JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 9n 233-241 (1988)

Stability of Children's Behavior Problems: A 3Y2-Year

Longitudinal Study JAMES P. O'DoNNELL

DAVID J. LEICHT FAITH L. PHILLIPS

JOSEPH P. MARNETT Southern Illinois University at Carbondale

WADE F. HORN Children's Hospital National Medical Center

This study examined the stability of behavior problems in a population of 81 boys and 83 gids from first through fourth grades. For a 6-month interval, the correlations for Conduct, Anxiety-W'~thdrowal, and Distroctibility-Hyperodivity ranged from .60 to .80. For 1-year intervals, the correlations ranged from .34 to .68. The stability of Conduct and Distractibility (which did not differ) was significantly greater than the stobility of Anxiety-Withdrawal. Despite moderate to high stability coeffi- cients, classifications (:~ 1.5 SD above the mean) of individual children lacked con- sistency across rating periods. There were no sex differences in behavior problem stability. Finally, there was significant "drift" in behavior rating scores across time with the direction of drift depending upon the grade of the initial rating as well as the time interval between ratings.

Psychopathological syndromes can be inferred from their distinct symptom pat- tern, prognosis, etiology, and treatment (Buss, 1966; Rutter, 1965). The second factor, prognosis, implies that different syndromes should be associated with different outcomes. Because prospective follow-up studies constitute the most important empirical method for obtaining information on the outcome of child- hood symptom patterns (Robins, 1979), we used this method to assess the longitudinal course of three commonly described dimensions of childhood psy- chopathology: Conduct, Anxiety-Withdrawal, Distractibility-Hyperactivity.

This research was supported by Grant No. 2-10983 from the Graduate School, Southern Illinois University at Carbundale. The authors express their appreciation to the following people for making this research possible: F. E. (Joe) Glassford, Director of the Wabash and Ohio Valley Special Education District; Marion Kallenbach, Superintendent of the Eldorado. IL, Public Schools; Kenneth Walker, Superintendent of the Harrisburg, IL, Public Schools; the principals and teachers of the elementary schools in Eldurado and Harrisburg, IL, Public Schools.

Correspondence and requests for reprints should he sent to James P. O'Donneil, Department of Psychology, Southern Illinois University at Carbondale, Carbondale, IL 62901.

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234 O'DONNELL, LEICHT, PHILLIPS, MARNETT, AND HORN

It is generally agreed that Anxiety-Withdrawal is independent of Conduct (Achenbach & Edelbrock, 1978; Quay, 1979). However, there is some contro- versy as to whether Conduct subsumes Distractibility-Hyperactivity or whether Distractibility-Hyperactivity constitutes a separate syndrome. After reviewing available factor-analytic studies, Quay (1979) concluded that Conduct subsumes Distractibility-Hyperactivity. Barkley (1982) and Trites and Laprade (1983), however, have argued forcefully that Conduct and Distractibility-Hyperactivity should be maintained as separate dimensions. Follow-up data from the present study could assist in resolving this controversy. If Conduct and Distractibility- Hyperactivity are distinct dimensions or syndromes, then they should exhibit different natural histories (i.e., temporal stability). On the other hand, similar temporal stabilities would be consistent with the unidimensionality of these symptom patterns. The f'LrSt purpose of this study was to investigate these pos- sibilities.

Previous studies that have examined the children's symptomatology over periods longer than 1 year have found that Conduct (or Fighting) has been moderately stable, with stability coefficients ranging from .50 to .74 (Gersten, Langner, Eisenberg, Simcha-Fagan, & McCarthy, 1976; Victor & Halverson, 1976). Distractibility-Hyperativity has also been found to be relatively stable with coefficients ranging from .54 to .64 (Victor & Halverson, 1976). Direct comparisons between these dimensions have not been made. Somewhat inconsis- tent results have been obtained for Anxiety-Withdrawal. Gersten et al. (1976) obtained moderate stability for Anxiety (r (Regressive Anxiety) = .52), but low stability for Withdrawal (r (Isolation) = .31). Victor and Halverson (1976) obtained low stability for Anxiety-Withdrawal (r (boys) = .28; r (girls) = .35). These studies measured symptoms at only two time points, thus obscuring possi- ble developmental changes. In contrast, we obtained measures at five time points across a 3V2-year period. In this way we were able to examine developmental trends and to obtain more reliable estimates of the temporal stability of these symptom patterns.

Sex differences in children's behavior problems are well documented (e.g., Eme, 1979) with boys consistently exhibiting more frequent acting-out, overac- tive behaviors. However, few studies have addressed the issue of sex differences in the temporal stability of children's symptom patterns. Victor and Halverson (1976) presented stability coefficients separately by sex and these coefficients did not reveal sex differences. The third purpose of the present study was to add to this literature by measuring behavior problems at five time periods across a 3~/2-year interval.

The final purpose of this study was to investigate drift in the average level of behavior problem scores across ratings. Gersten et al. (1976) examined the averaged behavior problem scores for the same children at two time points and found that antisocial behaviors increased with age whereas neurotic-type prob- lems decreased with age. Glow, Glow, and Rump (1982) examined changes in

BEHAVIOR PROBLEM STABILITY 235

Conners' Teacher Rating Scale scores over a 1-year period and found generally lower mean scores at the second rating. The present study sought to extend these findings by examining changes in behavior problem ratings at five time points over a 3½-year period.

METHOD

Subjects The subjects for this study were 81 boys and 83 girls enrolled in regular public school classrooms. They comprised 72% of intact classes of f'wst-grade children initially studied by Horn and O'Donnell (1984). Moving out of the district was the major cause of attrition. The mean age of these children at the beginning of the study was 6.4 years (SD = 0.4) and all had a Slosson IQ -> 80 (M = 112.7; SD = 3.4). Ninety-eight percent of the children were Caucasion and 2% were black. The families averaged 37.0 (SD = 14.8) on the VanDusen and Zill (1977) system, indicating that most children were from lower to middle socioeconomic status (SES) families (e.g., coal minei', carpenter, laborer). In terms of SES, the families of the participating children did not differ from the families of the drop- outs (M = 35.1; SD = 16.3).

Instruments From the Behavior Problem Checklist (BPC; Quay & Peterson, 1976), we se- lected eight Conduct Problem items (negativism, temper tantrums, irritability, disruptiveness, destructiveness, boisterousness, disobedience, fights) and eight Anxiety-Withdrawal items (depressed, easily flustered, self-conscious, overly serious, feelings of inferiority, fearful, hypersensitive, and lacking in serf-confi- dence). These items were selected because they were among the most salient items defining their respective dimensions in previous factor analytic studies of the BPC (Quay & Peterson, 1976). We also selected four items (short attention span, restless, inattentive, and distractible) which reflected Distractibility-Hy- peractivity in previous research with young children (O'Donnell & VanTuinan, 1979). These items were arranged in random order and each was rated on a 4- point scale from 0 (never occurs) to 3 (very frequently occurs).

Procedure Classroom teachers rated each child on each item after studying the items and observing the children for at least 2 weeks. Ratings were obtained at five time points: fall and spring of fwst grade (F-l; S-l); spring of second grade (S-2); spring of third grade (S-3); spring of fourth grade (F-4). First-grade ratings were obtained from the same teachers; second-, third-, and fourth-grade ratings were obtained from different teachers.

236 O'DONNELL, LEICHT, PHILLIPS, MARNETT, AND HORN

RESULTS

Table 1 shows product-moment correlations ~ among the five time points for the total sample as well as separately for each sex. Examination of this table reveals several general patterns. First, for each dimension and for each sex, the correla- tions were highest for the 6-month interval from fall to spring of first grade (range = .60-.85). Second, for the l-year intervals (S-1 to S-2; S-2 to S-3; S-3 to S-4), for the 2-year intervals (S-I to S-3; S-2 to S-4) and for the 3-year interval (S-1 to S-4), the correlations remained moderately high (range = .20-.71). The exception was the 2-year stability of Anxiety-Withdrawal for boys where the correlations (r = . 11) were quite low. Even for the 3V2-year interval (F-1 to S-4), the correlations (R = .30-.61) remained moderately high. Finally, for both sexes and the total sample, the correlations for Conduct and for Distractibility-Hyper- activity appear to be consistently greater than for Anxiety-Withdrawal.

In order to evaluate apparent between-dimension and possible sex differences in these correlations, the coefficients in Table 1 were normalized by transforming them to Fisher's z' statistic (Edwards, 1960). This normalizing process allows the use of statistical analyses that require normal distributions (Minium, 1978, pp. 354-356). The z' values were then treated as dependent variables in a sex by dimension ANOVA. In this analysis, rating intervals were treated as "subjects" (n = 20, sex was a between-subjects and dimensions was a within-subjects variable. The results of this analysis revealed a strong between-dimensions ef- fect, F(2, 36) = 28.8, p < .0001. Post hoc Tukey tests (Hays, 1981, pp. 432- 438) indicated that Conduct (M = .61; S D = .22) and Distractibility-Hyperac- tivity (M = .69; S D = . 13) did not differ from each other but that both were significantly greater, p < .01, than Anxiety-Withdrawal (M = .38; S D = . 16). Neither the between-sex effect, F (1, 18) < 1.0, nor the sex by dimension interaction, F (2, 36) = 2.2, were significant.

Because the reference unit for the clinicians is the individual child, it is crucial to know the stability of classifications of individual children in addition to knowing the stability of rating scale scores. Therefore, we designated a child as "Conduct Disordered," "Anxiety Disordered," or "Distractible" if that child's score was >- 1.5 S D above the mean of all children for a specific rating period. We then examined the individual classifications to determine whether a child who was - 1.5 S D above the mean at one rating period would also be -> 1.5 S D above the mean at later rating periods. These classifications are shown in Table 2. Examination of the top panel of this table shows that, of the 15 children who were > 1.5 S D above the mean for Conduct Problems in fall of f'LrSt grade, 10 (67%) remained > 1.5 S D above the mean in spring of fwst grade. By spring of second, spring of third, and spring of fourth grades, respectively, only 5 of the 15 (33%), 5 of 15 (33%), and 3 of 15 (20%) consistently remained > 1.5 S D

tSpeannan's rank-order correlations were also computed and examined. There were no signifi- cant differences in the magnitudes of the two correlational procedures across the three dimensions fox boys or for girls.

BEHAVIOR PROBLEM STABILITY

TABLE 1 Product-Moment Correlations

237

Behavior Problem Dimensions Boys (n = 81) Girls (n = 8 3 ) Total (n = 164)

Conduct A-W D-H Conduct A-W D-H Conduct A-W D-H

F-1 to S-1 .85 .60 .78 .66 .61 .67 .80 .60 .79 F-1 to S-2 .62 .40 .40 .33 .31 .59 .56 .36 .50 F-1 to S-3 .61 .30 .57 .63 .32 .58 .62 .31 .59 I:-1 to S-4 .30 .34 .50 .40 .37 .61 .34 .35 .56 S-1 to S-2 .59 .49 .56 .32 .27 .56 .54 .38 .57 S-1 to S-3 .63 .11 .58 .50 .36 .58 .62 .24 .59 S-1 to S-4 .27 .26 .50 .50 .29 .70 .35 .27 .60 S-2 to S-3 .67 .42 .53 .61 .35 .58 .68 .38 .57 S-2 to S-4 .42 .11 .62 .44 .44 .58 .46 .25 .62 S-3 to S-4 .56 .20 .71 .56 .50 .60 .59 .34 .68

above the mean. The stability of Distractibility paralleled that of Conduct. Anx- iety-Withdrawal was even less stable. The bottom panel of Table 2 gives com- parable data when the initial rating was taken in the spring of first grade. Again, only 50% or less of the children continued to be rated as "disordered" 1 year following the initial (S-I) rating. More extreme cut-off points (e.g., -> 2.0 SD) resulted in even less stability.

In order to investigate "drif t" in behavior problem ratings, three sex by testing ANOVAs were performed, one for each behavior problem dimension. Table 3 shows the means and standard deviations from these analyses. For Conduct, F (1,162) = 17.2, p < .001, and Distractibility-Hyperactivity, F (1,162) = 8.6, p < .01, boys had significantly more problems than girls. No sex difference emerged for Anxiety-Withdrawal, F (1,162) < 1.0.

There were significant testing effects for Conduct, F (4,648) = 7.0, p < .001, for Anxiety-Withdrawal, F (4,648) = 21.7, p < .001, and for Dislrac- tibility-Hyperactivity, F (4,648) = 10.5, p < .001. Post-hoe Tukey tests were then performed. For Conduct problem scores, F-1 was significantly higher than all other time periods except S-3. For Anxiety-Withdrawal, the Tukey Test showed that the S-1 scores were significantly higher than the scores of all other time periods. Also, Anxiety-Withdrawal was significantly higher in F-I, than in S-2 and S-4; and S-3 was significantly higher than S-4. For Distractibility, post- hoe comparisons showed that S-1 was greater than F-1 and S-4, and that S-2 ratings were significantly lower than all other time periods, with the exception of S-4.

DISCUSSION

Our analyses of the transformed correlation coefficients showed that behavior problem stability was significantly greater for Conduct and Distractibility-Hyper- activity than for Anxiety-Withdrawal. This finding suggests a different natural

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BEHAVIOR PROBLEM STABILITY 239

history for aggressive, restless, distractible behaviors than for anxious, with- drawn behaviors. Because the presence of different natural histories is one crite- rion for grouping symptoms into different syndromes (Rutter, 1965), because Conduct and Distractibility-Hyperactivity cannot be discriminated from each other but can be discriminated from Anxiety-Withdrawal (Stein & O'Donnell, 1984), and because aggressive and hyperactive-distractible symptoms saturate the same or highly correlated factors (Achenbach & Edelbrock, 1978; O'Donnell & VanTuinan, 1979; Quay, 1979), it seems appropriate to conclude that ag- gressive, disruptive, distractible, and hyperactive symptoms do, in fact, com- prise a unitary syndrome.

The correlational data demonstrated moderate to high stability in behavior problem scores both across a 6-month interval and for periods as long as 3V2 years. In particular, the moderately high coefficients from F-1 to S-4 for Conduct and for Distractibility-Hyperactivity suggest that, by early in first grade, chil- dren's symptomatic behavior has begun to take on considerable predictive sig- nificance. For boys' Conduct scores in particular, the high stability coefficients, together with a generally increasing level of aggressive, disruptive behavior, suggests that this class of behaviors is becoming both a stable habit and in- creasingly disturbing to classroom teachers. The importance of these findings for individual children is illustrated by the fact that 10 of 15 (67%) of children with Conduct scores --> 1.5 SD above the mean in fall of grade 1 were also ~ 1,5 SD above the mean in spring of grade 1. This level of stability tends to justify attempts to ameliorate symptoms during the primary grades, particularly Con- duct problems. However, the rather low levels of stability in the classifications of individual children over longer periods of time indicate that extreme caution must be exercised in diagnosing or in "pigeon holing" children. Because a majority of children "recovered" within periods of 6 to 12 months in the ab- sence of planned interventions, labels implying enduring traits should not be applied to children, at least not on the basis of ratings from a single source.

In contrast to previous studies (Victor & Halverson, 1976), our data did not reveal sex-dependent stability differences either in checklist scores or in indi- vidual classifications. This finding implies that early intervention efforts could be equally applicable to either sex.

Our longitudinal analysis of average behavior problem scores revealed signifi- cant "drif t" over time. From fall to spring of first grade, this drift may have been attributable to some combination of teacher sensitivity and pupil behavior during a single academic year. However, because different teachers were in- volved, and because these teachers were spread across different buildings, such an interpretation would not apply to differences between the S-l, S-2, S-3, or S-4 ratings. These latter ratings confirm the drift observed by previous investigators (Glow et al., 1982). However, by measuring behavior problems at five time points, the present data also show that drift is not a simple linear function. Thus, these data suggest that whether an increase or a decrease in symptom frequency

240 CYDONNELL, LEICHT, PHILLIPS, MARNETT, AND HORN

is observed over time may depend upon the age at which ~ e initial measure is taken as well as the interval between measures. The presence of year-to-year drift in children's behavior problems also points to the importance of viewing chil- dren's symptomatology in relation to a comparably aged reference group.

Two factors may limit the generality of the present findings. First, although the construct validity of the Conduct, Anxiety-Withdrawal, and Distractibility- Hyperactivity scores was assured by selecting the most salient items from pre- vious factor analysis studies, the criterion and discriminant validities of these scores is unknown. Second, the present study used children from regular classes who had no formally diagnosed psychopathology. The stability of ratings for diagnosed children may be somewhat different.

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