Yoon Phaik Ooi

International comparisons of behavioral and emotional problems in preschool children: Parents' reports from 24 societies

International comparisons were conducted of preschool childrens behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½–5 by parents in 24 societies (N = 19,850). Item ratings were aggregated into scores on syndromes; Diagnostic and Statistical Manual of Mental Disorders–oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3–12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0–198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes < 1%). Across all pairs of societies, correlations between mean item ratings averaged .78, and correlations between internal consistency alphas for the scales averaged .92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies.

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.

Identification of Autism Spectrum Disorders Using the Child Behavior Checklist in Singapore

We tested the ability of the 2001 CBCL syndromes to discriminate among 86 children with Autism Spectrum Disorder (ASD), 117 children with Attention Deficit Hyperactivity Disorder—Inattentive type, 426 children with Attention Deficit Hyperactivity Disorder—Hyperactive-Impulsive or Combined type, 200 clinically referred children who did not receive a diagnosis, and 436 typically-developing children in a community sample. The Withdrawn/Depressed, Social Problems, and Thought Problems syndromes significantly discriminated the ASD group from the four other groups. An ASD scale, constructed from nine CBCL items, demonstrated moderate to high sensitivity (68 to 78%) and specificity (73 to 92%). Consistent with previous research, findings from this study provide strong support for the CBCL as a screening tool for ASD.

Parent–Teacher Agreement on Children's Problems in 21 Societies

Parent–teacher cross-informant agreement, although usually modest, may provide important clinical information. Using data for 27,962 children from 21 societies, we asked the following: (a) Do parents report more problems than teachers, and does this vary by society, age, gender, or type of problem? (b) Does parent–teacher agreement vary across different problem scales or across societies? (c) How well do parents and teachers in different societies agree on problem item ratings? (d) How much do parent–teacher dyads in different societies vary in within-dyad agreement on problem items? (e) How well do parents and teachers in 21 societies agree on whether the childs problem level exceeds a deviance threshold? We used five methods to test agreement for Child Behavior Checklist (CBCL) and Teachers Report Form (TRF) ratings. CBCL scores were higher than TRF scores on most scales, but the informant differences varied in magnitude across the societies studied. Cross-informant correlations for problem scale scores varied moderately across societies studied and were significantly higher for Externalizing than Internalizing problems. Parents and teachers tended to rate the same items as low, medium, or high, but within-dyad item agreement varied widely in every society studied. In all societies studied, both parental noncorroboration of teacher-reported deviance and teacher noncorroboration of parent-reported deviance were common. Our findings underscore the importance of obtaining information from parents and teachers when evaluating and treating children, highlight the need to use multiple methods of quantifying cross-informant agreement, and provide comprehensive baselines for patterns of parent–teacher agreement across 21 societies.

Examining the criterion validity of CBCL and TRF problem scales and items in a large Singapore sample.

This study examined the criterion validity of the Child Behavior Checklist (CBCL) and Teacher’s Report Form (TRF) problem scales and items in demographically-matched Singapore samples of referred and non-referred children (840 in each sample for the CBCL and 447 in each sample for the TRF). Internal consistency estimates for both the CBCL and TRF scales were good. Almost all CBCL and TRF problem scales and items significantly discriminated between referred and non-referred children, with referred children scoring higher, as expected. The largest referral status effects were on attention problems scales and their associated items, with the TRF having larger effects than the CBCL. Effect sizes for demographic variables such as age, gender, ethnicity and SES were much smaller than effect sizes for referral status, across both the CBCL and TRF forms and at both the scale and item levels. These findings suggest that teachers can be effective partners in identifying children who need mental health services and those who do not.

The continued development and practice of school psychology in Singapore: Using REACH as an Illustration

School psychology in Singapore gained greater prominence with the development of the National Mental Health Blueprint in 2007 that included a focus on children and adolescents. A partnership between the Ministry of Health and the Ministry of Education was formed to develop a community mental health pilot program called ‘Response, Early Intervention and Assessment in Community Mental Health for Students’ (REACH). Disruptive behavior disorders (DBD) are among the most common disorders seen in schools and child psychiatric clinics in Singapore. Children with disruptive behavior disorders (DBD) often exhibit deficits in social cognition and behavior, thereby influencing their cognitive appraisal processes and interpersonal problem-solving skills. This in turn affects their processing and interpretation of social cues in ambiguous situations, and mars subsequent production of socially competent behavior. This article describes a potential framework based on the cognitive-behavioral approach for working with children with disruptive behaviors and aggression in the school system. By combining REACH, a national collaborative framework, and evidence-based treatment programs, we provide a promising model of care to support children and their families in Singapore.

Comparisons between autism spectrum disorders and anxiety disorders: findings from a clinic sample in Singapore.

The goals of the present study were to: (i) examine similarities and differences in behavioral/emotional problems manifested by children with autism spectrum disorder (ASD) and those with anxiety disorder (ANX); (ii) test the ability of each of the eight child behavioral checklist (CBCL) and teacher report form (TRF) syndrome scales to differentiate the ASD group from the ANX group; and (iii) test the ability of an ASD scale derived by Ooi et al. to differentiate the ASD group from the ANX group.

Self-reported depression and anxiety symptoms in school-aged Singaporean children

Few studies have examined anxiety and depression experiences of primary (middle) school‐aged children from ethnically diverse backgrounds, and most have relied on parents or others as informants. The present study aimed to investigate self‐reported anxiety and depression symptoms in Singaporean primary school‐aged children. Age, gender, and ethnic differences and interactions were explored as well as similarities and differences between Singaporean children and US norms.

Omega-3 ( ω -3) and social skills interventions for reactive aggression and childhood externalizing behavior problems: a randomized, stratified, double-blind, placebo-controlled, factorial trial

BACKGROUND While studies suggest that nutritional supplementation may reduce aggressive behavior in children, few have examined their effects on specific forms of aggression. This study tests the primary hypothesis that omega-3 (ω-3), both alone and in conjunction with social skills training, will have particular post-treatment efficacy for reducing childhood reactive aggression relative to baseline. METHODS In this randomized, double-blind, stratified, placebo-controlled, factorial trial, a clinical sample of 282 children with externalizing behavior aged 7-16 years was randomized into ω-3 only, social skills only, ω-3 + social skills, and placebo control groups. Treatment duration was 6 months. The primary outcome measure was reactive aggression collected at 0, 3, 6, 9, and 12 months, with antisocial behavior as a secondary outcome. RESULTS Children in the ω-3-only group showed a short-term reduction (at 3 and 6 months) in self-report reactive aggression, and also a short-term reduction in overall antisocial behavior. Sensitivity analyses and a robustness check replicated significant interaction effects. Effect sizes (d) were small, ranging from 0.17 to 0.31. CONCLUSIONS Findings provide some initial support for the efficacy of ω-3 in reducing reactive aggression over and above standard care (medication and parent training), but yield only preliminary and limited support for the efficacy of ω-3 in reducing overall externalizing behavior in children. Future studies could test further whether ω-3 shows promise in reducing more reactive, impulsive forms of aggression.

Web-based CBT for the Treatment of Selective Mutism: Results from a Pilot Randomized Controlled Trial in Singapore

Introduction: Cognitive behavioral therapy (CBT) approaches have shown promise for some children with Selective Mutism (SM), but to date there are limited published randomized controlled trials (RCT) of CBT interventions for SM. We present findings from a pilot RCT of the Meeky Mouse program, a 14-week web-based CBT program for children with SM. Method: A total of 21 children (6-12 years old) with a primary diagnosis of SM from a child psychiatric outpatient clinic were included in this study. They were randomly assigned to either 14 weeks of the Meeky Mouse program (n=10) or to a control condition in which they interacted with the therapist while playing computer games (n=11). Results: No significant group differences were found on anxiety symptoms. The control group showed significant improvements from pre- to post-treatment on total frequency of speech. Children in the Meeky Mouse group showed greater improvements in clinician-rated severity of mental illness and had higher clinician-rated improvement scores relative to those in the control group. Conclusions: Findings from our pilot RCT study suggest that the web-based CBT using anxiety management strategies may be no different from an intervention that involves regular monitoring of child’s engagement in socializing activities for improving SM symptoms. Further study is needed to determine optimal strategies for treating children with SM with the use of web-based applications.