Parent-reported competence and emotional and behavioral problems in Finnish adolescents

This study was part of an 8-year follow-up study of the Epidemiological Multicenter Child Psychiatric Study in Finland. The Child Behavior Checklists (CBCLs) were analyzed for 598 15- to 16-year-old adolescents living in the southwestern area of Finland in 1997. The internal consistency of the CBCL syndrome scales was adequate (the alpha coefficient ranged from 0.66 to 0.89). The CBCL scores differentiated between non-referred adolescents and adolescents who had been referred to the mental health service or had severe problems according to the parents. Boys had more externalizing problems than girls in the maladjustment group. Girls had more somatic symptoms in the maladjustment group than boys.     

Parent-reported competence and emotional and behavioral problems in Finnish adolescents

This study was part of an 8-year follow-up study of the Epidemiological Multicenter Child Psychiatric Study in Finland. The Child Behavior Checklists (CBCLs) were analyzed for 598 15- to 16-year-old adolescents living in the southwestern area of Finland in 1997. The internal consistency of the CBCL syndrome scales was adequate (the alpha coefficient ranged from 0.66 to 0.89). The CBCL scores differentiated between non-referred adolescents and adolescents who had been referred to the mental health service or had severe problems according to the parents. Boys had more externalizing problems than girls in the maladjustment group. Girls had more somatic symptoms in the maladjustment group than boys.     

Effectiveness of autogenic relaxation training on children and adolescents with behavioral and emotional problems

OBJECTIVE: To investigate the effectiveness of autogenic relaxation training in a mildly disturbed outpatient population of children and adolescents with mostly internalizing symptoms, and/or some aggressive, impulsive, or attention deficit symptoms. METHOD: Fifty children and adolescents from southern Germany (mean age 10.2 years; range 6-15 years; mostly intact middle class family background) participated in a group intervention program. Fifteen patients were randomly assigned to a waiting-list control group. Behavior symptoms (Child Behavior Checklist), psychosomatic complaints (Giessen Complaint List), and level of stress were assessed before and after the intervention or after the waiting phase. Individual goal attainment was evaluated at the end of the intervention and in a 3-month follow-up. RESULTS: The parent report on CBCL reflected reduced symptoms compared with control. The child report indicated reduced stress and psychosomatic complaints both in the intervention and control group, and no significant group x time interaction effects occurred on these scales. Effect sizes of 0.49 in the CBCL and 0.36 in the complaint list indicated clinically relevant effects of the intervention compared with the control group. At the end of the intervention, 56% of the children and 55% of the parents reported partial goal attainment, 38% of the children and 30% of the parents reported complete goal attainment; 71% of the parents confirmed partial goal attainment 3 months postintervention. CONCLUSIONS: Autogenic relaxation training is an effective broadband method for children and adolescents.     

Empirical classification of behavioral and psychiatric problems in children and adolescents with mental retardation

A quantitative method for typing psychopathology of youngsters with mental retardation was assessed. Parents of 601 students in special educational placements rated them with the ABC. The sample was randomly divided into two subgroups. We used Ward's hierarchical method of cluster analysis and derived eight clusters in Subsample 1 and satisfactory agreement, kappa =.64, for the eight-cluster solution in Subsample 2. Clusters were: Problem Free, Within Normal Limits, Conduct Problem, Shy/Inactive, Hyperactive, Social Withdrawal With Agitation, Undifferentiated Behavior Disturbance, and Autistic-Like Behavior. We also used demographic (age, gender, IQ, physical handicaps) and clinical variables (DSM diagnoses and target behaviors) extracted from school records of 228 participants to appraise validity of the empirically derived clusters. The external data provided modest to strong support for all except one cluster (Social Withdrawal With Agitation).     

Sleep, emotional and behavioral difficulties in children and adolescents

Links between sleep and psychopathology are complex and likely bidirectional. Sleep problems and alteration of normal sleep patterns have been identified in major forms of child psychopathology including anxiety, depression and attention disorders as well as symptoms of difficulties in the full range. This review summarizes some key findings with regard to the links between sleep and associated difficulties in childhood and adolescence. It then proposes a selection of possible mechanisms underlying some of these associations. Suggestions for future research include the need to 1) use multi-methods to assess sleep; 2) measure sleep in large-scale studies; 3) conduct controlled experiments to further establish the effects of sleep variations on emotional and behavioral difficulties; 4) take an interdisciplinary approach to further understand the links between sleep and associated difficulties.     

Maternal-reported behavioral and emotional problems in Taiwanese preschool children

There has been limited epidemiologic information concerning preschoolers’ behavioral and emotional problems in Eastern societies. This study was therefore aimed to investigate behavioral and emotional problems in a large sample of Taiwanese preschoolers using the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5). The CBCL/1.5-5 was scored by mothers of 645 Taiwanese preschoolers aged 24-71 months. Psychometric features of the scale as well as the raw scores and prevalence rates of behavioral problems of Taiwanese preschoolers were compared with those of American counterparts. Several demographic variables with the Total Problems and syndromes scores were also examined. The CBCL/1.5-5 was found to have good to excellent levels of reliability (internal consistency, test-retest reliability and inter-parent agreement) and an acceptable model fit of seven-syndrome factor structure (root mean square error of approximation = 0.055) when used with Taiwanese preschoolers. The prevalence rate of Total Problems, Internalizing syndrome and Externalizing syndrome score in the clinical range was 25.1%, 11.2% and 25.4%, respectively. Cross-cultural comparisons showed that Taiwanese preschoolers had higher scores in six narrow-band syndromes (effect size d = 0.17-0.43, all p's < 0.005) and prevalence rates of four Internalizing-related syndromes and Sleep Problems than American sample (odds ratio = 2.4-4.9, all p's < 0.005). Analyses of behavioral correlates revealed associations of first birth order with higher Internalizing, Externalizing and Total Problems scores (all p's < 0.05). Furthermore, younger ages (24-47 months) and male gender were associated with higher Externalizing and Total Problems scores (all p's < 0.05). Our data have provided important epidemiologic information to assist in clinical assessment and management of preschoolers’ behavioral and emotional problems in an Eastern society.     

Coping strategies and behavioral/emotional problems among Chinese adolescents

This study was carried out to describe strategies used to cope with stress and to explore the association between coping strategies and behavioral/emotional problems in a community sample of adolescents from Mainland China. Participants completed a self-administered questionnaire incorporating the Chinese Trait Coping Style Questionnaire, the Chinese version of the Youth Self-Report of Child Behavior Checklist, and a number of demographic questions. Results indicated that Chinese adolescents often used multiple coping strategies when faced with stress. Principal factor analysis followed by oblique rotation revealed two dimensions of coping strategies in Chinese adolescents: active coping and avoidant coping. A series of logistic regression analyses showed that avoidant coping was significantly associated with increased risk for internalizing and externalizing problems, but active coping was associated with reduced risk, after adjustment for child's age and sex and father's occupation. These findings provide evidence of the association between coping and mental health problems in Chinese adolescents.     

Social determinants of self-reported emotional and behavioral problems in Greek adolescents

OBJECTIVE: This study aimed to assess the social factors associated with self-reported emotional and behavioral problems among Greek adolescents. METHODS: At age 18, a population-based sample of 3373 Greek adolescents completed the Youth Self-Report (YSR) questionnaire. RESULTS: The results from the multivariate analysis indicated that both lack of intimate friendships and not having parental monitoring were independently associated with problem behavior among both male and female adolescents. Engagement in sexual activities was significantly associated with higher YSR scores among both genders. Absence of academic motivation was associated with higher YSR scores in girls only. CONCLUSIONS: Our results confirm that social factors, including negative family functions, lack of academic motivation and not having close friends, were associated with emotional and behavioral problems among adolescents and imply the need to develop a supportive social network for adolescents.     

Ten-year trends in self-reported emotional and behavioral problems of Dutch adolescents

BACKGROUND: Research comparing population samples from different time periods to investigate secular changes in adolescents' psychosocial problems have mostly focused on parent and teacher reports. The few studies using self-reports have limitations, such as using only school-based samples or investigating a limited range of problems. AIM: We investigated changes from 1993 to 2003 in Dutch 11- to 18-year-old girls' and boys' self-reported emotional and behavioral problems. We also examined whether trends were different for various socio-demographic groups. METHOD: We used the Youth Self-Report (YSR) to assess emotional and behavioral problems, and obtained self-reports of police contact, substance abuse, suicidal ideation and self-harm across two adolescent population samples, assessed in 1993 and 2003. To investigate whether reports were different for the 2 years, we performed analyses of variance on the mean scores, and chi-square analyses on the percentages of deviant-scoring children and children reporting specific problem behaviors for boys and girls separately. Logistic regressions were conducted to investigate interactions of year with various sociodemographic variables. RESULTS: For boys, results showed a few small changes, indicating decreases from 1993 to 2003 in self-reported Social Problems, Externalizing, Aggressive Behavior, and Rule-Breaking Behavior. For girls, Thought problems, Somatic Complaints, Internalizing problems, suicidal ideation and self-harm increased. Drunkenness and drug use increased for both boys and girls. There were some differences between socio-demographic groups. Boys from low-SES families and younger adolescent girls experienced most increases. CONCLUSION: We found evidence for some small trends in self-reported problems. For boys, some decreases were seen, regarding mostly behavioral problems, whereas for girls, some increases were seen in emotional and behavioral problems. Changes appeared to have most negatively affected young adolescent girls' functioning.     

Measuring outcomes of care for adolescents with emotional and behavioral problems

OBJECTIVES: To validate the prototype Adolescent Treatment Outcomes Module (ATOM), examine its sensitivity to clinical change, and determine its feasibility for administration in routine clinical settings. METHOD: A sample of 67 adolescents, aged 11 through 18, was selected from new patients at two inpatient and two outpatient mental health programs. Adolescents and parents completed the ATOM and validating instruments at intake, 1 week postintake, and again at 6 months. RESULTS: Nine self-report symptoms predicted positive diagnoses of oppositional defiant, conduct, anxiety, and depressive disorders on the basis of structured diagnoses, with sensitivities of 0.7 to 0.8. Test-retest correlations for outcome scales were largely excellent (>0.70). Scales that measured functioning at home, in school, and in the community were moderately correlated in the expected direction with global functioning. Decreases in symptom severity and functional impairment were generally associated with decreases in validating instruments. Administration time averaged 25 minutes for adolescents and 28 minutes for parents. CONCLUSIONS: Both parents and adolescents readily completed the ATOM. Module scales demonstrated excellent reliability and good to fair concurrent validity. The ATOM was able to detect change and its absence.     

Somatic symptoms in children and adolescents referred for emotional and behavioral disorders

Medically unexplained physical symptoms are frequently endorsed by children and adolescents in both clinical and community samples. The aim of this exploratory study is to examine the prevalence of somatic symptoms in a sample of 162 Italian children and adolescents consecutively referred to a Division of Child Neurology and Psychiatry from emotional and/or behavioral disorders. The role of age, gender, and psychiatric status was considered as a variable. Each patient received a DSM-IV assessment, including a diagnostic structured interview (DICA-R). The sample was divided according to gender (96 males, 66 females), age (70 children younger and 92 adolescents older than 12 years), and psychiatric diagnosis (Anxiety, Depression, Depression/Anxiety, Other). The presence of medically unexplained somatic symptoms was based on the responses to the DICA-R. Somatic complaints were reported in 69.2% of the patients. Headache was the most frequent somatic symptom (50.6%). Younger children showed higher rates of abdominal complaints than adolescents. No gender differences in frequency of somatic complaints were reported. Subjects with anxiety and/or depression reported significantly higher rates of somatic complaints, namely headache, than subjects with other mental disorders. No differences in frequency of somatic symptoms were evident between patients with anxiety, depression, and comorbid anxiety-depression. Our data suggest that an unexplained somatic symptom can be often considered as indicative of a neglected anxiety and/or depressive disorder. A collaboration between primary care physicians, pediatricians, and child psychiatrists may promote early diagnoses and timely treatments and prevent negative social and scholastic consequences.     

Emotion regulation in adolescents with mental health problems

Introduction. Current literature points to a clear and consistent association between poor emotion control and psychopathology in adolescence, a critical developmental period during which most adult mental health problems emerge. However, nearly all of the studies in this literature have assessed emotion regulation in nonclinical cohorts, or indexed this construct using only self-report methodology. Method. The present study compared adolescents with a mental illness (n = 41) to demographically matched controls (n = 45) on an experimental task that required them to either suppress or amplify their emotion expressive behavior in response to images that were either negative or positive in affective valence. Results. Clinical participants (like controls) showed evidence of being able to regulate their behavioral expression of emotion, indicating that the presence of mental health problems in adolescence does not prevent a basic level of control being exercised over the emotions that are expressed to others. However, the capacity to amplify expressive behavior was reduced, particularly for negative emotions. In addition, poorer emotion regulation in the clinical group was associated with reduced quality of life. Conclusions. These data indicate that specific aspects of emotion expressive behavior are disrupted in adolescents with mental illness and are discussed in the context of theoretical models that regard emotion dysregulation as a core, transdiagnostic feature of mental illness.     

Self-reported competence and emotional and behavioral problems in a sample of Finnish adolescents

The Youth Self-Report (YSR) was completed by 586 15- to 16-year-old Finnish adolescents. The internal consistency of the YSR problem scales ranged from 0.61 to 0.90. Girls reported significantly more internalizing, withdrawn, somatic, anxious-depressive thought and attention problems. The adolescent was defined as having maladjustment if he she had used mental health services or had more severe problems than the peer group according to parent or self-report (11% of the sample). There were significant differences at the 0.001 level on all YSR scales between maladjustment and non-maladjustment groups. In logistic regression analysis anxious-depressive and delinquency scales had the strongest association with maladjustment. The results are compared with results from previous population-based studies using the YSR in Nordic countries.     

Self-reported competence and emotional and behavioral problems in a sample of Finnish adolescents

The Youth Self-Report (YSR) was completed by 586 15- to 16-year-old Finnish adolescents. The internal consistency of the YSR problem scales ranged from 0.61 to 0.90. Girls reported significantly more internalizing, withdrawn, somatic, anxious-depressive thought and attention problems. The adolescent was defined as having maladjustment if he she had used mental health services or had more severe problems than the peer group according to parent or self-report (11% of the sample). There were significant differences at the 0.001 level on all YSR scales between maladjustment and non-maladjustment groups. In logistic regression analysis anxious-depressive and delinquency scales had the strongest association with maladjustment. The results are compared with results from previous population-based studies using the YSR in Nordic countries.     

Family factors contributing to emotional and behavioral problems in Korean adolescents with epilepsy

PurposeWe aimed to determine whether different aspects of family functioning are associated with emotional and behavioral problems in adolescents with epilepsy and, if not, to document any indirect associations mediated by other family factors.MethodsThis was a cross-sectional, multicenter study. A total of 297 adolescents with epilepsy and their parents participated. Adolescent psychopathology was measured using the Youth Self-Report. Family factors were classified into proximal (parent–child interaction), distal (parent characteristics), and contextual factors (family characteristics) in accordance to their level of proximity to the adolescent's everyday life. Regression analyses were used to analyze the unique and combined predictive power of family factors in relation to psychopathology.ResultsIn total, 44 (14.8%) and 51 (17.2%) adolescents with epilepsy scored above the borderline cutoff (T-score ≥ 60) of internalizing and externalizing problems, respectively. Proximal and distal factors were independently associated with both internalizing and externalizing problems. High levels of parental depressive mood and parental overcontrol were the strongest factors contributing to internalizing and externalizing problems, respectively. Contextual factors were indirectly associated with both internalizing and externalizing problems through more proximal factors.ConclusionsBoth proximal and distal family factors affect psychopathology in Korean adolescents with epilepsy. Parental feelings of depression and parental overcontrol are the strongest factors contributing to internalizing and externalizing problems, respectively.     

Help seeking for emotional and behavioural problems in children and adolescents

In order to understand the discrepancy between rates of child and adolescent psychopathology and rates of mental health service use, variables influencing the help-seeking process need to be investigated. The present article aims to extend and refine previous findings by reviewing 47 recent empirical studies on parental and adolescent problem recognition and help seeking, and problem recognition by the general practitioner (GP). Several variables (child age, the presence of medical and school-related problems, informal help seeking, past treatment of parents or relatives, family size, and type of maltreatment) were discovered to influence parental/adolescent problem recognition and/or help seeking,while refinements were found for the effects of type of psychopathology, child gender, adolescent attitudes and personality, parental psychopathology, social support, and sociodemographic variables. Although recent studies uncovered several determinants of problem recognition by the GP (child gender, age, past treatment, academic problems, family composition, life events, type of visit, and acquaintance with child), this aspect of the help-seeking pathway remains relatively uncharted and, therefore, needs to be the focus of future research.     

Sleep problems and mental health among young Norwegian adolescents

Abstract

Purpose: The present study investigated the associations between the aspects of sleep problems and mental health in Norwegian young adolescents.

Materials and methods: Adolescents (12–13 years) were recruited from the primary schools in Telemark County, Norway. Sleep related problems were assessed by asking parents three questions related to their childrens’ sleep quality, sleep sufficiency, and daytime sleepiness. Parents reported data on mental health by the extended version of the Strengths and Difficulties Questionnaire (SDQ), and information on the child’s physical activity, screen time, eating pattern, gender, and background variables. Height and weight were objectively measured. Complete data were obtained for 690 adolescents.

Results: Multiple logistic regressions were used. Bivariate analyses indicated important associations between the sleep aspects and mental health. When adjusting the sleep variables for each other, lifestyle factors and background variables, sleep quality problems were associated with any psychiatric problem (OR_adj: 4.0, CI: 2.0-8.2), emotional problems (OR_adj: 15.1, CI: 3.4-66.8), and hyperactivity-inattention problems (OR_adj: 5.1, CI: 2.2-12.1). Daytime sleepiness problems were associated with any psychiatric problem (OR_adj: 2.3, CI: 1.2-4.4), and hyperactivity-inattention problems (OR_adj: 2.5, CI: 1.1-5.5). Bivariate associations between problems with sufficient sleep and mental health problems lost the significance when adjusted for other sleep variables.

Conclusions: The results indicate that different aspects of sleep problems may be important underlying factors for mental health problems in adolescents, independently of lifestyle factors, BMI-category, gender, and background variables. This highlights the importance of examining specific sleep problems when investigating associations between sleep and mental health.     

Financing mental health services for children and adolescents

Proponents of extended hospitalization for the most seriously disturbed children and adolescents face increasing difficulty in obtaining funds for such expensive care. The author advocates a continuum-of-care system that will provide a spectrum of treatment modalities, and she notes that when costs are averaged for all children treated at various points on the continuum, the cost per child drops dramatically. She challenges mental health care professionals to justify their treatment effectiveness to payers (1) by developing creative treatment programs that will reduce costs and (2) by compiling research data to demonstrate the cost-effectiveness of extended hospitalization for seriously disturbed children and adolescents.