Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study

Examining alternative explanations of the covariation of ADHD and anxiety symptoms in children: a community study

Attention-deficit hyperactivity disorder (ADHD) is comorbid with a range of other disorders, including anxiety disorders. The aim was to examine different explanations for the covariation of these symptom domains in children according to the framework provided by (Lilienfeld, S. O. Comorbidity between and within childhood externalizing and internalizing disorders: Reflections and directions. Journal of Abnormal Child Psychology, 2003). The covariation of ADHD symptoms and anxiety symptoms were examined over a 12-month period in a community sample of 499 children aged 8-13; 91% were retained at 12-month follow-up. Dimensional assessments were conducted using questionnaires given to children, parents and teachers, with results analyzed via structural equation modeling. Positive associations between ADHD and anxiety symptoms were linked with inattention symptoms, were particularly pronounced for girls, and were linked via temperament and behavioral problems. No support for the hypothesis that ADHD symptoms predicted the development of anxiety symptoms over time or vice versa. ADHD symptoms (particularly inattention) and anxiety symptoms are covarying phenomena that are linked with an irritable temperament and disruptive behavior.

Prospective relations between organized activity participation and psychopathology during adolescence

This longitudinal study examined psychopathology as a predictor and outcome of organized activity involvement during high school among 198 adolescents who varied in risk for psychopathology as a function of their mother's depression history. Higher levels of internalizing and externalizing symptoms in eighth grade significantly predicted lower levels of involvement in academic clubs during high school, over and above risk and SES. Tobacco use prior to high school predicted lower levels of involvement overall and in academic clubs and performance arts. Controlling for psychopathology prior to high school, higher levels of activity involvement were associated with lower levels of externalizing symptoms, less tobacco use, and fewer diagnoses of behavior disorders and substance abuse in 12th grade. The positive association between risk and adolescent psychopathology was not buffered by adolescent activity involvement. Overall, these findings suggest that involvement in organized activities may contribute to lower levels of externalizing psychopathology during high school even when controlling for prior psychopathology.

Factors influencing mother-child reports of depressive symptoms and agreement among clinically referred depressed youngsters in Hungary

BACKGROUND

Psychiatric assessments of children typically involve two informants, the child and the parent. Understanding discordance in their reports has been of interest to clinicians and researchers. We examine differences between mothers' and children's report of children's depressive symptom severity, and factors that may influence their reports and level of agreement. We hypothesized that agreement between mother and child would improve if (1) the mother is depressed, due to improved recall of mood congruent symptoms, (2) the child is older, due to better social-cognitive and communication skills, and (3) the child is a female.

METHODS

Subjects were 354 children (158 girls; mean age 11.69 years, SD: 2.05 years) with Major Depressive Disorder. Depressive symptoms were evaluated by a semi-structured interview separately with the mother and the child. Agreement on symptom severity was based on concordance of the presence and extent of symptoms.

RESULTS

Maternal reports were significantly higher than their son's but not daughters'. Girls, particularly with increasing age, reported higher levels of symptoms; however mothers' reports were not affected by child sex or age. Maternal depression predicted more severe symptom reports for both children and mothers. Agreement between the mother and the child increased as children got older.

LIMITATIONS

The same clinician interviewed the mother and the child, which might inflate rates of agreement. However, this method mirrors clinical evaluation.

CONCLUSION

During a clinical interview one must consider the age and sex of the child and the depressive state of the mother in assimilating information about the child.

Interpreting the magnitude of the placebo effect: mountain or Molehill?

The ambiguity involved in interpreting numbers and words is central to Hróbjartsson and Gøtzsche's (this issue) claim of "powerful spin" in the Wampold, Minami, Tierney, Baskin, and Bhati (2005) re-analysis of their meta-analytic findings on the placebo effect in medicine. Meta-analytic results reported by the two sets of authors are nearly identical, yet their conclusions differ dramatically. In our comment, we discuss the findings of the respective authors and consider options for representing and interpreting the magnitude of meta-analytic effect size estimates. We conclude that although the meta-analyses described indicate that placebo effects do exist and cannot be dismissed as unimportant, given contextual information, it is consistent with existing research to describe the obtained mean effect size for placebos in medicine as small in magnitude.

Internalizing symptoms and disorders in families of adolescents: a review of family systems literature

Internalizing symptoms and disorders are relatively common during adolescence and impact considerably on social and emotional functioning. Using a family systems framework, this paper reviews the current literature examining the impact of internalizing symptoms and disorders on the functioning of the family system, the spouse subsystem and the parent-child subsystem. Moreover, literature examining the relationship between parents' and adolescents' internalizing symptoms and disorders is reviewed. The reviewed research demonstrates that there exists an association between internalizing symptoms and disorders and poorer functioning at various levels of the family system. Longitudinal studies have generally reported that parent internalizing symptoms and disorders predict poorer functioning in the family system as well as internalizing symptoms and disorders in adolescents. However, few longitudinal studies have examined whether adolescent internalizing symptoms and disorders predict poorer family functioning and internalizing symptoms and disorders in parents. Those that have examined such effects report mixed results. On the basis of our review, we make recommendations about future research directions. In particular, it is argued that more research on the reciprocal effects of internalizing symptoms and disorders within families is needed to better understand the antecedents and consequences of these conditions for families of adolescents.

Integrating theoretical, measurement, and intervention models of youth social competence

Social competence is of great interest to developmental psychopathologists and is assessed frequently in both basic and applied research. A review of the literature reveals not only significant heterogeneity in definitions of this construct but an apparent disconnect between theoretical, measurement, and intervention models of competence in youth. This paper attempts to integrate these disparate enterprises by identifying four types of predictors theorists have associated with competence--child, behavior, situation, and judge--and critiquing common models in light of these dimensions. In general, assessment and intervention approaches appear less complex than theoretical conceptualizations of competence. When considering whether to incorporate additional predictors, notably situation- and judge-level factors, into these models, researchers must weigh parsimony versus the model misspecification that results from omitting important variables. Basic research that may assist in making these decisions is identified.

Further evidence of the reliability and validity of DSM-IV ODD and CD in preschool children

OBJECTIVE

To test the reliability and validity of DSM-IV oppositional defiant and conduct disorders (ODD and CD) and symptoms using the Kiddie Disruptive Behavior Disorders Schedule and generate data on the manifestation of symptoms of ODD and CD in 3- to 5-year-old children.

METHOD

One hundred twenty-three consecutive referrals to a child and adolescent psychiatry clinic and 100 children recruited from a pediatric clinic and their biological mothers participated. Mothers were interviewed about current ODD and CD symptoms, and mother and teachers completed measures of impairment. Twenty-five percent of the interviews were randomly selected and coded by a second rater to test interrater reliability. A separate sample of 31 children was recruited for a 1-week test-retest study.

RESULTS

Overall, reliability of ODD and CD symptoms as measured by interrater and test-retest reliability was moderate to high. Reliability was not affected by age or sex of the child. Validity was demonstrated via associations with impairment and differentiation between referred and nonreferred children.

CONCLUSIONS

Most DSM-IV ODD and CD symptoms can be reliably and validly assessed in preschool children. Some developmental modifications are recommended. The results add to the literature on best methods of assessment of preschool psychopathology.

A Family-Centered Approach to Planning and Measuring the Outcome of Interventions for Children with Attention-Deficit/Hyperactivity Disorder

This paper discusses a set of closely related parenting and family factors that should be considered when planning and measuring the outcome of interventions for children with attention-deficit/hyperactivity disorder (ADHD). These include parenting and parent-child relationships, parental cognitions, parental adjustment, marital interactions, general family relationships, and adaptive child functioning within the family. The measurement of each construct is discussed, and comparative, longitudinal, and treatment outcome studies using these measures are reviewed. It is concluded that measures of treatment outcome for children with ADHD could be improved by utilizing multiple informants, developing tools with greater content and contextual validity, relying more on observational methods, and identifying those measures which are of greatest importance to families. Given the multiple pathways via which both psychosocial and pharmacological interventions exert their influence, composite measures combining multi-informant, multimethod constructs may represent more useful measures of treatment outcome than measures of primary ADHD symptoms.

Bias in psychopathology research

PURPOSE OF REVIEW

Biases are frequently invoked in psychopathology research, either as core features of particular forms of psychopathology or as errors and distortions that affect psychiatric assessment, diagnosis, treatment, and research methodology. This review provides an overview of recent research on the forms of bias that are commonly examined in the field.

RECENT FINDINGS

Recent research has made a number of advances in the analysis of cognitive and affective biases underpinning psychopathology: the effect of rating and other biases on psychiatric assessment and diagnosis; the role of race and gender in psychiatric practice; financial and institutional influences on psychiatric services; and several biases affecting research methodology, study design, and statistical inference.

SUMMARY

Bias has several distinct meanings, and encompasses a disparate set of phenomena, so no over-arching conclusion about the place of bias in psychopathology research can be drawn. Recent work, however, makes solid progress toward a better understanding of systematic distortions and how they can be recognized and reduced.

Informant Discrepancies in Assessing Child Dysfunction Relate to Dysfunction Within Mother-Child Interactions

Examined whether mother-child discrepancies in perceived child behavior problems relate to dysfunctional interactions between mother and child and stress in the mother. Participants included 239 children (6-16 years old; 58 girls, 181 boys) referred for oppositional, aggressive, and antisocial behavior, and their mothers. Mother-child discrepancies in perceived child behavior problems were related to mother-child conflict. Moreover, maternal stress mediated this relationship. The findings suggest that discrepancies among mother and child evaluations of child functioning are not merely reflections of different perspectives or artifacts of the assessment process, but can form components of conceptual models that can be developed and tested to examine the interrelations among critical domains of child, parent, and family functioning.

Conceptualizing changes in behavior in intervention research: the range of possible changes model

An international movement has focused on identifying evidence-based interventions that were developed to change psychological constructs and that are supported by controlled studies. However, inconsistent findings within individual intervention studies and among multiple studies raise critical problems in interpreting the evidence, and deciding when and whether an intervention is evidence-based. A theoretical and methodological framework (Range of Possible Changes [RPC] Model) is proposed to guide the study of change in intervention research. The authors recommend that future quantitative reviews of the research literature use the RPC Model to conceptualize, examine, and classify the available evidence for interventions. Future research should adopt the RPC Model to both develop theory-driven hypotheses and conduct examinations of the instances in which interventions may or may not change psychological constructs.

Modeling relations between hassles and internalizing and externalizing symptoms in adolescents: A four-year prospective study

This study examined the relations between hassles and internalizing and externalizing symptoms across 4 years in adolescents who varied with regard to their risk for psychopathology. The sample comprised 240 adolescents assessed in 6th, 7th, 8th, and 9th grades regarding their level of peer and academic hassles and internalizing and externalizing symptoms. Structural equation modeling was used to construct latent variables of hassles and internalizing and externalizing syndromes. Results varied by informant about the teens' symptoms. For adolescent report, the stress exposure model fit the data best for internalizing syndromes; that is, higher levels of stressors predicted significantly higher levels of self-reported symptoms 1 year later. For mother report of adolescents' symptoms, the stress generation model fit the data best for both internalizing and externalizing syndromes; that is, higher levels of adolescents' internalizing and externalizing symptoms, as reported by their mothers, significantly predicted higher levels of hassles 1 year later.

Relations of Parenting and Negative Life Events to Cognitive Diatheses for Depression in Children

In a sample of 299 children (grades 2, 4, and 6), we examined parenting and negative life events as predictors of depressive cognitions, specifically low self-perceived competence, depressive cognitive schemas, and depressogenic attributional style. We also examined developmental trends in these relations. Children completed measures of parenting, negative life events, and depressive cognitions. Parents also completed measures of parenting and negative life events. Consistent with our hypotheses, negative parenting and negative life events corresponded with higher levels of depressive cognitions, whereas positive parenting corresponded with lower levels of depressive cognitions. The relations between negative parenting and negative automatic thoughts were stronger for older children. Theoretical and practical implications are discussed.

Arbitrary metrics: Implications for identifying evidence-based treatments

Research designed to establish the empirical underpinnings of psychotherapy relies heavily on arbitrary metrics, and researchers often do not know if clients receiving an evidence-based treatment have improved in everyday life or changed in a way that makes a difference, apart from the changes the arbitrary metrics may have shown. In other words, it is possible that evidence-based treatments with effects demonstrated on arbitrary metrics do not actually help people, that is, reduce their symptoms and improve their functioning. Clarifying the nature of arbitrary metrics and assessing their implications are important initial steps. Needed next steps are detailing the range of strategies to better connect arbitrary measures to real-world referents and developing measures in which arbitrariness is eliminated or minimized from the start.