The confluence of mental, physical, social, and academic difficulties in middle childhood. II: developing the Macarthur health and Behavior Questionnaire

J Am Acad Child Adolesc Psychiatry. 2002 May;41(5):588-603. doi: 10.1097/00004583-200205000-00017.


Objectives: (1) To evaluate the psychometric properties of the MacArthur Health and Behavior Questionnaire (HBQ) in two studies of 4- to 8-year-old children and (2) to explore the empirical and theoretical implications of HBQ-based study findings.

Method: Samples of children were recruited from (1) mental health clinics (n = 53) and community schools (n = 67) for a case-control study in three research sites and (2) a Wisconsin-based community cohort study of families and work, comprising children with high levels of internalizing and/or externalizing behavior problems and asymptomatic children (N = 122). Combinations of mothers, fathers, and teachers completed the HBQ at one or two time points in four geographically and culturally distinctive settings.

Results: Assessment of HBQ reliability showed high test-retest stability and cross-informant agreement. The instrument discriminated strongly and significantly among symptom groups (i.e., high internalizing, high externalizing, high both, and low both) and showed moderate to large effect sizes for between-group differences. Substantial covariance was also found among the HBQ mental, physical, social, and academic problem subscales.

Conclusions: The HBQ is a reliable and valid parent- and teacher-report instrument for assessing multiple dimensions of health and dysfunction in middle childhood and for identifying children on whom more intensive diagnostic procedures may be warranted. Confluences among the four health dimensions suggest phenomenological and perhaps etiological commonalities among traditionally partitioned childhood difficulties and suggest possible artificiality in the conventional distinction between pediatric and child psychiatric morbidities.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Child
  • Child, Preschool
  • Comorbidity
  • Developmental Disabilities / diagnosis
  • Developmental Disabilities / epidemiology*
  • Female
  • Health Status*
  • Humans
  • Learning Disabilities / diagnosis
  • Learning Disabilities / epidemiology*
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology*
  • Personality Assessment / statistics & numerical data*
  • Psychometrics
  • Reproducibility of Results
  • Social Adjustment*
  • United States / epidemiology