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Relationship between the family APGAR and behavioral problems in children
W D Smucker1, B G Wildman, T R Lynch
1Department of Family Medicine, Summa Health System, Akron, Ohio, USA.
Insights
The Family APGAR tool showed a weak agreement with physician diagnoses for child psychosocial problems. However, low Family APGAR scores were linked to a higher likelihood of clinically significant Child Behavior Checklist (CBCL) scores.
Area of Science:
- Pediatrics
- Family Medicine
- Child Psychology
Background:
- Assessing psychosocial problems in children is crucial for early intervention.
- The Family APGAR is a tool designed to measure family functioning.
- Its utility as a supplement to clinical methods requires evaluation.
Purpose of the Study:
- To evaluate the Family APGAR instrument's effectiveness in detecting psychosocial issues in children.
- To compare Family APGAR scores with physician diagnoses and Child Behavior Checklist (CBCL) scores.
- To determine the relationship between family functioning and child psychosocial problems.
Main Methods:
- A cross-sectional study was conducted in a family medicine training program.
- 152 parents of children aged 3-16 years participated.
- Family functioning was assessed using the Family APGAR, with scores ≤5 indicating poor functioning. Clinically significant CBCL scores were defined as T scores >90th percentile.
Main Results:
- Agreement between Family APGAR and physician detection of psychosocial problems was weak (kappa = 0.23).
- No significant relationship was found between Family APGAR scores and physician perception of family dysfunction (kappa = -0.05).
- Families with low Family APGAR scores were over twice as likely to have children with clinically significant CBCL scores (RR = 2.08).
Conclusions:
- The Family APGAR demonstrated weak correlations with physician assessments of child psychosocial problems.
- A low Family APGAR score was associated with a more than twofold increased likelihood of clinically significant CBCL scores.
- While family functioning is related to child psychosocial issues, the Family APGAR may not enhance screening effectiveness.
Objectives:
To assess the use of the Family APGAR instrument as a supplement to usual clinical methods for the detection of psychosocial problems in children and to evaluate the relationship between the Family APGAR and physician diagnosis and elevated Child Behavior Checklist (CBCL) scores.
Design:
Cross-sectional.
Setting:
Ambulatory care center of a community-based, university-affiliated family medicine training program.
Subjects:
One hundred fifty-two parents of children aged 3 to 16 years.
Main Outcome Measures:
Family functioning was considered poor if Family APGAR scores were 5 or less. For the CBCL, sum total T scores greater than the 90th percentile for nonreferred children were considered clinically significant. Physicians used a checklist to indicate the presence of psychosocial problems or family dysfunction.
Results:
Agreement between the Family APGAR scores and the physician's detection of child psychosocial problems was weak (kappa = 0.23). There was no relationship between the Family APGAR scores and physician perception of family dysfunction (kappa = -0.05). Although agreement between the Family APGAR and CBCL classifications was weak (kappa = 0.20), families with low Family APGAR scores were more than twice as likely to have children with clinically significant CBCL scores than those with higher scores (risk ratio = 2.08; 95% confidence interval = 1.02 to 4.24).
Conclusions:
The relationships among the Family APGAR and CBCL scores and physician detection of child psychosocial problems were weak. Child psychosocial problems were more than twice as likely to be present when the Family APGAR score was low. These findings suggest that family functioning is related to child psychosocial problems, but that the Family APGAR may not improve screening for child psychosocial problems.