Screening in Schools for Behavior Disorders: Use of Mothers’ Reports of Symptoms

Abstract

SCREENING HAS long been a basic component of school health services. School mental health ser vices, however, have not yet found a simple and reliable method for screening school-age children for behavior disorders. evaluation of preventive mental health pro grams requires a measure of adjustment which can be used with economy with large groups of sub jects. As a part of a larger study designed to eval uate a community mental health program (2), sever al sub-studies have been undertaken to test the screening efficiency of a symptom invento r y de signed for use with mothers. A small-s amp le study has been reported previously (3). This is a report of the first large-sample study of the screen ing method. Whether knowledge about symptoms alone can be used as a screening tool depends on whether they can be used successfully to predict the presence and degree of clinical sickness in children. This subject has been discussed among child psychia trists for many years. Some feel it is dangerous to use presence or absence of symptoms as an indi cation of whether the child is sick or well. Gard ner (4) is a representative of this group. He d i vides children's problems into two categories, i. e., those requiring short-term therapy, and those requiring long-term treatment. Of the short-term group he says that therapy aimed at relieving the symptom will probably allow the child an extreme ly good chance of .continuing thereafter a normal and orderly personality development, (4, pp. 131 33). Of the long-term group he warns against using absence or disappearance of symptoms as an indication either for stopping treatment or of the recovery of the child. He says, (4, p. 133), Re moval of the presenting symptom may delay but not prevent the child from developing a more ser ious disability later in childhood or in adult life. In summary, Gardner, appears to doubt that symp toms themselves can be used to discriminate be tween si?k or well children, or those with differ ent degrees of emotional adjustment. On the other hand, Levy believes that symptoms can be used to determine sickness or health in children. He says, (11, p. 227), One of the find ings that resulted from a series of follow-up stud ies starting at the Institute of Child Guidance in New York and utilizing material from about a doz en child guidance clinics . . . was that the highest correlation with general personality growth was the disappearance of the presenting symptoms. Witmer (16) also finds that disappearance of symp toms in children treated in a child guidance clinic correlates higher with clinical improvement than any other factor. Support for the use of symptoms in determining adjustment in adults is found in recent work by Hunt, Wittson, and Hunt (8,9) where there was dem onstrated to be a positive relationship between the number of presenting symptoms in adults, the sev erity of the neuropsychiatrie disorder, and suita bility for military service. Kanner (10) lays much emphasis on the com plaint, i.e. , the mother's statement of symptoms, as a critical factor in determining treatment. He says, The clearing up, or persistence, of the dif ficulties complained of may frequently, though not always, be used as a measure of the reasonable ness and adequacy of the handling of the maladjust ment. In 1954, Eitzman (7) found, in an inte ns ive follow-up study of twelve children treated in the St. Louis County Child Guidance Clinic, that moth ers reported markedly fewer symptoms after treat ment than they reported at the time the child was referred. Specifically, at the time of referral, the twelve mothers reported a total of 86 current symptoms (mean, 7.2). After treatment, these same mothers reported a total of only 40 symp toms (mean, 3. 3). I In a study of 91 public school children and 35