Quantifying Normative Expression of Internalizing Behaviors in Preschool-Aged Children: Advances Using a Daily Diary Method

• In Event: 1-210 - Improving the Quality and Efficiency of Measurement in Early Life

Integrative Statement

Introduction: Internalizing (i.e., mood and anxiety) behaviors can emerge early in childhood, impair functioning, and persist over time (Egger & Angold, 2006). However, these behaviors (e.g., irritability, sadness, separation anxiety; Gullone, 2000; Muris et al., 1998; Stringaris, 2011) overlap substantially with typical development during the preschool period; without empirical guidelines, it is unclear how to distinguish typical from potentially clinically significant behavior. Assessments usually rely on parents’ judgement of the relative frequency of behaviors in questionnaires and only rating behaviors that meet diagnostic criteria in interviews; further, most assessments are limited by retrospective recall bias. The present study utilized a novel daily diary measure to characterize the range of frequencies of internalizing behavior and limit recall to one day. In addition, more typical measures were used to compare approaches.
Method: We recruited 291 primary caregivers of 3-5-year-olds (Mage=4.3+.8;52.9% female) who completed a 14-day daily diary and reported about children’s mood, separation anxiety, and social anxiety behaviors and impairment. In addition, parents completed the Early Childhood Inventory (ECI) mood, anxiety, and impairment items.
Results: All (291) participants completed at least 7 of 14 diary entries; 271 (93.1%) completed at least 10 days, and 200 (68.7%) completed all 14 days. To examine the frequencies of each behavior, we recoded the distribution across the diary period into ordinal variables (Table 1); the frequencies of items varied such that some items (e.g., distress when anticipating separation; shyness around new people) were more frequent than other items (e.g., separation nightmares; low interest/pleasure). Confirmatory Factor Analysis supported unidimensional constructs each for mood, social and separation anxiety behaviors. To examine item characteristics, graded response models were computed with Item Response Theory using robust maximum likelihood estimation; patterns varied across items (see Table 2 for results). Finally, to compare the novel diary to typical measurement, associations between behavior and impairment were evaluated. Across behaviors, the magnitudes of associations between daily diary behavior and impairment were stronger than between ECI behavior and impairment. Using Fisher r-to-z transformations, the association between diary-rated separation anxiety and impairment (r=.81), for example, was significantly higher than the same association with the ECI (r=.36), p<.001.
Conclusions: These data provide information about the use of a daily diary measure for assessing internalizing behaviors in preschool-aged children. The frequencies of mood and anxiety behaviors were identified, along with item characteristics of each behavior. Patterns varied across items; for example, sadness has to occur 31 times or more over 14 days for the behavior to be considered severe/rare; worry that caregiver would not return and shyness with familiar adults had to occur at least 3-4 times, whereas shyness around peers and new people were not severe at any frequency. In addition, diary-rated associations between internalizing behavior and impairment were significantly stronger than associations identified with a typical measure. Given extensive and rapid development during early childhood, as well as the overlap between psychological symptoms and typical behaviors, these data provide normative information on preschoolers’ behaviors that can enhance empirically-driven assessment of internalizing behaviors.

Authors

• Sara J Bufferd, California State University - San Marcos
  Presenting Author

• Lea R Dougherty, University of Maryland, College Park
  Non-Presenting Author

• Thomas M Olino, Temple University, Department of Psychology
  Non-Presenting Author