Longitudinal Changes in Preschoolers’ Self-reported Psychological and Social Problems:
Feasibility, Reliability, and Cross-informant Agreement
Children’s socioemotional adjustment at a young age is an important predictor to a wide range of life outcomes including mental and physical health, academic achievements, and interpersonal relationships (Denham et al., 2015; Nigg, 2017). Hence, early identification of socioemotional problems such as internalizing and externalizing behavioral problems as well as social competence in preschool children is critical for timely interventions. For decades, developmental research has relied on parental reports, especially maternal, to understand children’s socioemotional development and parenting due to the lack of suitable tools to assess children’s perspective at preschool age. The Berkeley Puppet Interview (BPI) is a valuable and innovative tool that uses hand puppets to obtain questionnaire type data from young children regarding their perceptions of their own socioemotional functioning (Measelle et al., 1998). Recent studies have adopted this age-appropriate method and gained important insight into child development (Luby et al., 2007). A vast body of studies have shown adequate internal consistency and validity of BPI scales among children around 5 years old (Coldwell et al., 2006; Measelle et al., 1998; Ringoot et al., 2013; Stone et al., 2014). However, very few studies have used BPI with children younger than 5 years old and it is unclear whether or how the performance of children changed between ages 4 and 5. Further, limited studies have used both mother- and father-reports to evaluate the cross-informant agreement of child-reported psychological and social problems using BPI scales, especially the parenting scale. Hence, the current study examined the changes in feasibility, reliability, and cross-informant agreement of child-reported psychological symptoms and social problems between ages 4 and 5 using multi-informant data from mothers, alternate caregivers (AC), and coders.
The Importance of Preschoolers as Informants & Cross-informant Perspectives
The majority of past developmental research on young children has relied heavily on maternal reports using questionnaires while perspectives from other informants in the family such as fathers were often overlooked (Martel et al., 2017). Informed by the family system perspective, multi-informant data collection including multiple family members has been encouraged in recent years to obtain a more comprehensive understanding of child development and parenting (Renk, 2005; Sessa et al., 2001). Interestingly, correlations between reports from multiple informants such as father, mother, and teacher are generally low to moderate, reflecting different perspectives and contexts (De Los Reyes et al., 2015).
Despite the increasing likelihood of collecting multi-informant data, data from young children are still rarely obtained due to concerns about whether young children could reliably report their own behaviors and experiences given potential challenges, such as short attention spans, low verbal abilities, and response biases (Measelle et al., 1998; Ringoot et al., 2013). Although structured verbal interviews were developed to aid children to share their experience, especially in the context when children’s testimony is essential (Hershkowitz et al., 2012), some open-ended interviews requiring higher level of verbal ability and long attention span may not always be the most suitable method (Miller & Aloise, 1989). Therefore, researchers have been exploring other methods that are more appropriate for children. Methods like interviews using puppets or storytelling using toy props have been proposed. However, their appropriateness for gaining reliable and valid reports from children is still an active research area. Increasing empirical research has found that children could be reliable reporters of their experiences when puppets are utilized, demonstrating the possibility of obtaining self-report from children (Bretherton & Oppenheim, 2003; Measelle et al., 1998; Sessa et al., 2001).
Assessing children’s self-perception of their own behaviors and family environment is key. First, studies have suggested that children’s internalizing behaviors may be more difficult for parents or teachers to detect and more likely to be identified by children themselves (Stone et al., 2014). Thus, it may be critical to obtain self-report of children’s internalizing problems for early identification. Second, past research has shown that children’s perception of parenting and family relationships are important predictors of their later development (Ablow et al., 2009). Therefore, it is crucial to assess children’s perception in addition to parent’s own subjective perception of their parenting behaviors or marital relationship. Interestingly, Sessa et al. (2001) indicated that the child-report and observer’s rating of mother’s parenting were more closely related than that between child- and mother-report as well as observer’s rating and mother-report. As such, there might be potential biases in mothers’ self-reporting on their own parenting, supporting the importance of child-report and cross-informant perspectives on parenting.
The BPI was designed to assess self-perception of own emotional and behavioral problems, social and school functioning, as well as family environment among young children between age 4 and 8 (Albow et al., 1999; Ringoot et al., 2013). The design of BPI aimed at overcoming challenges in collecting reliable data from young children. Specifically, given that children generally favor toys over paper and pencil measures, the BPI utilizes puppets to maintain attention in children (Greenspan, 2008; Measelle et al., 1998). Past studies have found that puppets could keep young children engaged in the interview by creating a dynamic interaction between the child and the interviewers (Eder, 1989). Additionally, the puppets in the interview act as peers of children hence minimizing the sense of judgement from adults and create a comfortable environment for children to provide honest responses. Interviewers were also instructed to use vocabulary and language that matches with the language ability of young children. In addition to this age-appropriate design, scales of BPI were also carefully developed. The original paper on BPI published in 1998 provided a detailed account of how the items and scales in BPI were constructed (Measelle et al., 1998). Principal component analyses (Albow et al., 1999; Measelle et al., 1998; Sessa et al., 2001) as well as confirmatory factor analyses (Jia et al., 2016; Ringoot et al., 2013) were conducted to support the development of a number of scales, including symptomatology, social, and academic scales. The BPI has been used in over hundreds of peer-reviewed studies across multiple countries and translated to seven different languages. The vast body of literature using the BPI has collectively shown that the BPI is a feasible tool to obtain self-report from children at age 5 to 8. Nonetheless, the feasibility and reliability of BPI at an even younger age as well as longitudinal changes in child-reporting are underexplored.
Developmental Perspectives on Preschoolers’ Self-reporting
The evaluation of whether the BPI is an age-appropriate tool for younger preschoolers warrants a developmental perspective since children’s ability to self-report their emotions, behaviors, and social surroundings depends largely on their cognitive development. Given the rapid development in the first few years of life, even with a one-year age difference, there could be major developmental changes that may lead to potential differences in the ability of self-reporting accurately and reliably. Here we review developmental changes between the fourth and fifth birthdays that could be relevant to their performance in BPI, which include three broad aspects – social cognition, executive function, and language development.
Important developmental milestones in social cognition around the age of four to five include the development of the theory of mind, the understanding of self and others’ mental states. At around age 4.5 children typically start to develop a false belief understanding that one can hold a belief that is different from the reality (Wellman & Liu, 2004). The understanding of own and others’ mental states is essential for self-reporting in the BPI since it requires children to be introspective of own thoughts and feelings as well as being aware of others’ thoughts and feelings in daily life. Relatedly, preschoolers also develop their emotion understanding, which includes the ability to identify, predict, and explain their own and others’ emotions (Harris, 2008). Although children at age 4 demonstrate some emotion understanding, children older than four may be better able to understand intrapersonal and interpersonal factors underlying their own emotional experience, which may facilitate children’s self-understanding and ability to accurately report their own emotions and behaviors.
Developmental changes in executive functioning, including working memory and inhibitory control, could also result in differences in BPI performance across four and five-year-olds. According to a comprehensive review on executive function (Best & Miller, 2010), a linear improvement in working memory task can be observed from ages 4 to 14. Therefore, it is possible that 5-year-olds can hold longer statements in memory than 4-year-olds and hence perform better in BPI, especially for longer items. Additionally, although most children can learn what responses are acceptable from the practice items and avoid using non-codable responses (e.g., just “yes/no”) for subsequent items, children who have poor inhibitory control tend to show difficulties in inhibiting their prepotent and often still respond with non-codable response. Inhibitory control can also contribute to children’s concentration and attention during the BPI. Thus, it is important to investigate the feasibility of using the BPI with younger children whose inhibitory control and concentration are still undergoing rapid development. Lastly, at the age of four, most children have already developed the ability to use pronouns, take turns in conversation, as well as understand questions, negative sentences, and compound sentences (Tyack & Ingram, 1977; Visser-Bochane et al., 2020), which are all essential for completing the BPI. However, between ages 4 and 5, children also begin to be able to produce compound sentences themselves and become more intelligible in their speech (Visser-Bochane et al., 2020).
Together, important developments in social cognition, executive function, and language/comprehension between children’s fourth and fifth birthdays play important roles in determining their ability to self-report through BPI. Conceivably, due to developmental differences, children may perform less optimally at age 4 than 5 but it is unclear whether 4-year-olds still pose the sufficient basic ability for completing the BPI and producing reliable responses.
Limited Studies on Reliability and Cross-informant Agreement of Preschoolers’ Self-report
Most past research adopting the BPI primarily utilized the symptomatology scales, which assessed children’s internalizing symptoms including depression, separation anxiety, over-anxiousness, and externalizing symptoms such as oppositionality and defiance, overt aggression/hostility, conduct problems, and relational aggression. The psychometric properties of the symptomatology scales among children aged 5 to 8 have been examined. Research showed acceptable internal consistency for the overall symptomatology scale (Howland et al., 2016; Huber et al., 2019; Measelle et al., 1998) but reported mixed results for internal consistency for individual subscales (e.g., Cronbach’s alphas ranged from 0.36 to 0.81) (Albow et al., 1999; Arseneault et al., 2005). Although some symptomatology subscales have been reported with low internal consistency in certain study (Albow et al., 1999), the BPI is still one of the very few tools that can assess common psychological symptoms, including depression, anxiety, and aggression, in young children. Hence, it is valuable to examine the reliability of these scales in different samples to provide more empirical findings to guide informed decision on the use of the scale in future studies. The test-retest reliability and inter-rater reliability on the symptomatology scales are good (0.71 and 0.90, respectively) (Arseneault et al., 2005). Past studies have also found significant and positive correlation between mothers and child’s report on children’s internalizing and externalizing problems (Luby et al., 2007; Ringoot et al., 2013, 2017). Yet, limited studies have examined the agreement between child-report and reports from caregivers other than mothers as well as the longitudinal stability, if any, of child-report via BPI.
Aside from the symptomatology scales, BPI also includes social scales to assess children’s own perception of social competence and peer acceptance. A total of seven scales are included under social (or socioemotional) scales, including prosocial, peer acceptance/rejection, social inhibition/extraversion, bullied by peers, asocial with peers, emotion regulation, and emotion knowledge (Ablow & Measelle, 2018), among which prosocial behavior and social acceptance were included in the current study. Limited research has tested the reliability and validity of these new social scales in BPI. One study has tested the reliability of these new social scales with children at ages 5 to 7 and reported acceptable Cronbach’s alphas of peer acceptance (.68-.79) (Ringoot et al., 2013). Another study has shown a good reliability (Cronbach’s alphas = .70-.73) for the prosocial behavior subscale with children of 4 years 5 months to 5 years 3 months (Huber et al., 2019). However, the validity or cross-informant agreement of the social scales is underexplored. The BPI parenting scale is also developed recently to assess children’s perception of their parents’ behaviors (Ablow & Measelle, 2018). The scale included a total of six subscales. The current study focused on the warmth/enjoyment and anger/hostility subscales since some studies have already reported an acceptable reliability with young children (Coldwell et al., 2006; Sessa et al., 2001) and found agreement with parental reports of anger (Coldwell et al., 2006; Pike et al., 2016). However, it is unclear whether child-report parenting behaviors in BPI are associated with mothers’ and fathers’ own reporting of parenting.
Overall, there are limited reports on the feasibility, reliability, and cross-informant agreements of the BPI scales when used with younger preschoolers. Thus far, only four papers have reported the use of the BPI among children younger than 5-year-old (Kuntsche, 2017; Luby et al., 2002, 2007; Sessa et al., 2001). Luby et al. (2002, 2007) and Sessa et al. (2001) used the BPI symptomatology and social scales, respectively, while Kuntsche (2017) designed a new scale to assess children’s perception of adult’s alcohol use and mood. Although some of these papers suggested reasonable reliability (Cronbach’s alpha > .70; Sessa et al., 2001) and validity (Luby et al., 2002) when using the BPI with children as young as four, which is a promising start, more thorough investigation of the similarities and differences in BPI performance between children of age 4 and 5 are needed to inform future use of BPI with younger children.
The Current Study
Ample research has indicated that BPI could generate reliable and valid data from children above 5 years of age, yet there are very few studies that explore the potential of using BPI in children younger than age 5. It is unclear how the performance of children in BPI may differ between the age of 4 and 5 given their developmental changes. Although the performance of younger children’s self-reporting may be less optimal, it would still be informative to identify scales that may be appropriate to use with younger children given the importance of early identification of psychological symptoms and obtaining children’s perspective on their experience to providing suitable intervention. The current study examined the feasibility, reliability, and cross-informant agreements of the symptomatology, social, and parenting scales of BPI among young preschool children at two time points (mean age was 4.03 at time 1 and 5.22 at time 2). To evaluate feasibility, we reported the percentage of completion and codable responses. We also examined the global impression ratings on the level of believability, consistency, social desirability, and concentration of children’s responses as well as their level of distress during BPI. Two types of reliability were evaluated: internal consistency across items within each subscale and inter-rater reliability. Stability between responses at age 4 and age 5 was also assessed though mostly exploratory. Evidence of stability in children’s internalizing/externalizing symptoms have been found in past studies but not always consistent (Basten et al., 2016). Furthermore, it is unclear whether children’s self-report of social and parental environment is stable over time. Cross-informant agreement was examined based on the association between the child-report on BPI scales and both mother and AC’s ratings on similar constructs. We compared the feasibility, reliability, and cross-informant agreements of child-report across the two timepoints to gain insight into the changes between ages 4 and 5.
About half of the children in our sample had mothers who met the clinical criteria of major depressive disorder (MDD). Considering that depressed mothers’ report on their children’s behaviors tend to be negatively biased (Ordway, 2011), acquiring the perception from the child and the AC could be particularly valuable. Although we acknowledge that children with depressed mothers may have a higher risk of behavioral and emotional problems, the focus of the current study was to evaluate the performance of BPI at different ages, so we reframed from comparing the differences in BPI scores between the depressed and nondepressed groups before the appropriateness of this tool has been established.