Psychosocial functioning and psychiatric comorbidity among substance-abusing Icelandic adolescents

Our objectives were to compare behaviour problem scores (BPS) for Icelandic adolescents admitted for detoxification treatment for alcohol and narcotic abuse as compared with the general population, in accordance with the Youth Self Report (YSR), and to describe psychosocial functioning and psychiatric comorbidity for the treated adolescents. The case series consisted of 103 adolescents, ages 12-18 years, who completed the YSR at the end of a 10-day stay at the National Hospital of Addiction Medicine. The total BPS tallied from the YSR items was compared with scores for the general population. The psychiatric comorbidity and psychosocial functioning of the case series were assessed through diagnostic interviews in accordance with DSM-IV and ICD-10 criteria. The BPS for the 36 treated girls was significantly higher than for the general population (104 versus 36) and higher than for the 56 treated boys (82 versus 56) with 2 standard deviations above the norm for the population. Three-quarters of the adolescents had psychiatric comorbidity: conduct disorder (44%), depression (28%), or posttraumatic stress disorder (11%). The findings support the discriminative validity of the YSR as part of a structured global assessment of substance-abusing adolescents, in particular to identify the frequently present psychiatric comorbidities.     

Patterns of agreement among parent, teacher and youth ratings in a referred sample

ObjectiveThe purpose of this study was to investigate the degree of agreement among parents, teachers and adolescents with respect to the Child Behavior Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self Report (YSR). In addition we evaluated the suitability of these three forms (CBCL, TRF and YSR) in terms of their contribution to understanding internalizing and externalizing disorders in youths being referred to a child and adolescent unit of a psychiatric care facility.MethodsA total of 611 patients aged 11–18 years (mean age 13.0, SD 1.6) were assessed using the CBCL, the TRF and the YSR.ResultsIntraclass coefficients (ICC) showed low to moderate agreement among informants. Furthermore, the level of agreement was generally less among patients suffering from internalizing disorders than for young patients who displayed externalizing disorders. Logistic regression revealed that the TRF internalizing syndrome scale, the CBCL internalizing syndrome scale and gender were relevant prognostic factors for the occurrence of internalizing disorders in youth. The YSR internalizing syndrome scale, on the other hand, was not a relevant factor among adolescents of a clinical target population. Likewise, only the TRF externalizing syndrome scale, the CBCL externalizing syndrome scale and gender were relevant prognostic factors for the occurrence of externalizing disorders in youth.ConclusionsParticularly the CBCL and TRF are useful instruments in assessing internalizing and externalizing disorders in adolescents referred to a mental health setting.     

Agreement between youth-reported and parent-reported psychopathology in a referred sample

Objective  The study examined parent-youth agreement regarding reports on psychopathology among adolescents suffering from psychiatric disorders. Method  A total of 1,718 patients between the age of 11 and 18, as well as their parents, were assessed using the child behavior checklist (CBCL), and the youth self-report (YSR). Results  Poor to low agreement between parent- and adolescent-reported problem behavior on the internalizing scale, the total problem scale and moderate agreement concerning the externalizing scale of the CBCL and the YSR were found. Independent from the amount of psychiatric diagnoses, adolescents reported significantly less behavioral problems than their parents. Concerning externalizing problems, parent-youth disagreement was stronger for patients suffering from comorbid psychiatric disorders, than for adolescents displaying only one psychiatric disorder. Conclusion  In clinically referred children, parents are likely to emphasize the severity of the difficulties, whereas adolescents’ under-report symptoms.     

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.     

Comparison of self-reported emotional and behavioral problems in Turkish immigrant,Dutch and Turkish adolescents

Abstract.Objective: The aim of this study was to compare self-reported emotional and behavioral problems for Turkish immigrant, native Dutch and native Turkish adolescents.Method: A total of 379 Turkish immigrant adolescents living in the Netherlands, and 1,039 Dutch adolescents from the general population completed the Dutch translation of the Youth Self-Report (YSR); 2,151 Turkish adolescents from the general population completed the Turkish translation of the YSR; parents of Turkish immigrant adolescents filled in the Turkish translation of the Child Behavior Checklist (CBCL/4–18).Results: Turkish immigrant adolescents scored themselves significantly higher than Dutch adolescents on five of the 11 YSR syndromes, most markedly on the Anxious/Depressed, Withdrawn and Internalizing scales. Dutch adolescents scored themselves higher than immigrant adolescents on the Somatic Complaints and Delinquent Behavior scales. Turkish immigrant adolescents scored themselves higher than Turkish adolescents on five of the 11 scales, most markedly on the Delinquent Behavior scale. Total problems scores for Turkish immigrant adolescents were higher than for Dutch and Turkish adolescents. Turkish immigrant adolescents scored themselves higher than their parents assessed them on seven of the 11 scales.Conclusion: Turkish immigrant adolescents reported more problems in comparison to their Dutch and native Turkish peers. Different patterns of parent-child interaction, family values and delay of Dutch language skills are considered to be responsible for these differences in scores.     

Randomised controlled trial of school-based humanistic counselling for emotional distress in young people: Feasibility study and preliminary indications of efficacy

Background

Clinician-rated measures are used extensively in child and adolescent mental health services (CAMHS). The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) is a short clinician-rated measure developed for ordinary clinical practice, with increasing use internationally. Several studies have investigated its psychometric properties, but there are few data on its correspondence with other methods, rated by other informants. We compared the HoNOSCA with the well-established Achenbach System of Empirically Based Assessment (ASEBA) questionnaires: the Child Behavior Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self-Report (YSR).

Methods

Data on 153 patients aged 6-17 years at seven outpatient CAMHS clinics in Norway were analysed. Clinicians completed the HoNOSCA, whereas parents, teachers, and adolescents filled in the ASEBA forms. HoNOSCA total score and nine of its scales were compared with similar ASEBA scales. With a multiple regression model, we investigated how the ASEBA ratings predicted the clinician-rated HoNOSCA and whether the different informants' scores made any unique contribution to the prediction of the HoNOSCA scales.

Results

We found moderate correlations between the total problems rated by the clinicians (HoNOSCA) and by the other informants (ASEBA) and good correspondence between eight of the nine HoNOSCA scales and the similar ASEBA scales. The exception was HoNOSCA scale 8 psychosomatic symptoms compared with the ASEBA somatic problems scale. In the regression analyses, the CBCL and TRF total problems scores together explained 27% of the variance in the HoNOSCA total scores (23% for the age group 11-17 years, also including the YSR). The CBCL provided unique information for the prediction of the HoNOSCA total score, HoNOSCA scale 1 aggressive behaviour, HoNOSCA scale 2 overactivity or attention problems, HoNOSCA scale 9 emotional symptoms, and HoNOSCA scale 10 peer problems; the TRF for all these except HoNOSCA scale 9 emotional symptoms; and the YSR for HoNOSCA scale 9 emotional symptoms only.

Conclusion

This study supports the concurrent validity of the HoNOSCA. It also demonstrates that parents, teachers and adolescents all contribute unique information in relation to the clinician-rated HoNOSCA, indicating that the HoNOSCA ratings reflect unique perspectives from multiple informants.     

Poor peer relations predict parent- and self-reported behavioral and emotional problems of adolescents with gender dysphoria: a cross-national,cross-clinic comparative analysis

This study is the third in a series to examine behavioral and emotional problems in children and adolescents with gender dysphoria in a comparative analysis between two clinics in Toronto, Ontario, Canada and Amsterdam, the Netherlands. In the present study, we report Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) data on adolescents assessed in the Toronto clinic (n = 177) and the Amsterdam clinic (n = 139). On the CBCL and the YSR, we found that the percentage of adolescents with clinical range behavioral and emotional problems was higher when compared to the non-referred standardization samples but similar to the referred adolescents. On both the CBCL and the YSR, the Toronto adolescents had a significantly higher Total Problem score than the Amsterdam adolescents. Like our earlier studies of CBCL data of children and Teacher’s Report Form data of children and adolescents, a measure of poor peer relations was the strongest predictor of CBCL and YSR behavioral and emotional problems in gender dysphoric adolescents.     

Competencies and problems of Irish children and adolescents

This study set out to investigate the behavioural and emotional problems and competencies of Irish children and adolescents using Achenbach's Child Behaviour Checklist (CBCL) and Youth Self Report (YSR). The Child Behaviour Checklist was completed by parents of 481 Irish school children aged 7–9 years and 13–15 years, and the Youth Self Report was completed by 240 adolescents. The schools were selected to represent a wide social and cultural spread. Irish young people of all ages scored significantly lower than their American counterparts on measures of competence, whether rated by themselves or their parents. The parents of the 7–9 year olds rated their children as having significantly lower total problem scores than their American counterparts, but for 13–15 year olds there were no differences in total problem scores between the Irish and American samples, whether rated by parents or the adolescents themselves. Total problem scores and externalizing scores increased with age on the CBCL and the YSR, a pattern in which Irish young people differed from those in most other cultures. Despite differences in sampling and methodology, the Irish results are similar in many respects to those seen in a number of other European studies. Accepted: 22 July 1998     

Reliability and validity of the Youth Self-Report, Bangladesh version

The objectives of this study were to develop the Bangladesh version of the Youth Self-Report (YSR), and assess its reliability and validity in an adolescent population in Dhaka city, Bangladesh. One-hundred-and-eighty-seven boys (mean age: 14.6 years, SD: 2.1) and 137 girls (mean age: 15.2 years, SD: 2.0) from residential areas, and 27 boys (mean age: 17.0, SD: 1.4) and 14 girls (mean age: 15.4, SD: 2.8) from a psychiatric hospital, all within the range of 11-18 years, were interviewed using a questionnaire that consisted of the Bangla translation of the YSR and other questions. Thirty-eight randomly selected adolescents were administered the same questionnaire one week after the first administration. All the core scores and most of the subscales showed high internal consistency other than small item-number subscales, and satisfactory test-retest reliability. Good discriminant validity was shown for most of the scale scores. This study showed that the Bangla translation of the YSR had sufficient reliability and validity for use in Bangladesh. The cutoff scores of the scales were higher for the Bangla version than for the original English version, and further studies exploring this point would be an asset.     

The German version of the "Screen for Child Anxiety Related Emotional Disorders" (SCARED): parent- and self report in a clinical sample

The psychometric properties and cross-informant agreement of the German version of the "Screen for Child Anxiety Related Emotional Disorders" (SCARED) were assessed in a clinical sample. 77 children and adolescents aged 11 to 18 years in outpatient psychotherapy and 66 parents filled out the SCARED and Youth Self Report (YSR) or Child Behavior Checklist (CBCL), respectively. In n = 57 cases both parent and self-report was available. The German SCARED is shown to have good convergent and divergent validity compared with YSR/CBCL scales. The total score discriminated between children with an anxiety disorder and children with another psychiatric disorder. Cross-informant agreement was moderate with children reporting more and more severe anxiety symptoms than their parents. In conclusion, both the parent and the child version of the German SCARED proved valid. In clinical settings the integration of data from both perspectives seems important.     

Denial of symptoms and psychopathology in adolescent anorexia nervosa

OBJECTIVE: To evaluate the psychopathological status and denial of symptoms in a sample of 38 consecutively admitted adolescents with anorexia nervosa (AN). METHOD: The Schedule for Affective Disorders and Schizophrenia for School-Aged Children was used to determine the categorical diagnosis of eating disorder. The anorexic adolescents completed the EAT-40 (Eating Attitude Test) and, on the basis of its score, the sample was dichotomized in a false-negative group (FNG) scoring under 30 and a positive group (PG) scoring over 30. We compared these two subgroups in terms of clinical variables (age of onset and admission, duration of illness prior to admission, diagnosis, BMI) and psychopathology assessed by the CBCL (Child Behaviour Checklist) and the YSR (Youth Self-Report). In order to evaluate the possible role of diagnosis and BMI on the EAT score we also dichotomized the sample with respect to the diagnosis (full vs. partial AN) and to the mean female BMI (< or = 15 vs. > 15). RESULTS: A significant difference was found in terms of duration of illness prior to admission, which was briefer in the FNG. Higher CBCL and YSR values were found in the PG with significant differences in terms of YSR internalizing symptoms. A large amount of significantly positive Pearson's correlations were found between the CBCL and YSR values in the FNG. No significant Pearson's correlations were found between EAT, BMI and diagnosis. CONCLUSIONS: The lower CBCL and YSR values in the FNG seem to point out a tendency of this group to deny anxiety and depression as well as an eating pathology; the longer duration of illness prior to admission in the PG seems to support the hypothesis that the PG may be considered to be not so much more disturbed as more aware of its eating attitudes and psychopathology. The nature of denial in anorexic adolescents is discussed.     

Comparing the German versions of the Strengths and Difficulties Questionnaire (SDQ-Deu) and the Child Behavior Checklist

 The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire that can be completed in about 5 minutes by the parents and teachers of 4–16 year olds. The scores of the English version correlate well with those of the considerably longer Child Behavior Checklist (CBCL). The present study compares the German versions of the questionnaires. Both SDQ and CBCL were completed by the parents of 273 children drawn from psychiatric clinics (N = 163) and from a community sample (N = 110). The children from the community sample also filled in the SDQ self-report and the Youth Self Report (YSR). The children from the clinic sample received an ICD-10 diagnosis if applicable. Scores from the parent and self-rated SDQ and CBCL/YSR were highly correlated and equally able to distinguish between the community and clinic samples, with the SDQ showing significantly better results regarding the total scores. They were also equally able to distinguish between disorders within the clinic sample, the only significant difference being that the SDQ was better able to differentiate between children with and without hyperactivity-inattention. The study shows that like the English originals, the SDQ-Deu and the German CBCL are equally valid for most clinical and research purposes. Accepted: 22 February 2000     

Measures of psychopathology in children with complex partial seizures and primary generalized epilepsy with absence

OBJECTIVE: This investigation examined psychopathology in 48 children with complex partial seizures (CPS), 39 children with primary generalized epilepsy with absence (PGE), and 59 nonepileptic children, aged 5 to 16 years, by comparing the Child Behavior Checklist (CBCL) and the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). METHOD: The CBCL was completed by parents and the K-SADS was administered to both parent and child. RESULTS: The CBCL identified psychopathology in 26% and the K-SADS in 51% of the CPS and PGE patients (kappa = 0.32). The CPS and PGE groups had significantly higher mean CBCL scores, as well as higher rates of psychiatric diagnoses and symptoms of psychopathology, compared with the nonepileptic group. However, the CPS and PGE groups did not differ in these measures. Within each patient group, Full Scale IQ, but not seizure control, was associated with these measures of psychopathology. CONCLUSION: These findings suggest that the K-SADS identifies more children with psychopathology than the CBCL in children with CPS and PGE.     

Correlates of parental stress and psychopathology in pediatric epilepsy

Background:

Chronic conditions like epilepsy in a child can affect his/her entire family. The failure of the family members to adapt adequately to the unique demands of this childhood chronic illness can be considered as an important risk factor for development of psychopathology.

Objectives:

The objectives of this study were to study the profile of parenting stress in parents of children with epilepsy and its correlates; and, to examine the correlates of psychopathology in these children.

Material and Methods:

Twenty three epileptic children and their families were subjected to Parenting Stress Index (PSI), Scores for indices such as The Children''s Depression Inventory (CDI), Benton Visual Retention test, Spence anxiety scale for children, The Child Behavior Checklist (CBCL) and Wechsler Intelligence Scale for Children were calculated.

Results:

Mean verbal and performance IQ score was 94, while the mean total IQ score was 95. Mean scores for all Wechsler IQ Scores as well as Benton Visual retention test were within the average range. Means for total internalizing CBCL t scores (M, Mean=70; Standard Deviation, SD=4.4), total externalizing CBCL t scores (M=60, SD=9.6), and total behavior problems CBCL t scores (M=67, SD=5.2) were above the standard cut off levels of 65 for clinical behavioral problems. Mean score on CDI was 42 ± 2. Scores of the PSI equal to or higher than 85^th percentile were considered pathologically high.

Conclusion:

The results of our study indicated that pediatric patients with epilepsy, specifically with intractable cases, are correlated with high levels of parental stress.     

Prevalence of psychopathology in children of a bipolar parent

OBJECTIVE: To determine psychopathology in adolescent children of a bipolar parent living in the Netherlands, using multiple sources of information (self-, parent, and teacher reports). METHOD: Problem behavior in 140 offspring (aged 12-21 years) of 86 bipolar parents was assessed with the Child Behavior Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self-Report (YSR) between 1997 and 1999. All adolescents, bipolar parents, and their available spouses were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS: Higher problem scores were found for 8 of the 11 CBCL scales for girls and 4 of the 11 CBCL scales for boys, compared with a Dutch normative sample, and 1 Young Adult Self-Report (YASR) scale for girls compared with an American normative sample. Lower problem scores were found on 4 YSR and 4 YASR scales for boys, 1 TRF scale for girls, and 1 TRF scale for boys. The prevalence of current DSM-IV diagnoses in the offspring was 29% and of life-time DSM-IV diagnoses, 44%. CONCLUSIONS: The prevalence of problem behavior and DSM-IV diagnoses found in our sample did not support the notion that the level of psychopathology in children aged 12 to 21 years of bipolar parents is highly elevated. This study, similar to prior studies, suffers from lack of information on the representativeness of the sample and a rather low response rate.     

Criterion validity of the Strengths and Difficulties Questionnaire (SDQ) with inpatient adolescents

Increasing rates of adolescent admissions to inpatient psychiatric settings and acute length of stay necessitates valid psychiatric screening tools. The Strengths and Difficulties Questionnaire (SDQ) appears to have valuable clinical application due to its brevity and strong psychometric properties. In this study we aimed to evaluate the criterion validity of the SDQ in 159 psychiatric inpatients between the ages of 12–17 against the Computerized Diagnostic Interview Schedule for Children (CDISC). In determining the criterion validity of the SDQ against the CDISC-IV, we further sought to compare its classification accuracy with the DSM-oriented scales of two widely-used clinical screeners for children and adolescents, the Child Behavior Checklist (CBCL) and Youth Self Report (YSR). Results demonstrated comparable diagnostic accuracy for the three measures in detecting common emotional and behavioral disorders. Tentative clinical cutoffs were proposed specific to American adolescents for parent and youth reports. Sensitivity and specificity values are also reported and discussed.     

Internalizing and externalizing conditions in adolescent anorexia

OBJECTIVE: To identify the prevalence of internalizing and externalizing conditions in referred anorexic adolescents. METHOD: Child Behavior CheckList (CBCL) and Youth Self Report (YSR) were used to assess psychopathology: (a) in the global sample (43 adolescents); (b) in different subtypes of anorexia; (c) considering the timing of admission after the onset of the disease. RESULTS: A high percentage of patients were found in the internalizing clinical range both at CBCL and YSR. Higher mean values were found in full syndromes both at CBCL and YSR, and in the binge-eating subtype only at the YSR. Subjects arrived within the first year of illness showed a less severe psychopathology. CONCLUSIONS: Adolescents with anorexia have high rates of internalizing psychopathology. The less severe psychopathology in adolescents arrived within the first year of illness shed light on discontinuity between anorexia and internalizing condition. On the basis of the psychopathological severity, three types of adolescent anorexia are proposed which could be of interest for therapeutic decisions.     

The Youth Self-Report (YSR) and the Depression Self-Rating Scale (DSRS) as measures of depression and suicidality among adolescents

Two hundred and thirty-seven adolescents from a junior high school in a small community outside G?teborg, Sweden, completed the Youth Self Report (YSR) and the Depression Self Rating Scale (DSRS). Self-reported suicidality and biographical data were also recorded. The school doctor and nurse assessed the adolescents' somatic, psychological and behavioural problems using school health-records. The convergent validity of the YSR total problems scale and syndrome scales were tested against the DSRS. Discriminant validity was assessed by the two measures' ability to predict suicidality and school health problems. The Internalising (r = 0.65**) and Anxious/Depressed (r= 0.61**) syndrome scales of the YSR had the highest correlations with the DSRS. However, all YSR syndrome scales were significantly, though more modestly, correlated with the DSRS. Using stepwise logistic regression analysis, four YSR sub-scales [Social Withdrawal, Anxious/Depressed, Attention problems and Delinquency] predicted mild-severe self-reported depression (DSRS scores 12 and above). The YSR syndrome scales Anxious/Depressed and Delinquency predicted suicide ideation whereas the Self-destructive/Identity problem and Social Withdrawal (low scores) scales predicted Suicide attempts. The YSR Anxious/Depressed sub-scale and the DSRS total score seem to measure a similar dimension. However, the Anxious/Depressed and Selfdestructive/Identity problem scales were superior in predicting suicidality.     

Behaviour problems in children with dyslexia

The association between behaviour problems and dyslexia was assessed in a population sample of 10- to 12-year-old children. Twenty-five dyslexic children and a matched control group were recruited through a screening in primary schools in the city of Bergen, Norway. For the assessment of behaviour problems the Child Behavior Checklist (CBCL), Teacher Self Report (TRF), and Youth Self Report (YSR) were filled out by parents, teachers, and children, respectively. Information on health and developmental factors were obtained from parents on a separate questionnaire designed for the study. The dyslexic group had significantly more behaviour problems than the control group according to both the CBCL and the TRF. On the YSR there was no significant difference between the groups. Dyslexic children had higher CBCL and TRF scores on the Total Behaviour Problem scale, the Internalizing and Externalizing subdomains, and the Attention problem subscale. The groups differed in social background, prenatal risk factors, birth weight, preschool language problems, and IQ, but these variables showed no relationship to the level of behaviour problems in the present sample. We conclude that pre-adolescent dyslexic children show a wide range of behaviour problems that cannot be attributed to social or developmental background variables.     

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.