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59 Pages·2016·0.64 MB·English

Running head: QUANTITATIVE AND QUALITATIVE CHILD PSYCHOPATHOLOGY 1
A Comparison of Quantitative and Qualitative Methods in the Assessment of Internalizing
Behaviors in Preschool-Aged Children from Mexican Farmworker Families
Rogelio Gonzalez
California State University San Marcos
QUANTITATIVE AND QUALITATIVE CHILD PSYCHOPATHOLOGY 2
Abstract
Evidence suggests that internalizing behaviors (e.g., anxiety, irritability, sadness) emerge early in
childhood. However, very few researchers have investigated these behaviors in vulnerable
preschool-aged (3-6-year-old) children from Mexican/Mexican American farmworker families.
This population may be at an increased risk for poor mental health due to chronic exposure to
risk factors associated with farmwork. In addition, the utility of standard measures of child
psychopathology in such samples is unclear. Evidence suggests there may be cultural differences
in the description and expression of internalizing behaviors in young children. The current study
aimed to examine mental health in preschool-aged children from Mexican/Mexican-American
farmworker families. Mothers (N = 100) completed measures of child internalizing behavior
(affective [i.e., mood] and anxiety problems; Child Behavior Checklist; CBCL) and impairment
(Impairment Rating Scale; IRS). In addition, a culturally sensitive semi-structured qualitative
interview was used to assess parent-reported behaviors of child internalizing behaviors. CBCL
mood and anxiety problems were found to be associated with child impairment. When examining
the association between quantitative and qualitative data, CBCL mood problems were associated
with qualitative interview mood scores, whereas CBCL anxiety problems were not associated
with interview anxiety scores. In addition, the number of years the mother has spent in the U.S.
did not moderate the relationship between CBCL and interview scores. Qualitative analyses
showed that CBCL mood items and qualitative themes derived from the interviews overlap in
some mother-reported behaviors (e.g., crying, decreased energy levels). However, other
behaviors such as social withdrawal and somatic symptoms were endorsed by mothers as
depressive symptoms on the interview but were not mood items on the CBCL. Qualitative
analyses also showed that CBCL anxiety items generally did not align with themes endorsed by
QUANTITATIVE AND QUALITATIVE CHILD PSYCHOPATHOLOGY 3
mothers in the interviews. Thus the CBCL anxiety scale may not be culturally appropriate for
this particular community of preschool-aged children of Mexican farmworker families. By
identifying culturally relevant emotional problems in this group as well as highlighting
methodological and thematic overlap with and differences between standard and qualitative
measures, this study can provide important information to drive culturally competent health care,
policies, prevention, and interventions for children from farmworker families.
QUANTITATIVE AND QUALITATIVE CHILD PSYCHOPATHOLOGY 4
A Comparison of Quantitative and Qualitative Methods in the Assessment of Internalizing
Behaviors in Preschool-Aged Children from Mexican Farmworker Families
Evidence suggests that symptoms of internalizing problems (including, for example,
anxiety, irritability, sadness) often emerge early in childhood (Bufferd, Dougherty, Carlson, &
Klein, 2011; Bufferd, Dyson, Hernandez, & Wakschlag, 2016; Dougherty et al., 2013, 2015;
Hudson & Dodd, 2012; Luby, Belden, Pautsch, Si, Spitznagel, 2009; Mian, Godoy, Briggs-
Gowan, & Carter, 2012). However, most research has focused on school-aged children (i.e., 6-12
years old) and adolescents; relatively fewer studies have assessed these behaviors in preschool-
aged children aged 3-6 years old (Luby, Si, Belden, Tandan, & Spitznagel, 2009; Mesman,
Bongers, & Koot, 2001; Sterba, Prinstein, & Cox, 2007). In addition, much of the work has been
dedicated to externalizing behaviors (e.g., Reef, Diamantopoulou, van Meurs, Verhulst, & van
der Ende, 2011; Wakschlag et al., 2012, 2014), whereas internalizing behaviors during the
preschool age have often been overlooked (Mesman et al., 2001).
Some researchers posit that the lack of investigation in this age group stems from a belief
that young children simply “grow out” of emotional problems (Lavigne, LeBailly, Hopkins,
Gouze, & Binns, 2009), a fear of “labeling” young children early in their lifespan (Egger &
Angold, 2006), or the perception that is too difficult to reliably measure internalizing behaviors
during a period of rapid development (Sterba et al., 2007). These issues may help explain why
many preschoolers who may benefit from mental health services are never referred for treatment
(Egger & Angold, 2006). However, in the limited work that has investigated internalizing
problems in young children, it appears that some children do show symptoms of impairing
internalizing behaviors as early as the preschool period that persist over time (Birmaher et al.,
QUANTITATIVE AND QUALITATIVE CHILD PSYCHOPATHOLOGY 5
2009; Bufferd, et al., 2011; Bufferd, Dougherty, Carlson, Rose, & Klein, 2012; Franz et al.,
2013; Luby et al., 2009a, 2009b; Mesman et al., 2001).
Despite this growing knowledge base on the impairing and persistent nature of early-
emerging emotional difficulties, researchers have not yet considered cultural expressions and
interpretations of internalizing problems in ethnic minority preschool-aged children. One group
that has been relatively absent from the literature is Mexican/Mexican-American children from
farmworker families. This group is particularly vulnerable to mental health difficulties given the
economic, health, and cultural hardships these families encounter (Evans, 2004; Evans &
English, 2002; Koruk et al., 2010; Raikes & Thompson, 2005; Scararmella, Neppl, Ontai, &
Conger, 2008)
This study sought to examine the level of emotional difficulties in Mexican/Mexican-
American preschool-aged children from farmworker families and identify the similarities and/or
differences between standard assessment of these difficulties and culturally sensitive assessment.
To do so, I conducted a quantitative assessment using standardized measures of internalizing
behavior and impairment in young children to document the rate of internalizing behavior in this
population and compared this method to a culturally-sensitive qualitative assessment in which
descriptive themes were extrapolated from semi-structured interviews to examine whether these
methods revealed similar information.
Internalizing behaviors
Internalizing behaviors are over-controlled and inner-directed behaviors related to
anxiety and depression such as shyness, fear, sadness, and irritability and are often associated
with social isolation and withdrawal (Achenbach & Rescorla, 2000; de Leon Siantz, Coronado,
& Dovydaitis, 2010; Lecompte, Moss, Cyr, & Pascuzzo, 2014; Madigan, Atkinson, Laurin, &
QUANTITATIVE AND QUALITATIVE CHILD PSYCHOPATHOLOGY 6
Benoit, 2013). More specifically, anxiety is marked by intense fear or worry and is associated
with avoidant behaviors in situations that cause anxiety (American Psychiatric Association
[APA], 2000). Depression can include moods such as irritability and feelings of sadness, as well
as symptoms such as diminished sleep and energy, and appetite disturbances (APA, 2000). Some
children demonstrate internalizing behaviors as early as preschool age, including anxiety (Franz
et al., 2013; Henin et al., 2005; Hudson & Dodd, 2012; Mesman et al., 2001, Mian et al., 2012)
and depression (Bufferd et al., 2011, 2014; Dougherty et al., 2010; Lavigne et al., 2009; Luby et
al., 2009a, 2009b).
Studies typically rely on maternal reports that demonstrate preschool-aged children
exhibit symptoms of anxiety and depression and, in some cases, meet criteria for diagnosis
(Bufferd et al., 2011, 2014; Domenèch-Llaberia et al., 2009; Dougherty et al., 2010; Fuhrmann,
Equit, Schmidt, & von Gontard, 2012). Several studies that have examined rates of anxiety and
depression diagnoses in young children based on maternal report have estimated that 0.5-19.6%
met criteria for any anxiety disorder and 0.3-2.1% of preschool-aged children met criteria for
depression (Bufferd et al., 2011; Egger & Angold, 2006; Lavigne et al., 2009). The rates of
preschool psychopathology are roughly similar to that of school-aged children and adolescents
(Bufferd et al., 2011; Copeland, Angold, Shanahan, & Costello, 2014; Egger & Angold, 2006;
Gadow, Sprafkin, & Nolan, 2001).
Despite these efforts to detect early emerging psychopathology, very little work has
focused on examining internalizing problems in Mexican/Mexican-American preschool-aged
children, and even less so with preschool-aged children of Mexican/Mexican-American
farmworker families. One study using maternal-report measures in a farmworker sample found
that 31.5% and 1.9% of their school-age children met criteria for anxiety and depression
QUANTITATIVE AND QUALITATIVE CHILD PSYCHOPATHOLOGY 7
diagnoses, respectively (Kupersmidt & Martin, 1997). In another study with Mexican/Mexican-
American preschool-aged farmworker children that assessed mother-reported internalizing
symptoms, approximately 9% of children fell within the criteria for clinical concern for
internalizing behaviors on a symptom checklist measure (de Leon Siantz et al., 2010). However,
more information is needed about the rate of emotional difficulties in children from these
vulnerable families.
Comorbidity
Some children exhibit co-occurring symptoms or meet criteria for two or more disorders
simultaneously (Wichstrøm & Berg-Nielsen, 2014; Wichstrøm et al., 2012; Wilens et al., 2002).
Similar to older children, adolescents, and adults, comorbid symptoms and disorders are
common in children (Franz et al., 2013; Wichstrøm & Berg-Nielsen, 2014; Wichstrøm et al.,
2012). In particular, anxiety and depression often co-occur in young children (Bufferd et al.,
2011; Egger & Angold, 2006; Lavigne et al., 2009). For example, in a community sample of
Norwegian preschool-aged children, children with an anxiety diagnosis were seven times more
likely to meet criteria for a depression diagnosis than those without an anxiety diagnosis
(Wichstrøm et al., 2012). Similarly, Franz and colleagues (2013) found that in a large sample of
preschool-age children, those with a generalized anxiety disorder were 3.7 times more likely to
also have comorbid depression. For some children, their comorbid symptoms continue
throughout the lifespan (Keiley, Lofthouse, Bates, Dodge, & Pettit, 2003; Lavigne, Hopkins,
Gauze, & Bryant, 2015; Mesman et al., 2001; Sourander et al., 2006). Given this overlap, the
examination of both anxiety and depressive symptoms is important.
QUANTITATIVE AND QUALITATIVE CHILD PSYCHOPATHOLOGY 8
Continuity
Longitudinal studies have enhanced our understanding of the course of internalizing
behaviors from preschool through school-age, adolescence and adulthood (Keiley et al., 2003;
Kessler & Magee, 1994; Mesman et al., 2001; Pihlakoski et al., 2006; Shaw, Keenan, Vondra,
Delliquadri, & Giovannelli, 1997; Sourander et al., 2006). It appears that internalizing behavior
problems that begin early in childhood may remain stable into adolescence and adulthood
(Kovacs & Devlin, 1998; Rapee, 2014). For example, Bufferd and colleagues (2012) reported
that children who met criteria for an anxiety diagnosis at age 3 were approximately four times
more likely to meet criteria for anxiety at age 6 than children who did not meet criteria at age 3.
Similarly, Luby, Gaffrey, Tillman, April, and Belden (2014) found that preschool-onset
depression predicted major depression at age 6, even after controlling for several other risk
factors. These studies suggest that children with emotional problems are at risk for future
disorders. In addition, longitudinal work suggests that many adult disorders have childhood
roots; psychopathology can often be traced back to early stages of development and contribute to
negative outcomes throughout development (Davis & Sandman, 2012; Maughan & Kim-Cohen,
2005; Rutter, Maughan, & Kim-Cohen, 2006). Therefore, it is important to detect
psychopathology early in life to improve children’s developmental trajectories.
Impairment Associated with Internalizing Behavior
Internalizing behavior in preschool-aged children is associated with deficits in several
domains such as peer relationships, academic performance, and family functioning. During early
childhood, children begin to form relationships and develop the ability to regulate their emotions
and behaviors with adults and peers (Bufferd et al., 2016; Dollar & Stifter, 2012). Preschool-
aged children who suffer from psychological problems, such as anxiety and depression, often
QUANTITATIVE AND QUALITATIVE CHILD PSYCHOPATHOLOGY 9
also have impaired relationships with others. For example, teachers of children with these
difficulties are likely to report low social functioning in children (e.g., targets of teasing; not
well-liked by peers; Danzig et al., 2013). In addition, teacher-reports of children’s anxiety and
depression correlated with low academic functioning (e.g., difficulty learning; Dobbs, Doctoroff,
Fisher, & Arnold, 2006). Preschoolers with internalizing behaviors also tend to experience
difficulties with their families. Côté and colleagues (2009) found that family conflict is
associated with escalating levels of anxiety and depressive symptoms in preschool-aged children.
Another study reported that stress and family conflict showed indirect pathways to higher levels
of anxiety and depression in preschool-aged children (Hopkins, Lavigne, Gouze, LeBailly,
Bryant, 2013). In addition, stressful family life events are associated with preschool depression
such that children who have higher number life stress events are susceptible to experiencing
higher levels of depression and anxiety than children who have lower life stress events (Luby,
Belden, & Spitznagel, 2006). Another study found that parents of preschool-aged children with
anxiety were 3.5 times more likely to report that their child’s behavior had a negative impact on
their family’s functioning in comparison to families with children without anxiety disorders
(Towe-Goodman, Franz, Copeland, Angold, & Egger, 2014). Mothers of preschool-aged
children with anxiety have also reported rejecting feelings towards family life (Yurdşen, Erol,
Gençöz, 2013), suggesting that children’s difficulties impair family members as well. Taken
together, these studies provide evidence of the impairment associated with childhood
psychopathology.
Limitations of Previous Studies
Although previous studies have identified the presence of emotional problems in
preschool-aged children, this work has typically lacked investigation of internalizing behavior in