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We examined cross-cultural differences in (1) sibling power balance and (2) the associations between sibling power balance and internalizing and externalizing problems in three separate cross-cultural studies (early childhood, late childhood, and adolescence). The "early childhood samples" consisted of 123 Turkish and 128 Dutch mothers (mean age for children was 4.9 years). In the "late childhood samples," self-report data were collected from 124 Indian and 129 Dutch children (mean age 10.9 years). In the "adolescent samples" self-report data were collected from 165 ethnic Moroccan and 165 ethnic Dutch adolescents (mean age 15.2 years). In all studies, questionnaire data on sibling power imbalance and internalizing and externalizing problems were collected. Results showed only one significant cross-cultural difference in sibling power imbalance: The Indian sample reported more sibling power imbalance than the Dutch. Links between sibling power imbalance and problem behavior were highly similar between the different cultural samples. The only significant difference was a stronger impact of sibling power imbalance on externalizing problems for the Dutch compared to the Turkish sample. Concluding, few cross-cultural differences were found in sibling power imbalance. Across cultures and age groups, more sibling power imbalance was linked to more internalizing and externalizing problems.

Difficulties in peer acceptance during elementary school have been associated with emotional and behavioural problems. This study used a randomized controlled intervention design to test whether improvements in peer acceptance mediated reduced rates of emotional and behavioural problems in intervention compared to control-group children. A total of 615 elementary school children in the Netherlands were followed annually from kindergarten through second grade. Intervention children showed reductions in emotional and behavioural problems, and improved peer acceptance compared to controls. Improved peer acceptance mediated reductions in emotional and behavioural problem development. However, this mediation pathway held only for boys with low receptive vocabulary skills. These results indicate poor peer acceptance as a common underlying factor in emotional and behavioural problem development, particularly for children who are at risk for developing problems.

This longitudinal study explores differences between native Dutch and immigrant Moroccan adolescents in the relationship between internalizing and externalizing problems across time. By using generalized estimating equations (GEE), the strength and stability of associations between internalizing and externalizing problems in 159 Moroccan and 159 Dutch adolescents was studied over a period of 4 years. No differences in strength of co-occurring problems were found between Moroccan and Dutch adolescents. However, for Moroccan adolescents, associations between problems increased over time, whereas in Dutch adolescents, associations remained stable. The increase of co-occurring problems may be a result of undertreatment and increasing complexity of problems in Moroccans during adolescence. The results of this study imply that investigating processes leading to co-occurring problems in subgroups of adolescents, such as immigrant youths, is needed to optimize prevention and intervention efforts.

While stress is a common experience for parents caring for a child with a developmental disability, current measures fail to distinguish between general stress in parents and the demands of parenting and perceptions of parenting skills (parenting stress). This study examined differences in "parenting stress" reported by parents of children with autism and typically developing children. This study examined the role of child characteristics (age, autism severity, child quality of life and problem behaviour) on parenting stress in 150 parents of cognitively able children and adolescents with autism. The results revealed that child hyperactivity was the only factor significantly related to parenting stress in parents of children with autism, overruling measures of autism severity and child quality of life. This finding indicates the significant influence of problematic behaviours on parenting demands and perceptions of parenting skills in parents of children with autism, over other child characteristics conceived as within the parent's control. Study implications for future research are discussed.

Background: It is well documented that friends' externalizing problems and negative parent-child interactions predict externalizing problems in adolescence, but relatively little is known about the role of siblings. This four-wave, multi-informant study investigated linkages of siblings' externalizing problems and sibling-adolescent negative interactions on adolescents' externalizing problems, while examining and controlling for similar linkages with friends and parents. Methods: Questionnaire data on externalizing problems and negative interactions were annually collected from 497 Dutch adolescents ("M" = 13.03 years, "SD" = 0.52, at baseline), as well as their siblings, mothers, fathers, and friends. Results: Cross-lagged panel analyses revealed modest unique longitudinal paths from sibling externalizing problems to adolescent externalizing problems, for male and female adolescents, and for same-sex and mixed-sex sibling dyads, but only from older to younger siblings. Moreover, these paths were above and beyond significant paths from mother-adolescent negative interaction and friend externalizing problems to adolescent externalizing problems, 1 year later. No cross-lagged paths existed between sibling-adolescent negative interaction and adolescent externalizing problems. Conclusions: Taken together, it appears that especially older sibling externalizing problems may be a unique social risk factor for adolescent externalizing problems, equal in strength to significant parents' and friends' risk factors. (Contains 3 tables, 1 figure, and 2 notes.)

Background: Traditionally, special educational needs (SEN) were often defined in terms of child deficits. Recently, there has been a tendency to define SEN in terms of (additional) support needed in the classroom. However, little is known about how teachers define students with special educational needs. To close this gap, characteristics of teacher-identified students with special educational needs in Dutch mainstream primary education were explored. In order to identify these students, 52 teachers from 14 mainstream primary schools were asked: Which of your students are in need of additional support to achieve set educational goals? It was made clear that educational goals could pertain to a specific subject, but also to a student's social, emotional or behavioural development. Purpose: The study aims at exploring characteristics of students with special educational needs in mainstream primary education of those identified by teachers as in need of (additional) support to attain set educational goals. When teachers assess their students' special educational needs, it is likely that they take students' characteristics into account that could be hindering the learning processes: students' perceived self-competence, teacher-perceived students' on-task behaviour, teacher-perceived relationship with the students and teacher-perceived students' internalising and externalising (problem) behaviour. Thus, the present study was designed to compare these characteristics of teacher-identified students with norm-referenced groups. Sample: A total of 151 students (58.9% boys; mean age 9.7 (0.98)), range 8-12 years) were identified by their teachers as in need of additional support to accomplish set educational goals. Methods: Validated questionnaires measured students' perceived self-competence, teacher-perceived students' on-task behaviour, teacher-perceived relationship with the students and teacher-perceived students' internalising and externalising (problem) behaviour. Scale scores of teacher-identified students were compared with norm-referenced groups. Within-group analysis compared high- to low-achieving teacher-identified students. Results: About two-thirds of teacher-identified students with special educational needs were male and about 40% were scoring higher than the national average in key skills. The majority had no clinical diagnosis (boys 76.4%, girls 82.3%). On average, the characteristics of teacher-identified students with special educational needs did not differ radically from the norm-referenced groups. However, teacher-identified students showed significantly more problematic scores on the scales "depression" and "self-competence" than the norm-referenced group. Within-group analysis showed several significant differences between high- and low-achieving teacher-identified students with special educational needs. Conclusion: The group of teacher-identified students with special educational needs was heterogeneous, including boys and girls, high- and low achievers, and mainly children without a clinical diagnosis. The teachers' view demonstrated in this study underlined the multifaceted nature of special educational needs. Therefore, these students should not be regarded a homogenous group that can be defined categorically, rather a group characterised by a spectrum of needs with many variations. Further research is being done by the authors to discriminate sets of support needs of teacher-identified students with special educational needs.

Qualitative differences in social interaction style exist "within" the autism spectrum. In this study we examined whether these differences are associated with (1) the severity of autistic symptoms and comorbid disruptive behavior problems, (2) the child's psycho-social health, and (3) executive functioning and perspective taking skills. The social interaction style of 156 children and adolescents (6-19 years) with high-functioning autism spectrum disorder (HFASD) was determined with the Wing Subgroups Questionnaire. An active-but-odd social interaction style was positively associated with symptoms of autism, attention deficit and hyperactivity. Furthermore, an active-but-odd social interaction style was negatively associated with children's psycho-social health and positively with executive functioning problems. Social interaction style explains part of the heterogeneity among children with HFASD. (Contains 2 tables.)

Spending leisure time with deviant peers may have strong influences on adolescents' delinquency. The current 3-wave multi-informant study examined how parental control and parental prohibition of friendships relate to these undesirable peer influences. To this end, annual questionnaires were administered to 497 Dutch youths (283 boys, mean age = 13 years at baseline), their best friends, and both parents. Cross-lagged panel analyses revealed strong longitudinal links from contacts with deviant peers to adolescent delinquency, but not vice versa. Parent-reported prohibition of friendships positively predicted contacts with deviant peers and indirectly predicted higher adolescent delinquency. Similar indirect effects were not found for parental control. The results suggest that forbidden friends may become "forbidden fruit," leading to unintended increases in adolescents' own delinquency.

This study examined whether the quality of parent-adolescent interactions moderate the association between stressful life events and internalizing and externalizing problems in referred adolescents (N = 101, M age 13.41 years, SD = 1.81). Adolescents and their parents reported on psychological problems at the time of referral and 4 years later. At follow-up parents reported on stressful life events and an interaction task was conducted to observe autonomy and relatedness promoting behaviors. For adolescents exposed to stressful events, levels of internalizing and externalizing problems went up except if observed parent-adolescent interactions were characterized by high autonomy and relatedness. The results implied that autonomy and relatedness protect adolescents against the deleterious effects of stressful life events. These findings build on previous research showing for psychologically vulnerable adolescents that parenting that promotes autonomy while maintaining relatedness is associated with resilience in times of stress.

Background: Children with poorer language skills are more likely to show externalizing behavior problems, as well as to become rejected by their peers. Peer rejection has also been found to affect the development of externalizing behavior. This study explored the role of peer rejection in the link between language skills and the development of externalizing behavior. Methods: Six hundred and fifteen (615) children were followed from kindergarten to grade 4. Receptive language skills were measured with the Peabody Picture Vocabulary Test in grade 2. Teachers reported externalizing behavior and peer reports of social rejection were measured annually. Results: Children with poorer receptive language skills showed increasing externalizing behavior, while children with better receptive language skills showed decreases in externalizing behavior. Children with poorer receptive language skills experienced peer rejection most frequently. The link between receptive language skills and the development of externalizing behavior was mediated by the development of peer rejection. Findings suggested that this mediational link applied mostly to boys. Conclusion: Children with poorer language skills are at increased risk of becoming rejected by mainstream peers, which adds to the development of externalizing behavior. (Contains 2 tables and 2 figures.)

The authors explored the utility of the Difficulties in Emotion Regulation Scale (DERS) in assessing adolescents' emotion regulation. Adolescents (11-17 years; N = 870) completed the DERS and measures of externalizing and internalizing problems. Confirmatory factor analysis suggested a similar factor structure in the adolescent sample of the authors as demonstrated previously among adults. Furthermore, results indicated no gender bias in ratings of DERS factors on three scales (as evidenced by strong factorial gender invariance) and limited gender bias on the other three scales (as evidenced by metric invariance). Female adolescents scored higher on four of six DERS factors than male adolescents. DERS factors were meaningfully related to adolescents' externalizing and internalizing problems. Results suggest that scores on the DERS show promising internal consistency and validity in a community sample of adolescents. (Contains 6 tables.)

Background: Psychopathology in youth appears to be linked to deficits in regulating affective responses to stressful situations. In children, high-quality parental support facilitates affect regulation. However, in adolescence, the role of parent-child interaction in the regulation of affect is unclear. This study examined physiological reactivity to and recovery from stress in adolescents at risk for psychopathology, and their associations with internalising and externalising problems and parent-adolescent interactions. Methods: A total of 99 adolescents (M = 13.57 years, SD = 1.83) with a history of mental health problems underwent the Alarm Stress Task and were reunited with their primary caregiver after the stressor, while the physiological responses of the parasympathetic (respiratory sinus arrhythmia) and sympathetic (pre-ejection period) systems were measured. The quality of parent-adolescent interaction was determined from observations of secure-base seeking and providing during the task. Affect regulation was measured as physiological reactivity and recovery after the stressor. Results: Adolescents with high levels of externalising problems and low levels of secure-base support showed weaker parasympathetic reactivity and recovery. Higher level of adolescent secure-base seeking was associated with stronger sympathetic reactivity and recovery. Conclusions: Secure-base interactions between parents and adolescents facilitate physiological regulation of stress, especially for adolescents with externalising symptomatology.

In high care settings for persons with intellectual disability (ID) aggressive incidents often occur. Still little is known about factors that are associated with an increased risk for aggressive behavior in clients who are admitted to an inpatient treatment facility. In four inpatient facilities, 108 adults with mild and borderline ID and behavior problems were categorised into three aggressive incidents groups (no, mild, severe) according to their actual aggressive behavior observed for six months. The three groups were compared with regard to background and admission characteristics, psychiatric co-morbidity and emotional and behavioral problems. Results show that antisocial behaviors, behaviors indicative of a lack of impulse control, psychotic behaviors, mood related behaviors, and auto-aggressive behavior increased the likelihood of severe aggression. The three groups did not differ with regard to client and admission characteristics or psychiatric co-morbidity. Behaviors that are predictive of severe inpatient aggression in settings for adults with mild to borderline ID and behavior problems closely resemble those that are distinguished in risk assessment instruments for forensic non-disabled individuals. (Contains 4 tables.)

Adolescent delinquency and academic underachievement are both linked with child and adolescent behavior problems. However, little is known about behavioral pathways leading to these adverse outcomes. Children's aggression, opposition, status violations, and property violations scores were collected at ages 5, 10, and 18. Delinquency and academic functioning was rated at age 18. Age 18 status violations were linked to delinquency, and property violations to academic underachievement. Engagement in status and property violations was predicted by childhood opposition. Findings suggest that (a) disaggregated forms of externalizing behavior are needed to understand behavioral pathways to adverse outcomes and (b) prevention of adolescent delinquency and academic underachievement should target childhood opposition. (Contains 2 tables, 1 figure and 1 footnote.)

Background: This study examined the relation between stress and change in emotional and behavioural problems in children and adolescents referred for mental health services. Method: At three waves across four years, children and their parents (N = 310, mean age at the first wave = 11.26 years, SD = 3.18) reported emotional and behavioural problems, as well as stressful life events (parent report) and perceived stress (child report). Results: Major life events before referral were associated with higher levels of parent-reported internalising and externalising problems at referral. Life events after referral were associated with a slower recovery from internalising problems. The associations between stressful life events and the course of parent- and self-reported problems were mediated by children's subjective feelings of stress. Conclusion: Stressful life events appear to interfere with recovery from internalising problems in the years after referral through increasing the experience of stress in daily life.

Background: Health risk behaviors like substance use (alcohol, tobacco, soft/hard drugs) and risky sexual behavior become more prevalent in adolescence. Children with behavior problems are thought to be prone to engage in health risk behaviors later in life. It is, however, unclear which problems within the externalizing spectrum account for these outcomes. Methods: Three hundred and nine children were followed from age 4/5 years to 18 years (14-year follow-up). Level and course of parent-rated opposition, physical aggression, status violations and property violations were used to predict adolescent-reported substance use and risky sexual behavior at age 18 years. Results: Both level and change in physical aggression were unique predictors of all forms of adolescent health risk behavior. Levels of status violations predicted smoking and soft drug use only, while change in property violations predicted each of the health risk behaviors. The links between opposition and health risk behaviors were accounted for by co-occurring problem behaviors. Conclusions: Of externalizing problems, physical aggression is the best predictor of adolescent substance use and risky sexual behavior from childhood onwards. Possible explanations and implications of these findings, and future research directions are discussed.

Background: This study described similarities and differences in the 5-year stability and change of problem behaviour between youths attending schools for children with mild to borderline (MiID) versus moderate intellectual disabilities (MoID). Methods: A two-wave multiple-birth-cohort sample of 6 to 18-year-old was assessed twice across a 5-year interval using the Developmental Behaviour Checklist Primary Carer version (n = 718) and Teacher version (n = 313). Results: For most types of problem behaviour youths with MiID and MoID showed similar levels of stability of individual differences, persistence and onset of psychopathology. Whenever differences were found, youths with MoID showed the highest level of stability, persistence and onset across informants. Mean levels of parent-reported, but not teacher-reported, problem behaviour, regardless of level of intellectual disability, decreased during the 5-year follow-up period. Conclusions: Youths with MoID and MiID are at risk for persistent psychopathology to a similar degree. Different informants showed to have a different evaluation of the level and the amount of change of problem behaviour, and should be considered complementary in the diagnostic process.

Objective: The societal changes experienced by Western societies in recent decades have raised concerns about increases in the level of children's mental health problems. Although studies of secular changes in the prevalence of psychiatric diagnoses have indeed shown increases, their results may have been influenced by methodological problems, such as changing diagnostic criteria. Although repeated population studies using identical measures have not indicated such a clear increase in mental health problems, these studies have been limited to school-age children. We therefore investigated changes in Dutch parents' reports of very young children's emotional and behavioral problems over a 14-year period. Method: We compared Child Behavior Checklist scores across two Dutch general population samples of 2- and 3-year-olds, one sample assessed in 1989 and one in 2003. Results: Results revealed only a few changes over time, indicating small decreases in parent-reported problems. Between 1989 and 2003, there were decreases in the mean scores and in the proportions of children with deviant scores on the Anxious/Depressed, Total Problems, Internalizing, and DSM-oriented attention-deficit/hyperactivity problems scales. Conclusions: Despite indications of increasing problems among school-age children and adolescents, parent-reported problem levels of very young Dutch children have not increased. Our findings even showed some small improvements in parents' reports of very young children's functioning between 1989 and 2003. (Contains 5 tables.) [This study was supported by a grant from the Sophia Foundation of Medical Research.]

Background: Achenbach & Rescorla (2003) recently developed the Adult Behavior Checklist (ABCL) to assess psychopathology in the general population. The ABCL should be completed by a proxy informant. The use of proxy informants, instead of self-reporting, makes the ABCL potentially suitable for the assessment of psychopathology in adults with intellectual disability. The aim of the present study was to examine reliability and validity of the ABCL in 124 adults with mild intellectual disability or low IQ, and severe challenging behaviour referred for residential treatment. Methods: The ABCL was completed by two independent informants to assess inter-rater reliability. To examine the validity of the ABCL, its relationship with three measures of functioning was assessed. Furthermore, association between scales of the ABCL and DSM-IV axis I disorders was examined. Results: The ABCL was reliable in terms of internal consistency of its scales, and inter-rater reliability. Relationships between clusters of axis I DSM-IV disorders and scales of the ABCL were found as expected. Moreover, ABCL scales predicted different measures of functioning. Conclusions: The ABCL appears to be a reliable and valid measure to assess psychopathology in persons with mild intellectual disabilities or low IQ, admitted for treatment in facilities for adults with mild intellectual disability and severe challenging behaviour.

Background: To assess the co-occurrence in deviant trajectories of parent-rated symptoms of conduct disorder (CD), oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD) from age 4 to 18 years old in a general population sample of Dutch children. Methods: Developmental trajectories of CD, ODD, and ADHD were estimated in a sample of 1,016 males and 1,060 females. Children's disruptive problem behaviors were rated at 5 time-points. The co-occurrence patterns between the deviant CD trajectory, and the high ODD and high ADHD trajectory were studied for males and females separately. Results: Four percent of males and 2% of females followed a deviant CD trajectory. Six percent of the sample followed a high ODD trajectory, and 5% a high ADHD trajectory. Engagement in the deviant CD trajectory was predicted by ODD and ADHD in females, but only by ODD in males. Conclusions: Although ADHD co-occurs with CD, the association between ADHD and CD is largely accounted for by accompanying ODD. Gender differences should be taken into account in understanding the onset of CD.

Background: We aimed to describe similarities and differences in the developmental course of psychopathology between children with and without intellectual disabilities (ID). Methods: Multilevel growth curve analysis was used to analyse the developmental course of psychopathology, using the Child Behavior Checklist (CBCL), in two longitudinal multiple-birth-cohort samples of 6- to 18-year-old children with ID (N = 978) and without ID (N = 2,047) using three repeated measurements across a 6-year period. Results: Children with ID showed a higher level of problem behaviours across all ages compared to children without ID. A significant difference between the samples in the developmental courses was found for Aggressive Behaviour and Attention Problems, where children with ID showed a significantly larger decrease. Gender differences in the development of psychopathology were similar in both samples, except for Social Problems where males with ID showed a larger decrease in problem behaviour across time than females with ID and males and females without ID. Conclusions: Results indicate that children with ID continue to show a greater risk for psychopathology compared to typically developing children, although this higher risk is less pronounced at age 18 than it is at age 6 for Aggressive Behaviour. Contrary to our expectations, the developmental course of psychopathology in children with ID was quite similar from age 6 to 18 compared to children without ID. The normative developmental trajectories of psychopathology in children with ID, presented here, can serve as a yardstick against which development of childhood psychopathology can be detected as deviant.

Six types of antisocial and delinquent behaviors (e.g., property destruction and authority avoidance) were assessed in 526 youths (11 to 24 years of age) with mild to borderline intellectual disabilities and 1,030 11- to 18-year-olds without intellectual disabilities. Overall, 10% to 20% of youths with intellectual disabilities exhibited some type of antisocial and delinquent behavior, which were quite persistent over a 5-year period. Youths who exhibited one type of antisocial and delinquent behavior were likely to also exhibit other types of such behaviors. Being male, younger, and having behavioral problems particularly predicted these behaviors across a 5-year period. Overall, boys but not girls with intellectual disabilities exhibited antisocial and delinquent behaviors more often than peers without intellectual disabilities. Clinical implications and implications for future research are discussed.

A 24-item short form of the 96-item Developmental Behaviour Checklist was developed to provide a brief measure of Total Behaviour Problem Score for research purposes. The short form Developmental Behaviour Checklist (DBC-P24) was chosen for low bias and high precision from among 100 randomly selected item sets. The DBC-P24 was developed from epidemiological data in the first three waves of the Australian Child to Adult Development study, and cross validated for groups with autism, fragile X, Prader-Willi, and Williams in this longitudinal study and in cross sectional Dutch, English, and Finnish samples of young people with intellectual disability. The DBC-P24 has low bias and high precision in cross-validation samples and achieves high sensitivity and specificity to full DBC-P based caseness decisions.

Background: This study investigated the occurrence, cross-informant agreement, 1-year stability, and context characteristics of externalizing behaviors in 12-month-old children, as compared to 24- and 36-month-olds. Method: In a general population sample of 786 12-month-olds, 720 24-month-olds, and 744 36-month-olds, the CBCL/1 1/2-5 was obtained from mothers and fathers and again one year later for a subsample of 307 children. Mothers of 1,831 children also provided complete data on child, mother, and family characteristics. Results: Over three-fourths of the externalizing behaviors occurred in more than 10% of 12-month-olds, over one-third of the items in more than 25%. For almost all externalizing behaviors, the occurrence was significantly lower in 12-month-olds compared to 24- and 36-month-old children. Mother-father agreement and 1-year stability of externalizing behaviors in 12-month-old children were significant, but generally somewhat lower than in 24- and 36-month-olds. Context characteristics were related to externalizing behaviors in 12-month-olds as well as in older children. Some associations were less pronounced in 12-month-old children, but the overall pattern of correlates was similar across age groups. Conclusions: The results of this study show that externalizing behaviors in 12-month-old children merit further research and can be assessed with the CBCL in a valid way.

Objective: To compare the predictive validity of the clinical-diagnostic and the empirical-quantitative approach to assessment of childhood psychopathology, and to investigate the usefulness of combining both approaches. Method: A referred sample (N = 96), aged 6 to 12 years at initial assessment, was followed up across--on average--a period of 3.2 years. It was assessed to what extent DISC/DSM-III-R diagnoses--representing the clinical-diagnostic approach, and CBCL scores--representing the empirical-quantitative approach, predicted the following signs of poor outcome: outpatient/inpatient treatment, or parents' wish for professional help for the child at follow-up, disciplinary problems in school, and police/judicial contacts. Results: Both diagnostic systems added significantly to the prediction of poor outcome, and neither of the two systems was superior. Use of both systems simultaneously provided the most accurate estimation of the prognosis, reflected by the occurrence of future poor outcome. Even diagnostic concepts that are generally regarded as relatively similar, such as ADHD (DSM) and attention problems (CBCL), or conduct disorder (DSM) and delinquent behavior (CBCL), appeared to differ in their ability to predict poor outcome. Conclusions: The present study supports the use of the empirical-quantitative approach and the clinical-diagnostic approach simultaneously, both in research and in clinical settings, to obtain a comprehensive view of the prognosis of psychopathology in children.

Analysis of parent and teacher Developmental Behavior Checklist (DBC) ratings on a combined sample of 1,536 Dutch and Australian children (ages 3-22) with mild to profound intellectual disabilities produced five subscales: Disruptive/Antisocial, Self-Absorbed, Communication Disturbance, Anxiety, and Social Relating. Internal consistency of the subscales ranged from .66 to .91. (Contains references.) (Author/CR)

Examines the relationship of individual family members' perceptions and family mean and discrepancy scores of cohesion and adaptability with child psychopathology in a sample of 138 families. Results indicate that family mean scores, contrary to family discrepancy scores, explain more of the variance in parent-reported child psychopathology than do individual scores. (RJM)