Use of Different Measures to Identify Preschoolers At-Risk for Emotional or Behavioral Disorders: Impact on Gender and Ethnicity

Abstract Very few definitive standards exist for school diagnosis of emotional or behavioral disorders in terms of measurements for symptoms versus functional impairment, ratings obtained from parents versus teachers, or various combinations of instruments. Such issues are even more complex in preschool children since diagnoses in children below age 6 are seldom studied and standards are inaccurate at best. In this study, different measures of symptoms and functional impairment were obtained on a sample of 285 Head Start children from diverse ethnic backgrounds. These included six instruments completed by teachers and two completed by parents. clinical cut-off scores were used to identify children who could be considered at relatively serious risk for emotional or behavioral disorders. The at risk classifications for each measure were examined singly and in combination using gender, ethnicity, and an overall measure of psychiatric impairment as outcome variables. Identification of children considered at risk ranged fr om a low of 1% to a high of 34%, with considerable evidence of differential effects on gender or ethnicity for some measures and combinations of measures. Implications for choosing instruments to establish eligibility for emotional or behavioral disorders in preschoolers are discussed. ********** Diagnostic procedures for identifying a child as being at-risk for an emotional or behavioral disorder (EBD) usually involve a number of data sources (Witmer, Doll, & Strain, 1996). Presence of symptoms is usually determined on a general rating scale such as the Child Behavior Checklist (CBCL; Achenbach, 1985; Achenbach & Edelbrock, 1983), the Behavior Problem Checklist (Quay & Peterson, 1983), or the Child Symptom Inventory (CSI, Gadow & Sprafkin, 1994). Checklists may also be used for specific disorders, such as the Conner's scale for aggression and attention-deficit! hyperactivity disorder (ADHD; Conner's, 1969,1973) or the Reynolds Child Depression Scale for depression or dysthymia (Reynolds, 1987, 1989). A more complex instrument such as the Diagnostic Interview Schedule for Children (Shaffer et al., 1996) may be more definitive, but it requires special clinical skill and training and is less frequently used in school settings. A scale to document behavioral strengths (Epstein & Sharma, 1998) and an inst rument to establish the cultural validity of items on a symptom checklist (McIntyre, 1995) have also been developed. In addition to diagnosing symptoms of EBD, some indication of adverse effect on social or functional adaptation is usually needed. In this respect the federal definition of emotional disturbance has not changed and continues to require some evidence of adverse educational performance on formal or informal measures of academic achievement (Forness & Kavale, 1997). Most school professionals would agree, however, that a broader interpretation of functional impairment is warranted (Forness, 1992a, 1992b; Witmer, Doll, & Strain 1996). This imposes use of additional instruments such as the School Adaptive Behavior Scale (Lambert, Windmiller, Cole, & Figueroa, 1974), the Social Skills Rating Scales (Gresham & Elliott, 1990), or even a global measure of impairment such as the Global Assessment of Functioning used in psychiatric diagnosis (American Psychiatric Association, 1994). With almost all the above measures, however, questions may arise about the source of the information or about who completes the checklists o r rating scales involved (McConaughy, 1993). With the assumption that problems must be demonstrated in two different settings, these issues take on special significance. Developing an algorithm to determine whether a child is at-risk for a disorder or not has always been problematic, particularly in school situations (Forness, 1990, Kavale, Forness, & Duncan, 1996). …