screening for behaviour problems in nurseries: the...

/ Child Psychiat. Vol. 27, No. 1, pp. 7-32, 1986. 0021-9630/86 $3.00 + 0.00Printed in Great Britziin. Pergamon Press Ltd.

© 1986 Association for Child Psychology and Psychiatry.

SCREENING FOR BEHAVIOUR PROBLEMS IN NURSERIES:THE RELIABILITY AND VALIDITY OF THE

PRESCHOOL BEHAVIOUR CHECKLIST

JACQUELINE McGuiREand NAOMI RICHMAN

Institute of Child Health, Guilford Street, London WCl, U.K.

Abstract—The development of the Preschool Behaviour Checklist, for screening emotional andbehavioural problems in preschool children in group settings, is described. Inter-rater reliability andinternal consistency was established, and its validity was shown using a variety of methods. Theseinclude observations of the children, interviews with staff, comparison between clinic and nonclinicpopulations, factor and cluster analysis and comparison with another screening questionnaire. Usesof the PBCL for training and inservice work are outlined. The limitations of screening as a methodof identifying children with behaviour problems are discussed.

Keywords: Behaviour problems, preschool children, screening, nurseries

INTRODUCTION

THE MAIN aim of this study was to develop a screening instrument to be used by staffworking in group settings with preschool children, covering most aspects of emotionaldisturbance or behavioural problems, and to demonstrate its reliability and validitywith a sample including day nursery and nursery school attenders. To achieve thisit was decided that several types of validity should be examined, including differen-tiating between clinical and normal samples, between groups identified as havingproblems by an observer and by staff descriptions. A further aim was to comparefactor and cluster analysis.

There is a growing amount of knowledge about the prevalence of emotional andbehavioural problems of preschool children, based upon information given by theirparents (Bone, 1977; Chazan, Laing & Jackson, 1971; Earls, 1980; Jenkins, Bax &Hart, 1980; Richman, Stevenson & Graham, 1975, 1982). A sizeable proportion ofthis age group currently attend preschool facilities (Hughes, Mayall, Moss, Perry,Petrie & Pinkerton, 1980; Stevenson & Ellis, 1975), but less has been documentedabout their problems in group settings as judged by the adults who work with them.In addition, the question of whether attendance at a particular type of facility mightmDitate against or perhaps promote any particular difficulties has not been examinedin detail. The scale described in this paper was designed to be used to determinethe prevalence of behavioural and emotional difficulties exhibited by 2-5 year olds invarious nursery settings. It was also intended that the instrument should have somepractical relevance to the staff completing it, in terms of planning managementprogrammes for children with difficulties.

Accepted manuscript received 18 December 1984

8 J. McGUIRE AND N. RICHMAN

Prevalence rates of emotional and behavioural problems have been reported onthe basis of one or two questions to a head or teacher, asking whether any child has"emotional disturbance or social maladjustment" (Clark & Cheyne, 1979). However,more detail than this is preferable if prevention or management is to be planned.There are very few checklists available which were designed specifically to be usedwith staff in preschool facilities. Two have been validated in terms of their usefulnessas screening instruments in the U.S.A. but not in Britain (Behar & Stringfield,1974; Kohn & Rosman, 1975). Behar and Stringfield (1974) modified the teacherquestionnaire devised by Rutter (1967) producing a 30 item checklist suitablefor use with 3-6 year olds. For each behaviour described the rater ticks either'does not apply', 'applies sometimes' or 'frequently applies'. The Problem Checklist(Kohn & Rosman, 1973) is a similar, though much longer scale consisting of 50items which are rated as 'not at all typical', 'somewhat typical' or 'very typical'.

The Classroom Behaviour Inventory (15 7-point scales. Walker, 1973) was usedextensively in research concerning the Head Start programmes, but without havingbeen adequately validated (Walker, Bane & Bryk, 1973). A modified version hassubsequently been used in a British study (Ferri, Birchall, Gingell & Gipps, 1981),but the authors stress that they were using it to describe social behaviour within thenormal range rather than as a means of identifying children with problems. Roperand Hinde (1979) have also developed a social behaviour questionnaire consisting of39 items. This is also intended to be used to discriminate between children withinthe normal range rather than to screen for those with problems.

Although these scales were available it was decided that a new one would beuseful, for several reasons. An instrument was required which was short, easy tocomplete and which could be used not only as a screening instrument but also toprovide the basis of a working plan, for those children who did have problems. Toachieve these aims, the Preschool Behaviour Checklist (PBCL) was devised. Thisscale describes behaviours as specifically as possible, asking the rater to choosebetween several alternatives rather than saying how applicable one statement is to achild. In this way detail about frequency and severity of the behaviours can beincluded in the definitions. The number of items (22) is less than in most of the existingscales.

There is a wide range of different preschool facilities, staffed with adults whofrequently have quite dispEirate backgrounds in terms of experience and qualifications,and who perceive their roles quite differently (Gipps, 1982a), and we wished toexamine the applicability of our scale in different settings. It has been found in theU.S.A. that paraprofessioncd aides are more positive about children than teachers(Rickel, 1982) and that staff in low status jobs are more subjective about the qualitiesof the children in their care (Katz, 1971). In a British study it was found that theratings of verbal-social skills made by nursery nurses who worked in day nurserieswere positively correlated with their attitudes about the children, while this was notthe case for nursery nurses in schools, or for teachers (Gipps, 1982b). The nurserynurses in the day nurseries were also more likely to be what was described as 'tender-minded' about the children. For instance, they more often said that it was easy tolike all the children. It was hoped that a scale including more detail would be lesssusceptible to the effects of staff qualifications ot role.

SCREENING FOR BEHAVIOUR PROBLEMS IN NURSERIES 9

VALIDITY

Direct observations have not often been used to examine the validity of scaleswhich describe overall adjustment, though they have been used to validate measuresof specific behaviours such as overactivity (Campbell, Endman & Bernfeld, 1977),helping (Severy & Davies, 1971), prosocial behaviour (Weir & Duveen, 1981) andsocial competence (Connolly & Doyle, 1981). Close agreement has also been foundbetween teacher's ratings of general social behaviour and detailed observations(Hinde, Easton & Meller, 1984).

The range of behaviours included in the PBCL is fairly wide. To gather specificdata by observation on frequent acts (e.g. overactivity, disobedience, clinginess,social withdrawal from peers) and rare acts (e.g. wetting, aggression, tantrums) avariety of observational techniques would be necessary—time sampling at differenttimes of the day and incident recording. However, clinical judgement based uponunstructured observations made while spending several days with a group has beenfound effective when describing emotioned or social adjustment of children in aday-care setting (Braun & Caldwell, 1973). Clinical judgements have also beenuseful as a source of validity for a parent questionnaire covering behaviour problems(Earls, Jacobs, Goldfein, Silbert, Beardslee & Rivinus, 1982). It was thereforedecided that the criterion validity of the PBCL would be assessed not only by itsability to differentiate between a clinical and a normal group, but also by its abilityto differentiate between groups divided on the basis of clinical judgements derivedfrom observed behaviour.

If a checklist is to be meaningful to the staff using it, the children selected ashaving significant problems should coincide fairly close with the children who givethe staff concern, keeping in mind the possibility that the setting, role or qualificationsof the staff may influence the extent to which they see behaviour as problematic. Itwas decided therefore that interviews should be conducted with staff completing thePBCL to see whether verbal reports agreed with the questionnaire ratings. Agreementbetween the PBCL and the Preschool Behaviour Questionnaire (PBQ, Behar &Stringfield, 1974) which covers much of the same behaviour as the PBCL was alsoexamined.

Factor analysis is very frequently used to establish construct validity for behaviourratings (Behar & Stringfield, 1974; Fowler & Park, 1979; Kohn & Rosman, 1973;Trites & Laprade, 1983), although studies vary regarding the number of factors ordimensions which best describe the problems of preschool children. However, asPaykel (1981) points out, factor analysis generates dimensions along which behavioursgroup and is not ideal for studying how well individuals fit into psychiatric classi-fication systems. Cluster analysis (Everitt, 1974), which generates groups ofindividuals rather than behaviours, is therefore a potentially more effective test ofthe construct validity of a behaviour rating scale and has been used to study parentratings (Richman et al, 1982; Wolkind & Everitt, 1974). Comparisons between theclusters and factors described in these studies is complicated because of the variationsin content, e.g. some clusters include feeding, sleeping and wetting behaviours whichdo not feature in the factors derived from behaviour seen in nursery settings. Bycompleting both factor and cluster analysis on the same scale it should be possible


to see which method does produce the most meaningful results in terms of theirrelevance to current clinical classifications.

METHODDevelopment of the checklist

The questions were based in part on the Behaviour Screening Questionnaire (BSQ) (Richman &Graham, 1971), a 12-item scale which has been used in a large scale epidemiological study involvingparents of 3 and 4 year olds (Richman et al., 1982). For each behaviour several alternatives (usuallythree) are described, with quantitative details wherever possible. For instance, 'sometimes' wets thebed is defined as 'up to once or twice a week'. The items cover feeding, sleeping, soiling, activity,concentration, separation, tempers, management, fears, worries, relationships with other children andmood.

For the PBCL some of the items from the BSQ were excluded since the situations which theydescribed would not be encountered in most nursery situations, except for some day nursery children(e.g. bed-wetting, feeding problems, settling for sleep). Several new questions were added which wereparticularly relevant to behaviour in a group (e.g. social isolation, reluctance to talk to adults orchildren, aimless wandering, verbal or physical aggression to peers). The PBCL is given in full inAppendix B.

In a pilot exercise the initial! scale was completed by staff in a nursery school, a nursery class and aday nursery (A^= 140). Two checklists were completed per child in as many cases as possible. Followingdiscussion with the staff, the wording of some of the questions was ziltered and some questions wereomitted. In particular behaviour during separation from the parent was dropped since knowledge ofseparation differed a great deal, depending upon how the nursery was organised. Detail was addedto the descriptions in questions concerning concentration, miserable or tearful behaviour, attentionseeking, withdrawal from staff and temper tantrums. Some of the staff commented that they wereunlikely to know about all fears or habits but these questions were retained.

The final sceJe consists of 22 items, each scored 0, 1 or 2, giving a total possible score of 44. In all butfour questions the scoring is based on the choice between three alternatives. For activity a maximumscore is obtainable for either a high level of activity or for extreme inactivity. For habits the finalscore is based upon summing how many habits are occasional or frequent. The two questions con-cerning speech (reluctance to talk and unclear speech) have alternatives for the child who is not fluentin English, which receives no score. Unclear speech also takes into account whether or not speechconsists of more than single words.

Tlie cut-off pointDuring the pilot work previously mentioned with 140 children in nursery settings, the range and

distribution of scores on an earlier version of the scale were examined. The children were observedby the method described in the main study and rated as showing a definite, dubious or no problem bythe observer. Discussions were also held with the staff about which children they considered to showproblematic behaviour. The cut-off point was then selected as 12 since this included all childrenconsidered to have definite problems by staff and observer and few children without problems. It wasnoted that approximately 80% of those in the nursery school group fell below the assigned cut-off,which was in agreement with other studies of this age group in finding a prevalence of 15-20% ofbehaviour and emotional difficulties.

The sampleThe entire sample for the main study consisted of 187 children (90 girls, 97 boys), ranging in age

from 26 to 58 months (mean 48.5), and all living in an outer London borough. Ninety-one wereattending half day sessions in two nursery classes in infant schools, 51 were attending two council runnurseries and 45 were attending a children's centre combining a day nursery with a nursery class,based in a school (combined children's centre). The latter group was made up of 29 who were half daypupils entering via the education department and 16 who were admitted for a full day via the socialservice administration. The whole sample did not pzuticipate in all stages of the reliability and validity.During the presentation of results the sample characteristics will be described when they differ from thewhole group of 187.


ReliabilityThe reliability of the PBCL was examined in terms of inter-rater agreement and the scale's internal

consistency. The effect of the staff's qualifications upon inter-rater agreement was also examined. Inthose cases where a teacher and a nursey nurse both worked with the child the teacher was describedas rater 1 and the nursery nurse (or assistant) was rater 2. In the day nursery the nursery nursespecifically assigned to the child was rater 1 and rater 2 was one who was assigned to other children.For the day nursery group in the combined centre rater 2 was in some cases the officer in charge ratherthan a nursery nurse. Children in this centre were not assigned to specific members of staff. It was notpossible to do test-retest reliability because of staff work pressure but it is hoped to examine thissubsequently.

ValidityThe validity of the scale was assessed in a number of ways. Concurrent Vcilidity was examined by

comparing PBCL scores with ratings based upon observations of the children and upon interviews withthe staff. It was also studied by comparing PBCL scores with those obtained from an existing checklistfor nursery staff, the PBQ (Behar & Stringfield, 1974). Criterion validity was ascertained by com-paring a clinical sample with a normal nursery group. The construct validity was studied with factorand cluster analysis and the content validity was examined in terms of item analysis.

Details of the validity proceduresObservations. The children were observed over a minimum of 3 days, though the cimount of time needed

depended on the organisation of the nursery. For instance, in a day nursery where the family groupsspent a proportion of their day in separate rooms more time was needed to observe the entire groupthan was necessary for a larger nursery class who spent the whole session together. The childrenwere not asked to wear name tags since the procedure of learning each child's identity was a usefulstart to the observation procedure. The observer (JM) was mainly non-participatory with the childrenand talked only socially to the staff, but not about the children since their judgement was to be comparedwith the observer's. The PBCL's were distributed after the final day of observation with the requestthat they be completed as soon as possible.

On the first and second days the observer scanned the group throughout the day looking for behaviourscovered in the scale such as: physical aggression, verbal aggression, crying, aimless wandering andvacant staring, repetitive aimless play, following staff and/or asking to be held, interrupting duringgroup activities, receiving discipline and the manner of reacting to it, non-participation in groupactivities, wetting. Each incident was recorded with the identity of the child(ren) concerned. At theend of each day every child on the register was listed and all incidents involving them were writtenout from the notes. On the third and any subsequent days the children with the most entries wereobserved in more detail, with running descriptions made for approximately 10 min at a time. Finally,all the children were placed into one of the following four categories:1. No problem.2. Dubious—one or two behaviours which could be considered a problem but which may or may not

interfere with their ability to function in the nursery.3. Mild/moderate problem—behaviour which is likely to interfere with their ability to function in the

group and which is expected to concern the staff.4. Severe problem—behaviour which seriously interferes with the child's abUity to function in the

group.A reliability check on the categorisation system was completed in one nursery where two observers

were present (NR and JM). There was complete agreement about 27 of the 31 children rated (16 noproblem, 6 dubious, 3 mild/moderate, 2 severe). The four disagreements were all one point, 3 childrenrated as dubious by one observer and as no problem by the other and one child receiving ratings ofdubious and mild/moderate problems.

The mean PBCL scores of groups 1-4 were compared to see whether they were significantly differentfrom each other.

Interviews with the staff. Interviews with the staff were conducted soon after the observations and afterthe checklists had been completed. The interviewer (NR) was blind to the PBCL scores and had onlya list of names. In the case of the two day nurseries, where each person to be interviewed was responsible

, /12 J. McGUIRE AND N. RICHMAN

for only a small number of children, the name of each child in their group was on the list. For the largergroups in a nursery class the list was made up of the top and bottom thirds (PBCL scores) randomlymixed.

The interviews consisted of asking systematically about the behaviour, language and developmentof each child on the list in turn. The staff were asked whether they were concerned about the child and/orwhether they considered their behaviour to be a problem in any way, giving details where necessary.They were then asked to rank those identified as having problems and they were also asked (whereapplicable) whether they were concerned about any other children not on the list. On the basis of thisinformation the interviewer divided the children into the four categories described in the previoussection. The mean PBCL scores for the groups were compared to see whether they could be dis-tinguished, in the same way as the groups obtained by observation had been. In addition the observerratings were compared with the interview ratings, for the whole group and separately for nursery nursesand teachers.

Clinical group comparison. Ratings were obtained for a group of children attending a psychiatric daycentre at Great Ormond Street Hospital for Sick Children, for families of preschool children withemotional or behavioural problems. The mean score of this group was compared with the means of thewhole nursery sample, the school sample and the day nursery group.

Other behaviour checklist. In the combined centre and a day nursery, with a larger number of staff, twoscales were completed on each child, the PBCL and the PBQ (Behar & Stringfield, 1974). The scoreswere correlated and the numbers of children placed above or below the cut-off point on each werecompared using a cut-off of 17 on the PBQ.

Cluster and factor analysis. Ward's method of clustering was selected because in a previous study ofpreschool behaviour it was found to be the most effective (Wolkind & Everitt, 1974) and in order tocompare our results with those obtained from parental descriptions of children's behaviour (Richman,Stevenson & Graham, 1982). This method involves an 'agglomerative hierarchical technique', in whichat each stage individuals or groups which are the most alike are successively grouped together. Thusthe first step involves grouping together the two individuals from the whole sample who are most alike.The second step involves either grouping together another two individuals who are alike or addinganother individual to the first group of two, depending upon where the greatest similarity lies, andso on. At each step in the analysis the number of groups or individuals is reduced by one. Decisionsabout similarity are based on a correlation matrix of all behavioural items in all subjects, using theprogramme Clustan (Wishart, 1982).

Obviously grouping individuals blurs the differences between them and the loss of information thusproduced can be measured by the total sum of squared deviations of each individual from the meanof the cluster in which they are placed. By examining the loss of information it is possible to select thenumber of clusters which most satisfactorily describe the subjects under study.

The method of factor analysis used was orthogonal rotation of initial inferred factors (PA2 withVarimax rotation, see Nie et al., 1975). For the cluster and factor analyses item 18 (teasing) had to beomitted. Its definition had been changed during the study and only a reduced number of the samplehad been rated on the final version.

Item analysis

The ability of each individual item to discriminate between children described as having a problem,on the basis of observations, and those said to have no problems was examined. Grouping the childreninto those with a problem (dubious, mild/moderate or severe) and those without, the mean item scoresfor the two groups were compared using Student's t-test. Each item was also correlated with thetotal PBCL score, computing Pearson product-moment coefficients.

Age and sexThe mesm item scores were broken down by the sex of the child and by their age group (24-35,

36-47 and 48-59 months). One-way analyses of variance were calculated to show whether either ofthese independent variables influenced the item scores, demonstrated by the F-ratio (between groupsmean square/within groups mean square).


RESULTSReliability

Inter-rater agreement. The inter-rater agreement was examined by two staff memberscompleting checklists on each child in one nursery class, the combined centre andone day nursery (A == 108). The Pearson product-moment correlation coefficientbetween the scores given by raters 1 and 2 was 0.68 {P"^ 0.001), with no overalldifference between the mean scores (rater 1 = 6.8, rater 2 = 6.5;i = 0.77, paired ^test).The problem/no problem agreement between the two raters was 83% overall(Table 1). However, percentages inflate the actual agreement between raters sincechance agreements are not taken into account. By looking only at those thought to

TABLE 1. AGREEMENT BETWEEN RATERS IN ASSIGNING CHILDREN ABOVE OR BELOW THE CUT-OFF( > 11) (PERCENTAGES IN PARENTHESES)

(a) Whole reliability sample

Above

Below

RaterAbove

11(10)

5 (5)

2Below

13(12)

79 (73)

Total

24

84Rater 1

Total 16 92 108

Total agreement = 83% of cases.Sample: A = 108 (48 girls, 60 boys). Mean age 48.5 months (range 28-58).

(b) Agreement between teachers and nursery nurses/assistants

Rater 2Above Below Total

Above 4(6) 5 (7) 9Rater 1

Below 2(3) 57(84) 59

Total 6 62 68Total agreement = 90% of cases.Sample: iV= 68 (32 girls, 36 boys). Mean age 51.7 months (range 42-58).Rater 1 = teacher.Rater 2 = nursery nurse or assistant.

(c) Agreement between staff in a day nurseryRater 2

Above Below Total

Above 4(17) 7(30) 11Rater 1

Below 1 (4) 11(48) 12

Total 5 18 23Total agreement = 65% of cases.Sample: A = 23 (11 girls, 12 boys). Mean age 40.1 months (range 28-57).Rater 1 = nursery nurse assigned to child.Rater 2 = nursery nurse assigned to other children.


have a problem it can be seen that agreement about abnormality is not as close as theoverall figure would suggest. Of the 108 children rated by two staff members, 29 wereplaced above the cut-ofT point by at least one of them. Of these 29, there was totalagreement about their placement in the 'problem' category in only 11 cases (38%).Thus 18, almost two-thirds of those selected by one rater, would be considered a falsepositive according to the other staff member. Six of the 18 cases of disagreement couldbe considered minor (4 points or less) while two-thirds were more marked (5 or morepoints, up to 15). In these instances it is likely either that the perceptions ofabnormality held by raters differed greatly or one of them knew more about thechild's behaviour. In 7 of these 18 cases (39%) one of the scores was equal to thecut-off point of 12 with the other score lower. Altering the cut-off to 13 would haveeliminated these 7 disagreements but would have created one new one.

A cut-off point at 12 is probably most useful since for screening purposes it isdesirable to choose a cut-off which produces high sensitivity (i.e. few false negatives)at the risk of some loss of specificity (i.e. more false positives).

Role and qualifications. Since it has been found that nursery nurses and para-professional aides are more 'tender-minded' than teachers about the children intheir care (Gipps, 1982b; Katz, 1971; Rickel, 1982), their ratings were compared.There were 68 teacher/nursery nurse pairs of PBCL scores, from the combined centreand one nursery class. There was no significant difference between the means(teachers = 5.4; nursery nurses = 5.1; ^ = 0.65) and the ranking of children was verysimilar (r = 0.78, /»< 0.001). It must be noted, however, that very few of the childrenconcerned were above the cut-off (9 according to teachers, 6 according to nurserynurses). Looking at those children who were thought to have significant problemsby either rater (11, see Table Ib), more were rated as having a problem by theteacher only than by the nursery nurse or assistant only (5 vs 2), which is in accordancewith previous studies. Ratings of a larger group of children with problems is neededbefore conclusions can be drawn about differences between staff in terms of the effectsof qualifications or role upon their judgements of problem behaviour.

Nevertheless, despite the small numbers, the results from one day nursery areinteresting because they differ considerably from those obtained for the sample as awhole. The correlation coefficient between the two raters is lower (0.54, P < 0.01);rater l's mean score is significantly higher (rater 1 = 10.7; rater 2 = 8.3; / = 2.21,P < 0.05) and the problem/no problem agreement is only 65% with rater 1 placing 11above the cut-off and rater 2 only 5; agreement on abnormality occurring in 4 of 12cases (Table lc). In this nursery rater 1 is the nursery nurse specifically assigned tothe child and rater 2 is assigned to other children.

Reliability of items. The inter-rater agreement for each item is shown in Table 2. Allbut four of the items (whines, fights, withdrawn from staff, habits) have coefficientsabove 0.40 (range 0.23-0.81; mean 0.55). All but one (habits, P< 0.01) are sig-nificant at the P < 0.001 level. The lower agreement about whether a child whinedand was miserable or was withdrawn from staff suggest that some children may beclingy only to certain adults. The lack of agreement concerning fighting and habitsmay be related to idiosyncratic baselines being used or different interpretations ofbehaviour. Informal discussions with staff during the pilot work suggested that there


TABLE 2. CORRELATION BETWEEN ITEM SCORESGIVEN BY RATER 1 AND RATER 2

Item

123456789a9b9

10111213141516171819202122

Activity levelNot liked by others (peers)WetsSoilsPoor concentrationDifficult to manageAttention seekingSpeech not clearReluctance to speak—staffReluctance to speak—childrenTotal reluctance to speakTemper tantrumsNot sociable with peersWhinesSensitiveFightsAimlessInterferes with othersMiserableTeasingWithdrawn (staff)DestructiveFearfulHabits

Correlation

0.600.560.650.560.650.810.640.690.470.580.520.580.540.360.490.340.530.660.460.570.350.750.560.23

Correlations all significant: items 1-21, P< 0.001;item 22,/ '< 0.01.

Sample details as in Table la.Correlation = Pearson product-moment co-

efficient.

was some disagreement about which children were usually aggressive and which werejust playing or being boisterous. Table 3 shows that one point disagreements werecommon but two point disagreements were rare except for question 12 (whines andcomplains) and question 22 (habits).

Internal consistency. The internal consistency of the PBCL was found, using theSpearman-Brown split half (odd-even) formula, to be 0.83. Cronbach's 2dpha, ameasure of how closely each item is related to all the others and to the total, gave asimilar result of 0.83.

ValidityObservations. Observations were made of 163 children, in all the locations described

and the children were put into one of four categories, ranging from no problem toserious problem (see Appendix A for examples). For the purpose of analysis the'mild/moderate' and 'severe' groups were combined into a 'definite' problem category,since only three children were judged to have a severe problem. The mean scores onthe PBCL in the resulting three categories (no problem, dubious problem, definite


TABLE 3. INTER-RATER AGREEMENT AND NUMBERS OF ONE AND TWO POINT DISAGREEMENTS PER ITEM

(PERCENTAGES IN PARENTHESES)

123456789a9b9

10111213141516171819202122

Question

Activity levelNot liked by others (peers)WetsSoilsPoor concentrationDifficult to manageAttention seekingSpeech not clearReluctzince to speak—staffReluctzmce to speak—childrenTotal reluctance to speakTemper tantrumsNot sociable with peersWhinesSensitiveFightsAimlessInterferes with othersMiserableTeasingWithdrawn (staff)DestructiveFearfulHabits

Times 1 or2 assignedby either

4841108

7527564323212929484870393940243432302921

Agreement

(AO

221742

40162819657

11191236122021

6151015116

(%)

(46)(41)(40)(25)(53)(59)(50)(44)(26)(24)(24)(38)(40)(25)(51)(31)(51)(52)(25)(44)(31)(50)(38)(28)

One p>ointdisagreement

(AO

2422

66

3511272316152118272932251818171920151810

(%)

(50)(54)(60)(75)(47)(41)(48)(54)(70)(71)(72)(62)(56)(60)(46)(64)(46)(45)(71)(56)(63)(50)(62)(48)

Two pointdisagreement

(AO

220000111110272211102005

(%)

(4)(5)(0)(0)(0)(0)(2)(2)(4)(5)(3)(0)(4)

(15)(3)(5)(3)(3)(4)(0)(6)(0)(0)

(24)

Sample details as in Table la.

problem) were all significantly different (Table 4). Two thirds (16/24) of those ratedby the observer as having a definite problem were also identified by the PBCL. Thenumber of false negatives (8/24) is comparable with other checklists (Richman,1977). Ninety-six per cent of the no problem group {N = 105) have scores which arelower thzin 12 (mean = 4.2). The mean score for the 'dubious' group (9.1, A' = 34)falls just below the cut-off, as would be expected from their definition, while themean of the problem group is above it (13.0).

Interviews. Interviews with staff members were completed on 122 of the children inone school, two day nurseries and the combined centre and on the basis of theseinterviews the children were grouped as having no, dubious or a definite problem.The mean PBCL scores of these groups were compared and found to be significantlydifferent (Table 5). Fifty-four per cent of those rated as 'dubious' and 70% of the'definite problem' group have scores above the cut-off, giving a false negative ratevery similar to the observation results. In 113 cases ratings were available from bothobservations and interviews. There is fairly close agreement between them (Table 6).Ninety-two of the children (81%) are in the same category for both methods, theobserver agreeing with the interview rating in 90% (62) with no problem, 70% (16)of the 'dubious' group and 67% (14) of those with a definite problem. The Pearsoncorrelation coefficient between the observer and interview ratings is 0.83.


TABLE 4. DIFFERENCES BETWEEN PROBLEM GROUPS AS DEFINED BY OBSERVATION

Problem groupNo problem Dubious Definite

Characteristic (105) (34) (24)

Mean PBCL score 4.2Range of scores 0-15Stzmdard deviation 3.4Number above cut-off (% in parentheses) 4 (4)Number below cut-off (% in parentheses) 101 (96)

/between adjacent groups 5.8*** 3.2**

One-way ANOVA F=6l.O d.f. =2, 160 P< 0.0001

Sample: N= 163 (80 girls, 83 boya). Mean age = 49.1 months (range 26-58).***P< 0.001, **P<: 0.01.

9.11-184.7

12 (35)22(65)

13.03-224.5

16(67)8(33)

TABLE 5. DIFFERENCES BETWEEN PROBLEM GROUPS, AS DEFINED BY INTERVIEW

Problem groupNo problem Dubious Definite

Characteristic (73) (26) (23)

Mean PBCL scoreRange of scoresStandard deviationNumber above cut-off (% in parentheses)Number below cut-off (% in parentheses)

t between adjacent groups

One-way ANOVA F=59.5, df=2, 119, P < 0.0001

4.40-133.3

2 (2)71(98)

5

10.20-214.9

14(54)12(46)

.6*** 2.

13.76-224.4

14(70)7(30)

7**

Sample: / /= 122 (64 girls, 58 boys). Mean age = 47.3 months (range 26-58).***/»<: 0.001, *

TABLE 6. AGREEMENT BETWEEN OBSERVER JUDGEMENT AND STAFF INTERVIEWRATING

Observerjudgement

No problemDubiousDefinitePer cent observeragrees with interview

Total agreement in 92

No problem

6261

90

cases (81%),

StaffinterviewDubious

3164

70

underlined.

Definite

07

14

67

Sample: A^- 113 (60 girls, 53 boys). Mean age = 47.9 months (range 26-58).


Clinical group comparison. Scores on the PBCL differentiated significantly betweenchildren attending the psychiatric day centre (A' = 23) and the entire nursery sample{N= 187) ( = 4.5, P< 0.001; Table 7). The group attending nursery classes {N= 120including 'education' children in the combined centre) and the one made up of thoseattending day nurseries {N= 67 including children referred to the combined centrevia social services) were both significantly different from the psychiatric group(school group: ^ = 5.6, P < 0.001; day nursery group: / = 2.5, PK 0.01), and alsodifferent from each other ( = 6.1, P < 0.0001). The day nursery group had a meanscore close to the cut-off (9.8, S.D. = 5.4). This further supports the validity of thePBCL since the day nursery children in the borough concerned are selected forattendance on the basis of problems within the family concerning the child's behaviourand/or the parents' ability to cope with the child. Therefore one would expect moreof them to have behavioural or emotional difficulties.

TABLE 7. ABILITY OF THE PBCL TO

Psychiatric day centre (GOS)Total nursery sampleNursery class sampleDay nursery sample

Sample characteristucs:

GOSTotal nurseryNursery classDay nursery

DIFFERENTIATE BETWEEN CLINICAL

SAMPLES

N

2318712067

Girls

8905634

Mean

14.16.85.19.8

Boys

15976433

S.D.

7.55.24.35.4

Mean age(months)

43.548.551.842.5

AND NORMAL

^testvsGOSgp.

4.5***5.6***2.5**

Range

24-6226-5844-5826-58

t - Student's /-test with independent samples.

Relationship with an existing checklist. In one day nursery and the combined centre= 73) the staff completed the PBCL and the PBQ. The Pearson correlation

coefficient between the two scores is 0.89 (P< 0.001). Fourteen children (19%) wouldhave been categorised differently depending upon the scale used. Eight of thesewere identified as having problems on the PBCL and six on the PBQ(Table 8).

Cluster and factor analysis. In order that the results from the PBCL could be com-pared with the results obtained by previous cluster analysis studies (Richman et al.,1982; Wolkind & Everitt, 1974), the five cluster stage was examined. This was alsothe point subsequent to which the rate of loss of information began to rise moresharply (error coefficients: 6 clusters = 2.6, 5 clusters = 3.1, 4 clusters = 3.8, 3clusters = 4.8). The groups of individuals identified on the basis of the PBCL are insome ways similar to those which were described by Wolkind and Everitt (1974).They identified five clusters using a modified version of the BSQ (Richman &Graham, 1971), expanding the section on fearful or anxious behaviour. Wolkind


TABLE 8. RELATIONSHIP BETWEEN SCORE ON THE PBCL AND THE PRESCHOOLBEHAVIOUR QUESTIONNAIRE. NUMBERS OF CHILDREN ABOVE AND BELOW

THE CUT-OFF ON EACH SCALE (PERCENTAGES IN PARENTHESES)

Below cut-off (< 12)PBCL

Above cut-off (> 12)

Total

Correlation 0.89***Agreement = 81 % of cases

Below cut-off(<17)

44 (60)

8(11)

52

PBQAbove cut-off

(>17)

6 (8)

15(21)

21

Total

50

23

73

Sample: (38 girls, 35 boys). Mean age = 46.2 months (range 26-58).***P< 0.001.

and Everitt described three disturbed groups which they labelled an early conductdisorder (13% of the sample, with: bed-wetting, management problems, difficultywith relationships, tempers, fears and worries), an early neurotic disorder (6%,with: fears, habits, separation anxiety, dependency, worrying and bed-wetting)and an atypical, socially isolated cluster of children who had no opportunity tointeract with peers. A further 26% were described with developmental problems(sleeping or eating difficulties) and 50% were in a 'normal' cluster. Richmanet al. (1982) did not identify a neurotic cluster but a conduct/disturbed/night-wettinggroup (10%) was described.

Of the five clusters derived from PBCL ratings, two are definite problem groups,based upon their mean PBCL scores. Cluster 1 (conduct disorder with restlessness,14% of the sample) has a mean score of 12.7. The items on which they score mosthighly are poor concentration, interfering with the play of others, being destructive,aggressive, active and difficult to manage (Table 9). In the other cluster which has amean score above the cut-off (cluster 5, isolated and immature, mean = 13.4) thechildren (12% of the group) also have poor concentration but they are in additionvery sensitive, withdrawn from peers, not well liked, attention seeking and have somespeech problems. This cluster is somewhat similar to Wolkind and Everitt's earlyneurotic disorder and to Fowler and Park's (1979) anxious factor. Cluster 3 (nervousand lethargic) is a smaller group (4%) who are also withdrawn from peers andattention seeking, with some speech problems and a tendency to be aimless. Inaddition they are nearly all said to be very inactive. Cluster 4 (clingy and attentionseeking) has a mean below the cut-off (10.0) and the children are characterised bybeing sensitive, whiney and likely to demand a lot of attention from staff. All otheritems have low means, suggesting that their behaviour might be a specific reactionto the group situation. Their features correspond fairly well to the type of childdescribed by Jones (1980) as immature and dependent. The 'normal' cluster (cluster2), makes up 59% of the sample which is very comparable with the 50% found byWolkind and Everitt and with the observation ratings, which judged 64% (105 outof 163) to have no problems.


TABLE 9. CLUSTER ANALYSIS OF THE PBCL; six ITEMS IN EACH CLUSTER WITH THE HIGHEST MEANSCORES (>0.5)

Cluster

1(A^= 26)

2(A^-111)

3(A^=8)

4(A^- 19)

5(A^= 23)

Me2inPBCL score

12.7

3.2

10.9

10.0

13.4

Six items with highestmean scores

Poor concentrationInterferes, play of peersDestructiveActiveDifficult to manageFights, hits etc.

No items with a mean > 0.5

Not active enoughSpeech not clearNot sociable, peersAimless wanderingHabitsAttention seeking

SensitiveWhines, complainsAttention seeking(Remander of items < 0.5)

Poor concentrationSensitiveSpeech not clearNot sociable, peersAttention seekingNot liked

Meanitem score

1.61.31.21.21.00.9

2.61.00.90.90 90.9

1.51.31.0

1.31.21.11.10.90.7

Description

Conduct disorder withrestlessness

Normal group

Nervous and lethargic

Clingy and attention seeking

Isolated and immature

As a further check on the clinical usefulness of the clusters, the observation ratingsof the individuals in each were examined (Table 10). Eighty-seven per cent of thosein cluster 2 ('normals') received a 'no problem' rating, 11% were placed in the'dubious' category and only 2% were rated as having a definite problem. In contrast60% of cluster 4 (clingy and attention seeking), 67% of cluster 1 (conduct withrestlessness), 71 % of cluster 3 (nervous and lethargic) and 88% of cluster 5 (isolatedand immature) were said to have at least a dubious problem.

TABLE 10. NUMBERS IN EACH CLUSTER RATED AS HAVING PROBLEMS BY THEOBSERVER (PERCENTAGES IN PARENTHESES)

Cluster

12345

Total(N)

26111

81923

Numberobserved

24100

71517

Observer ratingNo problem

8(33)87 (87)2(29)6(40)2(12)

Dubious

7(29)11(11)1(14)6(40)9(53)

Definite

9(38)2 (2)4(57)3(20)6(35)


TABLE 11. PRESCHOOL BEHAVIOUR CHECKLIST ITEMS WITH HIGHEST LOADINGSON SIX ROTATED FACTORS

Item

ActiveNot likedWetsSoilsPoor concentrationDifficult to manageAttention seekingUnclear speechReluctant to talkTemper tantrumsWithdrawn/peersWhines and complainsSensitiveFights, etc.Aimless wanderingInterferes in playMiserableWithdrawn/staffDestructiveFearfulHabits

1

0.700.49

0.600.73

0.39

0.42

0.33

0.58

0.69

2

0.58

0.38

0.530.69

0.49

0.38

3

0.42

0.72

0.65

0.36

4

0.37

0.430.36

0.55

0.55

5

0.77

0.66

6

0.870.65

Varimax rotation of principal factors with iterations (selected on the basis ofeigenvalues > 1.0).

Loadings < 0.30 not included in the table.

Six factors were derived from factor analysis, on the basis of retaining initialfactors with eigen values of 1.0 or more. The first and largest factor is a combinationof management problems, destructive behaviour, restlessness and poor concentration,all of which have loadings of 0.60 or more (factor 1 'conduct/restless'. Table 11).The clear distinction between conduct problems and overactivity as identified byBehar and Stringfield (1974) is not evident. Some of the items loading onto factor 1are also present on other factors. In particular fighting loads very strongly (0.71) onfactor 3 ('aggressive') in combination with interfering in the play of others (0.65)and to a lesser extent whining to staff (0.42) and being destructive (0.36). Factor 2('emotional/miserable') loads highly on being sensitive, attention seeking, whining,miserable, prone to tempers and fearful. Factor 4 ('immature/isolated') is less clear-cut, with no loadings over 0.60. It includes aimless wandering, social isolation,unclear speech and poor concentration. Social isolation from peers and adults alsoload on to factor 5 ('socigJ withdrawal'). The final factor contains sphincter problems(factor 6). The presence of habits is the only item which does not load above 0.30on any of the factors.

A further factor analysis was completed, requesting only three factors, in orderto compare the results with those obtained by previous studies (Behar & Stringfield,1974; Fowler & Park, 1979; Kohn & Rosman, 1973). The first factor incorporatesconduct/restlessness/aggression (factor I, Table 12), factor II includes social isolation


TABLE 12. PRESCHOOL BEHAVIOUR CHECKLIST ITEMS WITH HIGHESTLOADINGS ON THREE ROTATED FACTORS

Item

ActiveNot likedPoor concentrationDifficult to manageAttention seekingUnclear speechReluctant to talkTemper tantrumsWithdrawn/peersWhines and complainsSensitiveFights, etc.Aimless wanderingInterferes in playMiserableWithdrawn/staffDestructiveFearful

IConduct/restless/

aggressive

0.660.440.600.77

0.35

0.35

0.36

0.59

0.77

0.76

II

Isolated/immature

0.340.38

0.430.71

0.65

0.51

0.56

III

Emotional/miserable

0.50

0.30

0.550.67

0.57

0.37

Varimax rotation of principal factors with iterations, three factorsolution requested.

Loadings < 0.30 not included in the table.

with immaturity and factor III is the 'emotional/miserable' dimension almostunchanged. Sphincter problems do not load on any factor in this matrix.

Item analysisThe ability of each item to discriminate between children thought to have problems

and those judged to be coping well in the nursery was examined. The observationratings were used to define the groups, combining the dubious, mild/moderate andthe severe categories (A' = 58). Overall, the only items which do not appear to be usefulin distinguishing between children with problems and those with none are wetting,aimless wandering, being withdrawn from staff and being fearful (Table 13). Item18 was left out of this analysis because it had been completed for less than half thesample, the definition having been changed during the study.

Choice of cut-off pointThe 1 S.D. cut-off has been used by Kohn and Rosman (1973) and the 90th

percentile, just beyond 1 S.D., is suggested for the PBQ (Behar, 1974). The cut-offpoint of 12 for the PBCL was set on the basis of pilot work but does seem appropriateon the basis of the results described here. Taking the sample as a whole, the mean PBCLscore is 6.8 with a standard deviation of 5.2, which makes a score of 12 one standarddeviation above the mean. If one assumed a normal distribution, a score of 12 or more


TABLE 13. PBCL ITEMS WHICH DIFFERENTIATED BETWEEN CHILDRENRATED AS HAVING PROBLEMS OR NO PROBLEM, ON THE BASIS OFOBSERVATIONS, AND CORRELATIONS OF ITEM WITH TOTAL SCORE

123456789a9b9

1011121314151617181920212223

PBCL item

Activity levelNot liked by others (peers)WetsSoilsPoor concentrationDifficult to manageAttention seekingSpeech not clearReluctance to speak—staffReluctance to speak—childrenTotal reluctance to speakTemper tantrumsNot sociable with peersWhinesSensitiveFightsAimlessInterferes with othersMiserableTeasingWithdrawn (staff)DestructiveFearfulHabitsStaff concerned

Significanceofaest

mm*

«*«

ns*

*•*

******

**

*«*

***ns***

-ns***nsmm

mmm

Item/totalcorrelation

r

0.480.490.120.240.550.520.430.45

--

0.320.360.360.400.320.430.400.530.43

-0.330.490.290.21

-

Sample details as in Table 4. No problems, N= 105; dubious ordefinite problem, N=58.

r - Pearson product-moment correlation coefficient.t = Student's /-test with independent samples.

0.001, **P< 0.01, *P< 0.05.

would be expected to identify 16% of the sample as having problems, and in fact it identified21.9%. This is fairly high, but comparable with prevalence rates described in previousstudies, which range from 24% in an American sample (Barron & Earls, 1984) to15% in a British infant school population (Chazan & Jackson, 1971). Taking thesample as a whole, the distribution is skewed, with more cases on the lower end ofthe scale (skewness = 0.67). However, looking at the school and day nursery groupsseparately one can see that for those attending nursery education the distribution isfar more skewed to the left (skewness = 0.92) with only 10.8% of the children scoringat or above 12. In contrast the day nursery children's ratings are close to a normaldistribution, but with a flatter curve (skewness = 0.12, kurtosis = -0.73) and 41.8%are at or above the cut-off. More information about the distribution of scores and thesuitability of the cut-off, particularly in relation to age, will be obtained from aprevalence study in progress.


TABLE 14. THE EFFECT OF AGE AND SEX ON PBCL ITEM SCORES AND THETOTAL SCORE

123456789a9b9

10111213141516171819202122

Item

Activity levelNot liked by others (peers)WetsSoilsPoor concentrationDifficult to manageAttention seekingSpeech not clearReluctance to speak—staffReluctance to speak—childrenTotal reluctance to speakTemper tantrumsNot sociable with peersWhinesSensitiveFightsAimlessInterferes with othersMiserableTeasingWithdrawn (staff)DestructiveFearfulHabitsTotal PBCL

Between groupAge

2.84.5**

14.9***16.7***2.30.62.94.7**

10.7***12.7***12.8***

1.810.9***2.05.4**4.1*8.5***2.1

15.9***-

5.6**1.65.4**5.1**

17.1***d.f. 2, 184

variation (F)Sex

6.8**3.70.10.5

19.9***4.2*3.75.7*1.60.30.93.11.100.88.5**0.77.4**0.2

-0.3

16.5***3.05.9*6.9**

d.f. 1, 185

B(B)

BB

(G)B

(B)

B

B

B

GB

Analysis of variance on each item score by age group (3) and by sex (2).Age groups: 24-35, 36-47 and 48-59 months.G = girls have higher mean score; B = boys have higher mean score.All significant age differences in the direction of younger children having

higher mean scores. Parentheses indicate a non-significant trend {P^ 0.10).***/»< 0.001, **i '<0.01, *P<0.05.

Age and sexAge and sex were both found to have significant effects upon the mean PBCL

score. The effects were in the expected direction in that younger children and boyshad higher scores (one-way ANOVA: age, F=i7.1, P< 0.0001, d.f. 2, 184; sex,F=6.9, P< 0.01, d.f. 1, 185). It must be remembered, however, that all the childrenin the 24-36 month age group were a selected group attending day nurseries. It hasalready been shown that the day nursery group had a higher mean score than theschool group (Table 7). Nevertheless, this difference between day nursery andnursery school was still present when the younger children were not included in theanalysis ( = 4.42, P< 0.001), which shows that the result is not wholly an ageeffect but probably a difference related to the selection criteria for day nurseryattendance.

Fourteen of the items were significantly related to age and in particular wetting,soiling, miserable or aimless behaviour, being sensitive and tearful and having poorrelationships with others (Table 14). The items describing conduct problems and


restlessness were significantly greater for the boys. They were said more often to bedestructive, physically aggressive, to interfere more in the play of others, to havepoorer concentration, to be more active and difficult to manage. In addition theyhad more speech problems. Only the prevalence of habits was higher for girls, witha non-significant trend to be more attention seeking.

DISCUSSION

The results show that the scale is a reliable instrument in that when two peopledescribe the same child, the final scores and the items selected are usually verysimilar. There is also fairly close agreement about placement above or below cut-off.On the basis of this study there is no clear evidence that the qualifications of theinformant have an effect upon ratings, since teachers and nursery nurses in theschool setting agreed fairly well. However, there was a suggestion in the results fromone day nursery that the role of the staff member might affect their responses, as thenursery nurses who were assigned to particular children rated them as having moreproblem behaviour than staff members primarily assigned to other children (Table lc).This result was based upon a very small group and needs examining in more locationsbut could have a number of implications. For example when a child is being assessedin a setting with assigned staff it is obviously important to obtain information fromthe specifically assigned staff member. Second, staff may behave quite differentlywith the children to whom they are not assigned, being less concerned with difficultbehaviour because it is not their responsibility.

The scale has been shown to be valid in a variety of ways. It was able to identifygroups said to have problems when the groups were defined either by membership ofa clinical group, by judgements from observations or by ratings based upon inter-views with the staff. However, there was a substantial number of false negatives;33% of the children on the basis of observations and 30% when the children wererated from the interviews. One of the limitations of checklists is that they are likely tomiss children who have one or two very severe but isolated symptoms. This must betaken into account when using them to study individuals rather than groups. Manyof the children described as 'dubious' by the observer were of this type and morethan half of them (65%) had scores below the cut-off. Nevertheless, the false positiverate was low. Only a small number of the children described as having no problemwere identified by the PBCL (4%, observer ratings; 2%, interview ratings).

The majority of the items were significantly more common in the children ratedas having problems by the observer. The exceptions being wetting, soiling andbeing fearful or aimless, indicating that the presence of these behaviours in isolationis not necessarily indicative of behavioural or emotional difficulties, which is notsurprising in this age group. Weir (1982), looking at parental descriptions of thebehaviour of over 700 three year olds, also concluded that sphincter problems inisolation were probably indicative of poor training or physical immaturity rather thanbehavioural problems.

The dimensions of behaviour revealed by factor analysis are similar to structuresdescribed in previous studies, showing that the PBCL has construct validity. Theresults also provide some information which could be relevant to the development of


classification systems for the problems of preschool children. Studies vary regardingthe number of factors or dimensions used to describe young children. Jones (1980)names four common types of problem seen clinically: shy/withdrawn, aggressive/antisocial, restless/overactive and immature/dependent. Using factor analysis withthe PBQ, Behar and Stringfield (1974) identified three factors: hostile/aggressive,anxious/fearful and hyperactive/distractible, while Fowler and Park (1979), studyingthe same scale, identified only two: aggressive/poor attention/active and anxious/fearful/emotionally labile. Kohn and Rosman (1973) found only two from theirProblem Checklist: apathy/withdrawal and anger/defiance. The clearest factorderived from the PBCL (I-conduct/restlessness/aggression) corresponds closely tothe conduct factors found by Kohn and Rosman (1973) and Fowler and Park (1979).Although a separate category of restlessness is described in classifications designedfor older children (Rutter et al., 1969), a division which was found to be meaningfulin a clinic sample (Thorley, 1984), it has been suggested that the evidence for aseparate restless/overactive factor separate from conduct problems is not justified(Trites & Laprade, 1983). One previous study of preschool age children (Behar &Stringfield, 1974) has described separate factors for conduct problems and over-activity. However, the validity of separating them during the preschool period is notsupported on the basis of these results.

Cluster analysis of the PBCL, grouping individuals rather than behaviours,provides further support for this idea. The first cluster includes children charac-terised by higher scores on overactivity and management difficulties. A divisionwhich does emerge from both the cluster and factor analyses, and which is not soclearly described in previous work, is between emotionad and isolated/withdrawnchildren. Kohn and Rosman (1973) labelled their second factor apathy/withdrawad,while Fowler and Park described an anxious/fearful/emotionally labile dimension,very similar to Behar and Stringfield's (1974) anxious/fearful factor. The PBCLproduces factors which separate emotional/miserable/fearful and withdrawn/immature behaviours. Cluster analysis also separates emotionally labile, attentionseeking children from those who are withdrawn and isolated. The possibility thatthis could be related to inclusion by us of somewhat younger children will be examinedin our larger prevalence study.

A prevalence study in progress at the moment will report in more detail upon ageand sex differences in PBCL scores. However, from these preliminary results it isclear that younger children have higher means and a higher incidence of many ofthe items. This would be expected since many of the behaviours are developmentalin nature. Young boys are referred to child guidance services more frequently thangirls (Clarizio & McCoy, 1970; Wolff, 1961), and their problems are more often of aconduct disorder type (Richman et al., 1975, 1982). This seems also to be the case forpreschool age boys in group settings since they had a higher mean score on thePBCL and behaviours such as fighting, destructiveness, lack of concentration andrestlessness were more often ascribed to them.

The PBCL was designed as an instrument which could be useful in the managementof children with problems. This use has been piloted in a series of informal work-shops. The items with the highest scores for an individual were discussed in terms oftheir consequences for the staff and children. Inconsistencies between two or more

SCREENING FOR BEHAVIOUR PROBLEMS IN NURSERIES 2 7

raters were often found to be useful, by highlighting contrasting methods in manage-ment by staff. It is clear that those working with preschool children operate with avariety of norms and beliefs about behaviour. There is a need for more systematictraining concentrating on behavioural and emotional aspects of development forthose planning to work in this field. Systematic training would obviously increasethe potential accuracy of the questionnaire and its usefulness. Several staff membersmentioned during the reliability and validity work that sitting down and going throughthe checklists had helped them to become more aware of the children, particularlythose who were isolated, nervous or withdrawn. The use of regular assessments hasbeen identified in previous work as a potentially useful way of helping staff to beaware of the children's needs (Coleman & Laishley, 1977) although the staff con-cerned commented that pressure of work made this difficult in practice (Laishley &Coleman, 1978). More work is planned in this area, to see whether the PBCL isuseful in developing techniques for helping children. An instrument like the PBCLcould alert staff to behaviour which signifies potential difficulties for a child. Itcould also help them to focus on particular behaviours which can be monitoredobjectively and to assess changes in response to management.

Overall, the PBCL is a screening checklist which can be completed fairly quicklyby nursery teachers, nursery nurses or assistants and which appears to be able toidentify groups of children with behavioural or emotional problems in group settings.In common vydth other checklists it has limitations when individuals are being studied.It covers in more detail than some existing scales behaviours which indicate socialisolation, nervousness or immaturity and this is reflected in its ability to differentiatewithdravyni groups of children in addition to those with emotional or conduct problems.

Acknowledgements—V^e would like to express our thanks to the staff in the day nurseries and nurseryschools for their enthusiastic cooperation, and to the boroughs concerned for allowing the research totake place. The work was supported by a grant from the Mental Health Foundation.

REFERENCES

Barron, A. P. & Earls, F. (1984). The relation of temperament and social factors to behavior problemsin thrce-ycai-oXd c\iiLidTen. Journal of Child Psychology and Psychiatry, 25, 23-33.

Behar, L. B. (1974). Manual for the Preschool Behaviour Questionnaire. Learning Institute of North CarolinaPress.

Behar, L. B. & Stringfield, S. A. (1974). A behavior rating scale for the pre-school child. DevelopmentalPsychology, 10, 601-610.

Bone, M. (1977). Pre-school children and the need for day-care. London: HMSO.Braun, S. & Caldwell, B. (1973). Emotional adjustment of children in day care who enrolled prior to

or after the age of three. Early Child Development and Care, 2, 13-21.Campbell, S. B., Endman, M. W. & Bernfeld, G. (1977). A three year follow-up of hyperactive

pre-schoolers into elementary school. Journal of Child Psychology and Psychiatry, 18, 239-249.Chazan, M. & Jackson, S. (1971). Behaviour problems in the infant school. Journal of Child Psychology

and Psychiatry, 12, 191-210.Chazan, M. , Laing, A. &Jackson, S. (1971). Just before school. Oxford: Blackwell.Clarizio, H. F. & McCoy, G. F. (1970). Behavior disorders in school-aged children. New York: Chandler

Publishing.Clark, M. M. & Cheyne, W. W. (1979). Handicapped aind exceptional children in pre-school units.

In M. M. Clark & V\ . M. Cheyne (Eds), Studies in pre-school education (pp. 152-217). London:Hodder & Stoughton.


Coleman, J. & Laishley, J. (1977). Expanding the scope of educational psychology. Child: Care, healthand development, 3,105-109.

Connolly, J. & Doyle, A. (1981). Assessment of social competence in preschoolers: teachers versuspeers. DevelopmenUdPsychology, 17,454—462.

Earls, F. (1980). The prevalence of behaviour problems in three-year-old children: a cross-nationalreplication. Archives of General Psychiatry, 37,1153-1157.

Earls, F., Jacobs, G., Goldfein, R., Silbert, A., Beardslee, W. & Rivinus, T. (1982). Concurrentvalidation of a behaviour problems scale to use with 3-year-olds. Journal of the American Academy ofChild Psychiatry, 21,47-57.

Everitt, B. (1974). Cluster analysis. London: Heinemann Educational Books (for the SSRC).Ferri, E., Birchall, D., Gingell, V. & Gipps, C. (1981). Combined nursery centres. London: Macmillan.Fowler, F. C. & Park, R. M. (1979). Factor structure of the Preschool Behavior Questionnaire in a

normal population. Psychological Reports, 45, 599-606.Gipps, C. (1982a). Nursery nurses and nursery teachers—I: their assessment of children's verbad-social

behaviour. Journal of Child Psychology and Psychiatry, 23, 23 7-254.Gipps, C. (1982b). Nursery nurses and nursery teachers—II: their attitudes towards pre-school

chUdren andtheirparents. Journal of Child Psychology and Psychiatry, 23, 255-266.Hinde, R. A., Easton, D. F. & Meller, R. E. (1984). Teacher questionnaire compared with observa-

tion£il data on effects of sex and sibling status on preschool behaviour. Journal of Child Psychologyand Psychiatry, 25, 285-304.

Hughes, M., Mayall, B., Moss, P., Perry, J., Petrie, P. & Pinkerton, G. (1980). Nurseries now.Harmondsworth: Penguin.

Jenkins, S., Bax, M. & Hart, H. (1980). Behaviour problems in pre-school children. yourwa/ of ChildPsychology and Psychiatry, 21,5-17.

Jones, J. (1980). The management of behaviour problems in young children. Booklet No. 5. Behaviourmodification. University of Swansea: Department of Education.

Katz, L. (1971). Sentimentality in pre-school teachers: some possible interpretations. Peabody Journal ofEducation, 42, 96-105.

Kohn, M. & Rosman, B. L. (1975). A two-factor model of emotional disturbance in the young child.Journal of Child Psychology and Psychiatry, 14,31-56.

Laishley, J. & Coleman, J. (1978). Action research in day nurseries: evaluating programmes throughstaffperceptions and attitudes. Child Care Health and Development, 4, 159-170.

Nie, N., Hull, C , Jenkins, J., Steinbrenner, K. &Bent, D. (1975). SPSS. Statistical package for the socialsciences, 2nd edn. New York: McGraw-Hill.

Paykel, E. S. (1981). Have multivariate statistics contributed to classification? British Journal ofPsychiatry, 139, 357-362.

Richman, N. (1977). Is a behaviour checklist for preschool children useful? In P. J. Graham (Ed.),Epidemiological approaches to child psychiatry (pp. 125-136). London: Academic Press.

Richman, N. & Graham, P . J . (1971). A behavioural screening questionnaire for use with three yearold children. Preliminary findings. Journal of Child Psychology and Psychiatry, 12, 5-33.

Richman, N., Stevenson, J. & Graham, P. (1975). Prevalence of behaviour problems in three year oldchildren: an epidemiological study in a London borough. Journal of Child Psychology and Psychiatry16,277-287. ^ ^ .^

Richman, N., Stevenson, J. & Graham, P. (1982). Preschool to school: a behavioural study. London:Academic Press.

Rickel, A. U. (1982). Perceptions of adjustment problems in preschool children by teachers and para-professional axdes. Journal of Community Psychology, 10, 29-35.

Roper, R. & Hinde, R. A. (1979). A teacher's questionnaire for individual differences in socialhehacv'ioMT. Journal of Child Psychology and Psychiatry, 20, 287-298.

Rutter, M. (1967). A children's behaviour questionnaire for completion by teachers: preliminaryfindmgs. Journal of Child Psychology and Psychiatry, 8, 1-11.

Rutter, M., Lebovici, S., Eisenberg, L., Sneznevskij, A., Sadun, R., Brooke, E. & Tsung-Yi, L.(1979). A triaxial classification of mental disorders in childhood. Journal of Child Psychology andPsychiatry, \{i,^\-%\.

Severy, L. J. & Davies, K. E. (1971). Helping behaviour among normal and retarded children.Child Development, 42,1017-1033.


Stevenson, J. & Ellis, C. (1975). Which three year olds attend preschool facilities? Child: Care Healthand Development, 1,397-411.

Stott, L. H. (1962). Personality at age four. ChildDevebpment, 33, 287-311.Thorley, G. (1984). Hyperkinetic syndrome of childhood: clinical characteristics. British Journal of

Psychiatry, 144,16-24.Trites, R. L. & Laprade, K. (1983). Evidence for an independent syndrome of hyperactivity./ouma/

of Child Psychology and Psychiatry, 24, 573-586.Walker, D. (1973). Socio errwtional measure for preschool and kindergarten children. New York: Jossey Bass.Walker, D. Bane, M. & Bryk, A. (1973). The quality of the Head Start planned variation data. Report of the

Office of Child Development. Huron Instute (cited by D. Walker, 1973).Weir, K. (1982). Night and day wetting among a population of three year olds. Developmental Medicine

and Child Neurology, 24,479-484.Weir, K. & Duveen, G. (1981). Further development and validation of the prosocial behaviour

questionnaire for use by teachers. Journal of Child Psychology and Psychiatry, 22, 357-374.Wishart, D. (1982). Clustan. User manual. Edinburgh University.Wolff, S. (1961). Social and family background of preschool children with behaviour disorders attend-

ing a child guidance clinic. Journal of Child Psychology and Psychiatry, 2, 260-268.Wolkind, S. N. & Everitt, B. (1974). A cluster analysis of the behavioured items in the pre-school child.

Psychological Medicine, 4, 422-427.

APPENDIX A

Examples of children in the observational categories (names changed to ensure anonymity)

PatrickPatrick, a three year, eleven month old who attends a day nursery, is very slight and small for his age.

He is extremely restless and does not concentrate on any table play or game for more than a minute. Herarely sits down with the group for an entire story or song.

He seeks adult attention very frequently, often by crying, and usually wants to be held. Howeverhe interacts less with the children, except when disputing possession of a toy or initiating fights. Hisuse of toys is not age appropriate and he tends to be wild and destructive, sweeping things onto thefloor or banging them together.

He is often disobedient to staff and temper tantrums occur at least daily. These can last up to 20minutes and involve crying or screaming, lying on the floor and sometimes throwing objects. He swearsa great deal to staff and other children.

Observer rating—Severe problemPBCL score—31

TriciaTricia is three years, two months old and attends a day nursery. Her behaviour is very variable. At

times she appears to be very anxious and nervous, sitting silently apart from the group, chewing herlips or tongue and twisting the fabric of her clothes. She is often reluctant to speak and attempts attimes to communicate with staff non-verbally, though she can be talkative. She often requests help orpraise from adults when playing and she rarely plays with other children.

She lacks concentration unless she is working one to one with an adult. Her appetite is very poor £indshe refuses most foods, chewing very slowly the small amount which she does eat.

Observer rating—Mild/moderate problemPBCL score—14.


Duane is four years, ten months old and attends a nursery class for a half-day session. He is wellbuilt and fairly large for his age. Most of his time in freeplay is spent in loud active chasing gameswith other boys, which often turn into fights. He likes to organise the other children but at times thiscan become bullying, and he does not accept the suggestions of others readily. He is sometimes sulky orstubborn when reprimanded by staff. Though often initially compliant, he usually returns to prohibitedactivities fairly quickly. He is able to concentrate, particularly with constructional toys, but colouring,drawing or craft activities are completed hurriedly and without care. He only participated in table playfollowing the suggestions of adults.

Observer rating—Dubious problemPBCL score—6

APPENDIX B

Preschool Behaviour Checklist. Below is a list of behaviours often shown by young children. For each ques-tion please put a cross opposite the description which you think fits the child best at the present time.If in doubt choose the alternative which you think is most often seen.

NURSERY

NAME OF CHILD SEX

DATE OF BIRTH

DATE OF ENTRY TO NURSERYATTENDS FOR: A.M. P.M. WHOLE DAY

1. Too active, hardly ever sits still for meals, or at other times for more than five minutes,always rushing around. DVery active, not always able to sit still when necessary. DNot markedly active, usually sits still when necessary. DNot active enough, tends to be lethargic. D

2. Seems to be liked by other children. DNot liked by some children. \3Most children seem not to like her/him. D

3. Never or rarely wets during the day (less than once a week). DWets during the day once or twice a week. DWets during the day three or more times a week. D

4. Completely bowel trained, never dirties pants. DOccasionally soils, up to once or twice a week. DSoils pants three or more times a week. D

5. Hardly ever concentrates for more than a few minutes on any table play. DConcentration varies, sometimes finds it difficult to concentrate on table play. DHas good concentration, usually stays at table play for 10 minutes or more. D


6. Frequently very difficult to manage or control; problems (e.g. defiant, disobedientor interrupts during group activities) almost every day. DSometimes defiant, disobedient, interrupts during group time, or difficult to manage. DEasy to manage and control. D

7. Rarely demands a great deal of attention. DSometimes asks for a lot of attention, but can work or play independently. DFrequently demands attention (e.g. often wants to be helped, to be carried, followsstaff around most of the time). D

8. No speech yet or only single words. DNot fluent in English but speaks another language. DStutters, stammers or has poor articulation. DSpeech sometimes not clear. DClear speech, easy to understand. D

9. No speech yet, or not fluent in English. D(a) staff (b) children

Speaiks freely to: D DSome reluctance to speak to: D DWill not speak or very reluctant to speak to: D D

10. Doesn 't have temper tantrums. DSometimes has tantrums (lasting usually a few minutes). DHas frequent (at least daily) or very long tantrums, with screaming, kicking, orcomplete loss of control. D

11. Often plays with or approaches other children, very sociable. DSome reluctance to play with other children, but will join in sometimes. DRarely or never plays with other children, tends to ignore them. •

12. Whines, complains or moans to staff a great deal. DSometimes whines, complains or moans, but not daily. DRarely or never whines, moans or complains. D

13. Very sensitive, gets upset easily over many minor things (e.g. falling over, breakingthings, changes in routine, getting dirty hands). •Sometimes very upset over minor things. DNot over sensitive, not easily upset. D

14. Rarely bites, kicks, hits or fights with other children. DSometimes fights, bites, kicks or hits other children. DFrequent (i.e. at least daily) unprovoked fighting, hitting, biting or kicking. D

15. Spends much of the time at nursery staring into space or aimlessly wandering. DSpends some periods wandering or staring into space. DUsually occupied, rarely seen aimlessly wandering or staring. D

16. Frequently interferes with the work or play of other children (e.g. messes up a game,tries to boss others). •Sometimes interferes with the work or play of other children. DHardly ever interferes with other children's games, toys, painting etc. D

17. Rarely cries or looks unhappy, except for brief periods (e.g. when tired, hungry, unwell). DSometimes tearful or miserable for long periods. DFrequently miserable, on most days, for long periods. D

18. Frequently taunts, teases or is spiteful to other children. DSometimes spiteful or teasing. DRarely or never spiteful or teasing. D

32 J- McGUIRE AND N. RICHMAN

19. Very emotionally withdrawn from staff. •Somewhat withdrawn from all staff or responsive to only one particular adult. DCan be responsive to all staff. n

20. Rarely destructive with toys or equipment. DOccasionally is destructive (e.g. throwing, breaking or banging into things deliberately). DVery often deliberately destructive. D

21. Very feJirful, shows many mzirked fear reactions. DSomewhat fearful, several mild, or one to two marked fears. DRarely fearful, mild fears only. D

22. HABITSPlease rate each of them as follows:

0—never occurs.1—occasionally occurs for brief periods only.2—occurs frequently or for long periods.

Rocking D Masturbation DThumb sucking D Hair sucking, pulling etc. DBottle sucking D Head-banging DSucking dummy D Other D

23. Are you concerned about this child's behaviour or adjustment ?Please describe. No D

Possibly nYes D

Any other comments you would like to make:

Thank you very much.

I have known this child since

Signature

Date

Nursery nurse/assistant/teacher (please underline).

screening for behaviour problems in nurseries: the...

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