Measuring Problem Behaviors in Young Children.

* Recent years have witnessed a growing interest in the description, diagnosis, and treatment of behavioral and emotional problems in very young children. The rapidly changing behavior that characterizes development in toddlerhood complicates the design of instruments for the purposes of description and diagnosis of deviant behaviors. One of the measures used most widely with this population has been the Child Behavior Checklist/2-3 (CBCL/2-3: Achenbach, Edelbrock, & Howell, 1987), which was revised by Achenbach and Rescorla (2000) and re-normed as a measure applicable for children ranging in age from 1 1/2 to 5 years. This new measure (i.e., the Achenbach System of Empirically Based Assessment Preschool Form or CBCL/1 1/2-5) is nearly identical to the earlier version in terms of item composition (of the 99 items, only 2 items were replaced and 6 were further qualified). However, changes were reported to the first-order factor structure, which is often used to describe dimensions of problem behavior. As was the case with the well-validated 2- to 3-year version of the CBCL, the revised 1 1/2- to 5-year version first derives dimensions of problem behavior using factor analysis of results from clinically referred samples of children and then derives norms for these factor-based dimensions using community samples. The present study addresses the applicability of the 1 1/2- to 5-year version's factor structure in community samples and across groups of children who differ on gender, ethnic, and socioeconomic status. By examining the first-order factor structure (originally derived in a referred sample) in a large community sample and in differing groups, this study adds to the body of information available on the new CBCL/1 1/2-5 in terms of its capacity to describe problem behaviors similarly across children identified with problems and nonidentified children. Given that this instrument is likely to be used in community samples of nonidentified children and with children in various gender, ethnic, and socioeconomic groups, the extent to which the first-order factors that appear in these groups are concordant with the factor structure published for the problem-identified derivation sample provides users with additional important information. Defining and Diagnosing Psychopathology in Young Children Despite a general recognition that current diagnostic frameworks are inappropriate for toddlers due to behavioral instability and other developmental issues (Rappley et al., 1999; Thomas et al., 1997), young children are frequently diagnosed with, and treated for, emotional and behavioral disorders (Koot & Verhulst, 1991; Lavigne et al., 1993). Although there are only limited prevalence data available on psychopathology in toddlers, estimates generally range from 5% to 12%, with disruptive behavioral disorders far outnumbering any other disorders such as depression or anxiety (Keenan, Shaw, Walsh, Delliquandri, & Giovannelli, 1997; Lavigne et al., 1993). As an example of the frequency with which diagnostic classification decisions are made for young children, Rappley and his colleagues (1999) reported 223 children age 3 or younger as having received an ADHD diagnosis (prevalence data were not included). It is important to note that this diagnostic classification decision was associated with treatment using at least one psychotropic medication for more than half (57%) of these 223 children. These data are of concern given the limited knowledge we have about using psychotropic medications with this population (Barkley, 1998). The study by Rappely and colleagues is illustrative of what appears to be a growing trend toward use of psychiatric classifications for diagnoses of behavior problems in young children and that such decisions are paired with medication-based treatments typically used with older children. Thus, there appears to be an extension of psychiatric description and treatment models used with older children downward in age to 2 and 3 year olds. …