Catherine T. Howell

Empirically based assessment of the behavioral/emotional problems of 2- and 3- year-old children.

The aim was to determine whether ratings of 2- and 3-year-olds could yield more differentiation among their behavioral/emotional problems than the internalizing-externalizing dichotomy found in previous studies. The 99-item Child Behavior Checklist for Ages 2–3 (CBCL/2–3) was designed to extend previously developed empirically based assessment procedures to 2-and 3-year-olds. Factor analyses of the CBCL/2–3 completed by parents of 398 2- and 3-year-olds yielded six syndromes having at least eight items loading ≥ 30 and designated as Social Withdrawal, Depressed, Sleep Problems, Somatic Problems, Aggressive, and Destructive. Second-order analyses showed that the first two were related to a broad-band internalizing grouping, whereas the last two were related to a broad-band externalizing grouping. Scales for the six syndromes, two broad-band groupings, and total problem score were constructed from scores obtained by 273 children in a general population sample. Mean test-retest reliability r was 87, 1-year stability r was 69, 1-year predictive r with CBCL/4–16 scales at age 4 was 63, 2-year predictive r was 55, and 3-year predictive r was 49. Children referred for mental health services scored significantly higher than nonreferred children on all scales. A lack of significant rs with the Minnesota Child Development Inventory, Bayley, and McCarthy indicate that the CBCL/2–3 taps behavioral/emotional problems independently of the developmental variance tapped by these measures.

Are American Children's Problems Getting Worse? A 13-Year Comparison

OBJECTIVE To determine whether the prevalence of childrens behavioral/emotional problems changed significantly over a 13-year period. METHOD Problems and competencies reported by parents and teachers for a random sample of 7 to 16 years old assessed in 1989 were compared with those reported by parents for a 1976 sample and by teachers for a 1981 to 1982 sample. Parent reports were obtained with the Child Behavior Checklist; teacher reports were obtained with the Teachers Report Form. RESULTS Problem scores were higher and competence scores were lower in 1989 than in the earlier assessments. The secular changes were small but included diverse problems, syndromes, and competencies. Changes did not differ significantly by age, gender, socioeconomic status, nor black/white ethnicity. Correlations of 0.97 to 0.99 between rankings of item scores across 7.5- and 13-year intervals support the stability of the assessment procedures. Despite increases in problem scores, the 1989 U.S. scores were not higher than those in several other cultures. CONCLUSIONS Viewed categorically in terms of caseness, more untreated children in the 1989 than the 1976 sample would be considered to need help. Multicohort longitudinal studies now in progress will test predictors of within- and between-cohort change.

Six-Year Predictors of Problems in a National Sample of Children and Youth: I. Cross-Informant Syndromes

OBJECTIVE To illuminate the development of psychopathology by tracing 6-year predictive paths to outcomes assessed in terms of empirically based syndromes. METHOD A national sample assessed at ages 4 through 12 years via parent reports was reassessed 3 and 6 years later via parent, teacher, and self-reports. RESULTS For syndromes having the clearest DSM counterparts, cross-informant predictive paths revealed similar traitlike patterns for Aggressive Behavior in both sexes; Delinquent Behavior was less traitlike, with greater sex differences in predictive paths; the Attention Problems syndrome was developmentally stable, but, surprisingly, it was associated with more diverse difficulties among girls than boys; conversely, Anxious/Depressed was associated with more diverse difficulties among boys than girls. CONCLUSIONS Quantification of problems via empirically based syndromes can detect important sex, age, and developmental variations that may be masked by uniform diagnostic cutoff points for both sexes and diverse ages. This may be especially true for diagnostic cutoff points derived mainly from clinical cases of one sex, such as depression for girls versus attention and conduct disorders for boys.

Six-year predictors of problems in a national sample. III: Transitions to young adult syndromes

OBJECTIVE To test developmental paths from adolescent syndromes and other candidate predictors to young adult syndromes. METHOD A national sample assessed at ages 13 through 16 and 16 through 19 years was reassessed at 19 through 22 years in terms of six syndromes derived empirically from parent and self-reports, two syndromes derived only from parent reports, and one derived from self-reports. RESULTS Several young adult syndromes were similar to adolescent syndromes and were strongly predicted by these syndromes. A new syndrome designated as Shows Off and an adult Aggressive Behavior syndrome were both predicted by the adolescent Aggressive Behavior syndrome. This indicates a developmental transition away from overt aggression among some aggressive youths but not others. A syndrome designated as Irresponsible was predicted by the adolescent Attention Problems syndrome and may be an adult phenotype of attention deficit disorder. Surprisingly, attention problems were associated with more diverse problems among females than males. CONCLUSIONS There are strong predictive relations from adolescent to adult syndromes. Sex differences in predictive paths argue against basing assumptions about both sexes on findings for one sex.

Minimizing Adverse Effects of Low Birthweight: Four-Year Results of an Early Intervention Program

The outcome of an early intervention program for low-birthweight (LBW) infants was examined in this study. The intervention consisted of 11 sessions, beginning during the final week of hospitalization and extending into the home over a 3-month period. The program aimed to facilitate maternal adjustment to the care of a LBW infant, and, indirectly, to enhance the childs development. Neonates weighing less than 2,200 grams and under 37 weeks gestational age were randomly assigned to experimental or control conditions. A full-term, normal birthweight (NBW) group served as a second control. 6-month analyses of dyads who completed all assessments over a 4-year period (Ns = 25 LBW experimental, 29 LBW control, and 28 NBW infant-mother dyads) showed that the experimental group mothers reported significantly greater self-confidence and satisfaction with mothering, as well as more favorable perception of infant temperament than LBW control group mothers. A progressive divergence between the LBW experimental and LBW control children on cognitive scores culminated in significant group differences on the McCarthy GCI at ages 36 and 48 months, when the LBW experimental group caught up to the NBW group. Possible explanations for the observed delay in the emergence of intervention effects on cognitive development and the mediating role of favorable mother-infant transactional patterns are discussed in light of recent evidence from the literature.

Six-Year Predictors of Problems in a National Sample of Children and Youth: II. Signs of Disturbance

OBJECTIVE To identify 1986 and 1989 variables that significantly predicted signs of disturbance assessed in 1992. METHOD 1986 parent reports and 1989 parent, teacher, and self-reports of syndromes, competencies, family variables, and stressful experiences were tested as predictors of 1992 reports of academic problems, school behavior problems, receipt of mental health services, suicidal behavior, police contacts, substance abuse, and the sum of these six signs. RESULTS The predictors accounted for large percentages of variance in most signs and predicted fairly accurately which members of case-control samples would manifest specific signs. Overall predictive accuracy was similar for both sexes, but many predictors differed for boys versus girls. The six signs were weakly associated with each other but were strongly associated with particular syndromes. CONCLUSIONS Signs of disturbance were predictable over a 6-year period despite the diversity of a national sample. Previous manifestations of certain signs were modest predictors of the same signs. The Delinquent Behavior and Attention Problems syndromes, plus stressful experiences, predicted the most signs. Sex differences in predictors argue against generalizing findings and inferences from one sex to the other.