The development and validation of the children's self-report psychiatric rating scale

What have birth cohort studies asked about genetic, pre- and perinatal exposures and child and adolescent onset mental health outcomes? A systematic review

Increased understanding of early neurobehavioural development is needed to prevent, identify, and treat childhood psychopathology most effectively at the earliest possible stage. Prospective birth cohorts can elucidate the association of genes, environment, and their interactions with neurobehavioural development. We conducted a systematic review of the birth cohort literature. On the basis of internet searches and 6,248 peer-reviewed references, 105 longitudinal epidemiological studies were identified. Twenty studies met inclusion criteria (prospectively recruited, population-based cohort studies, including at least one assessment before the end of the perinatal period and at least one assessment of behaviour, temperament/personality, neuropsychiatric or psychiatric status before 19 years of age), and their methodologies were reviewed in full. Whilst the birth cohort studies did examine some aspects of behaviour and neurodevelopment, observations in the early months and years were rare. Furthermore, aspects of sampling method, sample size, data collection, design, and breadth and depth of measurement in some studies made research questions about neurodevelopment difficult to answer. Existing birth cohort studies have yielded limited information on how pre- and perinatal factors and early neurodevelopment relate to child psychopathology. Further epidemiological research is required with a specific focus on early neurodevelopment. Studies are needed which include the measures of early childhood psychopathology and involve long-term follow-up.

Corporal punishment: mother's disciplinary behavior and child's psychological profile in Alexandria, Egypt

Although all professionals oppose abusive physical punishment, nonabusive physical punishment is still controversial. The aim of the present study was (i) to determine parents' behavior regarding the discipline of their children using corporal punishment or other alternative disciplinary methods, (ii) to identify the different associated factors for corporal punishment, and (iii) to determine the association between exposure of the child to corporal punishment and his or her psychosocial well-being. A representative sample of 400 fifth-grade primary school children and their mothers were subjected to a cross-sectional survey. Mothers were subjected to a questionnaire to assess their behavior on corporal punishment and other disciplinary methods. The children were subjected to Coopersmith Self-Esteem Inventory to assess their self-esteem, and a questionnaire to assess their relationship with others. About three-quarter of children (76.3%) were corporally punished, and about half of them (46.2%) were punished on sites other than the extremities or buttocks. In 59.3% of them the frequency of the punishment ranged from once or twice/week to more than once/day, and it left marks in about 20%. Other disciplinary methods used by mothers were yelling/insulting (43.5%), taking away a toy or privilege (39.3%), discussing/explaining (9.5%), and time out (2.8%). The significant predictors of mothers' use of corporal punishment were male gender of the child (p < 0.01), rural origin of the father (p= 0.02), the mother's bad history of rearing experience (p < 0.01), and poor interparental relationship (p= 0.02). The relation between corporal punishment of children and their self-esteem was not statistically significant; however, corporally punished children scored lower on their relationship with others than noncorporally punished ones (Z= 2.60, p < 0.05). Corporal punishment is a widespread disciplinary method in Alexandria. The use of corporal punishment could have adverse effects on the child especially on his or her relationship with others. Planning an awareness-raising educational program for current and expectant parents is recommended, to promote positive nonviolent methods of child rearing, via the media and campaigns, and encouragement of political, community, and religious leaders; medical personnel; journalists; and sports and entertainment figures to share in these campaigns.

Characteristics of Health-related Self-report Measures for Children Aged Three to Eight Years: A Review of the Literature

AIMS

To review and make recommendations about the format and quality of health-related self-report measures for children aged 3-8 years.

METHODS

Literature searches used to identify measures of QOL, self-esteem, self-concept and mental health. The format (i.e., scale type, presentation style) and quality (i.e., item generation, reliability, validity, responsiveness) of measures were compared and evaluated.

RESULTS

Fifty three measures were identified: QOL (n = 25, 47%), self-esteem/concept (n = 15, 28%), mental health (n = 13, 25%). Likert scales were used most frequently to represent response choices (n = 34, 64%). The authors of 11 (21%) measures provided justification for their scale choice. Items were most commonly presented in written format (n = 24, 45%). Item content was generated from the respondent population in only 21 (40%) measures. Twenty-seven (51%) measures reported internal reliability between 0.70 and 0.90, and 12 (23%) reported reproducibility in this range. Although validity was reported for 48 (91%) measures, evidence for three or more aspects occurred for only 9 (17%). Eleven (21%) measures evidenced responsiveness to change.

CONCLUSION

Authors should provide clearer evidence for reliability and responsiveness. Newly developed instruments need to meet established standards, and further studies should assess the impact of scale and presentation types on the psychometrics of measures.

Multimodal School-Based Intervention for At-Risk, Aggressive, Latency-Age Youth

This pilot study examines the effects of a school-based multimodal intervention project to assist aggressive students at risk for school drop out and delinquency. School climate, peer-pairing, teacher education and whole class interventions are main clinical strategies which seek to attain a multiple reinforcement model for increased social inclusion, healthy behaviour and social interaction in the at-risk student group. Results show significant positive effects (p< .01) in participant group with more mature interpersonal negotiation skills, and a trend toward decreased negative peer perceptions, with no change in control group. These changes are felt to be important protective factors aiding the development of friendships and self-esteem. The study emphasizes the need for more sensitive measures of at-risk children's psychological and academic changes and emphasizes the need for longitudinal program intervention and follow-up.

Long-term consistency in speech/language profiles: II. Behavioral, emotional, and social outcomes

OBJECTIVE

This study examined the 7-year behavioral, emotional, and social outcome of speech/language-impaired and control children selected from a community sample.

METHOD

Speech/language and psychosocial measures were administered to the children at ages 5 and 12.5 years. Using children's age 5 speech/language test results, a cluster analysis was performed to ascertain whether specific linguistic subgroups would emerge. The association between speech/language cluster at age 5 and psychosocial functioning at age 12.5 was examined.

RESULTS

Children with receptive and pervasive speech/language problems at age 5 demonstrated greater behavioral disturbance than children without such impairment. Controlling for initial behavioral status, early childhood language profile was still associated with behavioral and social competence ratings, 7 years later. Children without receptive language problems showed superior social adjustment.

CONCLUSIONS

Empirically supported speech/language classifications identified as early as age 5 were associated with behavioral disturbance in late childhood. Receptive and pervasive speech/language impairment in early childhood was associated with the greatest risk at follow-up. Early auditory comprehension problems may be a specific risk factor for later aggressive and hyperactive symptoms. These findings identify the need for effective intervention with speech/language-impaired children.

Prediction of adjustment from preschool to middle childhood

This study identified predictor variables associated with outcome in middle childhood in a clinical preschool sample. These variables were examined in relation to functional level at outcome. At Time 1 the sample consisted of 129 children admitted to a psychiatric preschool program; 82 of these children comprised the follow-up sample at Time 2. The results indicated that the variables significantly associated with each child's outcome were IQ, the presence of diagnosis at Time 1 and the length of time each child was in the treatment program. Different predictors were important for different outcomes and a given predictor variable was not equally salient across all levels of outcome.

Clinical, cognitive, and neurophysiological effects of alprazolam in children and adolescents with overanxious and avoidant disorders

In a double-blind, placebo-controlled study, the efficacy and safety of alprazolam was investigated in childhood and adolescent anxiety disorders. Thirty patients (mean, 12.6 years) diagnosed with overanxious or avoidant disorders participated in the study. Evaluations included clinical, laboratory, cognitive, and qualitative EEG measurements. On a clinical global rating, there was no statistical difference between alprazolam and placebo. Relative to baseline EEG, acute alprazolam administration increased beta power in the right occipital lead, and chronic administration increased beta power in both leads. Alprazolam was well tolerated, and adverse effects were few, mild, and transient.

Confirmatory factor models of attention deficit and conduct disorder

The paper presents four alternative confirmatory factor models to represent the structure of measures of attention deficit and conduct disorder obtained from multiple sources. These models range in complexity from a simple one-factor model with no method effects to a two-factor model with method effects. These models were fitted to data gathered on maternal, teacher and self-report of attention deficit and conduct disorder for a sample of New Zealand children studied at ages 9 and 10 years. The analysis strongly suggests that the best representation of the data was a two-factor model in which there were distinct factors of attention deficit and conduct disorder with these factors being highly correlated (r = 0.87-0.88). It is suggested that the most suitable clinical nomenclature may be to describe conduct disorder and attention deficit generically as externalizing disorders, subscripting this classification with clauses which describe the relative contributions of conduct disorder and attention deficit. The implications of this finding for the measurement, classification and explanation of conduct disorder and attention deficit disorder are discussed.

Vulnerability to childhood problems and family social background

The relationship between family social background and risks of problems in the areas of health, education, behaviour and offending was examined in a birth cohort of New Zealand children studied to the age of 11 years. The analysis showed the presence of small consistent correlations between family social background and individual outcomes on a range of childhood measures. These correlations ranged from 0.12 to 0.31 with a median value of 0.18. The association between family social background and childhood outcomes was modelled using LISREL modelling methods which assumed that this association was mediated by common non-observed vulnerability processes. This analysis suggested that while variations in family social background act as relatively weak determinants of specific problem outcomes, these factors had a relatively strong influence on the child's generalized vulnerability to a wide range of childhood problems. The implications of these results for research into social background and childhood are discussed.

Life events: children's reports

Children 7 to 12 years of age were asked to indicate events they had experienced in the previous three months in a questionnaire devised for the study. Most children were able to complete the questionnaire and reported positive and negative events, the most common themes being personal achievement, illness-related events and problems in relationships. The agreement between parents and child reporting of individual events was uneven and children reported more events than parents. Psychiatrically disturbed children noted an excess of negative and loss events and children attending paediatric clinics reported fewer events, particularly fewer positive happenings, than non-attending primary school children. A child Life Events questionnaire may be of use to explore disturbed and ill children's perception of their lives.

Mental health in Dutch adolescents: self-reported competencies and problems for ages 11-18

Beside parents and teachers, adolescents themselvess may be valuable informants about their own psychological functioning. The present study, which provides prevalence data on behavioral/emotional problems and competencies reported by adolescents aged 11-18 from the general population, was preceded by two studies providing such data for parent and teacher reported problems. The instrument used in the present study is the Youth Self Report (YSR) developed by Achenbach and Edelbrock to obtain adolescents' self-reports on their problems and competencies in a standardized way. YSRs completed by 52 adolescents on two occasions with a time-interval of 3-4 weeks revealed test-retest reliability expressed as intraclass correlation coefficients of 0.87 for total problem scores and 0.69 for total competence scores. The YSR was completed by 941 adolescents aged 11-18 from the general population. For each of the 103 problem items and 17 competence items, the prevalence rates were presented graphically for both genders in two-year age-groups. To identify differences related to sex, age and socio-economic status (SES), ANCOVAs were performed on the scores for each problem and competence item as well as on total problem and total competence scores. Whereas the level of problem scores was the same across the 11-18 years age-span, girls obtained higher total problem scores with increasing age. Younger girls scored lower and older girls scored somewhat higher than boys. Implications of these findings with respect to sex differences in referral rates for children and adults are discussed. The increase with increasing age in self-reports of problems concerning inner feelings and thoughts may reflect the adolescent's change in cognitive, socio-emotional and physical functioning. We could not demonstrate significant SES differences in problem scores. Comparisons of problem scores obtained for referred and nonreferred adolescents revealed a correct classification rate of 73.6%, which seems satisfactory given the fact that parents rather than the adolescent usually initiate referrals. Comparisons of problem item scores in ANCOVAs of referred and nonreferred samples revealed significant referral status effects for 68 of the 103 problem items, with referred adolescents scoring higher than nonreferred adolescents. The largest effect of referral status was found for the item "Nervous". The third largest effect was obtained for the item "Unhappy, sad, depressed", which also showed strong discrimination between parent scores for referred and nonreferred samples. Competence scores showed much weaker discrimination between referred and nonreferred groups.

The children's self-report questionnaire: factor score age trends and gender differences

Age trends and gender differences in a normative sample of 1,676 children (6- to 13-years) were explored with the use of scores obtained from the Children's Self-Report Questionnaire (SRQ). Several interesting trends emerged. Boys scored higher than girls on Conduct Problems, and girls scored higher than boys on dimensions labeled Worry and Sensitive-Emotional. Scores on other SRQ factors exhibited orderly increases or decreases across age groups. These trends are discussed in an attempt to clarify behavioral cognitive and affective age appropriate norms and are cautiously interpreted within a developmental framework. The identification of age and gender trends are a necessary step in the development of a diagnostic instrument intended for use with children. The age and gender trends observed lend additional support to the validity of the SRQ.

Diagnostic interviewing with children: the use and reliability of the diagnostic coding form

There have been few attempts to standardize assessment methods in Child Psychiatry. This paper describes a semi-structured approach to diagnostic interviewing of the child. Thirty-four children six to 13 years of age, and their parents, were interviewed two weeks apart by two different psychiatrists. A diagnostic coding form consisting of 29 clinical symptom items, eight summary items, and nine positive health ratings was used. Three diagnostic items were also included: "severity of clinical condition," "probability of disorder," and "adjustment status." Twelve of the Time 2 interviews with the child and parent were videotaped and rated by three different psychiatrists. Results indicated that summary items had higher reliability than individual symptom items and the three diagnostic items had the highest reliability, suggesting reliability is better for broad classes of behaviour. Interrater reliability was higher for the face-to-face rating than videotaped ratings. This suggests first that face-to-face interviews are reasonably stable over a two week period and second, since videotaped ratings had lowest reliability on items that depended on inferences about the child's feedlings, an important source of variance in assessment may be the clinician's ability to empathize with the child and draw inferences about internal feeling-states. It was concluded that this interview schedule can be a part of routine clinical practice. It ensures a reasonably standard, yet flexible and reliable approach to diagnostic interviewing.

Estimation of method and trait variance in ratings of conduct disorder

A structural equation model designed to estimate the contributions of trait, method and error variance to maternal and teacher and child ratings of conduct disorder is presented. This model was fitted to data collected on a birth cohort of New Zealand children studied over a 3 yr period. On the basis of the fitted model it was estimated that between 28% and 40% of the variance in maternal and teacher ratings was ascribable to variations in the child's generalized behavioural tendencies and the remaining variance to either method-specific factors or random errors of measurement. The implications of these results are discussed.

Empirical classification of speech/language impairment in children. II. Behavioral characteristics

Behavioral symptomatology in 188 children, 5 years of age, classified according to four different speech/language profiles, is described. Information was collected from the teacher, parent, child self-report, and psychiatric interview. The results indicated that risk for psychiatric disorder, particularly ADHD, is greatest among children with general linguistic impairment. Specific deficits such as poor auditory comprehension or articulation problems were not consistently associated with behavioral disturbance. It is postulated that neurodevelopmental immaturity may be the common underlying antecedent of both linguistic impairment and psychiatric disorder.

Self-report measures for use with children: a review and comment

This article underscores the need for self-report instruments for children to complement the teacher and parent questionnaires traditionally used to assess various aspects of children's psychological lives. Some of the problems inherent in using teachers, parents, and children as informants are delineated. Many self-report instruments, in particular those that are used to assess children's self-concept, anxiety, depression, and personality, are reviewed. The Children's Self-Report Questionnaire (SRQ) was designed to assist in the diagnosis and detection of psychological deviance in 7- to 12-year-old children. The SRQ is easily administered, has broadly based norms, and has acceptable reliability and validity. The SRQ can be used as an aid to both research and clinical assessment and may provide insight into the inner world of the child.

Alprazolam effects in children with anxiety disorders

Children with overanxious and/or avoidant disorder (DSM-III) were treated with alprazolam (Xanax, Upjohn) to determine its safety, clinical and cognitive effects. Ten male and two female patients (age range 8.8 to 16.5 years; mean 11.5) participated in an open clinical trial consisting of a baseline placebo period (1 week), alprazolam therapy (4 weeks), a drug-tapering period (1 week), and a post-drug placebo period (1 week). There was a drug-free follow-up approximately 4 weeks after termination of the study. Dosages were individually adjusted and the daily maximum ranged from 0.50 mg to 1.5 mg. Evaluations included clinical assessments, parent, teacher and self ratings, and cognitive tests. Clinical global improvement with alprazolam therapy was marked in 1 patient, moderate in 6, minimal in 4, and none in 1. Clinician ratings indicated significant improvements of anxiety, depression, and psychomotor excitation. Parent questionnaires indicated significant improvements of anxiety and hyperactivity while teacher questionnaires showed significant improvement of an anxious-passive factor. Significant improvements in the paired associate learning tasks, maze task and the block design tasks were maintained after drug withdrawal suggesting a practice effect. Adverse effects were infrequent, mild and transient. There were no clinically significant changes of laboratory values, blood pressure, pulse or respiration during the 4 weeks of alprazolam administration. Body weight increased significantly (mean increase was 0.87 kg). Double-blind trials with alprazolam are recommended in child psychiatry disorders.

Bupropion effects in attention deficit and conduct disorders

Children with Attention Deficit and/or Conduct Disorders were treated with bupropion, a new antidepressant, to determine its clinical, cognitive, and EEG effects. Seventeen male patients (age range 7 to 13.4 years; mean 10.4) participated in an open clinical trial consisting of a baseline placebo period (4 weeks), bupropion therapy (8 weeks), and post-drug placebo (2 weeks). Evaluations included clinical assessments, parents, teachers, and self-ratings; cognitive tests and blood level measurements of bupropion. Fifteen patients received a daily maximum of 150 mg, one received 100 mg and one 50 mg. Clinical global improvement with bupropion therapy was marked in 5 patients, moderate in 7, mild in 2, and none in 3. The Children's Psychiatric Rating Scale indicated improvements of hyperactivity, withdrawal, anxiety, hostility/uncooperativeness, sleep disorder, antisocial behaviour, neuroticism, depression and eating disturbance. Parents' Questionnaires indicated significant improvements of conduct disorder, anxiety, hyperactivity, muscle tension and psychosomaticism. While no single cognitive test showed significant improvement, all nine tests changed in the positive direction. Adverse effects were infrequent, transient and mild. There were no clinically significant changes of the laboratory values and vital signs. Two weeks following bupropion discontinuation, clinical global improvement was maintained in 8 patients, 7 showed relapses, while 2 remained unimproved. Analyses of computerized EEG revealed that degree of clinical improvement was indexed by baseline EEG parameters and that there were significant bupropion effects on EEG measures. Double-blind trials of bupropion are recommended in child psychiatry disorders.