Psychiatry and Clinical Neurosciences 2014; 68:

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1 Psychitry nd Clinicl Neurosciences 214; 68: doi:1.1111/pcn Regulr Article Relibility nd vlidity of Brief Problem Monitor, n bbrevited form of the Child Behvior Checklist Brin J. Piper, PhD, 1,2 * Hilry M. Gry, MS, 2,4 Jcob Rber, PhD 2,3 nd Meliss A. Birkett, PhD 5 1 Deprtment of Bsic Phrmceuticl Sciences, Husson University, Mine, 2 Deprtment of Behviorl Neuroscience, 3 Deprtments of Neurology & Rdition Medicine, Oregon Helth nd Science University, 4 Deprtment of Counselor Eduction, Portlnd Stte University, Oregon, nd 5 Deprtment of Psychology, Northern Arizon University, Arizon, USA Aim: The prent form of the 113-item Child Behvior Checklist (CBCL) is widely utilized by child psychitrists nd psychologists. This report exmines the relibility nd vlidity of recently developed bbrevited version of the CBCL, the Brief Problem Monitor (BPM). Methods: Cregivers (n = 567) completed the CBCL online nd the 19 BPM items were exmined seprtely. Results: Internl consistency of the BPM ws high (Cronbch s lph =.91) nd stisfctory for the Internlizing (.78), Externlizing (.86), nd Attention (.87) scles. High correltions between the CBCL nd BPM were identified for the totl score (r =.95) s well s the Internlizing (.86), Externlizing (.93), nd Attention (.97) scles. The BPM nd scles were sensitive nd identified significntly higher behviorl nd emotionl problems mong children whose cregiver reported psychitric dignosis of ttention-deficit hyperctivity disorder, bipolr disorder, depression, nxiety, developmentl disbilities, or utism spectrum disorders reltive to comprison group tht hd not been dignosed with these disorders. BPM rtings lso differed by the socioeconomic sttus nd eduction of the cregiver. Mothers with higher nnul incomes rted their children s hving 38.8% fewer totl problems (Cohen s d =.62) s well s 42.8% lower Internlizing (d =.53), 44.1% less Externlizing (d =.62), nd 3.9% decresed Attention (d =.39). A similr pttern ws evident for mternl eduction (d =.3.65). Conclusion: Overll, these findings provide strong psychometric support for the BPM, lthough the differences bsed on the chrcteristics of the prent indicte tht dditionl informtion from other sources (e.g., techers) should be obtined to complement prentl reports. Key words: dolescents, nxiety, children, relibility, vlidity. THE CHILD BEHAVIOR Checklist (CBCL) is cregiver-completed questionnire of child behviorl nd emotionl problems tht is stndrdized, objective, nd widely utilized by child psychitrists, peditricins, developmentl psychologists, nd other mentl helth professionls for clinicl nd reserch purposes. 1 The CBCL hs been revised since *Correspondence: Brin J. Piper, PhD, Deprtment of Bsic Phrmceuticl Sciences, One College Circle, Husson University, Bngor, ME 441, USA. Emil: psy391@gmil.com Received 26 August 213; revised 22 Februry 214; ccepted 11 April 214. its originl introduction by Thoms Achenbch, PhD, nd collegues nd there re vrious forms of the instrument vilble depending on the informtion source (prent, techer, nd self-report), lnguge of the respondent, nd child ge (preschool or school ge). The CBCL/6 18 prent-report hs high test retest relibility, internl consistency, criterion vlidity nd shows good greement between mternl nd pternl rtings. 2 6 The influence of differences in the socioeconomic environment for CBCL rtings is mtter of some contention. 3,7,8 Vrious investigtors re in generl greement tht children living in more economiclly disdvntged households re rted s 759

2 76 B. J. Piper et l. Psychitry nd Clinicl Neurosciences 214; 68: hving more problems but the mgnitude of this effect hs been reported s either modest 9 or, more commonly, s sizble One potentil concern with the CBCL/6 18 is its length. There re 113 problem items tht tke pproximtely 1 min to complete nd the optionl competence items require nother 5 1 min. The development of n bbrevited version of the CBCL offers severl dvntges. First, shorter form llows clinicins to more esily determine the potentil presence of behviorl nd emotionl problems. This could involve repeted mesurement of single child to ssess the utility of phrmcologicl or psychoeductionl intervention. Second, this instrument could provide non-specilists with screening tool to identify children nd dolescents for whom follow up with specilist is pproprite (e.g. for neurodevelopmentl disorder, schizophreni, bipolr disorder). Third, shortened version would be useful for investigtors interested in lerning bout individul difference in emotion nd behviorl functioning but who view the full-length form s prohibitively long within the context of multiple dt collection demnds (e.g. n epidemiologicl neurogenetics study). The Brief Problem Monitor (BPM) prent form ws introduced in 211 by Achenbch nd coworkers nd cn be completed in only 2 min s it consists of only 19 items (Appendix A) from the CBCL tht form scles for Internlizing, Externlizing, nd Attention. 13 The BPM is modifiction nd extension of the 12-item Brief Problem Checklist (BPC). 14 The six items tht form the Internlizing nd Externlizing scles of the BPC were identified vi ppliction of item response theory nd fctor nlysis to lrge rchivl CBCL dtset. Three-month test retest relibilities of the BPC when the instrument ws dministered in n interview formt were stisfctory (r =.73.82). An dvntge of the BPM over the BPC is tht the former contins dditionl items to ssess ttention. The prevlence of ttention-deficit hyperctivity disorder (ADHD, 5%) 15 is sufficiently high to wrrnt the ddition of the six dditionl items to the BPC for the BPM (Tble 2 of the report by Chorpit et l. 14 contins complete list of BPC items). The BPM 13 lso includes n dditionl Externlizing item on disobedience. Therefore, the objective of the present report ws to build nd expnd upon the erlier work nd exmine severl psychometric properties of the BPM, including internl consistency nd vlidity, similrities with the CBCL, nd lso to determine if there re ny individul differences ssocited with demogrphic vribles (e.g. eduction of the respondent). METHODS Procedures Reserch Electronic Dt Cpture (REDCp), version 1.3.9, web-bsed progrm for obtining online dtbses, which hs multiple sfegurds for protecting personl informtion, 16 dministered the nonymous survey. Flyers were posted throughout the Oregon Helth nd Science University (OHSU) nd Doernbecher Children s hospitls, the Portlnd, Oregon metro re, nd western Oregon nd western Wshington (e.g. coffee shops, lundromts, grocery stores). Links to the investigtion were plced on the community nd volunteer sections of Crigslist (crigslist.org) in the USA nd Cnd for 1 yer. The Institutionl Review Bords of OHSU nd Northern Arizon University pproved ll procedures, which were in ccordnce with the Declrtion of Helsinki. Mesures After completing n online consent to complete this investigtion, cregivers begn the survey, which took pproximtely 2 min to finish. Items on the first hlf (Appendix B) included mternl nd child demogrphics (ge, sex, ethnicity, eduction nd household income). Hs your child ever been dignosed with ny of the following? ws listed with 28 options, including common psychitric nd medicl conditions (e.g. ADHD, utism spectrum disorder [ASD], ttchment disorder, bipolr disorder, developmentl disorder, dibetes, schizophreni). Dt bout pternl chrcteristics were not obtined in this initil study due to desire to minimize the survey completion time for ech prticipnt. Informtion from items bout mternl drug use nd child outcomes is presented elsewhere. 17 The lst hlf of the survey consisted of the CBCL. Cregivers were instructed to rte over the pst hlf-yer whether n item (e.g. inttentive) ws not, somewht, or very true bout their child with scores of, 1, or 2 points. Dt nlysis All nlyses were completed in Systt, v 13. (Chicgo, IL, USA). Exclusionry criteri included omitting items bout the child ge nd sex; child ge

3 Psychitry nd Clinicl Neurosciences 214; 68: Brief Problem Monitor 761 (>18 or <6); nd not completing more thn one BPM item. Note tht lthough REDCp hs the cpbility to require responses, the only required item ws the consent in order to keep the procedures s similr s possible to trditionl (i.e. pper nd pencil) dministrtion. The 19 items tht mke up the BPM (Appendix A) were isolted nd scle scores clculted. Internl consistency of the BPM nd ech scle ws obtined using Cronbch s lph. A common stndrd for internl consistency is tht Cronbch s lph vlues should be greter thn Person product moment correltions (r) nd the proportion of vrince ccounted for (R 2 ) were clculted between the BPM nd CBCL s exmining the correltion between the full-length nd bbrevited instrument is common step in test development Respondents (n = 28) who selected the unknown/ prefer not to disclose option for the demogrphic item on nnul income were removed from subsequent income nlyses. As the demogrphic items focused on the birth mother (e.g. Wht is the highest level of schooling tht the biologicl mother completed?) nlyses of these vribles nd their correltions with the BPM were restricted to biologicl mother cregivers. Non-prmetric (χ 2 ) nlyses were conducted with BPM totl nd scle scores tht were ctegorized s high (T 5 65). A non-clinicl comprison group ws defined s children who hd not been dignosed with ADHD, depression, bipolr disorder, nxiety, including post-trumtic stress disorder (PTSD), n ASD, developmentl disbility, fetl lcohol syndrome, nd cerebrl plsy. Construct vlidity ws evluted by exmining with t-test if the generlly expected BPM elevtions were observed (e.g. Do children dignosed with ADHD, reltive to the comprison group, show significnt increses in ttention problems?). As online reserch studies in child psychitry re only grdully 17,23 becoming more widely utilized, the prevlence of comorbidities ws exmined to determine if this dtset showed the expected ptterns s hs been identified with other methodologies. 15 An lph of <.5 ws considered significnt lthough sttistics tht met more conservtive thresholds were noted. Group differences were lso expressed in terms of Cohen s d with.2 considered smll,.5 medium, nd.8 lrge effect sizes. RESULTS The vst mjority of cregivers completing the study (n = 567) were the biologicl mother (82.3%) followed by doptive/foster prents (1.9%), the biologicl fther (4.6%) or other fmily members (2.1%). Mny respondents were from the western USA (Oregon = 36.4%, Wshington = 13.%, Cliforni = 11.8%, Arizon = 3.8%, Idho = 2.5%) or other regions (Cnd = 4.5%, Texs = 3.6%, New York = 3.4%, Wisconsin = 2.3%). Among biologicl mother prticipnts, two-fifths hd been dignosed with depression (41.%), over one-qurter hd n nxiety disorder, including PTSD (26.6%) followed by bipolr disorder (7.5%), dibetes (6.4%), ADHD (4.7%), nd epilepsy (2.1%). The highest level of eduction completed by the mother ws high school or generl equivlency diplom for pproximtely one-qurter (26.3%) of the smple with three-fifths ttending or completing college (58.4%), nd the remining prticipnts (15.3%) hving grdute or professionl eduction. Annul household income ws bove $5 for lmost hlf (45.%) nd below $2 for one-sixth (17.7%) of cregivers. Hlf the children were femle (5.1%) with n verge ge of 11.5 ±.2 yers (6 9: 41.3%, 1 13: 29.5%, 14 18: 29.3%); primrily white (75.2%), Hispnic (7.6%), Africn Americn (2.8%), Ntive Americn (3.4%), or other (11.%) ethnicity. Children were ttending public school (83.2%), privte school (5.7%), n lterntive eduction progrm (4.4%), or were home-schooled (3.9%). An pprecible minority of children hd been dignosed with ADHD (17.4%) followed by nxiety (12.7%), depression (9.5%), n ttchment disorder (5.%), PTSD (4.4%), developmentl disbility (4.4%), ASD (4.1%), bipolr disorder (3.2%), fetl lcohol syndrome (1.6%), Tourette s syndrome (.9%), epilepsy (.7%), or cerebrl plsy (.5%). The internl consistency of the BPM ws quite stisfctory with Cronbch s α of.91 for ll items,.79 for Internlizing,.86 for Externlizing, nd.87 for the Attention Problems scles. The consistency of biologicl prents ws compred to doptive/foster prents nd found to be quite similr (Supporting Informtion Tble S1). There were lso no pprecible differences bsed on the sex or ge of the child (Supporting Informtion Tble S2). The correspondence between the BPM nd the CBCL ws excellent for the totl scores (R 2 (51) =.9), Internlizing (R 2 (565) =.74), Externlizing (R 2 (565) =.86), nd Attention Problems (R 2 (565) =.94) scles (Fig. 1). Tble 1 shows tht children nd dolescents with vriety of psychitric dignoses, including ADHD,

4 762 B. J. Piper et l. Psychitry nd Clinicl Neurosciences 214; 68: () 35 (b) 12.5 Brief Problem Monitor: Totl Brief Problem Monitor: Internlizing Child Behvior Checklist: Totl Child Behvior Checklist: Internlizing (c) 15 (d) 12.5 Brief Problem Monitor: Externlizing 1 5 Brief Problem Monitor: Attention Child Behvior Checklist: Externlizing Child Behvior Checklist: Attention Figure 1. Sctterplots with liner regression between the prent form of the full-length Child Behvior Checklist nd the bbrevited Brief Problem Monitor items for the () totl (r(51) =.95, P <.5), (b) Internlizing (r(547) =.87, P <.5), (c) Externlizing (r(547) =.93, P <.5), nd (d) Attention Problems (r(555) =.97, P <.5) scles. mood disorders, ttchment disorder, or n ASD hd totl BPM tht ws t lest doubled reltive to non-dignosed comprison group. Cregivers of ADHD children reported three-fold increse in Attention problems. Internlizing problems were similrly more common mong children with depression (3.6-fold) or n nxiety disorder (3.2- fold). Children with bipolr disorder hd substntil increses in Externlizing (3.6 fold), Internlizing (3.4 fold), nd Attention (3.2 fold) problems.

5 Psychitry nd Clinicl Neurosciences 214; 68: Brief Problem Monitor 763 Tble 1. Brief Problem Monitor totl nd scle scores mong children dignosed with ADHD, depression, n nxiety disorder (including PTSD, n = 25), bipolr disorder, n ttchment disorder, developmentl disorder, n ASD (including utism n = 14), or speech dely Comprison ADHD Depression Anxiety Bipolr AD DD ASD Speech dely n = 384 n = 76 n = 54 n = 82 n = 18 n = 28 n = 25 n = 23 n = 44 Totl 6.5 (.3) 16.7 (.7) CC 17.6 (1.) CC 16.6 (.9) CC 22.1 (1.4) CC 17.8 (1.5) CC 17.1 (1.6) CC 14.5 (1.6) CC 13.5 (1.2) CC Internlizing 1.5 (.1) 2.9 (.3) CC 5.4 (.4) CC 4.8 (.3) CC 5.1 (.7) CC 3.9 (.5) CC 3.8 (.6) CC 3.5 (.6) C 2.6 (.4) C Externlizing 2.5 (.1) 6. (.4) CC 6.2 (.5) CC 5.7 (.5) CC 9.2 (.9) CC 7. (.8) CC 6.1 (.7) CC 4.6 (.7) C 4.5 (.5) C Attention 2.5 (.1) 7.8 (.3) CC 6.1 (.5) CC 6.1 (.4) CC 7.9 (.6) CC 6.8 (.6) CC 7.1 (.8) CC 6.4 (.7) CC 6.4 (.6) CC C P <.5 or CC P.5 t-test versus the comprison group. AD, ttchment disorder; ADHD, ttention-deficit hyperctivity disorder; ASD, utism spectrum disorder; DD, developmentl disorder; PTSD, post-trumtic stress disorder; Further nlyses reveled the nticipted high comorbidities with over one-qurter of the ADHD group lso dignosed with depression (28.9%) nd lmost hlf hving n nxiety disorder (47.4%). The mjority of the children with bipolr lso hd ADHD (61.1%) or n nxiety disorder (55.6%). Two-thirds of children with depression (66.7%) lso hd n nxiety disorder. Three-qurters with n ttchment disorder hd n nxiety disorder nd over hlf lso hd depression (53.6%) or ADHD (53.6%). Less thn one-third of offspring with speech dely lso hd developmentl disbility (29.5%), ADHD (27.3%) or n nxiety disorder (22.7%) nd pproximtely only one-tenth hd n ASD (13.6%) or depression (9.1%). Finlly, nlyses were conducted to determine if demogrphic vribles contributed to scores on the BPM. Among biologicl mothers, those with college eduction reported 2.5% fewer Externlizing problems in their progeny reltive to those with highschool eduction (t(391) = 2.28, P <.5, d =.24) but only 15.5% fewer totl problems (t(24.4) = 1.85, P =.66). Mothers with professionl or grdute eduction lso relted 43.2% fewer totl problems (t(189.2) = 4.56, P.5, d =.64), 3.% reduction in Internlizing problems (t(191) = 1.98, P <.5, d =.3), 48.7% fewer Externlizing problems (t(188.7) = 4.6, P <.5, d =.65), nd 45.5% fewer Attention problems (t(188.6) = 2.56, P.5, d =.6) thn women with high-school eduction. Biologicl mothers with professionl/grdute eduction, s compred with respondents with college eduction, lso rted their children s hving significntly fewer totl problems (t(143.3) = 3.76, P.5, d =.46), Externlizing problems (t(147.3) = 3.37, P.1, d =.41), nd Attention problems (t(151.) = 3.96, P.5, d =.47, Fig. 2). Similr to the pttern of findings for eduction, biologicl mothers with higher household nnul income ( $2 49 9/yer) rted their offspring s hving 22.5% fewer totl problems (t(242) = 2.67, P <.1, d =.4), 3.% fewer Internlizing problems (t(242) = 2.63, P <.1, d =.35), nd 24.% decrese in Externlizing problems (t(242) = 2.46, P <.5, d =.33) reltive to mothers with lower incomes (<$2 /yer). Children with biologicl mothers with even higher incomes (>$5 /yer) hd 38.8% decrese on the BPM totl (t(274) = 4.84, P.5, d =.62), s well s 42.8% reduction for Internlizing (t(274) = 4.23, P <.5, d =.53), 44.1% decrese for Externlizing (t(274) = 4.83, P.5, d =.62), nd 3.9% reduction for Attention (t(274) = 3.3, P <.5, d =.39, Fig. 2b). The contribution of eduction nd fmily income to BPM rtings ws lso identified mong respondents with (Supporting Informtion Fig. S1), nd without (Supporting Informtion Fig. S2), mjor mentl illness. Supporting Informtion Tble S3 shows very similr pttern for eduction nd income when the dt were expressed s the percent of children tht scored bove the clinicl cut-off (T 5 65). No pprecible BPM differences were noted bsed on the ethnicity of the respondent (dt not shown) or the child (Supporting Informtion Tble S4). DISCUSSION The CBCL hs been extensively utilized s clinicl nd reserch instrument for wide vriety of psychitric, neurologicl, nd other medicl conditions, including brin dmge, oppositionl disorder, cncer, cystic fibrosis, Prder Willi syndrome, led

6 764 B. J. Piper et l. Psychitry nd Clinicl Neurosciences 214; 68: Problems (% of High-School) Problems (% of <2) () Eduction b (b) Annul income toxicity, HIV, nd epilepsy. 1 Instruments like the CBCL re importnt becuse of the incresed recognition of the mny disorders where symptom expression my occur prior to dulthood. This includes not only ADHD, ASD, conduct disorder, nd lerning disbilities but lso some nxiety disorders, bipolr I disorder, nd prnoid personlity disorder. 15,24 One limittion is tht the prent form of the CBCL consists of 113 items, including one item with severl prts, nd my require t lest 1 min to complete. Totl Internlizing Externlizing Attention b Totl Internlizing Externlizing Attention Figure 2. () Brief Problem Monitor (BPM) totl nd scle scores by eduction of the biologicl mother expressed s percentge of the high-school group (totl = 9.9, SEM =.7; Internlizing = 2.3, SEM =.2; Externlizing = 3.8, SEM =.3; Attention = 3.8, SEM =.3). P <.5 versus high-school, b P <.5 versus college., High-school;, college;, professionl. (b) BPM by current nnul income (in thousnds) expressed s percentge of the <$2 /yer group (totl = 11.2, SEM =.8; Internlizing = 2.9, SEM =.3; Externlizing = 4.3, SEM =.3; Attention = 4.1, SEM =.4). c P <.5 t-test versus <$2 /yer, d P <.5 t-test versus $2 49 /yer., <$2 /yer;, $2 49 /yer;, >$5 /yer. b b b This report shows tht the BPM (Appendix A), despite being only one-sixth s long s the originl, hs excellent psychometric properties, including good internl consistency nd high correltions with the full-length CBCL. This includes the bility to differentite children with vrious psychitric dignoses. These findings indicte tht the short form s composite nd scles re mesuring substntively the sme constructs s the CBCL. The BPM, like the CBCL, 1 will likely be of substntil use in pplied nd experimentl environments for use with children nd dolescents with ADHD, nxiety, depression, s well s mny other neurobehviorl conditions. It is rther interesting tht the BPM totl s well s the Internlizing, Externlizing, nd Attention scles were significntly elevted mong children nd dolescents with wide rry of conditions, including bipolr disorder, n ttchment disorder, developmentl disbilities or n ASD, reltive to comprison group without these disorders. This pttern of results suggests tht the BPM my hve very good sensitivity. The pronounced increse in Externlizing mong the children with bipolr, in ttention problems in ADHD children, nd in Internlizing mong the nxious nd depressed groups is consistent with predictions. Further, prior reserch with children with lnguge development disorders show brod CBCL increses, 25 which is congruent with the present findings with speech dely. However, dditionl study with children with fewer comorbid conditions will be informtive in determining the specificity of the BPM s specificity ws limited in this investigtion. Although the finding tht mternl chrcteristics contribute to BPM rtings ws not unnticipted, 26 we were surprised by the mgnitude of this effect. The effect size ws t lest moderte (d.6) for mternl eduction nd nnul income for the BPM totl nd low to moderte (d =.3 to.64) for ech scle. As hs been noted by others, 7 one might resonbly infer from reding the originl CBCL mnul tht the contribution of socioeconomic sttus (SES) to prentl rtings is smll or even trivil. Achenbch nd Rescorl 6 very briefly note tht 23 CBCL items do show higher scores for lower SES children but lso tht the proportion of vrince uniquely ccounted for by SES for ech item ws rther smll. In contrst, investigtors tht hve used the CBCL with disdvntged urbn smple discovered tht over onequrter of low-ses children scored in the clinicl/ borderline rnge. 11 Similrly, difference of.7 SD in the CBCL totl score between offspring of Dutch

7 Psychitry nd Clinicl Neurosciences 214; 68: Brief Problem Monitor 765 prents with high nd low eduction (d =.61) ws observed with only slightly smller effect size (d =.54) for prentl occuptionl sttus. 1 One cvet with the CBCL, which lso likely pplies to the BPM, is tht mentl helth of the respondent my be ssocited with elevted prentl rtings of their children. Mothers who were nxious nd depressed were four times more likely to hve children with CBCL problems. 27 The greement mong different informnts bout the child s behvior in different circumstnces (e.g. prent vs child vs techer) is often only moderte t best. 5,18 We would like to re-emphsize tht the BPM is only one source of informtion which, given the sizble group differences depicted in Figure 2, should be complemented, whenever possible, with further dt from techers nd the child. 28 An erlier effort to develop short form of the CBCL, the BPC, 14 forms crucil foundtion for the present study but couple of methodologicl differences should lso be highlighted. The BPC consists of the six Internlizing nd six Externlizing items tht re lso contined in the BPM but does not contin the ttention items. The BPM, but not the BPC, is currently supported by the Achenbch System of Empiriclly Bsed Assessment, becuse interventions often trget problems with inttention nd overctivity 13 nd dditionl focus on tht domin ws wrrnted. Therefore, there is much greter likelihood tht the BPM will become the stndrd bbrevited form of the CBCL. The mode of dministrtion lso differed between investigtions with Chorpit nd collegues using fce-to-fce interviews 14 while this study employed online delivery. Electronic survey dministrtion is potentilly dvntgeous over more trditionl (i.e. pper nd pencil) methods in tht clcultion of scled scores cn be utomted nd prticipnts tht might be difficult to interview (e.g. fmilies in rurl res) cn redily be included. Alterntively, possible disdvntge is tht respondents in their home environments might be unble to devote their undivided ttention to filling out the instrument or be less likely, once strted, to complete n online survey. For much more expnsive discussion of the pros nd cons of online dt-collection with convenience smples see Heiervng nd Goodmn. 29 As the Cronbch s lphs for the BPM totl nd scles were bove generlly ccepted guidelines 19 nd pproximtely equivlent to the Brief Problem Checklist (.5 higher for Externlizing but.5 lower for Internlizing), 14 these results imply tht cregivers cn provide dt tht re t lest s internlly consistent s those obtined through other methods. These findings ttest to the mny dvntges of informtion gthered electroniclly, prticulrly for mteril of sensitive nture, reltive to other methodologies. 3 Three limittions nd future directions should lso be noted. First, lthough the smple ws modertely lrge nd contined substntil number of both respondents nd children with diverse psychitric conditions, the prticipnts were primrily mothers who were lso uncompensted volunteers (i.e. they were self-selected) from the western USA. The gol of this report ws to include respondents who would be similr to those tht will be completing the BPM in the future. Reltive to the US census, the present smple ws ethniclly diverse (24.9% non-white versus 22.1% from the census) but lso included disproportionte number of respondents from low- SES bckground. As the CBCL is currently vilble in over 9 lnguges, we nticipte tht mny dditionl studies will be forthcoming tht evlute lterntive forms of the BPM with smples from mny other countries. Second, this report relied on mternl reporting of whether children hd been dignosed with vrious psychitric disorders. This rises the possibility of under/over-reporting or misdignosis. Future studies could t lest prtilly ddress this concern by mking greter use of other informtion sources (fthers, grndprents, or techers) or by exmining medicl records to corroborte the prentl reports. Third, while this is the first study to exmine the psychometric properties of the BPM, further reserch is wrrnted. One potentil concern with evluting the criterion vlidity of the BPM with items extrcted from the CBCL is overlpping mesurement error, which could inflte the correltion. Unfortuntely, there is not single formul tht is uniformly ccepted to correct for this but, when formuls re pplied, 31 the mgnitude of reduction is reltively modest (.3). Nevertheless, the present findings in conjunction with prior dt using instruments with scles tht overlp with the BPM but with the CBCL dministered seprtely 14 ttest to the strong criterion vlidity of this mesure. Future objectives include evluting the test retest relibility of the BPM s well s compring results with those obtined with other behviorl screening questionnires. 32 Overll, these findings provide strong psychometric support for the prent form of the BPM. The BPM

8 766 B. J. Piper et l. Psychitry nd Clinicl Neurosciences 214; 68: offers relible nd vlid option when n bbrevited form of the CBCL is pproprite. ACKNOWLEDGMENTS This work ws supported by the Oregon Clinicl Trnsltionl Reserch Institute (UL1 RR2414), the Ntionl Institute of Environmentl Helth Sciences (T32 ES76-31A1), the Ntionl Institute of Drug Abuse (L3 DA ), nd the Husson School of Phrmcy. We would like to express our specil thnks to the reserch prticipnts. All uthors report no relevnt conflicts of interest. REFERENCES 1. Achenbch TM, Ruffle TM. The Child Behvior Checklist nd relted forms for ssessing behviorl/emotionl problems nd competencies. Peditr. Rev. 2; 21: Achenbch TM. The child behvior profile: I: Boys ged J. Consult. Clin. Psychol. 1978; 46: Achenbch TM, Edelbrock CS. The child behvior profile: II: Boys ged nd girls ged 6 11 nd J. Consult. Clin. Psychol. 1978; 47: Achenbch TM, Edelbrock CS. Behviorl problems nd competencies reported by prents of norml nd disturbed children ged four through sixteen. Monogr. Soc. Res. Child Dev. 1981; 46: Achenbch TM, McConughty SH, Howell CT. Child/ dolescent behviorl nd emotionl problems: Implictions of cross-informnt correltions for situtionl specificity. Psychol. Bull. 1987; 11: Achenbch TM, Rescorl LA. Mnul for the ASEBA School Age Forms nd Profiles. ASEBA, Burlington, Cuce AM. On norms nd cutoffs. J. Am. Acd. Child Adolesc. Psychitry 1995; 34: Xue Y, Leventhl T, Brooks-Gunn J, Erls FJ. Neighborhood residence nd mentl helth problems of 5- to 11-yer-olds. Arch. Gen. Psychitry 25; 62: Achenbch TM. Integrtive Guide for the 1991 CBCL/4-18, YSR, nd TRF Profiles. University of Vermont: University of Vermont Reserch Center for Children, Youth, nd Fmilies, Burlington, Klff AC, Kroes JSH, Hendriksen JGM et l. Neighbourhood level nd individul level SES effects on child problem behvior: A multilevel nlysis. J. Epidemiol. Community Helth 21; 55: Rdl M, Milgrom P, Cuce AM, Mncl L. Behvior problems in 5- to 11-yer old children from low-income fmilies. J. Am. Acd. Child Adolesc. Psychitry 1994; 33: Roussos A, Krntnos G, Richrdon C et l. Achenbch s Child Behvior Checklist nd Techer s Report form in normtive smple of Greek children 6 12 yers old. Eur. Child Adolesc. Psychitry 1999; 8: Achenbch TM, McConughy SH, Ivnov MY, Rescorl LA. Mnul for the ASEBA Brief Problem Monitor (BPM). University of Vermont: University of Vermont Reserch Center for Children, Youth, nd Fmilies, Burlington, Chorpit BF, Reise S, Weisz JR et l. Evlution of the Brief Problem Checklist: Child nd cregiver interviews to mesure clinicl progress. J. Consult. Clin. Psychol. 21; 78: Americn Psychitric Assocition. Dignostic nd Sttisticl Mnul of Mentl Disorders, 5th edn. Americn Psychitric Assocition, Arlington, Hrris PA, Tylor R, Thielke R, Gonzlez N, Conde JG. Reserch Electronic Dt Cpture (REDCp) metdtdriven methodology nd work-flow process for providing trnsltionl reserch informtics support. J. Biomed. Inform. 29; 42: Piper BJ, Gry HM, Birkett MA. Mternl smoking cesstion nd reduced cdemic nd behviorl problems in offspring. Drug Alcohol Depend. 212; 121: Nunnly J. Psychometric Theory. McGrw-Hill, New York, Biedermn J, Petty CR, Fried R et l. Utility of n bbrevited questionnire to identify individuls with ADHD t risk for functionl impirments. J. Psychitr. Res. 28; 42: Fox CF, Mueller ST, Gry HM, Rber J, Piper BJ. Evlution of short-form of the Berg Crd Sorting Test. PLoS ONE 213; 8: e LeJeune B, Beebe D, Noll J, Kenely L, Isquith P, Gioi G. Psychometric support for n bbrevited version of the Behvior Rting Inventory of Executive Function (BRIEF) prent form. Child Neuropsychol. 21; 16: Putnm SP, Rothbrt MK. Development of short nd very short forms of the Child Behvior Questionnire. J. Pers. Assess. 26; 87: Mrcell MM, Flls AL. Online dt collection with specil popultions over the World Wide Web. Downs Syndr. Res. Prct. 21; 7: Kessler RC, Berglund P, Demler O, Jin R, Merikngs KR, Wlters EE. Lifetime prevlence nd ge-of-onset of DSM-IV disorders in the Ntionl Comorbidity Survey Repliction. Arch. Gen. Psychitry 25; 62: Willinger U, Brunner E, Diendorfer-Rdner G, Sns J, Sirsch U, Eisenwort B. Behvior in children with lnguge development disorders. Cn. J. Psychitry 23; 48: Piper BJ, Corbett SM. Executive function in the offspring of women tht smoked during pregnncy. Nicotine Tob. Res. 212; 14: Njmn J, Willims GM, Nikles J et l. Mothers mentl illness nd child behvior problems: Cuse-effect ssocition or observtion bis? J. Am. Acd. Child Adolesc. Psychitry 2; 39:

9 Psychitry nd Clinicl Neurosciences 214; 68: Brief Problem Monitor Crowley SL, Worchel FF, Ash MJ. Self-report, peer-report, nd techer-report mesures of childhood depression: An nlysis by item. J. Pers. Assess. 1992; 59: Heiervng E, Goodmn R. Advntges nd limittions of web-bsed surveys: Evidence from child mentl helth survey. Soc. Psychitr. Epidemiol. 211; 46: vn Gelder MM, Bretveid RW, Roeleveid N. Web-bsed questionnires: The future in epidemiology? Am. J. Epidemiol. 21; 172: Kufmn AS. Should short-form vlidity coefficients be corrected? J. Consult. Clin. Psychol. 1977; 45: Goodmn R. The Strengths nd Difficulties Questionnire: A reserch note. J. Child Psychol. Psychitry 1997; 38: SUPPORTING INFORMATION Additionl Supporting Informtion my be found in the online version of this rticle t the publisher s web-site: Figure S1. (A) Brief Problem Monitor (BPM) totl nd scle scores by eduction mong biologicl mother respondents not dignosed with mjor mentl illness (n = 265) expressed s percentge of the high-school group (Totl = 7.5, SEM =.9; Internlizing = 1.8, SEM =.3; Externlizing = 2.7, SEM =.4; Attention = 3.1, SEM =.4). P <.5 versus high-school, b P <.5 versus college. (B) BPM by current nnul income (in thousnds) expressed s percentge of the <$2 /yer group (Totl = 1.7, SEM = 1.4; Internlizing = 2.5, SEM =.5; Externlizing = 3.9, SEM =.5; Attention = 4.3, SEM =.6). c P <.5 t-test versus <$2 /yer, d P <.5 t-test versus $2 49 /yer. Figure S2. (A) Brief Problem Monitor (BPM) totl nd scle scores by eduction mong biologicl mother respondents with dignosed mentl illness (n = 199), including depression (n = 191), bipolr (n = 35), schizophreni (n = 1), nd dissocitive identity disorder (n = 1) expressed s percentge of the high-school group (Totl = 12., SEM = 1.; Internlizing = 2.8, SEM =.3; Externlizing = 4.8, SEM =.5; Attention = 4.5, SEM =.4). P <.5 versus high-school, b P <.5 versus college. (B) BPM by current nnul income (in thousnds) expressed s percentge of the <$2 /yer group (Totl = 11.7, SEM = 1.; Internlizing = 3.1, SEM =.4; Externlizing = 4.6, SEM =.5; Attention = 4., SEM =.4). c P <.5 t-test versus <$2 /yer, d P <.5 t-test versus $2 49 / yer. Tble S1. Internl consistency of the Brief Problem Monitor nd scles for biologicl mothers (n = 466), biologicl fthers (n = 26), doptive (n = 54) nd foster (n = 8) prents. Tble S2. Internl consistency of the Brief Problem Monitor nd scles by sex nd ge (children = 6 11 yers, dolescents = yers). Tble S3. High (T 5 > 65) Brief Problem Monitor totl nd scle scores by eduction nd income (thousnds/yer) of the biologicl mother. H P <.5 or HH P <.5 versus high-school; C P <.5 versus college; L P <.5 or LL P <.5 versus incomes <$2 /yer; T P <.5 versus $2 49 /yer. Tble S4. Brief Problem Monitor totl nd scle scores (± SEM) by ethnicity of the child. High = T 5 score 65. Other includes Africn Americn, Asin, Ntive Hwiin, Pcific Islnder, Ntive Americn, Ntive Alskn, nd other. Appendix SA. Brief Problem Monitor Prent Form (BPM-P) for ges 6 18 yers. Appendix SB. Consent nd online questionnire, including mternl nd child demogrphic items.