Child and Adult Appraisal of Child Mental Health Problems: A Latent Class Analysis

Background: Distinguishing children’s mental health needs from typical development is complex, depending on both child and adult appraisals of the child’s experiences. Some child experiences – externalizing behaviors, poor social skills – are more visible and may easily be problematized. Other child experiences – internalizing behaviors – are harder to detect, but are impactful, nonetheless. As child behaviors become more socially consequential, adults may become more likely to notice, but an appraisal that a child’s behavior reflects a mental health problem may vary based on culture, context, and the expectations/biases of the appraiser. Given racial, socio-economic, and gender disparities in school disciplinary practices and access to mental health services/supports, research is needed to understand child mental health holistically, at the nexus of what the child experiences, the severity of those experiences, and who appraises those experiences as problematic.

Methods: Using data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-99 fifth-grade year, we conducted a latent class analysis (LCA), exploring patterns of child, parent, and teacher appraisal of child mental/behavioral health symptoms. 12 indicators were included (4 child-, 4 parent-, 4 teacher- report), tapping internalizing, externalizing, self-control and interpersonal problem domains. Results from the LCA were used to assign each child to their expected “class”; classes were then compared using ANOVA and chi-square to identify differences in demographic/background factors.

Results: Results indicated 4 distinct classes. In class 1 (all see big problems), all appraisers are likely to report problems across domains. In class 2 (parents think differently), everyone but parents are likely to notice problems. In class 3 (going it alone), only children are likely to report. In class 4 (all see small problems), there is agreement about low prevalence across domains. Classes differed by gender, race and SES. Girls were overrepresented in class 4, and boys overrepresented in classes 1 and 2 (p<.000). The largest share of Hispanic, Asian, and Indigenous children were in class 3, while the greatest share of white children were in class 1, and the greatest share of Black children were in class 2 (p<.000). Children with a higher SES were overrepresented in class 4 (p<.000).

Conclusions and Implications: Findings highlight the complexity within children’s holistic experience of their psycho-social/behavioral wellbeing, and the contexts in which key adults appraise that experience. Some classes of children (1 and 4) vary in symptom severity and type but experience general congruence with adult appraisals. Children of color are disproportionately in classes with differences in appraisal. Black children are overrepresented in the class (2) where parents appraise less of a problem than the child and teacher. Hispanic, Asian and Indigenous children are overrepresented in the class (3) where the child alone appraises a problem. Future research should explore the reasons for appraisal differences, and social workers should be attuned to the implications of these differences, ensuring support to children whose difficulties might otherwise go unnoticed, and partnering with parents to understand their perspectives on their children’s strengths and behaviors - both in and outside of school.