Marina Monzani da Rocha

International Epidemiology of Child and Adolescent Psychopathology II: Integration and Applications of Dimensional Findings From 44 Societies

OBJECTIVE To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teachers Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society, gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications. METHOD Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, DSM-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies. RESULTS CFAs supported the tested syndrome models in all societies according to the primary fit index (Root Mean Square Error of Approximation [RMSEA]), but less consistently according to other indices; effect sizes were small-to-medium for societal differences in scale scores, but very small for gender, age, and interactions with society; items received similarly low, medium, or high ratings in different societies; problem scores from 44 societies fit three sets of multisociety norms. CONCLUSIONS Statistically derived syndrome models fit parent, teacher, and self-ratings when tested individually in all 44 societies according to RMSEAs (but less consistently according to other indices). Small to medium differences in scale scores among societies supported the use of low-, medium-, and high-scoring norms in clinical assessment of individual children.

Child Behavior Checklist (CBCL),Youth Self-Report (YSR) and Teacher's Report Form(TRF): an overview of the development of the original and Brazilian versions

O Sistema de Avaliacao de Base Empirica de Achenbach para criancas/adolescentes em idade escolar inclui tres instrumentos para avaliar problemas emocionais e/ou comportamentais: Child Behavior Checklist (CBCL) [pais], Youth Self-Report (YSR) [adolescentes] e Teachers Report Form (TRF) [professores]. Este artigo de revisao fornece informacoes detalhadas sobre o desenvolvimento desses instrumentos nos Estados Unidos e no Brasil, descrevendo as principais alteracoes em itens, escalas e pontos de corte na pontuacao, ocorridas nas versoes originais de 1991 a 2001, e o processo de traducao, retrotraducao e adaptacao cultural dos questionarios originais para desenvolver as atuais versoes brasileiras oficiais do CBCL, YSR e TRF. A utilidade desses instrumentos em pesquisa e na pratica clinica e salientada, mencionando estudos epidemiologicos e de avaliacao de intervencoes conduzidos no Brasil. Pesquisadores e clinicos sao instruidos a respeito do uso correto das atuais versoes brasileiras oficiais, dando exemplos de perguntas frequentes, relevantes para o contexto brasileiro.

Behavioural/emotional problems in Brazilian children: findings from parents' reports on the Child Behavior Checklist

Background. To compare Child Behavior Checklist (CBCL) findings for a large Brazilian general population sample with those for US children considering: (a) mean problem item ratings; (b) fit of the US-derived CBCL 8-syndrome model; (c) scale internal consistency measured by Cronbachs alphas; (d) effects of society, age, gender on CBCL problem scores; and (e) ability to discriminate referred from non-referred children. Methods. Parents of 1228 non-referred 6-to-11-year-olds from three different regions of Brazil and 247 referred 6-to-11-year-olds from one clinic rated their childrens behavioural and emotional problems using the CBCL/6-18. Results. Results for mean item ratings and scale internal consistencies were very similar to those found in the US and in Uruguay. Confirmatory factor analysis indicated that Brazilian data showed the best fit to the US 8-syndrome model of all countries studied to date. Gender patterns were comparable to those reported in other societies, but mean problem scores for non-referred Brazilian children were higher than those for US children. Therefore, the CBCL discriminated less well between non-referred and referred children in Brazil than in the US. Conclusions. Overall, our findings replicated those reported in international comparisons of CBCL scores for 31 societies, thereby providing support for the multicultural robustness of the CBCL in Brazil.

Syndromes of Self-Reported Psychopathology for Ages 18–59 in 29 Societies

This study tested the multi-society generalizability of an eight-syndrome assessment model derived from factor analyses of American adults’ self-ratings of 120 behavioral, emotional, and social problems. The Adult Self-Report (ASR; Achenbach and Rescorla 2003) was completed by 17,152 18–59-year-olds in 29 societies. Confirmatory factor analyses tested the fit of self-ratings in each sample to the eight-syndrome model. The primary model fit index (Root Mean Square Error of Approximation) showed good model fit for all samples, while secondary indices showed acceptable to good fit. Only 5 (0.06%) of the 8,598 estimated parameters were outside the admissible parameter space. Confidence intervals indicated that sampling fluctuations could account for the deviant parameters. Results thus supported the tested model in societies differing widely in social, political, and economic systems, languages, ethnicities, religions, and geographical regions. Although other items, societies, and analytic methods might yield different results, the findings indicate that adults in very diverse societies were willing and able to rate themselves on the same standardized set of 120 problem items. Moreover, their self-ratings fit an eight-syndrome model previously derived from self-ratings by American adults. The support for the statistically derived syndrome model is consistent with previous findings for parent, teacher, and self-ratings of 1½–18-year-olds in many societies. The ASR and its parallel collateral-report instrument, the Adult Behavior Checklist (ABCL), may offer mental health professionals practical tools for the multi-informant assessment of clinical constructs of adult psychopathology that appear to be meaningful across diverse societies.

Syndromes of collateral-reported psychopathology for ages 18-59 in 18 Societies

The purpose was to advance research and clinical methodology for assessing psychopathology by testing the international generalizability of an 8-syndrome model derived from collateral ratings of adult behavioral, emotional, social, and thought problems. Collateral informants rated 8,582 18-59-year-old residents of 18 societies on the Adult Behavior Checklist (ABCL). Confirmatory factor analyses tested the fit of the 8-syndrome model to ratings from each society. The primary model fit index (Root Mean Square Error of Approximation) showed good model fit for all societies, while secondary indices (Tucker Lewis Index, Comparative Fit Index) showed acceptable to good fit for 17 societies. Factor loadings were robust across societies and items. Of the 5,007 estimated parameters, 4 (0.08%) were outside the admissible parameter space, but 95% confidence intervals included the admissible space, indicating that the 4 deviant parameters could be due to sampling fluctuations. The findings are consistent with previous evidence for the generalizability of the 8-syndrome model in self-ratings from 29 societies, and support the 8-syndrome model for operationalizing phenotypes of adult psychopathology from multi-informant ratings in diverse societies.

Microcefalia e outras manifestações relacionadas ao vírus Zika: impacto nas crianças, nas famílias e nas equipes de saúde

The present study aimed to present an overview of recent national and international research on the Zika virus (ZIKV), as well as to explore possible action plans focused on children, their families and the health teams involved.Therefore, the study proposes the implementation of tracking systems in order to identify, describe and characterize the potential correlates of prenatal exposure to ZIKV, divided into three lines of action: 1. Diagnostic and etiological evaluation as well as screening of developmental problems in children confirmed or suspected of prenatal ZIKV infection. 2. Investigation of the emotional impact, quality of life, coping strategies and support network of the affected children and their families. 3. Training of multidisciplinary teams to conduct assessments and intervention programs throughout these childrens development, especially in the first three years of life. In conclusion, the recent ZIKV outbreak in Brazil and several other Latin American countries places a significant burden on the health care systems: to understand the real meaning of a potential new teratogen; to unravel the pathogenic mechanisms of ZIKV, particularly in a prevention perspective; and to recognize the broad spectrum of clinical manifestations in order to devise intervention programs.O presente estudo objetivou apresentar um panorama nacional e internacional atual dos estudos sobre o virus Zika (ZIKV) e, ancorado no avanco deste conhecimento, refletir sobre planos de acao voltados para as criancas, familias e equipes de saude envolvidas. Neste sentido, o estudo propos a implementacao de sistemas de seguimento para conhecer, descrever e caracterizar aspectos que devem estar relacionados a exposicao pre-natal ao ZIKV, divididos em tres eixos de atuacao: 1. Avaliacao diagnostica e etiologica e rastreamento de problemas de desenvolvimento nas criancas incluidas como casos confirmados ou suspeitos. 2. Investigacao do impacto emocional, da qualidade de vida, das estrategias de enfrentamento e da rede de apoio as familias das criancas incluidas. 3. Capacitacao de equipes multiprofissionais para avaliar e elaborar programas de intervencao ao longo do desenvolvimento das criancas, principalmente nos tres primeiros anos de vida. Como conclusao, o presente trabalho ressalta que o sistema de assistencia a saude encontra-se diante de grandes desafios: entender o real significado de um potencial novo teratogeno; desvendar os mecanismos patogenicos do ZIKV, principalmente para o enfrentamento preventivo, e reconhecer o amplo espectro de manifestacoes clinicas para a elaboracao de programas de intervencao.

Child Behavior Checklist (CBCL), Youth Self-Report (YSR) e Teacher's Report Form (TRF): uma visão geral sobre o desenvolvimento das versões originais e brasileiras

O Sistema de Avaliacao de Base Empirica de Achenbach para criancas/adolescentes em idade escolar inclui tres instrumentos para avaliar problemas emocionais e/ou comportamentais: Child Behavior Checklist (CBCL) [pais], Youth Self-Report (YSR) [adolescentes] e Teachers Report Form (TRF) [professores]. Este artigo de revisao fornece informacoes detalhadas sobre o desenvolvimento desses instrumentos nos Estados Unidos e no Brasil, descrevendo as principais alteracoes em itens, escalas e pontos de corte na pontuacao, ocorridas nas versoes originais de 1991 a 2001, e o processo de traducao, retrotraducao e adaptacao cultural dos questionarios originais para desenvolver as atuais versoes brasileiras oficiais do CBCL, YSR e TRF. A utilidade desses instrumentos em pesquisa e na pratica clinica e salientada, mencionando estudos epidemiologicos e de avaliacao de intervencoes conduzidos no Brasil. Pesquisadores e clinicos sao instruidos a respeito do uso correto das atuais versoes brasileiras oficiais, dando exemplos de perguntas frequentes, relevantes para o contexto brasileiro.

QUESTÕES RELACIONADAS AO RASTREAMENTO DE PROBLEMAS EMOCIONAIS/COMPORTAMENTAIS EM PRÉ-ESCOLARES

Graduation Program in Development Disorders, Universidade Presbiteriana Mackenzie, São Paulo, SP, Brazil. Received on September 27, 2017.

Testing Syndromes of Psychopathology in Parent and Youth Ratings Across Societies

As societies become increasingly diverse, mental health professionals need instruments for assessing emotional, behavioral, and social problems in terms of constructs that are supported within and across societies. Building on decades of research findings, multisample alignment confirmatory factor analyses tested an empirically based 8-syndrome model on parent ratings across 30 societies and youth self-ratings across 19 societies. The Child Behavior Checklist for Ages 6–18 and Youth Self-Report for Ages 11–18 were used to measure syndromes descriptively designated as Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, and Aggressive Behavior. For both parent ratings (N = 61,703) and self-ratings (N = 29,486), results supported aggregation of problem items into 8 first-order syndromes for all societies (configural invariance), plus the invariance of item loadings (metric invariance) across the majority of societies. Supported across many societies in both parent and self-ratings, the 8 syndromes offer a parsimonious phenotypic taxonomy with clearly operationalized assessment criteria. Mental health professionals in many societies can use the 8 syndromes to assess children and youths for clinical, training, and scientific purposes.

Disentangling the mental health impact of childhood abuse and neglect: A replication and extension study in a Brazilian sample of high-risk youth

Childhood maltreatment is a key predictor of mental health problems across the life span. Yet, how maltreatment types independently and jointly influence the risk for psychiatric problems remains unclear. The aim of the study was two-fold: first, to replicate recent findings regarding the impact of maltreatment types on youth psychiatric symptoms, based on a Brazilian sample of high-risk adolescents (n = 347; age range = 11-17 yrs), and second, to extend existing findings by examining whether this relationship is mediated by bullying victimization and/or perpetration. Measures included self-report ratings of childhood maltreatment and peer victimization, as well as multi-informant reports of internalizing and externalizing symptoms. Consistent with prior research, we found that: (i) maltreatment types often co-occurred; (ii) there was a linear association between number of maltreatment types experienced and symptom severity (i.e. cumulative effect); and (iii) emotional abuse emerged as the most consistent independent predictor of poor mental health across domains, raters, and gender. Additionally, this study extends previous findings by showing that the influence of maltreatment on psychiatric outcomes is partially mediated by peer victimization, but not by bullying perpetration. In conclusion, these findings expand our understanding of the heterogeneity in individual responses to maltreatment as well as highlighting emotional abuse as an important predictor of poor mental health.