Assessment of Childhood Depression: Correspondence of Child and Parent Ratings

Transcription

1 Assessment of Childhood Depression: Correspondence of Child and Parent Ratings ALAN E. KAZDIN, PH.D., NANCY H. FRENCH, R.N., M.S., ALAN S. UNIS, M.D., AND KAREN ESVELDT-DAWSON, M.A. The present investigation evaluated the correspondence of child and parental reports of the children s depression. One-hundred-four children (ages 5-13) hospitalized on a psychiatric intensive care service, 101 mothers, and 47 fathers independently completed several measures to assess severity and duration of the children s depression. To validate the depression instruments, measures of hopelessness and self-esteem (completed by the children) and somatic complaints and internalizing (completed by the parents) were also included. The results indicated that different measures of depression completed by the same rater (child, mother, or father) were highly intercorrelated. However, there was little or no relationship between mother-child and father-child reports of the children s depression for the same or different measures of depression. Children s ratings of depression were positively correlated with hopelessness and parent ratings of somatic complaints and negatively correlated with self-esteem. Children independently diagnosed as depressed (DSM-111) were higher in severity of depression than nondepressed children on child and parent completed measures. The implications of the present results for further evaluation of child self-report and factors that may contribute to correspondence with parental report are highlighted. Journal of the American Academy of Child Psychiatry, 22,2: ,1983. A critical step in the diagnosis and assessment of childhood disorders is obtaining information about the presence and severity of specific symptoms. Because children may not be capable of reporting on selected aspects of their functioning, child self-report is usually supplemented by information obtained from others such as parents or clinicians (Carlson and Cantwell, 1979; Orvaschel et al., 1981; Poznanski et al., 1979). Relatively high agreement has been found when children and parents provide factual information or report on the presence or absence of specific symptoms (Herjanic et d., 1975; Orvaschel et al., 1982). However, reporting on the severity and duration of symptoms may require more subtle discriminations on the part Dr. Kazdin is Professor of Child Psychiatry and Program and Research Director of the Children s Psychiatric Intensive Care Service (CPICS) at the Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine (3811 O Hara St., Pittsburgh, PA 15261), where reprints may be requested. Ms. French is Assistant Professor of Child Psychiatry and Associate Director of CPICS. Dr. Unis is Assistant Professor of Child Psychiatry and Medical Director of CPICS. Ms. Esveldt-Dawson is Research Associate of CPICS. This investigation was supported in part by a Research Scientist Development Award (1 KO2 MH00353) to the senior author from the National Institute of Mental Health and by a Clinical Research Center Study of Affective Disorders (5 P50 MH ) from the National Institute of Mental Health. The authors are grateful to Drs. Richard L. Cohen and David J. Kupfer for their comments on an earlier draft and to Sherry Wilson, R.N., M.S., and Rosanna B. Sherick, B. S., and the clinical-research team of the Children s Psychiatric Intensive Care Service /83/ $02.00/0. Copyright by the American Academy of Child Psychiatry. 157 of children than their presence or absence. Indeed, valid severity ratings of psychiatric impairment are often difficult to obtain from adults (Prusoff et al., 1972). Several self-report and interview assessment measures have recently emerged to assess the severity of childhood and adolescent depression (Kazdin, 1981; Kovacs, 1981). Measures often include questions regarding severity and duration of particular symptoms. Whether children are adept at reporting symptoms and their duration remains to be investigated. To date, few studies have examined the extent to which child self-report corresponds to parent report and other sources of data (e.g., peer or clinician reports). Discrepancies among alternative sources of information may present obstacles in reliably assessing childhood disorders. Current evidence suggests that parent or clinician views of the child s depression occasionally may be discrepant with those of the child (Cytryn et al., 1980; McKnew et al., 1979; Orvaschel et al., 1981; Robbins et al., 1979). In one of the few direct comparisons of child and parent reports of severity of depression, Weissman et al. (1980) administered the Children s Depression Inventory () and Center for Epidemiologic Studies- Depression Scale (CES-D) to children and the CES-D to mothers who rated their children s depression. The two measures of depression completed by the child were moderately correlated with each other but not correlated with the mothers reports on the CES-D.

2 158 KAZDIN ET AL. Also, mothers reports of their children s psychopathology and social adjustment correlated highly with each other but not with the children s reports. The discrepancies in child and parent reports need to be investigated further. To obtain a clear picture of the correspondence of child and parent reports, several of the same measures need to be given to each informant. That way, the correspondence or lack of correspondence can be separated from the influence of any single measure. The present investigation examined the correspondence of reports of inpatient children and their parents on several measures of childhood depression. Previous research was extended by including several measures of depression with a sample in inpatient children, by examining child and parent correspondence separately for severity and duration of depression, and by assessing both mother and father evaluations of child depression. Although several different self-report and interview measures of childhood depression have been identified, relatively little research exists on their validity (Kazdin, 1981). It is important to examine the interrelation of depression measures to each other and to measures of other constructs with which they would be expected to correlate (concurrent and convergent validity) and the extent to which various measures actually distinguish depressed and nondepressed children (criterion validity). Hence, a second purpose of the present investigation was to examine the validity of depression measures. In addition to a common set of measures completed by children and their parents, other measures were included to provide information about concurrent validity of the scales. Other measures of child functioning such as hopelessness, selfesteem, and somatic complaints were included because of their anticipated relationship to the diagnosis of depression. Method Children and Parents All children were patients at the Children s Psychiatric Intensive Care Service, an inpatient facility for acutely disturbed children ages 5-13, at Western Psychiatric Institute and Clinic. The unit houses 18 children at any one time. Children are admitted for an acute disorder or reaction including: highly aggressive and destructive behavior, suicidal or homicidal ideation or activity, an acute psychotic episode, or deteriorating family conditions where the family can no longer manage the child. Average patient stay is approximately 3 months. To be included in the project, children were required to have no evidence of neurologic impairment, acute confusional state, uncontrolled seizure disorder, or dementia. Children were also required to show a verbal or full scale WISC-R I& of 60 or above. One-hundred-four children (23 girls, 81 boys) participated. They ranged in age from 5 to 13 years (mean = 9.7 years) and WISC I& from 60 to 118 (mean = 89.6). Eighty-one children were white, 23 were nonwhite. Diagnoses of the children were based on DSM-I11 criteria. A diagnosis was based on direct interviews by a child psychiatrist with the children and their parents immediately prior to admission to the hospital. Preadmission interviews were supplemented with information obtained from a psychiatric evaluation after the child had been admitted. Diagnoses were reached without reference to or use of assessment devices included in the present investigation. Based on the above sources of information, two clinical interviewers independently completed the diagnoses. These staff were trained in the use of semistructured interviews with children and adults and in DSM-I11 criteria. Agreement on principal Axis 1 diagnosis was relatively high (77.5%). In cases of disagreements, the child was discussed to reach consensus on the appropriate diagnosis. The principal diagnoses included Major Depression (N = 15), Conduct Disorder (N = 36), Attention Deficit Disorder (N = 23), Anxiety Disorder (N = 5), Adjustment Disorder (N = 7), Psychoses (N = 8), and Other Mental Disorders (N = 10). To participate, children also were required to have at least one parent (biological, adoptive, step or foster parent) with whom they have lived who also agreed to complete the assessment. One-hundred-one mothers participated and ranged in age from 23 to 59 years (mean = 34.9 years) and included 82 white and 19 black mothers. Forty-seven fathers were also available and agreed to participate. The fathers ranged in age from 27 to 55 years (mean = 37.7 years) and included 40 white and 7 black fathers. The demographic profile of the parents who participated was as follows. The children s mothers included natural parents (N = 78), adoptive mothers (N = 4), stepmothers (N = 3) and foster mothers (N = 7), grandmothers (N = 6), other female relatives (N = a), or paramour (N = 1). The breakdown for fathers included biological fathers (N = 30), stepfathers (N = 9), foster fathers (N = 3), adoptive fathers (N = 4), and paramour (N = 1). Fifty-four of the mothers were married or living with someone; 47 were single, divorced, or widowed. Mothers social class, calculated by Hollingshead index of occupation, revealed the following breakdown: Classes V (8%), IV (60%), I11 (22%), I1 (lo%), and I (0%). As for income, 35 (35%) of the mothers were unemployed. Among those who were employed, estimated monthly income ranged from $500 to more than $2500 (mean = $771). Father s Hollingshead yielded the following breakdown: Classes V (14%), IV (43%), I11 (26%), I1 (lo%), and I (7%). Six

3 ASSESSMENT OF CHILDHOOD DEPRESSION 159 (13%) of the fathers were unemployed. Among those who were employed, monthly income ranged from $500 to more than $2500 (mean = $1107). Assessment Children, mothers and fathers, as available, were interviewed separately at preadmission at which point initial diagnostic information was obtained. This information was obtained before and independently of subsequent assessment for those measures included in this report. For purposes of assessment on the present measures, the child, mother and fat,her were interviewed separately by different assessors within the first week to 10 days of the child s admission to the hospital. For all measures, the focus was on the child s depression. Thus, child measures were rephrased when completed by the parents to clarify that the child s psychopathology was being rated. For the children, all measures were administered by reading the questions and response alternatives individually and recording the child s verbal response. Measures Administered to Both Child and Parent(s). The Children s Depression Inventory () was administered to children and their parents (KOvacs, 1981). The measure is patterned after the Beck Depression Inventory and includes 27 items which refer to affective, cognitive, and behavioral symptoms of depression. For each item, the child (or parent) selects one of three sentences (0 to 2-point scale) that best describes him or her over the past 2 weeks. Total scores range from 0 to 54, with higher scores reflecting more severe depression. The Bellevue Index of Depression (BID) is a semistructured interview for children or their parents (Petti, 1978). The measure included 26 items that pertain to symptoms of depression such as looking sad, crying easily, thinking about death, losing interest in activities, and others. Symptoms were rated separately on a 5-point scale for severity (1 = not at all, 5 = very much) and a %point scale for duration (1 = recent or new problem, 3 = always). Separate scores were evaluated for severity, duration, and total depression (sum of severity and duration ratings). The measure was included specifically to examine correspondence of parent and child ratings of these separate facets of depression. A Depression Symptom Checklist (DS-CL) was devised that included 10 major symptoms of depression embraced by DSM-I11 and by criteria utilized by Weinberg and his colleagues (Ling et al., 1970; Weinberg et al., 1973). The symptoms included dysphoric mood, feelings of worthlessness, sleep disturbances, changes in performance at school, decreased social interaction, loss of interest in activities, somatic complaints, and others. Within each symptom category, several alternative symptoms are presented. The symptom category is checked as positive if any of the constituent symptoms are evident. Scores on the measure ranged from 0 to 10 to reflect total number of depression symptoms. Measures Administered to Either the Child or Parent(s). Other measures were included to evaluate the validity of the childhood depression measures and were completed by either the children or their parents. Children completed a Hopelessness Scale which was derived from the scale used with adults (Beck et al., 1974). The measure has been shown to correlate significantly with depression on the Beck Depression Inventory for adults. The adult scale items were rephrased and pilot tested with inpatient children before their use in the present project. The final measure included 17 true-false items (e.g., I don t think I will have any real fun when I grow up. ). Children indicate if each item is true or not true for them. Although the direction of responding for an answer indicating hopelessness varies, the scale is scored so that the higher the score (0 to 17), the greater the hopelessness. The children also completed the Self-Esteem Inventory (Coopersmith, 1967) to provide a measure of self-concept and personal worth. The measure includes 58 items which children indicate are or are not like them. The Hopelessness Scale and Self-Esteem Inventory were included with the expectation that they would show positive and negative correlations, respectively, with other measures of depression. The children s parent(s) completed the Child Behavior Problem Checklist (CBCL) (Achenbach, 1978; Achenbach and Edelbrock, 1979). The measure includes 118 items scored on a 0 to 2-point scale to cover multiple symptom areas that have been derived through factor analyses separately by child age and gender groupings. Although several scales are included, for present purposes, specific scales were utilized that would help validate other measures of depression. Thus, three CBCL scales expected to correlate significantly with child depression measures included depression, somatic complaints, and internalizing. Preliminary Analyses Results To evaluate the influence of patient and demographic characteristics on depression scores, analyses of variance were completed for child age, gender, race, I&, and family Hollingshead classification. The results indicated no reliable differences in childhood depression among the different measures. Similarly, Pearson product-moment correlations indicated that child and family characteristics, with few exceptions noted below, were not significantly correlated with depression.

4 160 KAZDIN ET AL. The exceptions were a significant relationship between child age and DS-checklist performance (r = 0.20, p < 0.05), with older children scoring as slightly more depressed on the measure; a significant relationship between race and BID total depression (r = 0.24, p < 0.01), with nonwhites tending to score as less depressed than whites; and a significant relationship between I& and performance (r = -0.19, p < 0.05), with children of higher I& scoring slightly lower on the. The above correlations, while statistically significant, were low in magnitude and negligible in the amount of shared variance between the pertinent variables and depression measures. Test- Retest Depression Assessment To evaluate the stability of performance on the depression measures, a subsample of children (N = 37), mothers (N = 35), and fathers (N = 12) were retested 6 weeks after the initial testing. During the intervening period, the children remained in the hospital but continued contact with the parent(s) (e.g., parent visits to the hospital, occasional weekend home visits of the child). The test-retest correlations for each depression measure are presented in table 1 (in parentheses). With one exception, all of the correlations are in the moderate to high range, positive, and statistically sigmfkant. The exception is the father symptom checklist, where the correlation was positive but low and nonsignificant. The correlations convey the relative standing of children, mothers, and fathers on their respective measures from one testing occasion to the next. They do not address whether the scores changed significantly over time. To examine changes in severity of depression, repeated-measures analyses of variance were completed for each measure across raters (child, mother, father) and assessment occasion (test vs. retest). The analyses indicated that severity of depression decreased significantly over the 6-week test-retest interval on the [F(1,81) = 23.34, p < , and BID total depression [F(1,81) = 27.14, p < , an effect that approached significance on the DS checklist [F(1,81) = 3.44, p < A significant Rater x Occasion interaction was obtained only for the [F(2,81) = 8.36, p < which indicated that children, mothers, and fathers did not all change or change equally from one test occasion to another. Withingroup t tests for the indicated that mothers TABLE 1 Correlations Completed by Children and Their Parents for the Children's Depression Inventory (), Belleuue Index of Depression (BID), and the Depression Symptom Checklist (DS-CL) Children Mothers Fathers (N= 104) (N-101) (N=47) BID BID BID 0s-CL BID BID BID OS-CL CoI BID BID BID os-cl SEV DUR TGT SEV DUR TOT YV DUR TOT BID-SEV Children BID-DUR B 10-TOT DS-CL.(:. 50***).A(.66***) \.48***.92*** (.67***) \.50***.98***.97*** (.63***) \.32**.77***.El***. El*** (.47***)

5 ASSESSMENT OF CHILDHOOD DEPRESSION 161 showed a highly significant decrease in their ratings of the child s depression on the [t(34) = 7.82, p < Although children and fathers show some decrease over time in their ratings, these did not approach significance. Within-group t tests separately for each measure for children, mothers, and fathers indicated a general pattern in which mothers rated the child as significantly less depressed after the 6-week retest period on all measures. Although children and father scores decreased, none of the father s scores changed significantly. The children showed significant reductions in ratings of their depression with significant effects for two (BID total depression and DS checklist) of the three measures. In general, the test-retest data indicate that performance over time among raters tended to be significantly correlated. Nevertheless, within a 6-week period of hospitalization severity of the child s depression is rated lower, particularly on those measures completed by the mothers. Correspondence of Child and Parent Reports The initial question of interest is the extent to which parents and their children agree in identifying on the degree of the children s depression. Pearson productmoment correlations were computed between the depression measures completed by children and their parents. The correlation matrix (see Table 1) is presented in the format of a multitrait-multimethod matrix (Campbell and Fiske, 1959) to examine convergence of the same measures completed by different raters (child, mother, father) and convergence of the raters across different measures. The results indicate that different measures of the children s depression are consistently correlated within a particular rater (solid-line triangles). Thus, the child, mother, and father are quite consistent within their own ratings of the child s depression across several different measures. Although raters are internally consistent within their own appraisals of the child s depression, measures are not consistently correlated across children, mothers and fathers (see dashed-line triangles). Mother-child and father-child correlations tend to be low to moderate and generally not statistically significant. In contrast, the correlations between motherfather tend to be consistently significant and in the moderate range. A closer look at the correlations of particular measures is especially interesting. The diagonals in each of the dashed-line triangles reflect the convergence of the same measures sampled by different raters, often referred to as convergent validity. The conspicuous finding is the low correlations between parent and child scores for the same measures. For example, on the, mothers and fathers scores are not corre- lated with their children s scores (r = -0.03, r = 0.01, respectively), although mother-father scores are significantly correlated (r = 0.56, p < 0.001). For the BID total depression score, mother-child and fatherchild correlations are significant but low (r = 0.21, r 0.36, both p < 0.001). For the BID total depression score, mother-child and father-child correlations are significant but low (r = 0.21, r = 0.36, bothp < 0.05) with much higher agreement between mother-father scores (r = 0.66, p < 0.001). Correspondence between parents and children on the BID is not significantly different for severity or duration of symptoms. Finally, the DS checklist showed no relations between motherchild and father-child scores (r = 0.07, r = 0.09, respectively), but a significant relation between motherfather scores (r = 0.60, p < 0.001). Correlations with Other Measures Validity of the depression measures can be examined by looking at the relations among these measures with other instruments with which they would be expected to correlate. Table 2 presents correlations of the common set of depression measures across raters as well as measures of hopelessness and self-esteem (completed by the children) and checklist ratings of depression, somatic complaints, and internalizing on the CBCL (completed by the parents). As predicted, depression measures, completed by the child, correlated positively with hopelessness and negatively with the self-esteem. The highest correlations are for the hopelessness and self-esteem with the (r = 0.51, r = -0.49, respectively). Interestingly, the same depression measures completed by the mothers and fathers are not significantly correlated with the child s evaluation of hopelessness and self-esteem. These results again suggest that the source of information, in this case the child, accounts for the convergence among alternative measures. There are interesting exceptions where measures completed by mothers or fathers correlate with measures completed by the child. Mother and father ratings of somatic complaints on the CBCL consistently correlated with BID scores of duration, severity, and total depression as rated by the child (range of r = 0.19 to r = 0.43). Also, mother scores on the ratings of child somatic complaints correlated significantly with the symptom checklist completed by the child. However, even for somatic complaints, the correlations are slightly higher when the depression measures were completed by the same raters (mothers or fathers). Mother and father ratings of depression or internalizing scales of the CBCL were not significantly correlated with any of the depression measures completed by the child.

6 ~ 162 KAZDIN ET AL. TABLE 2 Correlations of Depression Measures by Different Raters with Hopelessness (HOPLS), Self-Esteem (SEI), and Selected Child Behavior Checklist ICBCLJ Scales Child Measures Mother CBCL Father CBCL Child BID-SEV BID-DUR BID-TOT DS-CL HOPLS SEI.51*** -.49***.35*** -.45***.37*** -.47***.37*** -.47*** Mother Father BID - S E V BID-DUR BID-TOT DS-CL BID - S E V BID - D U R BID-TOT DS-CL.79***.49***.75***.70***.53***.79***.53***.42***.57***.66***.51***.74***.67***.62***.69*** I I.52***.37**.46*** 1 I.49***.39**.48*** I I.30*.39**.30* '.45**.43**.45** 4.51***.41**.52***! c I.76***.54***.71***.75***.60***.8l***.47***.30*.57***.69***.52***.77***.67***.65***.73** Note: The solid-line rectangles include correlations for measures completed by the same rater. The dashed-line rectangles include correlations for measures completed by different raters. *p < 0.05, **p < 0.01, and ***p < Diagnosis and Performance on Depression Measures To examine the relationship between child diagnosis (DSM-111) and performance on measures completed by the children and their parents, children were grouped on the basis of whether they received a principal or secondary Axis I diagnosis of depression (major, minor, intermittent). As noted earlier, the diagnoses were reached independently of the measures included in the present investigation. Of the 104 children, 20 (19.2%) received a diagnosis of depression. Comparisdrns of depressed and nondepressed children on measures completed by the children, mothers, and fathers appear in table 3. Depressed children evaluated themselves as more depressed on all but one of the measures, although none of the differences attained statistical significance in analyses of variance. Children diagnosed as depressed were more depressed on all of the measures completed by the mothers; all but one of these attained statistical significance. Measures expected to be related to depression such as somatic complaints and internalizing scores from the mothers' CBCL also differentiated depressed and nondepressed children. Father ratings paralleled those of the mothers with all but one of the depression measures showing a significant difference between depressed and nondepressed children. Also, depressed children received higher ratings for somatic complaints and internalizing on father CBCL. These analyses suggest that parental ratings are consistent with diagnoses reached inde- TABLE 3 Differences between Children with and without Diagnosis of Depression (DSM-111) Children BID-Severity BID-Duration BID-Total Symptom Checklist Mothers BID-Severity BID-Duration BID-Total Symptom Checklist CBCL-Depression CBCL-Somatic Complaints CBCL-Internalizing Fathers BID-Severity BID-Duration BID-Total Symptom Checklist CBCL-Depression CBCL-Somatic Complaints CBCL-Internalizing Means Node- Depression pression (N = 20) in = 84) FValue *** 8.12** * 12.23*** 6.75** 12.37*** 6.75** 16.53*** 12.24** ** 17.41*** 9.90** 29.25*** 7.17** Note: Diagnoses reflect current episode. Depressed children include those with principal or secondary diagnosis of depression. *p < 0.05, **p < 0.01, and ***p <

7 ASSESSMENT OF CHILDHOOD DEPRESSION 163 pendently of performance on the assessment devices. The findings provide criterion validity for the depression measures by showing that they discriminate between a basic diagnostic delineation of the patients. Discussion The major findings of the present investigation are: (1) performance of children, mothers, and fathers on different measures designed to assess severity of the children s depression are relatively stable over time (test-retest); (2) different measures of depression completed by the same rater (children, mothers, or fathers) tend to correlate positively in the moderate to high range with each other; (3) however, the same or related measures completed by different raters generally do not correlate with each other; (4) mothers and fathers ratings of their children tend to be highly intercorrelated; and (5) measures of severity completed by either mothers or fathers tend to discriminate children independently diagnosed as suffering depression. The salient findings pertain to the lack of correspondence between child and parent reports of depression. As an exception, total depression on the BID yielded significant correlations between mother-child and father-child; however, the correlations were low indicating little shared variance. Related research with adults has also found low to moderate correlations between self-report and clinician ratings of depression (Carroll et al., 1973; Paykel et al., 1970). However, when clinician and self-report measures reflect similar item content, correspondence of the measures has been relatively high (Carroll et al., 1981). When child and parent measures fail to correspond, it is tempting to view one perspective as accurate and the other as inaccurate in reflecting the child s true degree of dysfunction. It is possible that children and parents may positively endorse different aspects of the children s dysfunction and, hence, both be partially accurate. Alternatively, it is possible that children are less likely than their parents to report symptoms of depression. This explanation is suggested by the fact that child scores for depression scales tended to be lower than the scores of their parents on the same measures (table 3). Similarly, Orvaschel et al. (1982) found that discrepancies between mothers and children on a semistructured interview (Kiddie-SADS) was accounted for primarily by the children failing to report symptoms. The present results are consistent with the view that children may underestimate their symptomatology, in this case severity rather than presence or absence of symptoms. Measures of severity completed by the parents reliably distinguished depressed from nondepressed children. Measures completed by the children were quite consistent with diagnostic criteria, Depressed children evinced higher scores than nondepressed children on each of the severity measures, although the differences failed to attain significance. Thus, child and parent ratings do not reflect qualitative differences across measures. Rather, measures completed by the parents simply delineate the differences of independently diagnosed depressed and nondepressed children more sharply than do measures completed by the children. The problem of self-report in failing to delineate diagnostic groups is not unique to the present investigation (Carroll et al., 1973). Recent studies have found that self-report depression measures do not invariably discriminate among adults (Myers and Weissman, 1980), adolescents (Chiles et al., 1980), or children (Yanchyshn and Robbins, 1980) who meet RDC for major depressive disorder. The present investigation provides validational evidence for different measures of childhood depression. Previous research has shown that children diagnosed as depressed score higher than nondepressed children on the, BID, Children s Affective Rating Scale, and Children s Depression Scale (Carlson and Cantwell, 1979; Kashani et al., 1981; Lang and Tisher, 1978; McKnew et al., 1979). The present findings are consistent with previous investigations but further suggest that the delineation is greater on parent rather than child measures of child dysfunction. On the other hand, the difference may in part be a function of the particular population included in the present investigation, insofar as it is feasible that inpatient children might report on their depression differently from outpatient samples utilized in the bulk of previous research. The present investigation also adds to existing information about the reliability of childhood depression measures. Relatively little attention has been given to test-retest reliability. Tisher and Lang (1982) found relatively high (r = 0.74) test-retest reliability for the Children s Depression Scale over a seven to 10-day period with a nonclinic sample. Similarly, Kovacs (1981) indicated moderately high test-retest reliability (r = 0.72) over a 1-month interval for the. Both of the above studies utilized a nonclinic sample. In the present investigation, test-retest reliability with an inpatient sample was found to be moderately high over a 6-week interval for both children and parents across different measures. However, over the course of hospitalization, severity of depression decreased significantly, especially for mother ratings of the child s depression. Further research on self-report of children and correspondence of child and parents reports is warranted. To begin with, the present study was limited to childhood depression. Child self-report and correspondence of child and parent report may vary as a function of

8 164 KAZDIN ET AL. the type of child psychopathology. Also, self-report and correspondence with parent reports may vary as a function of age and cognitive development of the child or the facet of symptomatology (affective, cognitive, behavioral) that is rated. Finally, parent characteristics may also influence reports of their children s psychopathology. Specifically parent psychopathology may influence the ability to report on aspects of their childrens dysfunction and affect correspondence of child-parent reports. In general, the relationship of child and parent perception of the child s dysfunction represents a topic in need of further research because of the importance of these alternative sources of information in assessing childhood disorders. References ACHENBACH, T. M. (1978), The child behavior profile: I. boys aged J. Consult. Clin. Physiol., 46: & EDELBROCK, C. S. (1979), The child behavior profile: 11. boys aged and girls aged 6-11 and J. Consult. Clin. Psychol., 47~ BECK, A. R., WEISSMAN, A., LESTER, D. & TREXLER, L. (1974), The measurement of pessimism: the hopelessness scale. J. Consult. Clin. Psychol., 42: CAMPBELL, D. T. & FISKE, D. (1959), Convergent and discriminant validation by the multitrait-multimethod matrix. Psychol. Bull., 56: CARLSON, G. A. & CANTWELL, D. P. (1979), A survey of depressive symptoms in a child and adolescent psychiatric population. This Journal, 18: CARROLL, B. J., FIELDING, J. M. & BLASHKI, T. G. (1973), Depression rating scales: a critical review. Arch. Gen. Psychiat., 28: FEINBERG, M., SMOUSE, P. E., RAWSON, S. G. & GREDEN, J. F. (1981), The Carroll rating scale for depression: I. Development, reliability and validation. Brit. J. Psychiat., 138: CHILES, J. A., MILLER, M. L. & Cox, G. B. (1980), Depression in an adolescent delinquent population. Arch. Gen. Psychiat., COOPERSMITH, S. (1967), The Antecedentsof Self-esteem. San Francisco: W. H. Freeman. CYTRYN, L., MCKNEW, D. H. & BUNNEY, W. E. (1980), Diagnosisof depression in children: a reassessment. Amer. J. Psychiat., 137: HERJANIC,B., HERJANIC, M., BROWN, F. & WHEATT, T. (1975), Are children reliable reporters? J. Abnorm. Child Psychiat., KASHANI, J. H., BARBERO, G. J. & BOLANDER, F. D. (1981), Depression in hospitalized pediatric patients. This Journal, KAZDIN, A. E. (1981), Assessment techniques for childhood depression: a critical appraisal. This Journal, KOVACS, M. (1981), Rating scales to assess depression in school aged children. Actu Paedopsychiat., LANG, M. & TISHER, M. (1978), Childrens Depression Scale. Victoria, Australia: Australian Council for Educational Research. LING, W., OFTEDOL, G. & WEINBERG, W. (1970), Depressive illness in childhood presenting as a severe headache. Amer. J. Dis. Child, MCKNEW, D. H., JR., CYTRYN, L., EFRON, A. M., GERSHONE, E. S. & BUNNEY, W. E. (1979), Offspring of patients with affective disorders. Brit. J. Psychiat., MYERS, J. K. & WEISSMAN, M. M. (1980), Use of a self-report symptom scale to detect depression in a community sample. Amer. J. Psychiat., 137: ORVASCHEL, H., WEISSMAN, M. M., PADIAN, N. & LOWE, T. L. (1981), Assessing psychopathology in children of psychiatrically disturbed parents: a pilot study. This Journal, PUIG-ANTICH, J., CHAMBERS, W. J., TABRIZI, M. A. & JOHN- SON, R. (1982), Retrospective assessment of child psychopathology with the Kiddie-SADS-E. This Journal, 21: PAYKEL, E. S., KLERMAN, G. L. & PRUSOFF, B. A. (1970), Treatment setting and clinical depression. Arch. Gen. Psychiat., PETTI, T. A. (1978) Depression in hospitalized child psychiatry patients: approaches to measuring depression. This Journal, 17~ POZNANSKI, E. O., COOK, S. C. &CARROLL, B. J. (1979), A depression rating scale for children. Pediatrics, 64: PRUSOFF, B. A., KLERMAN, G. L. & PAYKEL, E. S. (1972), Concordance between clinical assessment and patients self-report in depression. Arch. Gen. Psychiat., ROBBINS, D. R., ALESSI, N. W., COOK, S. C., POZNANSKI, E. 0. & YANCHYSHYN, G. W. (1979), The systematic assessment of depression in adolescent psychiatric inpatients. Paper presented at meeting of the American Academy of Child Psychiatry, Atlanta, Ga. (October). TISHER, M. & LANG, M. (1982), The children s depression scale: review and further developments. In: Childhood Depression, eds. D. P. Cantwell & G. A. Carlson, New York Spectrum (in press). WEINBERG, W. A., RUTMAN, J., SULLIVAN, L., PENICK, E. C. & DIETZ, S. G. (1973), Depression in children referred to an educational diagnostic center: diagnosis and treatment. Preliminary report. J. Pediat. 83: WEISSMAN, M. M., ORVASCHEL, H. & PADIAN, N. (1980), Children s symptom and social functioning self-report scales: comparison of mothers and children s reports. J. Neru. Ment. Dis., 168: YANCHSHYN, G. W. & ROBBINS, D. R. (1980), The assessment of depression in normal adolescents: a comparison study. Paper presented at meeting of the American Academy of Child Psychiatry, Chicago (October).