Child and adolescent patients may display mental health concerns within some contexts and not others (e.g., home vs. school). Thus, understanding the specific contexts in which patients display ...concerns may assist mental health professionals in tailoring treatments to patients' needs. Consequently, clinical assessments often include reports from multiple informants who vary in the contexts in which they observe patients' behavior (e.g., patients, parents, teachers). Previous meta-analyses indicate that informants' reports correlate at low-to-moderate magnitudes. However, is it valid to interpret low correspondence among reports as indicating that patients display concerns in some contexts and not others? We meta-analyzed 341 studies published between 1989 and 2014 that reported cross-informant correspondence estimates, and observed low-to-moderate correspondence (mean internalizing: r = .25; mean externalizing: r = .30; mean overall: r = .28). Informant pair, mental health domain, and measurement method moderated magnitudes of correspondence. These robust findings have informed the development of concepts for interpreting multi-informant assessments, allowing researchers to draw specific predictions about the incremental and construct validity of these assessments. In turn, we critically evaluated research on the incremental and construct validity of the multi-informant approach to clinical child and adolescent assessment. In so doing, we identify crucial gaps in knowledge for future research, and provide recommendations for "best practices" in using and interpreting multi-informant assessments in clinical work and research. This article has important implications for developing personalized approaches to clinical assessment, with the goal of informing techniques for tailoring treatments to target the specific contexts where patients display concerns.
To examine the use of implicit and explicit measures to predict adolescent nonsuicidal self-injury (NSSI) before, during, and after inpatient hospitalization.
Participants were 123 adolescent ...psychiatric inpatients who completed measures at hospital admission and discharge. The implicit measure (Self-Injury Implicit Association Test SI-IAT) and one of the explicit measures pertained to the NSSI method of cutting. Patients were interviewed at multiple time points at which they reported whether they had engaged in NSSI before their hospital stay, during their hospital stay, and within 3 months after discharge.
At baseline, SI-IAT scores differentiated past-year self-injurers and noninjurers (t121 = 4.02, p < .001, d = 0.73). These SI-IAT effects were stronger among patients who engaged in cutting (versus noncutting NSSI methods). Controlling for NSSI history and prospective risk factors, SI-IAT scores predicted patients' subsequent cutting behavior during their hospital stay (odds ratio (OR) = 8.19, CI = 1.56-42.98, p < .05). Patients' explicit self-report uniquely predicted hospital-based and postdischarge cutting, even after controlling for SI-IAT scores (ORs = 1.82-2.34, CIs = 1.25-3.87, p values <.01). Exploratory analyses revealed that in specific cases in which patients explicitly reported low likelihood of NSSI, SI-IAT scores still predicted hospital-based cutting.
The SI-IAT is an implicit measure that is outcome-specific, a short-term predictor above and beyond NSSI history, and potentially helpful in cases in which patients at risk for NSSI explicitly report that they would not do so in the future. Ultimately, both implicit and explicit measures can help to predict future incidents of cutting among adolescent inpatients.
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Objective
Suicide is a leading cause of death among adolescents, and suicidal thoughts represent key predictors to suicidal behavior. Yet, suicidal thoughts can be challenging to accurately assess. ...Symptoms that commonly co‐occur with suicidal thoughts, such as depressive symptoms, may provide valuable information for predicting these thoughts. Although clinicians commonly collect multi‐informant reports about adolescent depressive symptoms, these reports often yield discrepant findings as individual predictors of adolescents’ suicidal thoughts.
Method
We tested the ability of specific patterns of multi‐informant reports to predict adolescents’ suicidal thoughts. Ninety adolescent inpatients and their parents (i.e., “dyads”) reported on adolescent depressive symptoms, and adolescents completed self‐report assessments of suicidal thoughts at baseline and three‐month follow‐up.
Results
Dyads displayed variability in reporting patterns, and these patterns uniquely predicted suicidal thoughts. Adolescents reporting elevated depressive symptoms displayed increased concurrent suicidal thoughts relative to adolescents reporting subthreshold depressive symptoms, regardless of parent report. Yet, only adolescents who reported elevated depressive symptoms and whose parents reported subthreshold adolescent depressive symptoms displayed increased future suicidal thoughts.
Conclusions
Identifying patterns of multiple informants’ reports about adolescent depressive symptoms may improve the prediction of suicidal thoughts. These findings have important implications for assessing adolescents at risk for suicide.
Abstract Adolescent social anxiety (SA) assessments often include adolescent and parent reports, and low reporting correspondence results in uncertainties in clinical decision-making. Adolescents ...display SA within non-home contexts such as peer interactions. Yet, current methods for collecting peer reports raise confidentiality concerns, though adolescent SA assessments nonetheless would benefit from context-specific reports relevant to adolescent SA (i.e., interactions with unfamiliar peers). In a sample of 89 adolescents (30 Evaluation-Seeking; 59 Community Control), we collected SA reports from adolescents and their parents, and SA reports from unfamiliar peer confederates who interacted with adolescents during 20-minute mock social interactions. Adolescents and parents completed reports on trait measures of adolescent SA and related concerns (e.g., depressive symptoms), and adolescents completed self-reports of state arousal within mock social interactions. Adolescents’ SA reports correlated with reports on parallel measures from parents in the .30s and with peer confederates in the .40s to .50s, whereas reports from parent-confederate dyads correlated in the .07 to .22 range. Adolescent, parent, and peer confederate SA reports related to reports on trait measures of adolescent SA and depressive symptoms, and distinguished Evaluation-Seeking from Community Control Adolescents. Confederates’ SA reports incrementally predicted adolescents’ self-reported SA over and above parent reports, and vice versa, with combined R s ranging from .51 to .60. These combined R s approximate typical correspondence levels between informants who observe adolescents in the same context (e.g., mother-father). Adolescent and peer confederate (but not parent) SA reports predicted adolescents’ state arousal in social interactions. These findings have implications for clarifying patterns of reporting correspondence in clinical assessments of adolescent SA.
Fears of positive evaluation form important components of social anxiety. Researchers developed the Fear of Positive Evaluation Scale (FPES) to assess these fears. The FPES reliably and validly ...assesses fears of positive evaluation in undergraduates and adult social anxiety patients. However, it remains unclear if the FPES reliably and validly assesses these fears in clinic-referred adolescents. Further, implementing the FPES in clinical assessments of adolescents likely requires a multi-informant approach. Indeed, long lines of work indicate low cross-informant correspondence in reports of anxiety and anxiety-related constructs, and support the combined use of multiple informants’ reports (e.g., parents and adolescents). We examined the FPES in a clinic-referred sample of adolescents aged 14–17 years (
M
= 15.11; 20 females; 59.5 % African American). Thirty-seven parent-adolescent pairs completed the FPES, as well as reports of adolescent social anxiety, safety-seeking behaviors, and depressive symptoms. Both parent and adolescent reports on the FPES evidenced adequate levels of internal consistency. Further, when taking both parent and adolescent reports into consideration, the FPES significantly and positively related to measures of social anxiety and safety-seeking behaviors, over and above other widely used measures of adolescent social anxiety and depressive symptoms. The findings indicate that a multi-informant administration of the FPES yields internally consistent and valid estimates of fears of positive evaluation in a clinical sample of adolescents. These findings have important implications for properly assessing and treating social anxiety concerns in adolescents.
Youth who experience psychopathy display multiple impairments across interpersonal (grandiose-manipulative GM), affective (callous-unemotional CU), lifestyle (daring-impulsive DI), and potentially ...antisocial and behavioral features. Recently, it has been acknowledged that the inclusion of psychopathic features can offer valuable information in relation to the etiology of Conduct Disorder (CD). Yet, prior work largely focuses on the affective component of psychopathy, namely CU. This focus creates uncertainty in the literature on the incremental value of a multicomponent approach to understanding CD-linked domains. Consequently, researchers developed the Proposed Specifiers for Conduct Disorder (PSCD; Salekin & Hare, 2016) as a multicomponent approach to assess GM, CU, and DI features in combination with CD symptoms. The notion of considering the wider set of psychopathic features for CD specification requires testing whether multiple personality dimensions predict domain-relevant criterion outcomes above-and-beyond a CU-based approach. Thus, we tested the psychometric properties of parents' reports on the PSCD (PSCD-P) in a mixed clinical/community sample of 134 adolescents (M
= 14.49, 66.4% female). Confirmatory factor analyses resulted in a 19-item PSCD-P displaying acceptable reliability estimates and a bifactor solution consisting of GM, CU, DI, and CD factors. Findings supported the incremental validity of scores taken from the PSCD-P across multiple criterion variables, including (a) an established survey measure of parent-adolescent conflict; and (b) trained independent observers' ratings of adolescents' behavioral reactions to laboratory controlled tasks designed to simulate social interactions with unfamiliar peers. These findings have important implications for future research on the PSCD and links to adolescents' interpersonal functioning.
Clinical assessments of adolescent mental health often incorporate the perspectives of multiple caregivers (e.g., mothers and fathers). Caregiver reports tend to exhibit relatively high levels of ...correspondence versus other informant pairs such as caregivers and teachers. Yet, caregiver reports are not redundant with one another. Thus, researchers often apply strategies for integrating caregiver reports (e.g., composite score), assuming that greater convergence between caregivers on reports of high adolescent mental health concerns points to greater severity in such concerns. To our knowledge, this assumption has never been directly tested. We examined patterns of convergence and divergence between caregiver reports of adolescent mental health in a sample of 519 families from the National Institute of Child Health and Human Development’s Study of Early Child Care and Youth Development. Caregivers and adolescents completed reports of adolescent mental health, and independent coders rated levels of adolescent hostility displayed in separate caregiver–adolescent interactions (e.g., mother–adolescent vs. father–adolescent). We identified caregiver dyads that converged in their reports of relatively high levels of adolescent mental health concerns, as well as dyads that diverged in reports of such concerns. Relative to adolescents whose caregivers diverged in their reports of adolescent mental health, those adolescents with caregivers who converged on reports of relatively high adolescent mental health concerns both self-reported high levels of mental health concerns, and displayed greater levels of hostility within caregiver–adolescent interactions. Our findings have important implications for using convergence between caregiver reports of adolescent mental health concerns as an indicator of the severity of such concerns.
Social stressor tasks induce adolescents' social distress as indexed by low-cost psychophysiological methods. Unknown is how to incorporate these methods within clinical assessments. Having assessors ...judge graphical depictions of psychophysiological data may facilitate detections of data patterns that may be difficult to identify using judgments about numerical depictions of psychophysiological data. Specifically, the Chernoff Face method involves graphically representing data using features on the human face (eyes, nose, mouth, and face shape). This method capitalizes on humans' abilities to discern subtle variations in facial features. Using adolescent heart rate norms and Chernoff Faces, we illustrated a method for implementing psychophysiology within clinical assessments of adolescent social anxiety. Twenty-two clinic-referred adolescents completed a social anxiety self-report and provided psychophysiological data using wireless heart rate monitors during a social stressor task. We graphically represented participants' psychophysiological data and normative adolescent heart rates. For each participant, two undergraduate coders made comparative judgments between the dimensions (eyes, nose, mouth, and face shape) of two Chernoff Faces. One Chernoff Face represented a participant's heart rate within a context (baseline, speech preparation, or speech-giving). The second Chernoff Face represented normative heart rate data matched to the participant's age. Using Chernoff Faces, coders reliably and accurately identified contextual variation in participants' heart rate responses to social stress. Further, adolescents' self-reported social anxiety symptoms predicted Chernoff Face judgments, and judgments could be differentiated by social stress context. Our findings have important implications for implementing psychophysiology within clinical assessments of adolescent social anxiety.
Adolescents at a high-risk for experiencing social anxiety display elevated distress and social skills deficits in social interactions with unfamiliar peers. However, not all adolescents find the ...same interactions distressing, necessitating an approach that is sensitive to key aspects of the social contexts in which interactions manifest. Along these lines, socially anxious adolescents may display significant impairments within interactions with unfamiliar peers, and yet a core challenge in clinical assessment involves simulating social interactions with unfamiliar peers. Recent work suggests that one can construct cross-contextual interaction tasks using personnel trained to resemble unfamiliar same-age peers. This study examined the psychometric properties of independent observers’ ratings of adolescents’ social anxiety and social skills within these tasks. Eighty-nine adolescents (
M
= 14.50 years; 30 clinic-referred; 59 community control) and their parents completed reports of adolescent social anxiety on parallel surveys. Adolescents participated in a series of counterbalanced tasks with trained unfamiliar peer confederates. These tasks assessed adolescents’ reactions to interactions with unfamiliar peers within unstructured versus structured social contexts. Two trained observers independently completed behavioral ratings of adolescents using a well-established coding system, and peer confederates completed survey reports about social anxiety for the adolescents with whom they interacted. Observers’ ratings related to informants’ survey reports of adolescent social anxiety and social skills. Observers’ ratings distinguished adolescents on referral status. Observers rated adolescents’ social anxiety highest and social skills lowest during unstructured social contexts, relative to structured social contexts. These findings have important implications for constructing evidence-based, cross-contextual behavioral assessments of adolescents’ social anxiety.
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