Development of Aggression Subtypes from Childhood to Adolescence: a Group-Based Multi-Trajectory Modelling Perspective

The persistence of elevated subtypes of aggression beginning in childhood have been associated with long-term maladaptive outcomes. Yet it remains unclear to what extent there are clusters of individuals following similar developmental trajectories across forms (i.e., physical and indirect) and functions (i.e., proactive and reactive) of aggression. We aimed to identify groups of children with distinct profiles of the joint development of forms and functions of aggression and to identify risk factors for group membership. A sample of 787 children was followed from birth to adolescence. Parent and teacher reports, and standardised assessments were used to measure two forms and two functions of aggressive behaviour, between six and 13 years of age along with preceding child, maternal, and family-level risk-factors. Analyses were conducted using a group-based multi-trajectory modelling approach. Five trajectory groups emerged: non-aggressors, low-stable, moderate-engagers, high-desisting, and high-chronic. Coercive parenting increased membership risk in the moderate-engagers and high-chronic groups. Lower maternal IQ increased membership risk in both high-desisting and high-chronic groups, whereas maternal depression increased membership risk in the high-desisting group only. Never being breastfed increased membership risk in the moderate-engagers group. Boys were at greater risk for belonging to groups displaying elevated aggression. Individuals with chronic aggression problems use all subtypes of aggression. Risk factors suggest that prevention programs should start early in life and target mothers with lower IQ. Strategies to deal with maternal depression and enhance positive parenting while replacing coercive parenting tactics should be highlighted in programming efforts.

Item Generation and Content Validity of the Child-Adolescent Bullying Scale

BACKGROUND

Healthcare providers do not uniformly screen young patients for exposure to bullying, and no screening instruments have been developed for widespread use in clinical settings.

OBJECTIVES

The objectives of this study were to (a) generate scale items by identifying and eliciting concepts relevant to youths with potential exposure to bullying as well as to professionals who work with bullied youths and (b) assess the content validity of the new Child-Adolescent Bullying Scale (CABS) instrument.

METHODS

A mixed-methods design was used to develop an initial pool of 52 items. The study was conducted in four phases: (I) comprehensive review of the existing literature; (II) concept elicitation through the conduct of focus groups with school-age youths and professionals who work with bullied youths; (III) concept selection and item construction; and (IV) content validation assessment of relevance, clarity, and dimension of each item by a panel of 30 international bullying and measurement experts through completion of an online survey.

RESULTS

An initial pool of 52 potential items was developed during Phases I-III of the study. During Phase IV, item- and scale-level content validity indices were calculated and were used to refine the item pool. These strategies resulted in a new, 22-item tool, with scale-level content validity indices of .954 for clarity and .920 for representativeness.

DISCUSSION

Evaluation of the CABS tool with a sample of youths drawn from healthcare settings will be necessary to assess the performance of the CABS items, further evaluate its psychometric properties, and further refine the tool.

Developmental patterns of anger from infancy to middle childhood predict problem behaviors at age 8

Anger is a central characteristic of negative affect and is relatively stable from infancy onward. Absolute levels of anger typically peak in early childhood and diminish as children become socialized and better able to regulate emotions. From infancy to school age, however, there are also individual differences in rank-order levels of anger. For example, although decreasing in absolute levels, some children may stay the same and others may increase in rank order relative to their peers. Although change in rank order of anger over time may provide unique insight into children's social development, little is known concerning variations in developmental patterns of anger from a rank-order perspective and how these patterns are related to children's behavioral adjustment. The current study (N = 361) used group-based trajectory analysis and identified 6 distinct patterns of parent-reported child anger by rank across 9 months to 7 years: low-stable rank, average-stable rank, average-decreasing rank, average-increasing rank, high-decreasing rank, and high-stable rank. Most children (65.1%) were in low- to average-rank groups. However, 28.2% and 6.7% of the children were in average-increasing and high-stable groups, respectively. Children in the high-stable group showed elevated levels of externalizing and internalizing problems at age 8 compared to children in the average-stable, average-decreasing, and high-decreasing groups. These findings help to clarify different patterns of anger development across childhood and how they may relate to later problem behaviors. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Cross-Domain Symptom Development Typologies and Their Antecedents: Results From the UK Millennium Cohort Study

OBJECTIVE

Typologies of symptom development have been used to identify individuals with different symptom development in the externalizing and internalizing domains of child psychopathology separately despite the domains' high comorbidity and shared common etiologic risk. This study identified typologies of development jointly across the 2 symptom domains in childhood and investigated their associated antecedents with a specific focus on the comparisons between overall severity of symptoms and symptom expression in one or the other domain.

METHOD

Latent class analysis identified groups based on emotional and behavioral symptoms assessed at 3, 5, 7, and 11 years in the UK Millennium Cohort Study (N = 15,439). Different sociodemographic, family structure and environment, birth, infancy, and early childhood antecedents were examined.

RESULTS

Five groups were identified: 1. low symptoms (57%), 2. moderate behavioral (21%), 3. moderate emotional (12.5%), 4. high emotional and moderate behavioral (5.5%), and 5. high behavioral and moderate emotional (4%). Higher symptoms were predicted by larger numbers of antecedents and risk factors compared with the low symptom group and compared with moderate and high levels of symptoms in either domain (groups 5 versus 2 and 4 versus 3). Comparisons of groups with similar overall symptom levels but different dominant symptom domain (groups 2 versus 3 and 4 versus 5) indicated that apart from gender and ethnicity, there were few unique antecedents of whether children mainly internalize or externalize their symptoms.

CONCLUSION

It is possible and useful to define groupings or typologies jointly across externalizing and internalizing symptom development in childhood. Although numerous antecedents predict the experience of symptoms, there are few unique antecedents that differentiate individuals with similarly high levels of psychopathology expressed mainly as internalizing or externalizing symptoms. Identification of at-risk children and delivery of early intervention might benefit from a decreased focus on symptom domain with possible downstream effects through the life course for most common psychiatric disorders.

Classes of Physical Activity and Sedentary Behavior in 5th Grade Children

OBJECTIVES

We identified classes of physical activity (PA) and sedentary behaviors (SB) in 5th grade children, associated factors, and trajectories of change into 7th grade.

METHODS

This study included N = 495 children (221 boys, 274 girls) who participated in the Transitions and Activity Changes in Kids (TRACK) Study. PA was assessed objectively as well as by self-report. Children, parents, and school administrators completed surveys to assess related factors. Latent class analysis, growth modeling, and adjusted multinomial logistic regression procedures were used to classify children based on self-reported PA and SB and examine associated factors.

RESULTS

Three classes of behavior were identified: Class 1: Low PA/Low SB; Class 2: Moderate PA/ High SB; and Class 3: High PA/High SB (boys) or Class 3: High PA (girls). Class 3 children had higher levels of self-efficacy (boys), and enjoyment, parental support, and physical activity equipment at home (girls). Class 2 boys and Class 3 girls did not experience decline in PA (accelerometer) over time.

CONCLUSIONS

Self-efficacy (boys) and home environment (girls) may play a role in shaping patterns of PA in children. Findings may help to inform future interventions to encourage children to meet national PA guidelines.

A Novel Pilot Study of Internet-stored Videotapes and Pediatric Dentists Predicting Behavior of Preschoolers

PURPOSE

The purpose of this pilot study was to evaluate a web-based technology as a means of clinical research in assessing pediatric dentists' accuracy in predicting patient behaviors during a clinical procedure based on pre-procedural behaviors shown in vignettes.

METHODS

A private web-based server was used to house six two-minute vignettes and a questionnaire on children's behaviors and temperament characteristics. An electronic link via an e-mail invitation was sent to a sample of pediatric dentists. Six patients undergoing a clinical examination were pre-rated using the Ohio State Behavior Rating Scale and classified each as cooperative, potentially cooperative, and uncooperative. The vignettes displayed the children prior to undergoing an examination. Pediatric dentists were asked to predict the children's behaviors and temperament during the clinical examination based on the behavior in the vignettes.

RESULTS

Results indicated that 89 percent of the respondents were able to correctly classify and predict behaviors in at least four of the six vignettes. Respondents were less confident and accurate in their predictions for children who were rated as uncooperative (48 percent and 33 percent, respectively).

CONCLUSIONS

Web-based technology may be a promising tool for studies in pediatric dentistry. Pediatric dentists can rapidly perceive cues in classifying and discriminating behaviors.

Developmental transitions in presentations of externalizing problems among boys and girls at risk for child maltreatment

The present study examined the impact of children's maltreatment experiences on the emergence of externalizing problem presentations among children during different developmental periods. The sample included 788 youth and their caregivers who participated in a multisite, prospective study of youth at-risk for maltreatment. Externalizing problems were assessed at ages 4, 8, and 12, and symptoms and diagnoses of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder were assessed at age 14, during interviews with youth and caregivers. Information about maltreatment allegations was coded from official records. Latent transition analysis identified three groups of youth with similar presentations of externalizing problems ("well adjusted," "hyperactive/oppositional," and "aggressive/rule-breaking") and transitions between groups from ages 4, 8, and 12. A "defiant/deceitful" group also emerged at age 12. Girls were generally more likely to present as well adjusted than boys. Children with recent physical abuse allegations had an increased risk for aggressive/rule-breaking presentations during the preschool and preadolescent years, while children with sexual abuse or neglect allegations had lower probabilities of having well-adjusted presentations during middle childhood. These findings indicate that persistently severe aggressive conduct problems, which are related to the most concerning outcomes, can be identified early, particularly among neglected and physically and sexually abused children.

Childhood trajectories of anxiousness and disruptiveness explain the association between early-life adversity and attempted suicide

BACKGROUND

Suicidal behavior is frequently associated with a history of childhood abuse yet it remains unclear precisely how early life adversity may increase suicide risk later in life. As such, our aim was to examine whether lifetime trajectories of disruptiveness and anxiousness trait dysregulation explain the association between childhood adversity and suicidal behavior; and moreover, to test the potential modifying effects of mental disorders on these associations.

METHOD

A sample of 1776 individuals from a prospective school-based cohort followed longitudinally for over 22 years was investigated. We tested the influence of disruptiveness and anxiousness trajectories from age 6 to 12 years on the association between childhood adversity (i.e. sexual and physical abuse) and history of suicide attempts (SA) using logistic regression models. Both adolescent externalizing and internalizing Axis I disorders and gender were tested as potential modifiers of these associations.

RESULTS

Four distinct longitudinal trajectories were identified for both disruptiveness and anxiousness. The high disruptiveness trajectory accounted for the association between childhood adversity and SA, but only for females. The high anxiousness trajectory also explained the association between adversity and SA; however, in this case it was not sex but mental disorders that influenced the potency of the mediating effect. More specifically, anxiousness fully explained the effect of adversity on SA in the presence of externalizing disorders, whereas in the absence of these disorders, this effect was significantly attenuated.

CONCLUSIONS

This study provides evidence that both disruptiveness and anxiousness play an important role in explaining the relationship between childhood adversity and SA.

Base rates, multiple indicators, and comprehensive forensic evaluations: why sexualized behavior still counts in assessments of child sexual abuse allegations

Developmentally inappropriate sexual behavior has long been viewed as a possible indicator of child sexual abuse. In recent years, however, the utility of sexualized behavior in forensic assessments of alleged child sexual abuse has been seriously challenged. This article addresses a number of the concerns that have been raised about the diagnostic value of sexualized behavior, including the claim that when population base rates for abuse are properly taken into account, the diagnostic value of sexualized behavior is insignificant. This article also identifies a best practice comprehensive evaluation model with a methodology that is effective in mitigating such concerns.

"Making the child understand:" socialization of emotion in urban India

Using a combination of quantitative and qualitative methods, this study examined mothers' socialization of child emotion in suburban middle-class families in Gujarat, India. In particular, a community sample of 602 children, 6 to 8 years, was screened for emotional/behavioral problems using a parent-report measure standardized with this population. Based on the screening, four groups of children were formed: those with internalizing problems (n = 31), externalizing problems (n = 32), and somatic complaints (n = 25), and an asymptomatic control group (n = 32). Mothers of children across groups completed a previously pilot-tested, forced-choice, self-report questionnaire of their emotions and behaviors in response to their children's anger, sadness, and physical pain, and an individual open-ended interview further exploring their socialization behaviors, immediate goals, and expectations from their children. Quantitative data revealed that mothers of children in internalizing, externalizing, and somatic complaints groups reported more negative emotions (anger, disappointment, embarrassment, restlessness) and punitive/ minimizing behaviors than the control group, with the somatic-complaints group also reporting less sympathy and emotion-/ problem-focused behaviors than the control group. Qualitative data provided a culturally grounded overarching framework to understand emotion socialization in this sample, and suggested variation across groups with respect to the type of mothers' behaviors, along with expectations for appropriate behavior.

Quantifying peer interactions for research and clinical use: the Manchester Inventory for Playground Observation

Direct observation of peer relating is potentially a sensitive and ecologically valid measure of child social functioning, but there has been a lack of standardised methods. The Manchester Inventory for Playground Observation (MIPO) was developed as a practical yet rigorous assessment of this kind for 5-11 year olds. We report on the initial reliability and validity of the MIPO and its ability to distinguish social impairments within different psychopathologies. We observed 144 clinically referred children aged 5;00-11;11 (mean 8.8) years with Externalising (n = 44), Internalising (n = 19), Autism Spectrum Disorders (n = 39) or Specific Language Impairment (n = 42), and 44 class-controls, in naturalistic playground interaction. Observers, blind to clinical diagnosis, completed the MIPO and the teacher checklist from the Social Skills Rating System (SSRS). MIPO items showed high internal consistency (alpha = .924; all 'alpha if item deleted' values>.91), inter-observer reliability (mean κ(w) = .77) and test-retest stability (over 2 weeks; mean κ(w) = .58). MIPO totals showed convergence with SSRS (n = 68, r(s) = .78, p<.01) and excellent discrimination between case and control (sensitivity = 0.75 and specificity = 0.88, AUC = .897). Externalising, Autistic Spectrum and Language Impaired groups showed distinct profiles of MIPO impairment consistent with theory:Internalising disorders less so. 65.3% of clinical cases were classified accurately for primary diagnosis. The MIPO shows reliability and validity as a measure of children's social functioning relevant in developmental research and as a clinical tool to aid differential diagnosis and intervention planning.

A description of adaptive and maladaptive behaviour in children and adolescents with Cri-du-chat syndrome

BACKGROUND

Psychological tests can be useful to record adaptive and maladaptive behaviours of children with intellectual disability. The objective of this study was to describe the adaptive and maladaptive behaviour of children and adolescents with Cri-du-chat syndrome.

METHODS

The sample consisted of 10 children and adolescents with Cri-du-chat syndrome (mean chronological age=11.3 years, mean mental age=18 months). The developmental quotient was calculated through the Psychoeducational Profile - Revised. An observational protocol was used to record adaptive and maladaptive behaviours.

RESULTS

The number of maladaptive behaviours observed was different among participants. However, all of them had high rates of adaptive behaviours, such as rule-following.

CONCLUSIONS

These results, though preliminary, justify that we continue to think about the need for psychoeducational interventions aimed at stimulating the repertoire of adaptive behaviours, in people with Cri-du-chat syndrome.

Standardised Observation Analogue Procedure (SOAP) for assessing parent and child behaviours in clinical trials

BACKGROUND

Observational measures of parent and child behaviours have a long history in child psychiatric and psychological intervention research, including the field of autism and developmental disability. We describe the development of the Standardised Observational Analogue Procedure (SOAP) for the assessment of parent-child behaviour before and after a structured parent training program for children with pervasive developmental disorders (PDD). We report on the use of this procedure in a pilot study of 12 participants with PDD.

RESULTS

Inter-rater reliability across behaviours coded ranged from 75-100% agreement. Blindly scored observations of behaviour showed medium effect sizes for changes in inappropriate child behaviour. Analyses of baseline scores revealed a moderate positive correlation between inappropriate child behaviours as measured in all four SOAP conditions and parent ratings of child noncompliance (r(s) = .66, p < .05). By contrast, the correlations of SOAP scores with parent ratings of irritability was lower (r(s) = .40, p >.05).

CONCLUSIONS

As our treatment targeted compliance, these preliminary results suggest that the SOAP provides a valid measure of noncompliant behaviour in children with PDD and is sensitive to treatment effects on inappropriate child behaviours.

An exploratory analysis of the use of cognitive, adaptive and behavioural indices for cluster analysis of ASD subgroups

BACKGROUND

Autism spectrum disorder (ASD) includes symptoms that vary in severity and frequency between children. Consequently, multiple psychometric assessment procedures are recommended to detect an ASD, including scales which asses the presence and nature of ASD-related behaviour. However, to date, few studies have examined the relative and specific contribution which such behaviourally oriented scales can make to the diagnosis of individual children with ASD.

METHOD

Cluster analysis was used to explore the common characteristics of a group of 53 preschool and elementary school children with an ASD, based upon scores on tests of cognitive ability, adaptive behaviour and behavioural checklists designed to measure the presence of typical ASD.

RESULTS

Data confirmed the expected variability in intelligence test scores. In addition, measures of adaptive behaviour and data from a behaviourally based rating scale suggested that children with Asperger's Disorder and autism might be reclassified into subgroups according to the presence of particular ASD-specific behaviours.

CONCLUSIONS

As well as confirming that children with ASD vary in their adaptive behaviour and cognitive levels, these data emphasise the limited contribution such assessment procedures make to an understanding of the child's day-to-day behaviour and functioning, thus arguing for the inclusion of behaviourally based rating scales to develop ideographic intervention plans.

Can a broadband developmental-behavioral screening test identify children likely to have autism spectrum disorder?

Because services for children with autism spectrum disorder (ASD) are scarce, when children fail a broadband screening measure, providers need to carefully discern which children need ASD evaluations and which do not. This research considers how well a broadband screening test sorts those with and without probable ASD. The subjects were 427 children between 18 and 59 months of age with elevated risk scores on broadband screening, ie, Parents' Evaluation of Developmental Status (PEDS), a 10-item measure eliciting parents' concerns. Parents also completed the Modified Checklist of Autism in Toddlers (M-CHAT), an autism specific screen. The results showed that of the 427 children at risk on PEDS, 34% (N = 144) passed the M-CHAT. To determine whether these potential overreferrals could be reduced, parents' concerns on PEDS were used to predict M-CHAT results. Three or more discrete types of concerns, varying by age, characterized children who failed the M-CHAT while fewer than 3 were associated with passing. This reduced overreferrals by 70% while maintaining high levels of sensitivity (81%). Although compliance with the American Academy of Pediatrics recommendations for both broadband and autism-specific screening at 18 and 24 months is still recommended, viewing performance patterns on a broadband screening test can substantially reduce overreferrals to autism specialty services.

Screenieboppers and extreme screenies: the place of screen time in the time budgets of 10-13 year-old Australian children

OBJECTIVES

Excessive 'screen time' has been associated with a range of psychosocial disturbances and increasing pediatric obesity. This study describes the magnitude, distribution, composition and time-distribution of children's screen use; examines correlates of screen use; and characterises 'extreme' screen users (top quartile).

METHODS

1,039 South Australian children aged 10-13 years old completed a multimedia 24-hour activity recall diary on 2-4 occasions in 2002, including at least one school day and one non-school day.

RESULTS

The median screen time was 229 minutes.d(-1). This was higher in boys (264 vs. 196 minutes; p<0.001) and on non-school days (260 vs. 190 minutes; p<0.001), increased with age (p=0.003), and decreased with socio-economic status (SES; p=0.003). Television consumed 73% of all screen time, video games 19%, non-game computer use 6%, and cinema 2%. The top quartile of screen users were more likely to be boys (OR=3.8), have low physical activity (OR=4.3), spend >25% of screen time playing video games (OR=1.8), sleep less, and be of lower SES.

CONCLUSIONS AND IMPLICATIONS

Interventions to reduce screen time should target inactive, low-SES boys, encourage earlier bedtimes, and limit video game use.

Behavioral inhibition and clinical outcomes in children with cochlear implants

OBJECTIVES/HYPOTHESIS

Individual speech and language outcomes of deaf children with cochlear implants (CIs) are quite varied. Individual differences in underlying cognitive functions may explain some of this variance. The current study investigated whether behavioral inhibition skills of deaf children were related to performance on a range of audiologic outcome measures.

DESIGN

Retrospective analysis of longitudinal data collected from prelingually and profoundly deaf children who used CIs.

METHODS

Behavioral inhibition skills were measured using a visual response delay task that did not require hearing. Speech and language measures were obtained from behavioral tests administered at 1-year intervals of CI use.

RESULTS

Female subjects showed higher response delay scores than males. Performance increased with length of CI use. Younger children showed greater improvement in performance as a function of device use than older children. No other subject variable had a significant effect on response delay score. A series of multiple regression analyses revealed several significant relations between delay task performance and open set word recognition, vocabulary, receptive language, and expressive language scores.

CONCLUSIONS

The present results suggest that CI experience affects visual information processing skills of prelingually deaf children. Furthermore, the observed pattern of relations suggests that speech and language processing skills are closely related to the development of response delay skills in prelingually deaf children with CIs. These relations may reflect underlying verbal encoding skills, subvocal rehearsal skills, and verbally mediated self-regulatory skills. Clinically, visual response delay tasks may be useful in assessing behavioral and cognitive development in deaf children after implantation.

Global and Specific Behavioral Measures of Pain in Children With Cerebral Palsy

OBJECTIVES

The aim of this research was to validate global and behavioral observation methods for measuring pain in children with cerebral palsy (CP).

MATERIALS AND METHODS

Nineteen children diagnosed with CP (2-21 years of age) and their primary caregivers participated in this study. Children and their caregivers were videotaped in their home before, during, and after a stretching exercise, and tests of cognitive and social development were administered. Children who were able to pass a training task were also asked to rate their experience of pain using a numerical rating scale (self-report NRS), but only 5 children (24%) passed so their self-report scores were not included. Healthcare professionals rated videotaped segments for each of the 3 time periods in a randomized order using an observer NRS and the Non-Communicating Children's Pain Checklist-Postoperative Version (NCCPC-PV). Raters trained in the Child Facial Coding System (CFCS) examined the same videotaped segments.

RESULTS

Results showed significantly greater pain behavior (observer NRS, NCCP- PV) during the stretching procedure than during the baseline and recovery segments. There were no significant differences in CFCS scores, across time segments.

CONCLUSIONS

These findings support the hypothesis that children with CP express discernible pain behaviors regardless of cognitive or language ability. These results contribute to multidimensional assessment of pain in children with neurologic impairment.

Structural relationship of child behavior and its evaluation during dental treatment

The present study uses structural equation modeling to explore the structural relationship of child behavior type and its evaluation during dental treatment. The study population consisted of 33 children at their first visit to a pediatric dentist at the Dental Hospital of Tsurumi University. Child behavior was evaluated by the Frankl Behavior Rating Scale and the behavior evaluation scale developed by Kurosu. Factor analysis extracted 3 behavior types: escape, self-defense, and facial expression. The path diagram of structural relationships between child behavior and the Frankl Behavior Rating Scale indicated that facial expression had the strongest correlation to the Frankl Behavior Rating Scale.

An examination of the measurement properties of the pediatric volitional questionnaire

The Pediatric Volitional Questionnaire (PVQ) is a 15- item play-based assessment of a child's motivational strengths and weaknesses in various settings based on the Model of Human Occupation. A previous study examined the PVQ's ability to provide a valid measure of volition in ten non-disabled children. This study combined data from the previous study with data on eight children with disabilities to further test the instrument's psychometric properties. Data on 36 observations of the 18 participants were observed by a total of 20 raters. Each rater was randomly assigned to rate videotapes. Data were analyzed using the Rasch Measurement Model. Results indicate that the 15 items of the scale work well together to measure volition and were well matched to the volitional levels of the sample group. Nineteen of the twenty raters used the scale in a valid manner, though scores were affected by the extent of severity/leniency of the rater. All eighteen participants were validly rated and the scale items effectively differentiated levels of volition among the eighteen children. These findings supported the conclusion that the PVQ provides a valid and sensitive measure of volition. The study also found that the 4-point rating scale operated as a 3-point scale in this study and that raters differentiated in their severity/ leniency. These latter findings indicate the need to further clarify the rating scale.

Psychosocial status after pediatric traumatic brain injury: a subtype analysis using the Child Behavior Checklist

This study identified subtypes of psychosocial functioning in children who had sustained traumatic brain injury (TBI). Child Behavior Checklist (CBCL) profiles for 92 participants, aged 12 to 18 years, who had sustained a mild, moderate, or severe TBI were subjected to Q-Factor analysis. Sixty-four of the participants (75%) were classified into a four-category psychosocial typology labelled Normal (n = 32), Attention (n = 14), Delinquent (n = 10), and Withdrawn-Somatic (n = 8). This typology was found to overlap in part with previous TBI psychosocial typology (Butler et al., 1997), and with three of the clinical profile types derived by Achenbach (1993) for the CBCL. The majority of participants, including those who sustained severe TBI, were assigned to the Normal subtype and the overall level of psychosocial deviance was relatively mild in the other three subtypes. The results of this study support previous typology efforts and confirm the heterogeneous presentation of social and emotional functioning following TBI.

Interpretations of child compliance in individuals at high- and low-risk for child physical abuse

OBJECTIVE

Our studies compared individuals at high- and low-risk for child physical abuse on measures of social information processing.

METHOD

Two studies were conducted using similar methods. Twenty-eight childless women in Study 1 and 36 mothers in Study 2 read vignettes of parent-child interactions in which the child's level of compliance was difficult to interpret. Participants were asked a series of questions about the child's behavior and their own reactions.

RESULTS

Accuracy and bias in identifying compliant behavior were assessed using a signal detection paradigm. In both samples, high- and low-risk participants did not differ in their overall accuracy in identifying children's behaviors. However, they used different evaluation standards such that high-risk participants were biased toward seeing more noncompliance and low-risk participants were biased toward seeing more compliance. High- and low-risk participants also made different types of errors in interpreting children's behavior. Low-risk participants were more likely to misinterpret noncompliant behavior as compliant, and there was a trend for high-risk participants to not perceive compliant behavior when it occurred. There were no differences in reported disciplinary responses in either study and the results for affective reactions were mixed.

CONCLUSIONS

Specific differences in social information processing between high- and low-risk individuals replicated across samples, suggesting a reliable association between evaluation standards and risk of child physical abuse. However, the absence of differences in reported discipline and inconsistent findings on affective reactions indicate the need to identify the mechanism through which cognition influences parenting behavior.

Community norms on toy guns

OBJECTIVE

Toy gun play has been associated with aggressive behavior, and it has been suggested that child health professionals counsel families on limiting exposure. Effective violence prevention counseling requires an understanding of norms regarding parental attitudes, practices, and influencing factors. Both theories of reasoned action and planned behavior emphasize that subjective norms and attitudes affect people's perceptions and intended behavior. Few normative data exist on this issue from a cross-section of families. By establishing behavioral norms and understanding the spectrum of parental attitudes, community-sensitive and community-specific interventions for violence prevention can be developed. The objective of this study was to assess community norms on the topic of toy gun play from the perspective of parents.

METHODS

An anonymous self-report assisted survey was administered to a convenience sample of parents/guardians who visited child health providers at 3 sites: an urban children's hospital clinic, an urban managed care clinic, and a suburban private practice. The parent questionnaire included questions on child rearing attitudes, practice, and sociodemographic information.

RESULTS

A total of 1004 eligible participants were recruited for the study; 922 surveys were completed (participation rate 92%). The 830 (90%) respondents who were parents and had complete child data were the focus of additional analysis. Regarding toy guns, 67% of parents believed that it was never "OK for a child to play with toy guns," and 66% stated that they never let their children play with toy guns. Parents who thought that it was okay for children to play with toy guns and allowed them to play with toy guns were more likely to be male parents, have male children, and be white.

CONCLUSIONS

There is variability in norms regarding toy gun play among parents, with most discouraging toy gun play. Norms varied based on gender of the child, gender of the parent, and race. Understanding norms is a first step in designing effective community-sensitive interventions.

Gradients in risk for youth injury associated with multiple-risk behaviours: a study of 11,329 Canadian adolescents

This study used the Canadian version of the World Health Organization-Health Behaviour in School-Aged Children (WHO-HBSC) Survey to examine the role of multiple risk behaviours and other social factors in the etiology of medically attended youth injury. 11,329 Canadians aged 11-15 years completed the 1997-1998 WHO-HBSC, of which 4152 (36.7%) reported at least one medically attended injury. Multiple logistic regression analyses failed to identify an expected association between lower socio-economic status and risk for injury. Strong gradients in risk for injury were observed according to the numbers of multiple risk behaviours reported. Youth reporting the largest number (7) of risk behaviours experienced injury rates that were 4.11 times (95% CI: 3.04-5.55) higher than those reporting no high risk behaviours (adjusted odds ratios for 0-7 reported behaviours: 1.00, 1.13, 1.49, 1.79, 2.28, 2.54, 2.62, 4.11; p(trend) < 0.001). Similar gradients in risk were observed within subgroups of young people defined by grade, sex, and socio-economic level, and within restricted analyses of various injury types (recreational, sports, home, school injuries). The gradients were especially pronounced for severe injury types and among those reporting multiple injuries. The analyses suggest that multiple risk behaviours may play an important role in the social etiology of youth injury, but these same analyses provide little evidence for a socio-economic risk gradient. The findings in turn have implications for preventive interventions.

A comparison of multiple methods for the identification of children with reading disabilities

There has been considerable discussion of the methods used for the identification of children with reading disabilities. This study examined three different methods that could be used in the identification of children with reading disabilities and their consistency with teacher ratings of behaviors believed to be associated with reading disabilities. Standardized, norm-referenced measures of achievement, phonological processing measures, and curriculum-based measures of reading fluency were used with 40 children in Grades 1 and 2. Comparisons were made to determine which measures, if any, differentiated between children referred for reading disabilities (n = 20) and children who were progressing typically in reading in their general education classroom settings (n = 20). The results indicated significant between-group differences on standardized, norm-referenced measures of reading recognition, word attack, and comprehension; phonological measures of blending nonwords and elision; and reading fluency. Teacher ratings on the Dyslexia Screening Instrument were consistent with teacher beliefs regarding children's progress in reading. All measures were found to correlate significantly with each other. However, correlations were generally in the moderate range, suggesting that the measures used did not measure the same reading skills or, in the case of phonological processing, the underlying abilities believed to be necessary for reading. Given the differences in tasks and the moderate correlations, it is likely that the choice of measures may affect the conclusions reached regarding a student's reading ability.

Standardization of the behavioral and emotional rating scale: factor structure, reliability, and criterion validity

The present study reports on the standardization of the Behavioral and Emotional Rating Scale and examines its factor structure, reliability, and criterion validity. Data on a national sample of children without disabilities (n = 2,176) and children with emotional and behavioral disorders (n = 861) were collected. Analysis of the data from the first sample identified five factors: interpersonal strengths, family involvement, intrapersonal strength, school functioning, and affective development. The factors appeared to be highly stable and reliable (.79 to .99). No statistically significant age or gender differences were noted, although females were rated higher on each factor and the overall score. The second sample was rated significantly lower than the first across the factors and total score. The article discusses future research issues and practical implications.

Lack of association between parental alcohol or drug addiction and behavioral inhibition in children

OBJECTIVE

"Behavioral inhibition to the unfamiliar" has been proposed as a precursor to anxiety. A recent study proposed that it may also be a precursor to alcoholism. The authors sought to replicate the latter finding through a secondary analysis of data from a large study of young children (age 2-6 years)-offspring of parents with panic and depressive disorders-who had been assessed for behavioral inhibition through laboratory-based observations.

METHOD

The offspring were stratified on the basis of presence or absence of parental lifetime history of DSM-III-R alcohol dependence (N=115 versus N=166, respectively) or drug dependence (N=78 versus N=203). The rates of behavioral inhibition were then compared between groups.

RESULTS

Despite adequate power to detect associations, neither parental alcohol dependence nor drug dependence was associated with a higher risk for behavioral inhibition in the offspring.

CONCLUSIONS

These results are not consistent with the hypothesis linking behavioral inhibition to addictions.

Further evidence of association between behavioral inhibition and social anxiety in children

OBJECTIVE

The authors sought to examine psychopathological correlates of behavioral inhibition in young offspring of parents with panic disorder and/or major depression.

METHOD

Behavioral inhibition, determined by using standard laboratory observations, was assessed in four groups of children (age 2-6 years): 129 children of parents with both panic disorder and major depression, 22 children of parents with panic disorder alone, 49 children of parents with major depression alone, and 84 comparison children of parents with neither panic disorder nor major depression. Psychopathology in children > or =5 years was compared between children with behavioral inhibition (N=64) and without (N=152).

RESULTS

Social anxiety disorder (social phobia or avoidant disorder) was significantly more likely to be found in the children with behavioral inhibition (17%) than in those without (5%). Noninhibited children were significantly more likely than inhibited children to have disruptive behavior disorders (20% versus 6%, respectively) and had higher scores on the attention problems scale of the Child Behavior Checklist (mean=52.1 versus 50.8).

CONCLUSIONS

This study adds to the growing literature suggesting an association between behavioral inhibition and social anxiety disorder and an inverse relationship between inhibition and disruptive behavior disorders.

Dissociation in maltreated versus nonmaltreated preschool-aged children

OBJECTIVE

Dissociation is linked to the experience of child maltreatment for adults and for school-aged children. The goals of the current paper were: First, to extend existing research and examine the link between child maltreatment and preschool-aged children; and second, to examine which subgroups of maltreated preschoolers are most likely to evidence dissociation.

METHOD

A well-validated measure of dissociation in children, The Child Dissociative Checklist (CDC; Putnam, Helmers, & Trickett, 1993), was utilized in a sample of low SES maltreated and nonmaltreated preschoolers (N = 198). A measure of internalizing and externalizing symptoms was also utilized. The maltreated children were assessed for sexual abuse, physical abuse, neglect, and also for severity, chronicity, and multiple subtypes of maltreatment.

RESULTS

The sexually abused, physically abused, and neglected groups each demonstrated more dissociation than did the nonmaltreated group. Dissociation in the clinical (psychopathological) range was associated with physical abuse. Moreover, maltreatment severity, chronicity, multiple subtypes, and internalizing and externalizing symptomatology were each related to dissociation.

CONCLUSIONS

Child maltreatment is a factor in dissociation in preschool-aged children as it is in older children and in adults. Sexual abuse, physical abuse, neglect, severity, and chronicity are all implicated. Developmentally sensitive interventions that look beyond comorbidity with behavioral symptoms for dissociative preschool-aged children are needed.

Evaluations, attributions, affect, and disciplinary choices in mothers at high and low risk for child physical abuse

OBJECTIVE

The present study investigated several components of a social information-processing model of child physical abuse. The main objective was to examine the extent to which high-risk, relative to low-risk, mothers differed in their evaluations, attributions, negative affect, and disciplinary choices for children's behavior, and to explore whether these differences may be expressed in interactions between risk status and mitigating information.

METHOD

Nineteen high- and 19 matched low-risk mothers' evaluations of children transgressions, attributions, affect, and choices of disciplinary techniques were examined using six vignettes depicting a child engaging in moral, conventional, and personal transgressions. One-half of the vignettes contained mitigating information and one-half did not. High- and low-risk mothers were chosen based on their potential for physical child abuse. A three-factor (2 x 3 x 2) design was used to assess the dependent variables.

RESULTS

As expected, high-risk, relative to low-risk, mothers reported more hostile intent, stable and global attributions, aversiveness, annoyance, and use of power-assertion discipline. A risk group by type of transgression interaction was found for evaluation and indifference and a risk group by mitigating information interaction was found for evaluation of wrongness, internal attributions, and aversiveness. A risk by type of transgression by mitigating information interaction was found for global/specific attributions, aversiveness, and indifference toward child transgressions.

CONCLUSIONS

Results support a social information processing model of child physical abuse, which suggests that high-risk, compared to low-risk, mothers process child-related information differently and use more power-assertive disciplinary techniques.

Evaluations, attributions, affect, and disciplinary choices in mothers at high and low risk for child physical abuse

OBJECTIVE

The present study investigated several components of a social information-processing model of child physical abuse. The main objective was to examine the extent to which high-risk, relative to low-risk, mothers differed in their evaluations, attributions, negative affect, and disciplinary choices for children's behavior, and to explore whether these differences may be expressed in interactions between risk status and mitigating information.

METHOD

Nineteen high- and 19 matched low-risk mothers' evaluations of children transgressions, attributions, affect, and choices of disciplinary techniques were examined using six vignettes depicting a child engaging in moral, conventional, and personal transgressions. One-half of the vignettes contained mitigating information and one-half did not. High- and low-risk mothers were chosen based on their potential for physical child abuse. A three-factor (2 x 3 x 2) design was used to assess the dependent variables.

RESULTS

As expected, high-risk, relative to low-risk, mothers reported more hostile intent, stable and global attributions, aversiveness, annoyance, and use of power-assertion discipline. A risk group by type of transgression interaction was found for evaluation and indifference and a risk group by mitigating information interaction was found for evaluation of wrongness, internal attributions, and aversiveness. A risk by type of transgression by mitigating information interaction was found for global/specific attributions, aversiveness, and indifference toward child transgressions.

CONCLUSIONS

Results support a social information processing model of child physical abuse, which suggests that high-risk, compared to low-risk, mothers process child-related information differently and use more power-assertive disciplinary techniques.

A controlled study of behavioral inhibition in children of parents with panic disorder and depression

OBJECTIVE

"Behavioral inhibition to the unfamiliar" has been proposed as a precursor to anxiety disorders. Children with behavioral inhibition are cautious, quiet, introverted, and shy in unfamiliar situations. Several lines of evidence suggest that behavioral inhibition is an index of anxiety proneness. The authors sought to replicate prior findings and examine the specificity of the association between behavioral inhibition and anxiety.

METHOD

Laboratory-based behavioral observations were used to assess behavioral inhibition in 129 young children of parents with panic disorder and major depression, 22 children of parents with panic disorder without major depression, 49 children of parents with major depression without panic disorder, and 84 children of parents without anxiety disorders or major depression (comparison group). A standard definition of behavioral inhibition based on previous research ("dichotomous behavioral inhibition") was compared with two other definitions.

RESULTS

Dichotomous behavioral inhibition was most frequent among the children of parents with panic disorder plus major depression (29% versus 12% in comparison subjects). For all definitions, the univariate effects of parental major depression were significant (conferring a twofold risk for behavioral inhibition), and for most definitions the effects of parental panic disorder conferred a twofold risk as well.

CONCLUSIONS

These results suggest that the comorbidity of panic disorder and major depression accounts for much of the observed familial link between parental panic disorder and childhood behavioral inhibition. Further work is needed to elucidate the role of parental major depression in conferring risk for behavioral inhibition in children.

Upgrading the science and technology of assessment and diagnosis: laboratory and clinic-based assessment of children with ADHD

Reviews the usefulness of clinic-based and laboratory-based instruments and paradigms for diagnosing attention deficit hyperactivity disorder (ADHD) and monitoring treatment effects. Extant literature examining the performance of normal children and those with ADHD on an extensive range of neurocognitive tests, tasks, and experimental paradigms indicates that particular types of instruments may be more reliable than others with respect to detecting between-group differences. We review task parameters that may distinguish the more reliable from less reliable instruments. The value of clinic-based and laboratory-based instruments for monitoring treatment response in children with ADHD is questionable when evaluated in the context of ecologically relevant variables such as classroom behavior and academic functioning. We present a general conceptual model to highlight conceptual issues relevant to designing clinic-based and laboratory-based instruments for the purposes of diagnosing and monitoring treatment effects in children with ADHD. Application of the model to currently conceptualized core variables indicates that attention and impulsivity-hyperactivity may represent correlative rather than core features of the disorder. We discuss implications of these findings for designing the next generation of clinic-based and laboratory-based instruments.

The Child Behavior Checklist (CBCL) and related material: standardization and validation in Danish population based and clinically based samples

The Child Behavior Checklist (CBCL) and related material, developed by Achenbach and Edelbrock in Vermont, was validated in a mailed survey. A population based sample of 779 children between the age of four and 17 years was compared to a sample of 146 children referred for child psychiatric service. Danish children scored very much like our Scandinavian and German neighbours, but low compared to most others. The CBCL mean 'total behavior problem score' in the population was 17.7. The checklists, especially the parent and teacher versions, provided good construct validity. Youths generally reported more emotional problem behavior than their parents and teachers did about them. In general, parents and youths agree more, reporting emotional problems, and parents and teachers agree more, when scattering externalizing behavior. Short screening constructs are introduced, and by the use of latent trait analysis, four clinically relevant sub-scales were generated. Predictive value, sensitivity, specificity and clinical validity must be undertaken in a future two-phase study.

Syndrome dimensions of the child behavior checklist and the teacher report form: a critical empirical evaluation

The construct representation of the cross-informant model of the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF) was evaluated using confirmatory factor analysis. Samples were collected in seven different countries. The results are based on 13,226 parent ratings and 8893 teacher ratings. The adequacy of fit for the cross-informant model was established on the basis of three approaches: conventional rules of fit, simulation, and comparison with other models. The results indicated that the cross-informant model fits these data poorly. These results were consistent across countries, informants, and both clinical and population samples. Since inadequate empirical support for the cross-informant syndromes and their differentiation was found, the construct validity of these syndrome dimensions is questioned.

Attachment-based classifications of children's family drawings: psychometric properties and relations with children's adjustment in kindergarten

Investigated an attachment-based theoretical framework and classification system, introduced by Kaplan and Main (1986), for interpreting children's family drawings. This study concentrated on the psychometric properties of the system and the relation between drawings classified using this system and teacher ratings of classroom social-emotional and behavioral functioning, controlling for child age, ethnic status, intelligence, and fine motor skills. This nonclinical sample consisted of 200 kindergarten children of diverse racial and socioeconomic status (SES). Limited support for reliability of this classification system was obtained. Kappas for overall classifications of drawings (e.g., secure) exceeded .80 and mean kappa for discrete drawing features (e.g., figures with smiles) was .82. Coders' endorsement of the presence of certain discrete drawing features predicted their overall classification at 82.5% accuracy. Drawing classification was related to teacher ratings of classroom functioning independent of child age, sex, race, SES, intelligence, and fine motor skills (with p values for the multivariate effects ranging from .043-.001). Results are discussed in terms of the psychometric properties of this system for classifying children's representations of family and the limitations of family drawing techniques for young children.

Children's fantasy play and emotional understanding

Examined the relation between affective and cognitive processes in fantasy play and emotional understanding. Sixty-six children in the 1st and 2nd grades played with puppets (Affect in Play Scale; Russ, 1993), answered questions about their understanding of emotions (Kusche Affective Interview-Revised; Kusche, Greenberg, & Beilke, 1988), and completed a measure of verbal intelligence (Wechsler Intelligence Scale for Children-III; Wechsler, 1991). The major finding of this study was that consistent, yet modest, relations were found between dimensions of fantasy play and emotional understanding. Cognitive dimensions of fantasy play, but not affect expression, were related to facets of emotional understanding. These relations were independent of verbal ability. A composite fantasy play score accounted for a significant amount of variance in a composite emotional understanding score when verbal ability was accounted for. Variations in the pattern of correlations for girls and boys suggest sex differences in the relation between fantasy play and emotional understanding. Implications for clinical research and interventions are discussed.

Preschoolers' characterizations of multiple family relationships during family doll play

Investigated 4-year-olds' depictions of family relationships during a semistructured doll play task. Examined developmental and family correlates of these depictions, and their relative stability over a 1-month period. Forty-nine children related stories about happy, sad, mad, and worried families using dolls reflecting their own family configuration. For each story, coders recorded (a) proportion of total story time devoted to each family dyad and (b) number of conflictive, aggressive, and affectionate acts per dyad. Children divided their focus during stories evenly between father-child, mother-child, and father-mother relationships with child-sibling interactions occurring regularly among participants with siblings. Depictions of affection and aggression among family figures were relatively commonplace, related to mothers' reports of family climate, and stable across a 1-month period. Results substantiated preschoolers' awareness and discrimination of intrafamily relationship dynamics and provided some guidelines and cautions to practitioners who employ doll family assessments in their clinical work.

Psychological disorders and their correlates in an Australian community sample of preadolescent children

The nature and correlates of psychological disorders of preadolescent children from the longitudinal Australian Temperament Project (ATP) are reported. Almost half of the children identified via checklists completed by mothers, teachers, and the children themselves as being in the at-risk range for disorder received a DSM-III-R diagnosis. Nine per cent of comparison, or low-risk, children also received a diagnosis. Internalising disorders were the most common, and 44% of cases had multiple problems. Children rated as problematic by all three informants or by child plus teacher were the most likely to receive a diagnosis. The at-risk group had more difficult temperament, poorer family and peer relationships, lower levels of social skills, and were of lower SES than the comparison group. There were minimal differences on these variables between at-risk children who did, or did not, receive a DSM-III-R diagnosis. It is argued that especially for boys, checklists from multiple informants are effective tools for identifying clinically significant disorders.

Longitudinal and concurrent relations among temperament, ability estimation, and injury proneness

This study examined longitudinal and concurrent relations between temperament, ability estimation, and injury proneness. Longitudinal assessments of Inhibitory Control were collected through a behavioral battery at toddler (33 months) and preschool ages (46 months). Parent-reported measures of Inhibitory Control and Extraversion also were obtained at those ages. At school age (76 months), children participated in a set of tasks to assess overestimation and underestimation of physical abilities. Parents provided reports of children's temperament and injury history at school age. Results showed that children who were high on Extraversion and low on Inhibitory Control as toddlers and preschoolers tended to overestimate their physical abilities and to have more unintentional injuries at age 6. Children low on Extraversion and high on Inhibitory Control tended to underestimate their physical abilities. Implications for injury prevention are discussed.

A typology of parent rated child behavior for a national U.S. sample

The purpose of the current study was to build on the emerging effort to produce a meaningful typology of child behavior for school-aged children. The Behavior Assessment System for Children (BASC) Parent Rating Scales for Children (PRS-C) norming data were collected for 2029 6- to 11-year-old children at 116 sites representing various regions of the United States. The PRS-C has 130 items that are rated by the parent on a 4-point scale of frequency, ranging from "never" to "almost always". The Ward method of cluster analysis was used to identify the initial centroids or cluster seeds in this norming sample. An iterative clustering method, a K-means procedure, was used to refine the Ward cluster solution. A nine-cluster solution was selected based on both rational and empirical considerations. The resulting clusters were labeled adapted, physical complaints/worry, average, well-adapted, minimal problems, attention problems, internalizing, general psychopathology-severe, and disruptive behavior problems. The nine-cluster solution is similar to those of Achenbach (1991), Thompson, Kronenberger, and Curry (1989), and other researchers. At the same time, some significant differences exist. The resulting typology points the way toward future cluster studies of child psychopathology and normal behavioral development by delineating additional research and theoretical directions.

[Behavior problems in language-impaired children: therapy evaluation using child behavior checklist]

Speech and language impaired children often show accompanying behavioral and emotional problems, putting an additional burden on their developmental course. In a sample of 57 children with a specific speech and language disorder we evaluated the behavioral changes after therapeutic intervention. The children got intensive treatment for about 15 months. Before the beginning of the treatment, all children were assessed using clinical psychiatric interviews and observations and were diagnosed according to the multiaxial classification scheme. The CBCL was filled in by the same parent before and after the treatment program. The Total Behavior Problem Score was used to assess changes in behavioral problems. The school type as well as the still necessary therapeutic interventions after the completion of the treatment program were used as global measures of psychosocial adaptation. 45 of 57 children had a psychiatric diagnosis on axis 1 of the multiaxial classification scheme. Hyperkinetic disorder, with or without conduct disorders were the most commonly given diagnoses, in addition to emotional disorders and adjustment problems. Before treatment, the children with a psychiatric diagnosis had higher scores on the Total Behavior Problem Score than the children without a psychiatric diagnosis. The children with psychiatric problems showed a significant decrease in the Total Behavior Problem Score of the CBCL. Although the children with a conduct disorder also showed improvement after treatment, their CBCL scores remained high. The stability of their problems was associated with a worse school prognosis and with further institutional care after the end of the treatment.

Longitudinal patterns of tobacco smoking from childhood to middle age

This study described the development of tobacco smoking of subjects between ages 12 and 36 using prospectively collected self-reports of 212 Swedish men and women born in the 1950s. Smoking habits were studied in terms of stability, longitudinal patterns of smoking, and the relation between age of initiation and later smoking. Findings showed that light smoking (up to 6 cigarettes/day) did not remain stable after adolescence. Typical development patterns from age 15 to age 36 included staying a nonsmoker; smoking intensely (>10 cigarettes/day) and continuing into adulthood; smoking less intensely for some periods; or smoking intensely and quitting before age 36. Differences in age at smoking initiation were related to later habitual smoking only when participants reported initiation had occurred after age 12.

Factors influencing elementary school teachers' ratings of ADHD and ODD behaviors

Examined factors that influence teachers' ratings of children with either attention deficit hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD). 105 teachers watched 2 videotapes--1 depicting a normal child and the other a child with either ADHD or ODD--and rated each child using 2 different questionnaires. Results indicated that teachers accurately rated the child on the ADHD versus ODD tape as having significantly more inattention and hyperactivity but significantly less oppositionality. However, effect sizes indicated the presence of a unidirectional, negative halo effect of oppositional behaviors on ratings of hyperactivity and inattention. Teachers appeared less biased in their judgments when using a well-operationalized rating scale. Finally, knowledge, education, and experience with children with ADHD generally had no effect on the accuracy of teachers' ratings.

School-based methylphenidate placebo protocols: methodological and practical issues

Around 1990, psychologists and educators began to notice increasing use of methylphenidate by students. Diagnosis of attention-deficit/hyperactivity disorder by family physicians and pediatricians was most commonly based on brief behavioral descriptions by parents and, infrequently, by use of rating scales. At that time, the present researchers began to explore the development of a school-based, methodologically sound, and inexpensive method of assessing the efficacy of stimulant medications, which would ensure reasonable compliance by teachers, parents, and students in monitoring the effects of medications and placebos. This article focuses on the methodological issues involved in choosing instruments to monitor behavior, once a comprehensive evaluation has suggested trials on Ritalin. Case examples illustrate problems of teacher compliance in filling out measures, supplying adequate placebos, and obtaining physician cooperation, and with the practical issue of providing adequate data without overwhelming the time and resources of participants. Emerging school-based methodologies are discussed with recommendations for future efforts.

Early child care and self-control, compliance, and problem behavior at twenty-four and thirty-six months. The NICHD Early Child Care Research Network

To evaluate child-care effects on young children's self-control, compliance, and problem behavior, children enrolled in the NICHD Study of Early Child Care were tested and observed in the laboratory and in child care at 24 and 36 months, and mothers and caregivers completed questionnaires. Indicators of child-care quantity, quality, stability, type, and age of entry, along with measures of family background, mothering, and child characteristics obtained through the first 3 years of life were used to predict 2 and 3 year child functioning. Results revealed (1) mothering to be a stronger and more consistent predictor of child outcomes than child care; (2) little evidence that early, extensive, and continuous care was related to problematic child behavior, in contrast to results from earlier work; (3) that among the child-care predictors, child-care quality was the most consistent predictor of child functioning, although limited variance could be explained by any (or all) child-care variables; and (4) that virtually none of the anticipated interactions among child-care factors or between them and family or child measures proved significant.

The Children's Play Therapy Instrument (CPTI). Description, development, and reliability studies

The Children's Play Therapy Instrument (CPTI), its development, and reliability studies are described. The CPTI is a new instrument to examine a child's play activity in individual psychotherapy. Three independent raters used the CPTI to rate eight videotaped play therapy vignettes. Results were compared with the authors' consensual scores from a preliminary study. Generally good to excellent levels of interrater reliability were obtained for the independent raters on intraclass correlation coefficients for ordinal categories of the CPTI. Likewise, kappa levels were acceptable to excellent for nominal categories of the scale. The CPTI holds promise to become a reliable measure of play activity in child psychotherapy. Further research is needed to assess discriminant validity of the CPTI for use as a diagnostic tool and as a measure of process and outcome.

Oppositional children and their families: an adaptational dance in space and time

A conceptual map is proposed in which oppositional behavior is seen as an adaptational struggle within a context of interpersonal and intrapsychic spheres of family systems. Preservation of self is viewed as inherent in all childhood psychological symptomatology, and oppositionalism serves as a prime survival strategy, aimed at navigating the conflictual forces of connectedness and individuation and regulating the progression, through time, of the family life cycle.