Assessing Internalizing, Externalizing, and Attention Problems in Young Children: Validation of the MacArthur HBQ

doi:10.1097/chi.0b013e3180f616c6

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 46, Issue 10, October 2007, Pages 1315-1323

https://doi.org/10.1097/chi.0b013e3180f616c6 Get rights and content

ABSTRACT

Objective

To test the validity of the MacArthur Health and Behavior Questionnaire (HBQ) using receiver operating characteristic (ROC) analysis to determine optimal thresholds for the HBQ in predicting Diagnostic Interview Schedule for Children Version-IV (DISC-IV) diagnoses. The roles of child sex, level of impairment, and physical health in understanding of psychopathology were also considered.

Method

A sample of 814 8-year-old twin children was recruited from birth records. Mothers were interviewed over the telephone using the HBQ and were also interviewed in person using the DISC-IV. Fathers also completed the HBQ; children completed the parallel module of the Berkeley Puppet Interview.

Results

The HBQ identified more cases overall than the DISC-IV. Sex did not contribute to prediction of diagnosis. Impairment, DISC-IV symptom counts, father HBQ, child Berkeley Puppet Interview, and physical health significantly distinguished the HBQ low and high symptom groups.

Conclusions

The HBQ is a valid new screening measure of psychopathology for use with children under 9 years of age. It is sensitive to internalizing disorders, which may aid the understanding of depression and anxiety disorders that are often underappreciated in young children.

Section snippets

Participants

Participants were recruited from state birth records of all twins born in the state as part of a larger longitudinal project focused on the development of child psychopathology, the Wisconsin Twin Project (Lemery-Chalfant et al., 2006). The study was approved by the University of Wisconsin-Madison Institutional Review Board, and parents signed written letters of informed consent. Approximately 1,234 twins with a mean age of 8.1 years (SD 0.80) were screened. Screening involved administering the

RESULTS

We first provide prevalence and comorbidity rates by sex. Then, we describe the results of the ROC analyses for determining the optimal HBQ symptom thresholds, with and without sex as an additional predictor of diagnosis. Differences in impairment are then considered using the HBQ symptom thresholds and DISC diagnoses. Next, we test the utility of the HBQ thresholds using DISC symptom counts, father report on the HBQ, child report on the BPI, and physical health.

DISCUSSION

The HBQ has utility as a caregiver-report assessment of ADHD, Externalizing, and Internalizing psychopathologies in children. Boys qualified for more ADHD and Externalizing DISC-IV diagnoses overall (Fig. 1), although sex did not contribute to the placement of the thresholds in the ROC models. With ADHD, 8.7% of girls and 20.4% of boys screened positively, and 6.8% of girls and 18.3% of boys received a DISC diagnosis. With Externalizing, 11.9% of girls and 16.7% of boys screened positively,

REFERENCES (31)

JC Ablow et al.
The MacArthur three-city outcome study evaluating multi-informant measures of young children's symptomology
J Am Acad Child Adolesc Psychiatry
(1999)
WT Boyce et al.
The confluence of mental, physical, social, and academic difficulties in middle childhood. I: Exploring the “headwaters” of early life morbidities
J Am Acad Child Adolesc Psychiatry
(2002)
MJ Essex et al.
The confluence of mental, physical, social, and academic difficulties in middle childhood. II: Developing the MacArthur Health and Behavior Questionnaire
J Am Acad Child Adolesc Psychiatry
(2002)
P Jensen et al.
Scales, diagnoses, and child psychopathology: I. CBCL and DISC relationships
J Am Acad Child Adolesc Psychiatry
(1993)
J Luby et al.
Differential performance of the MacArthur HBQ and DISC-IV in identifying DSM-IV internalizing psychopathology in young children
J Am Acad Child Adolesc Psychiatry
(2002)
ME Schwab-Stone et al.
Criterion validity of the NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3)
J Am Acad Child Adolesc Psychiatry
(1996)
D Shaffer et al.
NIMH Diagnostic Interview Schedule for Children, Version IV (NIMH DISC-IV): description, differences from previous versions and reliability of some common diagnoses
J Am Acad Child Adolesc Psychiatry
(2000)
D Shaffer et al.
The Diagnostic Interview Schedule for Children-Revised version (DISC-R): I. Preparation, field testing, interrater reliability, and acceptability
J Am Acad Child Adolesc Psychiatry
(1993)
TM Achenbach
Manual for the Child Behavior Checklist/4-18 and 1991 Profile
(1991)
TM Achenbach et al.
Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity
Psychol Bull
(1987)

JM Armstrong et al.

Manual for the MacArthur Health and Behavior Questionnaire (HBQ 1.0). MacArthur Foundation Research Network on Psychopathology and Development (David J. Kupfer, Chair)

(2003)

JE Bates et al.

Objective and subjective components in mothers' perceptions of their children from age 6 months to 3 years

Merrill-Palmer Q

(1984)

MH Boyle et al.

Ontario Child Health Study. I: Methodology

Arch Gen Psychiatry

(1987)

MH Boyle et al.

Evaluation of the revised Ontario Child Health Study Scales

J Child Psychol Psychiatry

(1993)

M Eisen et al.

Conceptualization and Measurement of Health for Children in the Health Insurance Study

(1980)

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This research was supported byNational Institute of Mental Health Grant (R01-MH59785) to Drs. Goldsmith and Lemery-Chalfant. The John D. and Catherine T. MacArthur Foundation Research Network on Psychopathology and Development (David J. Kupfer, M.D., chair) supported the development of the HBQ and the parallel modules of the BPI. Special thanks to the staff and students at the Wisconsin Twin Project for their efforts in collecting the data.

Disclosure: The authors have no financial relationships to disclose.

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ARTICLESAssessing Internalizing, Externalizing, and Attention Problems in Young Children: Validation of the MacArthur HBQ

ABSTRACT

Objective

Method

Results

Conclusions

Section snippets

Participants

RESULTS

DISCUSSION

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Manual for the Child Behavior Checklist/4-18 and 1991 Profile

Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity

Psychol Bull

Manual for the MacArthur Health and Behavior Questionnaire (HBQ 1.0). MacArthur Foundation Research Network on Psychopathology and Development (David J. Kupfer, Chair)

Objective and subjective components in mothers' perceptions of their children from age 6 months to 3 years

Merrill-Palmer Q

Ontario Child Health Study. I: Methodology

Arch Gen Psychiatry

Evaluation of the revised Ontario Child Health Study Scales

J Child Psychol Psychiatry

Conceptualization and Measurement of Health for Children in the Health Insurance Study

ARTICLES
Assessing Internalizing, Externalizing, and Attention Problems in Young Children: Validation of the MacArthur HBQ