Analysis of the Child Behaviour Checklist

Analysis of the pincer demeanour ChecklistChapter II Literature ReviewAs apprizeed in the footing, m either inquiryers redeem explored the preponderance of aro mathematical functiond and conductal conundrums crosswise the globe. Researchers hurt to a fault investigated correlates (e.g., period and sexual activity) associated with stirred up and behavioral problems. The psychometric properties of instruments surveying frantic and doingsal problems do overly been a subject of interest. In addition, researchers collect in addition investigated cross-ethnical resemblingities and disparities among unrestrained and behavioral problems. The extensive literature that addresses these discovers, and which connatur whollyy patroned airulate the principle for the present-day(prenominal) study, is presented in five dents. The prototypal branch lastlights the problems associated with epidemiologic studies and comp argons the ii primary(prenominal) risees to epidemiologic studies, namely the vapid and the falsifiable barbel. The second section adds a detai guide description of the CBCL including the evolution of the legal profession, its psychometric properties, its advant ripens and disadvant get along withs, as healthy as its wave of applicability. The terzetto section permits a description of the divinatory precept for assessing pagan similarities and disparities associated with steamy and behavioral problems. Multicultural findings doped on the CBCL as s considerably uphead as era and sexual urge differences associated with aflame and behavioural problems be overly attract. The fourth part section consists of a review article of the motley processes convoluted in assessing the psychometric properties of instruments and findings found on psychometric properties of the several(a) translations of the CBCL. The 5th section consists of a brief cultural and socio-political description of Pakistani f amily followed by a description of the spectacular features (i.e., family, community and cultural fixingss) in relation to randy and behavioural problems in Pakistani society. Fin tout ensembley, thither is a description of the objectives of the reliable study.Epidemiology of Emotional and Behavioural fusssCurrent reviews of epidemiological studies depict that at that place is a soaring preponderance of aflame and behavioural problems among s pick uprren and adolescents nigh the realness (Costello et al., 2004 Hackett Hackett, 1999 Waddell et al., 2002). In one review, Costello et al. comp atomic number 18d findings crossways several veritable countries (including Canada, the unify States, the United Kingdom, Germany and Australia) to investigate the preponderance of turned on(p) and behavioural problems as advantageously as that of a nonher(prenominal) mental problems. base on their findings, the over any preponderance pass judgment of mental problems a mong children and adolescents had a very broad rank (0.1% to 42%), with metamorphoseing place for each category of disease. Categories let in tumultuous behaviour incommodes (i.e., conduct dis align, oppositional disorder and attention deficit hyperactivity disorder), mood disorders (i.e., study(ip) depressive disorder and bipolar disorder), apprehension disorders (i.e., phobias, generalized anxiety disorder, obsessive despotic disorder, and post-traumatic tenseness disorder) as rise up as substance ab lend oneself and dependence. A little examination of the studies implicated in the review revealed that variations in prevalence grade may be attributed to methodological flaws such(prenominal) as stiff dissimilitude crosswise studies with deference to sample size and the age start assessed. muchover, differences across studies in harm of the measures used, the criteria employed as well as the emblem of informant may also extradite mouldd the findings.In communication channel to Costello et al.s (2004) review, Waddell et al.s (2002) review was ground on more(prenominal) stringent criteria studies found on samples of similar size and age range, as well as using similar methodology were compargond. Based on Waddell et al.s review, the prevalence rank of unrestrained and behavioural problems varied between 10% and 20%. Although findings from twain(prenominal) reviews vary considerably, the prevalence rates of randy and behavioural problems across developed countries is passive high and warrants serious attention. Moreover, methodological disparities across studies unders eye the gather up for a coherent methodology to investigate the prevalence of emotional and behavioural problems.In crinkle to developed countries, on that point atomic number 18 fewer researchers investigating prevalence rates in growth countries (e.g., Bangladesh, India, Sri lanka, Sudan, and Uganda) (Costello, 2009 Fleitlich-Bilyk Goodman, 2004 Mul lick Goodman, 2005 Nikapota, 1991 Prior, Virasinghe, Smart, 2005). Moreover, in that location is a scarcity of reviews of the active studies. In one review, Hackett and Hackett (1999) comp bed way outs from India, Puerto Rico, Malaysia and Sudan, and the prevalence rates of mental disorders ranged from 1% to 49%. standardised to research in developed countries, researchers attribute variations in findings to methodological problems across studies, which intromit an inadequate sample size, paucity of diaphanous and internation alone in ally authoritative symptomatic criteria, as well as inconsistencies in judicial decision procedures (Fleitlich-Bilyk Goodman, 2004). Moreover, prevalence rates among developing countries may also partly be conjugated to the brformer(a)ly, economic and medical environment. For example, lack of medical resources and aw arness whatsoever psychological problems may result in parents non k outrighting how to want help (Gadit, 2007). gen ial taboos further compound the problem, preventing people from coverage problems and deterring help-seeking behaviour (Samad, Hollis, Prince, Goodman, 2005). More importantly, cultural variations in the conceptualisation and recognition of psychological problems may result in varied spread overing of prognostics (Gadit, 2007). These environ psychical differences and methodological inconsistencies across studies punctuate the subscribe for a cross-culturally robust methodology to investigate the prevalence of emotional and behavioural problems.Along with methodological problems and environmental differences, emotional and behavioural problems deserve investigation because they affect denary aspects of childrens carrying out such as pedantic performance and social enrolment (Montague et al., 2005 Nelson et al., 2004 Vitaro et al., 2005). Researchers also state that at that place is high comorbidity among emotional and behavioural problems, (SteinHausen, Metze, Meier, K annenberg, 1998) which creates threefold problems for children and their caregivers. Moreover, many childhood disorders overcompensate and influence functioning during adulthood. In fact, many adult disorders are now recognised as having roots in childhood vulnerabilities (Maughan Kim-Cohen, 2005 Tremblay et al., 2005). Furthermore, recognizing and treating problems early atomic number 50 let down the burden of the enormous human and financial costs associated with the judicial decision and intervention, peculiarly in countries where resources are scarce (Costello, Egger, Angold, 2005 James et al., 2002 Waddell et al., 2002). In addition, cross-cultural epidemiology of childrens emotional and behavioural problems may also better inform on-going familiarity some(predicate) the characteristics, course, and correlates of such problems, which in turn ply a scientific basis for appropriate mental health planning (Achenbach Rescorla, 2007 Waddell et al.). Therefore, thithe r is a strong need for a methodology that can be utilized for clinical as well as research purposes to assess emotional and behavioural problems among children and adolescents across cultures.Current literature indicates that there are devil primary(prenominal) flakes to investigate the epidemiology of emotional and behavioural problems, namely the monotone and the a posteriori lift. There are several differences in both salutees including conceptualization of psychological problems as well as the methodology employed for their judicial decision. twain approaches bequeath be discussed briefly.The unconditional approach. The savourless approach, ground on the biomedical perspective, views psychological problems as a grouping of maladaptive and distressing behaviours, emotions and thoughts which are qualitatively incompatible from the typical (Cullinan, 2004). That is, similar to medical diseases, an several(prenominal) may or may not stupefy a event psychological disorder. traditionalistic epidemiological studies are establish on the categorical approach as embodied in various redeings of the Diagnostic and Statistical manual for affable Disorders (DSM) (American Psychiatric Association (APA), 1980 1987 1994 2000) and the Inter matter Classification of Diseases (WHO, 1978 1992). Examples of instruments used in traditional epidemiological studies to derive DSM diagnoses embarrass the Diagnostic Interview inventory for baby birdren ( magnetic disc) (Costello, Edelbrock, Kalas, Kessler, Klaric, 1982) and the childrens interlingual rendition of the Schedule for Affective Disorders and Schizophrenia (Kiddie-SADS) (Puig-Antich Chambers, 1978). At present, there is goodish think about the validity of epidemiological studies base on the categorical approach. Researchers throw away highlighted that inconsistencies in prevalence rates may be collectable to conceptual and methodological issues linked with the DSM as well as methodologi cal disparities among studies (Achenbach Rescorla, 2007 Waddell et al., 2002). each of these agentive roles will be discussed briefly.DSM related problems. Multiple conceptual and methodological problems are associated with the DSM. First, the DSM does not provide a methodology to operationally make distinct psychological disorders (Widiger Clark, 2000). To operationally define DSM criteria, various diagnostic converses such as the DISC have been developed. Unfortunately, meta-analyses indicate that the diagnoses ground on the DISC and separate diagnostic interviews are not in agreement with diagnoses make with comprehensive clinical interviews, which indicate that, neither diagnostic nor clinical interviews provide good validity criteria for testing DSM categories (Achenbach, 2005 Costello et al., 2005 Lewczyk et al., 2003). Second, the diagnostic categories and criteria provided in the DSM encompass to trade as reflected in the salmagundis across the various variates of the DSM, namely the third edition (APA, 1980), third edition revised (APA, 1987), fourth edition (APA, 1994), and fourth edition text revised (APA, 2000), making pars across editions problematic (Achenbach, 2005). Third, although the current meter reading, cognize as the DSM-IV-text revised (APA, 2000), aims at introducing cultural sensitivity in opinion and diagnoses by including an outline for cultural formulation and a semblance of culture-bound syndromes (APA., 2000, pg. 897), it does not provide criteria or guidelines seeing the use of the classification trunk with detail cultural groups (Paniagua, 2005). Since many of the DSM diagnostic criteria are ground on Euro-American social norms, it is hard to use the DSM criteria to identify psychiatry in individuals from other cultures.In addition, there is growing consensus among researchers that DSM categories need to be more appropriate for children and adolescents of line of working ages and sexuality (Doucette, 2 002 Segal Coolidge, 2001). Turk et al. (2007) also highlight the saliency of reckons such as age and gender when investigating prevalence rates. However, at present, this is not the plate. Costello et al. (2005) have verbalize that the incessant developmental changes of childhood create the need for an age- and gender- proper(postnominal) approach to epidemiology. onwards incorporating a developmental perspective in epidemiological studies, it is natural to have a better understanding of developmental psychiatry. Developmental psychiatry is based on the view that problems bone up from dissimilar causes, distinct themselves otherwise at each stage, and may have diverse outcomes. Developmental psychologists do not support a item theory to explain all developmental issues. Instead, they try to arrest knowledge from multiple disciplines (Cicchetti Dawson, 2002). Moreover, developmental psychopathology also allow ins an depth psychology of the lasting jeopardize and pr otective factors indoors the individual and also in his/her environment over the course of development (Cicchetti Walker, 2003). jibe to Costello and colleagues (2004), a developmental perspective in epidemiological studies is based on the cellular inclusion of certain principles. First, minute judicial decision measures for the various phases in childhood and adolescence are take to compare childrens functioning with that of their similar-age peers. For example, problems such as maintenance of sulky places is considered typical for 6-year-olds but not for 12-year-olds. Furthermore, the developmental perspective would include longitudinal studies to evaluate the ways in which developmental processes influence the risk of specific psychological disorders. For example, the developmental trajectory of visible aggression is such that there is an increase in battleful Behavior during the prime(prenominal) few age of childhood, but it progressively decreases until adulthood ( Tremblay et al., 2004). Moreover, developmental epidemiology would include grass estimations to circumscribe the onset of disorders. Frequent assessments would also assist in the appellation of environmental and individual factors that contribute to the development of psychopathology. Although the developmental perspective emphasises the need for age- and gender-specific diagnostic criteria, longitudinal studies as well as frequent assessments, it is intemperate to incorporate this perspective in studies based on the categorical approach as it is not sensitive to developmental changes.Methodological disparities. A slender analysis of categorically based epidemiological studies reveals multiple methodological problems. These include inconsistencies in assessment and ingest procedures as well as absence seizure of guidelines about using information from multiple sources. In terms of assessment procedures, both symptoms as well as significant scathe are required to identify chi ldren with disorders. This is corroborated by Costello et al. (2004), who report that the disparity in the prevalence rates of phobias (i.e., 0.1% to 21.9%) may be attributed to how phobias were assessed in each study, in limited, whether both symptoms (e.g., concern of open places, snakes) as well as significant working(a) impairment were taken into account in the identification of phobias. Waddell et al. (2002) state that the use of exchangeable measures has lead to an improvement in the assessment of symptoms however, problems still exist with regard to how impairment is gauged or how measures may be feature to include symptoms as well as impairment. other problem with assessment procedures is that unalike interview schedules (e.g., DISC and the Kiddie-SADS) and DSM editions have been used across studies, which may have contributed to differences in prevalence rates.Incompatible sampling procedures may also have led to disparities in overall prevalence rates in categorical ly based epidemiological studies (Waddell et al., 2002). For example, studies such as the Great Smokey Mountains study (Costello, Angold, Burns, Erkanli, Stangel Tweed, 1996) were comparatively more comprehensive, and investigated a larger number of diagnostic categories than other studies. As a result, higher overall prevalence rates of psychological problems were reported compared to studies that did not assess as many disorders. Another sampling issue is that reviews were based on studies that differed with regard to the age range assessed some studies focus on a younger age bracket (i.e., between 8 to 11 year olds), others on an older age bracket (i.e., 11 geezerhood and older), whereas some researches included a very broad age range (i.e., 6 to 17 year olds). In addition, there were inconsistencies across studies in terms of the type of informant used some studies relied on parents only, some on children, while some combined data from parents, children as well as teachers. D ifferences in the age brackets assessed as well as the use of distinct informants may have contributed to disparities in epidemiological findings.Another salient issue with regard to categorically based epidemiological studies concerns the coordination and reading material of tuition from multiple informants. Since problem behaviours may only occur in specific situations or with specific individuals, multiple informants (e.g., teachers, parents and children) are necessary. However, since the responders context and science have a great impact on the identification of psychological problems, hapless agreement among respondents is frequently reported. For example, children normally report higher rates of internalizing symptoms (e.g., anxiety and depression) while parents tends to report higher rates of externalizing symptoms (e.g., Conduct Problems) (Rubio-Stipec, Fitzmaurice, Murphy, Walker, 2003). Additionally, children are not considered reliable reporters of their own behavi our due to differences in cognitive abilities as well as the ability to report their own behaviour (Achenbach McConaughy, 2003). condescension such findings, the categorical approach does not provide guidelines regarding obtaining and interpretation data from multiple sources, which complicates matters in terms of how to combine data into yes-or-no decisions about divergent symptoms.The various conceptual problems associated with the DSM as well as the methodological flaws in epidemiological reviews highlight the problems associated with using the categorical approach as a basis for epidemiological studies. Moreover, these issues unders midpoint the need for an approach that is methodologically fleshy and culturally appropriate for cross-cultural comparisons. An alternative to problems linked to the categorical approach, where an a priori criterion is imposed, can be a system that is through empiric observation based and identifies problems as they occur in a population. Suc h an approach would be helpful in highlighting cultural differences in the look of divergent emotional and behavioural problems. Moreover, there is also a need for a methodology that can be employed in a regularize, dogmatic fashion. Although the empirical approach is not a panacea for problems associated with epidemiological studies, it does provide solutions to some of the types of errors in the categorical system.Empirical or dimensional approach. The empirical or dimensional approach, in treaty with a psychosocial perspective, views mental health as a continuum. The dimensional perspective supports the notion that all individuals attend problems involving behaviours, emotions and thoughts to varying extents. Those who experience such problems to an extreme extent (unusual frequency, duration, intensity, or other aspects) are more likely to have a psychological disorder (Cullinan, 2004). In contrast to imposing a priori criteria on childrens emotional and behavioural proble ms, the empirical approach identifies problems as they present themselves in the population. consort to Cullinan (2004), there are certain go twisting in developing a dimensional classification system for emotional and behavioural problems. These steps include creating a collection of items that reflect measurable problem behaviours see by children, identifying a group of children to be studied, assessing every child in the group on each problem, and investigating the data to identify items that co-vary, indeed leading(p) to the identification of disparate dimensions or factors. After the dimensions have been derived, the puss of items can be used to assess and classify emotional and behaviour problems among bracing populations. Given that the empirical approach is based on the identification of coincidering problem behaviours in the population, instead of imposing a priori criteria, it is a approving approach for cross-cultural epidemiological studies.Within empirical ap proaches, the Achenbach System of through empirical observation Based Assessment (ASEBA) provides a good framework for epidemiological studies for multiple reasons. First, cosmos empirically based, ASEBA identifies emotional and behavioural problems as they occur in the population. Second, it is based on a developmental perspective, has a uniform methodology, and also provides explicit guidelines about using data from multiple sources (Achenbach McConaughy, 1997 Achenbach Rescorla, 2001). Hence it provides solutions to problems that arise in the categorical approach. Moreover, Cullinan (2004) and Krol et al. (2006) state that ASEBA measures have been used more extensively compared to other measures of emotional and behavioural problems, such as the Conners Rating Scale- revise (Conners,1990) and the Strengths and Difficulties Questionnaire (Goodman, 1997). Achenbach system of empirically based assessment (ASEBA).Although the ASEBA has a non-theoretical, empirical base per se, it is greatly influenced by the principles of developmental psychopathology. For example, Achenbach highlights that problems may include thoughts, behaviours, and emotions that may manifest themselves differently depending on the age and gender of the individual (Greenbaum et al., 2004). Therefore, each ASEBA form provides norms based on the age and gender of the child, which enables an individuals functioning to be assessed in comparison to same-age peers. Furthermore, ASEBA is a multiaxial system that encompasses a family of standardized instruments for the assessment of behavioural and emotional problems as well as adaptive functioning. The five axes of the assessment baffle include parent (Axis I) and teacher (Axis II) reports, cognitive (Axis III) and physical (Axis IV) assessments as well as the direct assessment of children (Axis V) (Achenbach McConaughy, 2003). The use of different ASEBA instruments provides a standardized and uniform methodology to incorporate information from multiple sources.Furthermore, all ASEBA instruments are empirically based. In accordance with the empirical approach, the construction of the ASEBA forms involved a series of steps (Achenbach McConaughy, 2003). Initially, a collection of potential symptom behaviours (i.e., items) was derived from multiple sources. These items were operationally defined in such a mode that respondents not trained in psychological theory could use them. In accordance with general item-development procedures, pilot tests were conducted to evaluate the clarity of items, response scales and item distribution. Finally, items that could tag between individuals who were not functioning well and their well functioning same-age peers were retained. multivariate statistical analyses were applied to the retained items in order to identify syndromes of problems that co-occur. Syndromes were place purely on the basis of co-occurrence, without any link to a particular cause. Subsequently, the syndromes of co-occurring problem items were used to construct scales. These scales were used to assess individuals in order to assess the degree to which they exhibit each syndrome. Since all ASEBA instruments are empirically based, findings can be compared on the basis of the manifestation of different emotional and behavioural problems, thereby providing a clearer picture of cross-cultural similarities and disparities of different emotional and behavioural problems.In terms of the historical evolution of the system, ASEBA originated to provide a more differentiated assessment of child and adolescent psychopathology than the DSM. When ASEBA was developed, the front closely edition of the DSM (APA, 1952) had only two categories for childhood disorders, which included adjustment reactions of childhood and schizophrenic reaction childhood type (Achenbach Rescorla, 2006). In contrast to the DSM, the first ASEBA publication highlighted more syndromes of emotional and behavioural problems (APA, 1 952). Moreover, based on factor analyses, Achenbach (1966) identified two broad groupings of problems for which he coined the terms Internalizing and Externalizing. As tell apartd earlier, Internalizing Problems included problems with the ego, such as anxiety, depression, withdrawal, and bodily Complaints, without any unpatterned physical cause. On the other hand, Externalizing Problems included problems with other people, as well as problems linked to non-conformance to social norms and mores, such as aggressive and tatterdemalion behaviour. Although all ASEBA forms are used extensively in clinical and research environments, the Child Behavior Checklist is the most widely recognized measure for the assessment of emotional and behavioural problems (Greenbaum et al., 2004 Webber Plotts, 2008).Child Behavior ChecklistAn essential part and the al-Qaida of Achenbachs multiaxial, empirical system is the Child Behavior Checklist (CBCL). Although the CBCL assesses social competencie s as well as problem behaviours, it is widely recognized as a measure of emotional and behavioural problems as opposed to social competencies. In fact, researchers suggest that the CBCL is the most extensively utilized measure for the assessment of problem behaviours among children and adolescents as ascertained by their parents and caregivers (Krol et al., 2006 Greenbaum et al., 2004).Although there have been multiple revisions to the initial CBCL, all versions have the same format and consist of two distinct sections. The first section measures social competencies. Parents are asked to respond to 20 questions regarding the childs functioning in sports, discordant activities, organizations, jobs and chores, and friendships. Items also cover the childs relations with significant others, how well the child plays and workings alone, as well as his/her functioning at school. Finally, respondents describe any known illnesses or disabilities, the issues that concern them the most about the child, and the ruff things about the child (Achenbach Rescorla, 2006). The second section assesses problem behaviour and consists of 118 items that describe specific emotional and behavioural problems, along with two open-ended items for reporting redundant problems. Examples of problem items include acts too young for age, barbaric to animals, too fearful or anxious, and unhappy, sad or downcast. Problem behaviours are organized in a hierarchical factor building that consists of octonary correlated first-order or narrowband syndromes, two correlated second-order or broadband factors (i.e., Internalizing and Externalizing Problems) and an overall nitty-gritty Problems factor. Parents/caregivers are asked to rate the child with regard to how truthful each item is at the time of assessment or deep down the past 6 months. The following scale is used 0 = not true (as off the beaten track(predicate) as you know), 1 = somewhat or sometimes true, and 2 = very true or often true. In the case of respondents with poor reading skills, a non-clinically trained clincian can also admisnter the CBCL (Achenbach Rescorla, 2006). For respondents who cannot read English but can read another language, translations are operational in over 85 languages (Berube Achenbach, 2008).Development of the CBCL.The first version of the CBCL dates venture to 1983. To date, there have been two revisions of the CBCL the first one in 1991 followed by the second in 2001, leading to considerable improvements in the measure. The main impuissance of the initial CBCL was that comparisons across different age groups and respondents were problematic since syndromes had the same label but different items across different age forms (i.e., 4 to 5, 6 to 11, 12 to 16 years) as well as across different respondent forms (i.e., CBCL, teacher report form TRF, and the youth self report YSR) To rectify the problem, the 1991 version included two clean types of syndromes, the core and cross-inf ormant syndromes. lens nucleus syndromes represented items that clustered together consistently across age and gender groupings on a single instrument. Cross-informant syndromes were based on those items from the core syndromes that get along on at least two of the three different respondent forms (i.e., CBCL, TRF, and YSR) (Greenbaum et al., 2004). These revisions facilitated comparisons across different age groups and informants. Moreover, the 1991 version of the CBCL also had new national level norms, which included norms for seventeen and eighteen year olds. by from concrete benefits, changes such as a broader age range and precise criteria for different developmental levels, genders and type of respondents, helped make the CBCL and ASEBA instruments more accurately typical of the developmental perspective of child psychopathology (Greenbaum et al.).Achenbach (1991) also conducted exploratory virtuoso factor analyses of the syndrome scales. Based on the loadings of differe nt syndromes, Achenbach identified ardent/Depressed, Withdrawn, and Somatic Complaints as indicators of Internalizing Problems, whereas Aggressive and Delinquent Behavior were identified as indicators of Externalizing Problems. Since Social Problems, melodic theme Problems and maintenance Problems did not load consistently on either second-order factor, they were not placed in any group (Achenbach, 1991 Greenbaum et al., 2004). Although Internalizing and Externalizing Problems identify different types of behaviour, the two categories are not mutually exclusive and may co-occur within the same individual. This is supported by research findings that indicate that there was a correlation between the two groups in both clinic-referred (.54) and non-referred (.59) samples matched on the basis of age, sex, race, and income (Achenbach, 1991).Description of the current CBCL.The current CBCL was published in 2001 and covers ages 6 to 18 years (CBCL/6-18 Achenbach Rescorla, 2001). The CBC L/6-18 (Achenbach Rescorla, 2001) provides raw pull ahead, T- scores and percentiles for the following (1) the three competence scales (Activities, Social, School) (2) the Total Competence scale (3) the eight cross-informant syndromes (4) Internalizing and Externalizing Problems and (5) Total Problems. The cross-informant syndromes of the CBCL/6-18 include Aggressive Behavior, Anxious/Depressed, Attention Problems, Rule-Breaking Behavior, Social Problems, Somatic Complaints, Thought Problems, and Withdrawn/Depressed.As far as similarities and differences from previous versions are concerned, the current CBCL introduced some major and a few minor changes. One major change was the introduction of the DSM-oriented scales, based on which CBCL and other ASEBA forms can now be scored in terms of scales that are oriented toward categories of the fourth edition of the DSM (A.P.A., 1994). The introduction of the DSM-oriented scales has combined the categorical and empirical approaches and enables users to view problems in both the categorical and dimensional approaches (Achenbach, Dumenci Rescorla, 2003 Achenbach Rescorla, 2006). The DSM-oriented scales include six categories, namely Affective Problems, Anxiety Problems, Somatic Problems, Attention dearth/Hyperactivity problems, Oppositional Defiant Problems as well as Conduct Problems. These scales are based on problem items that mental health experts from sixteen cultures across the world rated as being consistent with particular DSM diagnostic categories. kindred to the empirically based syndromes, the DSM- oriented scales also have age-, gender- and respondent-specific norms.Another major change was that new normative data was collected using multistage fortune sampling in forty U.S. states as well as the dominion of Columbia. The selected homes were considered to be representative of the continental United States with respect to geographical region, socio-economic status, ethnicity and urbanization (Ach enbach Rescorla, 2001). Moreover, interwoven new analyses based on new clinical and normative samples were conducted. However, the eight syndromes and Internalizing and Externalizing groupings published in 1991 were replicated with minor changes. Research findings indicated that correlations between scores on the 1991 syndromes and their 2001 counterparts ranged from .87 to 1.00 (Achenbach Rescorla, 2001Analysis of the Child Behaviour ChecklistAnalysis of the Child Behaviour ChecklistChapter II Literature ReviewAs suggested in the introduction, numerous researchers have explored the prevalence of emotional and behavioural problems across the globe. Researchers have also investigated correlates (e.g., age and gender) associated with emotional and behavioural problems. The psychometric properties of instruments assessing emotional and behavioural problems have also been a subject of interest. In addition, researchers have also investigated cross-cultural similarities and disparitie s among emotional and behavioural problems. The extensive literature that addresses these issues, and which also helped formulate the rationale for the current study, is presented in five sections. The first section highlights the problems associated with epidemiological studies and compares the two main approaches to epidemiological studies, namely the categorical and the empirical approach. The second section provides a detailed description of the CBCL including the evolution of the measure, its psychometric properties, its advantages and disadvantages, as well as its range of applicability. The third section provides a description of the theoretical rationale for assessing cultural similarities and disparities associated with emotional and behavioural problems. Multicultural findings based on the CBCL as well as age and gender differences associated with emotional and behavioural problems are also reported. The fourth section consists of a review of the various processes involved in assessing the psychometric properties of instruments and findings based on psychometric properties of the various translations of the CBCL. The fifth section consists of a brief cultural and socio-political description of Pakistani society followed by a description of the salient features (i.e., family, community and cultural factors) in relation to emotional and behavioural problems in Pakistani society. Finally, there is a description of the objectives of the current study.Epidemiology of Emotional and Behavioural ProblemsCurrent reviews of epidemiological studies indicate that there is a high prevalence of emotional and behavioural problems among children and adolescents around the world (Costello et al., 2004 Hackett Hackett, 1999 Waddell et al., 2002). In one review, Costello et al. compared findings across several developed countries (including Canada, the United States, the United Kingdom, Germany and Australia) to investigate the prevalence of emotional and behavioural problems as well as that of other psychological problems. Based on their findings, the overall prevalence rates of psychological problems among children and adolescents had a very broad range (0.1% to 42%), with varying rates for each category of disorder. Categories include disruptive behaviour disorders (i.e., conduct disorder, oppositional disorder and attention deficit hyperactivity disorder), mood disorders (i.e., major depressive disorder and bipolar disorder), anxiety disorders (i.e., phobias, generalized anxiety disorder, obsessive compulsive disorder, and post-traumatic stress disorder) as well as substance abuse and dependence. A critical examination of the studies included in the review revealed that variations in prevalence rates may be attributed to methodological flaws such as substantial disparity across studies with regard to sample size and the age range assessed. Moreover, differences across studies in terms of the measures used, the criteria employed as well as th e type of informant may also have influenced the findings.In contrast to Costello et al.s (2004) review, Waddell et al.s (2002) review was based on more stringent criteria studies based on samples of similar size and age range, as well as using similar methodology were compared. Based on Waddell et al.s review, the prevalence rates of emotional and behavioural problems varied between 10% and 20%. Although findings from both reviews vary considerably, the prevalence rates of emotional and behavioural problems across developed countries is still high and warrants serious attention. Moreover, methodological disparities across studies underscore the need for a uniform methodology to investigate the prevalence of emotional and behavioural problems.In contrast to developed countries, there are few researchers investigating prevalence rates in developing countries (e.g., Bangladesh, India, Sri lanka, Sudan, and Uganda) (Costello, 2009 Fleitlich-Bilyk Goodman, 2004 Mullick Goodman, 2005 N ikapota, 1991 Prior, Virasinghe, Smart, 2005). Moreover, there is a scarcity of reviews of the existing studies. In one review, Hackett and Hackett (1999) compared results from India, Puerto Rico, Malaysia and Sudan, and the prevalence rates of psychological disorders ranged from 1% to 49%. Similar to research in developed countries, researchers attribute variations in findings to methodological problems across studies, which include an inadequate sample size, paucity of explicit and internationally accepted diagnostic criteria, as well as inconsistencies in assessment procedures (Fleitlich-Bilyk Goodman, 2004). Moreover, prevalence rates among developing countries may also partly be linked to the social, economic and medical environment. For example, lack of medical resources and awareness about psychological problems may result in parents not knowing how to seek help (Gadit, 2007). Social taboos further compound the problem, preventing people from reporting problems and deterrin g help-seeking behaviour (Samad, Hollis, Prince, Goodman, 2005). More importantly, cultural variations in the conceptualization and identification of psychological problems may result in varied reporting of symptoms (Gadit, 2007). These environmental differences and methodological inconsistencies across studies emphasize the need for a cross-culturally robust methodology to investigate the prevalence of emotional and behavioural problems.Along with methodological problems and environmental differences, emotional and behavioural problems merit investigation because they affect multiple aspects of childrens functioning such as academic performance and social adjustment (Montague et al., 2005 Nelson et al., 2004 Vitaro et al., 2005). Researchers also state that there is high comorbidity among emotional and behavioural problems, (SteinHausen, Metze, Meier, Kannenberg, 1998) which creates multiple problems for children and their caregivers. Moreover, many childhood disorders continue a nd influence functioning during adulthood. In fact, many adult disorders are now recognized as having roots in childhood vulnerabilities (Maughan Kim-Cohen, 2005 Tremblay et al., 2005). Furthermore, recognizing and treating problems early can reduce the burden of the enormous human and financial costs associated with the assessment and intervention, especially in countries where resources are scarce (Costello, Egger, Angold, 2005 James et al., 2002 Waddell et al., 2002). In addition, cross-cultural epidemiology of childrens emotional and behavioural problems may also better inform current knowledge about the characteristics, course, and correlates of such problems, which in turn provide a scientific basis for appropriate mental health planning (Achenbach Rescorla, 2007 Waddell et al.). Therefore, there is a strong need for a methodology that can be utilized for clinical as well as research purposes to assess emotional and behavioural problems among children and adolescents across cultures.Current literature indicates that there are two main approaches to investigate the epidemiology of emotional and behavioural problems, namely the categorical and the empirical approach. There are several differences in both approaches including conceptualization of psychological problems as well as the methodology employed for their assessment. Both approaches will be discussed briefly.The categorical approach. The categorical approach, based on the biomedical perspective, views psychological problems as a group of maladaptive and distressing behaviours, emotions and thoughts which are qualitatively different from the typical (Cullinan, 2004). That is, similar to medical diseases, an individual may or may not have a specific psychological disorder. Traditional epidemiological studies are based on the categorical approach as embodied in various editions of the Diagnostic and Statistical Manual for Mental Disorders (DSM) (American Psychiatric Association (APA), 1980 1987 199 4 2000) and the International Classification of Diseases (WHO, 1978 1992). Examples of instruments used in traditional epidemiological studies to derive DSM diagnoses include the Diagnostic Interview Schedule for Children (DISC) (Costello, Edelbrock, Kalas, Kessler, Klaric, 1982) and the childrens version of the Schedule for Affective Disorders and Schizophrenia (Kiddie-SADS) (Puig-Antich Chambers, 1978). At present, there is considerable debate about the validity of epidemiological studies based on the categorical approach. Researchers have highlighted that inconsistencies in prevalence rates may be due to conceptual and methodological issues linked with the DSM as well as methodological disparities among studies (Achenbach Rescorla, 2007 Waddell et al., 2002). Each of these factors will be discussed briefly.DSM related problems. Multiple conceptual and methodological problems are associated with the DSM. First, the DSM does not provide a methodology to operationally define diff erent psychological disorders (Widiger Clark, 2000). To operationally define DSM criteria, various diagnostic interviews such as the DISC have been developed. Unfortunately, meta-analyses indicate that the diagnoses based on the DISC and other diagnostic interviews are not in agreement with diagnoses made through comprehensive clinical interviews, which indicate that, neither diagnostic nor clinical interviews provide good validity criteria for testing DSM categories (Achenbach, 2005 Costello et al., 2005 Lewczyk et al., 2003). Second, the diagnostic categories and criteria provided in the DSM continue to change as reflected in the changes across the various editions of the DSM, namely the third edition (APA, 1980), third edition revised (APA, 1987), fourth edition (APA, 1994), and fourth edition text revised (APA, 2000), making comparisons across editions problematic (Achenbach, 2005). Third, although the current version, known as the DSM-IV-text revised (APA, 2000), aims at intro ducing cultural sensitivity in assessment and diagnoses by including an outline for cultural formulation and a glossary of culture-bound syndromes (APA., 2000, pg. 897), it does not provide criteria or guidelines regarding the use of the classification system with specific cultural groups (Paniagua, 2005). Since many of the DSM diagnostic criteria are based on Euro-American social norms, it is difficult to use the DSM criteria to identify psychopathology in individuals from other cultures.In addition, there is growing consensus among researchers that DSM categories need to be more appropriate for children and adolescents of different ages and gender (Doucette, 2002 Segal Coolidge, 2001). Turk et al. (2007) also highlight the saliency of factors such as age and gender when investigating prevalence rates. However, at present, this is not the case. Costello et al. (2005) have stated that the constant developmental changes of childhood create the need for an age- and gender- specific a pproach to epidemiology.Before incorporating a developmental perspective in epidemiological studies, it is essential to have a better understanding of developmental psychopathology. Developmental psychopathology is based on the view that problems arise from different causes, manifest themselves differently at each stage, and may have diverse outcomes. Developmental psychologists do not support a specific theory to explain all developmental issues. Instead, they try to incorporate knowledge from multiple disciplines (Cicchetti Dawson, 2002). Moreover, developmental psychopathology also includes an analysis of the existing risk and protective factors within the individual and also in his/her environment over the course of development (Cicchetti Walker, 2003).According to Costello and colleagues (2004), a developmental perspective in epidemiological studies is based on the inclusion of certain principles. First, precise assessment measures for the different phases in childhood and ad olescence are required to compare childrens functioning with that of their same-age peers. For example, problems such as fear of dark places is considered typical for 6-year-olds but not for 12-year-olds. Furthermore, the developmental perspective would include longitudinal studies to evaluate the ways in which developmental processes influence the risk of specific psychological disorders. For example, the developmental trajectory of physical aggression is such that there is an increase in Aggressive Behavior during the first few years of childhood, but it progressively decreases until adulthood (Tremblay et al., 2004). Moreover, developmental epidemiology would include frequent assessments to determine the onset of disorders. Frequent assessments would also assist in the identification of environmental and individual factors that contribute to the development of psychopathology. Although the developmental perspective emphasises the need for age- and gender-specific diagnostic crite ria, longitudinal studies as well as frequent assessments, it is difficult to incorporate this perspective in studies based on the categorical approach as it is not sensitive to developmental changes.Methodological disparities. A critical analysis of categorically based epidemiological studies reveals multiple methodological problems. These include inconsistencies in assessment and sampling procedures as well as absence of guidelines about using data from multiple sources. In terms of assessment procedures, both symptoms as well as significant impairment are required to identify children with disorders. This is corroborated by Costello et al. (2004), who report that the disparity in the prevalence rates of phobias (i.e., 0.1% to 21.9%) may be attributed to how phobias were assessed in each study, in particular, whether both symptoms (e.g., fear of open places, snakes) as well as significant functional impairment were taken into account in the identification of phobias. Waddell et al . (2002) state that the use of standardized measures has lead to an improvement in the assessment of symptoms however, problems still exist with regard to how impairment is gauged or how measures may be combined to include symptoms as well as impairment. Another problem with assessment procedures is that different interview schedules (e.g., DISC and the Kiddie-SADS) and DSM editions have been used across studies, which may have contributed to differences in prevalence rates.Incompatible sampling procedures may also have led to disparities in overall prevalence rates in categorically based epidemiological studies (Waddell et al., 2002). For example, studies such as the Great Smokey Mountains study (Costello, Angold, Burns, Erkanli, Stangel Tweed, 1996) were relatively more comprehensive, and investigated a larger number of diagnostic categories than other studies. As a result, higher overall prevalence rates of psychological problems were reported compared to studies that did not as sess as many disorders. Another sampling issue is that reviews were based on studies that differed with regard to the age range assessed some studies focused on a younger age bracket (i.e., between 8 to 11 year olds), others on an older age bracket (i.e., 11 years and older), whereas some researches included a very broad age range (i.e., 6 to 17 year olds). In addition, there were inconsistencies across studies in terms of the type of informant used some studies relied on parents only, some on children, while some combined data from parents, children as well as teachers. Differences in the age brackets assessed as well as the use of different informants may have contributed to disparities in epidemiological findings.Another salient issue with regard to categorically based epidemiological studies concerns the coordination and interpretation of information from multiple informants. Since problem behaviours may only occur in specific situations or with specific individuals, multiple in formants (e.g., teachers, parents and children) are necessary. However, since the respondents context and perception have a great impact on the identification of psychological problems, poor agreement among respondents is frequently reported. For example, children normally report higher rates of internalizing symptoms (e.g., anxiety and depression) while parents tends to report higher rates of externalizing symptoms (e.g., Conduct Problems) (Rubio-Stipec, Fitzmaurice, Murphy, Walker, 2003). Additionally, children are not considered reliable reporters of their own behaviour due to differences in cognitive abilities as well as the ability to report their own behaviour (Achenbach McConaughy, 2003). Despite such findings, the categorical approach does not provide guidelines regarding obtaining and interpreting data from multiple sources, which complicates matters in terms of how to combine data into yes-or-no decisions about different symptoms.The various conceptual problems associate d with the DSM as well as the methodological flaws in epidemiological reviews highlight the problems associated with using the categorical approach as a basis for epidemiological studies. Moreover, these issues underscore the need for an approach that is methodologically sound and culturally appropriate for cross-cultural comparisons. An alternative to problems linked to the categorical approach, where an a priori criterion is imposed, can be a system that is empirically based and identifies problems as they occur in a population. Such an approach would be helpful in highlighting cultural differences in the manifestation of different emotional and behavioural problems. Moreover, there is also a need for a methodology that can be employed in a standardized, systematic fashion. Although the empirical approach is not a panacea for problems associated with epidemiological studies, it does provide solutions to some of the types of errors in the categorical system.Empirical or dimensional approach. The empirical or dimensional approach, in accordance with a psychosocial perspective, views mental health as a continuum. The dimensional perspective supports the notion that all individuals experience problems involving behaviours, emotions and thoughts to varying extents. Those who experience such problems to an extreme extent (unusual frequency, duration, intensity, or other aspects) are more likely to have a psychological disorder (Cullinan, 2004). In contrast to imposing a priori criteria on childrens emotional and behavioural problems, the empirical approach identifies problems as they present themselves in the population. According to Cullinan (2004), there are certain steps involved in developing a dimensional classification system for emotional and behavioural problems. These steps include creating a collection of items that reflect measurable problem behaviours experienced by children, identifying a group of children to be studied, assessing every child in the g roup on each problem, and investigating the data to identify items that co-vary, thus leading to the identification of different dimensions or factors. After the dimensions have been derived, the pool of items can be used to assess and classify emotional and behaviour problems among new populations. Given that the empirical approach is based on the identification of co-occurring problem behaviours in the population, instead of imposing a priori criteria, it is a favourable approach for cross-cultural epidemiological studies.Within empirical approaches, the Achenbach System of Empirically Based Assessment (ASEBA) provides a good framework for epidemiological studies for multiple reasons. First, being empirically based, ASEBA identifies emotional and behavioural problems as they occur in the population. Second, it is based on a developmental perspective, has a uniform methodology, and also provides explicit guidelines about using data from multiple sources (Achenbach McConaughy, 1997 Achenbach Rescorla, 2001). Hence it provides solutions to problems that arise in the categorical approach. Moreover, Cullinan (2004) and Krol et al. (2006) state that ASEBA measures have been used more extensively compared to other measures of emotional and behavioural problems, such as the Conners Rating Scale- Revised (Conners,1990) and the Strengths and Difficulties Questionnaire (Goodman, 1997). Achenbach system of empirically based assessment (ASEBA).Although the ASEBA has a non-theoretical, empirical base per se, it is greatly influenced by the principles of developmental psychopathology. For example, Achenbach highlights that problems may include thoughts, behaviours, and emotions that may manifest themselves differently depending on the age and gender of the individual (Greenbaum et al., 2004). Therefore, each ASEBA form provides norms based on the age and gender of the child, which enables an individuals functioning to be assessed in comparison to same-age peers. Furtherm ore, ASEBA is a multiaxial system that encompasses a family of standardized instruments for the assessment of behavioural and emotional problems as well as adaptive functioning. The five axes of the assessment model include parent (Axis I) and teacher (Axis II) reports, cognitive (Axis III) and physical (Axis IV) assessments as well as the direct assessment of children (Axis V) (Achenbach McConaughy, 2003). The use of different ASEBA instruments provides a standardized and uniform methodology to incorporate information from multiple sources.Furthermore, all ASEBA instruments are empirically based. In accordance with the empirical approach, the construction of the ASEBA forms involved a series of steps (Achenbach McConaughy, 2003). Initially, a collection of potential symptom behaviours (i.e., items) was derived from multiple sources. These items were operationally defined in such a manner that respondents not trained in psychological theory could use them. In accordance with gener al item-development procedures, pilot tests were conducted to evaluate the clarity of items, response scales and item distribution. Finally, items that could differentiate between individuals who were not functioning well and their well functioning same-age peers were retained. Multivariate statistical analyses were applied to the retained items in order to identify syndromes of problems that co-occur. Syndromes were identified purely on the basis of co-occurrence, without any link to a particular cause. Subsequently, the syndromes of co-occurring problem items were used to construct scales. These scales were used to assess individuals in order to assess the degree to which they exhibit each syndrome. Since all ASEBA instruments are empirically based, findings can be compared on the basis of the manifestation of different emotional and behavioural problems, thereby providing a clearer picture of cross-cultural similarities and disparities of different emotional and behavioural probl ems.In terms of the historical evolution of the system, ASEBA originated to provide a more differentiated assessment of child and adolescent psychopathology than the DSM. When ASEBA was developed, the first edition of the DSM (APA, 1952) had only two categories for childhood disorders, which included adjustment reactions of childhood and schizophrenic reaction childhood type (Achenbach Rescorla, 2006). In contrast to the DSM, the first ASEBA publication highlighted more syndromes of emotional and behavioural problems (APA, 1952). Moreover, based on factor analyses, Achenbach (1966) identified two broad groupings of problems for which he coined the terms Internalizing and Externalizing. As set forth earlier, Internalizing Problems included problems with the self, such as anxiety, depression, withdrawal, and Somatic Complaints, without any apparent physical cause. On the other hand, Externalizing Problems included problems with other people, as well as problems linked to non-conform ance to social norms and mores, such as aggressive and delinquent behaviour. Although all ASEBA forms are used extensively in clinical and research environments, the Child Behavior Checklist is the most widely recognized measure for the assessment of emotional and behavioural problems (Greenbaum et al., 2004 Webber Plotts, 2008).Child Behavior ChecklistAn essential part and the cornerstone of Achenbachs multiaxial, empirical system is the Child Behavior Checklist (CBCL). Although the CBCL assesses social competencies as well as problem behaviours, it is widely recognized as a measure of emotional and behavioural problems as opposed to social competencies. In fact, researchers suggest that the CBCL is the most extensively utilized measure for the assessment of problem behaviours among children and adolescents as observed by their parents and caregivers (Krol et al., 2006 Greenbaum et al., 2004).Although there have been multiple revisions to the initial CBCL, all versions have the sa me format and consist of two distinct sections. The first section measures social competencies. Parents are asked to respond to 20 questions regarding the childs functioning in sports, miscellaneous activities, organizations, jobs and chores, and friendships. Items also cover the childs relations with significant others, how well the child plays and works alone, as well as his/her functioning at school. Finally, respondents describe any known illnesses or disabilities, the issues that concern them the most about the child, and the best things about the child (Achenbach Rescorla, 2006). The second section assesses problem behaviour and consists of 118 items that describe specific emotional and behavioural problems, along with two open-ended items for reporting additional problems. Examples of problem items include acts too young for age, cruel to animals, too fearful or anxious, and unhappy, sad or depressed. Problem behaviours are organized in a hierarchical factor structure that c onsists of eight correlated first-order or narrowband syndromes, two correlated second-order or broadband factors (i.e., Internalizing and Externalizing Problems) and an overall Total Problems factor. Parents/caregivers are asked to rate the child with regard to how true each item is at the time of assessment or within the past 6 months. The following scale is used 0 = not true (as far as you know), 1 = somewhat or sometimes true, and 2 = very true or often true. In the case of respondents with poor reading skills, a non-clinically trained clincian can also admisnter the CBCL (Achenbach Rescorla, 2006). For respondents who cannot read English but can read another language, translations are available in over 85 languages (Berube Achenbach, 2008).Development of the CBCL.The first version of the CBCL dates back to 1983. To date, there have been two revisions of the CBCL the first one in 1991 followed by the second in 2001, leading to considerable improvements in the measure. The main weakness of the initial CBCL was that comparisons across different age groups and respondents were problematic since syndromes had the same names but different items across different age forms (i.e., 4 to 5, 6 to 11, 12 to 16 years) as well as across different respondent forms (i.e., CBCL, teacher report form TRF, and the youth self report YSR) To rectify the problem, the 1991 version included two new types of syndromes, the core and cross-informant syndromes. Core syndromes represented items that clustered together consistently across age and gender groupings on a single instrument. Cross-informant syndromes were based on those items from the core syndromes that appear on at least two of the three different respondent forms (i.e., CBCL, TRF, and YSR) (Greenbaum et al., 2004). These revisions facilitated comparisons across different age groups and informants. Moreover, the 1991 version of the CBCL also had new national level norms, which included norms for seventeen and eighteen ye ar olds. Apart from practical benefits, changes such as a broader age range and precise criteria for different developmental levels, genders and type of respondents, helped make the CBCL and ASEBA instruments more accurately representative of the developmental perspective of child psychopathology (Greenbaum et al.).Achenbach (1991) also conducted exploratory principal factor analyses of the syndrome scales. Based on the loadings of different syndromes, Achenbach identified Anxious/Depressed, Withdrawn, and Somatic Complaints as indicators of Internalizing Problems, whereas Aggressive and Delinquent Behavior were identified as indicators of Externalizing Problems. Since Social Problems, Thought Problems and Attention Problems did not load consistently on either second-order factor, they were not placed in any group (Achenbach, 1991 Greenbaum et al., 2004). Although Internalizing and Externalizing Problems identify different types of behaviour, the two categories are not mutually excl usive and may co-occur within the same individual. This is supported by research findings that indicate that there was a correlation between the two groups in both clinic-referred (.54) and non-referred (.59) samples matched on the basis of age, sex, race, and income (Achenbach, 1991).Description of the current CBCL.The current CBCL was published in 2001 and covers ages 6 to 18 years (CBCL/6-18 Achenbach Rescorla, 2001). The CBCL/6-18 (Achenbach Rescorla, 2001) provides raw scores, T- scores and percentiles for the following (1) the three competence scales (Activities, Social, School) (2) the Total Competence scale (3) the eight cross-informant syndromes (4) Internalizing and Externalizing Problems and (5) Total Problems. The cross-informant syndromes of the CBCL/6-18 include Aggressive Behavior, Anxious/Depressed, Attention Problems, Rule-Breaking Behavior, Social Problems, Somatic Complaints, Thought Problems, and Withdrawn/Depressed.As far as similarities and differences from p revious versions are concerned, the current CBCL introduced some major and a few minor changes. One major change was the introduction of the DSM-oriented scales, based on which CBCL and other ASEBA forms can now be scored in terms of scales that are oriented toward categories of the fourth edition of the DSM (A.P.A., 1994). The introduction of the DSM-oriented scales has combined the categorical and empirical approaches and enables users to view problems in both the categorical and dimensional approaches (Achenbach, Dumenci Rescorla, 2003 Achenbach Rescorla, 2006). The DSM-oriented scales include six categories, namely Affective Problems, Anxiety Problems, Somatic Problems, Attention Deficit/Hyperactivity problems, Oppositional Defiant Problems as well as Conduct Problems. These scales are based on problem items that mental health experts from sixteen cultures across the world rated as being consistent with particular DSM diagnostic categories. Similar to the empirically based syn dromes, the DSM- oriented scales also have age-, gender- and respondent-specific norms.Another major change was that new normative data was collected using multistage probability sampling in forty U.S. states as well as the District of Columbia. The selected homes were considered to be representative of the continental United States with respect to geographical region, socio-economic status, ethnicity and urbanization (Achenbach Rescorla, 2001). Moreover, complex new analyses based on new clinical and normative samples were conducted. However, the eight syndromes and Internalizing and Externalizing groupings published in 1991 were replicated with minor changes. Research findings indicated that correlations between scores on the 1991 syndromes and their 2001 counterparts ranged from .87 to 1.00 (Achenbach Rescorla, 2001