Jan van der Ende

The normative development of child and adolescent problem behavior.

The aim of this study was to identify normative developmental trajectories of parent-reported problems assessed with the Child Behavior Checklist (CBCL; T. M. Achenbach, 1991) in a representative sample of 2,076 children aged 4 to 18 years from the general population. The trajectories were determined by multilevel growth curve analyses on the CBCL syndromes in a Longitudinal multiple birth-cohort sample that was assessed 5 times with 2-year intervals. Most syndromes showed a linear increase or decrease with age or a curvilinear trajectory, except for thought problems. Trajectories for most syndromes differed for boys versus girls, except those for withdrawn, social problems, and thought problems. These normative developmental trajectories provide information against which developmental deviance in childhood and adolescence can be detected.

An empirical test of the utility of the observations-to-variables ratio in factor and components analysis

Many researchers have proposed a minimum ratio of observations to variables or an absolute minimum of observations in order to obtain stable factor config urations. However, hardly any empirical studies em ploying real data are available that attest to the tena bility of these proposals. A systematic analysis of the problem was undertaken, using self-report data from two large phobic samples on the Fear Survey Sched ule-III (N = 1104) and the Fear Questionnaire (N = 960). The data sets were randomly split into subsam ples with ratios varying from 1.3:1 to 19.8:1. Neither the observations to variables ratio nor an absolute minimum of observations had any influence on factor stability.

Emotional and behavioral problems in children and adolescents with and without intellectual disability

BACKGROUND The main objective of this study was to assess and compare the prevalence of a wide range of emotional and behavioral problems in children with and without intellectual disability (ID). METHODS We studied 1,041 non-residential children randomly selected from special schools for educable (IQ 60 to 80) and trainable (IQ 30 to 60) children without severe additional physical or sensory impairments, and compared them to 1,855 children randomly selected from the general population (both ages 6 to 18). Parents completed the Child Behavior Checklist (CBCL), and teachers the Teachers Report Form (TRF). RESULTS Controlling for sex, age, and socioeconomic status, we found that both educable and trainable children had significantly higher mean scores on all CBCL and TRF scales than children without ID, except for trainable children on the scales Anxious/Depressed and Somatic Complaints. Almost 50% of children with ID had a Total Problem score in the deviant range compared to about 18% in children without ID. Compared to children without ID, the most prominent problem behaviors of educable children were Social Problems, Attention Problems, and Aggressive Behavior, and trainable children had an increased risk for Social Problems, Attention Problems, Withdrawn and Thought Problems. CONCLUSIONS Elevated scale scores reflected differences between children with and without ID over a broad range of items, and not solely on items more likely to be related to developmental delay. Therefore, problem areas covered by the items in these scales deserve special attention in the mental health care of children with ID.

Child and Adolescent Problems Predict DSM-IV Disorders in Adulthood: A 14-Year Follow-up of a Dutch Epidemiological Sample

OBJECTIVE Few studies exist that examine continuities between child and adult psychopathology in unselected samples. This study prospectively examined the adult outcomes of psychopathology in an epidemiological sample of children and adolescents across a 14-year period. METHOD In 1983, parent ratings of behavioral and emotional problems were obtained for 1,578 children and adolescents aged 4 through 16 years from the Dutch general population. At follow-up, 14 years later, subjects were reassessed with a standardized DSM-IV interview. RESULTS High levels of childhood problems predicted an approximate 2- to 6-fold increased risk for adulthood DSM-IV diagnoses. The associations between specific childhood problems and adulthood diagnoses were complex. Social Problems in girls predicted later DSM-IV disorder. Rule-breaking behavior in boys predicted both mood disorders and disruptive disorders in adulthood. CONCLUSIONS High levels of childhood behavioral and emotional problems are related to DSM-IV diagnoses in adulthood. The strongest predictor of disorders in adulthood was childhood rule-breaking behavior. Attention Problems did not predict any of the DSM-IV categories when adjusted for the associations with other Child Behavior Checklist scales.

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).

Help seeking for emotional and behavioural problems in children and adolescents: a review of recent literature.

Abstract.In order to understand the discrepancy between rates of child and adolescent psychopathology and rates of mental health service use, variables influencing the help-seeking process need to be investigated. The present article aims to extend and refine previous findings by reviewing 47 recent empirical studies on parental and adolescent problem recognition and help seeking, and problem recognition by the general practitioner (GP). Several variables (child age, the presence of medical and school-related problems, informal help seeking, past treatment of parents or relatives, family size, and type of maltreatment) were discovered to influence parental/adolescent problem recognition and/or help seeking,while refinements were found for the effects of type of psychopathology, child gender, adolescent attitudes and personality, parental psychopathology, social support, and sociodemographic variables. Although recent studies uncovered several determinants of problem recognition by the GP (child gender, age, past treatment, academic problems, family composition, life events, type of visit, and acquaintance with child), this aspect of the help-seeking pathway remains relatively uncharted and, therefore, needs to be the focus of future research.

Factors associated with adolescent mental health service need and utilization.

OBJECTIVE To determine the association of parent, family, and adolescent variables with adolescent mental health service need and utilization. METHOD Correlates of adolescent mental health service utilization, self-perceived need and unmet need were investigated in a general population sample of 1,120 Dutch adolescents aged 11 to 18 years (78% response rate). RESULTS 3.1% of the sample had been referred for mental health services within the preceding year, and 3.8% reported unmet need. 7.7% of adolescents at risk for psychopathology, and 17.8% of those indicating a need for help, had been referred. Family stress and adolescents self-reported problems were most strongly associated with service need and utilization. Internalizing problems, female gender, and low education level were associated with self-perceived unmet need. Adolescent ethnicity and competence in activities and school were associated with service use, but did not influence service need, while the opposite effect was found for adolescent age and parental psychopathology. CONCLUSION In designing intervention programs aimed at increasing adolescent mental health service use, distinctions should be made between efforts focused at adolescents not recognizing their problems, and those with unmet need.

The development of a short form of the EMBU: Its appraisal with students in Greece, Guatemala, Hungary and Italy

Abstract Out of the necessity of having an abbreviated form of the EMBU, a measure of perceived parental rearing behaviour, a short form (s-EMBU) consisting of three scales (rejection, emotional warmth and protection) with, respectively, 7, 6 and 9 items (plus 1 unscaled item) was developed from the original 81-item version. The factorial and/or construct validity and reliability of this s-EMBU were examined among samples of 2373 students from Italy, Hungary, Guatemala and Greece. The data were presented for the four national groups separately. The 23-item s-EMBU is recommended as a reliable functional equivalent to the 81-item early EMBU. Attention was drawn to the need for further research to explain some of the observed cross-national differences in the correlations between parental rearing styles and personality.

Adult Outcomes of Childhood Dysregulation: A 14-Year Follow-up Study.

OBJECTIVE Using a general population sample, the adult outcomes of children who presented with severe problems with self-regulation defined as being concurrently rated highly on attention problems, aggressive behavior, and anxious-depression on the Child Behavior Checklist-Dysregulation Profile (CBCL-DP) were examined. METHOD Two thousand seventy-six children from 13 birth cohorts 4 to 16 years of age were drawn from Dutch birth registries in 1983. CBCLs were completed by parents at baseline when children from the different cohorts were 4 to 16 years of age and sampled every 2 years for the next 14 years. At year 14 the CBCL and DSM interview data were collected. Logistic regression was used to compare and contrast outcomes for children with and without dysregulation, as measured by the latent-class-defined CBCL-DP. Sex and age were covaried and concurrent DSM diagnoses were included in regression models. RESULTS Presence of childhood CBCL-DP at wave 1 was associated with increased rates of adult anxiety disorders, mood disorders, disruptive behavior disorders, and drug abuse 14 years later. After controlling for co-occurring disorders in adulthood, associations with anxiety and disruptive behavior disorders with the CBCL-DP remained, whereas the others were not significant. CONCLUSIONS A child reported to be in the CBCL-DP class is at increased risk for problems with regulating affect, behavior, and cognition in adulthood.

Parent-reported sleep problems during development and self-reported anxiety/depression, attention problems, and aggressive behavior later in life

OBJECTIVE To examine associations between sleep problems during development and subsequent emotional and behavioral difficulties. DESIGN Prospective longitudinal study. SETTING The Dutch province of Zuid-Holland. PARTICIPANTS At time 1 of data collection, a representative sample of 2076 children aged 4 to 16 years participated in the study. OUTCOME MEASURES Parents rated their childrens (4-19 years old) sleep at 5 assessments by completing the Child Behavior Checklist. Participants reported on their own emotional and behavioral symptoms at a later assessment (when aged 18-32 years) by completing the Young Adult Self-Report. RESULTS After adjusting for sex, age, socioeconomic status, and parent-rated scores through development for the difficulty being predicted, having any parental reports of sleeping less than others was a risk indicator of high scores on the Anxious/Depressed scale (odds ratio, 1.43; 95% confidence interval, 1.07-1.90; P = .01) and the Aggressive Behavior scale (odds ratio, 1.51; 95% confidence interval, 1.13-2.02; P = .005). There was some (albeit less robust) support for links between other reported sleep difficulties and later problems. Parental reports of sleeping more than others and nightmares were not associated with later difficulties. CONCLUSIONS Physicians should inquire about sleep problems during child development and should be aware that some, but perhaps not others, may constitute risk indicators of later difficulties.