Parent reports of child behavior problems in young Sami children: a cross-cultural comparison

 In a general population study of 4-year-olds, using the Child Behavior Checklist (CBCL), parent reports of child behavior problems were compared in samples of 67 monoethnic Sami, 52 multiethnic Sami/Norwegian, and 63 monoethnic Norwegian children from the Sami core area in northern Norway. Mean CBCL total problem scores were low for all three groups [Sami: 21.1 (SD 15.5), Sami/Norwegian: 19.4 (SD 12.2) and Norwegian: 18.8 (SD 13.6)]. No significant differences across ethnic groups were found for the Total Problems scale and the Internalizing and Externalizing scales, nor for the syndrome scales, except for the Withdrawn scale, the Sami/Norwegian sample showing the highest scores. However, significant ethnicity × gender interactions emerged, indicating that the effect of ethnicity was different for boys versus girls. Sami mothers reported the highest and the Norwegian mothers the lowest scores for girls, whereas the opposite pattern was found for boys. Correlations between mothers' and fathers' reports were generally low. Differences in mean scale scores between pairs of parents (n = 122) were found for boys but not for girls, mothers scoring higher than fathers. The authors underline the importance of taking gender differences, age and ethnic context into account when assessing problem behavior in minority children. Methodological problems in cross-cultural assessments, including the influence of cultural norms of child behavior on parents' problem ratings, are discussed. Accepted: 18 January 2000     

Social competence and emotional/behavioral problems in a birth cohort of Sami and Norwegian preadolescents in Arctic Norway as reported by mothers and teachers

In a 7-year follow-up birth cohort from the general population in the Sami core area in Finnmark, Arctic Norway, we examined mothers’ and teachers’ reports of social competence and emotional/behavioral problems among 71 indigenous Sami and 77 Norwegian 11–12-year-olds. The instruments used were the Child Behavior Checklist (CBCL) for parents and the Teacher Report Form (TRF). No ethnic differences were found on competence scales. Total Problems reported by Sami and Norwegian mothers were low in comparison with the overall mean found in multicultural meta-studies. Sami mothers reported lower Total Problems and Attention Problems than did Norwegian mothers. There were no ethnic differences on the TRF measures. Consistent with other international studies, mothers and teachers rated girls higher than boys on social competence and boys higher than girls on Externalizing and Attention Problems. Gender differences were larger on the TRF than on the CBCL. The very low problem ratings made by the Sami mothers indicate that there is a need for specific clinical cut-off points to distinguish between clinically referred and non-referred children in this indigenous Arctic population.     

Discriminant validity of the Child Behaviour Checklist CBCL-4/18 in German samples

This study examined the discriminant validity of the German version of CBCL in two large samples of referred and non-referred children and adolescents which were matched for age, sex and socio-economic status. The combined sample that was used for statistical analysis consists of 2,058 referred and 2,058 non-referred boys and girls between 4 and 18 years of age (mean age: referred boys= 10.9 years, non-referred boys = 10.9 years, referred girls=11.3 years, non-referred girls=11.1 years). Referral status was used as validity criterion. Statistical procedures included Odds Ratios, Total Predictive Values, ROC analyses and discriminant analyses. Results indicated that the discriminant validity of the German version of CBCL is comparable to the original English version. With the use of CBCL Total Problem Score as predictor (cut-off T > or = 60) 83.8% of children and adolescents could correctly be classified (sensitivity 83.6%, specificity 83.9%). Symptoms of the "Attention Problems Scale" show the highest discriminative power to distinguish between disturbed and undisturbed children and adolescents.     

Continuity and change of psychopathology from childhood into adulthood: a 14-year follow-up study

OBJECTIVE: To test the 14-year continuity and change of behavioral and emotional problems from childhood into adulthood. METHOD: For 1,615 children and adolescents aged 4 to 16 years from the general population, parents completed the Child Behavior Checklist (CBCL) at initial assessment. At follow-up 14 years later, subjects completed the Young Adult Self-Report (YASR), and their parents completed the Young Adult Behavior Checklist (YABCL). RESULTS: Of the subjects who were initially classified as deviant, 14 years later 41% were classified as deviant according to their YABCL Total Problem score, and 29% according to their YASR Total Problem score. Intrainformant (CBCL/YABCL) Withdrawn, Social Problems, Delinquent Behavior, and Aggressive Behavior scores, and cross-informant (CBCL/YASR) Anxious/Depressed, Thought Problems, and Delinquent Behavior scores were independent predictors of general levels of problem behavior. CONCLUSIONS: Childhood and adolescent problems persisted to a considerable degree into adulthood, although the majority of children who were deviant at initial assessment could not be regarded as deviant 14 years later. Children who were adolescents at initial assessment (12-16 years) showed higher stability of problem behaviors than subjects who were children at initial assessment (4-11 years).     

Symptoms defined by parents' and teachers' ratings in attention-deficit hyperactivity disorder: changes with age.

OBJECTIVE: To determine whether Child Behavior Checklist/4-18 (CBCL) and Teacher Report Form (TRF) scores of children and adolescents with a first-time diagnosis of attention-deficit hyperactivity disorder (ADHD) are different and whether there is a similar difference in normal control subjects. METHOD: We analyzed the CBCL and TRF scores of 146 patients (124 boys and 22 girls, aged 6 to 18 years; mean age 11.0 years, SD 3.6). We analyzed the same scores for 274 age and sex-matched control subjects recruited from a nationally representative sample. RESULTS: Subjects with ADHD had significantly higher CBCL and TRF scores than control subjects. Age was significantly correlated with scores on the CBCL and TRF subscales Social Withdrawal, Somatic Complaints, and Internalization Problems; with scores on the CBCL subscale Attention Problems; and with scores on the TRF subscale Anxiety-Depression. In the group with ADHD, age was negatively correlated with scores on the CBCL and TRF subscale Externalizing Problems and with scores on the TRF subscale Aggressive Behavior. In the control group, the only significant correlation was between age and the CBCL subscale Somatic Complaints score. CONCLUSIONS: These results indicate that underdiagnosis of ADHD in childhood may cause the emergence of greater internalization problems in adolescence.     

Recurrent seizures and behavior problems in children with first recognized seizures: a prospective study

PURPOSE: Children with epilepsy have high rates of behavior problems. The purpose was to describe prospectively the association of seizures and behavior problems in children with new-onset seizures. METHODS: Subjects were 224 children with new-onset seizures (aged 4-14 years) and 159 siblings (4-18 years). Caregiver's ratings of the behavior were collected 4 times: at baseline, and at 6, 12, and 24 months. During the 2-year period, 163 (73%) children had at least one additional seizure, and 61 (27%) had none. Data were analyzed by using repeated measures analysis of variance both with and without covariates [site, age, gender, race, caregiver education (years), and seizure medications]. RESULTS: On average, children had higher CBCL Total and Internalizing Behavior Problems scores across all times when experiencing recurrent seizures than when not experiencing recurrent seizures (Total Problems, p = 0.041, controlling for demographics and seizure medications). Siblings had significantly lower Total and Internalizing Problems scores than both children experiencing (Total Problems adjusting for covariates, p = 0.0001) and not experiencing recurrent seizures (p = 0.0004). Externalizing Problems scores were not significantly different among children with recurring seizures, children without recurring seizures, and siblings. CONCLUSIONS: Recurrent seizures significantly predicted behavior problems very early in the course of a seizure condition, even when key child, demographic, and seizure variables were controlled. Explanations for these findings include the possibilities that both seizures and behavior problems are caused by an underlying neurological disorder, that seizures per se disrupt behavior, or that children have negative psychological responses to seizure activity.     

Prevalence and risk factors of behavioral and emotional problems among Chinese children aged 6 through 11 years

OBJECTIVE: To examine the prevalence and risk factors of behavioral and emotional problems in Chinese children. METHOD: A sample of 2,940 children aged 6 through 11 years was randomly drawn from household registers in Shandong Province of China. Parents completed the Child Behavior Checklist (CBCL) and a structured self-rating questionnaire. RESULTS: The mean CBCL Total Problems score was 16.1 (SD = 14.0). There was no significant age effect on the Total Problems score; boys scored significantly higher than girls (17.2 versus 15.0; F = 24.94, p < .01). The overall prevalence rates of behavioral problems were 12.5% for boys and 8.3% for girls (chi 2 = 14.23, p < .01). Logistic regression analysis showed that a number of parental, prenatal, perinatal, and postnatal factors were significantly associated with increased risk of children's behavioral problems. CONCLUSIONS: The prevalence of parent-reported behavioral problems in Chinese children is lower than those found in other countries. Of multiple psychosocial and biological factors associated with children's behavioral problems, separation or divorce of parents is the most significant factor.     

Genetic influences on childhood competencies: a twin study

OBJECTIVE: To estimate genetic, environmental, and rater contrast influences on parental reports of Activities, Social, School, and Total Competence scales of the Child Behavior Checklist (CBCL). METHOD: Parents of 492 twin pairs aged 8-12 years completed CBCLs. Genetic, shared and unique environmental, and rater bias effects were estimated for the Activities, Social, School, and Total Competence scales. Data on boys and girls were analyzed separately. RESULTS: Moderate genetic influences were found only for the School scale (60%-76%), while shared environment accounted for most of the variance in Activities, Social, and Total Competence scales. Gender differences are reported. Similar to a prior twin study of CBCL problem syndromes, there was no evidence of rater bias. CONCLUSIONS: Estimates of genetic influence on these child competence domains were high for School Competence, while social competence and activity competence evidenced higher levels of shared environmental influences. Organization and wording of CBCL items may avoid rater biases in reporting. These findings have implications for interventions to improve school, social, and activities competence.     

Problems and competencies reported by parents of Vietnamese children in Hanoi.

OBJECTIVE: To determine the distribution of behavioral and emotional problems and competencies among a sample of Vietnamese children aged 4 through 18 years living in Hanoi. METHOD: A representative community sample of 1,526 children and adolescents was selected from 2 precincts in Hanoi. Problems and competencies were assessed with the Child Behavior Checklist (CBCL). RESULTS: Vietnamese children had lower mean raw scores than U.S. norms on the CBCL's Total, Externalizing, Internalizing, and Competence scales. Boys were reported to have more externalizing problems and girls more internalizing problems. Girls' levels of internalizing problems increased significantly with age. CONCLUSION: The lower levels of problems and competencies reported in Vietnamese children may represent differences in the prevalence of psychiatric disorders, in parental perceptions of what constitutes deviant behavior, or in parental comfort with reporting psychopathological behaviors. Further research is needed to clarify the relationship between the reported behavioral and emotional problems of Vietnamese children and the presence of psychiatric disorders. From a clinical perspective, the study's results suggest that levels of problems and competencies may vary significantly between different ethnic and cultural groups. Specific clinical cutoffs used to identify children requiring further psychiatric assessment need to be established separately for different ethnic groups.     

Parenting correlates of child behavior problems in a multiethnic community sample of preschool children in northern Norway

Abstract. A multiethnic community sample of 191 families with four-year-old children in northern Norway was used to explore whether parenting factors were associated with child behavior problems, and whether these associations differed for boys and girls or for the two main ethnic groups in this region: the indigenous Sami and the majority Norwegians. The Child Behavior Checklist (CBCL) and a semi-structured interview on child-rearing were used as instruments. As would be expected from a developmental perspective, elevated scores of child behavior problems were associated with lower levels of parental cuddling and with higher levels of physical punishment. Family demographics such as low maternal age and single parenthood were also associated with more behavioral problems. Girls seemed to be more strongly influenced by child-rearing factors than boys. Subgroup analyses suggested that for harsh treatment, patterns of correlations differed between Sami and Norwegian groups, especially for boys. A positive correlation between physical punishment and externalizing problems emerged for Norwegian boys, but not for Sami boys. Teasing/ridiculing was positively correlated with internalizing problems for Norwegian boys, but inversely correlated for Sami boys. These findings emphasize the importance of taking the childs cultural context and gender into account when assessing parenting influences on behavioral problems in children.     

Psychosocial problems among immigrant and non-immigrant children

Abstract Background This study aims to examine a) the prevalence of psychosocial problems and b) the association between parent-reported problems and the identification by doctors and nurses (child health professionals, CHP) working in preventive child health care, among immigrant and non-immigrant children. Methods CHPs examined 4,098 children aged 5 through 15 years (response: 90.1%) and interviewed parents and children during their routine health assessments in 19 Child Healthcare Services across the Netherlands, serving nearly all school-aged children routinely. The Child Behavior Checklist (CBCL) was completed by the parents. We compared five ethnic groups: indigenous Dutch, economic immigrants, immigrants from (former) Dutch colonies, from other non-industrialised, and from other industrialised countries. Results The prevalence of parent-reported problems on the CBCL is higher among children from former Dutch colonies and economic immigrant children than among indigenous children, especially regarding internalising problems (odds ratios (OR); 95% confidence interval: 1.84; 1.03 to 3.29, and 2.52; 1.46 to 4.34). CHPs identified more problems among economic immigrant children (OR: 1.62; 1.01 to 2.60). Regarding associations, rates of CHP-identified problems were higher among indigenous children with clinical compared with normal CBCL Total Problems scores (OR: 6.90; 5.27 to 9.03), but not among economic immigrant children (OR: 0.73; 0.16 to 3.21). Conclusions Psychosocial problems occur more frequently among some immigrant groups. CHP identification of psychosocial problems is poorly associated with parent report regarding economic immigrant children. This needs to be improved in order to provide better care.     

Behavioral and emotional problems in Chinese adolescents: parent and teacher reports.

OBJECTIVE: This study examined behavioral and emotional problems in Chinese adolescents. METHOD: A sample of 1,694 adolescents aged 12 to 16 years participated in this study in 1997. Parents completed the Child Behavior Checklist (CBCL), and teachers completed the Teacher's Report Form (TRF). RESULTS: For both parent and teacher reports, internalizing syndromes were scored higher in girls and externalizing syndromes were scored higher in boys. Scores on most of the CBCL and TRF subscales were higher for the older adolescents. The overall prevalence rates of parent- and teacher-reported behavioral problems were 23.1% and 19.2%, respectively. The eight cross-informant syndromes were highly comorbid, with a significant association across syndromes (mean odds ratio = 16.1 for CBCL and 22.5 for TRF). Correlations between parent and teacher reports were 0.51 for eight subscales and 0.68 for Total Problems. CONCLUSIONS: These findings demonstrate that behavioral and emotional problems tend to increase with age and cluster in the same individuals. The prevalence rates of behavioral problems in Chinese adolescents are comparable to those reported in Western countries. In contrast to findings for Western samples, parent reports of behavioral problems were highly correlated with teacher reports.     

The social competence and behavioral problem substrate of new- and recent-onset childhood epilepsy

This study examined patterns of syndrome-specific problems in behavior and competence in children with new- or recent-onset epilepsy compared with healthy controls. Research participants consisted of 205 children aged 8–18, including youth with recent-onset epilepsy (n = 125, 64 localization-related epilepsy [LRE] and 61 idiopathic generalized epilepsy [IGE]) and healthy first-degree cousin controls (n = 80). Parents completed the Child Behavior Checklist for children aged 6–18 (CBCL/6–18) from the Achenbach System of Empirically Based Assessment (ASEBA). Dependent variables included Total Competence, Total Problems, Total Internalizing, Total Externalizing, and Other Problems scales. Comparisons of children with LRE and IGE with healthy controls were examined followed by comparisons of healthy controls with those having specific epilepsy syndromes of LRE (BECTS, Frontal/Temporal Lobe, and Focal NOS) and IGE (Absence, Juvenile Myoclonic, and IGE NOS). Children with LRE and/or IGE differed significantly (p < 0.05) from healthy controls, but did not differ from each other, across measures of behavior (Total Problems, Total Internalizing, Total Externalizing, and Other Problems including Thought and Attention Problems) or competence (Total Competence including School and Social). Similarly, children with specific syndromes of LRE and IGE differed significantly (p < 0.05) from controls across measures of behavior (Total Problems, Total Internalizing, and Other Problems including Attention Problems) and competence (Total Competence including School). Only on the Thought Problems scale were there syndrome differences. In conclusion, children with recent-onset epilepsy present with significant behavioral problems and lower competence compared with controls, with little syndrome specificity whether defined broadly (LRE and IGE) or narrowly (specific syndromes of LRE and IGE).     

Competence, emotional and behavioural problems in Russian adolescents

Competence, emotional and behavioural problems were examined in 256 school-children, aged 13–17 years, in Novosibirsk, Russia, using the Youth Self-Report (YSR), the Child Behavior Checklist (CBCL) and the Teacher's Report Form (TRF). The internal consistency of syndrome scales for all three instruments was generally adequate. Interrater agreements for the problem scales were higher for girls than for boys in all combinations of informants. These findings are discussed in terms of gender role development. Gender effects on the scales' scores were more numerous and stronger than age. No SES differences were found. Russian children reported more problems than children of other nationalities did. Compared with American children, Russians were lower on competencies and higher on Somatic complaints and self-reported behavioural problems. On competence scales, Russian children in an unselected sample scored themselves lower than American children in a clinical sample. It is supposed that low self-esteem may be the first effect of the unfavourable development in Russian adolescents. Accepted: 7 May 1999     

Social competence and emotional/behaviour problems in 6–16 year-old Swedish school children

Social competence and emotional/behavioural problems as reported by parents on a Swedish version of the Child Behaviour Checklist (CBCL) were examined in 1308 Swedish school-aged children/adolescents recruited from a stratified, random sample of schools in urban, semirural, and rural areas in Uppsala County, Sweden, and from Stockholm, the capital city of Sweden. The overall response rate was 80.6%. Few gender differences were found, but adolescents received higher problem scores and higher social competence scores than the younger children. Children from the middle SES groups were regarded as having higher social competence levels, and children from the lower SES groups had higher emotional/behaviour problem scores. Children from the larger cities consistently obtained higher problem scores. Those who had received help during the previous year because of psychological problems (2%) had much higher problems scores than those who had not received help. The levels of emotional/behavioural problems in children and adolescents in the present sample seem to be comparable to those reported in similar Scandinavian studies where the CBCL has been used. However, they were considerably lower than those commonly reported in epidemiological studies of children/adolescents from other countries and cultures. Accepted: 26 August 1998     

The validity of the Child Behavior Checklist for children with epilepsy

The validity of the Child Behavior Checklist (CBCL) for patients with epilepsy has been questioned, because several items may reflect seizure semiology rather than habitual behavior. This study compared a standard version of the CBCL with an adjusted version that excluded those ambiguous items. Participants were 58 pediatric patients with epilepsy who were assessed preoperatively and 1 year after successful surgical treatment. Before surgery, the adjusted version indicated significantly lower values for the scales Attention Problems, Thought Problems, and Total Problems than the standard version. After surgery, the difference between the standard and adjusted versions and the scores for the ambiguous items were unchanged, although all patients were completely seizure free at that time. Elevated scores on the ambiguous items thus probably reflect real behavioral problems and are not due to confusion with seizure semiology. The results support the CBCL as a valid assessment tool in children with epilepsy.     

Agreement between parent- and self-reports of Algerian adolescents' behavioral and emotional problems

The present study examined agreement between scores obtained from self-reports of behavioral and emotional problems obtained from 513 Algerian adolescents on the Youth Self-Report (YSR) with scores obtained from reports provided by their parents on the Child Behavior Checklist (CBCL). The correlations between self- and parent-report were larger than those observed in many other cultures (e.g., intraclass correlation coefficient = 0.60 and Pearson r = 0.65 for Total Problems). On the whole, cross-informant agreement did not vary significantly as a function of problem type, identity of the parental informant, gender and age of the adolescent. Similar to all studied cultures, adolescents on average reported more problems than their parents reported about them, but the discrepancies were smaller than in all previous societies. Mean YSR/CBCL score discrepancies indicated higher YSR scores for several scales, but variability across dyads was large, and many dyads showed the opposite pattern.     

Self-reported behavioural/emotional problems in Norwegian adolescents from multiethnic areas

Self-reported behavioural/emotional problems were studied in 2647 15-18-year-old high school students by Youth Self-Report (YSR), Symptom Checklist (SCL-12) and a Conduct Problem scale. The response rate was 85%. The respondents were from three ethnic groups in northern Norway: indigenous Sami, Kvens (descendants of Finnish-speaking immigrants from northern Finland and Sweden) and Norwegians. Females' mean scores were higher than males' scores for Total Problems [47.2 (SD 19.3) vs. 40.9 (SD 19.4)], Internalising Problems, the Internalising syndrome scales and the Attention Problems scale. Males' mean scores were higher than females' scores for Delinquent Behaviour. There were few differences between the ethnic groups, but Sami had higher scores than Norwegians for the Withdrawn and Social Problems syndromes. Parental status (whether parents were living together) was weakly associated with Total Problems, Internalising and Externalising Problems, while age, socioeconomic status and urban/rural location were not associated with the problem scales. Results for Anxiety-depression (SCL-12) and Conduct Problems were compared with a national representative adolescent sample (n = 4567), showing slight differences between the samples in Anxiety-depression (with north Norwegian adolescents having lower scores) and no significant differences in Conduct Problems.     

Achenbach's Child Behavior Checklist and Teachers' Report Form in a normative sample of Greek children 6–12 years old

 Achenbach's Child Behavior Checklist (CBCL) and Teachers' Report Form (TRF) were administered to 6–12 year old school children comprising a large random community sample (n = 1200) drawn from the whole of Greece. These are the first data on the TRF in Greece and the first nation-wide data on the CBCL. Appropriate cutoff points for the behavioral problems and competence scales of both questionnaires were obtained for boys and girls. These were considerably higher than USA cutoffs for the CBCL but not for the TRF. Analysis of scores in relation to degree of urbanization showed that it was not necessary to define different cutoffs in different strata. Parents' and teachers' ratings of the same child were most highly correlated for Externalizing and Aggressive behavior for boys and for Attention problems for both sexes. Accepted: 9 December 1998     

Mental health, behaviour problems and incidence of child abuse at the age of 16 years

Of the 1,575 pregnant women registered at the public Antenatal Health Care Service in the city of Link?ping, Sweden during 1983, an index group of 78 women was identified that met specific well-defined psychosocial risk criteria related to drug addiction, mental insufficiency, and particular social circumstances of possible relevance to problems of pregnancy and early child development. A further 78 pregnant women who did not meet the inclusion criteria were used as a reference group. The present study is a 16-year follow-up in which 43 (57%) of the original index children and 63 (82%) of the original reference children were examined on indices of mental health, and the presence of child abuse. Their mental health was assessed with the Child Behaviour Checklist (CBCL) completed by the mothers and the Youth Self-Report (YSR) completed by the adolescents. The incidence of child abuse and Social Welfare interventions was obtained from Social Welfare records. The index children, especially the boys, displayed significantly poorer mental health as assessed by both CBCL (p<0.05) and YSR (p<0.02). Being an index child increased the odds ratio 16-27 times for different Social Welfare interventions, and child abuse had been investigated in 27% of the index children compared to 1% of the reference children.