Can young children reliably report their own behavioral problems?


Can young children reliably report their own behavioral problems?
January 31, 2023 MHO

Can young children reliably report their own behavioral problems?

The Child and Adolescent Behavior Assessment (CABA-Y[1]) is a self-report measure of behavioral problems for ages 8 to 18. However, in a sample of inpatient psychiatric care, a quarter of children under eight also used the CABA-Y to rate their own behavioral problems. The CABA-Y was the only assessment most of these children completed, without a similar assessment from the perspective of parents or clinicians. In fact, the CABA-Y was designed with a companion assessment for just that purpose, the CABA-Informant. You may wonder if young children have the cognitive abilities and introspection necessary to rate their own behavioral problems. Researchers have found that with an age-appropriate instrument, they can[2]. Allowing young children to rate their own problems gives voice to their unique perspective on their own experiences. For more insight on using the CABA-Y with children under eight, let’s examine our data!

Compared to their informants, younger children perceived their behavioral problems as less severe at admission (moderate difference) and discharge (small difference). However, we found similar discrepancies in older children as well. Moreover, discrepancies in child-adult informant agreement in rating of behavioral problems are reported across different assessments and ages[3]. Thus, the data supports children under eight can and should report their own behavioral problems, but it’s important to be aware their perspective may differ from an adult’s. Factors such as parental engagement, communication, and family dynamics may influence the degree of agreement between parents and children in assessing problems[4]. Socio-demographic factors also matter including gender of the child. And in the case of a parent informant, if the parent(s) lives with the child, their educational level, and income.

Are two informants better than one?

The literature and our data suggest clinicians would benefit from a multi-informant approach where both the young child and informant complete assessments. When there is a discrepancy, clinicians should investigate the validity or objectivity of ratings and consider what the discrepancy may mean in terms of family relationships or psychosocial status.

More research is needed to validate the CABA-Y for use with younger children. For now, if young children use the CABA-Y, we suggest that clinicians evaluate it with caution. This tool was designed for children with the developmental understanding of at least eight years old. It is likely that clinicians or other adults would need to assist children under 8 in reading or understanding items. And finally, the use of CABA-Y in children under eight can complement, but should not substitute for, rating information from the parent or adult perspective.




[1] Morin, AL., Miller, SJ., Smith, JR., & Johnson, KE. (2017). Reliability and Validity of the Child and Adolescent Behavior Assessment (CABA): A Brief Structured Scale. Child Psychiatry Hum Dev DOI, 48(2):200-213. 10.1007/s10578-016-0632-9

[2] Varni, W. J., Limbers, C. A., & Burwinkle, T. M. (2007). How young can children reliably and validly self-report their health-related quality of life?: An analysis of 8,591 children across age subgroups with the PedsQL™ 4.0 Generic Core Scales, Health and Quality of Life Outcomes, 5(1) doi:10.1186/1477-7525-5-1

[3] De Los Reyes, A., & Kazdin, A. E. (2005). Informant Discrepancies in the Assessment of Childhood Psychopathology: A Critical Review, Theoretical Framework, and Recommendations for Further Study. Psychological Bulletin, 131(4), 483–509.

[4] Roy, BV., Groholt, B., Heyerdahl, S., Clench-Aas., J. (2010). Understanding discrepancies in parent-child reporting of emotional and behavioural problems: Effects of relational and socio-demographic factors. BMC Psychiatry, 10:56,