Observer variance within families: confluence among maternal,paternal and child ratings

This paper examines patterns of agreement among different informants within the same family in order to determine the effects of maternal distress on the ratings of mothers and fathers. Mothers, fathers and children from a community cohort of 216 families with 13 to 15 years olds reported children's difficulties and strengths measured by the Rutter Revised Scale. The absolute scores on the children's ratings were higher than those of the fathers and mothers. The odds ratios for agreements between fathers and children ranged between 1.70 and 4.01 and for mother‐child agreement between 0.83 and 3.40. There were no significant differences between the mothers and fathers in the extent of their agreement with their children. When mothers were emotionally distressed, there was a significantly higher level of emotional disturbance in the children according to the ratings of both mothers and fathers, but not according to children's ratings. There is value in obtaining paternal, as well as maternal and child, ratings of children's behaviour. Maternal distress affects the ratings of both parents, but not those of the children; the reasons for these effects require further study but they cannot be assumed to reflect rating bias. Copyright © 2001 Whurr Publishers Ltd.     

Psychometric properties of a Swedish version of the “Strengths and Difficulties Questionnaire”

A new English instrument for screening mental health in children and adolescents, the Strengths and Difficulties Questionnaire (SDQ), was translated into Swedish and used for parental ratings of 900 children aged 6–10 years from the general population. The SDQ which comprises 25 items, divided into 5 subscales (prosocial, hyperactivity, emotional symptoms, conduct problems, and peer problems) was developed from the Rutter scales. An earlier English validation study has shown the two instruments to have equal ability to identify child psychiatric cases, but the SDQ also provides screening on empathy and prosocial behaviour which are aspects of child development emphasized in current child psychiatry. The design of the SDQ with both strengths` and difficulties` items supposedly increases acceptability of the instrument on behalf of informants and makes the questionnaire especially suitable for studies of general population where the majority of children are healthy. Our results, which are novel findings on the instrument, confirmed the postulated factor structure and showed significant gender-differences in results on the total scale, prosocial and hyperactivity subscales and on some of the single items. Moreover, our investigation showed that a Swedish translation of the parental version of the SDQ worked well. Accepted: 5 October 1998     

Parental Agreement on ADHD Symptom-Specific and Broadband Externalizing Ratings of Child Behavior

Mothers and fathers often disagree in their ratings of child behavior as evidenced clinically and supported by a substantial literature examining parental agreement on broadband rating scales. The present study examined mother-father agreement on DSM-based, ADHD symptom-specific ratings, as compared to agreement on broadband ratings of externalizing behavior. Using mother and father ratings from 324 children who participated in the Multimodal Treatment Study of Children with ADHD, parental agreement was computed and patterns of disagreement were examined. Mother-father ratings were significantly correlated. However, a clear pattern of higher ratings by mothers compared to fathers was present across ratings. Agreement on ADHD symptom-specific ratings was significantly lower than agreement for broadband externalizing behaviors or ODD symptoms. Of several moderator variables tested, parental stress was the only variable that predicted the discrepancy in ratings. Disagreement between parents is clinically significant and may pose complications to the diagnostic process.     

Mothers’ and Fathers’ Attributions and Beliefs in Families of Girls and Boys with Attention-Deficit/Hyperactivity Disorder

This study examined parent and child gender effects on parents’ attributions and beliefs in regards to child symptoms of attention-deficit/hyperactivity disorder (ADHD). Participants included mothers and fathers of 19 girls and 17 boys with ADHD. Groups of boys and girls, aged 5–13 years, were equated on age and medication status, as well as ADHD symptom severity. These groups also were similar in the severity of comorbid oppositional behaviors and internalizing problems, as well as a variety of demographic characteristics. Parents’ attributions for child behavior were assessed in response to written scenarios describing either hyperactive/impulsive or inattentive symptoms of ADHD. Parents also completed a questionnaire assessing beliefs and knowledge about ADHD. There were no child gender effects for parents’ attributions or beliefs. All parents attributed inattentive symptoms to more internal, global and stable causes than impulsive symptoms. Mothers attributed both inattentive and impulsive child symptoms to more global and stable causes than did fathers. Fathers, but not mothers, reported more negative reactions to ADHD symptoms that were perceived as having an internal cause. Finally, mothers scored higher on beliefs in behavior management than did fathers, and fathers believed more in psychological causes and treatments for ADHD. Possible explanations for and implications of these results are explored.     

Pre-school children with and without developmental delay: behaviour problems and parenting stress over time

BACKGROUND: Children with intellectual disability are at heightened risk for behaviour problems and diagnosed mental disorder. METHODS: The present authors studied the early manifestation and continuity of problem behaviours in 205 pre-school children with and without developmental delays. RESULTS: Behaviour problems were quite stable over the year from age 36-48 months. Children with developmental delays were rated higher on behaviour problems than their non-delayed peers, and were three times as likely to score in the clinical range. Mothers and fathers showed high agreement in their rating of child problems, especially in the delayed group. Parenting stress was also higher in the delayed group, but was related to the extent of behaviour problems rather than to the child's developmental delay. CONCLUSIONS: Over time, a transactional model fit the relationship between parenting stress and behaviour problems: high parenting stress contributed to a worsening in child behaviour problems over time, and high child behaviour problems contributed to a worsening in parenting stress. Findings for mothers and fathers were quite similar.     

Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka

A computerised algorithm was developed to predict child psychiatric diagnoses on the basis of the symptom and impact scores derived from Strengths and Difficulties Questionnaires (SDQs) completed by parents, teachers and young people. The predictive algorithm generates "unlikely", "possible" or "probable" ratings for four broad categories of disorder, namely conduct disorders, emotional disorders, hyperactivity disorders, and any psychiatric disorder. The algorithm was applied to patients attending child mental health clinics in Britain (N = 101) and Bangladesh (N = 89). The level of chance-corrected agreement between SDQ prediction and an independent clinical diagnosis was substantial and highly significant (Kendall's tau b between 0.49 and 0.73; p < 0.001). A "probable" SDQ prediction for any given disorder correctly identified 81-91% of the children who definitely had that clinical diagnosis. There were more false positives than false negatives, i.e. the SDQ categories were over-inclusive. The algorithm appears to be sufficiently accurate and robust to be of practical value in planning the assessment of new referrals to a child mental health service.     

Fathers of children born to adolescent mothers and their interactive behavior

Adolescent mothers and their children received much scientific attention in the past. Some studies also looked at characteristics of the interaction between mother and child. However, little is known about the interaction between children of adolescent mothers and their fathers, as research to date has focussed on paternal psychosocial aspects. The present study examines 19 partners of adolescent mothers in the interaction with their four-months-old infants. Results indicate that fathers of this sample--despite a sufficiently large intuitive repertoire--mainly relate to their infants with tactile stimulation and behaviours that facilitate eye contact. Most fathers succeed in adjusting their behaviour to their child's state. Fathers who are able to adjust their behaviour to their child's state show a larger repertoire of intuitive capacity. The infant's readiness to interact is associated with successful paternal adjustment. We discuss implications for involving fathers in the clinical work with children of adolescent mothers.     

Informant Agreement in Behavior Ratings for Children with Epilepsy

The purpose of this study was to determine the degree of informant agreement for behavioral ratings of children with epilepsy. Informants completed Achenbach's 1991 scales: parents completed the Child Behavior Checklist (CBCL), teachers completed the Teacher's Report Form (TRF), and youth completed the Youth Self-Report Form of the CBCL (YSR). Analyses included degree of concordance of ratings as a function of informant, child gender, and condition severity (active vs inactive epilepsy). Results indicated that across all four types of raters (mothers, fathers, teachers, and adolescents) there was a similar pattern. Mothers' ratings tended to be the highest and youths' ratings tended to be the lowest across scales. In general, agreement among adult raters was greater than between youth and adults. Mothers and teachers reported more internalizing symptoms than did youth; mother, father, and teacher ratings on externalizing symptoms were not significantly different from each other. There were no significant effects of gender and condition severity on concordance among ratings although there were some interesting trends.     

Screening for the attention deficit hyperactivity disorder phenotype using the strength and difficulties questionnaire

The strengths and difficulties questionnaire (SDQ) is a broad-band child mental health instrument, which has been reported to be a good screener for the ADHD phenotype. Questionnaires containing the SDQ and the 18 SNAP-IV items corresponding to the DSM-IV ADHD symptoms were completed by parents and teachers for 66% (N = 6,233) of all 7- to 9-year-olds in the city of Bergen, Norway, 2002. Screening properties of the five-item SDQ hyperactivity–inattention subscale for the DSM-IV ADHD phenotype were examined. Using the DSM-IV ADHD phenotype based on both informants as the gold standard (5.2% of the sample), the receiver operating characteristics (ROC) analyses demonstrated an area under the curve of 0.91 (95% CI: 0.90–0.92) for parent and 0.95 (95% CI: 0.94–0.95) for teacher SDQ hyperactivity–inattention subscale ratings. The SDQ hyperactivity–inattention predictive algorithm identified 74% of those with the ADHD combined subtype as possible or probable cases, but only 22% of those with the inattentive subtype. The 5-item long SDQ hyperactivity–inattention subscale is a shorter substitute for the 18-item ADHD symptom list. The SDQ predictive algorithm had an acceptable sensitivity for the ADHD combined subtype, but low sensitivity for the ADHD inattentive and the ADHD hyperactive subtypes.     

Children’s behavioural/emotional problems: a comparison of parents’ and teachers’ reports for elementary school-aged children

This study assessed the agreement between parents and teachers concerning behavioural/emotional symptoms of children. 5671 children born in 1981 (mean age 8.5 years at the time of study) were studied using the Rutter Parent Questionnaire (RA2) and the Rutter Teacher Questionnaire (RB2). Boys had more behavioural symptoms on both scales, 3.6% of the boys and 2.3% of the girls were deviant on both scales. Agreement between parents and teachers on single behaviours was better for deviant girls than for deviant boys. The factors constructed from the Rutter scale items (separately of each scale) represented externalising, internalising and hyperactivity behaviours. For all children, moderate correlations between parents’ and teachers’ ratings were found in externalising behaviour and hyperactivity. Correlations of the factors were clearly higher for deviant girls than for deviant boys. Scoring high on one of the scales increased the probability of scoring high on the second scale. The discussion focuses on factors that may affect agreement between parents and teachers when behavioural symptoms are assessed.     

Changes in social competence in young children treated because of conduct problems as viewed by multiple informants

In the present study changes in social competence were examined in a clinic sample of 127 children aged 4–8. The children were recruited to a controlled treatment study because of conduct problems at home and were randomised to the Incredible Years parent training (PT), combined PT and child therapy (CT) or a waiting-list control-group. Assessments were conducted pre- and post-treatment and at a one-year follow-up by multiple informants (mother, father, teacher and child). Parent training combined with child treatment showed most improvement in child social competence based on mother, father and child reports, however, father reports showed positive results for children treated with PT only. Treated mothers and fathers showed a decrease in correlations in their reports of social competence in the child after treatment as compared to parents in the waiting-list condition. No generalisation effects to peer-relationships in day-care/school were found, neither on teacher or child reports. A broad perspective using multiple informants from different settings is needed when effects of treatment of young children with conduct problems are evaluated and should include various aspects of social competence.     

Cross-informant correlations on social competence and behavioral problems in Sami and Norwegian preadolescents

In a community-based birth cohort from Arctic Norway, correlations between parents and teachers on child competence and behavioral problems were determined for Sami and Norwegian 11–12 year-olds, using as instruments the child behavior checklist (CBCL), teacher report form (TRF), and the impact supplement of the extended strength and difficulties questionnaire (SDQ). Parent–teacher correlations on child behavioral problems were generally high in the Norwegian group, but low in the Sami group. Cross-cultural differences in cross-informant correlations were highest regarding externalizing and attention problems. Parent–teacher correlations on total impact of child difficulties also differed between the ethnic groups. Once again, a lower correlation was found for the Sami children. The discrepancy between parents’ and teachers’ perception of problems that needed attention was highest for the Sami, and lowest for the Norwegians. The Sami parents reported fewer perceived difficulties and less impact of problems than did the Norwegian parents. In contrast, no ethnic differences emerged for teachers’ ratings. The paper discusses how cultural norms might influence the reports of child problems. It demonstrates the importance of combining parent and teacher reports of child behavior problems in minority and indigenous children, who often live under different cultural norms in home and school contexts.     

Suggestive diagnosis of attention-deficit/hyperactivity disorder in indigenous children and adolescents from the Brazilian Amazon

The prevalence of attention-deficit/hyperactivity disorder (ADHD) symptoms has been scarcely studied in indigenous cultures that preserve ancestral cultural characteristics. The objective of the study is to estimate the prevalence of suggestive diagnosis of ADHD among indigenous children and adolescents from villages in the Amazon. This is an analytical cross-sectional study using instruments to track ADHD symptoms (the Child Behaviour Checklist for ages 6–18: CBCL/6–18 and the teacher report form for ages 6–18: TRF/6–18) and to investigate their negative impact on the patients (using the Strengths and Difficulties Questionnaire—SDQ). The prevalence of a suggestive ADHD diagnosis according to the CBCL/TRF DSM-IV ADHD subscale without and with negative impact as assessed by the SDQ was 4.3% and 1.1%, respectively. Comorbid oppositional-defiant, conduct problems and anxious symptoms were present in all cases screening positive for ADHD. We also presented a case report as an illustration of the observed clinical presentation. ADHD is a recognizable disorder even in a culture that preserves millennial characteristics. Furthermore, the presence of ADHD symptoms was associated with significant impairment.     

The Strengths and Difficulties Questionnaire among Finnish school-aged children and adolescents

 The emotional and behavioural problems of 7- to 15-year-old Finnish children and adolescents (n = 735) were assessed in a community population by a brief screening instrument, the Strengths and Difficulties Questionnaire (SDQ). The parent-, teacher- and self-reports of the SDQ were obtained. The results show that for the total scores, the inter-rater agreement between the pairs of reports was 0.38–0.44. The internal consistency in all three questionnaires was 0.71. Functioning above the 90th percentile of the SDQ total difficulties scores in parent-, teacher- and self-reports was strongly associated with help-seeking variables and problematic behaviour according to parents. The correlation of the parental SDQ total scores and the Child Behaviour Checklist total scores was 0.75 and the correlation of the self-report SDQ total scores with the Youth Self Report total scores was 0.71. The differences in sex, grade and informants of the SDQ total difficulties scores are reported. The study gives further evidence of the usefulness of the SDQ as a promising screening instrument for epidemiological research and clinical purposes. Accepted: 17 April 2000     

Child mental health and resilience in the context of socioeconomic disadvantage: results from the Born in Bradford cohort study

Socioeconomic disadvantage has been linked to mental health difficulties in children and adolescents, although many children appear to do well despite exposure to financial adversity in childhood. Our study looked at the effects of family financial difficulty on children’s mental health outcomes (n = 636) at 4–5 years in a multi-ethnic UK cohort, the Born in Bradford cohort. We considered potential parent and child variables promoting resilience in this population. Univariate linear regression was used to identify associations between family financial difficulty measured antenatally and child mental health difficulties measured by teacher-rated Strengths and Difficulties (SDQ) scores at 4–5 years. Hierarchical multivariate regression was used to test for potential moderating effects of parent and child factors. Mothers completed the General Health Questionnaire-28, Kessler-6 Questionnaire and questions related to parenting warmth, hostility and confidence. Parent-rated Infant Characteristic Questionnaires and teacher-rated Early Years Foundation Stage scores provided information on child temperament, literacy and physical development as potential moderators. Financial difficulty was associated with worse mental health outcomes in children. High parent warmth, high child literacy scores and physical development scores were all associated with positive child mental health outcomes at 4–5 years. In terms of protective effects, only maternal warmth was found to significantly moderate the relationship between financial difficulty and child mental health difficulties. The current study demonstrates that family financial difficulty is associated with poorer child mental health outcomes in a UK cohort of mothers and their school-aged children. It provides evidence of the positive relationships between warm parenting, child literacy and child physical development with mental health in young children. The study supports the finding that warm parenting moderates the relationship between family financial difficulty and interventions supporting this aspect of parenting may therefore provide particular benefit to children growing up in this context.     

Parents of children with and without intellectual disability: couple relationship and individual well‐being

Background Research on parents of children with intellectual disability (ID) has identified a range of risk and protective factors for parental well‐being. In family research, the association between marital quality and depression is a vital field of investigation. Still little research has addressed how aspects of the couple relationship affect the adaptation of parents of children with ID. The present study examined predictive links between couple relationship factors (marital quality and coparenting quality) and individual well‐being. Methods Data were obtained through self‐report questionnaires completed by parents of children with ID (mothers, n = 58; and fathers, n = 46) and control children (mothers, n = 178; and fathers, n = 141). To test the hypothesis that couple relationship factors predicted individual well‐being, multiple regression analyses were performed controlling for the following risk factors identified by previous research: child self‐injury/stereotypic behaviour, parenting stress, and economic risk. Results Marital quality predicted concurrent well‐being, and coparenting quality predicted prospective well‐being. Mothers of children with ID reported lower well‐being than other parents. Conclusions There is a continued need for investigation of the details of the links between couple relationship and individual well‐being in parents of children with ID. Couple relationship factors should be given consideration in clinical interventions.     

Self-reported strengths and difficulties in a community sample of Finnish adolescents

The psychometric properties of the self-report version of the Strengths and Difficulties Questionnaire (SDQ) among Finnish 13- to 17-year-old adolescents (n = 1,458) were studied. The results show that the psychometric properties of the Finnish SDQ self-report were adequate. The results of the correlation analysis confirmed the postulated structure of the SDQ self-report. The correlations of the items to their respective subscales ranged from moderate to high (r = 0.47–0.73). The internal consistency was acceptable on three and somewhat lower on two of the five subscales (alpha = 0.53–0.71). In addition, the factor analysis sufficiently confirmed the postulated structure of the SDQ for girls and boys, except for the conduct problems scale of boys, which was fused with emotional symptoms and with hyperactivity. The means of the SDQ self-report total difficulties scores were very similar to those in a previous study in Great Britain. The results provide additional confirmation of the usefulness of the SDQ as a screening instrument in epidemiological research and clinical practice. Accepted: 12 January 2001     

The contribution of marital quality to the well-being of parents of children with developmental disabilities

Background This study examines the contribution of the marital relationship to the well‐being of both mothers and fathers of children with developmental disabilities. Parent well‐being is conceptualized in terms of mental health, parenting stress and parenting efficacy. Methods These analyses are based on data from 67 families participating in the Early Intervention Collaborative Study, an ongoing longitudinal investigation of the development of children with disabilities and the adaptation of their families. Multidimensional assessment techniques were used to collect data from married mothers and fathers and their child with a disability. Mother and father data were analysed separately using parallel hierarchical regression models. Results For both mothers and fathers, greater marital quality predicted lower parenting stress and fewer depressive symptoms above and beyond socio‐economic status, child characteristics and social support. In relation to parenting efficacy, marital quality added significant unique variance for mothers but not for fathers. For fathers, greater social support predicted increased parenting efficacy. Child behaviour was also a powerful predictor of parental well‐being for both mothers and fathers. Conclusion The findings support the importance of the marital relationship to parental well‐being and illustrate the value of including fathers in studies of children with developmental disabilities.     

It takes two! Exploring sex differences in parenting neurobiology and behaviour

Parents lay the foundation for their children's socio‐emotional experiences by sensitively responding to their needs. The hormonal and neurobiological changes that occur during the transition to parenthood importantly contribute to the parents’ caregiving behaviour toward their children. Much research has emphasised the relationship between the mother, who is most often the primary caregiver, and her infant, with less focus on the role of fathers in child development. However, recent accounts have suggested that fathers also play an important role in promoting the health, development and psychosocial wellbeing of their children. Evidence from the behavioural literature has indicated that there are significant differences between typical mother‐infant versus father‐infant interactions. The current review aims to outline differences between maternal and paternal caregiving by discussing the differences in their biological mechanisms. First, we focus on the different hormones that are correlated with sensitive parenting behaviours in mothers and fathers. Next, we discuss the differences between neural bases of motherhood and fatherhood. Lastly, we discuss ways in which parental hormones, parental brain and parental exposure to infant cues interact to shape parental caregiving behaviour. In summary, this review highlights the distinct but complementary nature of maternal and paternal caregiving.     

Parent ratings of school behaviour in children at risk of attention deficit/hyperactivity disorder

OBJECTIVE: To investigate whether parents are accurate informants of child hyperactivity symptoms and impairment at school. METHOD: Parents of a community sample of 93 children with pervasive hyperactivity completed rating scales about their child's behaviour at home and school. These were compared with teacher ratings. RESULTS: Parent ratings about school correlate more closely with parent (home) than teacher ratings. Such ratings systematically under-estimate teacher ratings and are influenced by the child's behaviour at both home and school as well as parental mental health. However, a parental report of impairment for the child at school is likely to be accurate. CONCLUSION: There are limitations in relying on parental accounts of school behaviour if teacher ratings are unavailable. As such ratings may under-identify children with ADHD and discrepancies between parent and teacher ratings may reflect actual differences in behaviour, this suggests that ratings are required from both sets of informants.