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.

Parent and adolescent reports in assessing adolescent sleep problems: results from a large population study

AIM

To compare parent and adolescent reports in exploring adolescent sleep problems and to identify the factors associated with adolescent sleep problem disclosures.

METHODS

Parent (n = 5185) and adolescent reports (n = 5171, age=13.9 ± 0.3 years), from a birth cohort were used to explore adolescent sleep problems. Kappa coefficients were used to assess the agreement, whereas, conditional agreement and disagreement ratios were used to identify the optimal informant. Logistic regression analysis was used to determine the factors affecting adolescent sleep problem disclosure.

RESULTS

Parental reports identified only about one-third of the sleep problems reported by adolescents. Whereas adolescent reports identified up to two-thirds of the sleep problems reported by parents. Combined reports of parents and adolescent did not show any considerable difference from the adolescent report. Adolescent and parent health, maternal depression, and family communication were significantly associated with adolescents sleep problem disclosures.

CONCLUSION

Adolescent reports could be used as the preferred source to explore adolescent sleep problems. Parental reports should be used when parents as observers are more reliable reporters, or where adolescents are cognitively unable to report sleep problems. Additionally, the impact of poor health, maternal depression and family communication on sleep problems disclosure should be considered for adolescent sleep problem diagnosis.

Do We Need Multiple Informants When Assessing Autistic Traits? The Degree of Report Bias on Offspring, Self, and Spouse Ratings

This study focused on the degree of report bias in assessing autistic traits. Both parents of 124 preschoolers completed the Social Communication Questionnaire and the Autism-spectrum Quotient. Acceptable agreement existed between mother and father reports of children’s mean scores of autistic traits, but interrater reliability for rank-order correlations was only fair. No evidence was found for report bias regarding parent-offspring autistic traits. However, adult autistic ratings were strongly biased: spouse-ratings were higher than self-ratings, correlations were only fair when both parents reported about the same person, and resemblance was higher for reports from the same person than for spouses’ separate self-reports. It is advisable to involve multiple informants when assessing autistic traits, and to use procedural and/or statistical remedies to control for report bias.

Using the Depression, Anxiety, Stress Scales–21 With U.S. Adolescents: An Alternate Models Analysis

As part of universal screening efforts in schools, validated measures that identify internalizing distress are needed. One promising available measure, the Depression, Anxiety, and Stress Scales–21 (DASS–21), has yet to be thoroughly investigated with adolescents in the United States. This study investigated the underlying factor structure of the DASS–21 in a sample of U.S. adolescents ( N = 2,454) by using confirmatory factor analytic techniques to test several alternate models. A bifactor model specifying general Negative Affectivity and three specific factors of Depression, Anxiety, and Stress yielded the best fit. Results from this study suggest that (a) the DASS–21 scales reflect a common factor, indicating that a total score of the DASS–21 can be derived as a measure of general negative affectivity, and (b) the DASS–21 may not adequately differentiate between the experiences of negative affectivity, anxiety, and stress in U.S. adolescents.

Advancing the Scientific Foundation for Evidence-Based Practice in Clinical Child and Adolescent Psychology

Evidence-based practice (EBP) has become a central focus in clinical child and adolescent psychology. As originally defined, EBP in psychology is the integration of the best available research evidence, patient characteristics, and clinical expertise. Although evidence-based perspectives have garnered widespread acceptance in recent years, there has also been some confusion and disagreement about the 3-part definition of EBP, particularly the role of research. In this article, we first provide a brief review of the development of EBP in clinical child and adolescent psychology. Next, we outline the following 4 points to help clarify the understanding of EBP: (a) knowledge should not be confused with epistemic processes, (b) research on clinician and client factors is needed for EBP, (c) research on assessment is needed for EBP, and (d) the 3-part conceptualization of EBP can serve as a useful framework to guide research. Based on these principles, we put forth a slightly revised conceptualization of EBP, in which the role of research is expanded and more clearly operationalized. Finally, based on our review of the literature, we offer illustrative examples of specific directions for future research to advance the evidence base for EBP in clinical child and adolescent psychology.

The Emergence of Parent-Child Coercive Processes in Toddlerhood

Parent-child coercion typically emerges in toddlerhood with the child's first acts of willful defiance and the parent's first disciplinary attempts. We explored how parents and children may contribute to this process by examining bidirectional and interactive effects between child and maternal negative behavior in 310 low-income, ethnically diverse boys. Using multiple informants and methods, child negative emotionality and maternal negative control were assessed at 18 months and child disruptive behavior and maternal negative control were measured at 24 months. Indicative of parent effects, maternal negative control at 18 months amplified the relation between children's negative emotionality at 18 months and disruptive behavior at 24 months. Child effects were found in an unexpected direction such that children's negative emotionality at 18 months predicted decreases in mothers' negative control at 24 months. Findings are discussed within a transactional framework that emphasizes mutual influence of children and parents over the course of development.

All anxiety is not created equal: Correlates of parent/youth agreement vary across subtypes of anxiety

Research has examined patterns and correlates of parent/youth informant discrepancies in the reporting of youth anxiety. However, little work has examined whether it is better to conceptualize patterns and correlates of informant disagreement across anxiety broadly, or more useful to consider disagreement on specific symptom clusters. Using data from the Child Adolescent/Anxiety Multimodal Study (CAMS; N = 488; Walkup et al., 2008), the current study applied the most recent recommended analytic strategies to study informant discrepancies and examined differences in the magnitude and patterns of disagreement for: (a) broadband anxiety symptoms, versus (b) symptoms of specific anxiety diagnoses (or anxiety subtypes; e.g., separation, social anxiety). Correlates of informant discrepancies were also examined. Results indicated that there was variability in agreement across anxiety subtypes, with parent/youth agreement higher on separation anxiety and school refusal symptoms relative to other domains. Parental psychopathology was associated with disagreement on broadband anxiety symptoms, such that parental psychopathology was highest when parents reported higher symptoms than their children; however, this finding was largely driven by a relationship between parental psychopathology and disagreement on separation anxiety symptoms. Age was associated with disagreement on total and separation anxiety symptoms. Gender was not associated with disagreement. Clinical implications are discussed.

Changes in mental health outcomes with the intensive in-home child and adolescent psychiatric service: a multi-informant, latent consensus approach

This study investigates the Intensive In-home Child and Adolescent Psychiatric Service (IICAPS), a large-scale home-based intervention that collaboratively engages the family, school, and various other service providers (e.g. health practitioners or judicial systems) to prevent the hospitalization, institutionalization or out-of-home placement of children and adolescents with serious emotional disturbance. Multi-informant data (youth, parents and clinician) on the level of youth problem severity and functioning was gathered from 7169 youth and their families served by the IICAPS network, pre- and post-intervention. A newly developed "Multi-informant Latent Consensus" (MILC) approach was employed to measure mental health "baseline levels" and change, within a Structural Equation Modeling framework. The MILC approach demonstrated promise integrating information from multiple informants involved in the therapeutic process to yield a more accurate and systemic view of a child's level of functioning and problem severity than each report taken individually. Results indicated that the IICAPS family and community based intervention model led to a reduction of problem severity and improved functioning in children and adolescents with severe emotional disturbance.

Coparenting Problems with Toddlers Predict Children's Symptoms of Psychological Problems at Age 7

This study examined whether coparenting during toddlerhood predicts children's later symptoms of attention deficit/hyperactivity disorder, oppositional defiant disorder, affective disorder, and somatic complaints. When children were 2 years old, 108 middle-class nonclinical families were observed in triadic interactions to assess two domains of dyadic coparenting (competitive and cooperative), as well as each parent's individual competitive behavior toward the spouse. Teachers and mothers reported children's symptoms of psychological problems at age 7. Independent of cooperative coparenting and each parents' individual harsh parenting, competitive coparenting predicted children's symptoms of ADHD and ODD. Interactions with child gender indicated that competitive coparenting predicted ADHD symptoms in boys (not in girls) and teacher-reported (not mother-reported) somatic complaints in girls (not in boys). ODD and ADHD symptoms were also predicted by fathers' (not mothers') individual competitive behaviors. The children of parents who were both low in competitive behaviors had the lowest teacher-rated symptoms of affective disorder.

[Relationship Between Child Behavior and Emotional Problems and School Based Effort Avoidance]

The present study has examined the relationship between school based effort avoidance tendencies and problem behavior in children aged 9 to 16 years. Effort avoidance tendencies were assessed in 367 children with and without child care. Teachers and social workers rated children on behavioral and emotional problems with the Strengths and Difficulties Questionnaire (SDQ). Results confirmed significant but low correlations between teacher ratings of behavior and emotional problems in children and selected subscales of self-reported effort avoidance in school, especially for children in child care institutions. For them "conduct problems" were significantly correlated with three of the four subscales and the total sum score of effort avoidance whereas "hyperactivity" was the only scale which was significantly associated with the fourth subscale. In the school sample only "hyperactivity" and "peer problems" were significantly correlated with one subscale of school-based effort avoidance. The findings suggest that more problem behavior is in relation to more school based effort avoidance tendencies.

Behavior Rating Inventory of Executive Functioning-Preschool (BRIEF-P) Applied to Teachers: Psychometric Properties and Usefulness for Disruptive Disorders in 3-Year-Old Preschoolers

OBJECTIVE

We provide validation data on the Behavior Rating Inventory of Executive Functioning-Preschool version (BRIEF-P) in preschool children.

METHOD

Teachers of a community sample of six hundred and twenty 3-year-olds, who were followed up at age 4, responded to the BRIEF-P, and parents and children answered different psychological measures.

RESULTS

Confirmatory factor analysis achieved adequate fit of the original structure (five-first-order-factor plus three-second-order-factor model) after excluding four items. The derived dimensions obtained satisfactory internal consistency, moderate convergent validity with psychopathology and temperament, and good ability to discriminate between children with ADHD. BRIEF-P scales were not associated with a performance-based measure of attention. The teacher's BRIEF-P adds significant clinical information for the diagnosis of ADHD (ΔR(2) from 5.3 to 15.3) when used with other instruments for the assessment of psychopathology, functional impairment, or performance-based attention.

CONCLUSION

The BRIEF-P may be useful in the identification of preschool children, specifically those with ADHD, who might have a dysfunction in executive functioning.

Measuring outcomes in outpatient child psychiatry: reliable improvement, deterioration, and clinically significant improvement

Given the increasing interest in demonstrating effectiveness in psychiatric treatment, the current paper seeks to advance outcome measurement in child psychiatry by demonstrating how more informative analytic strategies can be used to evaluate treatment in a real world setting using a brief, standardized parent-report measure. Questionnaires were obtained at intake for 1294 patients. Of these, 695 patients entered treatment and 531 (74%) had complete forms at intake and follow-up. Using this sample, we analyzed the data to determine effect sizes, rates of reliable improvement and deterioration, and rates of clinically significant improvement. Findings highlighted the utility of these approaches for evaluating treatment outcomes. Further suggestions for improving outcome measurement and evaluation are provided.

Parents and teachers reporting on a child's emotional and behavioural problems following severe traumatic brain injury (TBI): the moderating effect of time

BACKGROUND

Gathering information from parents and teachers following paediatric traumatic brain injury (TBI) has substantial clinical value for diagnostic decisions. Yet, a multi-informant approach has rarely been addressed when evaluating children at the chronic stage post-injury. In the current study, the goals were to examine (1) differences between parents' and teachers' reports on a child's emotional and behavioural problems and (2) the effect of time elapsed since injury on each rater's report.

METHODS

A sample of 42 parents and 42 teachers of children following severe TBI completed two standard rating scales. Receiver Operating Characteristic (ROC) curves were used to determine whether time elapsed since injury reliably distinguished children falling above and below clinical levels.

RESULTS

Emotional-behavioural scores of children following severe TBI fell within normal range, according to both teachers and parents. Significant differences were found between parents' reports relatively close to the time of injury and 2 years post-injury. However, no such differences were observed in teachers' ratings.

CONCLUSIONS

Parents and teachers of children following severe TBI differ in their reports on a child's emotional and behavioural problems. The present study not only underscores the importance of multiple informants, but also highlights, for the first time, the possibility that informants' perceptions may vary across time.

Youth-caregiver agreement on clinical high-risk symptoms of psychosis

Early identification of individuals who will go on to develop schizophrenia is a difficult endeavor. The variety of symptoms experienced by clinical high-risk youth make it difficult to identify who will eventually develop schizophrenia in the future. Efforts are being made, therefore, to more accurately identify at-risk individuals and factors that predict conversion to psychosis. As in most assessments of children and adolescents, however, both youth and parental report of symptomatology and resulting dysfunction are important to assess. The goals of the current study were to assess the extent of cross-informant agreement on the Structured Interview for Prodromal Symptoms (SIPS), a widely-used tool employed to determine clinical high-risk status. A total of 84 youth-caregiver pairs participated. Youth and caregiver raters displayed moderate overall agreement on SIPS-rated symptoms. Both youth and caregiver ratings of youth symptomatology contributed significantly to predicting conversion to psychosis. In addition, youth age and quality of youth-caregiver relationships appear to be related to cross-informant symptom ratings. Despite differences on individual SIPS domains, the majority of dyads agreed on youth clinical high-risk status. Results highlight the potential clinical utility of using caregiver informants to determine youth psychosis risk.

What Predicts Method Effects in Child Behavior Ratings

The purpose of this research was to determine whether child, parent, and teacher characteristics such as sex, socioeconomic status (SES), parental depressive symptoms, the number of years of teaching experience, number of children in the classroom, and teachers’ disciplinary self-efficacy predict deviations from maternal ratings in a multitrait-multimethod (MTMM) confirmatory factor analysis. The study included 978 families from the National Institute of Child Health and Development Study of Early Child Care and Youth Development. Results indicated that teachers with more disciplinary self-efficacy, teaching experience, and children in their classrooms generally rated their students’ behavior in a more consistent manner with ratings completed by the students’ mothers. In addition, fathers who reported more symptoms of depression rated their children’s behavior in a less consistent manner with ratings completed by mothers. Finally, the perspectives of mothers generally deviated more from the perspectives of fathers and teachers when they were rating boys.

Multiple informant agreement of child, parent, and teacher ratings of child anxiety within community samples

OBJECTIVE

Extant research concerning the degree of multiple informant (that is, parent, clinician, teacher, and child) agreement for child anxiety ratings generally uses clinical samples, and results have been mixed.

METHOD

Our study used a community sample of public school children (n = 1039) to investigate child (self), parent, and teacher reports of child anxiety across 3 time points (pretreatement, posttreatment, and follow-up) in 3 independent school prevention and intervention trials.

RESULTS

Results showed that parents and teachers had high informant agreement for ratings on anxiety across the 3 time points (r = 0.95 to 0.96, P < 0.001); agreement between parent and child (self) reports and between teacher and child (self) reports consistently showed lower agreement across the 3 time points (r = 0.14 and 0.28, respectively, P < 0.001). Group differences were also significant for sex and grade, whereby females more commonly self-reported higher anxiety and children in grades 3 and 4 self-reported higher anxiety, compared with students in grades 5 to 7.

CONCLUSION

Correlations between parent and teacher with child ratings were poor over 3 time points, and significant differences were found for sex and grade. Research is needed to understand reasons for poor concordance between parent, child, and teacher ratings of anxiety for all children.

Attention deficit hyperactivity disorder symptoms reporting in Malaysian adolescents: do adolescents, parents and teachers agree with each other?

Attention Deficit Hyperactivity Disorder (ADHD) is a clinical diagnosis relying on persistence of symptoms across different settings. Information are gathered from different informants including adolescents, parents and teachers. In this cross-sectional study involving 410 twelve-year old adolescents, 37 teachers and 367 parents from seven schools in the Federal Territory of Kuala Lumpur, reliability of ADHD symptoms among the various informants were reported. ADHD symptoms (i.e. predominantly hyperactive, predominantly inattentive and combined symptoms) were assessed by adolescents, teachers and parents, using Conners-Wells' Adolescent Self-report Scale (CASS), Conner's Teachers Rating Scale (CTRS) and Conner's Parents Rating Scale (CPRS) respectively. For predominantly hyperactive symptoms, there were statistically significant, weak positive correlations between parents and teachers reporting (r=0.241, p<0.01). Statistically significant, weak positive correlations were found between adolescents and parents for predominantly inattentive symptoms (r=0.283, p<0.01). Correlations between adolescents and parents reporting were statistically significant but weak (r=0.294, p<0.01). Weak correlations exist between the different informants reporting ADHD symptoms among Malaysian adolescents. While multiple informant ratings are required to facilitate the diagnosis of ADHD, effort should be taken to minimize the disagreement in reporting and better utilize the information.

Correction of distortions in distressed mothers' ratings of their preschool children's psychopathology

The often-reported low informant agreement about child psychopathology between multiple informants has lead to various suggestions about how to address discrepant ratings. Among the factors that may lower agreement that have been discussed is informant credibility, reliability, or psychopathology, which is of interest in this paper. We tested three different models, namely, the accuracy, the distortion, and an integrated so-called combined model, that conceptualize parental ratings to assess child psychopathology. The data comprise ratings of child psychopathology from multiple informants (mother, therapist and kindergarten teacher) and ratings of maternal psychopathology. The children were patients in a preschool psychiatry unit (N=247). The results from structural equation modeling show that maternal ratings of child psychopathology were biased by maternal psychopathology (distortion model). Based on this statistical background, we suggest a method to adjust biased maternal ratings. We illustrate the maternal bias by comparing the ratings of mother to expert ratings (combined kindergarten teacher and therapist ratings) and show that the correction equation increases the agreement between maternal and expert ratings. We conclude that this approach may help to reduce misclassification of preschool children as 'clinical' on the basis of biased maternal ratings.

Parent-child concordance in reporting of child eating disorder pathology as assessed by the eating disorder examination

OBJECTIVE

The aim of this study was to examine parent-youth concordance in reporting of eating disorder pathology, as assessed by the Eating Disorder Examination (EDE) in a clinical pediatric sample.

METHOD

The sample comprised 619 parent-youth dyads of youth (8-18 years) presenting for treatment at a specialist eating disorder clinic. A cross-sectional correlational design was used to examine the association between parent and youth symptom reports.

RESULTS

On the whole, parent-youth inter-rater agreement was poor to moderate. Agreement was acceptable for the presence of behavioral symptoms, with the exception of excessive exercise (PAK = 0.48-0.98). There was poor inter-rater agreement on frequency of behavioral symptoms, with parents providing lower estimates than youth (ICC = 0.07-0.52). Although we predicted that inter-rater agreement on cognitive symptoms would by higher with adolescents than children, both groups were discordant with parent reports. Younger children identified less severe eating disorder cognitions than parents and the opposite occurred for adolescents. An anorexia nervosa presentation and lower malnutrition were not associated with lower inter-rater agreement, as might have been expected through ego syntonicity. Youth with bulimia nervosa presentations reported significantly higher severity of cognitive symptoms and more frequent disordered eating behaviors compared with their parents.

DISCUSSION

Results support the utility of parent-youth assessment via the EDE to obtain a wider clinical picture of eating disorder psychopathology in children and adolescents, particularly for younger children. Clinical implications pertinent to administration of the EDE and parent literacy regarding eating disorder symptoms are discussed.

Social support and adaptation outcomes in children and adolescents with cerebral palsy

OBJECTIVES

This study had two main objectives: first, to describe the social support and psychological maladjustment of children and adolescents with cerebral palsy (CP); and second, to test a mediation model where psychological maladjustment was hypothesized to mediate the link between social support and health-related quality of life (HRQL). In addition, the moderating role of gender and age was examined for this mediation model.

METHODS

Self- and proxy-report questionnaires on the aforementioned variables were administered to a sample of 96 children/adolescents with CP and 118 healthy controls, as well as one of their parents. Univariate and multivariate analyses of covariance were conducted to examine differences in social support and psychological maladjustment, respectively. PROCESS computational tool was used for path analysis-based mediation, moderation and moderated mediation analyses.

RESULTS

Children/adolescents with CP reported lower levels of social support than their healthy peers, but no significant differences emerged in terms of their psychological maladjustment. For children/adolescents with CP, internalizing and externalizing problems were found to mediate the link between social support and HRQL, and these indirect effects were not conditional upon age or gender.

DISCUSSION

Children and adolescents with CP are likely have more negative perceptions of social support, but not necessarily more psychological adjustment problems than their healthy, able-bodied peers. Results further suggest that interventions targeting social support perceptions may positively affect HRQL outcomes in children/adolescents with CP, through the improvement of internalizing and externalizing dimensions of their psychological adjustment.

IMPLICATIONS FOR REHABILITATION

Social support perceptions are important intervention targets in psychosocial rehabilitation with children and adolescents with CP. Children and adolescents with CP do not necessarily present increased psychological maladjustment. Interventions targeting these children and adolescents' social support may promote their psychological adjustment and health-related quality of life. Developmental specificities, such as age and gender differences, should be considered when planning and implementing psychosocial interventions.

Psychometric properties of the Strengths and Difficulties Questionnaire(3-4) in 3-year-old preschoolers

We provide the first validation data on the Strengths and Difficulties Questionnaire (SDQ(3-4)), a brief screening tool for behavioral and emotional problems, in preschool children. Parents of a community sample of 1341 Spanish 3-year-olds and teachers of a sample of 622 children responded to the SDQ(3-4) and different measures of psychopathology. Confirmatory factor analysis yielded adequate fit of the model to the original structure. Internal consistency (omega coefficient) for total scores was .87 for parents and .91 for teachers. Convergent validity of SDQ(3-4)-parents' reports with Achenbach's taxonomy and diagnostic interview was good, but low for SDQ(3-4)-teachers' reports. The SDQ(3-4) showed predictive accuracy for discriminating use of mental health services and functional impairment. This is the first work presenting empirical evidence of the reliability and validity of the parents' and teachers' SDQ(3-4) for preschoolers. The SDQ(3-4) presents acceptable psychometric properties for use in the identification of preschool children who might have behavioral or emotional problems.

Negative affect shares genetic and environmental influences with symptoms of childhood internalizing and externalizing disorders

The co-occurrence of internalizing and externalizing disorders suggests that they may have common underlying vulnerability factors. Research has shown that negative affect is moderately positively correlated with both internalizing and externalizing disorders in children. The present study is the first to provide an examination of negative affect in relation to a wide spectrum of childhood internalizing and externalizing problems using a biometric model. This study extends prior findings of more narrowly focused associations by using a factor approach including multiple disorders. The sample for this study included families of 691 same-sex 7- to 13-year old twin pairs. A multifactorial independent pathway model was used to examine the genetic and environmental influences underlying the covariation of parent-reported negative affect, internalizing symptoms, and externalizing symptoms. Results of the current study suggest that negative affect shares genetic and environmental influences with both internalizing and externalizing disorders in childhood. These common influences may partially explain their comorbidity. Understanding that negative affect is at least one contributor to the covariation among these disorders may highlight avenues for early risk assessment, intervention, and perhaps prevention.

Comparison of Parent versus Child-Report of Child Impulsivity Traits and Prediction of Outcome Variables

Five personality traits that dispose individuals to rash or ill-advised action (i.e., sensation seeking, negative urgency, positive urgency, lack of planning, and lack of perseverance), can be reliably and validly assessed in children. This paper reports on the first test of parental reports of these traits. In a sample of 94 children (ages 7-13, mean age 10.6), the authors found the following. First, parental reports of the five traits in their children appeared to be reliable. Second, there was moderate convergent validity: parent and child reports of the same traits had a median correlation of r = .30. Third, there was adequate discriminant validity: within-parent reports on different traits had a median correlation of r = .11. Fourth, concurrent prediction of child behavior from parental reports generally was inconsistent with prior findings. Fifth, discrepancies between the two reporters did predict dysfunctional child behavior. There are advantages to securing both child self-report and parental report of personality dispositions to rash action, although there is limited evidence for the concurrent validity of parental reports.

Sources of data about children's executive functioning: review and commentary

Accurate measurement of a child's executive functioning (EF) is important for diagnosis, description of functional impairment, and treatment planning. EF assessment typically consists of administration of a battery of performance-based tests involving abilities such as attention, inhibition, reasoning, planning, and mental flexibility. In recent years, observer (e.g., parent) rating scales have been added to the typical EF battery. However, research has revealed that performance-based tests and parent rating scales are not highly correlated. In other words, level of impairment indicated by one source of data often does not match level of impairment indicated by the other source of data. This disagreement places the clinician in a difficult situation when attempting to interpret evaluation results. The profession of pediatric neuropsychology needs to provide guidance about handling this disagreement. Using the current assessment tools, specific EF subdomains may need to be examined systematically to identify precisely where the disagreements lie. Perhaps the relative validity of the two data sources can be determined, and decisions can be made about what to emphasize and what/when to interpret cautiously. Alternatively, perhaps the goal should be to develop and/or refine measurement tools to increase agreement in order to improve accuracy and validity of test interpretation. At this time, the results of performance-based tests and rating scales of EF are being used together but are not being integrated. Evidence-based practice requires that more work be done to enhance the use of these two sources of data.

Validation of diagnoses of distress disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Research diagnostic interviews need to discriminate between closely related disorders in order to allow comorbidity among mental disorders to be studied reliably. Yet conventional studies of diagnostic validity generally focus on single disorders and do not examine discriminant validity. The current study examines the validity of fully-structured diagnoses of closely-related distress disorders (generalized anxiety disorder, post-traumatic stress disorder, major depressive episode, and dysthymic disorder) in the lay-administered Composite International Diagnostic Interview Version 3.0 (CIDI) with independent clinical diagnoses based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). The NCS-A is a national survey of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) among 10,148 adolescents. A probability sub-sample of 347 of these adolescents and their parents were administered blinded follow-up K-SADS interviews. Good concordance [area under the receiver operating characteristic curve (AUC)] was found between diagnoses based on the CIDI and the K-SADS for generalized anxiety disorder (AUC = 0.78), post-traumatic stress disorder (AUC = 0.79), and major depressive episode/dysthymic disorder (AUC = 0.86). Further, the CIDI was able to effectively discriminate among different types of distress disorders in the sub-sample of respondents with any distress disorder.

Depressed mothers as informants on child behavior: methodological issues

Mothers with depressive symptoms more frequently report behavioral problems among their children than non-depressed mothers leading to a debate regarding the accuracy of depressed mothers as informants of children's behavior. The purpose of this integrative review was to identify methodological challenges in research related to the debate. Data were extracted from 43 articles (6 theoretical, 36 research reports, and 1 instrument scoring manual). The analysis focused on the methodologies considered when using depressed mothers as informants. Nine key themes were identified and I concluded that researchers should incorporate multiple informants, identify the characteristics of maternal depression, and incorporate advanced statistical methodology. The use of a conceptual framework to understand informant discrepancies within child behavior evaluations is suggested for future research.

Dietary intake of omega-3 fatty acids and risk of depressive symptoms in adolescents

BACKGROUND

Previous randomized controlled trials have demonstrated that omega-3 polyunsaturated fatty acids (n-3 PUFA) are beneficial in reducing symptoms of depression. However, there is limited evidence regarding the influence of dietary n-3 PUFA intake on mood in adolescents drawn from population studies.

OBJECTIVE

In the present investigation, we examined the relationship between dietary n-3 PUFA intake on depression symptomatology in a large prospective pregnancy cohort followed for 17 years.

METHODS

Adolescents enrolled in the Western Australian Pregnancy Cohort (Raine) Study completed a Food Frequency Questionnaire to assess dietary fatty acid intake, as well as other dietary factors at age 14 and a fasting blood sample was taken. Participants also completed the Beck Depression Inventory for Youth (BDI-Y) at age 14 (N = 1,407) and at age 17 (N = 995).

RESULTS

An inverse relationship was observed between intake of both saturated fat and of n-3 PUFA at age 14 and BDI-Y scores at both 14 and 17 years of age. However, after adjusting for energy (kJ) intake and other lifestyle confounders, the relationships were no longer significant.

CONCLUSIONS

Associations previously reported between n3 PUFA and depressive symptoms may be due to collinearity with other dietary and lifestyle factors.

Multiple informants in assessing stress and symptoms in adolescents with schizophrenia

We used exploratory data analysis to examine parents--adolescents congruencies and discrepancies and their correlates in assessing stress and symptoms in adolescents with schizophrenia. A total of 40 adolescents diagnosed with schizophrenia and their parents were drawn from a study of self-management therapy for youth with schizophrenia. Low to moderate congruencies in stress and symptoms were reported (r = .22~.41). Factors including adolescents' age, time spent with children, the number of hospitalizations, and level of disability explained the discrepancies. The results imply that health care providers should be aware that several factors are associated with the discrepancies between parents' and adolescents' reports.

Comparing parent and child perceptions of stigmatizing behavior experienced by children with burn scars

This study examined perceptions of stigmatization in a sample of 85 pediatric burn survivors and their parents. Survivors and a parent independently completed the Perceived Stigmatization Questionnaire (PSQ) rating the frequency that the child experienced three types of stigmatizing behaviors: absence of friendly behavior, confused and staring behavior, and hostile behavior. The sample was divided into a high (top 25%) and low (bottom 75%) perceived stigmatization groups. The mean ratings of parents did not significantly differ from that of children reporting low stigmatization. The mean PSQ parent ratings were significantly lower than those of children reporting high stigmatization. Additionally, the concordance on PSQ subscale scores within child-parent dyads was significantly lower in children reporting high stigmatization relative to child-parent dyads of children reporting low stigmatization. Children surviving burns may experience stigmatization that is under-perceived by their parents. Clinicians should be alert to this potential discrepancy.

Analyzing multiple informant data on child and adolescent behavior problems: Predictive validity and comparison of aggregation procedures

We compared the predictive validity of five aggregation methods for multiple informant data on child and adolescent behavior problems. In addition, we compared the predictive validity of these aggregation methods with single informant scores. Data were derived from the Minnesota Longitudinal Study of Parents and Children (N = 175). Maternal and teacher reports of child behavior problems were obtained at ages 7 and 16 using the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF). Adolescent self-report of child behavior problems was obtained at age 16 (Youth Self-Report). Adolescent psychopathology data was obtained at age 17.5 using a semi-structured diagnostic interview (The Kiddie Schedule for Affective Disorders and Schizophrenia; K-SADS). Results generally showed that the latent variable performed better in predicting adolescent psychopathology compared to the other aggregation methods and single informant scores. The other aggregation methods did not, however, outperform the single informant scores.

Concordance of the Children’s Executive Functions Scale With Established Tests and Parent Rating Scales

An increase can be seen in the number of tests designed to assess executive dysfunction in children, but few address ecological validity by attempting to measure functioning in the natural environment. This study examined the utility of the Children’s Executive Functions Scale (CEFS), a 99-item parent-report measure. The CEFS was designed to measure a variety of behaviors related to executive functioning, including social appropriateness, inhibition, problem solving, initiative, and motor planning. A sample of 59 children was evaluated with the CEFS, established tests of executive functioning, Child Behavior Checklist, and Conners’ Rating Scale. Correlations between the CEFS and the test variables were modest and produced a pattern slightly different from correlations obtained for the other parent report measures. The CEFS was significantly correlated with the other parent report measures; however, the magnitude of the coefficients suggests that the CEFS is providing unique information.

Relationship Between Parenting Stress and Ratings of Executive Functioning in Children With ADHD

Executive functioning is important to assess in children with attention deficit/hyperactivity disorder (ADHD). Parent report is used to obtain information about a child’s executive functioning; however, parent report can be influenced by many factors. This study’s hypothesis was that higher ratings of children’s executive dysfunction are associated with parenting stress. Parents of 32 children (ages 8-12 years) with ADHD completed the Parenting Stress Index and two executive function rating scales, the BRIEF and CEFS. Stress produced by child and family system characteristics was significantly correlated with composite scores and subscales from the executive function rating scales. Findings suggest that parent ratings of their children’s executive functioning appear related to the stress they experience being parents, particularly with regard to their children’s challenging behaviors.