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The Confluence of Mental, Physical, Social, and Academic Difficulties in Middle Childhood. II: Developing the MacArthur Health and Behavior Questionnaire

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ABSTRACT

Objectives

(1) To evaluate the psychometric properties of the MacArthur Health and Behavior Questionnaire (HBQ) in two studies of 4- to 8-year-old children and (2) to explore the empirical and theoretical implications of HBQ-based study findings.

Method

Samples of children were recruited from (1) mental health clinics (n = 53) and community schools (n = 67) for a case-control study in three research sites and (2) a Wisconsin-based community cohort study of families and work, comprising children with high levels of internalizing and/or externalizing behavior problems and asymptomatic children (N = 122). Combinations of mothers, fathers, and teachers completed the HBQ at one or two time points in four geographically and culturally distinctive settings.

Results

Assessment of HBQ reliability showed high test-retest stability and cross-informant agreement. The instrument discriminated strongly and significantly among symptom groups (i.e., high internalizing, high externalizing, high both, and low both) and showed moderate to large effect sizes for between-group differences. Substantial covariance was also found among the HBQ mental, physical, social, and academic problem subscales.

Conclusions

The HBQ is a reliable and valid parent- and teacher-report instrument for assessing multiple dimensions of health and dysfunction in middle childhood and for identifying children on whom more intensive diagnostic procedures may be warranted. Confluences among the four health dimensions suggest phenomenological and perhaps etiological commonalities among traditionally partitioned childhood difficulties and suggest possible artificiality in the conventional distinction between pediatric and child psychiatric morbidities.

Section snippets

MacArthur Health and Behavior Questionnaire

The HBQ is a parent- and teacher-completed instrument addressing four components of health. The measure yields dimensional ratings of 4- to 8-year-old children's functioning in the domains of (1) emotional and behavioral symptoms, (2) physical health, (3) social adaptation, and (4) school adaptation. The four health domains comprised 18 preliminary subscales covering (1) Externalizing Symptoms, Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms, Internalizing Symptoms, Functional

RESULTS

Both studies 1 and 2 were designed in part to evaluate the psychometric properties of the HBQ. While the studies shared this common purpose, each also provided a distinct assessment strategy and research design, allowing different questions to be addressed by the different studies. Although analyzed separately, their results are presented together as a means of highlighting both the homologies and differences in study-specific findings.

Table 1 displays demographic characteristics for the two

DISCUSSION

The two studies reported here yielded three principal findings from data derived from the HBQ. First, the HBQ was shown to be a reliable multidimensional outcome instrument providing measures of mental health, physical health, and social and academic functioning in 4- to 8-year-old children from diverse geographic areas. Test-retest reliabilities were strong over a 7- to 10-day period for both maternal and teacher reports. Furthermore, while many of the expected developmental trends were found

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  • Cited by (0)

    The research on which this paper was based was supported by the John D. and Catherine T. MacArthur Foundation's Research Network on Psychopathology and Development and by NIMH grant R01-MH44340. The MacArthur Assessment Battery Working Group comprises Jennifer C. Ablow, Abbey Alkon, Jeffrey M. Armstrong, W. Thomas Boyce, Marilyn J. Essex, Lauren H. Goldstein, Richard Harrington, Helena C. Kraemer, David J. Kupfer, Jeffrey R. Measelle, Charles A. Nelson, Jodi Quas, Nancy A. Smider, and Laurence Steinberg.

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