Epidemiological comparisons of American and Dutch children: II. Behavioral/emotional problems reported by teachers for ages 6 to 11.
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Biomedical subjects
Publications and source records attributed to F C Verhulst.
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Child Behavior Checklists completed by parents of 1863 clinically referred American and Dutch boys aged 6-11 and 12-16 were subjected to principal components analyses with varimax rotations. For each age group, the construct validity of seven empirically derived syndromes was supported by cross-national correlations ranging from 0.80 to 0.98. These syndromes were designated as Aggressive, Delinquent, Depressed (ages 6-11 only), Hyperactive, Schizoid (ages 12-16 only), Somatic Complaints, Uncommunicative, and Withdrawal (Social Withdrawal for ages 6-11; Hostile Withdrawal for ages 12-16). Cross-national similarities in the distribution of scores for normative samples supported the use of the same syndrome scales by clinicians and researchers in the two countries. The cross-national construct validity of Obsessive-Compulsive and Immature syndromes did not receive adequate support.
Parents' and children's reports of behavioural-emotional problems in 116 children assessed by the Child Assessment Schedule developed by Hodges et al. (Journal of the American Academy of Child Psychiatry, 21, 468-473, 1982) and the Graham & Rutter Parent Interview (British Journal of Psychiatry, 114, 581-592, 1968), both semi-structured interviews, revealed relatively high agreement compared with studies using highly structured assessment procedures. The majority of disagreements could be attributed to higher parents' scores. Only fears were reported more often by children, especially by the better-functioning children, suggesting that children's reports of fears may be related to a higher level of adaptive functioning rather than a higher level of psychopathology. Although the child interview may be crucial to obtain information often not reported by parents such as fears and anxiety, it was found that information from the child contributed only little to overall clinical judgement based on information already available from the parents.
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Standardized teacher reports on children's behavioral-emotional problems can provide information on areas of children's functioning not readily accessible to other informants such as parents or clinicians. Once we accept the generally low agreement between different informants as inevitable, we may make use of the different types of information available from different sources. To do so we need base-line data from different informants that take account of key demographic variables such as gender, age and socio-economic status. In a previous report we provided such data for parent reported behavioral-emotional problems in children aged 4 through 16. In the present study we reported on the prevalence of a wide range of specific behavioral-emotional problems reported by teachers in a representative sample of 1,162 Dutch children aged 4 through 12; identified differences related to demographic variables and compared our data with those from other population based surveys. We used the Achenbach Teacher's Report Form (TRF) to collect our data because a comparison between different standardized teacher assessment instruments showed the TRF to be the most promising due to its solid psychometric background and its ready applicability. Our data supported the TRF's reliability and validity. For each of the 118 behavioral-emotional problems, the prevalence rates were presented graphically for both genders in two-year age groups. ANCOVAs were performed to assess the main effects and interaction of age and gender with SES as covariate for each problem item and total problem score. Of the demographic variables gender showed most numerous effects on problem items and showed the largest effect on total problem score. The main findings were: Boys obtained higher scores than girls. Many items on which boys scored higher are related to socially disapproved behavior. Boys obtained higher scores on concentration, attention and hyperactivity problems. Boys (especially the younger ones) scored higher on problems related to academic functioning. Teacher reports revealed larger gender differences than parent reports. Both parents and teachers scored boys higher on items predominantly associated with the externalizing syndrome. More boys than girls were attending education in special schools. Age showed no significant effect on total problem score, although older children were scored higher on a number of items associated with academic, somatic and social functioning and with emotions related to inner feelings.(ABSTRACT TRUNCATED AT 400 WORDS)
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In this study the prevalence of nocturnal enuresis defined according to the DSM III criteria was determined in a random sample of 2070 children aged from 4 to 16 years. Nocturnal enuresis declines in prevalence with age and is more frequent in boys than in girls. Moreover, the decline in prevalence with age was found to take place earlier in girls than in boys. It is therefore argued that the DSM III age limit for enuresis should be raised to 8 years for boys.
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This study concerns the second, more clinically oriented, part of our epidemiological project. The prevalence of child psychiatric disorders in random samples of 8- and 11-year-old children is assessed by using standardized parent- and child-interviews. The relationships between different measures of child psychopathology are determined. Furthermore, additional validity measures of the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF) developed by Achenbach, are provided. Of the 153 8- and 11-year-old children selected through a two-stage sampling procedure, 116 (76%) children and their parents were intensively clinically assessed. The correlation between CBCL and direct child assessment is .42, whereas the correlation between the TRF and direct child assessment is .28. The correlation between TRF and CBCL is .26. The implications of the low correlation between raters who saw children is different situations are emphasized. The weight given to reports from different sources varies with the kind of problem the child exhibits. It is concluded that more research is needed to investigate the relative value of different types of data for different conditions. Seven percent of the 8- and 11-year-olds were judged severely disordered, whereas for 26% the clinicians judged the child to be moderately or severely disordered. The high prevalence rates found in our study compared with others is partly attributed to the arbitrary nature of clinical judgement. ANOVAs and discriminant function analysis were performed to obtain those CBCL items that showed the best discrimination between children who were clinically judged disordered and children from the normative comparison group. Many items found to be good discriminators of clinical status in this study were among the best discriminators of referral status in the earlier reported part of the study. A number of family and social factors were found to be associated with psychiatric disorder. These findings support those in other studies.
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In this article, the authors investigated the effect of maternal smoking during pregnancy on behavioral problems, which were not mediated by lower birth weight, in offspring at 3 y of age. The authors used the Child Behavior Checklist for ages 2-3 y (CBCL/2-3; Achenbach, Edelbrock and Howell) to assess behavioral problems in 1,377 2- to 3-y-old healthy twin pairs. Soon after the birth of twins, the authors collected pre- and perinatal information, including smoking habits of the mother during pregnancy. The question "Did you smoke during pregnancy?" could be answered by choosing one of three possible options: (1) never, (2) sometimes, or (3) regularly. The authors analyzed the effect of maternal smoking on the Child Behavioral Checklist total score and on several subscale scores for first- and second-born twins separately, and they adjusted for the possible confounding effects of birth weight, socioeconomic status, maternal age, and having been breast- or bottle-fed. There was a significant effect of maternal smoking on so-called externalizing behavior problems (oppositional, aggressive, overactive), but not on internalizing behavior problems (withdrawn, depressed, anxious), in both first- and second-born twins. The authors primarily attributed the enhanced externalizing problems to increased aggression. Although boys had higher externalizing (and aggression) scores than girls, the effect of maternal smoking was the same for boys and girls. The authors also discuss whether maternal smoking causes externalizing behavior problems.
We investigated the effects of maternal smoking during pregnancy on behavioral problems (i.e., not mediated by low birth weight) in 3-y-old offspring. We assessed behavioral problems in 1377 2- to 3-y-old twin pairs (registered in the Netherlands Twin Register) with the Child Behavior Checklist for ages 2-3 y (CBCL/2-3) from Achenbach, Edelbrock, and Howell. Two to 3 y earlier (i.e., soon after the birth of the twins) we collected information about the smoking habits (i.e., "never," "sometimes," and "regularly") of the mother during pregnancy. We analyzed the effect of maternal smoking on the CBCL total score and on several subscale scores for first- and second-born twins separately, and we adjusted for the possible confounding effects of birth weight, socioeconomic status, maternal age, and type of feeding (i.e., breast or bottle fed). There was a significant effect of maternal smoking on so-called "externalizing" behavioral problems (e.g., oppositional, aggressive, overactive), but not on "internalizing" behavioral problems (e.g., withdrawn, depressed, anxious), in both first- and second-born twins. The enhanced "externalizing" problems were attributed predominantly to increased aggression. Although boys have higher externalizing and aggression scores than girls, the effect of maternal smoking was the same for boys and girls.
Clinical experiences have indicated that family planning is affected by childhood leukemia. To investigate this issue, 130 mothers and fathers of 68 families with a long-term disease-free survivor were studied using interviews and questionnaires concerning the effects of childhood cancer on family planning. In one third of the families, either one or both partners reported that their child's disease affected their reproductive planning in various ways. The most extreme variations included having completed the family before diagnosis but still having another child versus not having completed the family before diagnosis but refraining from further progeny. More than half of the affected families refrained from having further offspring, delineating psychological motives for their decision. For parents whose family planning is affected by their experiences with childhood leukemia, the decision-making process is an extra burden. Therefore we advocate that support for the parents of a child with cancer should include counseling on progeny, in which both genetic and psychological information should be provided.