Problems reported by parents of children in multiple cultures: the Child Behavior Checklist syndrome constructs

OBJECTIVE: The purpose of this study was to compare syndromes of parent-reported problems for children in 12 cultures. METHOD: Child Behavior Checklists were analyzed for 13,697 children and adolescents, ages 6 through 17 years, from general population samples in Australia, Belgium, China, Germany, Greece, Israel, Jamaica, the Netherlands, Puerto Rico, Sweden, Thailand, and the United States. RESULTS: Comparisons of nine cultures for subjects ages 6 through 17 gave medium effect sizes for cross-cultural variations in withdrawn and social problems and small effect sizes for somatic complaints, anxious/depressed, thought problems, attention problems, delinquent behavior, and aggressive behavior. Scores of Puerto Rican subjects were the highest, whereas Swedish subjects had the lowest scores on almost all syndromes. With great cross-cultural consistency, girls obtained higher scores than boys on somatic complaints and anxious/depressed but lower scores on attention problems, delinquent behavior, and aggressive behavior. Although remarkably consistent across cultures, the developmental trends differed according to syndrome. Comparison of the 12 cultures across ages 6 through 11 supported these results. CONCLUSIONS: Empirically based assessment in terms of Child Behavior Checklist syndromes permits comparisons of problems reported for children from diverse cultures.     

Behavioral and emotional problems of Algerian children and adolescents as reported by parents

Objective To determine the level of behavioral and emotional problems among a sample of Algerian children and adolescents aged 6–18 years living in Algiers. Methods A school-based sample of 1,405 children and adolescents was recruited; problems were assessed with the Child Behavior Checklist filled out by parents or surrogates. Results The scores varied with age, gender, and socioeconomic status (SES). Contrary to findings in other samples, most Problem scores increased with age. As found in many other cultures, girls scored higher than boys on the Internalizing scales, but lower on Externalizing scales. Youths from lower socioeconomic families tended to score higher on some Problem scales. But, above all, Algerian children and adolescents had raw scores on all Problem scales much higher than those yielded by most previous cross-cultural studies. Conclusions The high level of problems may be attributable to traumatic environmental factors (terrorism and natural catastrophes), but the lack of data from countries that have similar geographic and cultural environments makes it hard to exclude explanations based on cultural factors.     

Problems reported for clinically referred American and Dutch children

Child Behavior Checklists completed by parents of 50 children of each sex at each age from 4 to 16 seen in 28 American and 21 Dutch mental health services (N = 2,600) were examined. Analyses controlling for sex, age, and socioeconomic status showed somewhat higher total problem scores for American than Dutch children, with a mean of 57.27 versus 53.18 on a scale ranging from 0 to 240. This nationality difference accounted for less than 1% of the variance in total scores. American children obtained higher scores on more externalizing items than Dutch children. Small but significant differences in total, externalizing, and internalizing problems found between the two samples may reflect nationality differences in referral patterns. Competence scores were significantly higher for American than Dutch referred children, but did not differ as much as in comparable normative samples. Competence scores may reflect cultural differences more than problem scores do.     

Competence and emotional/behavioural problems in 7-16-year-old Norwegian school children as reported by parents

Background: Previous studies from Nordic countries suggest that parent ratings of children's emotional and behavioural problems using the Child Behavior Checklist (CBCL) are among the lowest in the world. However, there has been no Norwegian population study with acceptable response rates to provide valid Norwegian reference data. Aims: Firstly, to compare CBCL Internalizing, Externalizing, Total Problems and Competence scores of Norwegian children and adolescents with those from 1) previous Norwegian studies, 2) other Nordic countries, and 3) international data. Secondly, to present Norwegian reference data in order to perform these comparisons. Thirdly, to investigate the effects of age, gender, socio-economic and urban/rural status on the CBCL. Methods: A stratified cluster sample of 2582 school children (1302 girls and 1280 boys) was identified from the general Norwegian population and their parents were asked to complete the CBCL. Results: The response rate was 65.5%. The mean Total Problems score for the whole sample was 14.2 (standard deviation, s = 14.1). Girls were rated as having greater Competence and fewer Total Problems than boys. Younger children had more Total Problems than adolescents. Parents with low education reported more child Total Problems and lower Competence than those with high education. All effect sizes were small, except for the effect of parental education on child Competence, which was moderate. Conclusions: Total Problems scores were lower than in other societies. The data from this study obtained from one county in central Norway provide an important reference for clinical practice and treatment outcome research.     

Prevalence and correlates of probable adolescent mental health problems reported by parents in Vietnam

Purpose

The purpose of the present study was to estimate the prevalence of probable mental health problems in an epidemiologic study of Vietnamese adolescents. A secondary aim was to examine the correlates of probable mental health caseness.

Methods

Interviewers visited 1,914 households that were randomly selected to participate in a multi-agency study of mental health in select provinces of Vietnam. Semi-structured interviews assessed adolescent mental health problems using the Strengths and Difficulties Questionnaire (SDQ) parent informant version, and additionally the interviewers collected information on demographic variables (age, gender, ethnic group, religious affiliation, social capital). The final sample included data on 1,368 adolescents (aged 11?C18?years).

Results

The average score on the total problem composite of the SDQ scale was 6.66 (SD?=?4.89), and 9.1% of the sample was considered a case (n?=?124). Bivariate analyses were conducted to determine which demographic variables were related to the SDQ case/non-case score. All variables except gender were significant in bivariate analyses, and therefore were entered into a logistic regression. Results indicated that age, religion, and wealth remained significant predictors of probable caseness.

Conclusions

Overall, prevalence estimates of mental health problems generated by the SDQ were consistent with those reported in the US and other Western and non-Western samples. Results of the current study suggest some concordance of risk and protective factors between Western and Vietnamese youth (i.e., age and SES).     

Role-taking ability and the interpersonal competencies of retarded children.

The relationship between social role-taking ability and competencies of 46 retarded children in dyadic interaction was examined. Subjects were rank ordered on Feffer's (Note 1) Role-Taking Task and assigned to dyads according to rank-order position. A specially designed two-person game, involving the delivery of differential reinforcements (pennies) to self or other, was used to operationalize the competencies of dyads in maximizing joint profit and in establishing a reciprocal exchange strategy. Analyses revealed discrepancies in performance over the course of the game for high and low role-taking ability dyads.     

Differences in personality between parents of asthmatic children and parents of non-asthmatic children

The purpose of this study was to examine whether there are any personality differences between the parents of asthmatic children and parents of children not subject to asthma. Using the CMPS personality test, 11 families with asthmatic children and 10 matched control families were investigated. The results indicate that the parents of asthmatic children are significantly more aggressive (p = 0.02) and significantly less exhibitionist (p = 0.003) than parents of non-asthmatic children. There were no intra-parental differences due to sex.     

A comparison of coping strategies used by parents of children with disabilities and parents of children without disabilities

The purpose of this study was to determine whether coping strategies differ in parents of children with disabilities and parents of children without disabilities. Participants consisted of 112 parents, including 50 parents of children with disabilities and 62 parents of children without disabilities. It was hypothesized that coping strategies would be different between the two parent groups. It was also hypothesized that parents of children with disabilities would Seek Social Support and utilize Planful Problem Solving more often than parents of children without disabilities. Coping strategies employed were significantly different between the groups. Seeking Social Support was a more commonly used method of coping among parents of children with disabilities, as was Escape Avoidance and Positive Reappraisal.     

Transition from East to West: Vietnamese adolescents and their parents

A 28-item questionnaire assessing family values was completed by 191 Vietnamese and 639 Caucasian adolescents in Oklahoma City Public Schools and by about half their parents. Vietnamese refugee parents, regardless of time in the United States, strongly endorsed traditional family values. Vietnamese adolescents tended to reject traditional values. This generation gap increased with time in the United States and was greater for girls than for boys. Despite wholehearted endorsement of traditional family values, Vietnamese parents tended to approve certain adolescent privileges. The results suggest that Vietnamese adolescents may receive conflicting messages from their parents. On the one hand, parents endorsed such traditional values as absolute obedience to parental authority but on the other, they registered relative approval of adolescent freedom of choice regarding dating, marriage, and career. Such ambivalence suggests that Vietnamese refugee families may experience considerable strain while adjusting to American values.     

Genetic and environmental influences on ratings of manifest anxiety by parents and children.

Parental reports and children's self-reports of manifest anxiety were obtained from a community-based sample of twin pairs on two occasions approximately 19 months apart, using the Revised Child Manifest Anxiety Scale (Reynolds & Richmond, 1978). In prior cross-sectional studies, a low degree of agreement between parent and child assessments of anxiety was found. Furthermore, parental reports were found to reflect a higher heritability than children's self-reports (Eaves et al., 1997; Thapar & McGuffin, 1995). The index of temporal stability was moderate for all informants (circa r = .5 to r = .6). To test whether the components contributing to the temporal stability differed between the informants, structural equation models were fitted to the data using the program, Mx: Statistical Modeling (Neale, 1995). The results showed substantial differences in genetic effects according to both gender and informant. For children's self-reports, temporal stability was largely a function of environmental effects, with genetic effects contributing a modest 20%, whereas for parental reports, temporal stability was largely a function of genetic effects. The heritability was higher for parental reports than for boys' self-reports and the genetic covariance between parents and their sons was near zero, indicating that they were reporting on quite different aspects of anxiety. However, for girls, heritability for maternal reports was lower than for self-reports, and the genetic covariance between mother and daughter was about the same as that between mothers and fathers, meaning that they were assessing the same genetically influenced aspect of anxiety. These results highlight the need to focus on gender differences.     

Competence and behavioral/emotional problems among Taiwanese adolescents as reported by parents and teachers

OBJECTIVE: To investigate competence and behavioral/emotional problems among nonreferred adolescents in Taiwan, using a Chinese version of the Child Behavior Checklist (CBCL-C) and the Teacher's Report Form (TRF-C). The psychometric properties of these instruments and cross-cultural differences were also examined. METHOD: Parents of 854 junior high school students aged 12 to 16 years in Taipei, Taiwan, were asked to complete the CBCL-C. Among these students, 162 had their teachers' ratings of the TRF-C. RESULTS: The internal consistency and 1-month test-retest reliability were satisfactory for both the CBCL-C and TRF-C, which were moderately correlated. Both exploratory and confirmatory factor analysis provided some support for the validity of Achenbach's cross-informant model. Parents' reports showed that compared with their American counterparts, Taiwanese adolescents tended to have lower scores on most competence scales, higher scores on scales that reflect covert behavior problems, and lower scores on scales that reflect more overt behavior problems. However, teachers' reports showed no significant differences on most competence and behavior problem scales. CONCLUSION: The CBCL-C and TRF-C are useful tools for assessing the mental health status of Taiwanese adolescents. The cross-cultural differences in adolescent behavior problems are discussed.     

Behaviorally-induced cardiovascular reactivity among sons of reported hypertensive and normotensive parents

The principal purpose of this investigation was to contrast the stress-related cardiovascular responses of sons of reported hypertensive and normotensive parents in a sample of 80 young adult volunteers. Each subject was scheduled for a single, one-hour experimental session. Measures of heart rate (HR) and systolic and diastolic blood pressure (SBP, DBP) were obtained during baseline periods and while subjects performed a difficult and frustrating cognitive task. Each subject also completed a standard family health inventory and, after exclusion of individuals indicating lack of information, uncertainty regarding parental health status, or otherwise providing unusable data (e.g. adopted sons), 20 of 69 remaining subjects reported a parental history of hypertension. Results indicated that relative to sons of normotensives, subjects reporting a hypertensive parent exhibited significantly higher mean SBP measurements during their performance of the experimental task, but not during a preceding (i.e. pre-task) baseline interval. Subsequent analyses also revealed that among subjects exhibiting the most appreciable HR acceleration in response to the experimental stressor, reported histories of parental hypertension were associated with elevated SBP measurements during both baseline and task periods. No similar relationships were observed with respect to DBP.     

Distress and hopelessness among parents of children with congenital heart disease, parents of children with other diseases, and parents of healthy children

OBJECTIVE: We examined differences in distress (i.e., depression, anxiety, and somatisation) and hopelessness (e.g., suicide ideation) among parents of congenital heart disease (CHD) children (PCCHD, n=1092), parents of children with other diseases (PCOD, n=112), and parents of healthy children (PHC, n=293). In addition, we determined the proportion of parents in each group whose scores in distress and hopelessness, respectively, exceeded norms for psychiatric outpatients (POPN) and depressed people, and identified determinants of distress and hopelessness among all parents, and the PCCHD. METHOD: The parents completed a questionnaire about such areas as distress and hopelessness. The design was cross-sectional and data were collected during 20 consecutive days. RESULTS: PCCHD were generally at higher risk of distress and hopelessness. A significant number of parents, in particular PCCHD, reported levels of distress and hopelessness within/above POPN and depressed people, respectively. Mothers within all parent groups had higher levels of distress and hopelessness than fathers, with the highest levels among mothers of children with CHD compared to mothers in the other groups. Fathers of children with CHD were doing worse than fathers belonging to the other groups. There were no differences between PCOD and PHC. Variables such as employment status and financial situation explained more of the variation in distress and hopelessness among parents than the diseases of their children. CONCLUSION: We corroborated previous findings and provide new insights into the experiences of PCCHD that may be of importance when considering intervention. Further research concerning the parents, in particular PCCHD, at risk of developing psychosocial problems is needed.     

Lithium in children of lithium-responding parents

Six offspring of manic-depressive patients, whose parents were lithium responders, were selected on the basis of their incapacitating psychopathology for treatment with lithium. The children ranged in age from 6 to 12. A double-blind, crossover design was used over 16–18 weeks. Weekly ratings were done, and average evoked potentials (EPs) were measured at each crossover. Two children diagnosed as having a bipolar affective disorder had a clear-cut response to lithium and were strong augmenters on the EP. This, taken together with the similarity of the EP changes on lithium to those occurring in adult patients treated with lithium, supports a physiological parallel between bipolar affective illness in adults and children.     

Behavioral and emotional problems reported by parents for ages 6 to 17 in a Swiss epidemiological study

In an epidemiological sample of children aged 6 to 17 a total of 1964 parents responded to the Child Behavior Check List (CBCL). A subgroup of 399 parents were interviewed with the Diagnostic Interview Schedule for Children (DISC). The mean syndrome scale scores in the various sex/age groups were in the lower range of several international studies using the CBCL. Effect analyses revealed sex to be more important than nationality (indigenous vs. immigrant) and age. All effects had to be considered as being small. Convergence between syndrome scales of the CBCL and interview-derived DSMIII-R diagnoses was good for three major groups of disorders.Supported by the Swiss National Science Foundation     

Psychiatric and family functioning in children with leukemia and their parents.

The present study reports data from a cross-sectional investigation of the psychiatric and psychosocial functioning of 55 children diagnosed with acute lymphocytic leukemia and their families at three points in time: diagnosis (newly diagnosed), 1 year postdiagnosis, and 1 year after the completion of chemotherapy (off-therapy). Results reveal minimal psychopathology in these children and their parents based on self- and informant-reports and structured diagnostic interviews. These families appear to be functioning adequately and report more family cohesiveness and marital satisfaction after chemotherapy was completed. Coping strategies commonly used by children and their parents include problem-solving, a positive outlook, and good communication. Implications for psychiatric consultation are presented.     

Saliva cortisol and response to dexamethasone in children of depressed parents.

BACKGROUND: Major depression (MDD) is heritable, and children of depressed parents are at higher risk for the development of depression. However, depression in a parent might also act as a stressor leading to increased activation of neuroendocrine stress circuits. To address this question we examined saliva cortisol in children whose parents have a history of MDD. METHODS: We recruited 15 families with one parent with MDD (26 prepubertal children) and 16 control families without history of parental MDD (32 prepubertal children). All parents and children underwent Structured Clinical Interview for DSM-IV and Kiddie Schedule For Affective Disorders And Schizophrenia interviews, respectively. Families were asked to collect morning, afternoon, and bedtime saliva samples for 4 days for 2 weeks. At bedtime of the 3rd day, dexamethasone was administered. Two doses, standard and low, were used in each family. RESULTS: The majority of children demonstrated no psychiatric diagnosis. Children with MDD parents showed higher cortisol basally and higher cortisol after both 25 mg and 5 mg dexamethasone. However, this effect occurred predominantly in children whose parents were currently depressed. There were strong correlations for cortisol between parents and children (r = 52 in depressed; r = 499 in control). CONCLUSIONS: Elevated cortisol and impaired feedback seemed to reflect an environmental effect of MDD in a parent.