Caregiver Strain Questionnaire Research Articles

129 Effect of DR/ER-MPH on Caregiver-Reported ADHD Symptom Improvement in Children With ADHD and Caregiver Strain: Results From a Phase 3 Trial

AbstractObjectiveEvening-dosed DR/ER-MPH (formerly HLD200), a delayed-release and extended-release methylphenidate, was designed to provide efficacy upon awakening and through the evening. The objective was to evaluate whether treatment with DR/ER-MPH in children with attention-deficit/hyperactivity disorder (ADHD): (1) improves caregiver-rated ADHD symptoms, and (2) reduces caregiver strain, versus placebo.MethodCaregiver-rated ADHD symptoms (Conners’ Global Index–Parent [CGI-P]) and caregiver strain (Caregiver Strain Questionnaire [CGSQ]) were assessed as secondary endpoints following 3 weeks of treatment in a randomized, double-blind, multicenter, placebo-controlled, parallel-group, phase 3 trial of DR/ER-MPH in children (6-12 years) with ADHD (NCT02520388). Using the 10-item CGI-P, parents rated their child’s ADHD symptoms on a 4-point scale (0=never/seldom; 3=very often/frequently). Caregivers also rated the impact of caring for a child with emotional and behavioral challenges on the 21-item CGSQ (5-point scale: 1=not at all; 5=very much). A reduction on individual item and total scores for both measures indicated an improvement.ResultsOf 163 children enrolled across 22 sites, 161 were included in the intent-to-treat population (DR/ER-MPH, n=81; placebo, n=80) and 138 completed the study. The mean DR/ER-MPH dose after 3 weeks of treatment was 68.1 mg. Mean CGI-P scores at baseline and CGSQ scores at screening (ie, before washout of prior ADHD therapy) were comparable for both DR/ER-MPH (CGI-P: 22.8, CGSQ: 54.5) and placebo (CGI-P: 21.8; CGSQ: 54.9) groups. After 3 weeks of treatment, caregivers of children onDR/ER-MPH reported significant reductions in CGI-P scores versus those on placebo (least-squares [LS] mean: 12.3 vs 17.4; P<0.001). Additionally, there was a significant reduction in CGSQ scores after 3 weeks of treatment with DR/ER-MPH versus placebo (LS mean: 41.2 vs 49.1; P<0.001). Post hoc analyses on the effect of DR/ER-MPHversus placebo on individual items of CGI-P and CGSQ, and the two subscales of CGI-P will be presented. No serious TEAEs were reported and all TEAEs were consistent with those of MPH.ConclusionsCaregivers reported significant improvements in their child’s ADHD symptoms and these improvements coincided with reductions in caregiver strain after 3 weeks of treatment on evening-dosed DR/ER-MPH versus placebo.Funding AcknowledgementsIronshore Pharmaceuticals & Development, Inc.

Parent Education for Young Children With Autism and Disruptive Behavior: Response to Active Control Treatment

This study examines parent and child characteristics in young children with autism spectrum disorder and disruptive behavior who showed a positive response to a parent education program in a randomized clinical trial of parent training. Children with autism spectrum disorder (N = 180) were randomized to parent training (PT) or parent education program (PEP) for 6 months. Using the Clinical Global Impression–Improvement scale, masked independent evaluators rated positive response in 68.5% of children in PT compared to 39.6% in PEP. We compared baseline characteristics and change in parental stress, strain, competence, and mental health for participants who showed a positive response to PEP (PEP-R) to those who did not (PEP-NR). We also compared change in child and parent measures for PEP-R participants to those who showed a positive response to PT (PT-R). At baseline, PEP-R and PEP-NR participants did not differ on any demographic or clinical characteristics. Parents in PEP-R reported significant reductions on the Parenting Stress Index, Caregiver Strain Questionnaire, and Parent Health Questionnaire, and increases on the Parenting Sense of Competence scale. Improvements in child disruptive behavior and parental stress, strain, competence, and mental health for PEP-R participants were similar to PT-R participants. Vineland Daily Living Skills improved only for children in PT-R. PEP was an active control treatment with nearly 40% of participants showing a positive response. Change in child disruptive behavior and parental stress, strain, competence, and mental health were remarkably similar for participants independently rated with a positive response to PEP and PT.

Teaching Parents Behavioral Strategies for Autism Spectrum Disorder (ASD): Effects on Stress, Strain, and Competence.

We report on parent outcomes from a randomized clinical trial of parent training (PT) versus psychoeducation (PEP) in 180 children with autism spectrum disorder (ASD) and disruptive behavior. We compare the impact of PT and PEP on parent outcomes: Parenting Stress Index (PSI), Parent Sense of Competence (PSOC), and Caregiver Strain Questionnaire (CGSQ). Mixed-effects linear models evaluated differences at weeks 12 and 24, controlling for baseline scores. Parents in PT reported greater improvement than PEP on the PSOC (ES = 0.34), CGSQ (ES = 0.50), and difficult child subdomain of the PSI (ES = 0.44). This is the largest trial assessing PT in ASD on parent outcomes. PT reduces disruptive behavior in children, and improves parental competence while reducing parental stress and parental strain.

The Children's Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes.

The Children's Attention-deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) tested the hypotheses that children and caregivers who received guideline-based treatment delivered through a hybrid telehealth service delivery model would experience greater improvements in outcomes than children and caregivers receiving treatment via a comparison delivery model. Here, we present caregiver outcomes. 88 primary care providers (PCPs) in seven geographically underserved communities referred 223 children (ages 5.5 - 12.9years) to the randomized controlled trial. Over 22weeks, children randomized to the CATTS service delivery model received six sessions of telepsychiatry and six sessions of caregiver behavior management training provided in person by community therapists who were trained and supervised remotely. Children randomized to the comparison Augmented Primary Care (APC) service model received management in primary care augmented by a single telepsychiatry consultation. Caregiver outcomes included changes in distress, as measured by the Patient Health Questionnaire (PHQ-9), Parenting Stress Index (PSI), Caregiver Strain Questionnaire (CSQ) and Family Empowerment Scale (FES). Caregivers completed five assessments. Multilevel mixed effects regression modeling tested for differences between the two service delivery models in caregiver outcomes from baseline to 25weeks. Compared to caregivers of children in the APC model, caregivers of children in the CATTS service model showed statistically significantly greater improvements on the PHQ-9 (β = -1.41, 95% CI = [-2.74, -0.08], p < .05), PSI (β = -4.59, 95% CI = [-7.87, - 1.31], p < .001), CSQ (β = -5.41, 95% CI = [- 8.58, -2.24], p < .001) and FES (β = 6.69, 95% CI = [2.32, 11.06], p < .01). Improvement in child ADHD symptoms mediated improved caregiver scores on the PSI and CSQ. Improvement in child ODD behaviors mediated caregiver CSQ scores. The CATTS trial supports the effectiveness of a hybrid telehealth service delivery model for reducing distress in caregivers of children with ADHD and suggests a mechanism through whichthe service model affected caregiver distress.

Effects of Mental Disorders in Children on Parents in the Context of Differentiated Approaches to Psychosocial Interventions in Pediatric Psychiatry

Objective. To identify the features of parental responses to the existence of mental disorders in their children to develop differentiated approaches to psychosocial family interventions. Materials and methods. The parents (mainly mothers) of 140 children with schizophrenia spectrum disorders, 100 children with autistic spectrum disorders, and 85 children with mental retardation were studied. Psychiatric investigations of parents were based on scales assessing the effects of the child’s emotional and behavioral problems on the parents (the Care Giver Strain Questionnaire, CGSQ) and the load imposed by the disease on the family (Experience of Caregiving Inventory, ECI). Results and conclusions. The emotional and behavioral features of parents’ responses to illness in their children were identified – both those common to all the conditions studied and those characteristic of individual forms of mental pathology in children. Factors (cognitive, emotional and behavioral) determining the targets for differentiated psychosocial interventions during work with parents were defined. Parent-orientated stress coping strategies were formulated.

Correlates of Subjective Caregiver Strain in Caregivers of Youth Evaluated in a Pediatric Psychiatric Emergency Room.

Although caregiver burden is relevant to the outcome for psychiatrically ill youth, most studies have focused on caregiver burden in the community or research settings. Therefore, we aimed at evaluating the subjective caregiver strain (SCS) at the time of presentation of youth to a pediatric psychiatric emergency room (PPER), assessing potential correlates to provide leads for improvements in formal support systems. In this retrospective cohort study, the internalized, externalized, and total SCS were assessed in caregivers of youth <18 years of age consecutively evaluated at a PPER during a 1 year period using the Caregiver Strain Questionnaire. Sociodemographic and a broad range of clinical data were collected during the PPER visit using a 12-page semistructured institutional evaluation form. The Appropriateness of Pediatric Psychiatric Emergency Room Contact scale, incorporating acuity, severity and harm potential, was used to rate appropriateness of the visit. In caregivers of 444 youth, the internalized SCS was significantly higher than the externalized SCS (p < 0.001). Multivariable analyses indicated that higher total and externalized SCS were associated with disruptive behavior or substance abuse/dependent disorder diagnosis, presenting complaint of aggression, and discharge plan to the police. Higher total and internalized SCS were associated with lower child functioning, whereas total and internalized SCS were lower in adopted children. In addition, higher externalized SCS was associated with investigator-rated inappropriateness of the emergency visit, presenting complaint of defiance, and a lack of prior psychiatric ER visits. High levels of CS in PPER highlight the necessity to adhere to existing guidelines regarding the inclusion of caregivers' perceptions into comprehensive psychiatric assessments. The particularly high strain in caregivers of children with externalizing disorders and in families with low-functioning youth may need to prompt PPER staff to provide efficient information on appropriate treatment options for these children and on support facilities for the parents.

Strain Among Caregivers of Youth Designated as Seriously Emotionally Disturbed: Do Place of Residence and Race Matter?

To what extent might race and where one lives at service start in Monroe County, New York, influence three dimensions of caregiver strain among those caring for a youth designated as having serious emotional disturbance? We used the Caregiver Strain Questionnaire to measure our outcomes: subjective internalizing strain—negative feelings of guilt and worry associated with having a child with behavioral and emotional problems; subjective externalizing strain—negative feelings about the child such as anger or embarrassment; and objective strain—interruption of personal time, lost work time, and/or financial strain in four geographical areas (place of residence) defined by ZIP code. These places included Low Income Urban (median ZIP code household income less than $39,000), High Income Urban (median ZIP code household income greater than or equal to $39,000), Suburban, and Rural. We found that place at service start and time predicted caregiver strain levels (though time was the only predictor for externalizing strain), controlling for several factors. Race had no detectable influence. Supports can be individualized to a greater extent to address specific factors influencing the type of strain experienced by a caregiver. Providers might begin by identifying caregiver strain by type and intensity as well as identifying the specific circumstances leading to feelings and concerns associated with each type of caregiver strain.

Caregivers' Distress: Youth with Attention-Deficit/Hyperactivity Disorder and Comorbid Disorders Assessed via Telemental Health

This article evaluates the additive effects of children's comorbid conditions with attention-deficit/hyperactivity disorder (ADHD) in relation to caregivers' distress, in a clinical trial conducted through telemental health (TMH). The Children's ADHD Telemental Health Treatment Study (CATTS) is examining the effectiveness of treatment delivered via TMH for children with ADHD who are living in underserved communities. The CATTS trial recruited 223 children (μ=9.53±2.06 years) and their caregivers. Diagnoses of ADHD and comorbid oppositional defiant disorder (ODD) and anxiety disorders (ADs) were established with the Child Behavior Checklist and the Computerized Diagnostic Interview Schedule for Children. We took advantage of rich baseline data from the CATTS trial to investigate associations between caregivers' distress and children's comorbid mental health conditions. Caregivers' distress was assessed with the Patient Health Questionnaire-9, Parenting Stress Index, and Caregiver Strain Questionnaire. ANOVAs were used to compare children with ADHD alone with children having one comorbid condition (ODD or ADs) and children having two comorbid conditions (ODD and ADs). Three quarters (75.3%) of participants met criteria for ODD and/or AD comorbid with ADHD: 24.7% had neither comorbidity; 47.5% had ODD or AD; and 27.8% had both ODD and AD comorbidities. The parents of children with multiple comorbid conditions experienced the highest levels of depression, stress, and burden of care. The CATTS sample that was recruited from underserved communities provided evidence of additive effects of child psychiatric comorbidities with caregivers' distress, echoing earlier findings from the Multi-modal Treatment of ADHD (MTA) study that was conducted with a metropolitan sample of youth. Results indicate that caregivers' distress should be addressed in developing treatment models for children with ADHD. http://clinicaltrials.gov/show/NCT00830700 .

Caregiver burden and nonachievement of healthy lifestyle behaviors among family caregivers of cardiovascular disease patients.

To determine whether caregiver burdens are associated with lifestyle behaviors 1 year following the hospitalization of a family member with cardiovascular disease (CVD). Prospective follow-up study of National Heart Lung and Blood Institute sponsored Family Intervention Trial for Heart Health participants. Hospital-based recruitment/baseline visit with 1-year follow-up. Family members of hospitalized CVD patients (N = 423; 67% female; 36% racial/ethnic minority; mean age 49 years). Systematic evaluation at 1 year to determine heart-healthy diet (defined as <10% kcal from saturated fat; Block 98 Food Frequency Questionnaire) and physical activity (defined as ≥4 d/wk; Behavioral Risk Factor Surveillance System Survey) behaviors and caregiver burdens (five domains: employment, financial, physical, social, and time; Caregiver Strain Questionnaire). Logistic regression adjusted for covariates. Heart-healthy diet was less frequent among caregivers citing feeling overwhelmed (odds ratio [OR] = .50; 95% confidence interval [CI] = .26-.97), sleep disturbance (OR = .51; 95% CI = .27-.96), financial strain (OR = .41; 95% CI = .20-.86), upsetting behavior (OR = .48; 95% CI = .25-.92), and/or time demands (OR = .47; 95% CI = .26-.85) as burdens. Physical activity was less frequent among caregivers reporting financial strain (OR = .32; 95% CI = .13-.81) or upsetting patient behavior (OR = .33; 95% CI = .15-.76) as burdens. The most commonly cited caregiver burdens included changes in personal plans (39%), time demands (38%), and sleep disturbance (30%). Caregiver burdens were associated with nonachievement of heart-healthy diet and physical activity behaviors among family caregivers 1 year after patient discharge. When developing heart-health promotion interventions, caregiver burden should be considered as a possible barrier to prevention among family members of CVD patients.

Measurement Quality of the Caregiver Strain Questionnaire-Short Form 7 (CGSQ-SF7)

This study examined the measurement quality of an abbreviated version of the Caregiver Strain Questionnaire. The CGSQ-Short Form 7 (CGSQ-SF7) is practical for routine assessment of objective and subjective internalized caregiver strain. The subjective externalized subscale is not included in the CGSQ-SF7. Findings indicate that the reliability and validity of the shortened objective and subjective internalized subscales are comparable to the original. Examination of construct validity suggested that caregiver, youth, and clinician ratings of child clinical severity were related to objective caregiver strain. However, youth and clinician ratings of child clinical severity were not related to subjective internalized caregiver strain.

Psychometric properties of the Caregiver Strain Questionnaire (CGSQ) among caregivers of children with autism

The purpose of this study was to test the psychometric properties of the Caregiver Strain Questionnaire (CGSQ) among caregivers of children with autism. The CGSQ was originally developed to assess burden experienced by parents of children and adolescents with serious emotional and behavioral disorders. Study data was collected from 304 primary caregivers of children with autism using a cross-sectional survey design. We tested the one-, two-, and three-factor CGSQ model. Though the three-factor CGSQ model fit better than the one- and two-factor model, it was still short of an acceptable fit. Minor modifications were made to the three-factor model by correlating error terms. The modified three-factor CGSQ model with correlated error indicated reasonable fit with the data. The 21-item CGSQ had good convergent validity, as indicated by the correlation of its three subscales with constructs including mental health-related quality of life, maladaptive coping, social support, family functioning, and care recipient level of functional impairment and extent of behavioral problems, respectively. The internal consistency reliability of the instrument was also good, and there were no floor and ceiling effects. The CGSQ was found to be a reliable and valid instrument to assess burden among caregivers of children with autism.

Racial and Ethnic Disparities in Caregiver Strain and the Use of Child Mental Health Services: A Structural Equation Model

Although racial and ethnic disparities in the use of child mental health services have been well documented, the causes of and solutions to these disparities are not clearly understood. This study examined the role of caregiver strain in the disproportionately low rates of services use among youths from racial or ethnic minority groups who had already had contact with public service systems. This cross-sectional study used secondary analysis of a stratified random sample of 1,370 youths from the Patterns of Youth Mental Health Care in Public Service Systems Study, who were involved with at least one of five public sectors of care. Caregiver strain and use of child mental health services in the past 12 months were assessed by the Caregiver Strain Questionnaire and the Service Assessment for Children and Adolescents, respectively. A structural equation model that examined the mediating role of caregiver strain for use of child services among three racial and ethnic groups was evaluated for goodness of fit. African-American caregivers reported lower levels of caregiver strain than did non-Hispanic white caregivers; Hispanic caregivers did not differ significantly from non-Hispanic white caregivers on reporting caregiver strain. Among African Americans, the effects of race on use of services were indirect, mediated through caregiver strain. Findings emphasize the importance of culturally influenced perceptions of caregiving practices and burden among caregivers of a child with emotional or behavioral problems. Intervention efforts to reduce disparities in use of services across racial or ethnic groups need to be informed by a better understanding of the causes of group differences in reporting caregiver strain and the relationship between reported caregiver strain and use of child mental health services.

Caregiver Strain and Youth Suicide Attempt: Are They Related?

There are scant data documenting the relationship between caregiver strain and suicidal behavior among youth. This study includes data from the caregivers of 1,854 youth who received services through the Comprehensive Community Mental Health Services for Children and Their Families Program. Caregiver strain, family functioning, and youth functional impairment were assessed with the Caregiver Strain Questionnaire, Family Life Questionnaire, and Columbia Impairment Scale. Caregivers of suicidal and nonsuicidal youth differed in subjective internalizing strain (e.g., worry and guilt) and objective strain (e.g., constraints on activities). Differences in objective strain persisted even after controlling for family life and youth functional impairment.

Caring for children with learning disabilities: an exploratory study of parental strain and coping

Accessible summary • Caring for a child with learning disability can be both a rewarding and difficult experience, but little is known about the experience of parents who provide care for children with learning disabilities in Ireland. • This study involved 32 parents of children (<16) with learning disabilities living in the Greater Dublin area. • The research investigated the kind of tasks involved in caring for a child with a learning disability, the extent and nature of any difficult behaviours with which parents must cope as well as parents’ attitudes towards caring. The use and availability of support services and how parents cope with their caring role were also explored. • This research is important to people with learning disabilities and their carers because it tells us about the practical, emotional and psychological benefits and drawbacks of caring for a child with learning disability and the importance of having appropriate and effective support services for both parents and their children. Summary Despite recurring concerns about the role and appropriate support of informal carers, little is known about the parental experience of caring for children with learning disabilities in Ireland. This study describes and analyses the nature and consequences of care and coping among parents of children (<16) with learning disabilities living in the Greater Dublin area. Participants (n = 32) completed the Caregiver Strain Questionnaire and an adapted version of the Carers Questionnaire which assessed: care tasks/behavioural difficulties; caregiver attitudes; service provision; and coping strategies. Qualitative analysis examined factors affecting carers’ ability to cope. Participants showed high levels of objective and subjective caregiver strain and most were receiving inadequate support. However, parents employed a range of strategies to help them cope more effectively. The qualitative data highlighted the difficulties and rewards of caregiving and the inadequacies of current service provision.

Brief Report: Psychosocial Functioning of Fathers as Primary Caregivers of Pediatric Oncology Patients

To evaluate the psychosocial functioning of fathers as primary caregivers of pediatric oncology patients. Fathers who identified themselves as the primary medical caregivers were given a packet of questionnaires, including the Brief Symptom Inventory (BSI), the Impact of Event Scale (IES), the Impact on Family Scale (IFS), the Caregiver Strain Questionnaire (CGSQ), and the Parent Experience of Child Illness (PECI) scale, to complete and return by mail. The 23 fathers who returned the questionnaire packets were compared with 23 mothers who were matched on demographic variables. There were no differences between groups on self-report measures of distress or illness-related parenting stress. Descriptively, however, the majority of parents were above normative means on measures of psychological distress with a significantly greater proportion of fathers endorsing elevated levels of depression on the BSI. Including fathers in pediatric psychosocial research is important and represents a growing trend in psycho-oncology.

Experience of Strain Among Types of Caregivers Responsible for Children With Serious Emotional and Behavioral Disorders

Parents and relative caregivers of children with severe emotional and behavioral disorders (EBD) often report high levels of strain associated with the care of that child.This study compares how parents and other relative caregivers, and different family caregiver groups, experience strain. Overall, we found that Medicaid caregivers ( n = 648) reported high levels of objective strain, whereas military caregivers ( n = 978) had high scores on the subjective internalized and externalized subscales of the Caregiver Strain Questionnaire (CGSQ). An exploratory common factor analysis showed that overall,the CGSQ performed similarly for the Medicaid and the military caregivers and was generally consistent with previous research showing three factors. However, among Medicaid caregivers, other relatives ( n = 109) reported two rather than one type of objective strain, and emotionally based items had lower correlations with the latent factor among other relatives as compared with parents ( n = 539).These findings suggest the need to tailor approaches to assisting different groups of caregivers in coping with their strain.

Racial Differences in Responses to the Caregiver Strain Questionnaire

The aim of this study was to examine differences in responses to the Caregiver Strain Questionnaire (CGSQ) between African American and White caregivers of children with emotional and behavioral challenges. Significant item- and scale-level differences were detected across groups with African Americans consistently reporting less strain. We examined whether these differences were more likely due to nonequivalent measurement than to real differences in the experience of caregiver strain. Confirmatory factor analysis showed that the model fit the data well for both racial groups, but there were some differences in structural components. Internal consistency was equivalent across the groups. In an examination of criterion validity, regression analyses showed that African American caregivers experienced a slower rate of increase in objective caregiver strain at a given increase in child internalizing problems. No other race differences were found in the regression analyses. In general, we conclude that the CGSQ can be useful for detecting caregiver strain and identifying family support needs for both White and African American caregivers. Differences across groups in reports of caregiver strain, however, call for more research on racial differences in the impact on the family of caring for a child with emotional and behavioral disorders.

Maternal caregiving strain as a mediator in the relationship between child and mother mental health problems

This study examined whether the general stress-caregiver strain-mental health outcome model may be as appropriate for caregivers of minor-age children as it has been for caregivers of adults with chronic illness. The authors examined whether children's behavioral problems are related to mothers' caregiving strains, which then is related to greater maternal mental health symptomatology. Mothers of 222 children referred for mental health services completed the Child Behavior Checklist (CBCL), Caregiver Strain Questionnaire (CGSQ), and three dependent variable measures: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and the SF-36 Mental Health Scale. Path analyses and Sobel tests supported the tested model that maternal caregiving strain mediates between child mental health problems and three indicators of maternal mental health problems, with significant indirect pathways through maternal caregiving strain replacing the formerly significant direct contribution of child's problem severity to each maternal mental health measure.

The Caregiver Strain Questionnaire

The impact on the family of having a family member with serious emotional problems has been an area of concern as deinstitutionalitation and managed care have shifted treatment to the community and primary caregiving to the family. Measures are needed to assess caregiver strain in a way that can lead to a better understanding of the phenomena, improve clinical interventions, and examine the outcomes of new treatment modalities on the client's family. In order to study the effects of this treatment shift, the Caregiver Strain Questionnaire (formerly the Burden of Care Questionnaire) was developed for use with families of children and adolescents with emotional and behavioral disorders. Findings from exploratory and confirmatory factor analyses support the existence of three related but unique dimensions of strain experienced by parents of this population. This study adds to the current body of knowledge by suggesting that subjective caregiver strain has two components, and not the single form claimed in previous research. The results also indicate that the Caregiver Strain Questionnaire is a reliable and valid scale for the measurement of caregiver strain among families of children with emotional or behavioral disorders.

Theoretical and psychometric analysis of caregiver strain

The purpose of the study was to establish the validity and reliability of an instrument for the measurement of caregiver strain, the Parent Caregiver Strain Questionnaire (PCSQ), with data from 283 adult children who were providing care to a neurologically impaired patient. Principal axis factor analysis of data rotated to an oblimin solution revealed five well-defined, first-order factors that explained 59% of the total variance in caregiver strain. The five-factors were interrelated with caregiver strain as theoretically predicted. Coefficient alphas for the five factors were in the range from .74 to .93. The findings provide beginning evidence of the adequacy of the PCSQ, and favor continued investigation into the theoretical and psychometric properties of the instrument. © 1996 John Wiley & Sons, Inc.