Child and Informant Influences on Behavioral Ratings of Preschool Children

Factors associated with parent-teacher hyperactivity/inattention screening discrepancy: Findings from a UK national sample

BACKGROUND

To fulfil the diagnostic criteria of Attention Deficit Hyperactivity Disorder in the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms should be observed in two or more settings. This implies that diagnostic procedures require observations reported from informants in different settings, such as teachers in school and caregivers at home. This study examined parent-teacher agreement in reporting hyperactivity/inattention and its relationship with child's, parent's, and family's characteristics.

METHOD

We used data from the 2004 United Kingdom Mental Health of Children and Young People survey, including 7977 children aged 4-17, to investigate cross-informant agreement between parents and teachers on the hyperactivity-inattention subscale of the Strengths and Difficulties Questionnaire. The characteristics of different patterns of informant agreement were assessed using multinomial logistic regression.

RESULTS

Cross-informant agreement of parent and teacher was low (weighted kappa = .34, 95% C.I.: .31, .37). Some characteristics, such as male child and parental emotional distress, were associated with higher likelihood of parent-teacher discrepancy.

CONCLUSION

We found low informant agreement in the hyperactive/inattention subscale, as hypothesised and consistent with previous studies. The current study has found several factors that predict discrepancy, which were partly consistent with previous research. Possible explanation, implications, and further research on parent-teacher informant discrepancy in reporting hyperactivity/inattention were discussed.

Prevalence of ADHD among Black Youth Compared to White, Latino and Asian Youth: A Meta-Analysis

OBJECTIVE

To systematically review the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among Black children and adolescents compared to White, Latino and Asian children and adolescents.

METHOD

Peer-reviewed articles were identified in seven databases and included if they reported prevalence of ADHD among Black children and adolescents living in a minority context and compared rates to at least one of White, Latino or Asian samples. A total of 7050 articles were retrieved and 155 articles were subjected to full evaluation. Twenty-three studies representing 26 independent samples were included.

RESULTS

The pooled sample size was n = 218,445 (k = 26), n = 835,505 (k = 25), n = 493,417 (k = 24), and n = 66,413 (k = 7) of Black, White, Latino, and Asian participants, respectively. Pooled prevalence rate of ADHD was 15.9% (95%CI 11.6% - 20.7%) among Black children and adolescents, 16.6% (95%CI 11.6% - 22.2%) among Whites, 10.1% (95%CI 6.9% - 13.8%) among Latinos and 12.4% (95%CI 1.4% - 31.8%) among Asians. There was no significant difference in prevalence between ethnic groups, whereas both Black and White children and adolescents had marginally statistically significant higher prevalence than Asians. The results of a meta-regression analysis showed no moderating effects of the type of sample and the year of publication of studies. A significant publication bias was observed, suggesting that other moderators were not identified in the present systematic review.

CONCLUSION

In contrast to the assertion in the DSM-5 that clinical identification among Black children and adolescents is lower than among White children and adolescents, the present meta-analysis suggests similar rates of ADHD among these two groups. The importance of considering cultural appropriateness of assessment tools and processes is emphasized.

Validity and Reliability of Executive Function Measures in Children With Heavy Prenatal Alcohol Exposure: Correspondence Between Multiple Raters and Laboratory Measures

BACKGROUND

Rating scales are designed to complement traditional performance-based measures, and both can provide useful information about the functioning of youth with histories of prenatal alcohol exposure. Few studies, however, have compared ratings from multiple informants or the relationship between these subjective rating scale scores and the objective results from laboratory performance-based scales.

METHODS

The current study addressed both of these questions in 3 study groups: children with histories of prenatal alcohol exposure (n = 47), attention-deficit/hyperactivity disorder (ADHD; n = 41), and typically developing controls (CON; n = 73). All subjects completed a standardized neuropsychological test battery, including laboratory measures of executive functioning and a self-report measure of executive function behaviors. Parents and teachers completed corresponding rating scales of executive function behaviors for each subject. This study assessed the relationship between these behavior rating scales and corresponding neuropsychological tests, and interrater agreement among the multiple informants.

RESULTS

Weak correlations were found between the rating scales and laboratory measures, indicating poor convergent validity for the behavior rating scale. Interrater reliability was found but it differed by group. Agreement was found between parent and teacher ratings for children with prenatal alcohol exposure, whereas teacher-child agreement was found for those with ADHD.

CONCLUSIONS

Findings from this study indicate that behavior ratings can be used to supplement laboratory measures but may not be measuring cognitive abilities regardless of whether a clinical diagnosis is present. A multimethod approach should be used when measuring skills in this domain. This was one of the first studies to examine cross-informant agreement in a sample of children with prenatal alcohol exposure. Further research is necessary to understand why interrater agreement differed for children with prenatal alcohol exposure and those with ADHD.

Prevalence and Risk Factors Associated With Attention-Deficit/Hyperactivity Disorder Among US Black Individuals: A Systematic Review and Meta-analysis

IMPORTANCE

As stated in the DSM-5, it is generally reported that the prevalence of attention-deficit/hyperactivity disorder (ADHD) is lower among Black individuals compared with the general population. However, Black individuals living in countries where they are considered a minority population group (eg, in Northern America and Europe) are underrepresented in studies evaluating ADHD.

OBJECTIVE

To estimate the pooled prevalence of ADHD and identify associated risk factors among US Black individuals.

DATA SOURCES

This systematic review and meta-analysis identified peer-reviewed studies published until October 18, 2019, using the APA PsycInfo, MEDLINE, Embase, Cochrane CENTRAL, CINAHL, ERIC, and Education Source databases.

STUDY SELECTION

Eligible trials were published in French or English, had empirical data on the prevalence of ADHD in samples or subsamples of Black people, and were conducted in countries with Black minority populations. All studies were assessed and passed quality evaluation.

DATA EXTRACTION AND SYNTHESIS

The PRISMA guideline was used for extracting and reporting data. Random-effects meta-analyses were generated to estimate the prevalence of ADHD among Black individuals using the metafor package in R.

MAIN OUTCOMES AND MEASURES

Prevalence and risk factors associated with ADHD among Black individuals were identified.

RESULTS

A total of 24 independent samples and subsamples from 21 studies published between 1979 and 2020 (154 818 Black participants) were included in this systematic review and meta-analysis. All included studies were conducted in the US. Two studies were conducted assessing adults (aged 18 years or older), 8 assessing children (0-12 years), 1 assessing adolescents (aged 13-17 years), and 13 assessing both children and adolescents. The pooled prevalence of ADHD was 14.54% (95% CI, 10.64%-19.56%). In a narrative review of the studies in this analysis, some studies found risk factors associated with ADHD, such as sociodemographic characteristics (age, sex, race, and socioeconomic status), familial factors, environmental factors, and risk behaviors, but the data did not permit a moderation analysis to assess these findings in this study.

CONCLUSIONS AND RELEVANCE

Contrary to what is stated in the DSM-5, the results of this systematic review and meta-analysis suggest that Black individuals are at higher risk for ADHD diagnoses than the general US population. These results highlight a need to increase ADHD assessment and monitoring among Black individuals from different social backgrounds. They also higlight the importance of establishing accurate diagnoses and culturally appropriate care.

The Influences of Multiple Informants' Ratings of Inattention on Preschoolers' Emergent Literacy Skills Growth

There is strong evidence that inattention is a correlate of reading-related skills; however, less research has examined the unique and longitudinal relations between multiple informants' ratings of inattention and the development of early reading skills across the preschool year. This study used latent growth curve analysis to examine whether ratings of inattention, completed by multiple informants, were unique predictors of emergent literacy development in preschoolers. Participants included 284 preschool children. ADHD-rating scales were completed by three different informants (i.e., classroom teachers, project teachers, and examiners) and measures of emergent literacy skills, a measure of working memory, and a measure of non-verbal cognitive ability were completed by the preschoolers. Each informant's rating of inattention uniquely predicted children's initial emergent literacy skills, but only the ratings of inattention made by project teachers were uniquely associated with growth in emergent literacy skills over the course of the preschool year.

Does Preschool Self-Regulation Predict Later Behavior Problems in General or Specific Problem Behaviors?

Findings from prior research have consistently indicated significant associations between self-regulation and externalizing behaviors. Significant associations have also been reported between children's language skills and both externalizing behaviors and self-regulation. Few studies to date, however, have examined these relations longitudinally, simultaneously, or with respect to unique clusters of externalizing problems. The current study examined the influence of preschool self-regulation on general and specific externalizing behavior problems in early elementary school and whether these relations were independent of associations between language, self-regulation, and externalizing behaviors in a sample of 815 children (44% female). Additionally, given a general pattern of sex differences in the presentations of externalizing behavior problems, self-regulation, and language skills, sex differences for these associations were examined. Results indicated unique relations of preschool self-regulation and language with both general externalizing behavior problems and specific problems of inattention. In general, self-regulation was a stronger longitudinal correlate of externalizing behavior for boys than it was for girls, and language was a stronger longitudinal predictor of hyperactive/impulsive behavior for girls than it was for boys.

Characteristics Associated With Parent-Teacher Concordance on Child Behavior Problem Ratings in Low-Income Preschoolers

OBJECTIVE

Assessment of pediatric behavior problems often requires rating scales from multiple reporters in different settings (eg, home and school); however, concordance between reporters may be low. Pediatricians must reconcile differences to inform treatment. We sought to examine characteristics predicting parent-teacher concordance on ratings of preschoolers' behavior problems.

METHODS

Data from 562 preschoolers were used from the Growing Healthy study, an obesity prevention trial in Head Start programs (2011-2015). Parents and teachers completed the Eyberg Child Behavior Inventory (ECBI)/Student Behavior Inventory (SBI) and the Social Competence and Behavior-Evaluation (SCBE). Outcome variables were: parent-teacher concordance (teacher minus parent score on each subscale of ECBI/SBI and SCBE); teacher reports problem behavior, parent does not (children rated in the top quintile of challenging behavior by teacher but not parent); and parent reports problem behavior, teacher does not (children rated in the top quintile of challenging behavior by parent but not teacher). Multiple linear and logistic regression models were created for each subscale outcome, including the following covariates: child sex, child race/ethnicity, parent age, parent education, family structure, parent depressive symptoms, and parenting self-efficacy, and time of school year.

RESULTS

Lower concordance was associated with child female sex, and child black or Hispanic race/ethnicity; parent older age, lower education, more depressive symptoms, and greater self-efficacy; and beginning of school year.

CONCLUSIONS

Low parent-teacher concordance may reflect different perceptions of child behavior. Pediatricians could consider parent depressive symptoms, culture, and implicit bias when interpreting differences in behavior ratings by parents and teachers.

Does Gender Moderate the Relations Between Externalizing Behavior and Key Emergent Literacy Abilities? Evidence From a Longitudinal Study

OBJECTIVE

There is a significant negative relation between externalizing behavior and emergent literacy skills among preschool children.

METHOD

The purpose of this study was to examine the impact of gender on the predictive relation of externalizing behavior and emergent literacy in a group of 178 preschool children (mean age = 48.50 months, SD = 3.66; 48% boys).

RESULTS

Externalizing behaviors predicted emergent literacy over time. Distinct patterns of predictive associations dependent on gender were found. Girls with higher levels of externalizing behaviors experienced less change in their vocabulary skills compared with the vocabulary change shown by girls with lower levels of these problem behaviors.

CONCLUSION

The results suggest that early identification programs that include externalizing behavior problems and their relation with emergent literacy development should account for potential gender differences. A theoretical framework in which girls with behavior problems receive less opportunity for vocabulary acquisition is presented.

Executive function of Spanish-speaking language-minority preschoolers: Structure and relations with early literacy skills and behavioral outcomes

Young children's executive function (EF) is increasingly recognized as an important construct associated with development in cognitive and socioemotional domains. To date, however, few studies have examined EF in populations of language-minority children. In this study, 241 Spanish-speaking language-minority preschoolers who ranged in age from 38 to 69 months (M=54.23 months, SD=6.17) completed three tasks designed to measure inhibitory control (IC) and four tasks designed to measure working memory (WM). Children completed assessments of their vocabulary skills, early literacy skills, and behavioral self-regulation in both English and Spanish, and their classroom teachers completed three behavior rating measures. Children were classified as more proficient in English or Spanish based on their scores on the vocabulary measures, and all IC and WM measures were administered in the children's more proficient language. Results of confirmatory factor analyses supported a two-factor model of EF for both groups of children as well as strong measurement and structural invariance across groups. Children's EF was substantially related to the language, early literacy, and behavioral self-regulation measures as well as teacher ratings of inattention and hyperactivity/impulsivity. For children with more proficient English, EF was associated with skills in both English and Spanish; however, for children with more proficient Spanish, EF was associated primarily with skills in Spanish. These results provide evidence of strong correspondence for EF measured in Spanish-speaking language-minority preschoolers and monolingual preschoolers, and they identify a potential key factor that can enhance understanding of development in this population of children.

Agreement between parents and teachers on preschool children's behavior in a clinical sample with externalizing behavioral problems

An accurate interpretation of information obtained from multiple assessors is indispensible when complex diagnoses of behavioral problems in children need to be confirmed. The present study examined the similarity of parents and kindergarten teachers ratings on children's behavior in a sample of 160 preschool children (a clinical group including 80 children with externalizing behavioral problems and a matched control group including 80 children). Behavioral problems were assessed using the SDQ, and the DISYPS-II questionnaires for ADHD and conduct disorders. The results revealed low levels of parent-teacher agreement for their ratings on the children's behavior in both groups with the highest correlations in the non-clinical sample. Parent-teacher agreement did not differ significantly across the samples. Parent and teacher ratings correlated with the prevalence of externalizing disorders and were found to be almost independent of each other. The results highlight the importance of multiple informants and their independent influence within the diagnostic process.

Predictors of discrepancies between informants' ratings of preschool-aged children's behavior: An examination of ethnicity, child characteristics, and family functioning

The present study examined predictors of discrepancies between mothers', fathers', and teachers' ratings of 3-year-old children's hyperactivity, attention problems, and aggression. Participants were families of 196 3-year-old children who took part in child and family assessments. Ethnicity was one of the most consistent predictors of discrepancies. African American mothers and fathers were more likely to rate their children's hyperactivity, attention problems, and aggression lower than teachers. In contrast, Latina mothers were more likely to rate their children as more hyperactive and inattentive than teachers. ADHD/ODD diagnoses, parental depression, number of children, and children's pre-academic skills were also predictive of discrepancies for some measures for some informants. These findings provide insight into factors that may contribute to informant discrepancies in ratings of preschool children.

Using Teacher Ratings to Track the Growth and Development of Young Children Using the Teaching Strategies GOLD® Assessment System

An important consideration in determining the validity of an observational assessment measure for young children is the variability attributed to the child versus that ascribed to the assessor or to some other factor such as classroom context. The Teaching Strategies GOLD® assessment system was used to elicit teacher ratings of a national sample of 21,592 children (age 12-51 months). Teacher ratings of child development and learning were associated in expected directions with both child demographic characteristics and classroom composition variables. Children with disabilities started behind their typically developing peers and grew slower, girls showed an advantage in some areas over boys, and English language learners (ELLs) were rated lower at the beginning of the year and showed some faster rates of growth than their native English-speaking peers.

Coparenting among lesbian, gay, and heterosexual couples: associations with adopted children's outcomes

Coparenting is associated with child behavior in families with heterosexual parents, but less is known about coparenting among lesbian- and gay-parent families. Associations were studied among self-reported divisions of labor, coparenting observations, and child adjustment (Mage  = 3 years) among 104 adoptive families headed by lesbian, gay, or heterosexual couples. Lesbian and gay couples reported sharing child care, whereas heterosexual couples reported specialization (i.e., mothers did more child care than fathers). Observations confirmed this pattern-lesbian and gay parents participated more equally than heterosexual parents during family interaction. Lesbian couples showed the most supportive and least undermining behavior, whereas gay couples showed the least supportive behavior, and heterosexual couples the most undermining behavior. Overall, supportive coparenting was associated with better child adjustment.

Multi-Method Assessment of ADHD Characteristics in Preschool Children: Relations between Measures

Several forms of assessment tools, including behavioral rating scales and objective tests such as the Continuous Performance Test (CPT), can be used to measure inattentive and hyperactive/impulsive behaviors associated with Attention-Deficit/Hyperactivity Disorder (ADHD). However, research with school-age children has shown that the correlations between parent ratings, teacher ratings, and scores on objective measures of ADHD-characteristic behaviors are modest at best. In this study, we examined the relations between parent and teacher ratings of ADHD and CPT scores in a sample of 65 preschoolers ranging from 50 to 72 months of age. No significant associations between teacher and parent ratings of ADHD were found. Parent-ratings of both inattention and hyperactivity/impulsivity accounted for variance in CPT omission errors but not CPT commission errors. Teacher ratings showed evidence of convergent and discriminant validity when entered simultaneously in a hierarchical regression. These tools may be measuring different aspects of inattention and hyperactivity/impulsivity.