Effectiveness of a teacher-based indicated prevention program for preschool children with externalizing problem behavior.

Externalizing behavior is common in preschool children and shows stability over the lifespan implying that strategies for early intervention and prevention are needed. Improving parenting reduces child behavior problems but it is unproven whether the effects transfer to kindergarten. Strategies implemented directly by teachers in the kindergarten may be a promising approach. The effectiveness of the teacher's module of the Prevention Program for Externalizing Problem Behavior (PEP-TE) was investigated in a study using a within-subject control group design. Each of the 144 teachers enrolled identified one child with externalizing problem behavior (aged 3-6 years) and rated that child's behavior problems [broadband externalizing, attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder] as well as their own behavior (attending skills) and burden by the child. Changes in child symptoms and teacher behavior or burden during the 3-month waiting period (control) and 3-month treatment period were compared. Stability of treatment effects at both 3- and 12-months follow-up after treatment was examined. Multilevel modeling analyses showed that, despite a reduction in externalizing behavior and ADHD scores during the waiting period, all child problem behavior scores decreased during the treatment period compared with the waiting period. The teacher's behavior also improved and their burden decreased. These treatment effects were stable during follow-up for the subsample remaining in the kindergarten for up to 1 year. This study shows that a teacher-based intervention alone is associated with improvements in both the externalizing behavior of preschoolers and teacher behavior and burden. Indications of long-term stability of effects were found.

The representation of early onset depression by ICD-9 and ICD-10 categories.

BACKGROUND: Concepts of affective disorders have not received substantial validation in childhood and adolescence even after the theoretical separation between neurotic and endogenous depression was changed. The aim of this study was to assess differences in children and adolescents with neurotic and endogenous depression according to ICD-9 and depression according to ICD-10 with regard to the severity of different symptoms as well as anamnestic and psychosocial risk factors. SAMPLING AND METHODS: Data of 33 and 88 patients (classified according to ICD-9 and ICD-10, respectively) with a confirmed diagnosis of depression were included. In a standardized study protocol, sociodemographic data, family history, psychopathological symptoms and psychosocial and environmental factors were analyzed. RESULTS: Patients diagnosed with endogenous depression more frequently had a positive family history of psychiatric disorders and had more comorbid symptoms in comparison to those with neurotic depression. Group comparisons of the ICD-9 and ICD-10 demonstrated fewer abnormal psychosocial and environmental factors and fewer affective symptoms in the ICD-9 sample. Logistic regression revealed predictors for endogenous depression in the ICD-9 sample and severe depression in the ICD-10 sample. CONCLUSIONS: Neurotic depression might represent a subthreshold depression diagnosis compared with endogenous depression. The present study was limited by small and different sample sizes and the fact that dysthymia was not classified within the ICD-10 diagnosis.

Preschool psychopathology reported by parents in 23 societies: testing the seven-syndrome model of the child behavior checklist for ages 1.5-5.

OBJECTIVE: To test the fit of a seven-syndrome model to ratings of preschoolers' problems by parents in very diverse societies. METHOD: Parents of 19,106 children 18 to 71 months of age from 23 societies in Asia, Australasia, Europe, the Middle East, and South America completed the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5). Confirmatory factor analyses were used to test the seven-syndrome model separately for each society. RESULTS: The primary model fit index, the root mean square error of approximation (RMSEA), indicated acceptable to good fit for each society. Although a six-syndrome model combining the Emotionally Reactive and Anxious/Depressed syndromes also fit the data for nine societies, it fit less well than the seven-syndrome model for seven of the nine societies. Other fit indices yielded less consistent results than the RMSEA. CONCLUSIONS: The seven-syndrome model provides one way to capture patterns of children's problems that are manifested in ratings by parents from many societies. Clinicians working with preschoolers from these societies can thus assess and describe parents' ratings of behavioral, emotional, and social problems in terms of the seven syndromes. The results illustrate possibilities for culture-general taxonomic constructs of preschool psychopathology. Problems not captured by the CBCL/1.5-5 may form additional syndromes, and other syndrome models may also fit the data.

Recruitment in an indicated prevention program for externalizing behavior - parental participation decisions.

BACKGROUND: Parents are the ones who decide whether or not to participate in parent focused prevention trials. Their decisions may be affected by internal factors (e.g., personality, attitudes, sociodemographic characteristics) or external barriers. Some of these barriers are study-related and others are intervention-related. Internal as well as external barriers are especially important at the screening stage, which aims to identify children and families at risk and for whom the indicated prevention programs are designed. Few studies have reported their screening procedure in detail or analyzed differences between participants and dropouts or predictors of dropout. Rates of participation in prevention programs are also of interest and are an important contributor to the efficacy of a prevention procedure. METHODS: In this study, we analyzed the process of parent recruitment within an efficacy study of the indicated Prevention Program for Externalizing Problem behavior (PEP). We determined the retention rate at each step of the study, and examined differences between participants and dropouts/decliners. Predictors of dropout at each step were identified using logistic regression. RESULTS: Retention rates at the different steps during the course of the trial from screening to participation in the training ranged from 63.8% (pre-test) to 81.1% (participation in more than 50% of the training sessions). Parents who dropped out of the study were characterized by having a child with lower symptom intensity by parent rating but higher ratings by teachers in most cases. Low socioeconomic status and related variables were also identified as predictors of dropout in the screening (first step) and for training intensity (last step). CONCLUSIONS: Special attention should be paid to families at increased risk for non-participation when implementing the prevention program in routine care settings. TRIAL REGISTRATION: ISRCTN12686222.

Covariation, co-occurrence and epiphenomenal correlation of empirically based syndromes in children and adolescents.

BACKGROUND: This paper determines the co-occurrence and correlations of different problem behaviours in children and adolescents in German clinical and general population samples. SAMPLING AND METHODS: The 2 samples were matched by age and gender (each sample n = 1,760). Including both categorical and dimensional models, rates of co-occurrence, relative risks, odds ratios and Pearson correlations were calculated. RESULTS: The bidirectional comorbidity rates ranged from 7.3 to 34.3% (epidemiological sample) and from 22.5 to 54.8% (clinical sample). Most correlations between syndrome scales show medium or large effects. Many can be identified as 'epiphenomenal'; partial correlations from each pair, excluding influences of other syndromes, are much lower. CONCLUSIONS: This study shows the cross-cultural generalizability of comorbidity rates. The epiphenomenal nature of some comorbidities warrants future attention.