International epidemiology of child and adolescent psychopathology I: diagnoses, dimensions, and conceptual issues.

OBJECTIVES: To review international findings on the prevalence of diagnosed disorders, generalizability of dimensional scales, and distributions of dimensional scores for school-age children and to address the conceptual and clinical issues raised by the findings. METHOD: A review of findings for interviews (Development and Well-Being Assessment, Diagnostic Interview Schedule for Children) and dimensional rating instruments (Conners Rating Scales, Strengths and Difficulties Questionnaire [SDQ]) that have been used to assess general population samples of at least 300 children in at least five societies. RESULTS: Prevalence estimates for diagnosed disorders varied greatly, owing at least in part to methodologic variations. A Goodman five-dimension model for the SDQ received some support, whereas a three-dimension internalizing-externalizing-prosocial model for the SDQ was supported for epidemiologic studies. The SDQ total difficulties scores varied less than the prevalence estimates for diagnoses, but population-specific norms may be needed. CONCLUSIONS: Numerous studies have shown the feasibility of assessing children in diverse societies with diagnostic interviews and dimensional ratings. However, the findings disclose challenges to be met to help clinicians take account of the similarities and differences found for psychopathology in different societies.