Andreas Becker

Multicultural assessment of child and adolescent psychopathology with ASEBA and SDQ instruments: research findings, applications, and future directions.

Around the world, cultural blending and conflict pose challenges for assessment and understanding of psychopathology. Economical, evidence-based, culturally robust assessment is needed for research, for answering public health questions, and for evaluating immigrant, refugee, and minority children. This article applies multicultural perspectives to behavioral, emotional, and social problems assessed on dimensions describing childrens functioning, as rated by parents, teachers, children, and others. The development of Achenbach System of Empirically Based Assessment (ASEBA) and Strengths and Difficulties Questionnaire (SDQ) forms and their applications to multicultural research are presented. A primary aim of both questionnaires is to identify children at high risk of psychiatric disorders and who therefore warrant further assessment. The forms are self-administered or administered by lay interviewers. ASEBA problem items are scored on 6 DSM-oriented scales and 3 broader band scales, plus 8 syndromes derived statistically as taxonomic constructs and supported by uniform confirmatory factor analyses of samples from many populations. Comparisons of ASEBA scale scores, psychometrics, and correlates are available for diverse populations. SDQ forms are scored on one broad-band scale and 5 a priori behavioral dimensions supported by data from various populations. For both instruments, factor analyses, psychometrics, and correlates are available for diverse populations. The willingness and ability of hundreds of thousands of respondents from diverse groups to complete ASEBA and SDQ forms support this approach to multicultural assessment. Although particular items and scales may have differential relevance among groups and additional assessment procedures are needed, comparable results are found in many populations. Scale scores vary more within than between populations, and distributions of scores overlap greatly among different populations. Ratings of childrens problems thus indicate more heterogeneity within populations than distinctiveness between populations. Norms from multiple populations can be used to compare childrens scores with relevant peer groups. Multicultural dimensional research can advance knowledge by diversifying normative data; by comparing immigrant children with nonimmigrant compatriots and with host country children; by identifying outlier findings for elucidation by emic research; and by fostering efforts to dimensionalize DSM-V diagnostic criteria.

Normative data and scale properties of the German parent SDQ.

Abstract.Background and objectives:The Strengths and Difficulties Questionnaire (SDQ) is a short assessment instrument which addresses positive and negative behavioural attributes of children and adolescents and generates scores for clinically relevant aspects. Although this brief questionnaire has been widely used in Germany to gather information from parents, teachers, and older children themselves, normative results obtained with the German version have not yet been reported to the international scientific community. To allow comparisons with SDQ findings in other countries, normative data for the German parentrated form as well as a communitybased evaluation of scale properties are summarised and complemented by results obtained in a number of clinical samples.Methods:Parent ratings were collected for a community-based sample of 930 children and adolescents aged between 6 and 16 years, in which both genders and all age levels were equally represented. Statistical evaluation of psychometric properties included a factor analysis verifying the proposed scale structure, assessment of scale homogeneities, and determination of age, gender and social class effects. Based on the distributions of SDQ scores observed in this normative sample, recommended bandings identifying normal, borderline, and clinical ranges were defined for each scale.Results:Exact replication of the original scale structure, satisfactory internal reliabilities, and observation of the expected associations with age and gender confirmed the equivalence of the German SDQ parent questionnaire with the English original. Differences between community-based results and clinical groups provided descriptive evidence of a dramatic impact of clinically defined psychiatric status on SDQ scores.Conclusions:After evaluating parent ratings obtained in a community-based sample, the German SDQ was shown to possess favourable psychometric properties. Thus, the German translation of this popular and versatile instrument seems to be a similarly reliable and useful assessment tool as the original English questionnaire.

Evaluation of the self-reported SDQ in a clinical setting: do self-reports tell us more than ratings by adult informants?

Abstract.Objectives:The aim of this study was to evaluate the German self-reported Strengths and Difficulties Questionnaire (SDQ) in a clinical setting. We also investigated whether this additional information gathered directly from older children and adolescents improves the prediction of clinical status when external ratings from their parents and/or teachers are already available.Methods:SDQ self-reports were collected from 214 in- and outpatients (81 girls and 133 boys) aged 11 to 17 years who were seen at the department of child and adolescent psychiatry of the University of Göttingen. Results obtained with the self-rated questionnaire were compared with the parent and teacher SDQs, corresponding CBCL/YSR scores, and the clinical diagnostic classification. Finally, the additional diagnostic benefits of the self-reports were examined.Results:The scales of the SDQ self-report proved to be sufficiently homogeneous, and acceptable correlations were found with the equivalent parent and teacher ratings. The self-rated version of the SDQ demonstrated good validity with respect to the differentiation between clinically defined cases and non-cases and in detecting various subcategories of psychiatric disorders within the clinic sample. SDQ self-reports significantly contributed to the prediction of diagnostic status, specifically if only parent or teacher ratings were available.Conclusions:The self-rated version of the SDQ was shown to be a reliable and valid method for the assessment of behavioural problems in children and adolescents. In the absence of adult informant reports from parents and teachers, the diagnostic value of self-ratings was also demonstrated.

Validation of the parent and teacher SDQ in a clinical sample.

Abstract.Objectives:This study examines whether the German translation of the Strengths and Difficulties Questionnaire (SDQ) is a reliable and valid screening instrument and whether it is as effective a tool for clinical diagnostics and scientific applications as the CBCL/TRF.Methods:We examined 543 children and adolescents (147 girls and 396 boys) with ages ranging from 5 to 17 years and correlated the results of the parent and teacher SDQ as well as the CBCL/TRF with clinical diagnoses. Furthermore, the adequacy of the scale structure of the SDQ was tested using confirmatory and exploratory factor analyses.Results:It was demonstrated that the scales of the parent and teacher versions were sufficiently homogeneous (0.72–0.83). Correlations between SDQ scales and corresponding CBCL/TRF scales showed a high degree of congruence, while an exact replication of the original SDQ scale structure could also be achieved. Parent and teacher versions of both questionnaires presented with good validity, not only with regard to the discrimination between child psychiatric patients and a representative community sample, but also in the identification of different categories of disorders within the clinical sample.Conclusion:The parent and teacher SDQs proved to be valid and helpful questionnaires for use in the framework of a multi-dimensional behavioural assessment, and appear to be well suited for screening purposes, longitudinal monitoring of therapeutic effects, and scientific research purposes.

Meta-analysis of randomized controlled comparisons of psychopharmacological and psychological treatments for anxiety disorders

Background. A number of meta-analyses have led to contradictory results regarding the efficacy of the psychological and pharmacological treatment of anxiety disorders. The main reasons for these inconsistent results seem to be the inclusion of heterogeneous studies and influences of selection biases. We performed a meta-analysis, which only included studies using a direct comparison of pharmacological, psychological, or combined treatments. Method. Sixteen studies on panic disorder, six studies on social anxiety disorder, and two studies on generalized anxiety disorder have been analyzed. Effect sizes for differences between the different treatment modalities were calculated. Also, the effect sizes of the pre–post differences were calculated. Results. Pharmacological treatment, cognitive-behavioural treatment, and the combination of both treatment modalities all led to substantial improvement between pre- and post-treatment. Combined pharmacological and psychological treatment was superior to the monotherapies for panic disorder. For social anxiety disorder, there is only preliminary support for combined treatment. Due to lack of sufficient data, no final conclusions can be drawn for generalized anxiety disorder. Conclusions. While drug treatment and CBT showed equal efficacy, only in panic disorder the combination of pharmacological and psychological treatment was superior to either treatment alone. For the other anxiety disorders, the evidence for greater efficacy of combination treatment is still not sufficient due to lack of studies.

Psychopathological screening of children with ADHD: strengths and difficulties questionnaire in a pan-European study

ObjectiveTo examine the psychometric properties of the Strengths and Difficulties Questionnaire (SDQ) parent version and to determine the effects of age, gender, country and investigator type (paediatrician, child psychiatrist, other physician) on the SDQ scores in the prospective, non-interventional ADORE study.MethodsThe SDQ was completed for 1,459 children with ADHD (aged 6–18 years) in 10 European countries.ResultsFactor analysis provided an exact replication of the original 5-factor SDQ subscale structure. All subscales were sufficiently homogeneous. The mean total difficulties and SDQ subscale scores of the ADORE sample clearly differed from UK normative data. Younger children were more impaired on different SDQ scales than older children, and girls were more emotionally affected than boys. Differences between countries were found for each SDQ scale, but the investigator type had no significant effect. Correlation coefficients between SDQ scales and other scales used in ADORE ranged from low (r<0.30) to high (r>0.50).ConclusionsThe present study confirmed the validity and reliability of the parent-reported SDQ scale structure and showed that the scale scores are dependent on age and gender. In contrast to investigator type, different cultures had a significant effect on SDQ scores. Correlations with other scales used in the ADORE study underline both separate domains and meaningful associations.

Methylphenidate normalizes elevated dopamine transporter densities in an animal model of the attention-deficit/hyperactivity disorder combined type, but not to the same extent in one of the attention-deficit/hyperactivity disorder inattentive type.

The spontaneously hypertensive rat (SHR/NCrl) is a validated model of attention-deficit/hyperactivity disorder (ADHD) combined subtype, whereas a recently identified substrain of the Wistar Kyoto rat (WKY/NCrl) is a model of ADHD inattentive subtype. In this study, we first examined the expression of genes involved in dopamine signaling and metabolism in the dorsal striatum and ventral mesencephalon of these two rat strains, as well as three reference control strains (WKY/NHsd, WK/HanTac, and SD/NTac) using quantitative real time RT-PCR. Next, striatal dopamine transporter (DAT) density was determined by ligand binding assay in the two ADHD-like strains at different developmental stages and after methylphenidate treatment. In adult rats, the mRNA expression of DAT and tyrosine hydroxylase was elevated in SHR/NCrl and WKY/NCrl rats compared to control strains, with differences between SHR/NCrl and WKY/NCrl rats also evident. During normal development, changes of striatal DAT densities occurred in both strains with lower densities in WKY/NCrl compared to SHR/NCrl after day 25. Two-weeks methylphenidate treatment during different developmental stages was associated with decreased striatal DAT density in both rat strains compared to the non-treated rats with more pronounced effects followed prepubertal treatment. These results suggest differences in the pathophysiology of the combined versus the predominantly inattentive animal model of ADHD. Finally, treatment with methylphenidate might reduce elevated DAT levels more effectively in the combined subtype especially when applied before puberty.

Neuronal network models of ADHD -- lateralization with respect to interhemispheric connectivity reconsidered.

AbstractBackgroundRecent research on structural and functional anatomy related to ADHD has concentrated on fronto-striatocerebellar circuits. These findings and resultant neurobiological models of ADHD may explain some of the disturbances. On the other hand, there is some evidence that the restricted look at anteriorposterior anomalies might neglect the important additional information of lateralization problems related to hemispheric connectivity.ObjectiveHence, the role of lateralization in the pathophysiology of ADHD should be reconsidered.MethodAfter a short review of imaging studies in ADHD the special role of the corpus callosum (including the influence of its anomalies on general brain development, lateralization and functioning) is outlined and the first case of total agenesis of corpus callosum in a child with ADHD is presented and discussed within this context.ConclusionsIn view of the remaining inconsistencies concerning structural and functional brain anomalies in ADHD, attention should be paid not only to anterior- posterior but also to leftright aspects of functional and structural brain anomalies. This should include disturbances probably related to anomalies of the corpus callosum, especially in regard to co-existing problems like dyslexia and developmental coordination disorder.

Color perception deficits in co-existing attention-deficit/hyperactivity disorder and chronic tic disorders

SummaryPreliminary findings suggest that color perception, particularly of blue-yellow stimuli, is impaired in attention-deficit/hyperactivity disorder (ADHD) as well as in chronic tic disorders (CTD). However, these findings have been not replicated and it is unclear what these deficits mean for the comorbidity of ADHD + CTD.Four groups (ADHD, CTD, ADHD + CTD, controls) of children with similar age, IQ and gender distribution were investigated with the Farnsworth-Munsell 100 Hue Test (FMT) and the Stroop-Color-Word Task using a factorial design. Color perception deficits, as indexed by the FMT, were found for both main factors (ADHD and CTD), but there were no interaction effects. A preponderance of deficits on the blue-yellow compared to the red-green axis was detected for ADHD. In the Stroop task only the ‘pure’ ADHD group showed impairments in interference control and other parameters of Stroop performance. No significant correlations between any FMT parameter and color naming in the Stroop task were found. Basic color perception deficits in both ADHD and CTD could be found. Beyond that, it could be shown that these deficits are additive in the case of comorbidity (ADHD + CTD). Performance deficits on the Stroop task were present only in the ‘pure’ ADHD group. Hence, the latter may be compensated in the comorbid group by good prefrontal capabilities of CTD. The influence of color perception deficits on Stroop task performance might be negligible.

Psychometric Validity of the Strengths and Difficulties Questionnaire-Dysregulation Profile

Background: In many severely mentally disordered children, the clinical presentation is complicated by comorbid affective and behavioral dysregulation. Recently, a highly heritable behavioral phenotype of simultaneous deviance on the anxious/depressed, attention problems, and aggressive behavior syndrome scales has been identified on the Child Behavior Checklist Dysregulation Profile (CBCL-DP). The aim of the present pilot study was to determine an equivalent to the CBCL-DP using the Strengths and Difficulties Questionnaire (SDQ). Sampling and Methods: We applied stepwise linear discriminant analyses and receiver operating characteristic (ROC) analysis to data from 543 consecutively referred children and adolescents, aged 5–17 years. The CBCL and the SDQ were completed by parents as part of the diagnostic routine. ICD-10 discharge diagnoses were established in consensus conferences. Results: A combination of five SDQ items (SDQ-Dysregulation Profile, SDQ-DP) yielded the best discrimination of children with and without CBCL-DP and classified 81.0% of the subjects correctly leading to an area under the curve of 0.93. The content of the five SDQ-DP items mirrors well the mixed behavioral phenotype of anxious-depressive, aggressive and attention problems captured by the CBCL-DP. SDQ-DP status was highly correlated with CBCL-DP status and was best defined by a SDQ-DP score ≧5. Conclusions: The psychometric properties of the SDQ-DP have been robustly tested and validated. Based on these results, clinicians may use the SDQ-DP as a useful and economical screening measure to improve the assessment, prevention, and treatment of severe dysregulation in childhood and adolescence. Future investigations should study the longitudinal stability, heritability, and genetic associations of this behavioral phenotype.