Systematic Integration of Multi-Informant Externalizing Ratings in Clinical Settings

Best practice clinical assessment of externalizing problems often necessitates collection of information from parents, youth themselves, and teachers. The present study tested the predictive validity of a psychometrically-driven scoring procedure to integrate multi-informant, dimensional ratings of externalizing problems. Participants were 2264 clinic-referred youth ages 6-18. Parents, teachers, and youth completed questionnaire ratings of externalizing problems (hyperactivity-inattention, conduct problems, and oppositionality-defiance) prior to an initial clinical appointment. The predictive validity of simple (highest informant rating; and all informant ratings separately) and more complex (latent S-1 bifactor model with specific informant factors; and moderated nonlinear factor analysis accounting for child age and sex) methods of informant integration was tested in predicting impairment, comorbidity, and number of clinical encounters. A simple model, in which all informant ratings were included, showed the best predictive validity across outcomes, performing as well or better than the use of the highest informant ratings or more complex latent variable models. The addition of child age and sex as moderators in the factor model did not improve predictive validity. Each informant (parent, teacher, and youth) contributes important information to the prediction of clinically-relevant outcomes. There is insufficient evidence at present to suggest that complex latent variable models should be favored over simpler models that preserve each informant's ratings.

Cross-cultural adaptation, validity, and reliability of the Child and Adolescent Behavior Inventory (CABI) for use in Brazil

OBJECTIVE

The Child and Adolescent Behavior Inventory (CABI) is a cost-free 75 question-questionnaire developed by an Italian group to collect information from parents on the behavior of children and adolescents aged 6 to 18 years. It assesses different areas of children's behavior and psychopathology, including internalizing and externalizing symptoms, and can be used to identify children at risk of mental disorders both in clinical and epidemiological settings. In this study, the authors present a Brazilian-Portuguese adaptation of the CABI and its psychometric properties.

METHODS

First, the authors conducted a rigorous transcultural adaptation of CABI's questions and instructions for the Brazilian context. In an online sample of 598 parents, the authors found high reliability (internal consistency) for the CABI's main subscales.

RESULTS

Validity was supported by exploratory factor analysis (the authors found 6 factors representing several aspects of psychopathology both according to the DSM and HiTop models) and significant differences in most CABI's subscales between children with parent-reported psychopathology and typically developing ones. The present study suggests that the adapted version of CABI is a valid and reliable measure that can be used in Brazil.

CONCLUSIONS

The CABI can be useful to the pediatrician to get fast but wide information from parents on the behavioral condition of their children or adolescents, and also to decide whether it is appropriate to consult a mental health professional.

A Multi-Rater Latent Growth Curve Model

To avoid the subjectivity of having a single person evaluate a construct of interest (e.g., a student's self-efficacy in school), multiple raters are often used. Increasingly, data that use multiple raters to evaluate psychological and social-emotional constructs over time are available. While a range of models to address measurement issues that arise when using multiple raters have been presented, including a small number for longitudinal data, few if any models are available to estimate growth in the presence of multiple raters. In this study, we provide a model that removes all but the shared perceptions of raters at a given timepoint (i.e., removes unique rater variance), then adds on a latent growth curve model across timepoints. Through simulation and empirical studies, we examine the performance of the model in terms of recovering true growth parameters, and relative to more crude approaches like estimating growth based on a single rater. Our results indicate that the model we propose performs quite well along these dimensions, and shows promise for use by researchers who want to estimate growth based on longitudinal multi-rater data.

Combined Approach to Multi-Informant Data Using Latent Factors and Latent Classes: Trifactor Mixture Model

Although collecting data from multiple informants is highly recommended, methods to model the congruence and incongruence between informants are limited. Bauer and colleagues suggested the trifactor model that decomposes the variances into common factor, informant perspective factors, and item-specific factors. This study extends their work to the trifactor mixture model that combines the trifactor model and the mixture model. This combined approach allows researchers to investigate the common and unique perspectives of multiple informants on targets using latent factors and simultaneously take into account potential heterogeneity of targets using latent classes. We demonstrate this model using student self-rated and teacher-rated academic behaviors (N = 24,094). Model specification and testing procedures are explicated in detail. Methodological and practical issues in conducting the trifactor mixture analysis are discussed.

Paternal Sensitivity and Children's Cognitive and Socioemotional Outcomes: A Meta-Analytic Review

In a series of meta-analyses, paternal sensitivity was associated with children's (age range: 7 months-9 years) overall cognitive functioning (N = 3,193; k = 23; r = .19), including language skills (k = 9; r = .21), cognitive ability (k = 9; r = .18), and executive function (k = 8; r = .19). Paternal sensitivity was not associated with children's overall socioemotional functioning (N = 2,924; k = 24; r = -.03) or internalizing problems, but it was associated with children's emotion regulation (k = 7; r = .22) and externalizing problems (k = 19; r = -.08). In the broad cognitive functioning, executive function, broad socioemotional functioning, and externalizing problems meta-analyses, child age was a significant moderator.

Maternal prenatal stress and postnatal depressive symptoms: discrepancy between mother and teacher reports of toddler psychological problems

PURPOSE

Maternal prenatal stress and postnatal depression are reported to increase the risk for early offspring psychological problems. We examined whether these two stressors predicted toddler emotional or behavioral problems based on the mother and teacher reports, respectively.

METHODS

A longitudinal study within the Odense Child Cohort (OCC). Prenatal stress was assessed (gestation week 28) using Cohen's Perceived Stress Scale (PSS). Depressive symptoms were assessed (3 months after birth) using the Edinburgh Postnatal Depression Scale (EPDS). Behavioral and emotional problems were assessed by mothers using the preschool version of Child Behaviour Checklist (CBCL) and by teachers using the caregiver-teacher report form (CTR-F).

RESULTS

N = 1302 mother-child dyads were included. CBCL (N = 1302) was collected at 29 months (SD 5.3) and C-TRF (N = 989) at 32.6 months (SD 6.9). N = 70 mothers (5.4%) were at high risk for postnatal depression (EPDS score > 12). Generalized additive models showed that prenatal stress (increase of + 1 on PSS-10 total score) predicted an increase in CBCL (+ 0.011) and C-TRF (+ 0.015) total scores. Postnatal depressive symptoms (increase of + 1 on EPDS total score) only predicted an increase in CBCL total score (+ 0.026).

CONCLUSION

Prenatal maternal stress was a significant predictor of both mother and teacher reported toddler emotional and behavioral problems, although effect sizes were small. Postnatal depressive symptoms were associated with increased maternal (but not teacher) reporting of toddler problems. Mothers reported more toddler psychological problems than teachers, and the mother-teacher discrepancy was positively correlated to maternal postnatal depressive symptoms.

What Differentiates Children with ADHD Symptoms Who Do and Do Not Receive a Formal Diagnosis? Results from a Prospective Longitudinal Cohort Study

ADHD diagnoses are increasing worldwide, in patterns involving both overdiagnosis of some groups and underdiagnosis of others. The current study uses data from a national longitudinal study of Irish children (N = 8568) to examine the sociodemographic, clinical and psychological variables that differentiate children with high hyperactivity/inattention symptoms, who had and had not received a diagnosis of ADHD. Analysis identified no significant differences in the demographic characteristics or socio-emotional wellbeing of 9-year-olds with hyperactivity/inattention who had and who had not received a diagnosis of ADHD. However, by age 13, those who had held a diagnosis at 9 years showed more emotional and peer relationship problems, worse prosocial behaviour, and poorer self-concept. Further research is required to clarify the developmental pathways responsible for these effects.

Multi-informant universal screening: Evaluation of rater, item, and construct variance using a trifactor model

Universal screening is a proactive method for identifying student risk, yet remains under-utilized in school systems. Instead, many schools rely on teacher reports and referrals without accounting for different informant perspectives. In the current study, multi-informant universal screening in evaluated using a trifactor model. The study utilized the Social, Academic, and Emotional Behavior Risk Screener (SAEBRS), specifically the teacher (SAEBRS-TRS) and student (mySAEBRS) self-report forms, with items indicating risk for social, academic, and emotional behavior. Data from a national sample of over 24,000 K-12 teacher-student dyads were used to examine the extent and variance of discrepant reports between students and teachers of common, perspective, and item factors. Results demonstrated that informant perspective factors were a strong predictor for student and teacher emotional behavior item ratings. Whereas age had a positive effect on younger student reports of risk on the behavior items compared to older student reports, teachers showed the opposite effect. The teacherperspective of social and emotional behaviors of students was predicted by gender. Implications and directions for future research are further discussed.

Method effects of the relation between family history of alcoholism and parent reports of offspring impulsive behavior

There is an extensive, albeit inconsistent, literature on the relation between parental alcoholism and offspring impulsive behavior. The reasons for this inconsistency are likely multiple but it seems probable that method effects due to different methodological approaches might explain some of the inconsistencies. Offspring behavior is typically assessed based on informant reports. However, no specific method has been demonstrated as optimal for analyzing informant reports, and conclusions may differ depending on the method used. The present study compared findings derived from a multi-informant method proposed by Bauer et al. (2013) to other structural equation models. Participants came from Wave 7 of the Alcohol, Health and Behavior study and included mother and father reports of offspring impulsive behavior on the Health and Behavior Questionnaire (Armstrong, Goldstein, & the MacArthur Working Group on Outcome Assessment, 2003). There were 368 offspring (50% female, age range 3-17 years, meanage = 6.78, SDage = 3.07) from 205 families. The multi-informant model and the single-reporter models each provided a good fit of the data; however, findings differed based on the approach employed. Specifically, the mother-only report model found that offspring with a family history of alcoholism (FHA) were more impulsive compared to offspring without a FHA; no effect of FHA was found in the other single-reporter models. Ratings of offspring impulsive behavior were higher on the father perspective factor suggesting alcoholic fathers were biased in their reports. These findings highlight the relation between FHA and impulsive behavior varies depending on the analytic method used.

Children's stress-related reports and stress biomarkers interact in their association with metabolic syndrome risk

The purpose was to examine the cross-sectional associations of stress-related reports and stress biomarkers with metabolic syndrome (MetS) risk in children while also testing the interaction between stress biomarkers and stress reports. In 353 children (5-10 years old, 7.9% overweight/obese), MetS risk was measured by blood pressure, waist circumference, glucose homeostasis, triglycerides, and high-density cholesterol. Stress was measured by stress-related reports (events, emotions, and internalizing/externalizing problems) and two biomarkers: salivary cortisol (total-day and morning output) and heart rate variability (percentage of consecutive normal RR intervals differing more than 50 ms and low-to-high-frequency ratio). Cross-sectional regression analyses with z scored total MetS risk as outcome were adjusted for age, sex, and socio-economic status. Only internalizing problems were directly related to a higher MetS risk score (β = 0.236). Cortisol and heart rate variability were significant moderators: High cortisol morning output resulted in a positive (unfavourable) report-MetS relationship (β = 0.259-0.552), whereas low percentage of consecutive normal RR intervals differing more than 50 ms resulted in a negative (favourable) report-MetS relationship (β = -0.298) and low low-to-high-frequency ratio in a positive (unfavourable) report-MetS relationship (β = 0.478). In conclusion, stress can sometimes be a disadvantageous factor in metabolic health of otherwise healthy children. The cortisol biomarker seems relevant because metabolic risk was highest when stress-related reports were accompanied by high morning cortisol output.

Do Extremely Violent Juveniles Respond Differently to Treatment?

This study increases knowledge on effectiveness of treatment for extremely violent (EV) youth by investigating their response to multisystemic therapy (MST). Using data of a randomized controlled trial on effectiveness of MST, we investigated differences in treatment response between EV youth and not extremely violent (NEV) youth. Pre- to post-treatment comparison indicated MST was equally effective for EV and NEV youth, whereas treatment as usual was not effective for either group. Growth curves of within-treatment changes indicated EV youth responded differently to MST than NEV youth. The within-treatment change was for EV youth non-linear: Initially, they show a deterioration; however, after one month, EV juveniles respond positively to MST, indicating longer lasting, intensive programs may be effective in treating extreme violence.

Incremental Validity of Teacher and Parent Symptom and Impairment Ratings when Screening for Mental Health Difficulties

Although universal screening for mental health difficulties is increasingly recognized as a way to identify children who are at risk and provide early intervention, little research exists to inform decisions about screening, such as the choice of informants and the type of information collected. The present study examined the incremental validity of teacher- and parent-rated (primarily mothers) symptoms and impairment in a non-referred sample of early elementary school children (n = 320, 49 % boys, ages 6 to 9) in terms of predicting impairment as rated by a different teacher 1 year later. Teacher-rated symptoms and impairment and parent-rated impairment were each unique predictors of later impairment; however, parent-rated symptoms did not contribute to the prediction of later impairment above and beyond these other indicators. The results indicate that, when screening for mental health difficulties in the school system, impairment ratings collected across settings add useful information, but it may not be necessary to use parent symptom ratings when teacher symptom ratings are available.

The Integration of Family and Group Therapy as an Alternative to Juvenile Incarceration: A Quasi-Experimental Evaluation Using Parenting with Love and Limits

The current study employed a quasi-experimental design using both intent-to-treat and protocol adherence analysis of 155 moderate- to high-risk juvenile offenders to evaluate the effectiveness of Parenting with Love and Limits® (PLL), an integrative group and family therapy approach. Youth completing PLL had significantly lower rates of recidivism than the comparison group. Parents also reported statistically significant improvements in youth behavior. Lengths of service were also significantly shorter for the treatment sample than the matched comparison group by an average of 4 months. This study contributes to the literature by suggesting that intensive community-based combined family and group treatment is effective in curbing recidivism among high-risk juveniles.

The contribution of parent and youth information to identify mental health disorders or problems in adolescents

BACKGROUND

Discrepancies between multiple informants often create considerable uncertainties in delivering services to youth. The present study assessed the ability of the parent and youth scales of the Strength and Difficulties Questionnaire (SDQ) to predict mental health problems/disorders across several mental health domains as validated against two contrasting indices of validity for psychopathology derived from the Development and Well Being Assessment (DAWBA): (1) an empirically derived computer algorithm and (2) expert based ICD-10 diagnoses.

METHODS

Ordinal and logistic regressions were used to predict any problems/disorders, emotional problems/disorders and behavioural problems/disorders in a community sample (n = 252) and in a clinic sample (n = 95).

RESULTS

The findings were strikingly similar in both samples. Parent and youth SDQ scales were related to any problem/disorder. Youth SDQ symptom and impact had the strongest association with emotional problems/disorder and parent SDQ symptom score were most strongly related to behavioural problems/disorders. Both the SDQ total and the impact scores significantly predicted emotional problems/disorders in males whereas this was the case only for the total SDQ score in females.

CONCLUSION

The present study confirms and expands previous findings on parent and youth informant validity. Clinicians should include both parent and youth for identifying any mental health problems/disorders, youth information for detecting emotional problems/disorders, and parent information to detect behavioural problems/disorders. Not only symptom scores but also impact measures may be useful to detect emotional problems/disorders, particularly in male youth.

Research Review: Multi-informant integration in child and adolescent psychopathology diagnosis

BACKGROUND

An empirically based, clinically usable approach to cross-informant integration in clinical assessment is needed. Although the importance of this ongoing issue is becoming increasingly recognized, little in the way of solid recommendations is currently provided to researchers and clinicians seeking to incorporate multiple informant reports in diagnosis of child psychopathology. The issue is timely because recent developments have created new opportunities for improved handling of this problem. For example, advanced theories of psychopathology and normal and abnormal child development provide theoretical guidance for how integration of multiple informants should be handled for specific disorders and at particular ages. In addition, more sophisticated data analytic approaches are now available, including advanced latent variable models, which allow for complex measurement approaches with consideration of measurement invariance.

FINDINGS

The increasing availability and mobility of computing devices suggests that it will be increasingly feasible for clinicians to implement more advanced methods rather than being confined to the easily memorized algorithms of the DSM system.

CONCLUSIONS

Development of models of cross-informant integration for individual disorders based on theory and tests of the incremental validity of more sophisticated cross-informant integration approaches in comparison to external validation criteria (e.g. longitudinal trajectories and outcomes, treatment response, and behavior genetic etiology) should be a focus of future work.

Effective Mental Health Screening in Adolescents: Should We Collect Data from Youth, Parents or Both?

Youth- and parent-rated screening measures derived from the Strengths and Difficulties Questionnaire (SDQ) and Development and Well-Being Assessment (DAWBA) were compared on their psychometric properties as predictors of caseness in adolescence (mean age 14). Successful screening was judged firstly against the likelihood of having an ICD-10 psychiatric diagnosis and secondly by the ability to discriminate between community (N = 252) and clinical (N = 86) samples (sample status). Both, SDQ and DAWBA measures adequately predicted the presence of an ICD-10 disorder as well as sample status. The hypothesis that there was an informant gradient was confirmed: youth self-reports were less discriminating than parent reports, whereas combined parent and youth reports were more discriminating-a finding replicated across a diversity of measures. When practical constraints only permit screening for caseness using either a parent or an adolescent informant, parents are the better source of information.

Respiratory sinus arrhythmia as a predictor of eating disorder symptoms in college students: Moderation by responses to stress and parent psychological control

This longitudinal study examined the prospective contribution of respiratory sinus arrhythmia (RSA), a key physiological indicator of self-regulation, to eating disorder symptoms in college students, and whether this link was moderated by maladaptive responses to stress and parent psychological control. At Wave 1, college students' RSA was measured at rest. At Waves 1 and 2 (six-month follow-up), students reported on their eating disorder symptoms, coping and involuntary responses to stress, and perceptions of their parents' use of psychological control. Significant three-way interactions indicated that the link between RSA and subsequent eating disorder symptoms was contingent on responses to stress and parent psychological control. In the context of maladaptive responses to stress and high psychological control, RSA predicted increased eating disorder symptoms over time. In the absence of parent psychological control, high RSA was beneficial in most cases, even when individuals reported maladaptive responses to stress. This study presents novel evidence that high RSA contributes to risk for or resilience to eating disorder symptoms over time. RSA can be protective against eating disorder symptoms, but in some contexts, the self-regulation resources that high RSA provides may be inappropriately applied to eating cognitions and behaviors. This research highlights the importance of examining physiological functioning conjointly with other risk factors as precursors to eating disorder symptoms over time.

Multiproblem Families Referred to Youth Mental Health: What's in a Name?

The purpose of this study was threefold, namely (1) to differentiate between multiproblem families and control families on characteristics and processes within the family based on a theoretical framework, (2) to identify multiproblem families by establishing cut-off scores on various questionnaires, and (3) to categorize multiproblem families into subtypes by cluster analyses. Various questionnaires were administered to multiproblem families (n = 85) and control families (n = 150). Results showed that what we propose to refer to as multiproblem families present a broad range of problems on seven domains: (1) child factors, (2) parental factors, (3) childrearing problems (inadequate or inconsistent parenting), (4) family functioning problems, (5) contextual problems, (6) social network problems, and (7) mental health care problems. Further, reliable cut-off scores were established for various questionnaires. Finally, three types of families were found: (1) community-problem families, (2) multiproblem families, and (3) child-focused mild-problem families. This paper looks to advance an evidence-based definition and assessment of "multiproblem families" suggesting the possible value of defining and assessing multiproblem families in relation to these seven dimensions. Moreover, the classification of multiproblem families stresses the importance of providing tailored treatments.

Early childhood aggression trajectories

High and stable levels of aggression and the presence of aggressive behaviour in multiple settings according to different informants are risk factors for later problems. However, these two factors have not been investigated in early childhood. The present study investigates trajectories of parent-reported child aggression from 1.5 up to 6 years of age and their association with aggressive behaviour, attention problems and rule-breaking behaviour in a different setting, as reported by the teacher. In a longitudinal population-based cohort study, parent-reported measures of aggressive behaviour were obtained using the CBCL when children were 1.5, 3, and 6 years of age ( n = 4,781). Teacher-reported problem behaviour at school was assessed at age 6.5, using the TRF questionnaire ( n = 2,756). Growth mixture modelling yielded three aggression trajectories, with high increasing (3.0%), intermediate (21.3%), and low decreasing (75.7%) aggression levels. Children in trajectories with higher and increasing levels of aggression showed more teacher-reported aggressive behaviour, attention problems and rule breaking behaviour. However, parent-reported aggression at age six predicted problem behaviour at school to the same extent as did the aggression trajectories, suggesting that the incremental value of trajectories is not always self-evident.

Developmental pathways from childhood aggression-disruptiveness, chronic peer rejection, and deviant friendships to early-adolescent rule breaking

Childhood aggression-disruptiveness (AD), chronic peer rejection, and deviant friendships were examined as predictors of early-adolescent rule-breaking behaviors. Using a sample of 383 children (193 girls and 190 boys) who were followed from ages 6 to 14, peer rejection trajectories were identified and incorporated into a series of alternative models to assess how chronic peer rejection and deviant friendships mediate the association between stable childhood AD and early-adolescent rule breaking. There were multiple mediated pathways to rule breaking that included both behavioral and relational risk factors, and findings were consistent for boys and girls. Results have implications for better understanding the influence of multiple social processes in the continuity of antisocial behaviors from middle childhood to early adolescence.

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.

Screening for childhood mental health disorders using the Strengths and Difficulties Questionnaire: the validity of multi-informant reports

AIM

This study investigated the diagnostic accuracy of the Strengths and Difficulties Questionnaire (SDQ) in a population of children born extremely preterm (<26wks gestation).

METHOD

Parents and teachers of 219 extremely preterm children (118 females, 101 males; age 11y) were asked to complete the SDQ to screen for psychological problems. Multi-informant ratings were aggregated using two methods: combined (parent or teacher rated the child with problems) and pervasive (parent and teacher rated the child with problems). Psychiatric diagnoses were assigned using the Development and Well-Being Assessment.

RESULTS

Pervasive ratings had the greatest diagnostic accuracy for emotional disorders (89%), conduct disorders (94%), attention-deficit-hyperactivity disorder (ADHD; 90%), and autism spectrum disorders (ASDs; 94%), but were associated with low sensitivity (≤50%). For clinical use, combined ratings were best for detecting emotional disorders (sensitivity 77%, specificity 75%), conduct disorders (83%, 88%), and ADHD (85%, 72%). Parent ratings were best for ASDs (93%, 66%). Teacher ratings significantly improved prediction over parent ratings alone for conduct disorders (∆χ(2) =9.3, p=0.002) and ADHD (∆χ(2) =24.1, p<0.001) only.

INTERPRETATION

Multi-informant data are preferable for assessing most mental health outcomes using the SDQ. As an outcome measure, pervasive ratings have the best predictive accuracy. For screening, combined ratings are best for detecting ADHD and emotional and conduct disorders. For ASDs, parent ratings were best.

Growing up after extremely preterm birth: lifespan mental health outcomes

There is growing interest in the long-term mental health sequelae of extremely preterm birth. In this paper we review literature relating to mental health outcomes across the lifespan. Studies conducted in the preschool years, school age and adolescence, and adulthood show continuity in outcomes and point to an increased risk for inattention, socio-communicative problems and emotional difficulties in individuals born extremely preterm. Both behavioural and neuroimaging studies also provide evidence of a neurodevelopmental origin for mental health disorders in this population. Here we summarise contemporary evidence and highlight key methodological considerations for carrying out and interpreting studies in this field.

Adversity and internalizing problems among rural Chinese adolescents

Throughout the developing world, adolescents living in rural poverty face multiple and inter-related adaptive challenges. Using longitudinal data from the Gansu Survey of Children and Families, we adopt an approach grounded in resilience theory to investigate the relationship between cumulative adversity and internalizing problems among 1,659 adolescents between the ages of 13 and 16 years in an interior Chinese province. We also investigate the compensatory roles of parental warmth and teacher support. Results of multivariate regression models suggest that internalizing problems increased in later adolescence in this sample. The rate of increase did not differ by gender, counter to most extant literature on sex differences in the developmental trajectory of internalizing problems. Along with parental warmth, teacher support emerged as an especially important compensatory factor, highlighting the significance of teachers as an often overlooked resource for poor rural adolescents.

Research Methods in Child Disaster Studies: A Review of Studies Generated by the September 11, 2001, Terrorist Attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina

BACKGROUND

A comprehensive review of the design principles and methodological approaches that have been used to make inferences from the research on disasters in children is needed.

OBJECTIVE

To identify the methodological approaches used to study children's reactions to three recent major disasters-the September 11, 2001, attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina.

METHODS

This review was guided by a systematic literature search.

RESULTS

A total of 165 unduplicated empirical reports were generated by the search and examined for this review. This included 83 references on September 11, 29 on the 2004 Tsunami, and 53 on Hurricane Katrina.

CONCLUSIONS

A diversity of methods has been brought to bear in understanding children's reactions to disasters. While cross-sectional studies predominate, pre-event data for some investigations emerged from archival data and data from studies examining non-disaster topics. The nature and extent of the influence of risk and protective variables beyond disaster exposure are not fully understood due, in part, to limitations in the study designs used in the extant research. Advancing an understanding of the roles of exposure and various individual, family, and social factors depends upon the extent to which measures and assessment techniques are valid and reliable, as well as on data sources and data collection designs. Comprehensive assessments that extend beyond questionnaires and checklists to include interviews and cognitive and biological measures to elucidate the negative and positive effects of disasters on children also may improve the knowledge base.

Race/ethnicity, parent-identified emotional difficulties, and mental health visits among California children

Variability in mental health services utilization by race/ethnicity was evaluated with a Behavioral Model approach. Subjects were 17,705 children 5 to 11 years of age in the 2005, 2007, and 2009 California Health Interview Surveys. Parents identified minor emotional difficulties in 18.7% of these children (ranging from 14.8% in Asians to 24.4% in African Americans) and definite or severe difficulties in 7.4% (5.5% in Asians to 9.7% in "other race"). Overall, 7.6% of children had at least one mental health visit in the prior year (2.3% in Asians to 11.2% in African Americans). Parent-identified need was the most salient predictor of mental health visits for all racial/ethnic groups. Beyond need, no consistent patterns could be determined across racial/ethnic groups with regard to the relationship between contextual, predisposing, and enabling measures and mental health service utilization. Different factors operated for each racial/ethnic group, suggesting the need for studies to examine mental health need, mental health service use, and determinants by racial/ethnic subgroup. These findings suggest that a "one-size-fits-all approach" with regard to policies and practices aimed at reducing mental health disparities will not be effective for all racial/ethnic groups.

Annual research review: embracing not erasing contextual variability in children's behavior--theory and utility in the selection and use of methods and informants in developmental psychopathology

This paper examines the selection and use of multiple methods and informants for the assessment of disruptive behavior syndromes and attention deficit/hyperactivity disorder, providing a critical discussion of (a) the bidirectional linkages between theoretical models of childhood psychopathology and current assessment techniques; and (b) current knowledge concerning the utility of different methods and informants for key clinical goals. There is growing recognition that children's behavior varies meaningfully across situations, and evidence indicates that these differences, in combination with informants' unique perspectives, are at least partly responsible for inter-rater discrepancies in reports of symptomatology. Such data suggest that we should embrace this contextual variability as clinically meaningful information, moving away from models of psychopathology as generalized traits that manifest uniformly across situations and settings, and toward theoretical conceptualizations that explicitly incorporate contextual features, such as considering clinical syndromes identified by different informants to be discrete phenomena. We highlight different approaches to measurement that embrace contextual variability in children's behavior and describe how the use of such tools and techniques may yield significant gains clinically (e.g., for treatment planning and monitoring). The continued development of a variety of feasible, contextually sensitive methods for assessing children's behavior will allow us to determine further the validity of incorporating contextual features into models of developmental psychopathology and nosological frameworks.

Depression in early, middle and late adolescence: differential evidence for the cognitive diathesis-stress model

Cognitive theory is a prominent framework to study depression in both adults and adolescents. This theory stated that dysfunctional schemas are moderators (known as diathesis) in the association of current stress and psychopathology. However, in adolescents, less evidence has been found so far to corroborate the importance of these schemas. This study aimed to investigate in a cross-sectional design the moderating role of adolescents' early maladaptive schemas (EMS) on depressive symptoms. This will be studied in relation to both important daily stressors (i.e., maternal, paternal and peer rejection) and stressful life events.

METHOD

Adolescents (N = 228, age 12-18 years), selected from inpatient and outpatient clinical settings and a non-referred sample, completed questionnaires and interviews measuring psychopathology, cognitive schemas, peer rejection, maternal and paternal rejection, and stressful life events. Parents completed questionnaires about their adolescent measuring psychopathology, stressful life events and peer rejection, as well as their own parental behaviour.

RESULTS

Correlational analyses revealed significant associations between the study variables. Evidence was found for an interaction effect between the adolescents' EMS and peer rejection in explaining depressive symptoms, but only in late adolescents.

KEY PRACTITIONER MESSAGE

Stress induced by maternal and, in lesser extent, paternal rejection is contributing to depressive symptoms primarily in younger and to lesser extent in older age groups. The quality of peer relationships becomes an increasingly salient source of distress as adolescence unfolds and is certainly an important mechanism affecting depression in adolescence. Maladaptive schemas only start functioning as a cognitive diathesis in late adolescence, increasing depression in response to peer-related distress. Since maladaptive schemas are not yet operating as cognitive vulnerability factors in early and middle adolescence, early interventions for depressive disorders may be more effective compared with treatment in later adolescence.

Long-term effects of prenatal cigarette smoke exposure on behavior dysregulation among 14-year-old offspring of teenage mothers

In this prospective study, we examined the long-term effects of prenatal cigarette smoke exposure (PCSE) on behavioral dysregulation (BD) in the offspring of adolescent mothers. The adolescent mothers (mean age = 16; range = 12-18; 70% African American) were interviewed about their tobacco use during pregnancy. Offspring were followed to age 14 years (n = 318). Indices of BD outcomes included aggression, rule breaking, externalizing, social problems, attention, distractibility and activity. Multiple measures and multiple informants were used for each construct. Regression analyses were conducted to test if PCSE predicted the BD outcomes, adjusting for demographic and maternal psychological characteristics, and for prenatal exposure to other substances. Independent effects of PCSE were found. Exposed offspring had more aggressive, social, and externalizing problems on both the maternal report and the adolescent self-report measures. They were more active, had more attention problems and greater difficulty with distraction and task orientation. Most PCSE effects were found from first trimester exposure and from exposure to as few as 10 cigarettes per day. These results are consistent with previous findings in this cohort when offspring were 6 and 10 years old, demonstrating that the effects of prenatal cigarette smoke exposure can be identified early and persist into adolescence.

Observed externalizing behavior: a developmental comparison of genetic and environmental influences across three samples

Estimates of genetic and environmental influences on externalizing behavior are markedly inconsistent. In an attempt to refine and extend our knowledge of externalizing behavior, the current study examined the etiology of externalizing behavior using observational data in middle childhood and adolescence from three twin and sibling samples. Observational ratings offer a unique perspective on externalizing behavior rarely examined within behavioral genetic designs. Shared environmental influences were significant and moderate to large in magnitude across all three samples (i.e., 44, 77, and 38%), while genetic influences (31%) were significant only for the adolescent sample. All three samples showed greater shared environmental influences and less genetic influence than is typically found when examining self-, parent-, and teacher-reports of externalizing behavior. These findings are consistent with other reports that have found evidence for shared environmental influences on measures of child externalizing behavior-in direct contrast to a commonly held perception that shared environmental factors do not have significant influences on behavior beyond early childhood.