Stephanie H. McConaughy

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.

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.

Three-year course of behavior/emotional problems in a national sample of 4- to 16-year-olds: III. Predictors of signs of disturbance.

We tested parent-reported family variables, problems, competencies, and stress as predictors of (a) academic problems, (b) school behavior problems, (c) receipt of mental health services, (d) childs need for additional help, (e) suicidal behavior, (f) police contacts, and (g) the sum of these 6 outcomes. Included in the study were 995 cases manifesting at least 1 sign of disturbance (from Outcomes a-f) and 995 matched controls from a national sample of 2,479 children assessed twice over a 3-year interval. Path analyses identified predictors that were significant across age and sex plus those specific to particular groups. The predictive models accounted for medium to large effects in Time 2 signs of disturbance. Time 2 Child Behavior Checklist scores were significantly associated with all Time 2 disturbance scores. The multiple significant risk factors associated with signs of disturbance indicated variations in pathways leading to particular signs of disturbance.

The Achieving, Behaving, Caring Project for Preventing ED: Two-Year Outcomes

Two-year outcomes are reported for a school-based early intervention program for 82 children identified as at risk for emotional disturbance (ED) by their kindergarten teachers. Matched pairs of children were randomly assigned to Parent-Teacher Action Research (PTAR) teams or to a control group for their first- and second-grade years. Teachers also provided social skills instruction to all participants, along with their classmates. At the end of the 2-year period, the PTAR group showed significantly greater reductions than the control group in teacher-reported internalizing problems and delinquent behavior; parent-reported total problems, externalizing, and delinquent behavior; and observed internalizing problems in the classroom. PTAR group parents also reported significantly greater increases in their childrens cooperation, self-control, and total competence, as well as in their own feelings of empowerment in obtaining school-based services for their children. The findings demonstrate long-term incremental benefits of PTAR teams combined with whole-class social skills instruction for children at risk for ED.

Evaluating Behavioral and Emotional Disorders with the CBCL, TRF, and YSR Cross-Informant Scales

A model of multiaxial empirically based assessment is described that incorporates standardized rating scales for obtaining parent, teacher, and self-reports of behavioral and emotional problems. Special emphasis is placed on the cross-informant scales of the 1991 scoring profiles for the Child Behavior Checklist (CBCL), Teachers Report Form (TRF), and Youth Self-Report (YSR). Their application to the federal special education definition of Serious Emotional Disturbance (SED) is illustrated in a case example. Data from multiple sources are applied to criteria for SED to determine eligibility for special education services.

Empirically Based Assessment of Serious Emotional Disturbance.

Abstract Our model of multiaxial empirically based assessment is described in a case study of a child identified as seriously emotionally disturbed (SED) according to Public Law 94-142 criteria. The case illustrates the use of the Child Behavior Checklist and related forms for obtaining standardized data on the childs competencies and problems from several sources, including teachers, parents, and direct observations. The empirically based measures are combined with clinical interviews and psychoeducational testing in a three-phase multiple gating process of assessment and intervention with the SED child.

Incremental Validity of Test Session and Classroom Observations in a Multimethod Assessment of Attention Deficit/Hyperactivity Disorder

This study tested the incremental validity of behavioral observations, over and above parent and teacher reports, for assessing symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) in children ages 6 to 12, using the Test Observation Form (TOF) and Direct Observation Form (DOF) from the Achenbach System of Empirically Based Assessment. The TOF Attention Problems and DOF Intrusive scales contributed significant unique variance, over and above parent and teacher ratings, to predicting parent and teacher ratings of hyperactivity and impulsivity and predicting categorical diagnoses of ADHD-Combined type versus Non-ADHD and ADHD-Combined type versus ADHD-Predominantly Inattentive type. The TOF Oppositional and Attention Deficit/Hyperactivity Problems scales contributed unique variance to predicting parent ratings of hyperactivity and impulsivity and the DOF Oppositional and Attention Deficit/Hyperactivity Problems scales contributed unique variance to predicting teacher ratings of hyperactivity and impulsivity.

How Long is Long Enough? Outcomes for a School-Based Prevention Program:

One-year versus 2-year outcomes are compared for a school-based prevention project for children at risk for emotional disturbance. Matched pairs of children were randomly assigned to Parent-Teacher Action Research (PTAR) teams or a control group for their 1st-and 2nd-grade years (Total n = 82). All children, along with their classmates, received social skills instruction from their teachers. Many more significant effects were found at the end of Year 2 than at the end of Year 1, including significant changes in childrens problems and competencies, as well as significant interactions demonstrating the effectiveness of PTAR teams. Implications are discussed regarding short-term versus more long-term implementation of prevention programs for elementary age at-risk children.

Life History Reports of Young Adults Previously Referred for Mental Health Services

In this article, we report factors associated with good versus poor outcomes for 173 young adults who were referred for mental health services as children or adolescents. Life history reports were compared for participants showing relatively good (n = III) versus poor (n = 62) outcomes, as determined by deviance on ≥ 2 of 3 measures of psychopathology. Participants with good outcomes differed from those with poor outcomes in the quality and stability of their living situations, full-time versus part-time employment, quality of peer relationships, goal orientation, types of successful experiences, number and types of stressful experiences, and use of mental health and other services.