Disagreement between parent and adolescent reports of functional impairment

Parent-youth discrepancy in the assessment and treatment of youth in usual clinical care setting: consequences to parent involvement

BACKGROUND

Involving parents in the treatment of youth referred for mental health problems is an important agenda. Parent involvement is associated with treatment retention, greater family participation, and positive outcomes. The main goal of the present study was to examine the role of youth and parent report of the youth's psychopathology and interpersonal problems on parent involvement in outpatient treatment of the youth.

METHODS

Data were gathered from 63 referred youth in treatment in an outpatient clinic. Subjects reported the youth's interpersonal problems and problem syndromes. The direct account of the youth and parents was examined for association with two indices of parent involvement, namely, the mothers' behavioral involvement (BI) and personal emotional involvement (PEI) in the treatment process.

RESULTS

Results showed that while direct reports of the youth and parents were not significant predictors of parent involvement, discrepancy scores predicted parent involvement. Further, there were twice as many scales of interpersonal problems that were related to parent involvement as the syndrome scales.

CONCLUSION

The ability of discrepancy scores in predicting parent involvement underscores that it is not only a risk factor for later development of adverse outcomes, but also related with essential treatment processes. Clinicians may be able to address these issues and aid in treatment processes leading to desired outcomes.

Course and predictors of mental health of unaccompanied refugee minors in the Netherlands: one year follow-up

This epidemiological investigation addresses the prevalence, course, and predictors of the psychological distress and behavioral problems of unaccompanied refugee minors living in the Netherlands. The legal guardians, teachers and minors themselves all reported on the mental health of the refugee minors (n=582) at baseline and follow-up approximately 12 months later. The self-reported psychological distress of refugee minors was found to be severe (50%) and of a chronic nature (stable for one year) which was confirmed by reports from the guardians (33%) and teachers (36%). The number of self-reported experienced adverse life events were strongly related to the severity of psychological distress. Baseline psychopathology was the largest predictor of psychological distress at follow-up reported by all informants accounting for 22-51% of the variance. The present study, which used a population-based sample, further enlarges the knowledge of mental health among refugee adolescents. The investigation is unique because of the large sample size, the longitudinal nature of the study, the use of multiple informants, and the culturally diverse sample.

Teenagers are right--parents do not know much: an analysis of adolescent-parent agreement on reports of adolescent substance use, abuse, and dependence

BACKGROUND

Previous studies have shown that when assessing child psychopathology, parents tend to report more symptoms than children for externalizing disorders such as attention deficit hyperactivity disorder (ADHD), whereas children tend to report more symptoms for internalizing disorders such as major depression. Whether for clinical or research purposes, parents are also frequently asked to report on their children's experiences with alcohol and drugs. The purpose of this study was to analyze correspondence between adolescent and parent reports of adolescent substance use and abuse or dependence.

METHODS

In the current study, 591 subjects 12 to 17 years old were interviewed using the child version of the Semi-Structured Assessment for the Genetics of Alcoholism (C-SSAGA) as part of the Collaborative Study on the Genetics of Alcoholism (COGA). One parent was also interviewed about each adolescent using the parent version of the C-SSAGA. Sensitivities, specificities, and kappa coefficients were calculated to assess parental agreement with adolescent reports of lifetime substance use and Diagnostic and Statistical Manual of Mental Disorders-Third Revision substance abuse or dependence.

RESULTS

The results indicate that parents are somewhat knowledgeable about their children's use of substances, particularly those that are used most commonly. For example, 55% of adolescents who had smoked cigarettes, 50% who had used alcohol, and 47% who had used marijuana had a parent who knew that they used. However, parents were less aware of substance-related problems experienced by their offspring, agreeing with adolescent reports only 27% of the time for diagnoses of alcohol abuse or dependence and 26% of the time for diagnoses of marijuana abuse or dependence. Parent reports added few cases of substance use for 12- to 13 year-olds and essentially no cases for 16- to 17-year-olds. Parent reports added a nominal number of diagnoses of substance abuse or dependence for older adolescents.

CONCLUSIONS

Whether for clinical or research purposes, the results emphasize the importance of directly assessing adolescents regarding alcohol and other substance use disorders. Furthermore, investigators should consider the specific disorder(s) being investigated and the ages of the children being studied when determining whether to include parent reports as part of study design.

Entwicklung und konfirmatorische Prüfung eines Rasch-skalierten Beurteilungsbogens für die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Grundschulalter

Zusammenfassung. Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) führt bei Schülern zu Lernschwierigkeiten und deutlich verringerten Schulleistungen. Innerhalb eines mehrstufigen diagnostischen Prozesses ist die Beurteilung durch Lehrkräfte eine wesentliche Grundlage für eine weiterführende Diagnostik sowie etwaige Behandlungsmaßnahmen durch psychologische und/oder medizinische Fachkräfte. In der vorliegenden Arbeit wurde ein Beurteilungsbogen für Lehrkräfte an Grundschulen entwickelt, der eine Rasch-skalierte Erfassung der vier Dimensionen Hyperaktivität, Aufmerksamkeitsdefizit, Emotionale Probleme und Soziale Probleme ermöglicht. Die analysierten Einschätzungen stammen von insgesamt 94 Lehrkräften in der Grundschule, die 141 Schülerinnen und Schüler der ersten vier Klassenstufen beurteilt haben. Die sehr guten Skaleneigenschaften und die Fragebogenstruktur konnten für einen zweiten Messzeitpunkt repliziert werden (N = 122). Es steht somit ein Instrument zur Verfügung, das die besonders wünschenswerten Eigenschaften von Rasch-Skalen (z. B. Intervallskalenniveau der diagnostischen Befunde, strikte Eindimensionalität und eindeutige Interpretierbarkeit) für die pädagogische Diagnostik nutzbar macht. Zudem ist die Basis für zukünftige Forschung geschaffen, in der insbesondere die Vergleichbarkeit und Gültigkeit unterschiedlicher Beurteilerperspektiven aufgrund der vielfältigen Möglichkeiten der Rasch-Analyse empirisch überprüft und optimiert werden kann.

Factors Associated with Mental Health Service Need and Utilization among Unaccompanied Refugee Adolescents

This study is the first to address the need for mental health Care (MHC) and the patterns of utilization of MHC services among Unaccompanied Refugee Minors (URM). Information concerning the well being, mental health need, and utilization of services of URM was collected from three informants, the minors themselves (n = 920), their legal guardians (n = 557), and their teachers (n = 496). The well-being, need and utilization of MHC services of URM was compared with those of a representative Dutch adolescent sample (n = 1059). The findings of this study indicated that URM that report a mental health care need (57.8%) also report higher levels of emotional distress than Dutch adolescents who report a similar need for MHC (8.2%). In addition, guardians and teachers detect emotional distress and mental health care needs in only a small percentage (30%) of URM. The referral of URM to mental health care services does not appear to be driven by the reported needs of the URM, but by the need and emotional distress as observed and perceived by guardians. This resulted in the fact that 48.7% of the URM total sample reported that their need for mental health care was unmet.

Mental health problems in juvenile justice populations

The limited literature on mental health problems in juvenile justice population has reported that most youth in juvenile justice hold psychiatric pathology. Although conduct disorder and substance abuse are the most prevalent conditions in this population, many other diagnoses can be found at alarmingly high rates; research on other diagnoses (eg, autism, psychosis) is limited. This finding underscores the necessity of implementing adequate diagnostic assessment within forensic settings and of developing interventions programs that take into account the presence of psychiatric problems.

Determinants of multiple informant agreement on child and adolescent behavior

This study examined whether characteristics of behavioral items reported by parent and child are related to parent-child agreement. Data were collected from 20 judges rating 59 child behaviors on 11 dimensions hypothesized to affect parent-child agreement. Data from 675 parent-child dyads (85% female caregivers, 62% male children, aged 7-17) reporting on 59 child behaviors were used to examine agreement. Behavior characteristics accounted for 43% of variability in parent-child agreement. Three components, saliency to the parent, saliency to the child, and observability/willingness to report, contributed uniquely to prediction of agreement.

Early predictors of parent- and self-reported perceived global psychological difficulties among adolescents: a prospective cohort study from age 3 to age 15

AIMS

To study predictors at age 3 and at age 12 for parent and self-reported perceived global psychological difficulties at age 15.

METHOD

A representative birth cohort was prospectively followed from early childhood to age 15. Ratings of children's behavioral and emotional problems were collected at age 3 (Child Behavior Check List 2/3) and at age 12 (Child Behavior Check List 4-16, Youth Self Report). Mothers and fathers separately completed a questionnaire on their own well-being, health and mental distress when the child was 12. At the same time-point, family functioning was measured with the Family Assessment device. Outcome variables included both parent and self-reports of children's perceived psychological difficulties at age 15.

RESULTS

At age 15, of the 707 children with both parent and self-reports on perceived difficulties available, 10% had more perceived difficulties than peers of the same age in parent or self-reports. There was a significant increase in perceived difficulties from age 12 to age 15 in self-reports but not in parent reports. The parent-child agreement on difficulties at both time-points was very low (proportion of agreement 0.12-0.17). At age 3, externalizing problems, especially aggressiveness, predicted parent reports of child's difficulties at 15 years of age in univariate analysis. At age 12, parent-reported child's externalizing symptoms and perceived difficulties, poor social competence in self-reports, and mothers' reports of her own poor well-being, independently predicted parents' reporting of their child's perceived difficulties at age 15. Self-reports of internalizing problems and mother's own reports of her depressiveness when the child was 12 independently predicted the 15-year old's self-reported difficulties. Furthermore, in univariate analysis, poor family functioning at age 12 predicted perceived difficulties in parent and self-reports.

CONCLUSIONS

Both parent and self-reports of a child's difficulties are the outcome of an accumulation of the child's psychopathology, parental distress, and family dysfunction. The results emphasize the importance of early detection of children at risk of negative developmental pathways. In clinical practice and in prevention interventions, it is important to take into account the child's individual psychopathology, parental distress, and family dysfunction.

Do negative life experiences predict the health-care-seeking of adolescents? A study of 10th-year students in Oslo, Norway

PURPOSE

To analyze associations among the negative life experiences and health-care-seeking of adolescents during the 12 months before the study.

METHODS

Cross-sectional questionnaire study among 10th-year students at all secondary schools in Oslo.

RESULTS

In 2000 and in 2001, 7329 (88%) of Oslo's 8316 secondary-school students responded to the questionnaire. Some contacts with primary health care during the previous year were reported by 71% of respondents, and 6% had seen a mental health practitioner (psychologist or psychiatrist). Health care utilization was not correlated with the family's financial situation as reported by the student (boys = 1019; girls = 1258), or with a parent's unemployment (boys = 253; girls = 325). The 2112 boys (59% of all) and 2378 girls (64%) who reported feeling strong pressure from others to succeed, had more contacts with all primary health care services. Girls, but not boys, who reported being bullied by others reported more psychologist or psychiatrist visits than did their nonbullied peers. Exposure to physical violence was associated with a significant increase in visits to the School Health Service, family physician, and emergency medical service, and was related to more than doubling the probability of visiting a mental health practitioner. Being sexually violated during the previous year increased the likelihood of boys visiting mental health practitioner more than four times (odds ratio [OR] 4.6; 95% confidence interval [CI] 1.7-12.2); and visiting School Health Service by nearly four times, (OR 3.7; 95% CI 1.0-13.5).

CONCLUSION

Variation in adolescent health care seeking can, by and large, be predicted by negative life experiences.

Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications

Attention-deficit/hyperactivity disorder (ADHD) is the most common mental disorder in childhood, and primary care clinicians provide a major component of the care for children with ADHD. However, because of limited available evidence, the American Academy of Pediatrics guidelines did not include adolescents and young adults. Contrary to previous beliefs, it has become clear that, in most cases, ADHD does not resolve once children enter puberty. This article reviews the current evidence about the diagnosis and treatment of adolescents and young adults with ADHD and describes how the information informs practice. It describes some of the unique characteristics observed among adolescents, as well as how the core symptoms change with maturity. The diagnostic process is discussed, as well as approaches to the care of adolescents to improve adherences. Both psychosocial and pharmacologic interventions are reviewed, and there is a discussion of these patients' transition into young adulthood. The article also indicates that research is needed to identify the unique adolescent characteristics of ADHD and effective psychosocial and pharmacologic treatments.

Functional impairment in clinical samples of Norwegian and Swedish children and adolescents with obsessive-compulsive disorder

The aims of the present study were to examine OCD-related impairments in clinical cases of childhood OCD and to replicate and extend previous research on OCD-related impairments.

METHOD

Sixty-eight patients aged 8-17 years recruited from four child psychiatric outpatient clinics in Norway and Sweden with a confirmed DSM-IV diagnosis of OCD were included in the study. All patients and their parents were interviewed for diagnosis and comorbidity (KSADS),OCD symptoms and severity (CY-BOCS), and global impairment (CGAS). OCD-specific impairments were assessed by means of the Child OCD Impact Scale (COIS), a 58 item questionnaire with parallel parent and child versions.

RESULTS

Overall, the majority of patients suffered from substantial impairments. The impact of OCD symptoms was found to be most severe at home, but impairments were also prominent in situations related to school and social settings.

CONCLUSIONS

Our study supports findings of previous research suggesting multiple impacts of OCD symptoms on children's psychosocial functioning. We conclude that impairment issues should be further addressed in future research to establish a better empirical basis for the understanding of different aspects of OCD-related impairment.