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Evaluation of the Eyberg Child Behavior Inventory as a predictor of disruptive behavior during an initial pediatric dental examination.

The purpose of this study was to investigate relationships between the Eyberg Child Behavior Inventory (ECBI), a parent rating scale of children's behaviors at home, and children's disruptive behaviors during an initial dental visit. Behaviors of 18 Headstart children, 40 to 55 months of age, undergoing an initial exam were observed. Four possible negative behaviors based upon the North Carolina Behavior Rating Scale (NCBRS), were recorded by two observers for each subject during five phases of an initial dental visit and statistically compared to the total ECBI score and individual answers within the ECBI questionnaire. Overall, the majority of subjects displayed clinically acceptable behavior. Four disruptive behaviors explained 92.9% of the variation in responses by the subjects to the initial visit. These were: high hand movement during the intraoral examination, crying or verbal protest during prophylaxis, oral physical resistance during prophylaxis, and oral-physical resistance during fluoride application. The following 6 questions explained 99.3% of the variation in ECBI responses by parents or guardians: (#9) refuses to obey until threatened with punishment, (#15) whines, (#18) hits parents, (#24) verbally fights with friends his own age, (#28) constantly seeks attention, and (#35) is overactive or restless. While the total number of subjects observed were too low to generate statistically significant results, the trends appear to indicate that a child's disruptive or nondisruptive behavior at home is not a reliable predictor of disruptive or nondisruptive behavior within the dental setting. These findings are independent of gender or race.

Analysis of Variance↗

A comparison of syndromes derived from the child behavior checklist for American and Dutch girls aged 6-11 and 12-16.

Child Behavior Checklists completed by parents of 1848 clinically referred American and Dutch girls aged 6-11 and 12-16 were subjected to principal components analyses with varimax rotations. For the 6-11 yr age group, seven of the nine empirically derived syndromes showed cross-national correlations ranging from 0.80 to 0.98. For 12-16-yr-old girls, all eight of the American syndromes were firmly replicated for Dutch girls with correlations ranging from 0.84 to 0.97. Furthermore, cross-national similarities in the distribution of scores for normative samples supported the use of the same syndrome scales by clinicians and researchers in the two countries.

Adolescent↗

A comparison of syndromes derived from the Child Behavior Checklist for American and Dutch boys aged 6-11 and 12-16.

Child Behavior Checklists completed by parents of 1863 clinically referred American and Dutch boys aged 6-11 and 12-16 were subjected to principal components analyses with varimax rotations. For each age group, the construct validity of seven empirically derived syndromes was supported by cross-national correlations ranging from 0.80 to 0.98. These syndromes were designated as Aggressive, Delinquent, Depressed (ages 6-11 only), Hyperactive, Schizoid (ages 12-16 only), Somatic Complaints, Uncommunicative, and Withdrawal (Social Withdrawal for ages 6-11; Hostile Withdrawal for ages 12-16). Cross-national similarities in the distribution of scores for normative samples supported the use of the same syndrome scales by clinicians and researchers in the two countries. The cross-national construct validity of Obsessive-Compulsive and Immature syndromes did not receive adequate support.

Adolescent↗

Early intervention in the path to alcohol problems through conduct problems: treatment involvement and child behavior change.

A program for the prevention of conduct problems among preschool-age sons of alcoholic fathers was implemented to interrupt what is likely to be a major mediating factor in the development of alcoholism in later years. A population-based sample of 42 families participated in a 10-month intervention involving parent training and marital problem solving. Differences in treatment outcome were examined, with the expectation that level of treatment involvement--entailing both level of participation and level of investment--would account for variability in child outcome at termination. Significant changes in positive and negative child behaviors were observed only within the group of families who completed the program and where the mothers demonstrated a higher level of treatment investment. When pretreatment child, parent, and family predictors of child behavior change were accounted for, subsequent analyses identified maternal treatment investment as a significant predictor of child outcome.

Alcoholism↗

Reliability of the Child Behavior Checklist for the assessment of behavioral problems of children and youth with mild mental retardation.

The assessment of psychopathology in persons with mental retardation requires reliable and valid instruments. In the present study, the reliability of the Child Behavior Checklist was determined, using data of 42 children and youth with mild mental retardation, with ages from 10 to 18 years. Kappa coefficients and intra-class correlations were computed to determine the reliability at item level and syndrome level. At item level, mean kappa's for inter-rater and test-retest reliability were 0.267 and 0.52, respectively. At syndrome level, mean intra-class correlations for inter-rater and test-retest reliability were 0.493 and 0.775, respectively. These results suggest that the Child Behavior Checklist may not always represent a reliable checklist for the assessment of psychopathology among children and youth with mild mental retardation.

Adolescent↗

Indiscriminate mothering as a contextual factor in aggressive-oppositional child behavior: "damned if you do and damned if you don't".

Fifty-two mother-child dyads took part in a parent training program to modify coercive, antisocial child behavior. Prior to intervention, scores on 14 measures of mother-child interaction and on an index of maternal community contacts (known as "insularity") were obtained for each dyad. This index was used to divide the sample into two groups (noninsular n = 21; insular n = 31). The interactional measures were then compared between the groups. Insular mothers were more aversive and indiscriminate than noninsular mothers in their use of aversive behavior toward their children, while their children were more aversive than noninsular children, especially in response to aversive maternal behavior. It was concluded that research and therapeutic work with deviant families should focus not only on immediate family interactions but also on the extrafamily environment in which these interactions take place.

Adult↗

Parent recruitment and retention in a universal prevention program for child behavior and emotional problems: barriers to research and program participation.

Despite the potential of parent training as a prevention and behavioral family intervention strategy, there are a number of important issues related to implementation (e.g., recruitment and retention of families). This paper presents recruitment and retention data from families enrolling in a randomized controlled universal prevention trial for child behavior problems conducted in Germany. The recruitment rate averaged 31% (general project participation), with families of lower socioeconomic status (SES) participating at a lower rate. Project-declining families most often reported intrusion of privacy as their primary concern. In contrast, once parents were enrolled in the project, participation among those randomized to the parent training group averaged 77% (program/intervention participation); non-participation was mostly due to logistical issues. Parents accepting the offer of parent training were more likely to report child behavior problems than did declining parents. Although parents from more disadvantaged areas had a lower overall level of participation in the project once recruited, parents with children having higher levels of behavior problems indeed were more likely to participate in the intervention. Different recruitment methods may be required to engage high-risk families from socioeconomically disadvantaged areas to further improve community-level impact on child mental health.

Adult↗

Dentist-implemented contingent escape for management of disruptive child behavior.

We evaluated the effectiveness of a dentist-implemented intervention in which brief escape from dental treatment was provided to manage disruptive child behavior during restorative dental treatment. Within a multiple baseline design across subjects, 4 children, aged 3 to 7 years, were provided temporary escape from dental treatment contingent upon brief periods of cooperative behavior. Disruptive behavior decreased when the appropriate escape contingency was used at least 80% of the time. The escape contingency required no more time than traditional management procedures (e.g., tell-show-do, reprimands and loud commands, restraint) to bring disruptive behavior under control. Independent ratings by two dentists provided social validation of the efficacy of the escape contingency.

Child↗

Predicting child behavior problems in maritally violent families.

Previous research indicates that children from violent marriages are more likely to suffer from conduct problems and/or anxiety disorders than children from nonviolent, satisfactory marriages. However, knowledge regarding specific factors present in violent marriages relating to child problems is limited. The present study examined the relationships involving interspousal aggression, parent-child aggression, and child behavior problems in a sample of 45 children from maritally violent families. Mothers indicated how often their children witnessed interspousal aggression and were victims of parent-child aggression. Mothers also rated their children's problem behaviors while children reported on their own depressive symptoms. The witnessing of interspousal aggression was highly associated with parental aggression directed toward children. Parent-child aggression related to attention problems, anxiety-withdrawal, motor excess, and conduct problems in children. However, the witnessing of interspousal aggression was not significantly related to child behavior problems. These results are consistent with theoretical predictions linking marital problems to child behavior by virtue of their association with parenting.

Anxiety Disorders↗

Does the child behavior checklist reveal psychopathological profiles of children with focal unilateral cortical lesions?

Psychopathological profiles were investigated in children with focal unilateral radiologically documented cortical lesions (15 right lesions and 22 left lesions). The 8 clinical subscales of the Child Behavior Checklist Parent Form (CBCL-P) and the Internalizing and Externalizing subscales were the dependent measures. The Internalizing and Externalizing scores did not dissociate as a function of lesion side. There were more Internalizing than Externalizing symptoms. Only the Attention Problems subscale yielded a significant difference as a function of lesion side; children with left lesions unexpectedly presented more problems. No significant differences were observed as a function offrontal versus nonfrontal lesion site, gender, or neurological variables on the Child Behavior Checklist (CBCL) subscales. Although sensitive to the presence of a focal lesion, the CBCL-P scarcely or misleadingly reflects any of the characteristics offocal unilateral cortical lesions in children. As suggested by the literature, most of the CBCL elevations in children with brain lesions could derive from the parent's and child's emotional response to any threatening medical condition.

Brain Neoplasms↗

Latent class analysis shows strong heritability of the child behavior checklist-juvenile bipolar phenotype.

BACKGROUND: The Child Behavior Checklist (CBCL) has been used to provide a quantitative description of childhood bipolar disorder (BPAD). Many have reported that children in the clinical range on the Attention Problems (AP), Aggressive Behavior (AGG), and Anxious-Depressed (A/D) syndromes simultaneously are more likely to meet the criteria for childhood BPAD. The purpose of this study was to determine if Latent Class Analysis (LCA) could identify heritable phenotypes representing the CBCL-Juvenile Bipolar (CBCL-JBD) profile and whether this phenotype demonstrates increased frequency of suicidal endorsement. METHODS: The CBCL data were received by survey of mothers of twins in two large twin samples, the Netherlands Twin Registry. The setting for the study was the general community twin sample. Participants included 6246 10-year-old Dutch twins from the Netherlands Twin Registry. The main outcome measure consisted of the LCA on the items comprising the AP, AGG, and A/D subscales and means from the suicidal items #18 and #91 within classes. RESULTS: A 7 class model fit best for girls and an 8 class fit best for boys. The most common class for boys or girls was one with no symptoms. The CBCL-JBD phenotype was the least common--about 4%-5% of the boys and girls. This class was the only one that had significant elevations on the suicidal items of the CBCL. Gender differences were present across latent classes with girls showing no aggression without the CBCL-JBD phenotype and rarely showing attention problems in isolation. Evidence of high heritability of these latent classes was found with odds ratios. CONCLUSIONS: In a general population sample, LCA identifies a CBCL-JBD phenotype latent class that is associated with high rates of suicidality, is highly heritable, and speaks to the comorbidity between attention problems, aggressive behavior, and anxious/depression in children.

Aggression↗

Prevalence and genetic architecture of Child Behavior Checklist-juvenile bipolar disorder.

BACKGROUND: No consensus has been reached yet on how best to characterize children with juvenile bipolar disorder (JBD). Several groups have shown that children on the attention problems (AP), aggressive behavior (AGG), and anxious-depressed (AD) syndromes of the Child Behavior Checklist (CBCL) are likely to meet criteria for DSM-JBD. We aimed to use a large population-based twin sample to evaluate the prevalence and genetic architecture of the CBCL-JBD (deviant on AP, AGG, and AD) phenotype and compare these data to children who are deviant on just the CBCL-AP syndrome. METHODS: Structural equation modeling (SEM) was applied to CBCL data from 5418, 3562, and 1971 Dutch twin pairs at ages 7, 10, and 12 years. RESULTS: The CBCL-JBD phenotype occurs in approximately 1% of children at each age. Among the children who meet criteria for the CBCL-AP phenotype ( approximately 5%), between 13 and 20% also meet criteria for CBCL-JBD. The best SEM for CBCL-JBD includes additive genetic, shared and unique environmental factors. The best SEM for CBCL-AP includes dominant and additive genetic and unique environmental factors. CONCLUSIONS: These data suggest that CBCL-JBD is common, and even more common among children who have severe attention problems. CBCL-JBD shows familial aggregation due to both genetic and shared environmental factors.

Adolescent↗

The Child Behavior Checklist (CBCL) and related material: standardization and validation in Danish population based and clinically based samples.

The Child Behavior Checklist (CBCL) and related material, developed by Achenbach and Edelbrock in Vermont, was validated in a mailed survey. A population based sample of 779 children between the age of four and 17 years was compared to a sample of 146 children referred for child psychiatric service. Danish children scored very much like our Scandinavian and German neighbours, but low compared to most others. The CBCL mean 'total behavior problem score' in the population was 17.7. The checklists, especially the parent and teacher versions, provided good construct validity. Youths generally reported more emotional problem behavior than their parents and teachers did about them. In general, parents and youths agree more, reporting emotional problems, and parents and teachers agree more, when scattering externalizing behavior. Short screening constructs are introduced, and by the use of latent trait analysis, four clinically relevant sub-scales were generated. Predictive value, sensitivity, specificity and clinical validity must be undertaken in a future two-phase study.

Adolescent↗

Assessing the influence of maternal depression on the validity of the Child Behavior Checklist.

The relative effects of maternal depression, child gender, and child psychiatric status on mothers' ratings of their children were assessed in a study of the validity of the Child Behavior Checklist (CBCL). Both maternal depression and gender were found to be significantly associated with mothers' ratings of their children on the CBCL. Nevertheless, mothers' ratings continued to differentiate groups of children with and without psychiatric problems even after the variance accounted for by maternal depression and child gender was removed. These findings support the criterion validity of the CBCL, and point also to the importance of assessing parents as part of the clinical evaluation of children.

Aggression↗

Acceptability of aversive procedures and medication as treatment alternatives for deviant child behavior.

The present investigation evaluated the acceptability of alternative treatments for deviant child behavior. Clinical cases of children who displayed severe behavioral problems at home and a school were described along with three different treatments. The treatments, time-out from reinforcement, locked seclusion, and medication, were rated by psychiatric inpatient children and parents in a 3 X 3 replicated Latin-square design. The investigation also evaluated whether acceptability ratings were influenced by the clinical effectiveness of treatment in altering behavior. Although children and parents did not differ overall in acceptability ratings, they differed in their ranking of different treatments. Children viewed medication as the most acceptable treatment, whereas parents viewed time-out as the most acceptable treatment. For both children and parents, treatments described as producing marked effects were rated as more acceptable than treatments producing weaker effects. The results indicated that disturbed children and their parents can readily distinguish the acceptability of alternative treatments. The implications of treatment acceptability for clinical applications of treatment are discussed.

Behavior Therapy↗

Interactions between child and parent temperament and child behavior problems.

OBJECTIVE: Few studies of temperament have tested goodness-of-fit theories of child behavior problems. In this study, we test the hypothesis that interactions between child and parent temperament dimensions predict levels of child psychopathology after controlling for the effects of these dimensions individually. METHODS: Temperament and psychopathology were assessed in a total of 175 children (97 boys, 78 girls; mean age, 10.99 years; SD, 3.66 years) using composite scores from multiple informants of the Junior Temperament and Character Inventory and the Achenbach System of Empirically Based Assessment. Parent temperament was assessed using the adult version of the Temperament and Character Inventory. Statistical analyses included multiple regression procedures to assess the contribution of child-parent temperament interactions after controlling for demographic variables, other types of child psychopathology, and the individual Temperament and Character Inventory and Junior Temperament and Character Inventory dimensions. RESULTS: Interactions between child and parent temperament dimensions predicted higher levels of externalizing, internalizing, and attention problems over and above the effects of these dimensions alone. Among others, the combination of high child novelty seeking with high maternal novelty was associated with child attention problems, whereas the combination of high child harm avoidance and high father harm avoidance was associated with increased child internalizing problems. Many child temperament dimensions also exerted significant effects independently. CONCLUSIONS: The association between a child temperament trait and psychopathology can be dependent upon the temperament of parents. These data lend support to previous theories of the importance of goodness-of-fit.

Age Factors↗