Effects of individual differences, society, and culture on youth-rated problems and strengths in 38 societies.

BACKGROUND: Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry, 28, 1107) found that much more variance in 72,493 parents' ratings of their offspring's mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents' reports are essential for clinical assessment of their offspring, they reflect parents' perceptions of the offspring. Consequently, clinical assessment also requires self-reports from the offspring themselves. To test effects of individual differences, society, and culture on youths' self-ratings of their problems and strengths, we analyzed Youth Self-Report (YSR) scores for 39,849 11-17 year olds in 38 societies. METHODS: Indigenous researchers obtained YSR self-ratings from population samples of youths in 38 societies representing 10 culture cluster identified in the Global Leadership and Organizational Behavioral Effectiveness study. Hierarchical linear modeling of scores on 17 problem scales and one strengths scale estimated the percent of variance accounted for by individual differences (including measurement error), society, and culture cluster. ANOVAs tested age and gender effects. RESULTS: Averaged across the 17 problem scales, individual differences accounted for 92.5% of variance, societal differences 6.0%, and cultural differences 1.5%. For strengths, individual differences accounted for 83.4% of variance, societal differences 10.1%, and cultural differences 6.5%. Age and gender had very small effects. CONCLUSIONS: Like parents' ratings, youths' self-ratings of problems were affected much more by individual differences than societal/cultural differences. Most variance in self-rated strengths also reflected individual differences, but societal/cultural effects were larger than for problems, suggesting greater influence of social desirability. The clinical significance of individual differences in youths' self-reports should thus not be minimized by societal/cultural differences, which-while important-can be taken into account with appropriate norms, as can gender and age differences.

Testing Syndromes of Psychopathology in Parent and Youth Ratings Across Societies.

As societies become increasingly diverse, mental health professionals need instruments for assessing emotional, behavioral, and social problems in terms of constructs that are supported within and across societies. Building on decades of research findings, multisample alignment confirmatory factor analyses tested an empirically based 8-syndrome model on parent ratings across 30 societies and youth self-ratings across 19 societies. The Child Behavior Checklist for Ages 6-18 and Youth Self-Report for Ages 11-18 were used to measure syndromes descriptively designated as Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, and Aggressive Behavior. For both parent ratings (N = 61,703) and self-ratings (N = 29,486), results supported aggregation of problem items into 8 first-order syndromes for all societies (configural invariance), plus the invariance of item loadings (metric invariance) across the majority of societies. Supported across many societies in both parent and self-ratings, the 8 syndromes offer a parsimonious phenotypic taxonomy with clearly operationalized assessment criteria. Mental health professionals in many societies can use the 8 syndromes to assess children and youths for clinical, training, and scientific purposes.

Emotional dysregulation and attachment dimensions in female patients with bulimia nervosa.

BACKGROUND: The aim of this study was to examine whether there is a difference in the dimensions of attachment and difference in emotional regulation between the group of female patients suffering from bulimia nervosa (BN) and the control group. We also wanted to examine whether emotional regulation has a mediating role in the relationship between dimensions of attachment and severity of BN symptoms. SUBJECTS AND METHODS: The study included a total of 100 female participants from 15 to 25 years of age (M=20.40, SD=3.26). The clinical group consisted of 50 patients suffering from BN, and the control group consisted of 50 healthy female subjects. RESULTS: Female patients suffering from BN achieved higher scores in the dimensions of anxiety (t98=-5.12, p=0.00) and avoidance (t98=-4.30, p=0.00). Dimension of attachment related anxiety (ß=0.44, p=0.00) proved to be a statistically significant predictor of BN symptoms. Subjects of the clinical group also achieved significantly higher (t98=7.41, p=0.00) emotional dysregulation than participants of the control group. We also found that the mediation effect of emotional regulation on the association between anxiety and BN symptoms was statistically significant (z'=4.43, p=0.00). CONCLUSIONS: Patients suffering from BN showed significantly higher levels of attachment related anxiety and avoidance as well as significantly higher level of difficulties in emotional regulation than healthy controls. Attachment anxiety proved to be a significant predictor of symptoms BN, suggesting that the attachment related anxiety is stronger correlate of BN symptoms than avoidance, and may represent a risk factor for more severe BN symptoms. It was also found that the relationship between attachment related anxiety and BN symptoms were mediated by emotional regulation.

PREDICTORS OF EATING DISORDER RISK IN ANOREXIA NERVOSA ADOLESCENTS.

- The purpose of the present study was to examine the association among the risk of eating disorder (ED), psychological adjustment, empathy, attachment style and thin-ideal internalization among adolescents with anorexia nervosa (AN), as compared to a healthy control (HC) group. The Questionnaire of General Data, the Eating Disorders Inventory-3 (EDI-3), the Questionnaire of Sociocultural Attitudes Towards Appearance-3 (SATAQ-3), the Experiences in Close Relationships-Revised (ECR-R) and the Basic Empathy Scale (BES) were administered to 35 female adolescents with AN and 35 HC adolescents. Eating disorder risk was found to be highest in AN females with higher levels of general psychological maladjustment (GPMC), followed by HC females with higher thin-ideal internalization. In the AN group, attachment style and thin-ideal internalization in combination with GPMC were not indicated as significant predictors of eating disorder risk. Study data provide support to conceptualizations of EDs that emphasize the role of general psychological maladjustment in the development of EDs.

COPING SKILLS IN CHILDREN WITH EPILEPSY--EVALUATION OF COGNITIVE BEHAVIORAL THERAPY INTERVENTION.

A pilot study was conducted to examine the efficiency and satisfaction of cognitive behavioral therapy (CBT) intervention in youth with epilepsy regarding coping strategies. The CBT intervention was based on the main principles and empirically supported cognitive-behavioral techniques. The intervention consists of epilepsy education, stress education, and coping skill strategies. Seventeen children and adolescents aged 9-17 diagnosed with epilepsy for at least one year, with at least average intelligence and no history of serious mental illness completed the CBT intervention during summer camp, providing data on the efficiency of and satisfaction with CBT intervention. Upon completion of the CBT intervention, study subjects achieved significantly higher scores on the following Scale of Coping with Stress subscales: Problem solving; Seeking for social support from friends; Seeking for social support from family; and Cognitive restructuring, for both measures of usage frequency and effectiveness of each subscale. The participants reported a high level of satisfaction with the CBT intervention. This study provided explanation of research limitations and recommendations for future clinical trials.

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 child's problem level exceeds a deviance threshold? We used five methods to test agreement for Child Behavior Checklist (CBCL) and Teacher's 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.

Delinquency in incarcerated male adolescents is associated with single parenthood, exposure to more violence at home and in the community, and poorer self-image.

AIM: To assess the relationships between delinquency and demographic and family variables, academic performance, war stressors, home/community, school, and media violence exposure, self-image, and psychopathology. METHODS: This cross-sectional study included 100 delinquent, incarcerated male adolescents and 100 matched schoolchildren from Croatia. It lasted from January 2008 to June 2009, and used socio-demographic questionnaire, questionnaire on children's stressful and traumatic war experiences, exposure to violence scale, the Offer Self-Image Questionnaire, and Youth Self-Report Questionnaire. RESULTS: Logistic regression analysis showed that delinquency in incarcerated adolescents was more likely related to having parents who did not live together (odds ratio [OR] 2.40; confidence interval [CI] 1.18-4.90, P=0.015), being more exposed to violence at home/community (OR 3.84; CI 1.58-9.34, P=0.003), and having poorer self-image (OR 1.09; CI=1.03-1.16, P>0.002). CONCLUSION: Preventive and therapeutic interventions in incarcerated delinquents should be specifically targeted toward single parenthood, family factors, trauma oriented interventions, and focused on multiple dimensions of self-concept of adolescents.

Cross-informant agreement between parent-reported and adolescent self-reported problems in 25 societies.

We used population sample data from 25 societies to answer the following questions: (a) How consistently across societies do adolescents report more problems than their parents report about them? (b) Do levels of parent-adolescent agreement vary among societies for different kinds of problems? (c) How well do parents and adolescents in different societies agree on problem item ratings? (d) How much do parent-adolescent dyads within each society vary in agreement on item ratings? (e) How well do parent-adolescent dyads within each society agree on the adolescent's deviance status? We used five methods to test cross-informant agreement for ratings obtained from 27,861 adolescents ages 11 to 18 and their parents. Youth Self-Report (YSR) mean scores were significantly higher than Child Behavior Checklist (CBCL) mean scores for all problem scales in almost all societies, but the magnitude of the YSR-CBCL discrepancy varied across societies. Cross-informant correlations for problem scale scores varied more across societies than across types of problems. Across societies, parents and adolescents tended to rate the same items as low, medium, or high, but within-dyad parent-adolescent item agreement varied widely in every society. In all societies, both parental noncorroboration of self-reported deviance and adolescent noncorroboration of parent-reported deviance were common. Results indicated many multicultural consistencies but also some important differences in parent-adolescent cross-informant agreement. Our findings provide valuable normative baselines against which to compare multicultural findings for clinical samples.

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 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.

Dreams of deceased children and countertransference in the group psychotherapy of bereaved mothers: clinical illustration.

This article presents, in the form of a clinical illustration, a therapeutic group of bereaved mothers with special reference to their dreams about their deceased children. The article presents descriptions of the emotions of these mothers and countertransference feelings, a topic that, to our knowledge, has not been frequently studied. The group was small, analytically oriented, slow-open, comprised of women bereaved by the death of a child, and conducted by a female therapist. Over more than three years, the group included 20 members in total. This article describes a number of dreams recorded during a period when the group included seven members. Dreams helped the group members access their emotional pain, helplessness, yearning for a relationship with the deceased, guilt, and feelings of survival guilt. The transference-countertransference relationships were characterized by holding. Countertransference feelings of helplessness predominated. The therapist and the group as a whole contained various emotions, allowing the group members to return to the normal mourning processes from the parallel encouragement of group development and interpersonal relationships.

Longitudinal studies of IQ stability in children with childhood autism - literature survey.

BACKGROUND: In this paper we present a survey of the literature dealing with IQ stability in children with childhood autism (CA) over the last ten years. Nowadays there is no clear evidence on this topic. SUBJECTS AND METHODS: We used the online "PubMed" database. By inputting the following key words: (autism and IQ and child) and (stability or outcome or follow-up) we obtained a total of 78 references. Out of those 78 references, some papers were left out in line with the exclusion criteria, so this survey includes 23 papers altogether. RESULTS: The average initial IQ point is in the range from borderline intelligence to mild mental retardation. Out of a total of 23 studies, the majority, 19 of them, generally state that there are no changes in IQ, 8 studies mention increased IQ, while 3 studies demonstrate a decrease in IQ. Some studies register different results in the same study. At an individual level, single studies show a similar trend to the general results. CONCLUSION: The majority of studies state that the IQ points will remain the same. Today the generally accepted belief is that therapy should be started intensely and early. Some children with good progress may attend regular school.

The loss of criteria for mental retardation and regression of symptoms of childhood autism during a five-year follow-up--a case report.

It is usually held that most individuals with childhood autism have poor prognosis. According to our knowledge, a favorable outcome of a child with childhood autism is quite rare and inspires a number of controversies. A 4-year-old boy was diagnosed with childhood autism and mild mental retardation. Interviews and findings reported by other specialists were used in the diagnosis and follow-up that lasted for five years, along with parental counseling and therapy. After three years, regression of the symptoms of childhood autism and loss of the criteria for mental retardation were observed. The difference between the second and first examination was 30 and 24 IQ points. The boy attends regular school with individual approach. Childhood autism and mental retardation should not be viewed as static conditions. Early and intensive therapy is recommended. Some children that make good progress can attend regular school.

[Delusional disorder of the paranoid type and unruptured intracerebral aneurysm--is there an association?]. / Sumanuti poremecaj paranoidnog tipa i nerupturirana intracerebralna aneurizma--postoji li povezanost?

INTRODUCTION: Contrary to ruptured intracerebral aneurysm, according to our knowledge, not many papers have been published dealing with the relation of psychic/neuropsychological symptoms and unruptured intracerebral aneurysm (UIA). As to our knowledge, there is no published paper relating delusional disorder, paranoid type (DD-PT) and UIA, which can have important clinical implication. AIM, METHOD AND RESULTS: We describe a case of a woman who had DD-PT and UIA. The patient in her fifties, a typist with elementary school education, presented to the psychiatrist with the symptoms of irritability, insomnia, suspiciousness and paranoid ideas lasting for about a year. She showed clear symptoms of a delusional disorder. The psychiatrist established the diagnosis of DD-PT according to ICD-10. Olanzapine therapy, 10 mg day, was introduced immediately, causing partial improvement. In further diagnostic procedure, psychological tests were performed. The finding confirmed the diagnosis and average intellectual efficacy. The additional findings of impaired verbal fluency (VF) and hand tremor signalized an organic origin. The patient was referred to a neurologist, who assessed hand tremor, but otherwise the finding was normal. Brain CT revealed the possible UIA. Neurological hospitalization was quickly organized, and the definitive diagnosis of basilar artery aneurysm of 22 mm in diameter was made by angiography. Several days later, osteoplastic supraorbital craniotomy was performed at the neurosurgical department, with right sided keyhole approach in microsurgical technique, and the aneurysmal neck was clipped. The postoperative course was accompanied by meningitis treated with antibiotics. In neurological status, cerebellar symptomatology, tremor of the left hand, mild hemiparesis on the left side and the right eyelid ptosis persisted. Paranoid delusions were absent, but depressive symptoms emerged. Eight months after the surgery (approx. 11 months after the first test), control psychological testing was performed. The finding showed depression with significant perceptive disorganization. The VF result was within the normal limits. The patient is still being continuously followed-up. During preliminary diagnostic work-up, the possible organic cause and/or relation was suspected, based only on the psychiatric assessment and psychological report, because neurological status was free from any abnormalities other than tremor of the hands. CONCLUSION: The reported case confirmed the importance of detailed psychiatric interview and psychological testing in persons with psychic disorders, as well as the importance of multidisciplinary approach in the diagnosis and therapy. In this case, we could not find the exact way of connection between DD-PT and UIA.

The Child Behavior Checklist, Teacher Report Form and Youth Self Report problem scales in a normative sample of Croatian children and adolescents aged 7-18.

The main goal of this study was to standardize the Child Behavior Checklist (CBCL), Teacher Report Form (TRF) and Youth Self Report (YSR) questionnaire problem scales on a normative random sample of children and adolescents (N=3309) aged 7 to 18 throughout Croatia. The second goal was to compare boys-girls problem scales data and CBCL-TRF-YSR differences in our sample. The mean value of CBCL scores for the Total Problems scale for different groups (children/adolescents; boys/girls) ranged from 17.07 to 20.71. Overall instruments' internal consistency ranged from 0.83 to 0.86. In almost all the scales parents reported higher scores than teachers (p < 0.01). In all the scales adolescents reported significantly higher scores than their parents and teachers (p < 0.01). This study standardized the questionnaires for our specific socio-cultural circle, which satisfy complex psychopathology study criteria. Problem scales results in our sample suggest similarity to previous European researches.

[General psychosomatics in children and adolescents]. / Opca psihosomatika u djecjoj i adolescentnoj dobi.

The purpose of this study is a review of contemporary knowledge from the field of children and adolescent psychosomatics by using standard textbooks and journals. Data are chosen according to their importance and easy reference for a clinical study and scientific research. Psychosomatics can be defined as medicine of mutual relationships in the widest sense. It seems that factors of bio-psycho-social area participate in etiology and pathogenesis, i.e. complex genetic, developmental, psychodynamic, neuroanatomical, psychoneurophysiological, neurobiochemical, psychoneuroimmunological, psychoneuroendocrinal, familiar, social and probably other factors. Children and adolescent psychiatry, pediatrics are mutually complementary. In the medical-psychosomatic field there is consideration in the form of spatial-operative models that have to be amended through the concepts of unconscious and preconscious as well as through a temporal-systematic perspective. A team approach will be applied in a therapy.

Comparison of self-reported and parent-reported emotional and behavioral problems in adolescents from Croatia.

The first goal of this study was to obtain, Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) problem-scales data for youths in Croatia, and compare them to the original American sample. The second goal of this study was to compare boys -girls problem scales data and CBCL-YSR differences. The instruments were administered to school adolescents aged between 12-18 comprising a non-referred sample (n=611) drawn from the whole country. Youths, compared to their parents, rated higher scores in all scales in both sexes (p < 0.001). According to parents' reports boys had higher scores in more scales (five out of eleven). According to adolescents'self-reports girls had higher scores in more scales (seven out of eleven). Consistent with other studies, Croatian sample confirmed a larger number of serious behavioral and emotional problems reported by adolescents. Adolescents were confirmed as the most reliable informants on their problems.

Self-image and refugee status in adolescents from Bosnia and Herzegovina and Croatia.

The first aim is focused in refugees comparing them with a comparison group in clinical characteristics. In addition, the authors compared scores on the self-image (S-I) scale of refugees and comparison subjects, after they had stratified them into four groups by gender and age. Subjects were 133 refugees from Bosnia and Herzegovina and comparison subjects were from Zagreb, Croatia (n = 189). The subjects were assessed by psychotherapeutic interview, Offer Self-Image Questionnaire (OSIQ), questionnaires of depressive symptoms, war stressors, posttraumatic reactions (PTS-reactions) and general data. Refugees had significantly higher scores on the questionnaires of war stressors and PTS-reactions (p < 0.001). Refugees didn't differ in the majority of 12 scales of OSIQ from comparison subjects, in all four groups. Younger male refugees had the most scales with significantly higher raw scores in S-I, four in total. S-I can give us useful insight into different dimensions of personality of refugees.