Journal of the American Academy of Child & Adolescent Psychiatry
ReviewInternational Epidemiology of Child and Adolescent Psychopathology II: Integration and Applications of Dimensional Findings From 44 Societies
Section snippets
Purposes
Our purposes were as follows: (a) to test how well the CBCL, YSR, and TRF syndrome models fit the data from 27 samples not included in previous CFA studies3, 4, 5; to test effects of society, age, and gender on CBCL, YSR, and TRF scores by integrating the 27 new samples with previous samples6, 7, 8; to test whether the same items received low, medium, or high ratings in different societies; to describe construction of multisociety norms; and to illustrate clinical applications.
Samples
Table 111, 12, 13, 14, 15, 16, 17, 18, 19, 20 describes the 27 samples used in the new CFAs (11 CBCL, 10 YSR, 6 TRF). For the international comparisons of scale scores and mean item ratings, we combined data from the 27 samples used for the CFAs with data from the samples used in previous international comparisons,6, 7, 8 yielding CBCL samples of 69,866 children and adolescents aged 6 through 16 years from 42 societies, YSR samples of 38,070 youths aged 11 through 16 years from 34 societies,
CFAs
For CFAs, items were dichotomized as 0 versus 1 to 2 to avoid low-frequency cells, and tetrachoric correlations were used as the input matrix. To account for non-normal item distributions, we used the weighted least squares with standard errors and mean- and variance-adjusted χ2 estimator (WLSMV) via Mplus 6.0.23 We used the root mean square error of approximation (RMSEA) as the primary fit index because of its superior performance with binary categorical data in a Monte Carlo simulation study.
Discussion
When new data obtained in North Africa (Algeria, Tunisia), Asia (China, Pakistan, Singapore), South America (Brazil, Colombia, Peru, Uruguay), the Balkans (Croatia, Kosovo, Serbia), and Western Europe (France, Italy, Norway, Portugal, Sweden) were combined with previous data from Europe, the Middle East, Africa, Asia, the Caribbean, Australia, and the U.S., the results indicated certain international consistencies but also some significant differences.
We used CFAs to test how well the syndrome
Clinical Applications
Clinicians use diagnoses to guide treatments (e.g., prescribing selective serotonin reuptake inhibitors [SSRIs] versus stimulants), and may also wish to use dimensional instruments. As detailed by Achenbach et al.,1 dimensional instruments can provide clinically useful data at different hierarchical levels. For the CBCL, YSR, and TRF, these hierarchical levels include specific problem items, narrow-band syndrome scales, broad-band Internalizing and Externalizing scales, and a global index of
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This work was supported by the nonprofit Research Center for Children, Youth, and Families (RCCYF), which publishes the Achenbach System of Empirically Based Assessment (ASEBA), and the Singapore Ministry of Health’s National Medical Research Council under its Individual Research Grant NMRC/0745-2003 (D.S.S.F., Y.P.O., B.S.C.W). The Portuguese study was supported by the Fundação Minerva-Cultura-Ensino e Investigação Científica, the founding organization of the Lusíada Universities (P.M., J.T.O.).
Disclosure: Dr. Rescorla is Vice President of the nonprofit RCCYF, from which she has received remuneration. She has received royalties for a book published by Guilford press in 2007 and honoraria for invited talks. Dr. Ivanova is Secretary of the nonprofit RCCYF, from which she has received remuneration. She has received honoraria for invited talks. Dr. Achenbach is President of the nonprofit RCCYF, which publishes the Achenbach System of Empirically Based Assessment (ASEBA) and from which he has received remuneration. He has received royalties for a book published by Guilford Press in 2007 and honoraria for invited talks. Dr. Rocha has received financial support from the Brazilian government for doctoral research, which involved collecting Youth Self-Report (YSR) data. She has provided ASEBA training workshops in Brazil, for which she has received no financial remuneration. Dr. Silvares has served as the ASEBA distributor in Brazil. Drs. Begovac, Chahed, Drugli, Emerich, Fung, Haider, Hewitt, Jaimes, Larsson, Maggiolini, Marković, Mitrović, Moreira, Oliveira, Hansson, Olsson, Ooi, Petot, Pisa, Pomalima, Rudan, Sekulić, Szirovicza, Shahini, Valverde, Vera, Villa, Viola, Woo, and Zhang report no biomedical financial interests or potential conflicts of interest.
This article is discussed in an editorial by Drs. Luis Augusto Rohde and Christian Kieling on page 1236.
An interview with the author is available by podcast at www.jaacap.org or by scanning the QR code to the right.