Journal of Clinical Child & Adolescent Psychology
ISSN: 1537-4416 (Print) 1537-4424 (Online) Journal homepage: https://www.tandfonline.com/loi/hcap20
International Comparisons of Behavioral and
Emotional Problems in Preschool Children:
Parents' Reports From 24 Societies
Leslie A. Rescorla , Thomas M. Achenbach , Masha Y. Ivanova , Valerie S.
Harder , Laura Otten , Niels Bilenberg , Gudrun Bjarnadottir , Christiane
Capron , Sarah S. W. De Pauw , Pedro Dias , Anca Dobrean , Manfred
Döpfner , Michel Duyme , Valsamma Eapen , Nese Erol , Elaheh Mohammad
Esmaeili , Lourdes Ezpeleta , Alessandra Frigerio , Daniel S. S. Fung , Miguel
Gonçalves , Halldór Guðmundsson , Suh-Fang Jeng , Roma Jusiené , Young
Ah Kim , Solvejg Kristensen , Jianghong Liu , Felipe Lecannelier , Patrick
W. L. Leung , Bárbara César Machado , Rosario Montirosso , Kyung Ja
Oh , Yoon Phaik Ooi , Julia Plück , Rolando Pomalima , Jetishi Pranvera ,
Klaus Schmeck , Mimoza Shahini , Jaime R. Silva , Zeynep Simsek , Andre
Sourander , José Valverde , Jan van der Ende , Karla G. Van Leeuwen , Yen-
Tzu Wu , Sema Yurdusen , Stephen R. Zubrick & Frank C. Verhulst
To cite this article: Leslie A. Rescorla , Thomas M. Achenbach , Masha Y. Ivanova , Valerie S.
Harder , Laura Otten , Niels Bilenberg , Gudrun Bjarnadottir , Christiane Capron , Sarah S. W.
De Pauw , Pedro Dias , Anca Dobrean , Manfred Döpfner , Michel Duyme , Valsamma Eapen ,
Nese Erol , Elaheh Mohammad Esmaeili , Lourdes Ezpeleta , Alessandra Frigerio , Daniel S. S.
Fung , Miguel Gonçalves , Halldór Guðmundsson , Suh-Fang Jeng , Roma Jusiené , Young Ah
Kim , Solvejg Kristensen , Jianghong Liu , Felipe Lecannelier , Patrick W. L. Leung , Bárbara César
Machado , Rosario Montirosso , Kyung Ja Oh , Yoon Phaik Ooi , Julia Plück , Rolando Pomalima ,
Jetishi Pranvera , Klaus Schmeck , Mimoza Shahini , Jaime R. Silva , Zeynep Simsek , Andre
Sourander , José Valverde , Jan van der Ende , Karla G. Van Leeuwen , Yen-Tzu Wu , Sema
Yurdusen , Stephen R. Zubrick & Frank C. Verhulst (2011) International Comparisons of Behavioral
and Emotional Problems in Preschool Children: Parents' Reports From 24 Societies, Journal of
Clinical Child & Adolescent Psychology, 40:3, 456-467, DOI: 10.1080/15374416.2011.563472
To link to this article: https://doi.org/10.1080/15374416.2011.563472
Published online: 29 Apr 2011.
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International Comparisons of Behavioral and Emotional
Problems in Preschool Children: Parents’ Reports
From 24 Societies
Leslie A. Rescorla
1
, Thomas M. Achenbach
2
, Masha Y. Ivanova
2
, Valerie S. Harder
2
,
Laura Otten
1
, Niels Bilenberg
3
, Gudrun Bjarnadottir
4
, Christiane Capron
5
,
Sarah S. W. De Pauw
6
, Pedro Dias
7
, Anca Dobrean
8
, Manfred Do
¨
pfner
9
, Michel Duyme
10
,
Valsamma Eapen
11
, Nese Erol
12
, Elaheh Mohammad Esmaeili
13
, Lourdes Ezpeleta
14
,
Alessandra Frigerio
15
, Daniel S. S. Fung
16
, Miguel Gonc¸alves
17
, Halldo
´
rGuðmundsson
18
,
Suh-Fang Jeng
19
, Roma Jusiene
´
20
, Young Ah Kim
21
, Solvejg Kristensen
3
, Jianghong Liu
22
,
Felipe Lecannelier
23
, Patrick W. L. Leung
24
,Ba
´
rbara Ce
´
sar Machado
7
,
Rosario Montirosso
15
, Kyung Ja Oh
25
, Yoon Phaik Ooi
16
, Julia Plu
¨
ck
9
, Rolando Pomalima
26
,
Jetishi Pranvera
27
, Klaus Schmeck
28
, Mimoza Shahini
29
, Jaime R. Silva
30
, Zeynep Simsek
31
,
Andre Sourander
32
, Jose
´
Valverde
26
, Jan van der Ende
33
, Karla G. Van Leeuwen
34
,
Yen-Tzu Wu
35
, Sema Yurdusen
36
, Stephen R. Zubrick
37
, and Frank C. Verhulst
33
1
Department of Psychology, Bryn Mawr College
2
Department of Psychiatry, University of Vermont
3
Department of Child and Adolescent Psychiatry, University of Southern Denmark
4
Glaesibaer Health Clinic
5
Department of Psychology, University of Montpellier 3
6
Department of Developmental, Personality, and Social Psychology, Ghent University
7
Faculty of Education and Psych ology, Center for Studies in Human Development, Catholic
University of Portugal
8
Department of Psychology, Babes-Bolyai University
9
Department of Child and Adolescent Psychiatry and Psychotherapy, University of Cologne
10
Department of Epidemiology, University of Montpellier 1, CNRS
11
Academic Unit of Child Psychiatry South West Sydney (AUCS),
University of New South Wales
12
Department of Child and Adolescent Psychiatry, Ankara University
13
Tehran Institute for Exceptional Children
14
Department of Clinical and Health Psychology, Universitat Auto
`
noma de Barcelona
15
Scientific Institute ‘‘E. Medea,’’ Bosisio Parini (LC)
16
Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore
17
Department of Psychology, University of Minho
18
Faculty of Social Work, University of Iceland
19
School and Graduate Institute of Physical Therapy, National Taiwan University College of
Medicine; Physical Therapy Center, National Taiwan University Hospital
20
Department of General Psychology, Vilnius University
21
Huno Consulting
22
School of Nursing, University of Pennsylvania
Correspondence should be addressed to Leslie A. Rescorla, Department of Psychology, Bryn Mawr College, 101 North Merion Avenue, Bryn
Mawr, PA 19010. E-mail: lrescorl@brynmawr.edu
Journal of Clinical Child & Adolescent Psychology, 40(3), 456–467, 2011
Copyright # Taylor & Francis Group, LLC
ISSN: 1537-4416 print=1537-4424 online
DOI: 10.1080/15374416.2011.563472
23
Faculty of Psychology, Center for Developmental Studies and Intervention of the Child,
University of Desarrollo
24
Department of Psychology, Chinese University of Hong Kong
25
Department of Psychology, Yonsei University
26
Peruvian National Institute of Mental Health
27
Faculty of Psychology, University of Dardania
28
Kinder-und Jugendpsychiatrische Klinik, Basel
29
University Clinical Center of Kosovo
30
Faculty of Medicine, Universidad de la Frontera
31
Department of Public Health, Harran University
32
Department of Child Psychiatry, Turku University and Turku University Hospital
33
Department of Child and Adolescent Psychiatry, Erasmus University Medical
Center-Sophia Children’s Hospital
34
Faculty of Psychology and Educational Sciences, Leuven University
35
School and Graduate Institute of Physical Therapy, National Taiwan University
College of Medicine
36
Department of Child and Adolescent Psychiatry, Hacettepe University
37
Centre for Child Health Research, University of Western Australia
International comparisons were conducted of preschool children’s behavioral and
emotional problems as reported on the Child Behavior Checklist for Ages 1½–5 by parents
in 24 societies (N ¼ 19,850). Item ratings were aggregated into scores on syndromes; Diag-
nostic and Statistical Manual of Mental Disorders–oriented scales; a Stress Problems scale;
and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score dif-
ferences among the 24 societies ranged from small to medium (3–12%). Although societies
differed greatly in language, culture, and other characteristics, Total Problems scores for
18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of
0–198). Gender and age differences, as well as gender and age interactions with society,
were all very small (effect sizes < 1%). Across all pairs of societies, correlations between
mean item ratings averaged .78, and correlations between internal consistency alphas
for the scales averaged .92, indicating that the rank orders of mean item ratings and inter-
nal consistencies of scales were very similar across diverse societies.
Preschool children’s behavioral and emotional problems
have received much less research attention than
older children’s behavioral and emotional problems
(Campbell, 2002; Egger & Angold, 2006). Egger and
Angold’s (2006) review of epidemiological research on
diagnoses in preschoolers identified only four studies,
all done in the United States. Two studi es (Earls, 1982;
Keenan, Shaw, Walsh, Delliquadri, & Giovannelli,
1997) included fewer than 150 children, whereas two
had larger samples (Egger et al., 2006; Lavigne et al.,
1993). Across these four studies, prevalence for ‘‘any dis-
order’’ ranged from 14% to 26%. Lavigne, Le Bailly,
Hopkins, Gouze, and Binns (2009) subsequently pub-
lished a fifth study from the United States. In their
sample of 796 4-year-olds in metropolitan Chicago,
prevalence rates for various disorders ranged from less
than 0.1% to 13%, depending on the disorder as well as
on the impairment criterion used.
One reason for widely varying prevalence rates is that
troubling behaviors displayed by most preschoolers with
diagnosable disorde rs (except perhaps autism) differ
mainly in degree from behaviors manifested by typical
preschoolers. That is, preschoolers generally come to
clinical attention because they are overly aggressive,
hyperactive, defiant, anxious, volatile, disruptive, stub-
born, or distractible, but these behaviors are quite com-
mon in typically developing preschooler s (Campbell,
2002, Wakschlag et al., 2007).
To distinguish levels of problems that are typical for
preschoolers from levels that are extreme enough to
warrant clinical attention, data from general population
samples are needed to establish the prevalence of pro-
blems. Furthermore, multicultural data are required to
identify possible differences in the prevalence of
particular kinds of problems across different cultural
groups. Instruments such as the Child Behavior Check-
list for Ages 1½–5 (CBCL= 1½–5; Achenbach &
Rescorla, 2000) and the Strengths and Difficulties Ques-
tionnaire (Goodman, 1997) are well suited to large-sca le
investigations of children’s problems because they are
INTERNATIONAL COMPARISONS
457
inexpensive, do not require training to administer, can
be self-administered, and yield quantitative scores.
Findings for the CBCL=2–3, the predecessor of the
CBCL=1½–5, were presented by Achenbach (1992),
who reported a mean Total Problems score of 34.4 for
368 preschoolers from a U.S. general population sam-
ple. Mean Total Problems scores of 27.5 were reported
for 109 Icelandic children (Hannesdo
´
ttir & Einarsdo
´
ttir,
1995) and of 30.4 for 374 Finnish children (Sourander,
2001). Erol, Simsek, Oner, and Munir (2005) reported
a mean CBCL=2–3 Total Problems score of 39.5 for a
nationally representative sample of 638 Turkish chil-
dren. For a sample of 684 3-year-olds in the United
Arab Emirates (UAE), Eapen, Yunis, Zoubeidi, and
Sabri (2004) reported a mean CBCL=2–3 Total Pro-
blems score of 34.6 for boys and 30.8 for girls. In the
Netherlands, Van den Oord, Koot, Boomsma, Verhulst,
and Orlebeke (1995) obtained mean CBCL= 2–3 Total
Problems scores of 34.4 for boys and 32.3 for girls
(N ¼ 420). Osa, Ezpeleta, and Navarro (1996) obtained
a mean Total Problems score of 27.26 in a sample of
188 Spanish preschoolers assessed with the CBCL=2-3.
When the CBC L=2–3 was revised to span ages 1½
to 5 (Achenbach & Rescorla, 2000), two items wer e
changed, new normative and clinical samples were
obtained, and new factor analyses yielded a seven-
syndrome model. To norm the CBCL=1½–5, a national
probability sample of 744 18- to 71-month-olds, which
closely matched the demographics of the U.S. popu-
lation according to census data, was obtained by sam-
pling hous eholds from 40 states. Data were obtained
via home interviews (completion rate ¼ 94%). Consist-
ent with the procedures used to norm other versions
of the CBCL (Achenbach & Rescorla, 2000), the chil-
dren who had received mental health or special edu-
cation services in the preceding 12 months (5% of the
sample) were excluded when deriving norms, to yield
what epidemiologists term a ‘‘healthy sample.’’ Mean
Total Problems score was 33.3, with minimal age and
gender differences (Achenbach & Rescorla, 2000). Four
international studies have also reported Total Problems
scores for the CBCL=1½–5. Kristensen, Henriksen, an d
Bilenberg (2010) reported a mean Total Problems score
of only 17.3 for 850 Danish children, whereas Total
Problems scores of 30.5 have been reported for 672
Dutch children (Tick, van der Ende, Koot, & Verhulst,
2007), of 33.4 for 466 Italian children (Frigerio et al.,
2006), and of 33.6 for 1,385 Chinese children (Liu,
McCauley, Zhao, Pinto-Martin, & Jintan Cohort
Study Group, 2010).
To our knowledge, multicultural comparisons of pre-
schoolers’ problem scores have not been condu cted to
date. However, multicultural comparisons of problems
among 6- to 16-year-olds (N ¼ 55,508) have indicated
considerable similarity in findings across 31 societies
(Rescorla et al., 2007). Although societal groups had
an 8% effect size (ES) on Total Problems scores, 19 of
31 societies had a mean Total Problems score within
5.7 points of the omnicultural mean of 22.5 on a scale
that could range from 0 to 224. Correlations between
societies for mean item ratings averaged .74, and inter-
nal consistency alpha coefficients were very similar
across societies. Age and gender effects, all small, were
also quite consistent across societies.
The Rescorla et al. (2007) study was etic in orien-
tation, meaning that the same instrument was us ed to
measure behavioral and emotional problems in many
different societies. This contrasts with emic research,
whereby the meanings of items are explored in different
societies. When etic research reveals important differ-
ences between societies, emic research may illuminate
possible reasons for those differences. Because, to our
knowledge, no rigorous comparisons of preschoolers’
behavioral and emotional problems across many socie-
ties have been published, etic studies are needed.
PURPOSE OF THE PRESENT STUDY
The present study conducted multicultural comparisons
of parent-reported CBCL scores for 19,850 1½- to
5-year-olds from 24 societies. In a related study, Ivanova
et al. (2010) conducted confirmatory factor analyses
(CFAs) of data from the 23 non-U.S. societies. The
CFA procedure applied was the ‘‘weighted least squares
with standard errors and mean- and variance-adjusted
chi-square estimator’’ on tetrachoric correlations of 0
versus 1 and 2 item ratings. This was the same procedure
Achenbach and Rescorla (2000) applied to the seven-
syndrome model in the United States. Although the
Ivanova et al. (2010) findings supported the U.S. CBCL
seven-syndrome model in all 23 samples, this does not
mean that scores on the syndromes or on other scales
would be similar in all the societies. An important pur-
pose of our study was therefore to determine the magni-
tude of differences between societies on each scale and to
identify societies that had particularly low or high scale
scores. Whether societies differed much in scale scores,
societal differences in gender roles and in customs
related to children’s age argued for testing interactions
between gender, age, and society in our analyses.
Because societies might also differ in the kinds of
problems that parents rated high versus low, we tested
these differences by computing correlations between
the mean ratings of the 99 items in each society
versus each other society. Finally, to measure societal
variations in internal consistencies of scale scores, we
computed correlations between Cronbach’s alpha coeffi-
cients on all scales for each society versus every other
society.
458
RESCORLA ET AL.
