May Britt Drugli

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.

Parent training for young Norwegian children with ODD and CD problems: Predictors and mediators of treatment outcome

Participants were 121 children, aged 4-8 years referred for conduct problems, and their mothers. A parent training intervention was implemented in two outpatient clinics in Norway. Treatment responders were defined as children scoring below a cut-off on the Eyberg Child Behavior Inventory, a score below an optimal cut-off for children in day-care and school as reported by teachers, in addition to a 30% reduction or greater in observed negative parenting. Self-reported parenting practices were explored as potential mediators. The results of logistic regression analyses showed that high levels of maternal stress, clinical levels of ADHD, and being a girl predicted a poorer outcome in conduct problems at home, while pretreatment clinical levels of ADHD predicted a poorer outcome as perceived by the teachers. Harsh and inconsistent parental disciplining emerged as significant partial mediators of changes in conduct problems, highlighting the importance of altering parenting practices to modify young childrens conduct problems.

Five- to six-year outcome and its prediction for children with ODD/CD treated with parent training

BACKGROUND While short-term effects of parent training (PT) have been extensively evaluated, long-term outcome and present predictors of a diagnosis for children with ODD/CD treated with parent training are very limited. METHOD In the present study, diagnostic status as outcome and predictors of treatment response were examined in a 5-6-year follow-up. Out of 99 children who had been treated in a randomised controlled trial evaluating the effects of The Incredible Years parent training (PT) or combined parent training and child treatment (PT+CT) programme, 54.5% participated in the 5-6-year follow-up study. Their diagnostic status was determined with the Kiddie-SADS interview. RESULTS While all children qualified for a diagnosis of ODD/CD before treatment, 5-6 years later, two-thirds no longer received such a diagnosis, the same proportion as found at the 1-year follow-up. The most powerful pre-treatment predictors of diagnostic status at the 5-6-year follow-up were living with mother only and being a girl. At post-treatment the most powerful predictor was found to be high levels of child externalising problems. CONCLUSION The findings of the study support the maintenance of positive long-term results for young children treated with parent training because of serious conduct problems, and identify characteristics of children and families in need of added support to parent training programmes.

Changes in social competence in young children treated because of conduct problems as viewed by multiple informants

In the present study changes in social competence were examined in a clinic sample of 127 children aged 4–8. The children were recruited to a controlled treatment study because of conduct problems at home and were randomised to the Incredible Years parent training (PT), combined PT and child therapy (CT) or a waiting-list control-group. Assessments were conducted pre- and post-treatment and at a one-year follow-up by multiple informants (mother, father, teacher and child). Parent training combined with child treatment showed most improvement in child social competence based on mother, father and child reports, however, father reports showed positive results for children treated with PT only. Treated mothers and fathers showed a decrease in correlations in their reports of social competence in the child after treatment as compared to parents in the waiting-list condition. No generalisation effects to peer-relationships in day-care/school were found, neither on teacher or child reports. A broad perspective using multiple informants from different settings is needed when effects of treatment of young children with conduct problems are evaluated and should include various aspects of social competence.

School competence and emotional/behavioral problems among Norwegian school children as rated by teachers on the Teacher Report Form

Of 1,409 eligible children aged 6-13 years in grades 1 to 7 who were randomly selected from a national sample of Norwegian schools, 858 participated in the present study (60.9%). The sample was stratified by school centrality, region and size of grade cohort. The teachers assessed their childrens academic performance, adaptive school functioning, and levels of emotional/behavioral problems using the 2001 version of the Teacher Report Form (TRF). Only one child was randomly selected from each grade cohort. Girls had significantly higher scores than boys in the Working Hard, Appropriate Behavior, Learning, and Total Adaptive Functioning domains. For girls, only the Working Hard domain was of medium effect size. While boys had significantly higher scores than girls on Attention, Thought Problems, Rule-Breaking, Aggression, Externalizing Problems and Total problems, only Attention Problems showed a medium effect size. Significant sex by age interaction effects were also found for Rule-Breaking, Externalizing, Internalizing, Anxious-Depressed and Total Problems. In all these comparisons, 10-13-year-old boys had significantly higher scores than 6-9-year olds, while girls had similar problem levels across age groups. Our mean Total Problems score (17.2) was lower than the grand mean (21.6) reported in a multi-country comparison but higher than in another Norwegian large-scale survey. Overall, our findings indicate that teachers in Scandinavia report, just as do parents, relatively low levels of emotional/behavioral problems among school-aged children.

Relationships between young children in full-time day care and their caregivers: a qualitative study of parental and caregiver perspectives

We studied the quality of caregiver–child relationships from the perspectives of parents and caregivers of young children in full-time day care. The sample consisted of 41 parents of children aged two years or younger (22 boys and 19 girls) in day care, and 35 of their caregivers. Parents and caregivers were interviewed. Parents and caregivers appeared to have up-to-date knowledge about caregiver–child relationships and about their importance. However, in evaluating the quality of the relationship between the individual child and its caregivers, both parties appeared to be more positive in their judgements than previous research would suggest. Caregivers are even more positive in their evaluations than parents. Day-care centres lack concrete assessment tools that might also reveal negative aspects of the relationship between caregivers and young children.We studied the quality of caregiver–child relationships from the perspectives of parents and caregivers of young children in full-time day care. The sample consisted of 41 parents of children aged two years or younger (22 boys and 19 girls) in day care, and 35 of their caregivers. Parents and caregivers were interviewed. Parents and caregivers appeared to have up-to-date knowledge about caregiver–child relationships and about their importance. However, in evaluating the quality of the relationship between the individual child and its caregivers, both parties appeared to be more positive in their judgements than previous research would suggest. Caregivers are even more positive in their evaluations than parents. Day-care centres lack concrete assessment tools that might also reveal negative aspects of the relationship between caregivers and young children.

How are Closeness and Conflict in Student–Teacher Relationships Associated with Demographic Factors, School Functioning and Mental Health in Norwegian Schoolchildren Aged 6–13?

This study explored the association between teacher-reported student-teacher relationship quality (closeness and conflict) and demographic factors, school functioning and child mental health in a cross-sectional study. The study was conducted among a national sample of Norwegian school children (N = 825) in grades 1 to 7. Bivariate analyses and standard multiple regression analysis were conducted. Conflict in student–teacher relationships correlated highly with child mental health factors and in particular, problems of externalization. For closeness in student-teacher relationships, demographic factors accounted for the largest proportion of variance. Our findings suggest that different strategies may be needed to promote closeness and reduce conflict in student–teacher relationships.

Factor Structure of the Student–Teacher Relationship Scale for Norwegian School-age Children Explored with Confirmatory Factor Analysis

The validity of the Student–Teacher Relationship Scale (STRS) was examined in a national sample of 863 Norwegian schoolchildren in grades 1–7 (aged 6–13). The original factor structure of the STRS was tested by confirmatory factor analysis (CFA). The CFA results did not support the original three-factor structure of the STRS. Subsequent CFA of the short form of the STRS (STRS-SF) supported the shortened version, which contained 15 items and two factors (closeness and conflict). The concurrent validity of the STRS-SF was also found to be good. This study provides initial support for the factor validity of the STRS-SF for Norwegian children in grades 1–7. This measurement should be useful for both researchers and practitioners who want to assess and evaluate the quality of student–teacher relationships.

Pervasive and non-pervasive conduct problems in a clinic sample aged 4-8 years: child, family and day-care/school factors

Differences between pervasive (home and day‐care/school) versus non‐pervasive (home only) conduct problems were examined in regard to various child, parent/family, and day‐care/school characteristics in an outpatient clinic sample of 120 children aged 4–8 years. All children scored above the 90th percentile on the Eyberg Child Behavior Inventory for home problems and met the criteria for a possible or a confirmed diagnosis of oppositional defiant behaviours. The proportion of children with pervasive conduct problems was high, 83%. Teachers in day care and school reported children in the pervasive group to have significantly more attention and internalizing problems as well as lower social competence scores than those in the non‐pervasive group. Children in the pervasive group also showed consistently more problems in their relationships both with teachers and peers than those in the non‐pervasive group. The implications for assessment and treatment of children with conduct problems in these age‐groups are discussed.

Do demographic factors, school functioning, and quality of student–teacher relationships as rated by teachers predict internalising and externalising problems among Norwegian schoolchildren?

The present study explored the association between child internalising and externalising problems in schools and demographic factors (sex and age), school functioning (academic performance and adaptive functioning) and teacher-reported student–teacher relationship quality in a cross-sectional study using structural equation modelling. The study was conducted among a sample of Norwegian schoolchildren (n=825) in grades 1–7. The results showed among others that conflict in student–teacher relationships had the strongest association with teacher-reported child externalising and internalising problems. The school system and the teachers probably need to place more focus on how to support children with these kinds of mental health problems.