1. J. MARKOVIĆ, D. MITROVIĆ, J. SRDANOVIĆ-MARAŠ, V. ŠOBOT, S. SEKULIĆ
Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Serbia Center for Child and Adolescent Psychiatry, Institut of Psychiatry, Novi Sad, Serbia SERBIAN CHILDREN ARE LESS HYPERACTIVE THAN AMERICAN CHILDREN ACCORDING TO TEACHERS’ ASSESSMENT
Dear collegues! I am honored to be here today to present to You work we’ve been doing on assessment of child psychopathology in Serbia.
I will present only a part of our work that we named “Serbian children are less hyperactive than american children according to the teachers’ assessment.”
J. MARKOVIĆ, D. MITROVIĆ, J. SRDANOVIĆ-MARAŠ, V. ŠOBOT, S. SEKULIĆ

2. Introduction
One of five children and adolescents under the age of 18 has a mental health problem (WHO, 2005).
3-4% of this age group has a serious mental disorder requiring treatment.
We lack information from developing countries
Current epidemiological data indicate that one of five children and adolescents under the age of 18 has a mental health problem.
3-4% of this age group has a serious mental disorder requiring treatment. Unfortunately, we lack information from developing countries
Emerging evidence from developing countries in many of the regions of the world suggest similar levels of morbidity.

3. Introduction
Many severe stressors, such as civil war, economic sanctions, bombing.
Consenquences: social instability, economic difficulties and deterioration of its healthcare system (Lecic Tosevski & Draganic Gajic, 2005).
Serbia is located on the Balkan peninsula, which served for centuries as a vulnerable crossroads between the East and the West.
The country has been exposed to many severe stressors, such as civil war, economic sanctions, bombing in 1999.
As a consequence, Serbia has experienced social instability, economic difficulties and deterioration of its healthcare system.
All those factors can have profound effects on children’s mental health.

4. What About Child Mental Health Problems in Serbia?
“Youth Mental health in Serbia” (2003): 1/3 bordereline or clinical score on YSR (Ćurčić, 2005)
Vojvodina: 2 child psychiatrists + 4 psychiatrists / children
Germany: 8 child psychiatrists/ children (Perna, L. et al., 2010).
Serbia
Vojvodina
0-18 years
~20% ~
~90 000
Data from Serbia on the prevalence of child mental health problems is restricted to information from a study that was conducted in where they found that one third of the adolescents had borderline or clinical score on YSR.
Vojvodina is an northern province of Serbia; has a population of about 2 million
When we apply 20% rate for children mental health problems on population in Serbia and Vojvodina,we have and children under 18 with some kind of mental health problem.
What about our resources? We have only 2 child psychiatrist and 4 psychiatrist who work with children per children. When we compare it with Germany where they have 8 child psychiatrist per chidren we could assume how scarce our resources are.

5. 7,000 publications in 80 societies and cultural groups
The ASEBA assesses competencies, adaptive functioning, and behavioral, emotional, and social problems from age 1½ to over 90 years (Achenbach, 2010).
7,000 publications in 80 societies and cultural groups
appearing in over 800 books and professional journals, by some 9,000 authors (Achenbach, 2010).
We choose ASEBA instruments for assessment because it is a well-established method for detecting signs of mental difficulties. Comprehensive evidence-based developed through decades of research and practical experience that assesses competencies, adaptive functioning, and behavioral, emotional, and social problems from age 1½ to over 90 years
The ASEBA is widely used in mental health services; schools; medical settings; child and family services; multicultural assessment; HMOs; public health agencies; child guidance; training; and research.

6. Child Behavior Checklist Teacher-Caregiver Report Form
Youth Self-Report
Adult Self Report
Adult Behavior Checklist
Older Adult Self-Report
Older Adult Behavior Checklist
There are all ASEBA forms. We used Teacher-Caregiver report form.

7. Why Teacher’s Report? Teachers are more neutral than parents
Teachers have better frame of Reference for disturbed behavior
Differences between informants’ reports remain among “the most robust findings in clinical child research” (De Los Reyes& Kazdin, 2005).
Assessment of child mental health problems should routinely use multiple informants
: We used only teachers as informants in our research, so there are some reasons for theacher as informants:
Teachers Are More Neutral Than Parents.
Teachers Have Better Frame Of Reference For Disturbed Behavior.
But although we have only teachers, we shoudn’t forget that assessment of child mental health problems should routinely use multiple informants despite the fact that diffrences between informants’ reports remain among “the most robust findings in clinical child research” (De Los Reyes& Kazdin, 2005)

8. International Research Using the Teacher’s Report Form (TRF)
Boys obtain higher scores than girls on Total Problems and Externalizing
Internalizing: girls > boys
Younger students had higher Total Problems scores than older students
Džmejka, taj-lend

9. International Research Using the TRF – Bicountry Comparisons
Dutch and U.S. TRF Total Problems did not differ significantly (Achenbach, Verhulst, Edelbrock, Baron, & Akkerhuis, 1987)
Croation teachers reported significantly less problems than American teachers on all dimensions ( Rudan, Begovac, Szirovicza, Filipovic & Skočić, 2005)
Thai teachers reported significantly more problems than American teachers on Total Problems, Internalizing, and Externalizing (Weisz et al., 1989)
Bajcantri...komperisons

10. International Research Using the TRF - Bicountry Comparisons
Jamaican students obtained slightly higher scores than U.S. Students on Total Problems, Internalizing, Externalizing and six syndromes ( Lambert, Knight, Taylor, and Achenbach, 1995)
Puerto Rican students obtained higher Total Problems scores than U.S. mainland students (Achenbach et al., 1990)
Chinese students generally had higer TRF rates than U.S. Students, except on Somatic Complaints and Aggressive Behavior (Weine, Phillips, and Achenbach, 1995)

11. Objectives:
To obtain comprehensive picture on TRF problem scales data for children in Serbia
gender differences and similarities
Because these countries differ widely in language, geographical region, political and economic system, racial and ethnic composition, religion, and educational system, comparing them provides a comprehensive test of the generalizability of problems reported by teachers on the TRF

12. Objectives:
To compare teacher-reported problems for a sample in Serbia with teacher-reported problems for a U.S. sample

13. Methods: Cross-sectional study
Novi Sad, from April, 2008 to October, 2010
Who attended lower grades of elementary schools in the citiy of Novi Sad (Serbia’s second largest city)

14. Sample: 11 (out of 37) elementary schools 492 (out of 13 200) students
(7-11)
110 teachers
20-80 students/school
Response rate 70%
We chosen representative sample of schools and then randomly sampling children within classrooms
Teachers rate 2-5 students per class

15. INSTRUMENT: TEACHER’S REPORT FORM (TRF)1
First published by Achenbach and Edelbrock (1986)
Revised by Achenbach and Rescorla (2001)
Translated into more than 20 languages
118 specific problem items + 2 open-ended problem items
0= not true (as far as you know), 1=somewhat or sometimes true, 2=very true or often true
Preceding 2 months
1 Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-Age Forms & Profiles.Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.
Teachers rate problems based on students’ functioning over the preceding 2 months

16. TOTAL PROBLEMS INTERNALIZING ANX/DEPRESS WITHDR/DEPRESS SOMAT COMPL
EXTERNALIZING
RULE BREAKING
AGGRESSIVE BEH
SOC PROBL
THOUGHT PROB
ATTENTION PROB
THERE ARE 4 LEVELS OF HIERARCHY WITH THE 120 PROBLEM ITEMS COMRISING THE LOWEST LEVEL, AND 8 SYNDROMES DERIVED BY FACTOR ANALYSIS COMRISING THE SECOND LEVEL.
The third level of hierarchy contains Internalizing and Externalizing scales, derived from second order factor analyses of the eight syndromes.
The total problem scale at the top of the hierarchy, is the sum of the ratings on all problem items.

17. DSM oriented scales Affective problems Anxiety problems
Somatic problems
ADHD problems
OD problems
Conduct problems
These scales comprise items identified by an international panel of experts as being very consistent with diagnostic criteria of the DSM IV

18. RESULTS:

19. Sample characteristics: Children
Half of the children were 9 and 10 years old,

20. Sample characteristics: Children

21. Sample characteristics: Parents

22. Sample characteristics: Parents
Meritial stetus

23. Cronbach α (internal consistency)
0.51 – 0.98
Excellent internal consistency (α > 0.9 ) for dimensions: Attention Problems, Agressivnes, Externalizing, Total Problems and DSM-ADHD.
Questionable int.consistency (α: ): DSM- Affective Disorder and Thought Problems
Weak internal consistency (α : ): DSM-anxious
Alpha coefficients
Mean alphas fot Total Problems, Internalizing and Externalizing were 0.96, 0.86 an 0.92 respectively (for the TRF scales across the 21 countries)
Across the countries, the highest alphas were obtained for :TP, Agr, Ext, Int, Att p, DSM ADHd

24. TRF Total Problems scores in 22 countries (N=31437) (Rescorla et al
Although Total Problems score could range from 0 to 230, mean Total problems scores ranged only from 8.4 for Japan to 31.6 for Puerto Rico, as illustrated in Figure. Japan, Finland and China scored more than 1 SD below the overal mean, whreas Jamaica, Puerto Rico and Thailand scored more than 1 SD above this mean.

25. Mean syndrome scores on TRF for boys and girls
Concerning the boys-girls difference,
This result is consistent with previous researches
Boys scored significantly higher than girls on Externalizing…

26. Mean TRF DSM-Oriented Scales scores for boys and girls
There are consistency across countries, boys scored significantly higher than girls on ADHD (19 of 21 countries), ODD (17 of 21) and CD (18 of 21)

27. COMPARISON WITH U.S. SAMPLE: GIRLS
We used p less than as the alpha level for t-test

28. COMPARISON WITH U.S. SAMPLE: BOYS
Our comparison of teacher reported problems in 2 societies that differ markedly in geographical region, political and economic systems, size, populations, history, ethnic and racial composition and religion yielded many striking similarities especially when we compare boys problems
These results are intriguing. Is this reflection of real picture of problems or is it purely an arefact generated by cultural factors affecting responses to the instruments?

29. DISCUSSION:
US teachers expect to see lots of ADHD so they are likely to rate it for boys and girls but Serbian teachers don't?
Serbian schools are more strict and girls behave better there?
Rates of ADHD are higher in the US than many other places, so maybe problems have to be more severe in Serbia before the teachers endorse them?

30. CONCLUSIONS:
This is the first study that provided us with standardized TRF data specific for our socio-cultural circle
The TRF Total Problems mean value for boys is and for girls is 13.96
Internal consistency of questionnaire was satisfying
Ubaci iz Rudan članka u diskusiji str 23

31. CONCLUSIONS: Teachers report more problems in boys
The girls’ problems less observable by teachers?
Concerning the boys-girls difference,
This result is consistent with previous researches
WE eXPLAINED it by our clinical observations that at this age i.e. The period of primary education, the girls are emotionally, cognitively and socially better prepared for school than boys...Rudan str 24

32. CONCLUSIONS: Great similarities between Serbian and U.S. boys
TRF scores were less similar when we compare Serbian and U.S. girls
Serbian teachers report less ADHD problems among boys and girls than their collegues in U.S
Our comparison of teacher reported problems in 2 societies that differ markedly in geographical region, political and economic systems, size, populations, history, ethnic and racial composition and religion yielded many striking similarities especially when we compare boys problems
Prevalence of ADHD in U.S is 8,6% (Merikangas KR, He JP, Brody D, at al. 2010)

33. THANK YOU!