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

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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 Teacher’s 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.

Section snippets

Purposes

Our purposes were as follows: (a) to test how well the CBCL, YSR, and TRF syndrome models fit the data from 27 samples not included in previous CFA studies3, 4, 5; to test effects of society, age, and gender on CBCL, YSR, and TRF scores by integrating the 27 new samples with previous samples6, 7, 8; to test whether the same items received low, medium, or high ratings in different societies; to describe construction of multisociety norms; and to illustrate clinical applications.

Samples

Table 111, 12, 13, 14, 15, 16, 17, 18, 19, 20 describes the 27 samples used in the new CFAs (11 CBCL, 10 YSR, 6 TRF). For the international comparisons of scale scores and mean item ratings, we combined data from the 27 samples used for the CFAs with data from the samples used in previous international comparisons,6, 7, 8 yielding CBCL samples of 69,866 children and adolescents aged 6 through 16 years from 42 societies, YSR samples of 38,070 youths aged 11 through 16 years from 34 societies,

CFAs

For CFAs, items were dichotomized as 0 versus 1 to 2 to avoid low-frequency cells, and tetrachoric correlations were used as the input matrix. To account for non-normal item distributions, we used the weighted least squares with standard errors and mean- and variance-adjusted χ2 estimator (WLSMV) via Mplus 6.0.23 We used the root mean square error of approximation (RMSEA) as the primary fit index because of its superior performance with binary categorical data in a Monte Carlo simulation study.

Discussion

When new data obtained in North Africa (Algeria, Tunisia), Asia (China, Pakistan, Singapore), South America (Brazil, Colombia, Peru, Uruguay), the Balkans (Croatia, Kosovo, Serbia), and Western Europe (France, Italy, Norway, Portugal, Sweden) were combined with previous data from Europe, the Middle East, Africa, Asia, the Caribbean, Australia, and the U.S., the results indicated certain international consistencies but also some significant differences.

We used CFAs to test how well the syndrome

Clinical Applications

Clinicians use diagnoses to guide treatments (e.g., prescribing selective serotonin reuptake inhibitors [SSRIs] versus stimulants), and may also wish to use dimensional instruments. As detailed by Achenbach et al.,1 dimensional instruments can provide clinically useful data at different hierarchical levels. For the CBCL, YSR, and TRF, these hierarchical levels include specific problem items, narrow-band syndrome scales, broad-band Internalizing and Externalizing scales, and a global index of

References (37)

  • L.A. Rescorla et al.

    Epidemiological comparisons of problems and positive qualities reported by adolescents in 24 countries

    J Consult Clin Psychol

    (2007)
  • L.A. Rescorla et al.

    Consistency of teacher-reported problems for students in 21 countries

    Sch Psychol Rev

    (2007)
  • Pike KL, ed. Language in Relation to a Unified Theory of Structure of Human Behavior. 2nd ed. Hague, Netherlands:...
  • T.M. Achenbach et al.

    Multicultural Supplement to the Manual for the ASEBA School-Age Forms and Profiles

    (2007)
  • D. Petot et al.

    Behavioral and emotional problems of Algerian children and adolescents as reported by parents

    Eur Child Adolesc Psychiatry

    (2008)
  • Rocha, M.M. Evidências de validade do "Inventário de Autoavaliação para Adolescentes" (YSR/2001) para a População...
  • J. Wang et al.

    The application of CBCL, YSR and TRF for 12-18 years of age students in Beijing

    Chin Ment Health J

    (2005)
  • V. Rudan et al.

    The Child Behavior Checklist, Teacher’s Report Form and Youth Self Report Problem Scales in a normative sample of Croatian children and adolescents aged 7–18

    Coll Antropol

    (2005)
  • Cited by (0)

    This work was supported by the nonprofit Research Center for Children, Youth, and Families (RCCYF), which publishes the Achenbach System of Empirically Based Assessment (ASEBA), and the Singapore Ministry of Health’s National Medical Research Council under its Individual Research Grant NMRC/0745-2003 (D.S.S.F., Y.P.O., B.S.C.W). The Portuguese study was supported by the Fundação Minerva-Cultura-Ensino e Investigação Científica, the founding organization of the Lusíada Universities (P.M., J.T.O.).

    Disclosure: Dr. Rescorla is Vice President of the nonprofit RCCYF, from which she has received remuneration. She has received royalties for a book published by Guilford press in 2007 and honoraria for invited talks. Dr. Ivanova is Secretary of the nonprofit RCCYF, from which she has received remuneration. She has received honoraria for invited talks. Dr. Achenbach is President of the nonprofit RCCYF, which publishes the Achenbach System of Empirically Based Assessment (ASEBA) and from which he has received remuneration. He has received royalties for a book published by Guilford Press in 2007 and honoraria for invited talks. Dr. Rocha has received financial support from the Brazilian government for doctoral research, which involved collecting Youth Self-Report (YSR) data. She has provided ASEBA training workshops in Brazil, for which she has received no financial remuneration. Dr. Silvares has served as the ASEBA distributor in Brazil. Drs. Begovac, Chahed, Drugli, Emerich, Fung, Haider, Hewitt, Jaimes, Larsson, Maggiolini, Marković, Mitrović, Moreira, Oliveira, Hansson, Olsson, Ooi, Petot, Pisa, Pomalima, Rudan, Sekulić, Szirovicza, Shahini, Valverde, Vera, Villa, Viola, Woo, and Zhang report no biomedical financial interests or potential conflicts of interest.

    This article is discussed in an editorial by Drs. Luis Augusto Rohde and Christian Kieling on page 1236.

    An interview with the author is available by podcast at www.jaacap.org or by scanning the QR code to the right.

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