Analysis of the Child Behaviour Checklist

Analysis of the Child Behaviour Checklist Chapter II: Literature Review As suggested in the introduction, numerous researchers have explored the prevalence of emotional and behavioural problems across the globe. Researchers have also investigated correlates (e.g., age and gender) associated with emotional and behavioural problems. The psychometric properties of instruments assessing emotional and behavioural problems have also been a subject of interest. In addition, researchers have also investigated cross-cultural similarities and disparities among emotional and behavioural problems. The extensive literature that addresses these issues, and which also helped formulate the rationale for the current study, is presented in five sections. The first section highlights the problems associated with epidemiological studies and compares the two main approaches to epidemiological studies, namely the categorical and the empirical approach. The second section provides a detailed description of the CBCL including the evolution of the measure, its psychometric prope rties, its advantages and disadvantages, as well as its range of applicability. The third section provides a description of the theoretical rationale for assessing cultural similarities and disparities associated with emotional and behavioural problems. Multicultural findings based on the CBCL as well as age and gender differences associated with emotional and behavioural problems are also reported. The fourth section consists of a review of the various processes involved in assessing the psychometric properties of instruments and findings based on psychometric properties of the various translations of the CBCL. The fifth section consists of a brief cultural and socio-political description of Pakistani society followed by a description of the salient features (i.e., family, community and cultural factors) in relation to emotional and behavioural problems in Pakistani society. Finally, there is a description of the objectives of the current study. Epidemiology of Emotional and Behavioural Problems Current reviews of epidemiological studies indicate that there is a high prevalence of emotional and behavioural problems among children and adolescents around the world (Costello et al., 2004; Hackett Hackett, 1999; Waddell et al., 2002). In one review, Costello et al. compared findings across several developed countries (including Canada, the United States, the United Kingdom, Germany and Australia) to investigate the prevalence of emotional and behavioural problems as well as that of other psychological problems. Based on their findings, the overall prevalence rates of psychological problems among children and adolescents had a very broad range (0.1% to 42%), with varying rates for each category of disorder. Categories include disruptive behaviour disorders (i.e., conduct disorder, oppositional disorder and attention deficit hyperactivity disorder), mood disorders (i.e., major depressive disorder and bipolar disorder), anxiety disorders (i.e., phobias, generalized anxiety disorde r, obsessive compulsive disorder, and post-traumatic stress disorder) as well as substance abuse and dependence. A critical examination of the studies included in the review revealed that variations in prevalence rates may be attributed to methodological flaws such as substantial disparity across studies with regard to sample size and the age range assessed. Moreover, differences across studies in terms of the measures used, the criteria employed as well as the type of informant may also have influenced the findings. In contrast to Costello et al.s (2004) review, Waddell et al.s (2002) review was based on more stringent criteria; studies based on samples of similar size and age range, as well as using similar methodology were compared. Based on Waddell et al.s review, the prevalence rates of emotional and behavioural problems varied between 10% and 20%. Although findings from both reviews vary considerably, the prevalence rates of emotional and behavioural problems across developed countries is still high and warrants serious attention. Moreover, methodological disparities across studies underscore the need for a uniform methodology to investigate the prevalence of emotional and behavioural problems. In contrast to developed countries, there are few researchers investigating prevalence rates in developing countries (e.g., Bangladesh, India, Sri lanka, Sudan, and Uganda) (Costello, 2009: Fleitlich-Bilyk Goodman, 2004; Mullick Goodman, 2005; Nikapota, 1991; Prior, Virasinghe, Smart, 2005). Moreover, there is a scarcity of reviews of the existing studies. In one review, Hackett and Hackett (1999) compared results from India, Puerto Rico, Malaysia and Sudan, and the prevalence rates of psychological disorders ranged from 1% to 49%. Similar to research in developed countries, researchers attribute variations in findings to methodological problems across studies, which include an inadequate sample size, paucity of explicit and internationally accepted diagnostic criteria, as well as inconsistencies in assessment procedures (Fleitlich-Bilyk Goodman, 2004). Moreover, prevalence rates among developing countries may also partly be linked to the social, economic and medical environment. For example, lack of medical resources and awareness about psychological problems may result in parents not knowing how to seek help (Gadit, 2007). Social taboos further compound the problem, preventing people from reporting problems and deterring help-seeking behaviour (Samad, Hollis, Prince, Goodman, 2005). More importantly, cultural variations in the conceptualization and identification of psychological problems may result in varied reporting of symptoms (Gadit, 2007). These environmental differences and methodological inconsistencies across studies emphasize the need for a cross-culturally robust methodology to investigate the prevalence of emotional and behavioural problems. Along with methodological problems and environmental differences, emotional and behavioural problems merit investigation because they affect multiple aspects of childrens functioning such as academic performance and social adjustment (Montague et al., 2005; Nelson et al., 2004; Vitaro et al., 2005). Researchers also state that there is high comorbidity among emotional and behavioural problems, (SteinHausen, Metze, Meier, Kannenberg, 1998) which creates multiple problems for children and their caregivers. Moreover, many childhood disorders continue and influence functioning during adulthood. In fact, many adult disorders are now recognized as having roots in childhood vulnerabilities (Maughan Kim-Cohen, 2005; Tremblay et al., 2005). Furthermore, recognizing and treating problems early can reduce the burden of the enormous human and financial costs associated with the assessment and intervention, especially in countries where resources are scarce (Costello, Egger, Angold, 2005; Jame s et al., 2002; Waddell et al., 2002). In addition, cross-cultural epidemiology of childrens emotional and behavioural problems may also better inform current knowledge about the characteristics, course, and correlates of such problems, which in turn provide a scientific basis for appropriate mental health planning (Achenbach Rescorla, 2007; Waddell et al.). Therefore, there is a strong need for a methodology that can be utilized for clinical as well as research purposes to assess emotional and behavioural problems among children and adolescents across cultures. Current literature indicates that there are two main approaches to investigate the epidemiology of emotional and behavioural problems, namely the categorical and the empirical approach. There are several differences in both approaches including conceptualization of psychological problems as well as the methodology employed for their assessment. Both approaches will be discussed briefly. The categorical approach. The categorical approach, based on the biomedical perspective, views psychological problems as a group of maladaptive and distressing behaviours, emotions and thoughts which are qualitatively different from the typical (Cullinan, 2004). That is, similar to medical diseases, an individual may or may not have a specific psychological disorder. Traditional epidemiological studies are based on the categorical approach as embodied in various editions of the Diagnostic and Statistical Manual for Mental Disorders (DSM) (American Psychiatric Association (APA), 1980; 1987; 1994; 2000) and the International Classification of Diseases (WHO, 1978; 1992). Examples of instruments used in traditional epidemiological studies to derive DSM diagnoses include the Diagnostic Interview Schedule for Children (DISC) (Costello, Edelbrock, Kalas, Kessler, Klaric, 1982) and the childrens version of the Schedule for Affective Disorders and Schizophrenia (Kiddie-SADS) (Puig-Antich Ch ambers, 1978). At present, there is considerable debate about the validity of epidemiological studies based on the categorical approach. Researchers have highlighted that inconsistencies in prevalence rates may be due to conceptual and methodological issues linked with the DSM as well as methodological disparities among studies (Achenbach Rescorla, 2007; Waddell et al., 2002). Each of these factors will be discussed briefly. DSM related problems. Multiple conceptual and methodological problems are associated with the DSM. First, the DSM does not provide a methodology to operationally define different psychological disorders (Widiger Clark, 2000). To operationally define DSM criteria, various diagnostic interviews such as the DISC have been developed. Unfortunately, meta-analyses indicate that the diagnoses based on the DISC and other diagnostic interviews are not in agreement with diagnoses made through comprehensive clinical interviews, which indicate that, neither diagnostic nor clinical interviews provide good validity criteria for testing DSM categories (Achenbach, 2005; Costello et al., 2005; Lewczyk et al., 2003). Second, the diagnostic categories and criteria provided in the DSM continue to change as reflected in the changes across the various editions of the DSM, namely the third edition (APA, 1980), third edition revised (APA, 1987), fourth edition (APA, 1994), and fourth edition text revised ( APA, 2000), making comparisons across editions problematic (Achenbach, 2005). Third, although the current version, known as the DSM-IV-text revised (APA, 2000), aims at introducing cultural sensitivity in assessment and diagnoses by including an â€Å"outline for cultural formulation and a glossary of culture-bound syndromes† (APA., 2000, pg. 897), it does not provide criteria or guidelines regarding the use of the classification system with specific cultural groups (Paniagua, 2005). Since many of the DSM diagnostic criteria are based on Euro-American social norms, it is difficult to use the DSM criteria to identify psychopathology in individuals from other cultures. In addition, there is growing consensus among researchers that DSM categories need to be more appropriate for children and adolescents of different ages and gender (Doucette, 2002; Segal Coolidge, 2001). Turk et al. (2007) also highlight the saliency of factors such as age and gender when investigating prevalence rates. However, at present, this is not the case. Costello et al. (2005) have stated that the constant developmental changes of childhood create the need for an age- and gender- specific approach to epidemiology. Before incorporating a developmental perspective in epidemiological studies, it is essential to have a better understanding of developmental psychopathology. Developmental psychopathology is based on the view that problems arise from different causes, manifest themselves differently at each stage, and may have diverse outcomes. Developmental psychologists do not support a specific theory to explain all developmental issues. Instead, they try to incorporate knowledge from multiple disciplines (Cicchetti Dawson, 2002). Moreover, developmental psychopathology also includes an analysis of the existing risk and protective factors within the individual and also in his/her environment over the course of development (Cicchetti Walker, 2003). According to Costello and colleagues (2004), a developmental perspective in epidemiological studies is based on the inclusion of certain principles. First, precise assessment measures for the different phases in childhood and adolescence are required to compare childrens functioning with that of their same-age peers. For example, problems such as fear of dark places is considered typical for 6-year-olds but not for 12-year-olds. Furthermore, the developmental perspective would include longitudinal studies to evaluate the ways in which developmental processes influence the risk of specific psychological disorders. For example, the developmental trajectory of physical aggression is such that there is an increase in Aggressive Behavior during the first few years of childhood, but it progressively decreases until adulthood (Tremblay et al., 2004). Moreover, developmental epidemiology would include frequent assessments to determine the onset of disorders. Frequent assessments would also a ssist in the identification of environmental and individual factors that contribute to the development of psychopathology. Although the developmental perspective emphasises the need for age- and gender-specific diagnostic criteria, longitudinal studies as well as frequent assessments, it is difficult to incorporate this perspective in studies based on the categorical approach as it is not sensitive to developmental changes. Methodological disparities. A critical analysis of categorically based epidemiological studies reveals multiple methodological problems. These include inconsistencies in assessment and sampling procedures as well as absence of guidelines about using data from multiple sources. In terms of assessment procedures, both symptoms as well as significant impairment are required to identify children with disorders. This is corroborated by Costello et al. (2004), who report that the disparity in the prevalence rates of phobias (i.e., 0.1% to 21.9%) may be attributed to how phobias were assessed in each study, in particular, whether both symptoms (e.g., fear of open places, snakes) as well as significant functional impairment were taken into account in the identification of phobias. Waddell et al. (2002) state that the use of standardized measures has lead to an improvement in the assessment of symptoms; however, problems still exist with regard to how impairment is gauged or how measures may be combined to include symptoms as well as impairment. Another problem with assessment procedures is that different interview schedules (e.g., DISC and the Kiddie-SADS) and DSM editions have been used across studies, which may have contributed to differences in prevalence rates. Incompatible sampling procedures may also have led to disparities in overall prevalence rates in categorically based epidemiological studies (Waddell et al., 2002). For example, studies such as the Great Smokey Mountains study (Costello, Angold, Burns, Erkanli, Stangel Tweed, 1996) were relatively more comprehensive, and investigated a larger number of diagnostic categories than other studies. As a result, higher overall prevalence rates of psychological problems were reported compared to studies that did not assess as many disorders. Another sampling issue is that reviews were based on studies that differed with regard to the age range assessed; some studies focused on a younger age bracket (i.e., between 8 to 11 year olds), others on an older age bracket (i.e., 11 years and older), whereas some researches included a very broad age range (i.e., 6 to 17 year olds). In addition, there were inconsistencies across studies in terms of the type of informant used; some studies relied on p arents only, some on children, while some combined data from parents, children as well as teachers. Differences in the age brackets assessed as well as the use of different informants may have contributed to disparities in epidemiological findings. Another salient issue with regard to categorically based epidemiological studies concerns the coordination and interpretation of information from multiple informants. Since problem behaviours may only occur in specific situations or with specific individuals, multiple informants (e.g., teachers, parents and children) are necessary. However, since the respondents context and perception have a great impact on the identification of psychological problems, poor agreement among respondents is frequently reported. For example, children normally report higher rates of internalizing symptoms (e.g., anxiety and depression) while parents tends to report higher rates of externalizing symptoms (e.g., Conduct Problems) (Rubio-Stipec, Fitzmaurice, Murphy, Walker, 2003). Additionally, children are not considered reliable reporters of their own behaviour due to differences in cognitive abilities as well as the ability to report their own behaviour (Achenbach McConaughy, 2003). Despite such finding s, the categorical approach does not provide guidelines regarding obtaining and interpreting data from multiple sources, which complicates matters in terms of how to combine data into yes-or-no decisions about different symptoms. The various conceptual problems associated with the DSM as well as the methodological flaws in epidemiological reviews highlight the problems associated with using the categorical approach as a basis for epidemiological studies. Moreover, these issues underscore the need for an approach that is methodologically sound and culturally appropriate for cross-cultural comparisons. An alternative to problems linked to the categorical approach, where an a priori criterion is imposed, can be a system that is empirically based and identifies problems as they occur in a population. Such an approach would be helpful in highlighting cultural differences in the manifestation of different emotional and behavioural problems. Moreover, there is also a need for a methodology that can be employed in a standardized, systematic fashion. Although the empirical approach is not a panacea for problems associated with epidemiological studies, it does provide solutions to some of the types of errors in the cat egorical system. Empirical or dimensional approach. The empirical or dimensional approach, in accordance with a psychosocial perspective, views mental health as a continuum. The dimensional perspective supports the notion that all individuals experience problems involving behaviours, emotions and thoughts to varying extents. Those who experience such problems to an extreme extent (unusual frequency, duration, intensity, or other aspects) are more likely to have a psychological disorder (Cullinan, 2004). In contrast to imposing a priori criteria on childrens emotional and behavioural problems, the empirical approach identifies problems as they present themselves in the population. According to Cullinan (2004), there are certain steps involved in developing a dimensional classification system for emotional and behavioural problems. These steps include creating a collection of items that reflect measurable problem behaviours experienced by children, identifying a group of children to be studied, assessi ng every child in the group on each problem, and investigating the data to identify items that co-vary, thus leading to the identification of different dimensions or factors. After the dimensions have been derived, the pool of items can be used to assess and classify emotional and behaviour problems among new populations. Given that the empirical approach is based on the identification of co-occurring problem behaviours in the population, instead of imposing a priori criteria, it is a favourable approach for cross-cultural epidemiological studies. Within empirical approaches, the Achenbach System of Empirically Based Assessment (ASEBA) provides a good framework for epidemiological studies for multiple reasons. First, being empirically based, ASEBA identifies emotional and behavioural problems as they occur in the population. Second, it is based on a developmental perspective, has a uniform methodology, and also provides explicit guidelines about using data from multiple sources (Achenbach McConaughy, 1997; Achenbach Rescorla, 2001). Hence it provides solutions to problems that arise in the categorical approach. Moreover, Cullinan (2004) and Krol et al. (2006) state that ASEBA measures have been used more extensively compared to other measures of emotional and behavioural problems, such as the Conners Rating Scale- Revised (Conners,1990) and the Strengths and Difficulties Questionnaire (Goodman, 1997). Achenbach system of empirically based assessment (ASEBA). Although the ASEBA has a non-theoretical, empirical base per se, it is greatly influenced by the principles of developmental psychopathology. For example, Achenbach highlights that problems may include thoughts, behaviours, and emotions that may manifest themselves differently depending on the age and gender of the individual (Greenbaum et al., 2004). Therefore, each ASEBA form provides norms based on the age and gender of the child, which enables an individuals functioning to be assessed in comparison to same-age peers. Furthermore, ASEBA is a multiaxial system that encompasses a family of standardized instruments for the assessment of behavioural and emotional problems as well as adaptive functioning. The five axes of the assessment model include parent (Axis I) and teacher (Axis II) reports, cognitive (Axis III) and physical (Axis IV) assessments as well as the direct assessment of children (Axis V) (Achenbach McConaughy, 2003). The use of different ASEBA instruments provides a s tandardized and uniform methodology to incorporate information from multiple sources. Furthermore, all ASEBA instruments are empirically based. In accordance with the empirical approach, the construction of the ASEBA forms involved a series of steps (Achenbach McConaughy, 2003). Initially, a collection of potential symptom behaviours (i.e., items) was derived from multiple sources. These items were operationally defined in such a manner that respondents not trained in psychological theory could use them. In accordance with general item-development procedures, pilot tests were conducted to evaluate the clarity of items, response scales and item distribution. Finally, items that could differentiate between individuals who were not functioning well and their well functioning same-age peers were retained. Multivariate statistical analyses were applied to the retained items in order to identify syndromes of problems that co-occur. Syndromes were identified purely on the basis of co-occurrence, without any link to a particular cause. Subsequently, the syndromes of co-occur ring problem items were used to construct scales. These scales were used to assess individuals in order to assess the degree to which they exhibit each syndrome. Since all ASEBA instruments are empirically based, findings can be compared on the basis of the manifestation of different emotional and behavioural problems, thereby providing a clearer picture of cross-cultural similarities and disparities of different emotional and behavioural problems. In terms of the historical evolution of the system, ASEBA originated to provide a more differentiated assessment of child and adolescent psychopathology than the DSM. When ASEBA was developed, the first edition of the DSM (APA, 1952) had only two categories for childhood disorders, which included adjustment reactions of childhood and schizophrenic reaction childhood type (Achenbach Rescorla, 2006). In contrast to the DSM, the first ASEBA publication highlighted more syndromes of emotional and behavioural problems (APA, 1952). Moreover, based on factor analyses, Achenbach (1966) identified two broad groupings of problems for which he coined the terms â€Å"Internalizing† and â€Å"Externalizing.† As described earlier, Internalizing Problems included problems with the self, such as anxiety, depression, withdrawal, and Somatic Complaints, without any apparent physical cause. On the other hand, Externalizing Problems included problems with other people, as well as problems linked to non-conformance to social norms and mores, such as aggressive and delinquent behaviour. Although all ASEBA forms are used extensively in clinical and research environments, the Child Behavior Checklist is the most widely recognized measure for the assessment of emotional and behavioural problems (Greenbaum et al., 2004; Webber Plotts, 2008). Child Behavior Checklist An essential part and the cornerstone of Achenbachs multiaxial, empirical system is the Child Behavior Checklist (CBCL). Although the CBCL assesses social competencies as well as problem behaviours, it is widely recognized as a measure of emotional and behavioural problems as opposed to social competencies. In fact, researchers suggest that the CBCL is the most extensively utilized measure for the assessment of problem behaviours among children and adolescents as observed by their parents and caregivers (Krol et al., 2006; Greenbaum et al., 2004). Although there have been multiple revisions to the initial CBCL, all versions have the same format and consist of two distinct sections. The first section measures social competencies. Parents are asked to respond to 20 questions regarding the childs functioning in sports, miscellaneous activities, organizations, jobs and chores, and friendships. Items also cover the childs relations with significant others, how well the child plays and works alone, as well as his/her functioning at school. Finally, respondents describe any known illnesses or disabilities, the issues that concern them the most about the child, and the best things about the child (Achenbach Rescorla, 2006). The second section assesses problem behaviour and consists of 118 items that describe specific emotional and behavioural problems, along with two open-ended items for reporting additional problems. Examples of problem items include â€Å"acts too young for age†, â€Å"cruel to animals†, â€Å"too fe arful or anxious†, and â€Å"unhappy, sad or depressed†. Problem behaviours are organized in a hierarchical factor structure that consists of eight correlated first-order or narrowband syndromes, two correlated second-order or broadband factors (i.e., Internalizing and Externalizing Problems) and an overall Total Problems factor. Parents/caregivers are asked to rate the child with regard to how true each item is at the time of assessment or within the past 6 months. The following scale is used: 0 = not true (as far as you know), 1 = somewhat or sometimes true, and 2 = very true or often true. In the case of respondents with poor reading skills, a non-clinically trained clincian can also admisnter the CBCL (Achenbach Rescorla, 2006). For respondents who cannot read English but can read another language, translations are available in over 85 languages (Berube Achenbach, 2008). Development of the CBCL. The first version of the CBCL dates back to 1983. To date, there have been two revisions of the CBCL; the first one in 1991 followed by the second in 2001, leading to considerable improvements in the measure. The main weakness of the initial CBCL was that comparisons across different age groups and respondents were problematic since syndromes had the same names but different items across different age forms (i.e., 4 to 5, 6 to 11, 12 to 16 years) as well as across different respondent forms (i.e., CBCL, teacher report form [TRF], and the youth self report [YSR]) To rectify the problem, the 1991 version included two new types of syndromes, the core and cross-informant syndromes. Core syndromes represented items that clustered together consistently across age and gender groupings on a single instrument. Cross-informant syndromes were based on those items from the core syndromes that appear on at least two of the three different respondent forms (i.e., CBCL, TRF, and YSR) (Greenbaum et al., 2004). These revisions facilitated comparisons across different age groups and informants. Moreover, the 1991 version of the CBCL also had new national level norms, which included norms for seventeen and eighteen year olds. Apart from practical benefits, changes such as a broader age range and precise criteria for different developmental levels, genders and type of respondents, helped make the CBCL and ASEBA instruments more accurately representative of the developmental perspective of child psychopathology (Greenbaum et al.). Achenbach (1991) also conducted exploratory principal factor analyses of the syndrome scales. Based on the loadings of different syndromes, Achenbach identified Anxious/Depressed, Withdrawn, and Somatic Complaints as indicators of Internalizing Problems, whereas Aggressive and Delinquent Behavior were identified as indicators of Externalizing Problems. Since Social Problems, Thought Problems and Attention Problems did not load consistently on either second-order factor, they were not placed in any group (Achenbach, 1991; Greenbaum et al., 2004). Although Internalizing and Externalizing Problems identify different types of behaviour, the two categories are not mutually exclusive and may co-occur within the same individual. This is supported by research findings that indicate that there was a correlation between the two groups in both clinic-referred (.54) and non-referred (.59) samples matched on the basis of age, sex, race, and income (Achenbach, 1991). Description of the current CBCL. The current CBCL was published in 2001 and covers ages 6 to 18 years (CBCL/6-18; Achenbach Rescorla, 2001). The CBCL/6-18 (Achenbach Rescorla, 2001) provides raw scores, T- scores and percentiles for the following: (1) the three competence scales (Activities, Social, School); (2) the Total Competence scale; (3) the eight cross-informant syndromes; (4) Internalizing and Externalizing Problems and (5) Total Problems. The cross-informant syndromes of the CBCL/6-18 include Aggressive Behavior, Anxious/Depressed, Attention Problems, Rule-Breaking Behavior, Social Problems, Somatic Complaints, Thought Problems, and Withdrawn/Depressed. As far as similarities and differences from previous versions are concerned, the current CBCL introduced some major and a few minor changes. One major change was the introduction of the DSM-oriented scales, based on which CBCL and other ASEBA forms can now be scored in terms of scales that are oriented toward categories of the fourth edition of the DSM (A.P.A., 1994). The introduction of the DSM-oriented scales has combined the categorical and empirical approaches and enables users to view problems in both the categorical and dimensional approaches (Achenbach, Dumenci Rescorla, 2003; Achenbach Rescorla, 2006). The DSM-oriented scales include six categories, namely Affective Problems, Anxiety Problems, Somatic Problems, Attention Deficit/Hyperactivity problems, Oppositional Defiant Problems as well as Conduct Problems. These scales are based on problem items that mental health experts from sixteen cultures across the world rated as being consistent with particular DSM diagnostic cat egories. Similar to the empirically based syndromes, the DSM- oriented scales also have age-, gender- and respondent-specific norms. Another major change was that new normative data was collected using multistage probability sampling in forty U.S. states as well as the District of Columbia. The selected homes were considered to be representative of the continental United States with respect to geographical region, socio-economic status, ethnicity and urbanization (Achenbach Rescorla, 2001). Moreover, complex new analyses based on new clinical and normative samples were conducted. However, the eight syndromes and Internalizing and Externalizing groupings published in 1991 were replicated with minor changes. Research findings indicated that correlations between scores on the 1991 syndromes and their 2001 counterparts ranged from .87 to 1.00 (Achenbach Rescorla, 2001 Analysis of the Child Behaviour Checklist Analysis of the Child Behaviour Checklist Chapter II: Literature Review As suggested in the introduction, numerous researchers have explored the prevalence of emotional and behavioural problems across the globe. Researchers have also investigated correlates (e.g., age and gender) associated with emotional and behavioural problems. The psychometric properties of instruments assessing emotional and behavioural problems have also been a subject of interest. In addition, researchers have also investigated cross-cultural similarities and disparities among emotional and behavioural problems. The extensive literature that addresses these issues, and which also helped formulate the rationale for the current study, is presented in five sections. The first section highlights the problems associated with epidemiological studies and compares the two main approaches to epidemiological studies, namely the categorical and the empirical approach. The second section provides a detailed description of the CBCL including the evolution of the measure, its psychometric prope rties, its advantages and disadvantages, as well as its range of applicability. The third section provides a description of the theoretical rationale for assessing cultural similarities and disparities associated with emotional and behavioural problems. Multicultural findings based on the CBCL as well as age and gender differences associated with emotional and behavioural problems are also reported. The fourth section consists of a review of the various processes involved in assessing the psychometric properties of instruments and findings based on psychometric properties of the various translations of the CBCL. The fifth section consists of a brief cultural and socio-political description of Pakistani society followed by a description of the salient features (i.e., family, community and cultural factors) in relation to emotional and behavioural problems in Pakistani society. Finally, there is a description of the objectives of the current study. Epidemiology of Emotional and Behavioural Problems Current reviews of epidemiological studies indicate that there is a high prevalence of emotional and behavioural problems among children and adolescents around the world (Costello et al., 2004; Hackett Hackett, 1999; Waddell et al., 2002). In one review, Costello et al. compared findings across several developed countries (including Canada, the United States, the United Kingdom, Germany and Australia) to investigate the prevalence of emotional and behavioural problems as well as that of other psychological problems. Based on their findings, the overall prevalence rates of psychological problems among children and adolescents had a very broad range (0.1% to 42%), with varying rates for each category of disorder. Categories include disruptive behaviour disorders (i.e., conduct disorder, oppositional disorder and attention deficit hyperactivity disorder), mood disorders (i.e., major depressive disorder and bipolar disorder), anxiety disorders (i.e., phobias, generalized anxiety disorde r, obsessive compulsive disorder, and post-traumatic stress disorder) as well as substance abuse and dependence. A critical examination of the studies included in the review revealed that variations in prevalence rates may be attributed to methodological flaws such as substantial disparity across studies with regard to sample size and the age range assessed. Moreover, differences across studies in terms of the measures used, the criteria employed as well as the type of informant may also have influenced the findings. In contrast to Costello et al.s (2004) review, Waddell et al.s (2002) review was based on more stringent criteria; studies based on samples of similar size and age range, as well as using similar methodology were compared. Based on Waddell et al.s review, the prevalence rates of emotional and behavioural problems varied between 10% and 20%. Although findings from both reviews vary considerably, the prevalence rates of emotional and behavioural problems across developed countries is still high and warrants serious attention. Moreover, methodological disparities across studies underscore the need for a uniform methodology to investigate the prevalence of emotional and behavioural problems. In contrast to developed countries, there are few researchers investigating prevalence rates in developing countries (e.g., Bangladesh, India, Sri lanka, Sudan, and Uganda) (Costello, 2009: Fleitlich-Bilyk Goodman, 2004; Mullick Goodman, 2005; Nikapota, 1991; Prior, Virasinghe, Smart, 2005). Moreover, there is a scarcity of reviews of the existing studies. In one review, Hackett and Hackett (1999) compared results from India, Puerto Rico, Malaysia and Sudan, and the prevalence rates of psychological disorders ranged from 1% to 49%. Similar to research in developed countries, researchers attribute variations in findings to methodological problems across studies, which include an inadequate sample size, paucity of explicit and internationally accepted diagnostic criteria, as well as inconsistencies in assessment procedures (Fleitlich-Bilyk Goodman, 2004). Moreover, prevalence rates among developing countries may also partly be linked to the social, economic and medical environment. For example, lack of medical resources and awareness about psychological problems may result in parents not knowing how to seek help (Gadit, 2007). Social taboos further compound the problem, preventing people from reporting problems and deterring help-seeking behaviour (Samad, Hollis, Prince, Goodman, 2005). More importantly, cultural variations in the conceptualization and identification of psychological problems may result in varied reporting of symptoms (Gadit, 2007). These environmental differences and methodological inconsistencies across studies emphasize the need for a cross-culturally robust methodology to investigate the prevalence of emotional and behavioural problems. Along with methodological problems and environmental differences, emotional and behavioural problems merit investigation because they affect multiple aspects of childrens functioning such as academic performance and social adjustment (Montague et al., 2005; Nelson et al., 2004; Vitaro et al., 2005). Researchers also state that there is high comorbidity among emotional and behavioural problems, (SteinHausen, Metze, Meier, Kannenberg, 1998) which creates multiple problems for children and their caregivers. Moreover, many childhood disorders continue and influence functioning during adulthood. In fact, many adult disorders are now recognized as having roots in childhood vulnerabilities (Maughan Kim-Cohen, 2005; Tremblay et al., 2005). Furthermore, recognizing and treating problems early can reduce the burden of the enormous human and financial costs associated with the assessment and intervention, especially in countries where resources are scarce (Costello, Egger, Angold, 2005; Jame s et al., 2002; Waddell et al., 2002). In addition, cross-cultural epidemiology of childrens emotional and behavioural problems may also better inform current knowledge about the characteristics, course, and correlates of such problems, which in turn provide a scientific basis for appropriate mental health planning (Achenbach Rescorla, 2007; Waddell et al.). Therefore, there is a strong need for a methodology that can be utilized for clinical as well as research purposes to assess emotional and behavioural problems among children and adolescents across cultures. Current literature indicates that there are two main approaches to investigate the epidemiology of emotional and behavioural problems, namely the categorical and the empirical approach. There are several differences in both approaches including conceptualization of psychological problems as well as the methodology employed for their assessment. Both approaches will be discussed briefly. The categorical approach. The categorical approach, based on the biomedical perspective, views psychological problems as a group of maladaptive and distressing behaviours, emotions and thoughts which are qualitatively different from the typical (Cullinan, 2004). That is, similar to medical diseases, an individual may or may not have a specific psychological disorder. Traditional epidemiological studies are based on the categorical approach as embodied in various editions of the Diagnostic and Statistical Manual for Mental Disorders (DSM) (American Psychiatric Association (APA), 1980; 1987; 1994; 2000) and the International Classification of Diseases (WHO, 1978; 1992). Examples of instruments used in traditional epidemiological studies to derive DSM diagnoses include the Diagnostic Interview Schedule for Children (DISC) (Costello, Edelbrock, Kalas, Kessler, Klaric, 1982) and the childrens version of the Schedule for Affective Disorders and Schizophrenia (Kiddie-SADS) (Puig-Antich Ch ambers, 1978). At present, there is considerable debate about the validity of epidemiological studies based on the categorical approach. Researchers have highlighted that inconsistencies in prevalence rates may be due to conceptual and methodological issues linked with the DSM as well as methodological disparities among studies (Achenbach Rescorla, 2007; Waddell et al., 2002). Each of these factors will be discussed briefly. DSM related problems. Multiple conceptual and methodological problems are associated with the DSM. First, the DSM does not provide a methodology to operationally define different psychological disorders (Widiger Clark, 2000). To operationally define DSM criteria, various diagnostic interviews such as the DISC have been developed. Unfortunately, meta-analyses indicate that the diagnoses based on the DISC and other diagnostic interviews are not in agreement with diagnoses made through comprehensive clinical interviews, which indicate that, neither diagnostic nor clinical interviews provide good validity criteria for testing DSM categories (Achenbach, 2005; Costello et al., 2005; Lewczyk et al., 2003). Second, the diagnostic categories and criteria provided in the DSM continue to change as reflected in the changes across the various editions of the DSM, namely the third edition (APA, 1980), third edition revised (APA, 1987), fourth edition (APA, 1994), and fourth edition text revised ( APA, 2000), making comparisons across editions problematic (Achenbach, 2005). Third, although the current version, known as the DSM-IV-text revised (APA, 2000), aims at introducing cultural sensitivity in assessment and diagnoses by including an â€Å"outline for cultural formulation and a glossary of culture-bound syndromes† (APA., 2000, pg. 897), it does not provide criteria or guidelines regarding the use of the classification system with specific cultural groups (Paniagua, 2005). Since many of the DSM diagnostic criteria are based on Euro-American social norms, it is difficult to use the DSM criteria to identify psychopathology in individuals from other cultures. In addition, there is growing consensus among researchers that DSM categories need to be more appropriate for children and adolescents of different ages and gender (Doucette, 2002; Segal Coolidge, 2001). Turk et al. (2007) also highlight the saliency of factors such as age and gender when investigating prevalence rates. However, at present, this is not the case. Costello et al. (2005) have stated that the constant developmental changes of childhood create the need for an age- and gender- specific approach to epidemiology. Before incorporating a developmental perspective in epidemiological studies, it is essential to have a better understanding of developmental psychopathology. Developmental psychopathology is based on the view that problems arise from different causes, manifest themselves differently at each stage, and may have diverse outcomes. Developmental psychologists do not support a specific theory to explain all developmental issues. Instead, they try to incorporate knowledge from multiple disciplines (Cicchetti Dawson, 2002). Moreover, developmental psychopathology also includes an analysis of the existing risk and protective factors within the individual and also in his/her environment over the course of development (Cicchetti Walker, 2003). According to Costello and colleagues (2004), a developmental perspective in epidemiological studies is based on the inclusion of certain principles. First, precise assessment measures for the different phases in childhood and adolescence are required to compare childrens functioning with that of their same-age peers. For example, problems such as fear of dark places is considered typical for 6-year-olds but not for 12-year-olds. Furthermore, the developmental perspective would include longitudinal studies to evaluate the ways in which developmental processes influence the risk of specific psychological disorders. For example, the developmental trajectory of physical aggression is such that there is an increase in Aggressive Behavior during the first few years of childhood, but it progressively decreases until adulthood (Tremblay et al., 2004). Moreover, developmental epidemiology would include frequent assessments to determine the onset of disorders. Frequent assessments would also a ssist in the identification of environmental and individual factors that contribute to the development of psychopathology. Although the developmental perspective emphasises the need for age- and gender-specific diagnostic criteria, longitudinal studies as well as frequent assessments, it is difficult to incorporate this perspective in studies based on the categorical approach as it is not sensitive to developmental changes. Methodological disparities. A critical analysis of categorically based epidemiological studies reveals multiple methodological problems. These include inconsistencies in assessment and sampling procedures as well as absence of guidelines about using data from multiple sources. In terms of assessment procedures, both symptoms as well as significant impairment are required to identify children with disorders. This is corroborated by Costello et al. (2004), who report that the disparity in the prevalence rates of phobias (i.e., 0.1% to 21.9%) may be attributed to how phobias were assessed in each study, in particular, whether both symptoms (e.g., fear of open places, snakes) as well as significant functional impairment were taken into account in the identification of phobias. Waddell et al. (2002) state that the use of standardized measures has lead to an improvement in the assessment of symptoms; however, problems still exist with regard to how impairment is gauged or how measures may be combined to include symptoms as well as impairment. Another problem with assessment procedures is that different interview schedules (e.g., DISC and the Kiddie-SADS) and DSM editions have been used across studies, which may have contributed to differences in prevalence rates. Incompatible sampling procedures may also have led to disparities in overall prevalence rates in categorically based epidemiological studies (Waddell et al., 2002). For example, studies such as the Great Smokey Mountains study (Costello, Angold, Burns, Erkanli, Stangel Tweed, 1996) were relatively more comprehensive, and investigated a larger number of diagnostic categories than other studies. As a result, higher overall prevalence rates of psychological problems were reported compared to studies that did not assess as many disorders. Another sampling issue is that reviews were based on studies that differed with regard to the age range assessed; some studies focused on a younger age bracket (i.e., between 8 to 11 year olds), others on an older age bracket (i.e., 11 years and older), whereas some researches included a very broad age range (i.e., 6 to 17 year olds). In addition, there were inconsistencies across studies in terms of the type of informant used; some studies relied on p arents only, some on children, while some combined data from parents, children as well as teachers. Differences in the age brackets assessed as well as the use of different informants may have contributed to disparities in epidemiological findings. Another salient issue with regard to categorically based epidemiological studies concerns the coordination and interpretation of information from multiple informants. Since problem behaviours may only occur in specific situations or with specific individuals, multiple informants (e.g., teachers, parents and children) are necessary. However, since the respondents context and perception have a great impact on the identification of psychological problems, poor agreement among respondents is frequently reported. For example, children normally report higher rates of internalizing symptoms (e.g., anxiety and depression) while parents tends to report higher rates of externalizing symptoms (e.g., Conduct Problems) (Rubio-Stipec, Fitzmaurice, Murphy, Walker, 2003). Additionally, children are not considered reliable reporters of their own behaviour due to differences in cognitive abilities as well as the ability to report their own behaviour (Achenbach McConaughy, 2003). Despite such finding s, the categorical approach does not provide guidelines regarding obtaining and interpreting data from multiple sources, which complicates matters in terms of how to combine data into yes-or-no decisions about different symptoms. The various conceptual problems associated with the DSM as well as the methodological flaws in epidemiological reviews highlight the problems associated with using the categorical approach as a basis for epidemiological studies. Moreover, these issues underscore the need for an approach that is methodologically sound and culturally appropriate for cross-cultural comparisons. An alternative to problems linked to the categorical approach, where an a priori criterion is imposed, can be a system that is empirically based and identifies problems as they occur in a population. Such an approach would be helpful in highlighting cultural differences in the manifestation of different emotional and behavioural problems. Moreover, there is also a need for a methodology that can be employed in a standardized, systematic fashion. Although the empirical approach is not a panacea for problems associated with epidemiological studies, it does provide solutions to some of the types of errors in the cat egorical system. Empirical or dimensional approach. The empirical or dimensional approach, in accordance with a psychosocial perspective, views mental health as a continuum. The dimensional perspective supports the notion that all individuals experience problems involving behaviours, emotions and thoughts to varying extents. Those who experience such problems to an extreme extent (unusual frequency, duration, intensity, or other aspects) are more likely to have a psychological disorder (Cullinan, 2004). In contrast to imposing a priori criteria on childrens emotional and behavioural problems, the empirical approach identifies problems as they present themselves in the population. According to Cullinan (2004), there are certain steps involved in developing a dimensional classification system for emotional and behavioural problems. These steps include creating a collection of items that reflect measurable problem behaviours experienced by children, identifying a group of children to be studied, assessi ng every child in the group on each problem, and investigating the data to identify items that co-vary, thus leading to the identification of different dimensions or factors. After the dimensions have been derived, the pool of items can be used to assess and classify emotional and behaviour problems among new populations. Given that the empirical approach is based on the identification of co-occurring problem behaviours in the population, instead of imposing a priori criteria, it is a favourable approach for cross-cultural epidemiological studies. Within empirical approaches, the Achenbach System of Empirically Based Assessment (ASEBA) provides a good framework for epidemiological studies for multiple reasons. First, being empirically based, ASEBA identifies emotional and behavioural problems as they occur in the population. Second, it is based on a developmental perspective, has a uniform methodology, and also provides explicit guidelines about using data from multiple sources (Achenbach McConaughy, 1997; Achenbach Rescorla, 2001). Hence it provides solutions to problems that arise in the categorical approach. Moreover, Cullinan (2004) and Krol et al. (2006) state that ASEBA measures have been used more extensively compared to other measures of emotional and behavioural problems, such as the Conners Rating Scale- Revised (Conners,1990) and the Strengths and Difficulties Questionnaire (Goodman, 1997). Achenbach system of empirically based assessment (ASEBA). Although the ASEBA has a non-theoretical, empirical base per se, it is greatly influenced by the principles of developmental psychopathology. For example, Achenbach highlights that problems may include thoughts, behaviours, and emotions that may manifest themselves differently depending on the age and gender of the individual (Greenbaum et al., 2004). Therefore, each ASEBA form provides norms based on the age and gender of the child, which enables an individuals functioning to be assessed in comparison to same-age peers. Furthermore, ASEBA is a multiaxial system that encompasses a family of standardized instruments for the assessment of behavioural and emotional problems as well as adaptive functioning. The five axes of the assessment model include parent (Axis I) and teacher (Axis II) reports, cognitive (Axis III) and physical (Axis IV) assessments as well as the direct assessment of children (Axis V) (Achenbach McConaughy, 2003). The use of different ASEBA instruments provides a s tandardized and uniform methodology to incorporate information from multiple sources. Furthermore, all ASEBA instruments are empirically based. In accordance with the empirical approach, the construction of the ASEBA forms involved a series of steps (Achenbach McConaughy, 2003). Initially, a collection of potential symptom behaviours (i.e., items) was derived from multiple sources. These items were operationally defined in such a manner that respondents not trained in psychological theory could use them. In accordance with general item-development procedures, pilot tests were conducted to evaluate the clarity of items, response scales and item distribution. Finally, items that could differentiate between individuals who were not functioning well and their well functioning same-age peers were retained. Multivariate statistical analyses were applied to the retained items in order to identify syndromes of problems that co-occur. Syndromes were identified purely on the basis of co-occurrence, without any link to a particular cause. Subsequently, the syndromes of co-occur ring problem items were used to construct scales. These scales were used to assess individuals in order to assess the degree to which they exhibit each syndrome. Since all ASEBA instruments are empirically based, findings can be compared on the basis of the manifestation of different emotional and behavioural problems, thereby providing a clearer picture of cross-cultural similarities and disparities of different emotional and behavioural problems. In terms of the historical evolution of the system, ASEBA originated to provide a more differentiated assessment of child and adolescent psychopathology than the DSM. When ASEBA was developed, the first edition of the DSM (APA, 1952) had only two categories for childhood disorders, which included adjustment reactions of childhood and schizophrenic reaction childhood type (Achenbach Rescorla, 2006). In contrast to the DSM, the first ASEBA publication highlighted more syndromes of emotional and behavioural problems (APA, 1952). Moreover, based on factor analyses, Achenbach (1966) identified two broad groupings of problems for which he coined the terms â€Å"Internalizing† and â€Å"Externalizing.† As described earlier, Internalizing Problems included problems with the self, such as anxiety, depression, withdrawal, and Somatic Complaints, without any apparent physical cause. On the other hand, Externalizing Problems included problems with other people, as well as problems linked to non-conformance to social norms and mores, such as aggressive and delinquent behaviour. Although all ASEBA forms are used extensively in clinical and research environments, the Child Behavior Checklist is the most widely recognized measure for the assessment of emotional and behavioural problems (Greenbaum et al., 2004; Webber Plotts, 2008). Child Behavior Checklist An essential part and the cornerstone of Achenbachs multiaxial, empirical system is the Child Behavior Checklist (CBCL). Although the CBCL assesses social competencies as well as problem behaviours, it is widely recognized as a measure of emotional and behavioural problems as opposed to social competencies. In fact, researchers suggest that the CBCL is the most extensively utilized measure for the assessment of problem behaviours among children and adolescents as observed by their parents and caregivers (Krol et al., 2006; Greenbaum et al., 2004). Although there have been multiple revisions to the initial CBCL, all versions have the same format and consist of two distinct sections. The first section measures social competencies. Parents are asked to respond to 20 questions regarding the childs functioning in sports, miscellaneous activities, organizations, jobs and chores, and friendships. Items also cover the childs relations with significant others, how well the child plays and works alone, as well as his/her functioning at school. Finally, respondents describe any known illnesses or disabilities, the issues that concern them the most about the child, and the best things about the child (Achenbach Rescorla, 2006). The second section assesses problem behaviour and consists of 118 items that describe specific emotional and behavioural problems, along with two open-ended items for reporting additional problems. Examples of problem items include â€Å"acts too young for age†, â€Å"cruel to animals†, â€Å"too fe arful or anxious†, and â€Å"unhappy, sad or depressed†. Problem behaviours are organized in a hierarchical factor structure that consists of eight correlated first-order or narrowband syndromes, two correlated second-order or broadband factors (i.e., Internalizing and Externalizing Problems) and an overall Total Problems factor. Parents/caregivers are asked to rate the child with regard to how true each item is at the time of assessment or within the past 6 months. The following scale is used: 0 = not true (as far as you know), 1 = somewhat or sometimes true, and 2 = very true or often true. In the case of respondents with poor reading skills, a non-clinically trained clincian can also admisnter the CBCL (Achenbach Rescorla, 2006). For respondents who cannot read English but can read another language, translations are available in over 85 languages (Berube Achenbach, 2008). Development of the CBCL. The first version of the CBCL dates back to 1983. To date, there have been two revisions of the CBCL; the first one in 1991 followed by the second in 2001, leading to considerable improvements in the measure. The main weakness of the initial CBCL was that comparisons across different age groups and respondents were problematic since syndromes had the same names but different items across different age forms (i.e., 4 to 5, 6 to 11, 12 to 16 years) as well as across different respondent forms (i.e., CBCL, teacher report form [TRF], and the youth self report [YSR]) To rectify the problem, the 1991 version included two new types of syndromes, the core and cross-informant syndromes. Core syndromes represented items that clustered together consistently across age and gender groupings on a single instrument. Cross-informant syndromes were based on those items from the core syndromes that appear on at least two of the three different respondent forms (i.e., CBCL, TRF, and YSR) (Greenbaum et al., 2004). These revisions facilitated comparisons across different age groups and informants. Moreover, the 1991 version of the CBCL also had new national level norms, which included norms for seventeen and eighteen year olds. Apart from practical benefits, changes such as a broader age range and precise criteria for different developmental levels, genders and type of respondents, helped make the CBCL and ASEBA instruments more accurately representative of the developmental perspective of child psychopathology (Greenbaum et al.). Achenbach (1991) also conducted exploratory principal factor analyses of the syndrome scales. Based on the loadings of different syndromes, Achenbach identified Anxious/Depressed, Withdrawn, and Somatic Complaints as indicators of Internalizing Problems, whereas Aggressive and Delinquent Behavior were identified as indicators of Externalizing Problems. Since Social Problems, Thought Problems and Attention Problems did not load consistently on either second-order factor, they were not placed in any group (Achenbach, 1991; Greenbaum et al., 2004). Although Internalizing and Externalizing Problems identify different types of behaviour, the two categories are not mutually exclusive and may co-occur within the same individual. This is supported by research findings that indicate that there was a correlation between the two groups in both clinic-referred (.54) and non-referred (.59) samples matched on the basis of age, sex, race, and income (Achenbach, 1991). Description of the current CBCL. The current CBCL was published in 2001 and covers ages 6 to 18 years (CBCL/6-18; Achenbach Rescorla, 2001). The CBCL/6-18 (Achenbach Rescorla, 2001) provides raw scores, T- scores and percentiles for the following: (1) the three competence scales (Activities, Social, School); (2) the Total Competence scale; (3) the eight cross-informant syndromes; (4) Internalizing and Externalizing Problems and (5) Total Problems. The cross-informant syndromes of the CBCL/6-18 include Aggressive Behavior, Anxious/Depressed, Attention Problems, Rule-Breaking Behavior, Social Problems, Somatic Complaints, Thought Problems, and Withdrawn/Depressed. As far as similarities and differences from previous versions are concerned, the current CBCL introduced some major and a few minor changes. One major change was the introduction of the DSM-oriented scales, based on which CBCL and other ASEBA forms can now be scored in terms of scales that are oriented toward categories of the fourth edition of the DSM (A.P.A., 1994). The introduction of the DSM-oriented scales has combined the categorical and empirical approaches and enables users to view problems in both the categorical and dimensional approaches (Achenbach, Dumenci Rescorla, 2003; Achenbach Rescorla, 2006). The DSM-oriented scales include six categories, namely Affective Problems, Anxiety Problems, Somatic Problems, Attention Deficit/Hyperactivity problems, Oppositional Defiant Problems as well as Conduct Problems. These scales are based on problem items that mental health experts from sixteen cultures across the world rated as being consistent with particular DSM diagnostic cat egories. Similar to the empirically based syndromes, the DSM- oriented scales also have age-, gender- and respondent-specific norms. Another major change was that new normative data was collected using multistage probability sampling in forty U.S. states as well as the District of Columbia. The selected homes were considered to be representative of the continental United States with respect to geographical region, socio-economic status, ethnicity and urbanization (Achenbach Rescorla, 2001). Moreover, complex new analyses based on new clinical and normative samples were conducted. However, the eight syndromes and Internalizing and Externalizing groupings published in 1991 were replicated with minor changes. Research findings indicated that correlations between scores on the 1991 syndromes and their 2001 counterparts ranged from .87 to 1.00 (Achenbach Rescorla, 2001

Saying No to Bribes †The Infosys Way

Corruption is widespread in every walk of life in many parts of the world. It is difficult to define and identify corruption in black and white. Bribing is a form of corruption many corporate bodies try to indulge. Companies like Infosys disagreed with Government and other contractors who take to corruption considering it as the way of the world phenomenon. Ultimately, the Infosys strategy worked and the message to the corporate world is that honesty, transparency and fairness can make you win irrespective of the corrupt environment around you. This gives a new insight in to the Virtue Matrix and suggests that a new socially responsible corporate world is in the offing. Saying No to Bribes – The Infosys Way The Cut Out Tasks As a Regional Sales Manager of South East Asia, located in Philippines, I prefer to take the bull by the horns. I have a tough time meeting my corporate goals. There are competitors. I understand my responsibilities that I owe to my employer. I do not have the freedom to show an entirely antagonistic approach to the existing forms of corruption. But I certainly have the freedom to choose the gradient with which I could maneuver scenarios that involve bribing either directly or indirectly. I am proud of Narayana Murthy of Infosys who asked the customs official â€Å"What is the alternative to paying bribe? † and later he decided â€Å"We will just do that. † (Abdelal, Di Tella & Kothandaraman, 2007) It was a threatening moment for Infosys politically and financially at the start-up. The question was raised whether Narayana Murthy had succeeded in corporate governance by being anti-corrupt. The answer very much lies in the fact that the Indian Government awarded Narayana Murthy with the corporate governance award in 2000. Infosys grew fabulously. Today it is known for transparency, honesty and trustworthiness. Besides, it stands as a role model inspiring the corporate world. I would avert any situation that lures me towards corruption and solely benefits me. I would be religious in deciding between choices. The hypothetical case narrated by Narayana Murthy that ‘if he were traveling in Siberia alone and a lady was ready to have a consensual relationship with him, he would deny it’ is a fine example that conscience governs us in our walk of life (Abdelal, Di Tella, Kothandaraman, 2007). The Infosys Strategy Next, I would think from a different perspective – the Infosys strategy. If Infosys could say no to bribe and overcome difficult times at its start-up phase, why not my company? Where there is a will, there is a way. I would like to develop my team with a positive note and motivate the team members to vie for an identity. Identity is earned through honest practices, transparency, sincerity, by being qualitative and competent in business. The first and serious test for Infosys was threatening both financially and politically when they did not have an identity. At a later stage, Narayana Murthy noted â€Å"We have had zero trouble with customs since then† (Abdelal, Di Tella, Kothandaraman, 2007). Other companies like Tata Consulting Services and Wipro followed its path to remain non-corrupt in their dealings. When a company is given to corruption for whatsoever reason, there is no guarantee that it would be in compliance with socially responsible behaviors. Companies like Infosys with its honesty, integrity, and transparency, will be able to keep in tact the civil foundation at the time of less healthy economies. During troubled times, only the trusted senior management of a company can avert the risks involved to perform well in the strategic frontier of the Virtue Matrix. The able leadership ingrained with corporate virtue alone can work in the growth and interests of the company that maintains equilibrium among shareholders, employees, their communities, and the environment. Besides the above-mentioned factors, the role of Government is vital in assisting the companies with policies that are impartial and supportive. This in turn will help the companies build socially responsible relations. The Infosys strategy is certainly the right strategy to build the civil foundation in India but with expectations still awaiting from all sides. There is a growing trend of many companies following at least a minimal degree of social responsibility. This is an indication that building a civil foundation in India using Virtue Matrix is a near possibility. The Growing Trend in Asia The last three decades have witnessed a lot of political and economic changes in the Asian countries. The pressure and demand by the Non-Governmental Organizations, regulators and the social organizations on corporate companies are more. The combined effort of Non-Governmental Organizations and a strong legal system can drive away corruption and improve working conditions as it is already happening in South Asia. By and large many companies started showing interests in social and environmental responsibilities. The scope of stepping up this positive trend lies in wise adaptation of the Virtue Matrix by the companies in Asia. However, the fact that corruption in many Asian countries compared to many European countries is high, makes it difficult to bring a drastic change (Abdelal, Di Tella, & Kothandaraman, 2007). Guarding S and E Corruption is an epidemic which could spread down the hierarchy following the pecking order. Only if the top order is non-corrupt and lead by example, the others in the company will follow it. When honesty and integrity are flouted by bribing, the company cannot show an impeccable face towards Skills and Engagements. If at all it does, it is in the self interests of the company for the sake of revenue. The companies should have ethics and corporate virtue while developing technology. This will promote socially responsible attitudes and avoid infringing the rights or utilizing the skill sets to their advantage.

Attention Deficit Hyperactivity Disorder ( Adhd ) - 966 Words

Attention Deficit Hyperactivity Disorder, (ADHD), all the more usually alluded to as Include (Attention Deficit Disorder) has just as of late come to notice of researchers. It affects 3.5 million individuals less than 18 years old and 5 million individuals beyond 18 years old. Its present reason for presence is because of deformities at neurotransmitter destinations, rendering patients unmindful and indiscreet. Nonetheless, consistently more advance is made in finding the cause and discovering more compelling medicines. ADHD s first determination was made in 1902 by Dr. George Still. He watched 20 kids who were oblivious, rash, hyperactive, and indicated inclination swings. He at first ascribed their conduct to mellow cerebrum harm. By 1917 ADHD or always dynamic was still thought to have this cause. As of now, popular encephalitis appeared to be connected to the illness in light of the fact that, subsequent to being tainted, kids had impeded consideration, memory, and motivation con trol. In 1937 ADHD was known as insignificant cerebrum brokenness and started to be treated with amphetamines, which made kids with the turmoil much more quiet. The Diagnostical and Measurable Manual of Mental Issue, Fourth Version (DSM-IV, the order manual that all analysts and specialists use in the United States) has cumulated all the different practices of youngsters with ADHD and recorded 9 trademark side effects of ADHD: 1. Often has difficulty awaiting turn 2. Interrupts or intrudesShow MoreRelatedAttention Deficit Hyperactivity Disorder ( Adhd )1710 Words   |  7 Pages Attention-deficit hyperactivity disorder or ADHD which is often referred to as childhood hyperactivity, it s a severe and chronic disorder for children. It is one of the most prevalent childhood disorders, and affects 3% to 5% of the school-age population. Boys outnumber girls three or more to one. Children with ADHD can experience many behavioral difficulties that often manifest in the form of inattention, being easily distracted, being impulsive, and hyperactivity. As a result, children withRead MoreAttention Deficit Hyperactivity Disorder ( Adhd )1744 Words   |  7 PagesI chose to research Attention-Deficit Hyperactivity Disorder, otherwise known as ADHD, in culture and child development for the following reasons. First, it is important as educators that we understand the difference between restlessness and Attention-Deficit Hyperactivity Disorder in children. Secondly, we must be conscious of the origins of ADHD, how to recognize it, the myths and prejudices against it, and kn ow the most appropriate intervention strategies. 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For some people, however, the problems that occur slim to none in our life occurs in the lives of theirs every day and interfere with every aspect of their life inclusive of home, academic, social and work. . The interaction of core ADHD symptoms with co-morbid problems and neuropsychological deï ¬ cits suggests that individuals with ADHD are likely to experience problems in academicRead MoreAttention Deficit Hyperactivity Disorder (ADHD)1259 Words   |  5 PagesAttention Deficit Hyperactivity Disorder (ADHD) is the most commonly found disorder in children in the United States. Statistics show that the male to female ratio for children with ADHD is eight to one. 4.4 million Children between the ages four to seventeen have diagnosed with ADHD (Cheng Tina L et al.). African American children are at a higher risk for having ADHD. Caucasian children are least likely to have ADHD. 2.5 million children receive medication for ADHD, but African American childrenRead MoreAttention Deficit Hyperactivity Disorder ( Adhd )1002 Words   |  5 PagesAbstract There are many disorders that are first diagnosed whether it is during infancy, childhood or adolescence. The disorders range from intellectual disabilities, learning disabilities, communication disorders, all the way through to elimination disorders. Attention-deficit and disruptive disorders are the most common. All including AD/HD, conduct disorder, oppositional defiant disorder, and unspecified disruptive disorder. Attention deficit hyperactivity disorder is one of the most commonRead MoreAttention Deficit Hyperactivity Disorder ( Adhd )1058 Words   |  5 Pagesfrom disorders such as Attention Deficit Hyperactivity Disorder (or ADHD/ADD.) While much is known about these disorders and how they affect the education of children, there are only a few known methods that consistently help an affected child focus and target in on what they need to learn. Medication for children With Attention Deficit (Hyperactivity) Disorder must be used as an aid to help the affected child to focus and comprehend information being presented to them. Children with Attention DeficitRead MoreAttention Deficit Hyperactivity Disorder ( Adhd )978 Words   |  4 Pagesin diagnoses of attention deficit hyperactivity disorder (ADHD) in children since the 21st century. Per the Centers for Disease Control and Prevention the increase has been seen as a difference from, â€Å"7.8% in 2003 to 9.5% in 2007 and to 11.0% in 2011† (p. 4). Many questions arise concerning why the numbers are on the rise, especially when boys are 7.6 percent more likely than girls to receive the diagnosis of ADHD. When should the line be drawn between a disorder, and hyperactivity that comes withRead MoreAttention Deficit Hyperactivity Disorder ( Adhd )1552 Words   |  7 PagesATTENTION DEFICIT HYPERACTIVITY DISORDER Seth was a second grader at West Elementary. He constantly got reprimanded by his teachers for not paying attention in class. He could not understand the information given to him during the school day. He thought he was stupid and useless. But he was not. His parents got him tested by a doctor for ADHD. He is one of many kids in the United States who have been recognized as having it. Attention Deficit Hyperactivity Disorder is a major issue in the educationRead MoreAttention Deficit Hyperactivity Disorder ( Adhd ) Essay700 Words   |  3 PagesWhat is ADHD? Attention Deficit Hyperactivity Disorder (ADHD) affects almost 10% of American children between 13 and 18 years old, as well as 4% of U.S. adults over 18. 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Children Dealing with Life and Death - 1903 Words

Most children ponder the thought of what life would be like without their parents. They imagine how amazing and fun a life filled with jokes and no rules would be. Not even having to go to school if you did not want to. Except this is not how life works. When a parent dies and the reality sets in, it quickly shows us that life is not all fun and games. The death of a parent is a devastating reality for any young child to bare. This abrupt reality may have long lasting effects as each child has their own unique way of perceiving life’s events. In the blink of an eye ones world may be completely twisted around. This kind of tragedy has the ability to shape a child in both negative and positive ways. They are now faced with the task of†¦show more content†¦Another type of death is one by tragedy that can be unexpected and can be more devastating than prolonged death in that it occurs suddenly and without notice. More often than not parents die unexpectedly and their chi ldren are left behind in a big scary world with no guidelines on how to survive. In part this is because parents do not expect to die while their child or children are still young. Planning ahead for the future can be difficult for parents emotionally as well as culturally and in some cases even financially. Initially when a parent dies it seems as if they have all the support in the world by people who love them. Most people seem to think that after a year or more children should be well adjusted, happy and have made it through their traumatic loss. A child’s perspective may seem different in fact they may feel more alone. A child named Abby had this to say about that topic â€Å"The pain got worse! Because the initial shock wears off, people stop coming to your house, and you are left†¦.with yourself† (Simon, Johnson 49). What most people do not realize is that they still are not okay. No one can completely prepare for the unknown when a child loses a parent no one can predict how each child will grieve. The caretaker of the child who is grieving has the responsibility of trying to understand the child’s thoughts or questions. When a child’s parent has died adjusting to a new way of life can be extremely difficultShow MoreRelatedElisabeth Kubler Ross On The Fear Of Death870 Words   |  4 Pages Elisabeth Kubler-Ross in On the Fear of Death claims that through the year’s death is becoming a taboo topic. No one likes to talk about it and no one wants to ever be around it. Kubler-Ross attributes this to a deep and ancient fear of death. She argues that children today, in particular, have been sheltered from death to the point that they cannot deal or even process death. Although I agree with her point that children cannot deal with death, I cannot not accept the overall conclusion that itRead MoreSocial And Behavioral Sciences : Death Dying And Grieving931 Words   |  4 PagesShort Project Paper Social and Behavioral Sciences: Death dying and Grieving I wrote a report on a person that lost his spouse. This paper relates to a person that has experienced a major tragedy in his life. His spouse of 31 years has died. I spoke with Don Joseph, a 59-year-old male who had experienced the death and grievance of his spouse, love of his life, mother to his children and lifetime friend. In Accordance with the periods of development from page 13 of the textbook, these events wereRead MoreFamily Life Cycle Position Paper887 Words   |  4 PagesThe Family Life Cycle Winston-Salem State University The dynamics of the â€Å"Family Life Cycle† are forever changing due to environmental factors around us. 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