Journal o f Abnormal Child Psychology Vol. 5, No. 3, 1977
The Children's Behavioral Classification Project: An Interim Report Ralph Mason Dreger Louisiana State University
As part of a series of similar endeavors, the Children's Behavioral Classification Project (CBCP) aims to establish a behaviorally based nosology for children's and adolescents' emotional disorders which will be useful for treatment and prevention. To this end several comprehensive instruments have been devised, one of which, for the CBCP, is described here. The CBCP is companion to the Preschool Behavioral Classification Project (PBCP) (Baker & Dreger, 1 9 7 7 this issue) and the Adolescent Behavioral Classification Project (ABCP), which is in the formative stage at present. Underlying the construction of the instruments in each case are two major assumptions: (a) Any nosology, no matter how refined or abstract it becomes eventually, must arise from observations of behavior; (b) parents or parent surrogates can report relevant behavior reliably if the stimuli presented to them for such reporting are sufficiently descriptive of actual behavior. It must be emphasized that the CBCP instrument, details about which are given below, is not an end in itself, even though 16 years in the making, but a means to an end: a practicable nosology. It seemed to the original and to subsequent BCP committees that a sound nosology and resultant nomenclature should start explicitly from directly observable behaviors and build higher-order constructs consistently from these observed behaviors, either by logical derivation or by factorial (factor-analytic) derivation. In respect to the second assumption, it has been the intent of the several BCP committees to keep as close to behaviors as feasible, without reaching the absurdities of complete molecularity. For every area of problems recognized by anyone, the question has always been, "What can a parent or other close ob-
289 T h i s j o u r n a l is c o p y r i g h t e d b y P l e n u m . Each article is available for $ 7 . 5 0 f r o m P l e n u m Publishing C o r p o r a t i o n , 2 2 7 West 2 7 t h Street, N e w Y o r k , N . Y . 1 0 0 1 1 .
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server see or hear (or in the case of the ABCP, smell) that would occasion an observer to say the child has a problem? ''1 The literature concerning children's emotional problems was combed initially and has been followed subsequently. Only an nth part can be mentioned here to provide continuity. In addition to DSM-11 (American Psychiatric Association, 1968), the first manual, published in 1952 and now known asDSM-1, was consulted, with a major intent of supplementing it with the CBCP. Ackerson's (1931/1942) two volumes on children's behavior problems are classics in the field, as are the Jenkins and Hewitt (1944), Hewitt and Jenkins (1946), and Jenkins and Glickman (1946) reports. A large volume by Katz, Cole, and Barton (1967) takes up issues pertinent to classification of children's problems; and the two numerical taxonomy texts by Sokal and Sneath (Sneath & Sokal, 1973; Sokal &Sneath, 1963) cover modern statistical approaches to classification in various fields, including psychology. Peterson and Quay (Peterson, 1961; Quay & Peterson, 1960) and Patterson (I956) did early work, utilizing a comparable methodology to portions of the BCP; and from evidence in this issue of Journal of. Abnormal Child Psychology a couple of them still vigorously pursue lines roughly parallel. Previous reports on the CBCP are found in Dreger (1964, 1970, 1975), in Dreger and Dreger (1962), and in Dreger, Reid, Lewis, Overlade, Rich, Miller, & Flemming (1964).
DESCRIPTION OF THE CBCP INSTRUMENT The present CBCP instrument contains a duplicated list of 274 behavioral and 3 demographic items, age, sex, and clinic-nonclinic status. Behavioral items (of the kind seen in Table I) are endorsed as either "True" or "False" by a parent, usually mother, or parent-surrogate. Experience with the demographic and personal history (DPHD) items brought a surprise to the original committee. With both the 229- and 274-item versions of the CBCP instrument, 11 and 22 DPHD items, respectively, were factored with the behavioral items. DPHD items, however, instead of aligning themselves with and helping to identify factors, as the committee expected, stubbornly aligned themselves with one another, with the exception of race and age, which are moderately correlated in a couple of instances with behavioral factors. Consequently, succeeding work with the several BCPs has proceeded with only from three to five DPHD variables. Of course, representativeness of samples in respect to DPHD variables has been a prime aim of data gathering, Not all of the items are des~:riptive of problem indicators. The committees have regularly included "positive" items which serve as foils to unrelieved difficulty indicators. Twentysix such "positive" items group themselves together to identify the factor which has been named "Appreciative, concerned, obedient social orientation versus unappreciative, aggressive disobedience." Examples of these items are "Expresses appreciation for kind acts toward him," "Plays well with others, or speaks well of others his own age," and "Takes care of his appearance by doing such things as combing his hair or dressing neatly."
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291
Table 1. Representative CBCP Factor Verbal psychoid reactions Item no.
Weight ("loading")
210
.60
183 165 241
.59 .52 .50
160
.49
266 231 29
.45 .44 .38
125 251
.38 .37
261 159
.37 .36
225 188
.36 .34
134 36
.33 -.34
Content In the middle of a sentence he fumbles for a word or uses a wrong .word, or says he forgot what he was trymg to say Stares into space, or stops in the middle of a sentence Has trouble pronouncing words, or uses baby talk, or lisps Says that he has trouble thinking, or says he cannot concentrate or keep his mind on things When words he has understood before are spoken, he shakes his head, or looks blank or puzzled, or says he does not understand Stutters or stammers more than others his age Others state that he says things that are peculiar or make no sense When asked questions about himself, he fails to answer, or says he does not know Mutters or mumbles or talks in a low voice When doing something, will turn away from what he is doing or stop what he is doing at almost any tittle sound or movement Cries or withdraws when teased Takes a long time to make up his mind, or asks others to decide for him, or fails to make choices Stares blankly into space Speaks in a monotone, or lets his voice trail off at end of sentence, or speaks in a weak voice Speaks rapidly, words "come tumbling out fast" Uses words easily without fumbling for words, or without using the wrong word, or without saying he forgot what he was trying to say
despite t h e e v i d e n t lack o f r e l a t i o n t o b e h a v i o r d i m e n s i o n s . A n d f u t u r e analyses will i n c l u d e a D P H D profile, f o r even i f t h e t w o t y p e s o f f a c t o r s are d i s t i n c t , t h e y m a y c o n t r i b u t e d i f f e r e n t i a l l y to grouping o f c h i l d r e n b y t h e i r profiles in t e r m s o f e m o t i o n a l disorders. A d m i n i s t r a t i o n o f t h e CBCP is s i m p l i c i t y itself. F o r p a r e n t s or p a r e n t s u r r o g a t e s w h o c a n read at least at t h e f o u r t h - g r a d e level, t h e f o r m is h a n d e d t o t h e m b y a w o r k e r w h o r e q u e s t s t h a t it b e f'dled o u t . T h e i n s t r u c t i o n s read: For each of the statements on the accompanying sheets, the question concerning your child is, "Has it been true or false of your child in the past 6 months?" If it has been true, make a mark on the line under "True." If it has not been true, make a mark on the line under "False." Please mark every item. If you do not know, mark "False." Mark the items carefully but quickly. Scoring is d o n e b y t o t a l i n g t h e f a c t o r s t r u c t u r e weights for i t e m s end o r s e d " T r u e " for each f a c t o r . These raw f a c t o r scores are t h e n t r a n s f o r m e d t o 5 - p o i n t s t a n d a r d scores b y m e a n s o f a c o n v e r s i o n t a b l e . : 2 Until the materials for scoring are published, they may be obtained from the author free of charge.
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STANDARDIZATION OF THE CBCP INSTRUMENT AND THE CLUSTERS ARISING FROM ITS USE The interdisciplinary committee wrestled with a series of issues relating to rationale for, substance of, and design of the study or studies undertaken as the Behavioral Classification Project. An instrument of assessment was not the principal aim. Rather, the committee was seeking a means of identifying dimensions of specific problems, and also of identifying specific types of children possessing certain patterns of problems, who and which would be amenable to specific therapies. This aim grew in turn out of the somewhat simple; even simplicistic, idea that assessing a child's problem behaviors before and after intervention would enable the clinician to determine the effectiveness, or lack of it, of his/her treatment. Accordingly, the standardization of the present instrument has been conceived only as a step in a much larger evaluative-therapeutic program. Details of the initial analyses of the 229-item instrument, utilizing parent respondents of 430 children, three-fourths clihical, 80 matched nonclinical, are given in Dreger and Dreger (1962) and Dreger et al (1964). From these analyses came 10 factors, 9 behavioral and 1 a parental age dimension. Following the initial analyses a Technical Assistance Project was held with multiprofessional representation from many parts of the country to critique the results and propose further strategy. The present 274-item instrument is the product of that conference. Together with 22 objectively scorable DPHD items, the CBCP instrument was utilized with 113 representative children. Again, DPHD items and behavioral items came out on separate sets of factors. Most amazing, however, was the fact that the most substantial factors arising from the 430-subject sample were replicated in the 113.subject sample. 3 Continued analyses with further samples yield comparable results. At first, with the type of overlapping factor analyses that had to be made on account of computer limitations, 50 factors were extracted. In the succeeding full-matrix analyses, however, 30 factors have been considered optimum for several reasons. First, the Scree test (CatteU, 1966) indicates 30 to be a satisfactory number. Second, to accommodate the psychotic, neurotic, asocial, antisocial, organic, academic, sleeping, eating, developmental, and physical problems, as well as the "positive" aspect of socialization and achievement orientation, a 9 fairly large number of dimensions had been judged to exist by the CBCP committee, but only 25 to 30, not 50 (or up to 67, which a latent-root-of-one would 3Rummel (1970) cites a number of investigations utilizing more variables than subjects, but makes a distinction which in statistics would be that between descriptive and inferential statistics, suggesting a 4-to-1 ratio of subjects to variables for inferential factor analysis as recommended by Cattell. Ordinarily, on statistical grounds this recommendation would be accepted. But the experience of the BCP with behavioral variables, rather than abstractions, has uniformly been that using fewer subjects than variables does not materially affect factor structures.
Children's Behavioral Classification
293
allow). And finally, even conceptualizing or requiring cluster programs to deal with 30 factors is difficult enough. Initially, only 25 factors were utilized, but despite the fact that the last 5 are relatively weak they are now included as representing important dimensions of children's behavior. Basic standardization of the CBCP instrument has been carried out on a total of 1,203 subjects from Florida and Louisiana. These represent children both rural and urban (both large and small cities), male and female (in clinical groups in the usual proportions of about four to one, in nonclinical groups about one to one), clinical and nonclinical, clinical children from public clinics (mostly) and private practice, black and white, of ages 6 to 13, and of all social classes. Factors derived from 341 of the most representative subjects have been scored on the 1,203 sample and the raw factor scores distributed for both the 341 subsample and the total sample. Standard scores (5-point scales)have been constructed for both groups. For several subprojects described below some of the subsample scores have been transformed to z-scores, but the extreme skewness of a number of the distributions results m distortions (though not sufficient to vitiate the work of these subprojects).
R eliabilities Several reliability checks have been attempted with the CBCP. There is first the evidence from factor replicability. Although the 10 original factors (derived from 142 items) have not persisted in unchanged form through subsequent analyses (from twice the number of items), every one of them has continued to be found in essence. In four instances they have remained virtually unchanged from sample to sample. In some instances the original factors have coalesced, and in one the factor has split into two. Further checks on reliability of a more traditional variety have been carried out. Sixty respondents from 12 clinics were requested to respond to the CBCP items twice with an average time between sets of responses of 1 month. The average correlation between first and second administrations was .79. The percentage of agreement for items ranged from 70.4 to 94.2, with an average of 85.3. For reliability relating to two respondents, 12 mothers and fathers were compared, first on agreement by items and then by factors, for the nine substantive factors originally delineated. For items, average agreement was a modest 36% with a range of from 10 to 55%. However, for factors, agreement, in correlation terms, averaged .76 (median = .76) with four of the rs above .90; on the other hand, three of the parent couples were below an r of .40, two being .17 and . 12, respectively. Moderate to low agreement on the average was also found for 25 of the present 30 factors by Gilkey (1972) between fathers, mothers, teachers, and the children themselves, though here, too, the range is enormous, especially for fathers and mothers, with rs from zero to .82. Costelloe (1973)
294
l)reger
likewise found similar moderate to low agreement in a study of visually handicapped children assessed by cottage parents ana own parents. It is safe to say for the CBCP as for the PBCP (Baker & Dreger, this journal) that the reliability of responses for the same type of respondent is relatively high, but that responses using different classes of respondents should not ordinarily be compared. Internal consistency reliability estimates are on the whole tied to the number of items scored for a factor. Overall, if the adaptation of the alpha coefficient (Nunnally, 1967) is applicable to the whole C B C P - and its applicability is questionable, for the instrument is usually not scored as a whole to assess anything except number of "True" responses- that estimate for the whole instrument is .94 and the corresponding correlation with true scores .97. For individual factors for which the alpha coefficient is applicable the estimates range from .23 (for one of the admittedly weak last five factors) to .84 (for Factor II, an academic orientation factor), with mean and median (Fisher's z-transformed) rs of .64 in each case. A comparison with reliabilities of factors reported in the literature indicates that the majority of CBCP factors have respectable internal consistency. One limitation must also accompany a discussion of reliability. That is, there is evidently a "fatigue effect" in respect to responding to the rather long instrument. A chi-square analysis of the numbers of responses to the first half of the CBCP compared to the latter half, using 340 subjects, reveals that respondents do indeed utilize more of the items in the first than in the latter half. No attempt has been made to discover what effect this result has on the different factors. Related to both reliability and validity is the assessment of social desirability (e.g., Edwards, 1970). Gay (1976) found that his measure of social desirability and the 30 CBCP factors individually were unrelated, with only one factor (XVIII) having an r significant at the predetermined .05 level (and at that a -.38), which in 30 rs could easily come by chance. Validities Respecting validities of the CBCP, the replication of factors from one set of subjects to another suggests there is "something there" that the instrument is measuring, whether it is a constancy in children or in mothers (who are the main respondents by far). In use the CBCP has shown considerable ability to discriminate among identified groups in the population of children as a whole. One study (Costelloe, 1973) found that sighted and sight-handicapped children could be reliably distinguished by use of mother's responses to the CBCP. Another (Glanville, 1974) found almost perfect discrimination among educable mentally retarded,
Children's Behavioral Classification
295
psychotic, and normal children by use of 15 of the factors, and relatively good discrimination with all of the 30 factors. Gifted and normal youngsters of I 1 to 13 years of age were found to be clearly differentiated by use of the 30 factors (Duncan, 1975). And minimal brain dysfunction children proved to be well differentiated from normal children by a majority of the factors taken individually, as well as by the overall set of 30 factors (Fitch, 1976). However, Gay (1976) did not find abusedl neglected, and normal children clearly distinguished by the CBCP reports of their mothers, though some indication was found that abused children and neglected children constitute several separate clusters. These various analyses used multiple discriminant analysis, multivariate analysis of variance, and cluster analyses. Clusters or Types of Children Assuming some measure of reliability and validity, Gay (1974) utilized linear typal analysis (Overall & Klett 1972) to -determine clusters among 300 children, 159 clinic subjects and 141 nonclinic subjects. Eight identifiable groups (types) appeared: A. Anxious, Non-Aggressive; B. Nuisance Aggressive; C. Bland Normal; D. Antisocial Aggressive; E. Withdrawing, Muscular Difficulty; F. Relatively Immature Aggressive; G. Withdrawing, Passive-Aggressive Retarded; H. Sublimated Aggressive. These types have yet to be validated in other samples of children. Practical Uses of the CBCP Tables of norms for the CBCP instrument have been constructed based on the 341 subjects on whose protocols the fundamental factor analysis was done and also on the 1,203, including the 341. Raw factor scores are converted in each case to standard scores, 5- or 3-point scales depending on the normality or nonnormality of the distribution of factor scores. From the nature of the items and their derived factors it was anticipated that some distributions would be markedly skewed, and they are. After all, items which are virtually pathognomic in themselves are found to be rare, as are the factors they identify. For example, not many children from CA 6-13 are reported as attempting suicide or threatening to kill someone or speaking about losing their minds, so the factor of Obsessive Sadomasochism identified by these items is extremely skewed. (Not at all incidentally, from a psychodynamic viewpoint, another identifying item for this factor is "Shows sex organs.") By use of the profile of standard scores on 30 factors, there emerges a fairly definite picture of a child, as observed by a parent or parent-surrogate. When the cluster analyses are completed, the profile can then be compared, visually or mathematically, with identifiable groups of children.
296
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In the long run, the aim of the Behavioral Classification Project in its.various forms is to establish a nosology, based on behavior, that will enable specific intervention procedures to be used most efficiently with specific groups or types of children, and ultimately to design preventive and not only therapeutic procedures.
REFERENCES Ackerson, L. Children's behavior problems (Vols. 1 & 2). Chicago: University of Chicago Press, 1931, 1942. American Psychiatric Association. DSM-II. Diagnostic and statistical manual of mental dis. orders (2nd ed.). Washington: American Psychiatric Association, 1968. Baker, R. P., & Dreger, R. M. The preschool behavioral classification project: A follow-up report. Journal of A bnormal tT/zildPsychology, 1977, 5, 241-248. Cattell, R. B. The meaning and strategic use of factor analysis. In R. B. Cattell (Ed.), Handbook of multivariate experimental psychology.-Chicago: Rand McNally, 1966. Costeiloe, C. A study of behavioral attributes of visually handicapped children (Doctoral dissertation, Louisiana State University, 1973). Dissertation Abstracts International, 1974,35, 1042B. Dreger, R. M. A progress report on a factor analytic approach to classification in child psychiatry. Psychiatric Research Report No. 18, 1964, 22-58. Dreger, R. M. The establishment of diagnostic categories for the evaluation of specific therapies for children's emotional disorders. Alabama Journal of Medical Sciences. 1970, 7, 55-60. Dreger, R. M. The standardization of the children's behavioral classification project. Unpublished paper, Louisiana State University, 1975. Dreger, R. M., & Dreger, G. E. Proceedings of the technical assistance project held at Jacksonville University, August 16-17, 1962. Behavioral Classification Report No. 1. Jacksonville, Florida: Behavioral Classification Project, 1962. Dreger, R. M., Reid, M. P., Lewis, P. M., Overlado, D. C., Rich, T. A., Miller, K. J., & Flemmine, E. L. Behavioral Classification Project. Journal of Consulting Psychology, 1964, 28, 1-13. Duncan, J. A. A behavioralanalysis of gifted children. Unpublished master's thesis, Louisiana State University, 1975. Edwards, A. L The measurement of personality traits by scales and inventories. New York: Holt, Rinehart and Winston, 1970. Fitch, J. M. A behavioral analysis of brain damaged children and children with minimal brain dysfunction. Unpublished master's thesis, Louisiana State University, 1976. Gay, J. R. A linear typal analysis of the Children's Behavioral Classification Project. Unpublished paper, Louisiana State University, 1974. Gay, J. R. Correlation o f CBCPfactors and social desirability. Unpublished paper, Louisiana State University, 1976. Gflkey, W. A., Jr. An investigation of interrater reliability of the Behavioral Classification Project." A comparison of the response of parents, teachers, and children to the BCP. Unpublished doctoral dissertation, Louisiana State University, 1972. Glanville, S. M. A cluster analysis utilizing the Children's Behavioral Classification Project with psychotic, educable mentally retarded, and normal children. Unpublished master's thesis, Louisiana State University, 1974. Hewitt, L. E. & Jenkins, R. L. Fundamental patterns of maladjustment: The dynamics of their origin. Unpublished paper, University of Illinois, 1946. Jenkins, R. L., & Glickman, S. Common syndromes in child psychiatry. American Journal of Orthopsychiatry, 1946, 16, 244-254.
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Jenkins. R. L., & Hewitt, L. E. Types of personality structure encountered in child guidance c~ ~-~.American Journal of Orthopsychiatry, 1944, 14, 84-94. Katz, M. M., Cole. J. L., & Barton, W. E. The role and methodology of classification in psychiatry and psychopathology. Chevy Chase, Maryland: U. S. Department of Health, Education, and Welfare, 1967. McGuire, C., & White, G. D. The measurement of social status. Research Paper in Human Development No. 3 (revised). Department of Educational Psychology, University of Texas, Austin, 1955. Nunnally, J. C. Psychorhetric theory. New York: McGraw-Hill, 1967. Overall, J. E., & Klett, C. J. Applied multivariate analysis. New York: McGraw-Hill, 1972. Patterson, G. R. A tentative approach to the clsssification of children's behavior problems. Unpublished doctoral dissertation, University of Minnesota, 1956. (University Microfilms, Ann Arbor, Michigan, Publication No. 16,562) Peterson, D. R. Behavior problems of middle childhood. Journal of Consulting Psychology, 1961,25, 205-209. Quay, H. C., & Peterson. D. R. Personality factors in the study of juvenile delinquency. Exceptional Children, 1960, 26, 472-476. Rummel, R. J. Applied factor analysis. Evanston, Illinois: Northwestern University Press, 1970. Sneath. P. H. A., & Sokal, R. R. Numerical taxonomy: The principles and practice of numerical classification. San Francisco: Freeman, 1973. Sokal, R. R., & Sheath, P. H. A. Principles of numerical taxonomy. San Francisco: Freeman, 1963. Warner, W. L., Meeker, M., & Eells, K. Social class in America. Chicago: Science Research Associates, 1949.
The Children's Behavioral Classification Project: An Interim Report Ralph Mason Dreger Louisiana State University
As part of a series of similar endeavors, the Children's Behavioral Classification Project (CBCP) aims to establish a behaviorally based nosology for children's and adolescents' emotional disorders which will be useful for treatment and prevention. To this end several comprehensive instruments have been devised, one of which, for the CBCP, is described here. The CBCP is companion to the Preschool Behavioral Classification Project (PBCP) (Baker & Dreger, 1 9 7 7 this issue) and the Adolescent Behavioral Classification Project (ABCP), which is in the formative stage at present. Underlying the construction of the instruments in each case are two major assumptions: (a) Any nosology, no matter how refined or abstract it becomes eventually, must arise from observations of behavior; (b) parents or parent surrogates can report relevant behavior reliably if the stimuli presented to them for such reporting are sufficiently descriptive of actual behavior. It must be emphasized that the CBCP instrument, details about which are given below, is not an end in itself, even though 16 years in the making, but a means to an end: a practicable nosology. It seemed to the original and to subsequent BCP committees that a sound nosology and resultant nomenclature should start explicitly from directly observable behaviors and build higher-order constructs consistently from these observed behaviors, either by logical derivation or by factorial (factor-analytic) derivation. In respect to the second assumption, it has been the intent of the several BCP committees to keep as close to behaviors as feasible, without reaching the absurdities of complete molecularity. For every area of problems recognized by anyone, the question has always been, "What can a parent or other close ob-
289 T h i s j o u r n a l is c o p y r i g h t e d b y P l e n u m . Each article is available for $ 7 . 5 0 f r o m P l e n u m Publishing C o r p o r a t i o n , 2 2 7 West 2 7 t h Street, N e w Y o r k , N . Y . 1 0 0 1 1 .
290
Drege~
server see or hear (or in the case of the ABCP, smell) that would occasion an observer to say the child has a problem? ''1 The literature concerning children's emotional problems was combed initially and has been followed subsequently. Only an nth part can be mentioned here to provide continuity. In addition to DSM-11 (American Psychiatric Association, 1968), the first manual, published in 1952 and now known asDSM-1, was consulted, with a major intent of supplementing it with the CBCP. Ackerson's (1931/1942) two volumes on children's behavior problems are classics in the field, as are the Jenkins and Hewitt (1944), Hewitt and Jenkins (1946), and Jenkins and Glickman (1946) reports. A large volume by Katz, Cole, and Barton (1967) takes up issues pertinent to classification of children's problems; and the two numerical taxonomy texts by Sokal and Sneath (Sneath & Sokal, 1973; Sokal &Sneath, 1963) cover modern statistical approaches to classification in various fields, including psychology. Peterson and Quay (Peterson, 1961; Quay & Peterson, 1960) and Patterson (I956) did early work, utilizing a comparable methodology to portions of the BCP; and from evidence in this issue of Journal of. Abnormal Child Psychology a couple of them still vigorously pursue lines roughly parallel. Previous reports on the CBCP are found in Dreger (1964, 1970, 1975), in Dreger and Dreger (1962), and in Dreger, Reid, Lewis, Overlade, Rich, Miller, & Flemming (1964).
DESCRIPTION OF THE CBCP INSTRUMENT The present CBCP instrument contains a duplicated list of 274 behavioral and 3 demographic items, age, sex, and clinic-nonclinic status. Behavioral items (of the kind seen in Table I) are endorsed as either "True" or "False" by a parent, usually mother, or parent-surrogate. Experience with the demographic and personal history (DPHD) items brought a surprise to the original committee. With both the 229- and 274-item versions of the CBCP instrument, 11 and 22 DPHD items, respectively, were factored with the behavioral items. DPHD items, however, instead of aligning themselves with and helping to identify factors, as the committee expected, stubbornly aligned themselves with one another, with the exception of race and age, which are moderately correlated in a couple of instances with behavioral factors. Consequently, succeeding work with the several BCPs has proceeded with only from three to five DPHD variables. Of course, representativeness of samples in respect to DPHD variables has been a prime aim of data gathering, Not all of the items are des~:riptive of problem indicators. The committees have regularly included "positive" items which serve as foils to unrelieved difficulty indicators. Twentysix such "positive" items group themselves together to identify the factor which has been named "Appreciative, concerned, obedient social orientation versus unappreciative, aggressive disobedience." Examples of these items are "Expresses appreciation for kind acts toward him," "Plays well with others, or speaks well of others his own age," and "Takes care of his appearance by doing such things as combing his hair or dressing neatly."
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291
Table 1. Representative CBCP Factor Verbal psychoid reactions Item no.
Weight ("loading")
210
.60
183 165 241
.59 .52 .50
160
.49
266 231 29
.45 .44 .38
125 251
.38 .37
261 159
.37 .36
225 188
.36 .34
134 36
.33 -.34
Content In the middle of a sentence he fumbles for a word or uses a wrong .word, or says he forgot what he was trymg to say Stares into space, or stops in the middle of a sentence Has trouble pronouncing words, or uses baby talk, or lisps Says that he has trouble thinking, or says he cannot concentrate or keep his mind on things When words he has understood before are spoken, he shakes his head, or looks blank or puzzled, or says he does not understand Stutters or stammers more than others his age Others state that he says things that are peculiar or make no sense When asked questions about himself, he fails to answer, or says he does not know Mutters or mumbles or talks in a low voice When doing something, will turn away from what he is doing or stop what he is doing at almost any tittle sound or movement Cries or withdraws when teased Takes a long time to make up his mind, or asks others to decide for him, or fails to make choices Stares blankly into space Speaks in a monotone, or lets his voice trail off at end of sentence, or speaks in a weak voice Speaks rapidly, words "come tumbling out fast" Uses words easily without fumbling for words, or without using the wrong word, or without saying he forgot what he was trying to say
despite t h e e v i d e n t lack o f r e l a t i o n t o b e h a v i o r d i m e n s i o n s . A n d f u t u r e analyses will i n c l u d e a D P H D profile, f o r even i f t h e t w o t y p e s o f f a c t o r s are d i s t i n c t , t h e y m a y c o n t r i b u t e d i f f e r e n t i a l l y to grouping o f c h i l d r e n b y t h e i r profiles in t e r m s o f e m o t i o n a l disorders. A d m i n i s t r a t i o n o f t h e CBCP is s i m p l i c i t y itself. F o r p a r e n t s or p a r e n t s u r r o g a t e s w h o c a n read at least at t h e f o u r t h - g r a d e level, t h e f o r m is h a n d e d t o t h e m b y a w o r k e r w h o r e q u e s t s t h a t it b e f'dled o u t . T h e i n s t r u c t i o n s read: For each of the statements on the accompanying sheets, the question concerning your child is, "Has it been true or false of your child in the past 6 months?" If it has been true, make a mark on the line under "True." If it has not been true, make a mark on the line under "False." Please mark every item. If you do not know, mark "False." Mark the items carefully but quickly. Scoring is d o n e b y t o t a l i n g t h e f a c t o r s t r u c t u r e weights for i t e m s end o r s e d " T r u e " for each f a c t o r . These raw f a c t o r scores are t h e n t r a n s f o r m e d t o 5 - p o i n t s t a n d a r d scores b y m e a n s o f a c o n v e r s i o n t a b l e . : 2 Until the materials for scoring are published, they may be obtained from the author free of charge.
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STANDARDIZATION OF THE CBCP INSTRUMENT AND THE CLUSTERS ARISING FROM ITS USE The interdisciplinary committee wrestled with a series of issues relating to rationale for, substance of, and design of the study or studies undertaken as the Behavioral Classification Project. An instrument of assessment was not the principal aim. Rather, the committee was seeking a means of identifying dimensions of specific problems, and also of identifying specific types of children possessing certain patterns of problems, who and which would be amenable to specific therapies. This aim grew in turn out of the somewhat simple; even simplicistic, idea that assessing a child's problem behaviors before and after intervention would enable the clinician to determine the effectiveness, or lack of it, of his/her treatment. Accordingly, the standardization of the present instrument has been conceived only as a step in a much larger evaluative-therapeutic program. Details of the initial analyses of the 229-item instrument, utilizing parent respondents of 430 children, three-fourths clihical, 80 matched nonclinical, are given in Dreger and Dreger (1962) and Dreger et al (1964). From these analyses came 10 factors, 9 behavioral and 1 a parental age dimension. Following the initial analyses a Technical Assistance Project was held with multiprofessional representation from many parts of the country to critique the results and propose further strategy. The present 274-item instrument is the product of that conference. Together with 22 objectively scorable DPHD items, the CBCP instrument was utilized with 113 representative children. Again, DPHD items and behavioral items came out on separate sets of factors. Most amazing, however, was the fact that the most substantial factors arising from the 430-subject sample were replicated in the 113.subject sample. 3 Continued analyses with further samples yield comparable results. At first, with the type of overlapping factor analyses that had to be made on account of computer limitations, 50 factors were extracted. In the succeeding full-matrix analyses, however, 30 factors have been considered optimum for several reasons. First, the Scree test (CatteU, 1966) indicates 30 to be a satisfactory number. Second, to accommodate the psychotic, neurotic, asocial, antisocial, organic, academic, sleeping, eating, developmental, and physical problems, as well as the "positive" aspect of socialization and achievement orientation, a 9 fairly large number of dimensions had been judged to exist by the CBCP committee, but only 25 to 30, not 50 (or up to 67, which a latent-root-of-one would 3Rummel (1970) cites a number of investigations utilizing more variables than subjects, but makes a distinction which in statistics would be that between descriptive and inferential statistics, suggesting a 4-to-1 ratio of subjects to variables for inferential factor analysis as recommended by Cattell. Ordinarily, on statistical grounds this recommendation would be accepted. But the experience of the BCP with behavioral variables, rather than abstractions, has uniformly been that using fewer subjects than variables does not materially affect factor structures.
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allow). And finally, even conceptualizing or requiring cluster programs to deal with 30 factors is difficult enough. Initially, only 25 factors were utilized, but despite the fact that the last 5 are relatively weak they are now included as representing important dimensions of children's behavior. Basic standardization of the CBCP instrument has been carried out on a total of 1,203 subjects from Florida and Louisiana. These represent children both rural and urban (both large and small cities), male and female (in clinical groups in the usual proportions of about four to one, in nonclinical groups about one to one), clinical and nonclinical, clinical children from public clinics (mostly) and private practice, black and white, of ages 6 to 13, and of all social classes. Factors derived from 341 of the most representative subjects have been scored on the 1,203 sample and the raw factor scores distributed for both the 341 subsample and the total sample. Standard scores (5-point scales)have been constructed for both groups. For several subprojects described below some of the subsample scores have been transformed to z-scores, but the extreme skewness of a number of the distributions results m distortions (though not sufficient to vitiate the work of these subprojects).
R eliabilities Several reliability checks have been attempted with the CBCP. There is first the evidence from factor replicability. Although the 10 original factors (derived from 142 items) have not persisted in unchanged form through subsequent analyses (from twice the number of items), every one of them has continued to be found in essence. In four instances they have remained virtually unchanged from sample to sample. In some instances the original factors have coalesced, and in one the factor has split into two. Further checks on reliability of a more traditional variety have been carried out. Sixty respondents from 12 clinics were requested to respond to the CBCP items twice with an average time between sets of responses of 1 month. The average correlation between first and second administrations was .79. The percentage of agreement for items ranged from 70.4 to 94.2, with an average of 85.3. For reliability relating to two respondents, 12 mothers and fathers were compared, first on agreement by items and then by factors, for the nine substantive factors originally delineated. For items, average agreement was a modest 36% with a range of from 10 to 55%. However, for factors, agreement, in correlation terms, averaged .76 (median = .76) with four of the rs above .90; on the other hand, three of the parent couples were below an r of .40, two being .17 and . 12, respectively. Moderate to low agreement on the average was also found for 25 of the present 30 factors by Gilkey (1972) between fathers, mothers, teachers, and the children themselves, though here, too, the range is enormous, especially for fathers and mothers, with rs from zero to .82. Costelloe (1973)
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likewise found similar moderate to low agreement in a study of visually handicapped children assessed by cottage parents ana own parents. It is safe to say for the CBCP as for the PBCP (Baker & Dreger, this journal) that the reliability of responses for the same type of respondent is relatively high, but that responses using different classes of respondents should not ordinarily be compared. Internal consistency reliability estimates are on the whole tied to the number of items scored for a factor. Overall, if the adaptation of the alpha coefficient (Nunnally, 1967) is applicable to the whole C B C P - and its applicability is questionable, for the instrument is usually not scored as a whole to assess anything except number of "True" responses- that estimate for the whole instrument is .94 and the corresponding correlation with true scores .97. For individual factors for which the alpha coefficient is applicable the estimates range from .23 (for one of the admittedly weak last five factors) to .84 (for Factor II, an academic orientation factor), with mean and median (Fisher's z-transformed) rs of .64 in each case. A comparison with reliabilities of factors reported in the literature indicates that the majority of CBCP factors have respectable internal consistency. One limitation must also accompany a discussion of reliability. That is, there is evidently a "fatigue effect" in respect to responding to the rather long instrument. A chi-square analysis of the numbers of responses to the first half of the CBCP compared to the latter half, using 340 subjects, reveals that respondents do indeed utilize more of the items in the first than in the latter half. No attempt has been made to discover what effect this result has on the different factors. Related to both reliability and validity is the assessment of social desirability (e.g., Edwards, 1970). Gay (1976) found that his measure of social desirability and the 30 CBCP factors individually were unrelated, with only one factor (XVIII) having an r significant at the predetermined .05 level (and at that a -.38), which in 30 rs could easily come by chance. Validities Respecting validities of the CBCP, the replication of factors from one set of subjects to another suggests there is "something there" that the instrument is measuring, whether it is a constancy in children or in mothers (who are the main respondents by far). In use the CBCP has shown considerable ability to discriminate among identified groups in the population of children as a whole. One study (Costelloe, 1973) found that sighted and sight-handicapped children could be reliably distinguished by use of mother's responses to the CBCP. Another (Glanville, 1974) found almost perfect discrimination among educable mentally retarded,
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psychotic, and normal children by use of 15 of the factors, and relatively good discrimination with all of the 30 factors. Gifted and normal youngsters of I 1 to 13 years of age were found to be clearly differentiated by use of the 30 factors (Duncan, 1975). And minimal brain dysfunction children proved to be well differentiated from normal children by a majority of the factors taken individually, as well as by the overall set of 30 factors (Fitch, 1976). However, Gay (1976) did not find abusedl neglected, and normal children clearly distinguished by the CBCP reports of their mothers, though some indication was found that abused children and neglected children constitute several separate clusters. These various analyses used multiple discriminant analysis, multivariate analysis of variance, and cluster analyses. Clusters or Types of Children Assuming some measure of reliability and validity, Gay (1974) utilized linear typal analysis (Overall & Klett 1972) to -determine clusters among 300 children, 159 clinic subjects and 141 nonclinic subjects. Eight identifiable groups (types) appeared: A. Anxious, Non-Aggressive; B. Nuisance Aggressive; C. Bland Normal; D. Antisocial Aggressive; E. Withdrawing, Muscular Difficulty; F. Relatively Immature Aggressive; G. Withdrawing, Passive-Aggressive Retarded; H. Sublimated Aggressive. These types have yet to be validated in other samples of children. Practical Uses of the CBCP Tables of norms for the CBCP instrument have been constructed based on the 341 subjects on whose protocols the fundamental factor analysis was done and also on the 1,203, including the 341. Raw factor scores are converted in each case to standard scores, 5- or 3-point scales depending on the normality or nonnormality of the distribution of factor scores. From the nature of the items and their derived factors it was anticipated that some distributions would be markedly skewed, and they are. After all, items which are virtually pathognomic in themselves are found to be rare, as are the factors they identify. For example, not many children from CA 6-13 are reported as attempting suicide or threatening to kill someone or speaking about losing their minds, so the factor of Obsessive Sadomasochism identified by these items is extremely skewed. (Not at all incidentally, from a psychodynamic viewpoint, another identifying item for this factor is "Shows sex organs.") By use of the profile of standard scores on 30 factors, there emerges a fairly definite picture of a child, as observed by a parent or parent-surrogate. When the cluster analyses are completed, the profile can then be compared, visually or mathematically, with identifiable groups of children.
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In the long run, the aim of the Behavioral Classification Project in its.various forms is to establish a nosology, based on behavior, that will enable specific intervention procedures to be used most efficiently with specific groups or types of children, and ultimately to design preventive and not only therapeutic procedures.
REFERENCES Ackerson, L. Children's behavior problems (Vols. 1 & 2). Chicago: University of Chicago Press, 1931, 1942. American Psychiatric Association. DSM-II. Diagnostic and statistical manual of mental dis. orders (2nd ed.). Washington: American Psychiatric Association, 1968. Baker, R. P., & Dreger, R. M. The preschool behavioral classification project: A follow-up report. Journal of A bnormal tT/zildPsychology, 1977, 5, 241-248. Cattell, R. B. The meaning and strategic use of factor analysis. In R. B. Cattell (Ed.), Handbook of multivariate experimental psychology.-Chicago: Rand McNally, 1966. Costeiloe, C. A study of behavioral attributes of visually handicapped children (Doctoral dissertation, Louisiana State University, 1973). Dissertation Abstracts International, 1974,35, 1042B. Dreger, R. M. A progress report on a factor analytic approach to classification in child psychiatry. Psychiatric Research Report No. 18, 1964, 22-58. Dreger, R. M. The establishment of diagnostic categories for the evaluation of specific therapies for children's emotional disorders. Alabama Journal of Medical Sciences. 1970, 7, 55-60. Dreger, R. M. The standardization of the children's behavioral classification project. Unpublished paper, Louisiana State University, 1975. Dreger, R. M., & Dreger, G. E. Proceedings of the technical assistance project held at Jacksonville University, August 16-17, 1962. Behavioral Classification Report No. 1. Jacksonville, Florida: Behavioral Classification Project, 1962. Dreger, R. M., Reid, M. P., Lewis, P. M., Overlado, D. C., Rich, T. A., Miller, K. J., & Flemmine, E. L. Behavioral Classification Project. Journal of Consulting Psychology, 1964, 28, 1-13. Duncan, J. A. A behavioralanalysis of gifted children. Unpublished master's thesis, Louisiana State University, 1975. Edwards, A. L The measurement of personality traits by scales and inventories. New York: Holt, Rinehart and Winston, 1970. Fitch, J. M. A behavioral analysis of brain damaged children and children with minimal brain dysfunction. Unpublished master's thesis, Louisiana State University, 1976. Gay, J. R. A linear typal analysis of the Children's Behavioral Classification Project. Unpublished paper, Louisiana State University, 1974. Gay, J. R. Correlation o f CBCPfactors and social desirability. Unpublished paper, Louisiana State University, 1976. Gflkey, W. A., Jr. An investigation of interrater reliability of the Behavioral Classification Project." A comparison of the response of parents, teachers, and children to the BCP. Unpublished doctoral dissertation, Louisiana State University, 1972. Glanville, S. M. A cluster analysis utilizing the Children's Behavioral Classification Project with psychotic, educable mentally retarded, and normal children. Unpublished master's thesis, Louisiana State University, 1974. Hewitt, L. E. & Jenkins, R. L. Fundamental patterns of maladjustment: The dynamics of their origin. Unpublished paper, University of Illinois, 1946. Jenkins, R. L., & Glickman, S. Common syndromes in child psychiatry. American Journal of Orthopsychiatry, 1946, 16, 244-254.
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Jenkins. R. L., & Hewitt, L. E. Types of personality structure encountered in child guidance c~ ~-~.American Journal of Orthopsychiatry, 1944, 14, 84-94. Katz, M. M., Cole. J. L., & Barton, W. E. The role and methodology of classification in psychiatry and psychopathology. Chevy Chase, Maryland: U. S. Department of Health, Education, and Welfare, 1967. McGuire, C., & White, G. D. The measurement of social status. Research Paper in Human Development No. 3 (revised). Department of Educational Psychology, University of Texas, Austin, 1955. Nunnally, J. C. Psychorhetric theory. New York: McGraw-Hill, 1967. Overall, J. E., & Klett, C. J. Applied multivariate analysis. New York: McGraw-Hill, 1972. Patterson, G. R. A tentative approach to the clsssification of children's behavior problems. Unpublished doctoral dissertation, University of Minnesota, 1956. (University Microfilms, Ann Arbor, Michigan, Publication No. 16,562) Peterson, D. R. Behavior problems of middle childhood. Journal of Consulting Psychology, 1961,25, 205-209. Quay, H. C., & Peterson. D. R. Personality factors in the study of juvenile delinquency. Exceptional Children, 1960, 26, 472-476. Rummel, R. J. Applied factor analysis. Evanston, Illinois: Northwestern University Press, 1970. Sneath. P. H. A., & Sokal, R. R. Numerical taxonomy: The principles and practice of numerical classification. San Francisco: Freeman, 1973. Sokal, R. R., & Sheath, P. H. A. Principles of numerical taxonomy. San Francisco: Freeman, 1963. Warner, W. L., Meeker, M., & Eells, K. Social class in America. Chicago: Science Research Associates, 1949.
