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Posted January, 2013

International Epidemiology of Child and Adolescent Psychopathology: Findings for Diagnoses and Dimensions in Many Societies

Two related articles have presented findings pertaining to child and adolescent psychopathology assessed with standardized diagnostic interviews (SDIs) and dimensional rating instruments in many societies. The first article reviewed findings on the prevalence of disorders identified by SDIs in epidemiological samples of >300 children in >5 societies (Achenbach et al., 2012). The percentage of children qualifying for >1 diagnosis ranged from 1.8% in India to 50.6% in the U.S. The big difference in the prevalence of diagnosed disorders might suggest that psychopathology is very rare in India but very common in the U.S. However, other studies have yielded substantially higher prevalence in India and lower prevalence in the U.S. Because SDI studies have differed so much with respect to the diagnoses that were assessed, the informants (children and/or parents and/or teachers), and the methods for using informant data, these methodological differences preclude drawing firm conclusions about true differences in the prevalence of diagnosable disorders. Greater standardization of SDI procedures is therefore needed to achieve more accurate prevalence estimates.
The first article also reviewed findings from dimensional rating instruments used to assess children and adolescents in different societies. The data have been subjected to confirmatory factor analyses (CFAs) to test the generalizability of their dimensional models, and their scale scores have been statistically compared across societies. The five dimensions of the Strengths and Difficulties Questionnaire (SDQ) have been supported in some CFAs, but a 3-dimensional internalizing-externalizing-prosocial model has been supported in epidemiological samples. The few direct statistical comparisons of SDQ scale scores from multiple societies have yielded smaller differences than were found for diagnoses made from SDIs. However, the differences were large enough to argue for norms that take account of population differences.
The second article reported findings and clinical applications based on data from population samples assessed with the CBCL/6-18, TRF, and YSR in 44 societies (Rescorla et al., 2012). CFAs supported the CBCL/6-18 and YSR 8-syndrome model and the TRF 7-syndrome model plus 2 TRFAttention Problems subsyndromes (Inattention and Hyperactivity-Impulsivity) in all samples. Considerable consistency was also found in the problems that received relatively low, medium, or high ratings in the various societies. Statistical comparisons of scale scores showed great uniformity for age and gender effects across societies but enough differences between societies in the magnitude of problem scores to warrant separate norms for societies with relatively low, intermediate, or high problem scores. Clinical applications of the different sets of norms were illustrated.


Achenbach,T.M. et al. (2012) International epidemiology of child and adolescent psychopathology I: Diagnoses, dimensions, and conceptual issues. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 1261-1272.

Rescorla, L.A. et al. (2012). International epidemiology of child and adolescent psychopathology II: Integration and applications of dimensional findings from 44 societies. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 1273-1283.

Copyright © 2017 by Thomas Achenbach