Multiple Informant Agreement of Child,Parent, and Teacher Ratings of Child Anxiety Within Community Samples

Objective:

Extant research concerning the degree of multiple informant (that is, parent, clinician, teacher, and child) agreement for child anxiety ratings generally uses clinical samples, and results have been mixed.

Method:

Our study used a community sample of public school children (n = 1039) to investigate child (self), parent, and teacher reports of child anxiety across 3 time points (pretreatement, posttreatment, and follow-up) in 3 independent school prevention and intervention trials.

Results:

Results showed that parents and teachers had high informant agreement for ratings on anxiety across the 3 time points (r = 0.95 to 0.96, P < 0.001); agreement between parent and child (self) reports and between teacher and child (self) reports consistently showed lower agreement across the 3 time points (r = 0.14 and 0.28, respectively, P < 0.001). Group differences were also significant for sex and grade, whereby females more commonly self-reported higher anxiety and children in grades 3 and 4 self-reported higher anxiety, compared with students in grades 5 to 7.

Conclusion:

Correlations between parent and teacher with child ratings were poor over 3 time points, and significant differences were found for sex and grade. Research is needed to understand reasons for poor concordance between parent, child, and teacher ratings of anxiety for all children.     

High concordance of parent and teacher attention-deficit/hyperactivity disorder ratings in medicated and unmedicated children with autism spectrum disorders

Abstract Objective: Parent and teacher ratings of core attention-deficit/hyperactivity disorder (ADHD) symptoms, as well as behavioral and emotional problems commonly comorbid with ADHD, were compared in children with autism spectrum disorders (ASD). Method: Participants were 86 children (66 boys; mean: age=9.3 years, intelligence quotient [IQ]=84) who met American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for an ASD on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS). Parent and teacher behavioral ratings were compared on the Conners' Parent and Teacher Rating Scales (CPRS-R; CTRS-R). The degree to which age, ASD subtype, severity of autistic symptomatology, and medication status mediated this relationship was also examined. Results: Significant positive correlations between parent and teacher ratings suggest that a child's core ADHD symptoms-as well as closely related externalizing symptoms-are perceived similarly by parents and teachers. With the exception of oppositional behavior, there was no significant effect of age, gender, ASD subtype, or autism severity on the relationship between parent and teacher ratings. In general, parents rated children as having more severe symptomatology than did teachers. Patterns of parent and teacher ratings were highly correlated, both for children who were receiving medication, and for children who were not. Conclusions: Parents and teachers perceived core symptoms of ADHD and closely-related externalizing problems in a similar manner, but there is less agreement on ratings of internalizing problems (e.g., anxiety). The clinical implication of these findings is that both parents and teachers provide important behavioral information about children with ASD. However, when a clinician is unable to access teacher ratings (e.g., during school vacations), parent ratings can provide a reasonable estimate of the child's functioning in these domains in school. As such, parent ratings can be reliably used to make initial diagnostic and treatment decisions (e.g., medication treatment) regarding ADHD symptoms in children with ASDs.     

Normative data and psychometric properties of the strengths and difficulties questionnaire among Japanese school-aged children

Background

Although child mental health problems are among the most important worldwide issues, development of culturally acceptable mental health services to serve the clinical needs of children and their families is especially lacking in regions outside Europe and North America. The Strengths and Difficulties Questionnaire (SDQ), which was developed in the United Kingdom and is now one of the most widely used measurement tools for screening child psychiatric symptoms, has been translated into Japanese, but culturally calibrated norms for Japanese schoolchildren have yet to be established. To this end, we examined the applicability of the Japanese versions of the parent and teacher SDQs by establishing norms and extending validation of its psychometric properties to a large nationwide sample, as well as to a smaller clinical sample.

Methods

The Japanese versions of the SDQ were completed by parents and teachers of schoolchildren aged 7 to 15 years attending mainstream classes in primary or secondary schools in Japan. Data were analyzed to describe the population distribution and gender/age effects by informant, cut-off scores according to banding, factor structure, cross-scale correlations, and internal consistency for 24,519 parent ratings and 7,977 teacher ratings from a large nationwide sample. Inter-rater and test-retest reliabilities and convergent and divergent validities were confirmed for a smaller validation sample (total n?=?128) consisting of a clinical sample with any mental disorder and community children without any diagnoses.

Results

Means, standard deviations, and banding of normative data for this Japanese child population were obtained. Gender/age effects were significant for both parent and teacher ratings. The original five-factor structure was replicated, and strong cross-scale correlations and internal reliability were shown across all SDQ subscales for this population. Inter-rater agreement was satisfactory, test-retest reliability was excellent, and convergent and divergent validities were satisfactory for the validation sample, with some differences between informants.

Conclusions

This study provides evidence that the Japanese version of the SDQ is a useful instrument for parents and teachers as well as for research purposes. Our findings also emphasize the importance of establishing culturally calibrated norms and boundaries for the instrument’s use.     

Asian American parents' attributions of children with Down syndrome: connections with child characteristics and culture

This study explores cultural differences between European American (n = 26) and Asian American (n = 17) parents' attributional ratings of children with Down syndrome. Links were examined among parents' attributions, reactions, and behaviors regarding their child's jigsaw-puzzle performance. Although the children's puzzle abilities did not differ, compared with European American parents, Asian American parents judged their child as less successful and had lower expectations for future success. Asian American parents also attributed the child's performance to lower ability and lower effort. Affectively, they indicated less sympathy and more anger and blame toward the child. Despite striking ethnic differences, parents in both groups judged their older children as more successful and reported offering them less encouragement and help. Implications of these findings are discussed.     

Preschoolers’ Psychosocial Problems: In the Eyes of the Beholder? Adding Teacher Characteristics as Determinants of Discrepant Parent–Teacher Reports

In this study, we explored informant characteristics as determinants of parent–teacher disagreement on preschoolers’ psychosocial problems. Teacher characteristics were included in the analyses, in addition to child and parent factors. Psychosocial problems of 732 4-year olds from a Norwegian community sample were assessed by parents and teachers (CBCL-TRF). Furthermore, teachers reported on their education, experience and relationship to the child. Parental stress and psychopathology were also measured. Teachers rated children considerably lower than their parents did, especially on internalizing problems. When teachers rated more child problems, this was strongly associated with conflict in the teacher–child relationship, which predicted disagreement more than other factors. The highest agreement was on boys’ externalizing problems. Girls’ behavior was rated much lower by teachers than boys’ behavior compared to parents’ ratings. Possible teacher perception biases are discussed, such as teacher–child conflict, non-identification of internalizing problems, and same-gender child preference.     

Aggression, hostility, and irritability in children at risk for bipolar disorder

OBJECTIVES: To assess aggression, irritability and hostility in children at risk for bipolar disorder (BP). METHODS: Using the parent and the child versions of the Children's Hostility Inventory (CHI), we assessed aggression, hostility, and irritability in 300 offspring aged 6-18 years old of BP parents and 169 children of community controls. RESULTS: Children of BP parents have significantly higher scores on the total CHI and its subscales than do children of control parents. After adjusting for demographic variables, both parents' non-BP psychopathology, child psychopathology, and within-family correlations, three factors remain significant: total CHI by parent rating, irritability subscale by parent rating, and irritability by child self-report. The hostility subscale by parent rating became a trend. CONCLUSIONS: Children of BP parents score higher on ratings of hostility and irritability than children of community control parents, independent of child psychopathology and non-BP parental psychopathology. Follow-up of these children to evaluate whether these symptoms are markers for the development of BP or mood disorders is warranted.     

Parent-child agreement regarding children's acute stress: the role of parent acute stress reactions

OBJECTIVE: We examined parent-child agreement regarding child acute stress disorder (ASD) and the relationship between parent ASD symptoms and parent ratings of child ASD. METHOD: Parent-child dyads (N = 219; child age 8-17 years) were assessed within 1 month of child injury. Parent-child agreement was examined regarding child ASD presence, severity, and specific symptoms. Relationships among parent ASD and parent- and child-reported child ASD were examined using regression analysis and generalized estimating equations (GEE). RESULTS: Parent-child agreement was low for presence of child ASD (kappa = 0.22) and for individual symptoms. Parent and child ratings of child ASD severity were moderately correlated (r = 0.35). Parent ASD was independently associated with parent-rated child ASD, after accounting for child self-rating (beta =.65). Generalized estimating equations indicated that parents with ASD overestimated child ASD and parents without ASD underestimated child ASD, compared to the child's self-rating. CONCLUSIONS: Parents' own responses to a potentially traumatic event appear to influence their assessment of child symptoms. Clinicians should obtain child self-report of ASD whenever possible and take parent symptoms into account when interpreting parent reports. Helping parents to assess a child's needs following a potentially traumatic event may be a relevant target for clinical attention.     

Agreement Between Parents and Teachers on Preschool Children’s Behavior in a Clinical Sample with Externalizing Behavioral Problems

An accurate interpretation of information obtained from multiple assessors is indispensible when complex diagnoses of behavioral problems in children need to be confirmed. The present study examined the similarity of parents and kindergarten teachers ratings on children’s behavior in a sample of 160 preschool children (a clinical group including 80 children with externalizing behavioral problems and a matched control group including 80 children). Behavioral problems were assessed using the SDQ, and the DISYPS-II questionnaires for ADHD and conduct disorders. The results revealed low levels of parent–teacher agreement for their ratings on the children’s behavior in both groups with the highest correlations in the non-clinical sample. Parent–teacher agreement did not differ significantly across the samples. Parent and teacher ratings correlated with the prevalence of externalizing disorders and were found to be almost independent of each other. The results highlight the importance of multiple informants and their independent influence within the diagnostic process.     

Modelling sources of informant variance in parent and teacher ratings of child psychopathology

Factors influencing agreement between parent and teacher ratings of child psychopathology were studied in a population-based survey of 1458 children aged six to 11. Child psychopathology was assessed with the Child Behaviour Checklist. Agreement on the internalizing scale, the externalizing scale, and the total score was assessed using log-linear models. Characteristics of the children and the informants, as well as variables pertaining to the testing conditions, were examined as possible predictors of informant agreement. In general, parent–teacher agreement was low on all three scales, especially on the internalizing scale, although it was significantly better than chance. Most of the beyond-chance agreement was due to the tendency for parents to give higher ratings when teachers did (correlation of ratings). Measures representing the teacher's familiarity and contact with the child were significant predictors of agreement for both the internalizing and externalizing scales. Agreement on the externalizing ratings was also influenced by several other factors, including the child's age and religion, the parent informant's gender and education, as well as school grade. Predictors of agreement on the total score included the child's age and gender, factors related to the child's academic functioning and need for treatment as perceived by the parent, and the parent's and teacher's preference for different mental health treatment providers. Copyright © 1998 Whurr Publishers Ltd.     

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.     

Three-year course of behavioral/emotional problems in a national sample of 4- to 16-year-olds: I. Agreement among informants.

Quantitative and categorical indices of psychopathology are reported for a nationally representative longitudinal sample assessed via eight empirically derived cross-informants syndromes, internalizing, externalizing, and total problems. Results showed medium to large stabilities for parents' ratings during a 3-year interval on all comparable scales. Predictive correlations between time 1 parents' ratings and time 2 teacher and self-ratings were weaker than parent-to-parent correlations. Classification of children as deviant showed weaker predictive relations than did quantitative scores. Odds ratios showed that children classified as deviant by parents' time 1 ratings were much more likely to be deviant at time 2 on corresponding parent, teacher, and self-ratings than were children initially classified as nondeviant.     

Parent–Teacher Disagreement on Ratings of Behavior Problems in Children with ASD: Associations with Parental School Involvement Over Time

ASD symptomology and behavioral problems pose challenges for children with ASD in school. Disagreement between parents and teachers in ratings of children’s behavior problems may provide clinically relevant information. We examined parent–teacher disagreement on ratings of behavior problems among children with ASD during the fall and spring of the school year. When child, teacher, and class characteristics were considered simultaneously, only ASD symptom severity predicted informant disagreement on internalizing and externalizing behavior problems. We also examined associations between informant disagreement and parent school involvement. Cross-lagged panel analyses revealed that higher informant disagreement on children’s behavior problems in the fall predicted lower parent school involvement in the spring, suggesting that greater informant agreement may foster parental school involvement over time.

     

Parent and Teacher Ratings of Challenging Behaviour in Young Children with Developmental Disabilities

Parent and teacher ratings on the Aberrant Behaviour Checklist were compared to determine its reliability for assessing challenging behaviour in young children with developmental disabilities. Twenty-four boys and eight girls aged 20 to 72 months (mean age = 51 months) were assessed independently by a parent and teacher using the Aberrant Behaviour Checklist. There were no significant differences between parent and teacher ratings on any of the five subscales. Spearman's rank correlation coefficients between parent and teacher ratings for each of the five subscales ranged from 0.50 to 0.83 (mean = 0.62). All correlations were significant (p < 0.01). Confirmatory factor analyses generated item loadings consistent with the original factor structure of the ABC and similar component loadings for parents and teachers. These results suggest the Aberrant Behaviour Checklist can provide a reliable assessment of challenging behaviour when used by parents and teachers of young children with developmental disabilities.     

Teachers' ratings of the academic performance of children with epilepsy

The present study examined how knowledge of a child's seizure condition is related to teachers' assessment of the child's academic ability. Children with epilepsy were divided into two groups based on teachers' awareness of the children's seizure condition (Label). The children's achievement was assessed using the Woodcock Johnson Tests of Achievement-Revised (WJ-R), and the teacher's ratings were obtained from the Child Behavior Checklist Teacher Report Form (TRF) (Source). A 2 (Source) x 2 (Label) mixed-design analysis of covariance (controlling for IQ and how well the teacher knew the child) revealed a significant interaction, F(1,121)=4.22, P=0.04. For the WJ-R there was no effect of Label on Achievement, but on the TRF lower scores were observed for children who were labeled. These results support the hypothesis that some teachers might underestimate the academic abilities of children with epilepsy.     

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.     

Rapid quantitative assessment of autistic social impairment by classroom teachers

OBJECTIVE: Teachers routinely observe children in the naturalistic social contexts of their classrooms and provide extremely important input in the evaluation of numerous psychiatric syndromes. Their precision in ascertaining and quantifying autistic symptomatology has not previously been established. In this study, we compared teachers' ratings of autistic symptomatology with those derived from parents, expert clinicians, and trained raters. METHOD: A total of 577 subjects (ages 4-18 years) with (n = 406) and without (n = 171) pervasive developmental disorders (PDDs) were assessed by one parent and one current teacher using the Social Responsiveness Scale, a quantitative measure of autistic traits. PDD subjects were assessed by expert clinicians, the Autism Diagnostic Interview-Revised, and/or the Autism Diagnostic Observation Schedule. All of the assessments were conducted during the period 1996-2006. RESULTS: Teacher Social Responsiveness Scale reports exhibited strong correlations with parent reports (0.72); use of quantitative ratings from both informants resulted in extremely high sensitivity and specificity for clinical and research diagnoses of PDDs (area under receiver operating characteristics curve = .95). CONCLUSIONS: Rapid quantitative assessments by teachers and parents constitute a cost-effective method for measuring and tracking the severity of autistic symptomatology in both educational and clinical settings.     

Help-seeking process of parents for psychopathology in youth with moderate to borderline intellectual disabilities

OBJECTIVE: To study the help-seeking process of parents for emotional or behavioral problems in their child with borderline to moderate intellectual disabilities. METHOD: In 2003, in a special education-based sample of 522 youths (ages 10-18 years, response = 77.9%), we studied the parents' perception of their child's problems, their subsequent felt need for professional help, actual help-seeking, and the factors possibly related to taking these steps. RESULTS: Even when parents indicated their child's emotional or behavioral functioning as "neither good nor bad," in about 70%, these problems were present according to standardized measures. Of the 213 parents (40.8%) who perceived problems, 70.6% felt a need, and 55.2% of these parents subsequently sought professional help. Parents more often sought help when their child had problems of anxiety and depression, experienced negative life events, and when parents perceived child psychopathology before the past year. Reported barriers to seeking help predominantly related to parents' evaluation of the severity of these problems and wanting to solve the problems themselves. CONCLUSIONS: Clinicians and other service providers should address parents' concerns regarding their child's emotional/behavioral functioning and treatment seeking. Also, they should provide information on treatment options and on signs and potential negative prospects of their child's problems.     

Agreement in multi-informant assessment of behaviour and emotional problems and social functioning in adolescents with Autistic and Asperger's Disorder

There is a paucity of evidence concerning the patterns of multi-informant agreement in populations with Autism Spectrum Disorders (ASD). This study compared ratings of behaviour and emotional problems and social functioning provided by 45 adolescents aged 12–18 years, with Autistic or Asperger's Disorder with ratings by their parents and teachers. Behaviour and emotional problems were measured using the Child Behaviour Checklist and social functioning was measured with the Social Skills Rating System. Moderate agreement was found between adolescent and parent ratings of psychopathology and social functioning. In general, parent and teacher ratings and adolescent and teacher ratings differed significantly. These findings suggest that behaviour varies across environmental contexts. Patterns of agreement between multiple informants observed in the current study frequently differed from those previously found in non-ASD populations. Clinicians and researchers need to consider a multi-informant approach to obtain a detailed picture of behaviour and emotional problems in adolescents with autism and Asperger's Disorder.     

The "military family syndrome" revisited: "by the numbers"

Because concerns have been raised about high levels of psychopathology in military children, the authors used standardized psychopathology rating scales to survey 213 six-to twelve-year-old children of military parents and their parents. Results from children's symptom self-reports, as well as from teachers' ratings of children, indicated that children's symptom levels were at levels consistent with national norms. In contrast, parents' (especially mothers') ratings of children were significantly higher than national norms, as were parents' ratings of their own symptoms. Also, parents' own symptom reports showed somewhat stronger relationships with life stressors presumably affecting the child than did the children's and teachers' reports. Results suggest that parents' reports of children's symptoms may be mediated by the effects of military life stressors on the parents, but these stressors do not necessarily result in higher symptoms in the children. Overall results do not support the notion that levels of psychopathology are greatly increased in children of military parents. Further studies of military families should address the effects of rank and socioeconomic status, housing, and the current impact of life stressors on the parents as well as the children in order to avoid drawing erroneous conclusions about parts or all of the military community.