4.4 Parent Stress and the Validity of Rating Scales for Preschool-Aged Children With Behavioral Concerns

Abstract

There is evidence of a persistent, bidirectional relationship between parent stress and child behavioral problems from infancy through adolescence. To optimize efficiency in health care, norm-referenced rating scales are used at increasing rates across disciplines to track development and to determine diagnoses/needs. Despite the established relationship between behavior problems and parent stress, there are no known studies examining the relationship between parent stress and the validity of their ratings of child behaviors. The Early Childhood Mental Health Clinic (ECMHC) provides multidisciplinary evaluations for children aged 0-5 years with behavioral, social-emotional, and development difficulties. Parents complete several questionnaires, including the Parenting Stress Index (PSI-4-SF) and the Behavior Assessment System for Children, Third Edition (BASC-3), which measures parent-reported behavioral/emotional functioning of the child. The BASC-3 F Index validity scale identifies unusual responses that may indicate that the parent rated the child more severely than warranted, suggesting interpretive caution. Participants (N = 279) were primarily male (68.2%) with a mean age of 57 months. Pearson correlations were used to analyze the relationships among each of the PSI-4-SF domains and BASC-3 Clinical and Validity Scales. There were significant differences in the mean levels of stress on all PSI-4-SF domains between parents who provided responses that resulted in “Acceptable” vs “Not Acceptable” classification on the BASC-3 F Index. Parents who reported more stress were more likely to be classified as “Not Acceptable” on the F Index. Further analyses revealed small but significant relationships between all but one of the PSI-4-SF domains and the F Index on the BASC-3. Present findings indicate that caution is warranted when interpreting parent report of their child’s behavior in the context of significant parenting stress. Relying exclusively on parent-report information to assess young children in the clinical setting appears contraindicated. Family/situational factors beyond the individual child are important to assess.