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Agreement Between Parents' Reports and Adolescents' Self-reports of Problem Behavior Frank C. Verhulst and Jan van der Ende

4r /—Parents' reports and adolescents' self-reports o( problem behaviors in 883 I l-19-year-t)ltls IVoin ihe general population were compared. Correlations belweeii both informants' CBCL syndrome .scores ranged from I).27 to 0.56. Adolescents reported many more problems than their parents did about them. Discrepancies were larger for externalizing than for internalizing problems, were larger lor girls than for boys and increased with age. The findings indicated that adolescents, especially as they grow older, are indispensable informants on their own problem behaviors. . Keywords: Parent-child agreement. Child Behavior Checklist, epidemiology, child and adolescent psychopathology

Introduction Information on adolescents' problem behavior may be obtained from diiTerent sources, including parents, and adolescents themselves. Parents are important informants on their children's problem behaviors because they are usually fatniliar with their child's functioning across time and across many situations. Adolescents themselves may be reliable sources about their own functioning (Kdelbrock, Costello, Dulcan, Kalas & Conover, 1985). Especially for those problems that may be hidden from the parents' view, the adolescent's self-report may be indispensable. Parents and adolescents often disagree in their reports on the presence and severity of problem behavior. Each informant represents a different perspective of an individual's functioning that may be valid in its own right. To obtain a comprehensive picture of the functioning of children and adolescents, we need multiple informants. Several studies have reported on the disagreement between the parents' and their children's accounts of the child's problem behavior as follows:

Accepted manuscript received 5 Juty 1991

Sophia Children's Hospital, Gordelweg 160, 3038 GE Rotterdam, The Netherlands. Requests for reprtnti to: Frank C Verhulst, Department of Child and Adolescent Psychiatry, Erasmus Universily Rotterdam, Academic Hospital Rotterdam-Sophia Children's Hospital, Gordelweg 160, 3038 GE Rotterdam, The Netherlands.

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F. C. Verhulst andJ, van der Ende

Clinic samples

Most studies investigating parent-child agreement concern children and adolescents referred to mental health agencies. Edelbrock, Costello, Dulcan, C^onover and Kalas (1986) found low-to-moderate levels of parent-child agreement in 299 6-18-yearolds referred for mental health services (average r = 0.27 across symptom scales). Agreement was higher for 14-18-ycar-olds than for 6-9-year-olds. Correlations between parent and child ratings were higher for externalizing than for internalizing problems. Children reported more internalizing problems than their parents, whereas parents reported more externalizing problems than their children. Herjanic, Herjanic, Brown and Wheatt (1975) found an overall agreement of 80% between reports of parents and 6-16-year-old children. However, no correction for chance agreement was applied. Weiner, Reich, Herjanic, Jung and Amado (1987) found kappas for the agreement between parent and child from 0.49 to 0.80. Subjects were 7-17-ycarolds referred for mental health services. Other studies investigating agreement between parent and child reports of children's problem behaviors in clinically referred children have covered only a limited range of problem behaviors (Kazdin, French, Unis & Esveldt-Dawson, 1983; Kazdin, Esvcldt-Dawson, Unis & Rancurello, 1983; Kazdin, ?Vench & Unis, 1983; Loeber, Green, Lahey & Stouthamer-Loeber, 1990; Moretti, Fine, Haley & Marriage, 1985). General population samples

Williams, McGee, Anderson and Silva (1989) investigated the agreement between parents and 11-year-oId children from the general population. Correlations between parent and self-reports ranged from r = 0.16 to r = 0.30. Two studies have investigated parent-child agreements in reports of depression in school children. Leon, Kendall and Garber (1980) found a correlation of r = 0.33 between ratings of children's depression by parents and children in grades 3-6. The low response rate of 46% limits the generalizability of the findings, however. Mokros, Poznanski, Grossman and Freeman (1987) studied parent-child agreement between ratings of depression in a sample of children aged 6-12. Correlations for problem items ranged from r = - 0.01 to r = 0.42. Parents and children did not differ significantly in the level of mean problem scores. Phares, Compas and Howcll (1989) reported modest parent-child agreement in 11-15-year-olds (r ranging from 0.22 to 0.37). Mixed and special samples

Weissman, Orvaschel and Padian (1980) investigated 28 children whose parents were in a study of affective disorders. They found that mothers' reports about their children's depression did not correlate with the children's reports about themselves. In a later study, Weissman et al. (1987) found that 6-23-year-olds reported more problems about themselves than their parents reported about them. Parents were either diagnosed as having major depression or were normal controls. Agreement ranged from nonexistent for substance abuse, to a kappa of 0.65 for conduct disorder.

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Herjanic and Reich (1982) found that mother-child agreement for 6-16-year-old child psychiatric and pediatric patients was low (kappa 0.29) for 27%. Kashani, Orvaschel, Burk and Reid (1985) investigated parent-child agreement in a sample of 50 7-17-year-old children of afiective-disordcred parents. Kappas >0.29 were obtained for 28% of the symptoms that were assessed. Parents reported more oppositional and attention problems than their children reported about themselves. On the majority of problems, however, children rated themselves higher than their parents. Achenbach and Edelbrock (1987) compared parents' ratings on the CBCL with adolescents' self-reports in referred and nonreferred samples. For the combined samples, the correlation for total problem scores was r = 0.39 for boys and r = 0.44 for girls. Agreement was slightly higher for externalizing than for internalizing problems in girls but not in boys. In summary, most studies have revealed low-to-moderate parent-child agreements on reports of children's problem behaviors. Across the various studies many conflicting results were obtained. However, most studies had samples that were limited in size, age-range and representativeness of either clinically referred or nonreferred children. Furthermore, the majority of studies investigated only a narrow range of problem behaviors, assessed with widely divergent measures and employing different diagnostic concepts. These factors severely limit the comparability of findings across studies and limit conclusions concerning the effects of sex, age and type of problem behavior on the level of parent-child agreement. The aims of the present study were: (1) to investigate the degree of agreement and the direction of discrepancies in reports of adolescents' problem behavior from parents and adolescents themselves in an epidemiological sample of 11-19-year-olds assessed in a standardized way, and (2) to investigate the eftects of sex, age and type of problem on the degree of agreement and on the direction of discrepancies.

Methods Data coUection procedure

The Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983) was used to obtain standardized reports of problem behavior in children and adolescents, Adolescenla completed the Youth Self-Report (YSR; Achenbach & Edelbrock, 1987). Of the 120 problem items of the CBCL, 103 are similar to the problem items of the YSR. Bolh instruments were translated with the help ol a linguist. The good reliability and validity of both inslninienis are well documented by Achenbach and Edelbrock (1983, 1987), and replicated by Verhulst. Akkerhuis and Alihaus (1985) and V'crhulsi. Prince, Vcrvuurl-Poot and De Jong (1989) tor the Dutch versions. The problem items of both instruments are scored as follows: 0 if the item is not true of the child, 1 if the item is somewhat or sometimes true, and 2 if it is very true or often true. A total problem score is computed by summing all Os, Is and 2s. Achenbach and Edelbrock (1983, 1987) reported two slightly diflerent sets of syndromes of problems seen by paren's and adolescents. Narrow-band syndrome scales were empirically derived via factor analyses of scores obtained by clinically referred subjects on the CBCL and the YSR. Achenbach (1991) has since constructed so-called cross-inibrmant syndrome constructs that were similar on the CBCL, the YSR and the Teacher's Report Form (TRF). These syndromes comprise 76 problem items that are similar on the three instruments. We used the cross-informant syndrome constructs as reported

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Table 1. Items defining cross-informant syndrome constructs Attention problems Acts too young Can't concentrate Can't sit still Confused Daydreams Impulsive Nervous, tense Poor school work Poorly coordinated Stares blankly (not on YSR)

Aggressive (£) Argues Brags Bullies Demands attention Destrt)ys own things Destroys others' things Disobedient at school Jealous Fights Attacks people

Anxious/Depressed (I) Lonely Cries a lot Fears impulses Needs to be perfect Feels unloved Feels persecuted Feels worthless Nervous, tense Fearful, anxious Feels too guilty Self-conscious Suspicious Unhappy, sad, depressed Worries

Delinquent behavior (E) Lacks guilt Bad companions Lies Prefers older kids Steals outside home Swearing, obscenity Truancy Alcohol, drugs Runs away from home* Sets fires' Steals at home*

Social problems Acls too young Too dependent Doesn't get along with peers Gets teased Not liked by peers Poorly coordinated Prefers younger kids

Somatic complaints (I) Dizziness Overtired Aches, pains Headaches Nausea Eye problems Rashes, skin problems Stomachaches Vomiting

Thought problems Can't get mind off thoughts Hears things Repeats acts Sees things Strange behavior Strange ideas

Withdrawn (I) Would rather be alone Refuses to talk Secretive Shy, timid Underactive Unhappy, sad, depressed Withdrawn Stares blankly (not on YSR) Sulks (nol on YSR)

Screams Shows off Stubborn Sudden mood changes Talks too much Teases Temper tantrums Threatens Loud

E = Syndrome belongs to the broad-band Externalizing syndrome. I = Syndrome belongs lo the broad-band Internalizing syndrome. *1 hese items not present on the Teacher's Report Form, the teacher version of the CBCL. To enable comparisons with TRF scores these items were not included in the present study, although these items are present on both the CBCL and the YSR.

by Achenbach (1991). Table 1 shows the items defining the eight syndromes that were used in the present

study. Two broad-band groups of syndromes, designated as 'Externalizing' and 'Internalizing', were also used in the analyse.s. The Internalizing group consists of the Anxious/Depressed. Somatic Complaints and Withdrawn syndromes. The Externalizing group consists of the Aggressive and Delinquent Behavior syndromes,

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Description of sample The original general population sample consisted of 4-16-year-olds drawn in 1983 from the Dutch province of Zuid-Holland. A random sample was drawn of 100 children of each sex and age with Dutch nationality {N = 2.600), Of ihe 2447 parents of children aged 4-16 in our sample that were reached, 2076 (84.8%) provided usable CBCL data (Verhulsl et at., 1985). The present study is part of a four-year follow-up of the original sample. Parents of children and adolescents aged 4-12 in 1983 (8-16 years in 1987) were visited by an interviewer. For adolescents who had been 7-12 years old in 1983 and whose parents completed the CBCL in 1987, the interviewer left an envelope containing the YSR, a postpaid return envelope, scoring instructions for the adolescent, and a leder explaining the aim of the study. The adolescents were inviti-d to contact members of the research Icam by telephone if they had questions concerning ihe YSR. Nonrespondents were sent a reminder, followed by a second reminder, if necessary. Those who still did not respond after two reminders were telephoned. Parents of adolescents who were originally aged 13-14 in 1983 (17-18 in 1987) were not interviewed. We therefore mailed YSRs to the 282 adolescents from the original 13-14 year cohorts as welt asCBCLs to their parents in separate envelopes. Reminders were sent on two occasions followed by a telephone call, if necessary. From the lotal of 1197 adolescents, 34 were untraceablc. For 883 subjects, we obtained both a usable CBCU- and YSR; 466 adolescents completed the YSR on the same day as their parents completed ihe CBCL; the remaining 417 adolescents provided information with a mean of 5.4 days later than [heir parents did. The response rate, corrected for untraceable subjects, was 73.8%.

Results Agreement between parents' reports and adolescents' self-reports

To lest the level of agreement belween parents' reports and adolescents' self-reports, product-momcni correlations were computed (Table 2).

Table 2. Correlations between syndrome scores on the parent and self-report version of the CBCL by sex and ages Jl-14 and l.'>-19 Sex Age (yrs) N

Boys

Girls

Total

11-14 224

15-19 193

11-14 224

15-19 242

0.46 0.48 0.35 0.48 0.48 0.53 0.21' 0.42 0.48 0.51 0,50

0.48 0.51 0.33 0.54 0.38 0.51 (0.14) 0.40 0.45 0,54

0.56 0.63 0.46 0.46 0.41 0.51 0.30 0.45 0.50 0.63

0.46 0.50 0.53 0.41 0.51 0.57 0.38 0.52 0.58 0.53

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Syndrome

Attention problems Aggressive behavior Anxiou s/ De pressed Delinquent behavior Social problems Somatic complaints Thought problems Withdrawn Internalizing Externalizing Total problems

All table entries are product-moment correlations. Non-significanl correlation in brackets. 'p < 0.01; all other correlations significant at /)< 0.001.

0.47 0.53 0.45 0.47 0.48 0.56 0.27 0.47 0.53 0.55 0.54

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Except for the syndromes Thought Problems, and Anxious/Depressed and Social Problems for boys, all correlations exceeded 0.40, with the highest correlation (0.63) being for Aggressive Behavior in 11-14-year-old girls. The only nonsignificant correlation was for Thought Problems in 15-19-year-old boys. For the total sample, parent-child agreement for the Externalizing syndrome was quite similar to that for the Internalizing syndrome. Highest agreement was found for the syndromes Aggressive and Somantic Complaints. Using 2-transformations, the mean correlation across the eight narrow-band syndromes was r = 0.48. Sex differences. To test differences between correlations, 2-transformations were used. Sex differences in correlations for combined age-groups revealed significantly higher correlations for girls than for boys on the syndromes Anxious/Depressed {correlations for boys = 0.34 and for girls = 0.50; z = 2.95; p < 0.01) and Thought problems (correlation for boys = 0.18 and for girls = 0.35; z = 2.66; / J < 0 . 0 1 ) . Age differences. No clear age difference in the level of parent-child agreement was found for boys. Agreement tended to be higher for older than for younger girls for the Internalizing syndrome, but not for the Externalizing syndrome. However, this age difference was not significant. The only significant age difference in the level of agreement was found for the Aggressive syndrome, for which younger girls showed higher agreement than older ones {z = 2.04; p

Agreement between parents' reports and adolescents' self-reports of problem behavior.

Parents' reports and adolescents' self-reports of problem behaviors in 883 11-19-year-olds from the general population were compared. Correlations bet...
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