression, Parent-Child Coercion, and Child Conduct Problems During Early Childhood

Maternal depression is among the most consistent and well-replicated risk factors for negative child outcomes, particularly in early childhood. Although children of depressed mothers are at an increased risk of adjustment problems, conversely, children with emotional or behavioral problems also have been found to adversely compromise maternal functioning, including increasing maternal depression. The purpose of this investigation was to examine transactional associations among maternal depression, parent-child coercive interaction, and children's conduct and emotional problems in early childhood using a cross-lagged panel model. Participants were 731 toddlers and families that were part of the Early Steps Multisite Study, a sample of diverse ethnic backgrounds and communities (i.e., rural, urban, suburban) recruited from Women, Infants, and Children Nutritional Supplement Centers. Analyses provided support for the existence of some modest transactional relations between parent-child coercion and maternal depression and between maternal depression and child conduct problems. Cross-lagged effects were somewhat stronger between children age 2-3 than age 3-4. Similar patterns were observed in the model with child emotional problems replacing conduct problems, but relations between coercion and maternal depression were attenuated in this model. In addition, the transactional hypothesis was more strongly supported when maternal versus secondary caregiver reports were used for child problem behavior. The findings have implications for the need to support caregivers and reinforce positive parenting practices within family-centered interventions in early childhood.

Reexamining ADHD-Related Self-Reporting Problems Using Polynomial Regression

Individuals with attention deficit hyperactivity disorder (ADHD) underreport symptoms compared with informants and objective measures. This study applied enhanced statistical methodology (polynomial regression) to the study of ADHD self-reporting to clarify what contributes to symptom underreporting by adolescents with ADHD ( N = 107; ages = 11-15 years). Polynomial regression models were conducted to test competing hypotheses about the nature of self-reporting problems. Traditional difference score models were nested within polynomial regression models to examine how modeling strategy influences results. Sixty-six percent of the sample substantially underreported symptoms compared with parents and 23.6% denied all symptoms. Polynomial regression models provided no evidence that the size of the discrepancy between parent and adolescent symptom reports possessed meaningful linear associations with any of the hypothesized predictors. Nested models indicated that the difference score approach led to very poor model fit and increased risk for Type I errors when examining underreporting among youth with ADHD. This finding suggests that past evaluations using a difference score approach should be replicated using polynomial regression to ensure that significant effects do not represent statistical artifact.

A Multisource Approach to Assessing Child Maltreatment From Records, Caregivers, and Children

Practitioners and researchers alike face the challenge that different sources report inconsistent information regarding child maltreatment. The present study capitalizes on concordance and discordance between different sources and probes applicability of a multisource approach to data from three perspectives on maltreatment-Child Protection Services (CPS) records, caregivers, and children. The sample comprised 686 participants in early childhood (3- to 8-year-olds; n = 275) or late childhood/adolescence (9- to 16-year-olds; n = 411), 161 from two CPS sites and 525 from the community oversampled for psychosocial risk. We established three components within a factor-analytic approach: the shared variance between sources on presence of maltreatment (convergence), nonshared variance resulting from the child's own perspective, and the caregiver versus CPS perspective. The shared variance between sources was the strongest predictor of caregiver- and self-reported child symptoms. Child perspective and caregiver versus CPS perspective mainly added predictive strength of symptoms in late childhood/adolescence over and above convergence in the case of emotional maltreatment, lack of supervision, and physical abuse. By contrast, convergence almost fully accounted for child symptoms for failure to provide. Our results suggest consistent information from different sources reporting on maltreatment is, on average, the best indicator of child risk.

Research Review: Multi-informant integration in child and adolescent psychopathology diagnosis

BACKGROUND

An empirically based, clinically usable approach to cross-informant integration in clinical assessment is needed. Although the importance of this ongoing issue is becoming increasingly recognized, little in the way of solid recommendations is currently provided to researchers and clinicians seeking to incorporate multiple informant reports in diagnosis of child psychopathology. The issue is timely because recent developments have created new opportunities for improved handling of this problem. For example, advanced theories of psychopathology and normal and abnormal child development provide theoretical guidance for how integration of multiple informants should be handled for specific disorders and at particular ages. In addition, more sophisticated data analytic approaches are now available, including advanced latent variable models, which allow for complex measurement approaches with consideration of measurement invariance.

FINDINGS

The increasing availability and mobility of computing devices suggests that it will be increasingly feasible for clinicians to implement more advanced methods rather than being confined to the easily memorized algorithms of the DSM system.

CONCLUSIONS

Development of models of cross-informant integration for individual disorders based on theory and tests of the incremental validity of more sophisticated cross-informant integration approaches in comparison to external validation criteria (e.g. longitudinal trajectories and outcomes, treatment response, and behavior genetic etiology) should be a focus of future work.

Irritability in child and adolescent psychopathology: An integrative review for ICD-11

In preparation for the World Health Organization's development of the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11) chapter on Mental and Behavioral Disorders, this article reviews the literature pertaining to severe irritability in child and adolescent psychopathology. First, research on severe mood dysregulation suggests that youth with irritability and temper outbursts, among other features of hyperactivity and arousal, demonstrate cross-sectional correlates and developmental outcomes that distinguish them from youth with bipolar disorder. Second, other evidence points to an irritable dimension of Oppositional Defiant Disorder symptomatology, which is uniquely associated with concurrent and subsequent internalizing problems. In contrast to the Diagnostic and Statistical Manual of Mental Disorders' (5th ed.) Disruptive Mood Dysregulation Disorder, our review of the literature supports a different solution: a subtype, Oppositional Defiant Disorder with chronic irritability/anger (proposal included in Appendix). This solution is more consistent with the available evidence and is a better fit with global public health considerations such as harm/benefit potential, clinical utility, and cross-cultural applicability. Implications for assessment, treatment, and research are discussed.

Effective Mental Health Screening in Adolescents: Should We Collect Data from Youth, Parents or Both?

Youth- and parent-rated screening measures derived from the Strengths and Difficulties Questionnaire (SDQ) and Development and Well-Being Assessment (DAWBA) were compared on their psychometric properties as predictors of caseness in adolescence (mean age 14). Successful screening was judged firstly against the likelihood of having an ICD-10 psychiatric diagnosis and secondly by the ability to discriminate between community (N = 252) and clinical (N = 86) samples (sample status). Both, SDQ and DAWBA measures adequately predicted the presence of an ICD-10 disorder as well as sample status. The hypothesis that there was an informant gradient was confirmed: youth self-reports were less discriminating than parent reports, whereas combined parent and youth reports were more discriminating-a finding replicated across a diversity of measures. When practical constraints only permit screening for caseness using either a parent or an adolescent informant, parents are the better source of information.

The Youth Anxiety Measure for DSM-5 (YAM-5): Development and First Psychometric Evidence of a New Scale for Assessing Anxiety Disorders Symptoms of Children and Adolescents

The Youth Anxiety Measure for DSM-5 (YAM-5) is a new self- and parent-report questionnaire to assess anxiety disorder symptoms in children and adolescents in terms of the contemporary classification system. International panels of childhood anxiety researchers and clinicians were used to construct a scale consisting of two parts: part one consists of 28 items and measures the major anxiety disorders including separation anxiety disorder, selective mutism, social anxiety disorder, panic disorder, and generalized anxiety disorder, whereas part two contains 22 items that focus on specific phobias and (given its overlap with situational phobias) agoraphobia. In general, the face validity of the new scale was good; most of its items were successfully linked to the intended anxiety disorders. Notable exceptions were the selective mutism items, which were frequently considered as symptoms of social anxiety disorder, and some specific phobia items especially of the natural environment, situational and other type, that were regularly assigned to an incorrect category. A preliminary investigation of the YAM-5 in non-clinical (N = 132) and clinically referred (N = 64) children and adolescents indicated that the measure was easy to complete by youngsters. In addition, support was found for the psychometric qualities of the measure: that is, the internal consistency was good for both parts, as well as for most of the subscales, the parent-child agreement appeared satisfactory, and there was also evidence for the validity of the scale. The YAM-5 holds promise as a tool for assessing anxiety disorder symptoms in children and adolescents.

Emotion Correlates of Bullies, Victims, and Bully-Victims in African American Children

Bullying is a pervasive and widely studied problem. Less is known about the emotion correlates that accompany being a bully, being a victim of bullying, and experiencing both bullying and victimization for African American elementary-school-age students. The current study examined differences in emotion dysregulation and internalizing symptoms (depression, anxiety) across levels of bullying and victimization. Children ( N = 336, Mage = 9.58 years, 42.3% boys, 100% African American) were recruited from two inner-city elementary schools and completed self- and peer-reports of bullying and self-reports of victimization, emotion dysregulation, and internalizing symptoms. Results indicated that emotion dysregulation and anxiety symptoms were predicted by an interaction between self-reported bullying and victimization. For children low in victimization, higher levels of self-reported bullying predicted an increase in emotion dysregulation and anxiety symptoms. However, for children high in victimization, bullying was not predictive of these outcomes. Depressive symptoms were predicted by self- and peer-reported bullying and self-reported victimization. Understanding underlying emotional correlates of bullying and victimization within this context have important implications for prevention programs.

Positive Parenting and Callous-Unemotional Traits: Their Association With School Behavior Problems in Young Children

The current study tested the associations of both positive (i.e., warm and responsive) and negative (i.e., harsh and inconsistent) aspects of parenting with callous-unemotional (CU) traits and conduct problems. Caregivers and teachers of 92 ethnically diverse (33% African American) kindergarten students (61% female) were recruited to complete a series of survey measures. Students' average age was 6.2 (SD = 0.42) years. Parent report of positive parenting practices, but not negative parenting practices, was associated with teacher report of conduct problems. Further, positive parenting interacted with CU traits in their association with conduct problems. Parental use of positive reinforcement was more strongly negatively related to conduct problems for youth with high levels of CU traits, whereas parent-child cooperation was positively related to conduct problems only for youth with low levels of CU traits. Finally, only parental warmth was negatively correlated with CU traits after controlling for level of conduct problems. Results were generally not moderated by the child's gender or ethnicity. These findings highlight the importance of positive parenting practices for understanding CU traits and as potential targets in clinical interventions to treat children who show elevated levels of these traits.

Predictors of parent-child agreement on child anxiety diagnoses on the ADIS-IV-C/P

Diagnostic agreement between parents' and children's reports on children's anxiety problems is notoriously poor; however, very few investigations have examined specific predictors of inter-rater agreement on child anxiety diagnoses. This study examined predictors of categories of parent and child diagnostic endorsement on the Anxiety Disorders Interview Schedule for Children-IV. One hundred eight children (ages 7-13) and their parents completed structured diagnostic interviews for non-OCD/PTSD anxiety diagnoses and paper and pencil measures of functioning and impairment in a variety of domains. Parent-child agreement was statistically significant for social phobia and separation anxiety disorder, but was overall poor for all anxiety diagnoses. Externalizing disorder status, family accommodation frequency, and child rated impairment in various domains differentially predicted informant discrepancies for different anxiety disorders. These data are among the first to suggest variables that may explain parent-child concordance.

Method Variance in Adolescents', Mothers', and Observers' Reports of Peer Management: Nuisance or Information?

The purpose of this investigation was to examine discrepancies among three informants' (adolescents, mothers, and observers) reports of maternal consulting in regard to peer relationships and the relation of the discrepancies to four social adjustment variables (prosocial behavior, loneliness, positive friendship quality, and physical victimization). An ethnically diverse sample of 70 early adolescents (51 % female) and their mothers participated in this multimethod investigation. Adolescent reports of parental consulting, but not mother or observer reports, were significantly associated with adolescent reports of four psychosocial outcomes. Recognizing that comparison of equivalent regression models can inform interpretations of the data such as the monomethod associations found in this study, this article describes and discusses a strategy for analyzing data from multiple informants. The associations of adolescent reports of parental consulting with loneliness and physical victimization could be fully explained in terms of adolescent bias or other systematic variance uniquely associated with adolescent reports, but those with prosocial behavior and positive friendship quality could not. The view that discrepancies between mother and adolescent reports of parental consulting reflect poor relationship quality appeared most applicable in models of positive friendship quality, somewhat applicable in models of prosocial behavior and physical victimization, and not applicable in models of loneliness. The view that discrepancies might reflect normative and adaptive autonomy was not supported. In addition to adding to our understanding of maternal consulting in regard to peer relationships, it is also hoped that the analytic approach developed for this study will stimulate developments in research that uses multiple informants.

Parenting Effects are in the Eye of the Beholder: Parent-Adolescent Differences in Perceptions Affects Adolescent Problem Behaviors

Although it is known that parents and adolescents hold different views regarding adolescent characteristics (e.g., inter-rater agreement on adolescent behaviors between parents and adolescents is low), we know little about parent-adolescent (dis)agreement in their perceptions of parenting. The current study used 220 parent-adolescent dyads (M _age = 13.3 years; 50.5 % female) to address this gap and examined how the discrepancy between parents' and adolescents' perceptions of the parent's negative reactions toward an adolescent's anger affects the adolescent's problem behaviors. Results suggested the direction of the disagreement between the two parties is important: when adolescents viewed parenting more negatively than parents did, adolescents showed elevated levels of broadband externalizing behaviors and, specifically, aggressive behaviors. This finding suggests the importance of adolescents' subjective views of how mothers and fathers react to them. The findings are discussed in terms of methodology in family studies and implications toward future research.

Agreement in Youth-Parent Perceptions of Parenting Behaviors: A Case for Testing Measurement Invariance in Reporter Discrepancy Research

While conventional wisdom suggests that parents and their adolescent offspring will often disagree, the nature of discrepancies in informant reports of parenting behaviors is still unclear. This article suggests testing measurement invariance in an effort to clarify if discrepancies in informant scores reflect true differences in perspectives on the same construct, or if the instrument is simply not measuring the same construct across parents and youth. The study provides an example by examining invariance and discrepancy across child, adolescent, and parent reports on the Alabama Parenting Questionnaire. The sample for this study was 255 youth (51.4 % male) aged 6-17 years (M age  = 12.3 years) and an accompanying parent. A five-factor model of the measure was found to provide approximately equivalent measurement across four participant groups (children under 12 years, adolescents aged 12-18 years, and parents of each group, respectively). Latent mean levels of reported parenting constructs varied greatly across informants. Age moderated the association between reports of two subscales, Parental Involvement and Positive Parenting, such that adolescents were more consistent with parents. The findings highlight the utility of testing measurement invariance across informants prior to evaluating differences in their reports, and demonstrate the benefits of considering invariance in the larger conversation over informant discrepancies.

Congruence of Parents' and Children's Perceptions of Parenting: A Meta-Analysis

Parents and children often report different perspectives about parents' behaviors. Such lack of congruence is important because it may reflect problems in their relationship and may be associated with children's maladjustment. We conducted a systematic, quantitative review of parent-child agreement and discrepancy about parenting behaviors, and potential moderators (e.g., children's age, race, clinical status, family intactness) of the extent of mother-child and father-child congruence. The meta-analyses included 85 studies with 476 effect sizes of the degree of agreement and discrepancy in parent-child reports of three parenting behaviors: Acceptance, Psychological Control, and Behavioral Control assessed with one of the most widely-used measures of parenting-the Children's Report of Parental Behavior Inventory. Mother-child and father-child dyads exhibited significant but modest levels of agreement (r) across parenting constructs. The amount and direction of discrepancy (Hedges' g) varied by the parenting construct and parents' sex. Overall, parents' reports were more favorable than their children's report about the parents' behaviors. Significant associations were found between the magnitude of agreement/discrepancy and children's age, race, clinical status, and family intactness. Moderators differed by parenting construct, parents' sex, and type of effect size. Implications of these findings for researchers and clinicians are discussed and highlight the need for further research about the meaning of parent-child incongruence, its relation to children's psychopathology, and interventions for reducing it.

The Depression Prevention Initiative: Impact on Adolescent Internalizing and Externalizing Symptoms in a Randomized Trial

This randomized controlled trial examined the longitudinal effects of two school-based indicated depression prevention programs on adolescents' internalizing and externalizing symptoms, as measured by adolescents, their parents, and their teachers. One hundred eighty-six adolescents participated in this study. The average age was 14.01 (SD = 1.22) years, and the sample was 66.7% female. One third of the sample belonged to a racial minority. Youth received either Interpersonal Psychotherapy-Adolescent Skills Training or group counseling. Symptoms were assessed using adolescent, parent, and teacher reports on the Achenbach System of Empirically Based Assessment at baseline, postintervention, and 6-month follow-up. Adolescents reported the most robust effects in favor of Interpersonal Psychotherapy-Adolescent Skills Training. Adolescents in Interpersonal Psychotherapy-Adolescent Skills Training reported significantly greater reductions in internalizing symptoms through the 6-month follow-up and significantly greater reductions in externalizing symptoms during the intervention as compared to group counseling. Less robust effects were found when examining parent and teacher reports, although there was evidence of significant within-group change in parent- and teacher-reported internalizing symptoms for both interventions and significant between-group differences in teacher-reported externalizing symptoms. This study provides additional evidence supporting the efficacy of Interpersonal Psychotherapy-Adolescent Skills Training as a depression prevention program for adolescents. Interpersonal Psychotherapy-Adolescent Skills Training appears to have fast-acting effects on broadband internalizing and externalizing symptoms as reported by adolescents. This suggests that Interpersonal Psychotherapy-Adolescent Skills Training may serve as a transdiagnostic preventive intervention. Moreover, given the disparate reports of adolescents, parents, and teachers, this study demonstrates the significance of collecting information from multiple sources when possible.

Pediatric Pain Beliefs Questionnaire: Psychometric Properties of the Short Form

Cognitive appraisals inform and shape individuals' pain experiences. As researchers examine mechanisms of cognitive-behavioral interventions for chronic pain, psychometrically sound measures based in cognitive theory are needed to directly assess pain beliefs. The Pain Beliefs Questionnaire (PBQ), a 32-item self-report measure informed by coping and appraisal theory, was designed to assess children's pain threat appraisals, problem-focused pain coping efficacy, and emotion-focused pain coping efficacy. The present study aimed to: 1) create a short form of the PBQ, and 2) evaluate the psychometric properties of the reduced measure in a large database of pediatric patients with functional abdominal pain (n = 871). Item reduction analyses identified an 18-item short form of the PBQ (PBQ-SF) that exhibited psychometric properties similar to the original measure. All 3 subscales of the PBQ-SF exhibited strong internal consistency (α levels ranged from .79 to .80) and adequate test-retest reliability at 2 weeks. Evidence for construct validity was provided by examining patterns of partial correlations for each subscale. The PBQ-SF represents a valid and reliable measure for evaluating children's pain beliefs. Future studies should investigate the treatment sensitivity of the PBQ-SF to evaluate its appropriateness for use in clinical trials.

PERSPECTIVE

This article presents the psychometric properties of a reduced 18-item version of a measure used to assess children's pain beliefs in a large sample of children with functional abdominal pain. This measure could help identify processes and individual differences underlying children's responses to psychological treatments for chronic pain.

Future Research Directions in the Positive Valence Systems: Measurement, Development, and Implications for Youth Unipolar Depression

The Positive Valence Systems (PVS) have been introduced by the National Institute of Mental Health as a domain to help organize multiple constructs focusing on reward-seeking behaviors. However, the initial working model for this domain is strongly influenced by adult constructs and measures. Thus, the present review focuses on extending the PVS into a developmental context. Specifically, the review provides some hypotheses about the structure of the PVS, how PVS components may change throughout development, how family history of depression may influence PVS development, and potential means of intervening on PVS function to reduce onsets of depression. Future research needs in each of these areas are highlighted.

Cross-Cultural Perspectives on Parent-Adolescent Discrepancies: Existing Findings and Future Directions

As summarized in this commentary, the first generation of cross-informant agreement research focused on perceptions of child and adolescent mental health. Contributions of this research include demonstrating that modest cross-informant agreement is a very robust phenomenon, utilizing numerous statistical approaches to measure degree of agreement, and identifying many factors that moderate agreement. An important focus of this work has been using multi-society international comparisons to examine cross-cultural similarities and differences in cross-informant agreement. The articles in this Special Issue represent a significant paradigm shift in which cross-informant agreement is examined as an independent variable predicting a wide variety of outcomes. Furthermore, moving beyond perceptions of adolescent mental health, these articles compare parent and adolescent perceptions of diverse aspects of family functioning (e.g., family conflict, parent-adolescent communication, family relationships, parental authority). Additionally, the research presented in this Special Issue employs innovative and sophisticated statistical techniques. Although the Special Issue represents some first steps toward considering cross-cultural aspects of perceptions of family functioning, much work still needs to be done in this area. Some suggestions for future research strategies to accomplish this goal conclude this commentary.

Psychometrically Informed Approach to Integration of Multiple Informant Ratings in Adult ADHD in a Community-Recruited Sample

Although Diagnostic and Statistical Manual of Mental Disorders-Fifth edition requires that attention-deficit/hyperactivity disorder (ADHD) symptoms are apparent across settings, assessed by multiple informants, there remains no standardized approach to integration of multiple sources in adult ADHD diagnosis. The goal of the study was to evaluate informant effects on adult ADHD symptom ratings. Participants were 406 adults, ages 18 to 37, and identified second reporters, recruited from the community, and completing a comprehensive diagnostic and cognitive assessment, including a clinician-administered diagnostic interview and self- and other-report questionnaires of ADHD symptoms. Structural equation modeling indicated good fit for a trifactor model of ADHD, including general ADHD, specific inattention and hyperactivity-impulsivity, and self- and other-perspective factors. Yet there were a number of symptoms on the specific hyperactive-impulsive and self-factors that exhibited nonsignificant loadings. Significant differential item functioning across self-ratings and informant ratings was also noted. The external validation indices of laboratory executive function and diagnostic team-rated impairment was significantly correlated with the specific inattentive factor. While executive function was marginally significantly correlated with the other perspective factor, impairment was associated with the self-perspective factor. Overall, inattentive symptoms may be more sensitive measures of adult ADHD, and other and self-ratings may provide different information in relation to external criteria.

Adolescent controversial status brokers: A double-edged sword

Using a 3-wave longitudinal, multidimensional approach, this study investigated the influence of social network position and social status on the psychosocial outcomes of 440 youth (45.1% girls; Mage = 16.1 years; 90.9% Caucasian) over 26 months, focusing on the controversial status classification (i.e., youth who are highly liked and disliked by their peers). Brokerage (i.e., the degree to which a person has relationships with peers who do not have a direct relationship with each other) was examined in conjunction with sociometric status to explain potential heterogeneity of outcomes for controversial status youth. Adolescents completed peer nominations and self-reports of adjustment. Results demonstrated that brokerage was related to poorer psychosocial outcomes for controversial compared to average status youth. Brokerage appears to add predictive value to youths' adjustment beyond traditional sociometric classifications, especially for controversial status youth. (PsycINFO Database Record

Strategic considerations in the search for transactional processes: Methods for detecting and quantifying transactional signals in longitudinal data

Over the last four decades the transactional model has emerged as a central fixture of modern developmental science. Despite this, we are aware of no principled approach for determining (a) whether it is actually necessary to invoke transactional mechanisms to explain observed patterns of stability in a given domain of adaptive functioning and (b) the extent to which transactional processes, once identified in aggregate, are accounted for by measured domains with which an aspect of adaptive functioning is theoretically in transaction. Leveraging the fact that transactional mechanisms produce excess stability in an outcome domain above and beyond autoregressive processes, along with the basic logic of mediational analysis, we introduce two novel indexes for studying transactional processes strategically. We apply these metrics to data from the NICHD Study of Early Child Care and Youth Development cohort on mother- and teacher-reported externalizing problems and social competence along with teacher-reported and objective assessments of academic skills acquired in Grades 1, 3, and 5. During this developmental period we find that (a) transactional contributions to stability are strongest for teacher-reported outcomes, next strongest for mother-reported outcomes, and relatively weak for objective assessments of academic skills and (b) observed maternal sensitivity (but not child-reported friendship quality) accounts for a modest proportion of the total transactional effects operative in most of the domains of adaptive functioning we studied. Discussion focuses on extending the logic of our approach to additional waves of measurement.

Introduction to the Special Issue: Discrepancies in Adolescent-Parent Perceptions of the Family and Adolescent Adjustment

Researchers commonly rely on adolescents' and parents' reports to assess family functioning (e.g., conflict, parental monitoring, parenting practices, relationship quality). Recent work indicates that these reports may vary as to whether they converge or diverge in estimates of family functioning. Further, patterns of converging or diverging reports may yield important information about adolescent adjustment and family functioning. This work is part of a larger literature seeking to understand and interpret multi-informant assessments of psychological phenomena, namely mental health. In fact, recent innovations in conceptualizing, measuring, and analyzing multi-informant mental health assessments might meaningfully inform efforts to understand multi-informant assessments of family functioning. Therefore, in this Special Issue we address three aims. First, we provide a guiding framework for using and interpreting multi-informant assessments of family functioning, informed by recent theoretical work focused on using and interpreting multi-informant mental health assessments. Second, we report research on adolescents' and parents' reports of family functioning that leverages the latest methods for measuring and analyzing patterns of convergence and divergence between informants' reports. Third, we report research on measurement invariance and its role in interpreting adolescents' and parents' reports of family functioning. Research and theory reported in this Special Issue have important implications for improving our understanding of the links between multi-informant assessments of family functioning and adolescent adjustment.