ERR_Question A_w2.pdf ERR_Question B_w2.pdf ERR_Question C_w2.pdf ERR_QUESTION D_w2.pdf Question A: ERR: (200 word minimum with 1 peer reviewed
reference. Make sure to include your opinion, observation, etc)

Question B: ERR: (200 word minimum with 1 peer reviewed
reference. Make sure to include your opinion, observation, etc)
Question C: ERR: (200 word minimum with 1 peer reviewed
reference. Make sure to include your opinion, observation, etc)

Question D: ERR: (200 word minimum with 1 peer reviewed
reference. Make sure to include your opinion, observation, etc)
Question E: Compare and contrast four approaches in clinical
psychology (200
word minimum with 1 peer reviewed reference. Make sure to include your opinion,
observation, etc)
Question F: Identify the strengths and limitations of
psychological assessment instruments. (200
word minimum with 1 peer reviewed reference. Make sure to include your opinion,
observation, etc)

Question G: Evaluate the appropriateness of psychological
testing instruments for various populations. (200 word minimum with 1 peer reviewed
reference. Make sure to include your opinion, observation, etc)
Question H: Four modern approaches to clinical
psychology (200
word minimum with 1 peer reviewed reference. Make sure to include your opinion,
observation, etc)
There are several current
and valid approaches to clinical psychology when working with patients or
clients. However, not all approaches are appropriate for every client. Research
four of the approaches: psychodynamic, cognitive-behavioral, humanistic
(client-centered), and family systems.
When determining what approach may be appropriate for a patient,
the patient interview can provide significant information. But before choosing
a specific approach or approaches, one needs to understand each approach and
know the similarities and differences among them.
This  discussion should concentrate on those elements. Use
examples to illustrate your points.
COGNITIVE-BEHAVUORAL THEORIES. IT is misleading and inaccurate on these topics.

Do not say that Freud was the
father of psychodynamic theory; he was a contributor and not the main one.
He was the father of psychoanalytic theory.
Skinner, Watson, and Pavlov
were behaviorists and DID NOT develop or contribute to
cognitive-behavioral theory (CBT). The focus of CBT is cognition and
changing thought patterns. The  behavioral aspects of CBT is
reinforcement of those thought changes.

Question I: (diagnosis) (200 word minimum with 1 peer reviewed
reference. Make sure to include your opinion, observation, etc)
The development of the DSM
is a product of the American Psychiatric Association. It is only used in the
United States. In the last two years the DSM has gone through dramatic changes,
not all are popular by clinicians. It is research based but there are political
influences as to what is published. however, it is used by every clinician
licensed to diagnose mental illness who practice in the United States.
The DSM,
now in version DSM 5 is an important diagnostic tool but what is it actually
and how do clinicians use it? Should it be the only factor used when diagnosing
a patient?
DSM-IVTR is still being used in some places. What are the differences in
focus between the two manuals? Which one discusses treatment for a person
with mental illness?Professional Psychology: Research and Practice
2007, Vol. 38, No. 4, 375–384
Copyright 2007 by the American Psychological Association
0735-7028/07/$12.00 DOI: 10.1037/0735-7028.38.4.375
Beyond Instrument Selection: Cultural Considerations in the Psychological
Assessment of U.S. Latinas/os
Ignacio David Acevedo-Polakovich
Geneva Reynaga-Abiko
University of Kentucky and University of South Florida
University of Illinois at Urbana–Champaign
Patton O. Garriott, Karen J. Derefinko, Mary K. Wimsatt, Lauren C. Gudonis, and Tamara L. Brown
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
University of Kentucky
Currently the second largest U.S. ethnic group, U.S. Latinas/os are projected to continue increasing as a
proportion of the U.S. population over the next century. The culturally competent psychological
evaluation of U.S. Latinas/os requires both the use of instruments that are adequately validated in that
population and the adequate consideration of culturally linked factors known to influence the assessment
process and its findings. This article makes foundational recommendations in this second area, organizing
them along 4 stages of professional practice in psychological assessment. Consultation with qualified
professionals is discussed as being important in ensuring the accurate and ethical psychological assessment of U.S. Latinas/os at all stages of professional practice.
Keywords: psychological assessment, cultural sensitivity, multiculturalism, Hispanic, Latinos
U.S. Latinas/os are a diverse demographic group— encompassing multiple races, ethnicities, cultures, traditions, social classes,
and reasons for immigrating—that is bound together by historical
ties to Latin American countries (Santiago-Rivera, Arredondo, &
Gallardo-Cooper, 2002). They are currently the largest U.S. ethnic
minority group (Marotta & Garcia, 2003), and demographic projections suggest their proportion in the population will continue to
grow until it approximates that of European Americans (U.S.
Census Bureau, 2000).
The increased salience of Latinas/os in the United States highlights a historical limitation to psychological assessment as it is
normally practiced in this country. The psychological assessment
practices in use today were primarily developed for, and refined
with, the intent of accurately estimating psychological phenomena
as they occur in European Americans (Dana, 2000). Not surprisingly, the available empirical literature raises some concerns over
the accuracy or appropriateness of these procedures when used to
evaluate Latinas/os (Dana, 1995, 1998, 2000; Paniagua, 2005). In
work with U.S. Latinas/os, the use of mainstream assessment
practices without taking into account cultural considerations has
been associated with inaccurate assessment results (Paniagua,
2005; Snowden & Cheung, 1990; Westermeyer, 1987).
IGNACIO DAVID ACEVEDO-POLAKOVICH is a doctoral candidate in clinical
psychology at the University of Kentucky and a predoctoral intern in public
sector psychology at the University of South Florida’s Louis de la Parte
Florida Mental Health Institute. His scholarly interests center on the
promotion of adaptive mental health in underserved and marginalized
populations, particularly ethnic or cultural minority adolescents.
GENEVA REYNAGA-ABIKO received her PsyD from Pepperdine University.
She is the chair of Latina/o Student Outreach, coordinator of the Counseling Center Paraprofessional Program, and a clinical counselor at the
University of Illinois at Urbana–Champaign Counseling Center. Her professional interests include multicultural counseling, culturally competent
assessment, training, and teaching.
PATTON O. GARRIOTT received his MS in counseling psychology from the
University of Kentucky. He currently teaches introductory psychology
laboratories at the University of Kentucky and is a consultant for an
immigration clinic on cases involving mental health. His research interests
include White racial attitudes, cross-cultural variations in attachment behavior, and cultural competency in counseling and assessment.
KAREN J. DEREFINKO holds an MS in clinical psychology from the University of Kentucky, where she is currently pursuing a doctoral degree in
clinical psychology. Her research interests include the early detection of
adult criminal outcomes, the developmental correlates of aggressive and
delinquent behavior, and the efficacy of contemporary treatment interven-
tion programs for conduct-disordered children and adolescents.
MARY K. WIMSATT received her MS in counseling psychology from the
University of Kentucky. She is currently a PhD student at Indiana University Bloomington. Her research interests include multicultural counseling
and assessment.
LAUREN C. GUDONIS holds an MS in clinical psychology from the University of Kentucky, where she is currently pursing a doctoral degree in
clinical psychology. She is currently working toward a certificate in Higher
Education Learning and Teaching and hopes to enjoy a faculty career one
day. Her research interests include the relation between disinhibitory
behavior, drug use, and delinquency.
TAMARA L. BROWN received her PhD from the University of Illinois at
Urbana–Champaign. She is a licensed clinical psychologist and an associate professor in the Department of Psychology at the University of Kentucky. Her research interests include examining the patterns and predictors
of substance use among ethnic minority adolescents, the role of culture in
psychopathology and treatment, and how religiousness and spirituality
influence psychological health.
David Acevedo-Polakovich, Dean’s Office, Louis de la Parte Florida
Mental Health Institute, 13301 Bruce B. Downs Boulevard, Tampa, FL
33612-3807. E-mail: or
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This concern over the cross-cultural relevance of assessment
procedures is reflected in the current Ethical Principles of Psychologists and Code of Conduct of the American Psychological
Association (APA; APA, 2002). Most broadly, Principle E compels psychologists to be aware of and respect cultural, individual,
and role differences—including those based on race, culture, and
national origin—and to consider these factors when working with
members of such groups. In the specific case of psychological
assessment, the Code of Conduct compels psychologists both to
“use assessment instruments whose validity and reliability have
been established for use with members of the population tested” (p.
1071) and to take into account linguistic and cultural differences
that might reduce the accuracy of their interpretations. These
ethical requirements are grounded in the understanding that a
culturally competent psychological evaluation of U.S. Latinas/os
requires both the use of instruments that are adequately validated
in that population and the adequate consideration of culturally
linked factors known to influence the assessment process and its
The literature dedicated to the examination of a psychological
assessment instrument’s cross-cultural relevance has grown significantly in recent decades. There is now excellent work available
that details the processes of examining an instrument’s crosscultural relevance and making adaptations when these are found to
be necessary (e.g., Geisinger, 1995, 2003), as well as a growing
corpus of empirical work examining the validity of many specific
instruments in U.S. Latina/o samples and adapting these when
necessary and appropriate. Examples of instruments subjected to
this type of scrutiny include, but are not limited to, the Wechsler
Scales, the Woodcock Johnson (López & Weisman, 2004), and the
Minnesota Multiphasic Inventory—2 (Velásquez et al., 1997,
2000; Velásquez, Garrido, Castellanos, & Burton, 2004). In a few
cases, assessment procedures have been developed specifically for
use with U.S. Latinas/os, such as the Tell-Me-A-Story test (Malgady, Costantino, & Rogler, 1984), a mental health screening test
developed originally for use with urban Latina/o children and
adolescents. The well-developed theoretical understanding of the
criteria needed to establish an assessment instrument’s crosscultural relevance, along with the excellent applied examples
available, provide a strong foundation for the abundant work still
needed to ensure that Latinas/os are assessed with culturally valid
instrumentation across each of the various domains of psychological assessment common in the United States.
The literature focused on the integration of cultural and linguistic factors into the interpretation of assessment findings has also
seen some seminal growth. Empirical and conceptual approaches
have been used to determine the mechanisms through which culture may influence the validity of assessment findings (e.g., Cofresi & Gorman, 2004; Malgady & Costantino, 1998), and attempts
have been made to develop recommendations for the avoidance of
culturally linked bias in the course of psychological assessment
with ethnic minority individuals (e.g., Paniagua, 2005; Roysircar,
2005). Although broad guidelines for culturally competent assessment with ethnic minorities, such as those currently available in
the literature, are important in light of the ethnic and cultural
diversity of the U.S. population, they can be difficult to operationalize when working with specific ethnic groups. For instance,
although the recommendation to consider cultural values in interpreting results is an important one, it does not clarify which
specific values are to be taken into account when working with any
given group, or how these may affect the validity of assessment
findings’ recommendations. Accordingly, this article presents
practical guidelines regarding the linguistic and cultural differences that might reduce the accuracy of assessment interpretations
when working with U.S. Latinas/os. The discussion is focused only
on those factors that are known to be of relevance among most
specific Latina/o groups (e.g., Mexican, Cuban, Central American,
Puerto Rican, Dominican) and to influence psychological assessment across a variety of settings (e.g., cognitive, academic, developmental, psychiatric, vocational). As such, the various recommendations provided in this article are intended to be foundational,
and to be complemented in specific settings by the consideration of
other important culturally linked factors whose influence is limited
to certain types of assessment or specific Latina/o groups and
factors that also influence the assessment process but are not
unique to Latinas/os (e.g., family variables when assessing mental
health, or developmental considerations when assessing children,
adolescents, or geriatric populations).
The recommendations provided in this article are organized
along four stages of professional practice with regard to psychological assessment: (a) before the assessment occurs (i.e., proactive
steps), (b) at the outset of the assessment process before selecting
standardized assessment procedures (i.e., clinical interview and
measure selection), (c) during the assessment process, and (d)
during the interpretation of and reporting of results. Consultation
with other professionals is discussed in a separate section as it can
play a crucial role in ensuring the accurate and ethical psychological assessment of U.S. Latinas/os at all stages of professional
practice. The article finishes with a conclusion section that elaborates on some of the strengths and limitations of the recommended practices.
Proactive Steps
Receive Formal Training
In delineating the boundaries of competence for psychologists,
the APA ethics code indicates that training must be obtained when
scientific or professional knowledge establishes that an understanding of factors associated with ethnicity, culture, or national
origin is essential for the effective implementation of services
(APA, 2002). Although, consistent with this ethical standard, the
APA now requires accredited graduate programs to include discussion of multicultural issues as a topic in psychological assessment training (Dana, 2002), postgraduate training may be necessary for psychologists trained before this requirement was in place
or in programs in which this requirement was addressed without a
level of specificity that allows direct application in the assessment
of Latinas/os. In both of these cases, psychologists may be inadequately trained to work with U.S. Latinas/os (Bernal & Castro,
1994; Dana, 2000). Indeed, a majority of participants in the most
recently available survey of psychologists conducting assessments
with Latina/o populations reported having inadequate skills to
work with that population (Echemendia, Harris, Congett, Diaz, &
Puente, 1997).
The exact nature and number of training opportunities required
for attaining competence in the culturally responsive assessment of
U.S. Latinas/os will depend on a psychologist’s prior experience
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and training but most often will require more than one course
devoted to multicultural issues (Brown, Acevedo-Polakovich, &
Smith, 2006; Roysircar, Arredondo, Fuertes, Ponterotto, & Toporek, 2003; Roysircar, Sandhu, & Bibbins, 2003). Available
guidelines suggest that adequate training in the psychological
assessment of U.S. Latinas/os should result in the following (Hansen, 2002):
1. An understanding of U.S. Latina/o-specific variables, constructs, and syndromes;
2. A knowledge of specific instruments exhibiting reliability
and validity among U.S. Latinas/os;
3. An ability to make culturally sensitive diagnoses and general
assessment conclusions relevant to U.S. Latinas/os; and
4. An ability to explain results in a manner that is responsive to
the cultural needs of U.S. Latinas/os.
Maintain Training
Efforts aimed at the maintenance of competence in the psychological assessment of U.S. Latinas/os are perhaps as important as
those targeted at receiving foundational training in this area. Without proper maintenance of training, psychologists are more likely
to make important decisions about their U.S. Latina/o clients on
the basis of inadequate, outdated, or even incorrect information.
Not surprisingly, Standard 2.03 of the APA ethics code (APA,
2002) requires that psychologists make ongoing efforts to maintain
Three basic strategies can be used to maintain competence in the
psychological assessment of U.S. Latinos/as. First, periodic review
of recent issues of specialty journals in both assessment (e.g.,
Psychological Assessment) and culturally inclusive mental health
(e.g., Cultural Diversity and Ethnic Minority Psychology, Hispanic Journal of Behavioral Sciences) can help identify the relevant work in this area (see Hall and Maramba, 2001, for a helpful
commentary on publication outlets focused on the psychology of
U.S. ethnic minorities). It may also be helpful to focus specifically
on authors who make regular contributions to the scholarly literature in this area, a sampling of which can be gleaned from this
article’s reference list. Second, ongoing social interaction with
U.S. Latinas/os can help psychologists increase their familiarity
with U.S. Latina/o culture. This will not only help psychologists
feel more comfortable during the assessment but can also reduce
the likelihood that their conceptualization of client issues is influenced by stereotypes (Reynaga-Abiko, 2005). Finally, there are
several professional organizations that bring together many of the
experts in the psychology of U.S. Latinas/os and are valuable
resources for further information and training. A list of several
such organizations is provided in the Appendix.
Clinical Interview and Measure Selection
The importance of a thorough psychosocial interview conducted
prior to selecting and implementing assessment procedures cannot
be overstated, as the information obtained from the client must be
used in selecting appropriate measures and interpreting assessment
results. APA ethical standards on the use of assessment instruments and interpretation of assessment results indicate that psychologists should consider an individual’s culture and linguistic
background, as well as other situational factors, both when select-
ing assessment instruments and when interpreting their results.
There are several of these factors common among U.S. Latinas/os
that can have an impact on the assessment process, including
immigration history, contact with other cultural groups, acculturative status, acculturative stress, socioeconomic status (SES), and
language ability and preference (Dana, 1993; Paniagua, 2005).
Immigration History
Clients’ immigration experiences can impact their psychological
health (Mitrani, Santisteban, & Muir, 2004). For instance, Central
American individuals who immigrated during the 1980s and 1990s
may have done so to escape conditions of war and violence, and
they may have been exposed to traumatic events in their country of
origin (Falicov, 1998; Santiago-Rivera et al., 2002). Regardless of
country of origin, many immigrants suffer traumatic experiences
before, during, and after the relocation process (Foster, 2001).
Immigrants also have different experiences of discrimination upon
entering the United States. Accordingly, information about a
Latina/o client’s immigration history is of primary importance in
conducting an effective assessment. At a minimum, the following
information should be obtained from the client:
1. Length of stay in the United States,
2. The circumstances under which the client left his or her
country of origin, and
3. The client’s current legal status in the United States as well as
the legal status of the client’s family and significant others.1
Contact With Other Cultural Groups
An issue related to immigration that should be addressed during
this phase of the psychological assessment process is the amount
of contact the client has had with members of other cultural
groups. It is essential to distinguish monocultural from multicultural environments as these may affect assessment outcomes. For
example, if a Latina/o lives in East Los Angeles where the population is 97% Mexican American and many residents are monolingual Spanish speakers (Therrien & Ramirez, 2001), his or her
experience will likely differ from a Latina/o who resides in a
region of the United States in which he or she appears different
from everyone else in the area. The following information about a
client’s current cultural environment should be obtained:
1. The ethnic makeup of the area in which the client lives,
2. The frequency with which the client ventures outside of this
3. The nature of the client’s experiences when venturing outside
of his or her home area (e.g., Does the client feel comfortable?
Does the client feel discriminated against?),
4. Length of stay at current residence,
5. Previous areas in which the client lived and the ethnic makeup
of those areas, and,
6. The frequency with which the client changes residences and
the subjective impact of these changes on the client’s life.
Many clients may be reluctant to discuss their immigrant status or that
of their significant others because of fear of deportation or other legal
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Acculturative Status
Acculturation refers to individuals’ adaptation to a culture other
than that which they hold to be their own. As they engage in the
process of acculturation, individuals negotiate multiple domains,
including values, behavior, and cultural identity, ideally maintaining their culture of origin while developing proficiency in additional cultures (Cabassa, 2003; Cortés, Rogler, & Malgady, 1994;
Cuéllar, Arnold, & Maldonado, 1995). Among Latinas/os, acculturative status has been shown to affect mental health both directly
and indirectly, and it is associated with the prevalence of various
types of psychopathology (Cuéllar, 2000; Gamst et al., 2002;
Rogler, Cortés, & Malgady, 1991). Acculturation includes multiple factors, such as cultural norms, behaviors, and language preferences. For this reason, demographic indicators—such as language proficiency, place of birth, generational status, and time
spent in the United States— offer only a limited perspective of an
individual’s acculturation (e.g., Cortés et al., 1994; Phinney, Dupont, Espinoza, Revill, & Sanders, 1994; Schwartz, Pantin, Sullivan, Prado, & Szapocznik, 2006; Tropp, Sumru, Coll, Alarcón, &
Vázquez Garcı́a, 1999). A formal assessment of acculturation can
help psychologists (a) identify cultural experiences that have an
impact on psychological processes and (b) determine whether
acculturative status has an effect on responses to assessment procedures.
Several acculturation scales exhibiting validity with Mexican
American, Puerto Rican, Nicaraguan American, Central American,
and Cuban American samples have been developed. These include
the Abbreviated Multidimensional Acculturation Scale (Zea,
Asner-Self, Birman, & Buki, 2003), the Brief Acculturation Scale
for Hispanics (Norris, Ford, & Bova, 1996), and the Acculturation
Rating Scale for Mexican Americans, Second Edition (Cuéllar et
al., 1995), among many others. Interested readers are referred to
Paniagua’s (2005, p. 120) helpful summary of available acculturation measures and the samples in which they have been validated.
Before selecting other assessment instruments to be used, acculturation should be formally assessed with instruments that are
based on a multidimensional model of acculturation that has demonstrated internal and external validity in the specific Latina/o
subpopulation to which the individual being tested belongs. It is
inappropriate and unethical to assume that a measure developed,
for example, for Mexican Americans will be valid for all other
Latina/o groups.
Measures of SES purport to represent the relative distribution of
prestige in a society. In the United States, as in many other
societies, SES is significantly correlated with ethnicity. U.S. Latinas/os report significantly lower average per capita incomes
($12,158) than do European Americans ($24,951), Asian Americans ($22,688), and African Americans ($15,007; U.S. Department
of Health and Human Services, 2001). This is important because
low SES is a significant risk factor for a broad array of mental
health problems (Hudson, 2005; U.S. Department of Health and
Human Services, 1999).
Although differences in financial capital across U.S. Latina/o
subgroups have been reported, studies examining this question
report inconsistent findings. For instance, one report based on data
provided by the U.S. Census Bureau shows that families of South
and Central American origin are the most affluent among U.S.
Latinas/os, followed by Mexican Americans, Puerto Ricans, and
Cuban Americans (Paniagua, 2005). However, other reports suggest that Cuban Americans are the most affluent U.S. Latina/o
group, followed by Puerto Ricans and Mexican Americans (U.S.
Department of Health and Human Services, 2001). These discrepant reports highlight the importance of directly evaluating SES in
the individual being assessed.
An adequate assessment of SES must include data about financial resources (most often per capita family income), social/
interpersonal resources (most often educational level or head of
household education), and nonmaterial resources (most often
household structure). In some cases, it may also be appropriate to
assess the occupational status of the individual being assessed, but
it should be noted that no occupational status scales based on U.S.
Latina/o ratings currently exist. In the absence of culture-based
ratings, psychologists may wish to consider using existing scales
that are tied to more objective criteria, such as Nakao and Treas’s
(1992) indices (see Acevedo-Polakovich, 2006, for information on
assessing SES). SES information should inform the interpretation
of assessment data and the recommendations based on these data.
Acculturative Stress
When a preassessment interview suggests that acculturative
factors are influencing a U.S. Latina/o’s psychological functioning, psychologists should consider assessing for acculturative
stress—the distress resulting from acculturation. Acculturative
stress can affect psychological functioning (Cofresi & Gorman,
2004), is not necessarily related to an individual’s level of acculturation (de las Fuentes, 2003), and can be found in people who
have lived in the United States for many years. Just as with
acculturation, acculturative stress should be measured with formal
assessment tools that have sound psychometric properties. One
such measure is the Multidimensional Acculturative Stress Inventory (Rodriguez, Myers, Mira, Flores, & Garcia-Hernandez, 2002),
developed for use with adults of Mexican origin.
An individual’s language ability and preference affect all aspects of the assessment process. For instance, clients whose primary language is Spanish appear to receive more severe ratings of
symptomatology when evaluated in Spanish than when evaluated
in English (Malgady & Costantino, 1998). Additionally, there are
unique issues to consider when working with bilingual clients,
including verbal and nonverbal communication. There are many
different types of bilingualism with varying levels of fluency
possible in each language spoken (Altarriba & Santiago-Rivera,
1994; Santiago-Rivera & Altarriba, 2002). For example, it is
possible for people to speak another language with fluency without
understanding the nuances of culturally based nonverbal behavior
(Cofresi & Gorman, 2004), which can lead to miscommunication.
Assessing language ability and preference at the outset of the
assessment process will help psychologists make accurate estimates of the client’s psychological functioning. The following
three recommendations are provided in order to ensure the adequate assessment and consideration of a U.S. Latina/o client’s
language abilities:
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1. Psychologists must assess a client’s language preference and
abilities prior to the selection of assessment methods and conduct
the assessment in that language (APA, 2002).
2. Any assessment of language fluency must be commensurate
with the language needs of the instruments that may be administered. For example, if the instrument requires a sixth grade reading
level, it should be determined whether the client’s language competence meets this level of development (Reynaga-Abiko, 2005).
3. When a client’s language ability cannot be determined with
reasonable certainty through an informal interview, a language
proficiency test should be administered. The language test chosen
should have been developed according to best practice standards of
test development. Tests meeting these requirements can be obtained from a variety of agencies, such as Test of English as a
Foreign Language Organization (, Language Testing International (, Center for Applied
Linguistics (, Alta Language Services (www, and Language Learning Enterprises (
4. The methods used for assessing language preference and
ability should be documented in the assessment report, including a
brief discussion of the possible effects of a client’s language
preference and proficiency on the choice of assessment procedures
and their interpretation.
Measure Selection and Assessment Planning
The validity of psychological assessment results is an issue of
vital importance as these are often used to inform important
decisions that impact a client’s life (e.g., competency to stand trial,
course of psychological treatment, access to employment). Obtaining valid results is contingent on many factors, not the least of
which is selecting measures whose validity has been demonstrated
in samples from the population to which the individual being
tested belongs (Geisinger, 1995). If a measure was translated, there
must be sufficient evidence that this process occurred with adequate care and review in order to ensure that the items retained
their meaning (see the next section for specific details on translation). Consideration of factors—such as a client’s immigration
history, contact with other groups, acculturative status, acculturative stress, SES, and language—should provide a more accurate
picture of the client’s population of origin, informing not only the
selection of assessment instruments according to existing validity
evidence but also the anticipated range and intensity of cultural
phenomena to be considered in the assessment process.
If a measure validated on the specific Latina/o subgroup to
which the individual being assessed belongs cannot be identified,
the psychologist may have no choice but to use a measure validated on other populations. It is suggested that the psychologist
take the following corrective steps to gain maximal utility from
these measures while also recognizing their potential inadequacy
for assessing the individual in question:
1. The psychologist should document in the assessment report
the lack of validity for members of the client’s Latina/o subgroup,
including the tentative nature of the results obtained from the
2. The clinician should seek records of the individual’s previous
performance on relevant criteria and incorporate this information
into the assessment. Any incongruence between current and past
assessments of performance would need to be explained, as discrepancies may be more a reflection of normative difficulties
associated with immigration and acculturation than of psychopathology.
Issues Surrounding Language, Translation, and Use of
If validated measures in the desired language are unavailable,
alternatives include conducting or commissioning a written translation of the available assessment measures or making use of an
on-site interpreter during the assessment process. Only in the rarest
of circumstances will the first of these options be accessible to
most individual psychologists. According to the International Testing Commission (2001), adequate translation requires the following considerations:
1. Back translation should be used whenever possible. This
process involves translating items into the second language, having
them translated back into the original language by a second translator, and comparing the two translations for equivalency.
2. Adapted measures should be piloted and modified in response
to comprehension problems reported by pilot groups.
3. Translated measures should be field tested, and evidence of
internal consistency and test–retest reliability should be provided.
4. Scores on the adapted measure should be restandardized for
the target population (norms from the original instrument may
yield invalid results).
5. Additional construct validation research should be conducted
to ensure that the instrument measures the same qualities in both
languages and is interpretable.
Deviations from these suggestions should be documented in the
assessment report along with their possible impact on the validity
of the assessment results and their interpretation.
The use of on-site interpreters is a relatively more accessible
approach to the assessment of Latinas/os with limited English
fluency and/or a preference for testing in a language other than
English. Competent interpreters should be able to provide documentation supporting their proficiency in two important areas of
professional functioning: language fluency and knowledge of interpreting ethics and practices (Acevedo, Reyes, Annett, & Lopez,
2003). Proficiency in both of these areas is most directly demonstrated through documentation establishing that an individual has
successfully completed an interpreter training program (e.g., has
received American Translator’s Association Certification, Federal
Court Interpretation Status). However, there are few nationally
recognized training programs for interpreters, and few states require certification (Hwa-Froelich & Westby, 2003). A less desirable alternative is providing documentation that indirectly supports
an interpreter’s competency in these areas. In the case of language
fluency, degrees obtained at foreign universities or foreign language degrees from domestic universities may meet this requirement. Similarly, a certificate of attendance from an interpreting
ethics workshop or formal letter of support from an established
language services firm can serve as evidence of at least cursory
knowledge of professional interpreting ethics and practices. In
practice, these qualifications are often not met by interpreters
(Acevedo et al., 2003; Hwa-Froelich & Westby, 2003). Thus,
interpreters should only be used when no other recourse is available and when it is clear that they have been properly trained.
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
The ethical use of interpreters is most likely to occur when
psychologists meet with them beforehand and ensure compliance
with each of the following four recommendations:
1. The use of a consecutive translation approach in which the
interpreter translates the message of only one person at a time,
waiting until that person has stopped speaking before translating
the message (Hwa-Froelich & Westby, 2003).
2. An interpreter’s agreement to serve as a language consultant,
explaining the contextualized meaning of any colloquialisms or
idioms that may be missed if the interpreter provides only a literal
translation (Kapborg & Bertero, 2002).
3. An interpreter’s agreement to discuss with the psychologist
any culturally inappropriate material that may present itself
throughout the session in order to prevent the clinician from
offending the client (Hwa-Froelich & Westby, 2003).
4. An interpreter’s agreement to maintain the confidentiality of all
material discussed in session (Altarriba & Santiago-Rivera, 1994).
When an interpreter is used, the following items should be
documented in the assessment report:
1. The fact that an interpreter was used, along with a detailed
description of the tasks performed by the interpreter,
2. The interpreter’s qualifications in language proficiency and
professional ethics, and
3. The likely impact of the interpreter’s qualifications on the
validity of the assessment results.
only information gleaned from the interview and behavioral observations but also information about the individual’s immigration
history, contact with other cultural groups, familial relations, SES,
language ability and preference, acculturative status, and acculturative stress. Incorporation of this information will allow the
psychologist to make more accurate interpretations of a Latina/o
client’s psychological functioning (Lewis-Fernandez & Kleinman,
Occasionally, assessment results are not consistent with the
historical information known about a client. Although difficult, it
is necessary for assessors to convincingly address these discrepancies, as inconsistent information may be an indication that the
information-gathering process is incomplete (Malgady, 1996) and
further assessment procedures may be necessary to identify the
source of the discrepancy (e.g., individual’s acculturative status,
appropriateness of the assessment procedures). As assessors develop hypotheses explaining incongruent findings, the client
should be used as a source of information. This allows client
feedback on interpretations drawn from standardized information
and may prevent premature conclusions. Additional insights provided by the client may be used in the assessment report as
supporting or contrasting information.
Considerations Surrounding Taxonomic Labels
Incorporating Cultural Explanations
Diagnosis, broadly defined, is often a goal of conducting assessment procedures and forms the basis for intervention recommendations. Like the prevailing assessment procedures, most of
the diagnostic taxonomies prevalent in U.S. assessment settings
are grounded in the cultural norms of European Americans and
may not adequately describe psychological functioning in individuals from other cultural backgrounds (Malgady, 1996). For instance, available research suggests that many U.S. psychological
disorders are not recognized in Latina/o cultures and that many
Latina/o subgroups have their own disorders (Baer et al., 2003).
For example, some Latina/o subgroups recognize the mental health
syndrome nervios, which, although often mistaken for anxiety,
encompasses a wider variety of symptoms and is deemed less
pathological (Baer et al., 2003). Moreover, individual markers of a
taxonomic label may not have cross-cultural applicability (Weller
et al., 2002). For instance, the belief that unseen forces are acting
on the individual to cause personal harm may, in mainstream U.S.
culture, indicate psychosis or paranoid ideation. However, for
Latinas/os who believe in brujerı́a and/or espiritismo,2 this belief
is consistent with normal psychological functioning. Without consideration of cultural influence, this diagnostic marker could be
misinterpreted and lead to incorrect conclusions.
Adherence to the following two procedures can assist psychologists in considering culture when assigning diagnostic categories,
thereby enhancing cultural sensitivity and compliance with relevant ethical standards:
1. A diagnostic label should only be assigned after it is established that this label is (a) culturally appropriate and (b) does not
pathologize behavior that is normative in the individual’s original
Beyond the careful selection and appropriate use of assessment
procedures, creating interpretive statements about an individual
requires the incorporation of all available sources of information
(APA, 2002). For Latina/o clients, it is necessary to include not
These terms refer to traditional systems of belief in which an enemy
can work through a spiritist to cause others harm (Guarnaccia, LewisFernandez, & Marano, 2003).
During the Assessment Process
Regardless of the specific assessment procedure(s) decided on,
psychologists assessing Latinas/os should record detailed behavioral observations and include these in the assessment report.
Behaviors include the client’s body language, eye contact, tone of
voice, and speech patterns. As nonverbal communication varies
cross-culturally (Santiago-Rivera & Altarriba, 2002), this information provides a useful supplement to other assessment results,
especially if the behavioral observations conflict with the results
obtained from assessment instruments. However, caution should
be maintained when interpreting nonverbal communication, as
accurate interpretation requires intimate knowledge of a target
culture (Cofresi & Gorman, 2004).
Interpreting and Reporting the Results
The accurate interpretation and reporting of results is of paramount importance in ensuring the adequate and ethical assessment
of U.S. Latinas/os. Shortcomings in interpretation or reporting can
compromise an otherwise accurate assessment and lead to erroneous diagnoses or recommendations. Assessors must take care to
ensure adequate consideration of cultural explanations for a client’s referral question—a consideration that is particularly important before classifying the client into any existing taxonomic
scheme, such as a psychiatric diagnosis.
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cultural context. When a diagnostic label is not assigned as a result
of failure to meet either of these conditions, the assessment report
should document and explain this decision.
2. If a diagnostic label is assigned to an individual with limited
proficiency in U.S. culture (as determined by assessing the individual’s acculturation status), the assessment report should include
a narrative describing (a) the behaviors that justify the label, (b) the
individual’s cultural identity, (c) cultural explanations of the illness, (d) cultural factors related to psychological functioning, and
(e) the cultural elements of the assessor– client relationship. When
psychological functioning is being assessed, the specific impairment associated with a diagnosis should also be documented
(American Psychiatric Association, 1994).
Reporting the Results
When the client in a psychological assessment is the Latina/o
individual being assessed, feedback must be approached with
sensitivity to the client’s cultural background. This is particularly
important when assessment is focused on psychological functioning as many Latina/o subcultures attach some stigma to mental
illness (de las Fuentes, 2003). Recommendations for reporting
findings to Latina/o clients include the following:
1. Use of an interactive approach that incorporates the client’s
feedback into a discussion of results. This approach can also
provide a final opportunity to identify cultural issues that may have
affected assessment findings.
2. When this is the client’s preference, inclusion of family
and/or community members in feedback sessions (Reynaga-Abiko,
2005), making sure to consider the position of the client in his or
her family hierarchy (Dana, 1993).
3. The contextualization of information, including the process
that was undertaken to arrive at the interpretations and treatment
recommendations, when results are reported in a written document
that will be accessed by the client (Reynaga-Abiko, 2005). When
the psychologist illuminates the cultural factors that may have
influenced the data, others who read the report may derive a better
understanding of the various factors that impacted the assessment
results (Ritzler, 1996). This is especially relevant when the information may be used by others who are less familiar with Latina/o
culture and/or culturally relevant assessment procedures.
The Role of Consultation
Consultation is the process of accessing a qualified colleague’s
input on a specific professional function (Arredondo, Shealy,
Neale, & Winfrey, 2004) and is included in APA (2002) ethical
Standard 2.01 (c) as one of the resources to be accessed by
“psychologists planning to provide services, teach, or conduct
research involving populations, areas, techniques, or technologies
new to them” (p. 1064). With regard to the psychological assessment of U.S. Latinas/os, consultation may prove beneficial
throughout the assessment process and is an option available to
psychologists regardless of their level of expertise. Depending on
the expertise level of the clinician seeking consultation, the consultant may be expected to (a) help plan the assessment procedure,
(b) assist in the identification of appropriate assessment methods,
(c) provide feedback on the interpretation of the assessment results
and their write-up, and, particularly in cases in which the consultee
is a trainee or student, (d) cosign the finalized assessment report.
A straightforward procedure for the use of consultation when
assessing U.S. Latinas/os involves the following:
1. Seeking a qualified consultant prior to planning any assessment of U.S. Latinas/os. The ideal consultant possesses (a) adequate formal training in the provision of psychological assessment
services to Latina/o populations and (b) a documented history of
psychological assessment service provision with that population.
When a qualified consultant is not available locally, the clinician
may conduct a literature search or elicit the help of members of an
online community, such as a professional listserv (Reynaga-Abiko,
2. Formally outlining and agreeing upon (preferably in writing)
the responsibilities of the consultant and consultee. The agreement
should cover the number and duration of consulting sessions and
the expected responsibilities of both parties. Formalized expectations of the consultee should include the timely and accurate
sharing of information and reasonable efforts to respond to the
consultant’s suggestions.
Although the practice of psychological assessment of U.S. Latinas/os has significantly advanced in recent decades, there is still
much work to be done. Excellent work has been conducted in
laying down the conceptual framework needed to evaluate the
cross-cultural validity of assessment processes, and seminal work
has focused on the cross-cultural validation of specific psychological instruments. However, the incorporation of culturally linked
factors into the selection of assessment measures and interpretation
of results has received relatively less attention. The existing literature in this second area has in some cases chosen a broad
multicultural focus whose application when working with specific
groups can be unclear. In other cases, experts have focused on the
role of discrete culturally linked factors that are not integrated into
a broader framework. Current recommendations bridge the gap
between these two approaches by presenting practice recommendations based on factors that are known to influence psychological
assessment across a variety of settings and across specific Latina/o
As stated in the introduction, these recommendations focus on
only one of two broad requirements of an accurate and ethical
assessment of U.S. Latinas/os: the incorporation of cultural factors
into the selection of assessment approaches and the interpretation
of results. Discussion about the second—and no less important—
broad requirement, the use of instruments whose validity has been
demonstrated in samples from an assessment target’s population of
origin, has been deferred to other excellent sources. Accuracy and
ethical compliance in the assessment of U.S. Latinas/os can only
be achieved when both of these broad issues are incorporated into
an assessment protocol.
Because current recommendations are based on culturally linked
factors whose influence is pervasive both across assessment settings and across Latina/o groups, adherence to these recommendations may not always ensure full consideration of all culturally
linked factors that affect a specific assessment. Two other sets of
factors must also be accounted for: first, other important culturally
linked factors whose influence is limited to certain types of assessment (e.g., traditional gender role orientation in an assessment
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
of family functioning, or family functioning in an assessment of
mental health) or specific Latina/o groups; second, factors that also
influence the assessment process but are not unique to Latinas/os,
such as developmental considerations when assessing children,
adolescents, or geriatric populations. As such, in the context of the
current discussion, an ethical and accurate assessment of U.S.
Latinas/os must include four broad components:
1. The use of assessment processes adequately validated in that
2. The incorporation of the broad and pervasive culturally linked
factors discussed in this document,
3. The incorporation of other culturally linked factors whose
influence is limited to the specific assessment settings and specific
group of the Latina/o individual being evaluated, and
4. The consideration of influencing factors that are not unique to
Although the four components summarized above can guide an
assessment process toward the accurate and ethical assessment of
U.S. Latinas/os, an individual psychologist’s competence and experience is the final predictor of these two outcomes. It is difficult
to imagine that an accurate and ethical assessment could be ensured by direct application of current recommendations by a psychologist with no other training or experience with U.S. Latina/o
psychology. This being said, it is equally true that successfully
working toward the development of broad cultural sensitivity does
not guarantee an understanding of the specific skills needed to
adequately conduct psychological assessments of U.S. Latinas/os
(Dana, 2000). As such, targeted recommendations such as those
presented in this article are a necessary compliment to broad
multicultural training efforts whenever the multicultural work occurs in a specific professional context.
Despite their limitations, these recommendations integrate findings from the available literature in a practical manner that can lay
the foundations for the accurate and ethical assessment of U.S.
Latinas/os, an approach that is particularly needed when the continued growth of the U.S. Latina/o proportion of the U.S. population highlights concerns over psychologists’ lack of preparedness
to accurately assess members of this group. It is hoped that these
recommendations will develop through empirical and conceptual
refinement, ensuring that in an era of increasing U.S. ethnic
diversity, the psychological needs of Latinas/os will no longer go
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(Appendix follows)
Sample Organizations and Special Interest Groups With a Focus on U.S. Latina/o Psychology
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
• National Latina/o Psychological Association (http://
• California Latino Psychological Association (
• Latino Psychological Association of New Jersey (http://
• Midwest Association of Latino Psychologists (http://
• Hispanic Neuropsychological Society (
• Society for the Psychological Study of Ethnic Minority Issues
• Association for Multicultural Counseling and Development
• National Hispanic Science Network on Drug Abuse (http://
Special Interest Groups
• Section on the Clinical Psychology of Ethnic Minorities
(Section VI) of the Society of Clinical Psychology (APA Division
• Section on Ethnic and Racial Diversity of the Society of
Counseling Psychologists (APA Division 17; http://
Received February 16, 2006
Revision received July 21, 2006
Accepted August 28, 2006 䡲
Assessing the Strengths of Young
Children at Risk: Examining
Use of the Preschool Behavioral
and Emotional Rating Scale With
a Head Start Population
Journal of Early Intervention
Volume 32 Number 4
September 2010 274-285
© 2010 Sage Publications
hosted at
Annette K. Griffith
Kristin Duppong Hurley
Alexandra L. Trout
Lori Synhorst
Michael H. Epstein
University of Nebraska–Lincoln
Elizabeth Allen
PRO-ED, Austin, Texas
Over the past decade, there has been an increased need for the development and use of psychometrically acceptable measures to assess the behavioral and emotional strengths of young
children served in statewide preschool and Head Start programs. One measure developed to
address this need is the Preschool Behavioral and Emotional Rating Scale (PreBERS), which
is a strength-based instrument designed to evaluate the behavioral and emotional strengths of
preschool children aged 3 to 5 years old. In a previous study with a nationally representative
sample, researchers found that (a) the items of the PreBERS can best be described by a fourfactor structure model (Emotional Regulation, School Readiness, Social Confidence, and
Family Involvement), (b) the subscales and total measure have highly acceptable levels of
internal consistency, and (c) differences were obtained for levels of strength for preschool
children with and without disabilities. The findings of this investigation replicate these previous results with a national sample of children (N = 962) enrolled in Head Start programs.
Confirmatory factor analysis and analyses of internal consistency and criterion validity provide support for the use of the PreBERS with children served in Head Start programs. Study
limitations and implications are addressed.
strength-based assessment; preschool children; Head Start
ith increasing numbers of children participating in state-funded preschool and Head
Start programs, there is a growing interest in the early identification of problem
behaviors (e.g., Conroy & Brown, 2004; Fairbanks, Sugai, Guardino, & Lathrop, 2007; Qi
& Kaiser, 2003). Although children are typically not formally identified with an emotional
Authors’ Note: We would like to thank the teachers, children, and families who were involved in this project.
Please address correspondence to Annette K. Griffith, Center for Child and Family Well-Being, University of
Nebraska–Lincoln, Lincoln, NE 68583-0732; e-mail:
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Griffith et al. / Assessing the Strengths of Young Children at Risk    275
and behavioral disorder until well into their elementary school years, a number of children
begin to display problem behaviors as early as preschool (Campbell, 2002; Walker,
Ramsey, & Gresham, 2004). Researchers have found that many of these young children
will go on to engage in problem behaviors as they progress through school and into adulthood and that many will evidence comorbid learning and school-related difficulties (e.g.,
Gresham, Lane, & Lambros, 2000; Walker et al., 2004). In light of these findings, federal
legislation now mandates that school personnel become active in the identification of
young children who are in need of early intervention or special education services (National
Center for Education Statistics, 2007).
Early identification is particularly important for children living in poverty (Qi & Kaiser,
2003). The United States has the highest level of child poverty of all industrialized nations,
with 18% (more than 13 million) of children living in poor families in 2007 (National
Center for Children in Poverty, 2008). Children who live in poverty are at a greater risk for
problem behaviors because of the number of associated risk factors that affect their families
(e.g., unemployment, poor living conditions, low levels of education, health problems;
Wakschlag & Keenan, 2001), and they tend to have significantly poorer educational outcomes than do their same-aged middle- or high-income peers (Ou & Reynolds, 2008).
Thus, although rates of problem behaviors are estimated to be between 3% and 6% for the
general preschool population, rates for preschoolers attending Head Start—a national preschool program for children of families living below the federal poverty guidelines or
receiving public assistance—have been reported to be between 16% and 30% (Qi & Kaiser,
2003). As a result, children living in poverty, such as those who are involved with Head
Start, have an increased need for early identification and early intervention services.
To address this need, several behavioral rating scales have been developed that are useful for
the identification and intervention planning of young children who have or are at risk for emotional and behavioral disorders—for example, the Child Behavior Checklist–Ages 1 1/2–5
(Achenbach & Rescorla, 2000) and the Behavior Assessment System for Children (Reynolds &
Kamphaus, 2004). Although these measures have a number of positive qualities, including their
demonstration of good psychometric properties, standardization on a large number of youth,
and developmental appropriateness for young children, one concern is that they rely on a deficit
model for assessment. Specifically, children are identified as being at risk or in need of services
on the basis of reports of their behavioral deficits and problems. Whereas the assessment of
deficits and problems is important because it identifies areas in which children may be having
difficulties, assessment that focuses solely on the negative aspects of children’s behaviors is
problematic in that it may limit the range of information available about children, ignoring
strengths and positive behaviors that can serve as protective factors moderating risks for negative outcomes (Epstein, Mooney, Ryser, & Pierce, 2004).
In contrast, strength-based measures that can identify areas for improvement in a lessstigmatizing manner by focusing on the positive aspects of behaviors are important for
gathering diverse information necessary for intervention planning (Cox, 2006; Epstein
et al., 2004). In fact, several years ago, the Working Group on Developmental Assessment
identified strengths-based assessment as 1 of 10 key principles that should guide the assessment of young children (Greenspan & Meisels, 1996). Strength-based measures are a more
positive method of assessment in that they assume that all children have strengths, and so
they focus on measuring
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276    Journal of Early Intervention
those behavioral and emotional skills, competencies and characteristics that create a sense of
personal accomplishment; contribute to satisfying relationships with family members, peers,
and adults; enhance one’s ability to deal with adversity and stress; and promote one’s personal,
social, and academic development. (Epstein & Sharma, 1998, p. 3)
The use of strengths-based assessment may be valuable in intervention planning for
several reasons, including (a) focused attention on children’s strengths versus their problems and accompanying opportunities for learning and growth, (b) enhanced motivation of
the family to be involved in planning and subsequent interventions, and (c) improved identification of competencies for progress monitoring of interventions (Epstein & Sharma,
1998; Greenspan & Meisels, 1996). For instance, rather than focus on the reduction of
problem behaviors that could be identified through a deficit-based assessment, use of
strength-based assessments can help to focus interventions on the improvement and development of positive behaviors that are incompatible with problem behaviors. This change in
focus may help teachers, parents, and children to remember and be aware of the positive
attributes of children.
In response to the need for strength-based measures to assess children’s behavioral and
emotional strengths, the Behavioral and Emotional Rating Scale (Epstein, 2004; Epstein &
Sharma, 1998) was developed, which has been shown to have acceptable psychometric
qualities and be a valuable tool for identifying the emotional and behavioral strengths of
school-age children. Given the increasing need to assess preschool children and the specific
need for strength-based measures, an early-childhood version was developed: the Preschool
Behavioral and Emotional Rating Scale (PreBERS; Epstein & Synhorst, 2009).
Preschool Behavioral and Emotional Rating Scale
The PreBERS is a standardized assessment designed to measure the emotional and
behavioral strengths of preschool children (Epstein & Synhorst, 2009). The assessment
protocol has 42 items rated with a 4-point Likert-type scale (0 = not at all like the child,
1 = not much like the child, 2 = like the child, 3 = very much like the child). The PreBERS
should be completed by preschool teachers, practitioners, or parents who are familiar with
children being assessed. The PreBERS measures four dimensions of emotional and behavioral strengths. Specifically, the emotional regulation dimension has 13 items that assess
children’s ability to appropriately manage their emotions in social situations (e.g., “reacts
to disappointments calmly,” “controls anger towards others”). The school readiness dimension includes 13 items that measure important learning and language skills related to school
success (e.g., “persists with tasks until completed,” “understands complex sentences”). The
social confidence dimension contains 9 items that assess children’s appropriate initiation
and responding in social situations (e.g., “asks for help,” “stands up for self”). Finally, the
family involvement dimension includes 7 items that represent important environmental and
family characteristics that are related to children’s behavioral and emotional development
(e.g., “interacts positively with siblings,” “trusts a significant person in his or her life”).
The PreBERS was based on the original Behavioral and Emotional Rating Scale
(Epstein, 2004; Epstein & Sharma, 1998) and was developed with a systematic process
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Griffith et al. / Assessing the Strengths of Young Children at Risk    277
of item review and analysis (Epstein & Synhorst, 2009). In addition, several aspects of
the reliability of the 42-item PreBERS were evaluated during the norming process for
preschool children with and without disabilities. For example, the internal consistency
of the scale was assessed with the original sample, and the Cronbach coefficients for
the subscale and total strength scores were high, ranging between .838 and .982
(Epstein & Synhorst, 2009). With parent and professional respondents rating the
PreBERS items for children, interrater and test–retest reliability coefficients were more
than .80, indicating that the PreBERS was stable over short-term intervals and consistent between raters (Epstein & Synhorst, 2008). Evaluations of teachers and paraprofessionals’ ratings of the behaviors of children with and without disabilities also
yielded acceptable levels of test–retest (correlations over .80) and interrater agreement
(correlations over .70; Epstein & Synhorst, 2008).
Although the PreBERS appears to be a promising measure to assess the strengths of preschool-age children, additional research is warranted to replicate findings from the norming
process and better determine if the assessment is appropriate for subpopulations of young
children. Therefore, we sought to extend the research on the psychometric properties of the
PreBERS to children in Head Start programs. Although the four-factor PreBERS scale was
based on a nationally representative sample of preschool children without developmental
delays, using the scale with high-risk preschool populations may change the manner in which
the items load into factors and the resultant psychometric properties of the model. To this
end, we addressed three research questions: Can the original PreBERS model with four factors be replicated with a Head Start sample? Can the internal consistency of the four-factor
model be replicated with a Head Start sample? Does the PreBERS differentiate between
children with and without developmental delays in a Head Start sample?
The sample included 962 preschool children in Head Start programs ranging in age from
3 years–0 months to 5 years–11 months. We collected individual child data from 2006 and
2007 in the following states: California, Indiana, Kansas, Kentucky, Missouri, Montana,
Nebraska, New Mexico, Oklahoma, Pennsylvania, South Dakota, Tennessee, Utah, Vermont,
Wisconsin, and Wyoming. Our sample selection procedures resulted in a national sample of
preschool children in Head Start programs. The characteristics of the sample with regard
to geographical area, gender, race, ethnicity, disability status, and age are reported as
percentages in Table 1, which are similar to those of children enrolled in Head Start programs nationwide (Administration for Children and Families, n.d.; O’Brien et al., 2002; see
Table 1). Specifically, visual analysis indicates that our sample is similar to preschool children in Head Start programs nationwide with respect to gender, race, ethnicity, and disability
status. However, it is not representative of the population in terms of geographic region and
age. The sample was overrepresented with children from the South and with 5-year-old
children and underrepresented with children from the Northeast.
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278    Journal of Early Intervention
Table 1
Demographic Characteristics of the Preschool Behavioral and Emotional
Rating Scale Head Start Norming Sample (N = 962)
Geographic area
Black / African American
3 (n = 286)
4 (n = 452)
5 (n = 224)
Sample (%)
U.S. Head Start Population (%)
Data collection. We recruited Head Start personnel from each of the 50 states to coordinate and assist in PreBERS data collection. Specifically, we e-mailed the directors of
local Head Start programs and asked them to be site coordinators at their agencies. In
addition, we sent follow-up e-mail as needed for directors who had not responded within
a 2-week period. Directors from 16 states (32%) agreed to participate, and we sent letters
providing instructions in the administration procedures of the PreBERS. We also provided instructions on how to recruit Head Start teachers and how to train them to complete the PreBERS.
We provided participating teachers with additional information on how to select the children at
their program sites. Specifically, we provided raters with the following instructions:
First, decide how many students you wish to rate. Then, start either at the top or bottom of
your class roster and rate every other child. Do not skip any child unless you have known this
child less than two months. Stop selecting and rating children when you have reached the
number of children you wished to rate.
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Griffith et al. / Assessing the Strengths of Young Children at Risk    279
We used this selection procedure to minimize the possibility of selection bias on the part
of the teachers conducting the ratings. Thus, the Head Start directors and Head Start preschool teachers who volunteered to participate served as a convenience sample. Directors
and teachers provided written consent before they participated, and recruitment and consent procedures were approved by the University of Nebraska Internal Review Board.
Instrument. The PreBERS is a 42-item rating scale that assesses four areas of emotional and
behavioral strengths in preschool children: emotional regulation, school readiness, social confidence, and family involvement (Epstein & Synhorst, 2009). Raters can complete the
PreBERS in approximately 10 minutes for each child by reading and coding the 42 queries.
For each query, raters’ responses reflect their perceptions of how much of a behavioral characteristic represents the individual child being assessed. Hence, preschool teachers or other
adults familiar with the children rate each item on a Likert-type scale. Standard scores are
calculated for each of the four subscales (M = 10, SD = 3). The sum of the subscale standard
scores is converted into a strength index that has a mean of 100 and a standard deviation of 15.
Data Analysis
Confirmatory factor analysis. We used confirmatory factor analysis to evaluate the fourfactor structure established during the norming process for the PreBERS (Epstein &
Synhorst, 2009). Specifically, we employed AMOS 5.0 (Arbuckle, 2003) to perform confirmatory factor analyses to judge the extent to which the Head Start data fit the original
PreBERS structure of four subfactors loading onto a higher-order “strength index” latent
factor. The four-factor model proved to be sufficient during the norming process, and we
used the same 42 items from the PreBERS during our study. In our analyses, we employed
participants’ scaled standard scores as indicators. We generated parameter estimates and
model fit estimates using covariance matrices and maximum-likelihood estimation to test
the fit of the PreBERS subscale assignment to the PreBERS strength index.
In testing this model, we computed four indexes of model fit: Bentler’s (1990) comparative fit index, Tucker and Lewis’s (1973) index of fit, Bentler and Bonnett’s (1980) normed
fit index, and Browne and Cudek’s (1993) root mean square error of approximation. Because
we evaluated different aspects of model fit with these indices, the criterion for an acceptable
fit varied among the indices. Methodologists have reported that the comparative fit index,
the Tucker–Lewis index, and the normed fit index values should be at or above .90 to indicate a satisfactory fitting model (cf. Hu & Bentler, 1999), with values close to 1 indicating
a very good fit on any of these indexes. A root mean square error of approximation of less
than .11 indicates a reasonable fit; a value of about .05 or less indicates a close fit of the
model in relationship to the degrees of freedom (cf. Browne & Cudek, 1993).
Internal consistency. To evaluate how well the total measure and each subscale assessed
the construct they were intended to assess (i.e., total strength, Emotional Regulation,
School Readiness, Social Confidence, Family Involvement), we performed a series of
five Cronbach’s coefficient alphas. In addition, we conducted a separate analysis for each
subscale verified in the confirmatory factor analysis.
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280    Journal of Early Intervention
Criterion validity. Criterion validity refers to how representative scores are for subpopulations of individuals. Given what is known about a subpopulation in regard to the content
covered by an assessment, each subpopulation’s set of scores should follow a logical pattern.
In regard to the PreBERS, which assesses emotional and behavioral strengths, we believe that
it is reasonable to assume that teachers will rate Head Start children with developmental delays
lower than Head Start children without developmental difficulties. To assess the criterion
validity for our sample of Head Start children, we performed five independent t-test analyses
to determine whether any significant differences existed between (a) children reported as having identified developmental delays (e.g., emotional or behavioral disorders, speech or language impairments) and special education services and (b) those without delays. Because of
the limited number of children with any specific type of developmental delay, we aggregated
identified children into one developmental delay category for analysis. We conducted an
analysis for each subscale and for the overall total strength index. We also calculated Hedge’s
g effect sizes to estimate the magnitude of the differences. To control for the number of comparisons performed, the Bonferroni correction method was used to adjust the alpha level to .01.
Confirmatory Factor Analysis
Figure 1 shows the results of the confirmatory factor analysis for the proposed model and
illustrates the factor representing the PreBERS strength index as a circle. The values on the
arrows between the factor and the subscales, which are represented by squares, are factor loadings. The factor loadings are regression coefficients that represent the influence of the factor—
the PreBERS strength index—on the subscale. The values on the arrows pointing from e1
through e4 to the subscales represent error variance. Error variance consists of random error
and may include unique systematic error unrelated to the variances of the other subscales.
According to Hopkins’s criteria (2002), the resultant factor loadings associated with all
subscales are in the range of large to very large and are significantly different from zero.
Specifically, for the Head Start sample, the subscales are large (> .60 for the Family
Involvement subscale) to very large (> .80 for the Emotional Regulation, School Readiness,
and Social Confidence subscales). Moreover, three of the four confirmatory factor indices
support the fit of the four-factor model to the data, with the comparative fit index equal to
.984, the Tucker–Lewis index equal to .951, and the normed fit index equal to .987. The
root mean square error of approximation equals .148, which exceeds the recommended
range of .11 or less for reasonable fit.
Internal consistency. We calculated Cronbach’s alphas for each subscale and the total
strength index, and the coefficients are as follows: .956 for Emotional Regulation, .943 for
School Readiness, .895 for Social Competence, .886 for Family Involvement, and .975 for
the total strength index, respectively.
Criterion validity. Table 2 displays the means and standard deviations for Head Start
children with and without developmental delays. Our t-test analyses indicate statistically
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Griffith et al. / Assessing the Strengths of Young Children at Risk    281
Figure 1
Confirmatory factor analysis results and standardized factor loadings
Strength Index
significant between-group differences, with children without developmental delays scoring
higher in emotional and behavioral functioning on the PreBERS than children with identified developmental delays. This finding is consistent across subscales and for the total
strength index. Hedge’s g effect sizes indicate that the magnitude of the size differences is
moderate to large.
With a nationally representative sample of preschool children, Epstein and Synhorst
(2009) demonstrated acceptable psychometric characteristics of the PreBERS with a fourfactor structure (Emotional Regulation, School Readiness, Social Confidence, and Family
Involvement). Our study replicates their findings with a national sample of children attending Head Start programs. Our confirmatory factor analyses indicate support for the original
model, with four subscales loading onto a higher-order “strength index” latent factor and
with large to very large factor loadings for the four subscales. In addition, three of the four
model fit indices—Bentler’s (1990) comparative fit index, Tucker and Lewis’s (1973)
index of fit, and the Bentler and Bonnett’s (1980) normed fit index—indicate good model
fit. The root mean square error of approximation value exceeds the recommended range for
a reasonable fit, likely because of relatively low degrees of freedom. Whereas the obtained
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282    Journal of Early Intervention
Table 2
Means and Standard Deviations for Preschool Behavioral and Emotional
Rating Scale Scores for Head Start Preschool Children With and Without
Identified Developmental Delays
Emotional Regulation
School Readiness
Social Confidence
Family Involvement
Total strength index
No Disability
Hedge’s Effect Size
8.25 (3.46)
7.86 (3.44)
8.23 (3.37)
8.85 (3.48)
90.47 (17.10)
10.33 (2.81)
10.45 (2.75)
10.28 (2.93)
10.21 (2.83)
101.78 (13.87)
Note: To control for the number of comparisons that were performed, the Bonferroni correction method was
used (adjusted alpha = .01). Each subscale: p > .001.
root mean square error of approximation value indicates a possible misspecification of the
model, the findings with the other three indices support the adequacy of the original model.
We also found evidence of high internal consistency of the four factors with the Head Start
sample. Our results provide evidence for a four-factor subscale structure of the PreBERS
with Head Start children, replicating previous findings with preschool populations (Epstein
& Synhorst, 2009) and lending further support to the use of the PreBERS with children
living in poverty and having identified developmental delays. Specifically, our results suggest that for children living in poverty and having developmental delays, the PreBERS will
likely retain its original empirically derived factor structure found for children in the general preschool population. Whereas the factor structure remains consistent in the Head Start
population, we provide evidence of criterion validity, with Head Start children without
identified developmental delays having PreBERS scores indicating higher functioning than
that of similar-aged Head Start peers with identified developmental delays.
Study Limitations
As with other applied investigations, we acknowledge several limitations with our study
to be addressed in the future. First, the PreBERs was developed for use with teachers; as
such, adults’ ratings of children did not include the important information of their parents
or other caregivers. For example, researchers have shown that ratings of children’s behaviors differ between parents and teachers (e.g., Achenbach & Edelbrock, 1978; Glaser,
Kronsnoble, & Forkner, 1997; Hartman, Rhee, Willcutt, & Pennington, 2007; Miner &
Clarke-Stewart, 2008). The environmental circumstances and adult expectations among
home, community, and school settings may be quite different. At preschools, children are
likely to participate in group activities in classroom settings with multiple peers; with
parents, however, children find themselves in a variety of behavioral settings (e.g., homes,
shopping centers, churches) and will likely participate in individual or small group activities. Moreover, adults with multiple roles (e.g., caregivers, professionals) may differ
greatly on their expectations for and perceptions of children’s behaviors. Hence, we recommend that researchers collect information from multiple informants, including parents
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Griffith et al. / Assessing the Strengths of Young Children at Risk    283
and preschool practitioners. Second, in our study we did not address issues regarding measurement invariance across demographic variables such as ethnicity and gender. Hence, we
suggest that researchers examine if the factor structure remains invariant for other demographically different subpopulations. Finally, although our study sample was relatively
large and reasonably well distributed nationally (as in many applied studies with children
and their families), it was one of convenience, and we do not know how representative the
sample is of young children served in Head Start or other preschool programs.
Implications for Practitioners
With our study, we provide support for the use of the PreBERS to assess the emotional
and behavioral strengths of preschool children—especially, those attending Head Start
programs. With the PreBERS, we and other researchers have demonstrated acceptable
psychometric properties, including short- and long-term test–retest reliability, convergent
validity, and interrater reliability (e.g., Epstein & Synhorst, 2008, 2009). We believe that
the confirmation of the factor structure in the Head Start population sampled indicates that
the instrument is stable and will perform similarly with a different preschool population.
Moreover, the extant findings suggest that the PreBERS may be appropriate for populations
of children living in poverty.
With mandates for educators and clinicians to identify potential behavioral and emotional competencies of young children, the appropriate use of the PreBERS offers practitioners an option for an assessment focused on child strengths. A strength-based approach
may assist preschool practitioners in effective identification of important emotional and
behavioral competencies for young children. We also believe that it may provide better
support for the development of intervention plans and educational goals aimed at teaching
essential social behaviors for preschoolers at risk for emotional or behavioral problems or
other developmental difficulties. Specifically, results from the PreBERS across the four
domains may be useful in developing individualized family, educational, social, and emotional goals that align well with children’s strengths and address their developmental and
behavioral needs (cf. Brown, Odom, & McConnell, 2008).
Implications for Researchers
As mentioned in our study limitations, we acknowledge that additional investigations
are needed to develop and further validate the PreBERS as a new behavioral assessment.
Specifically, we believe that researchers should perform additional psychometric studies to
examine the predictive and discriminant validity as well as the invariance of the measurement model for specific subpopulations. For example, we recommend development and
validation of the PreBERS in other languages to assist in its use with young children and
their parents who may not be fluent in English. In the United States, further development
of the PreBERS may be particularly important given the number of young children whose
families speak Spanish as their primary language. The availability of the PreBERS in other
languages may be especially beneficial if, as discussed previously, a parent report measure
is developed in the future. Hence, the PreBERS in other languages may be helpful with
identifying the emotional and behavioral strengths and intervention needs of children who
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284    Journal of Early Intervention
are English-language learners by soliciting important information from both their preschool teachers and their parents.
Many early childhood practitioners are in need of psychometrically appropriate and
strength-based assessments to identify emotional and behavioral competencies for young
children who may be at risk for behavioral and developmental problems. The PreBERS provides educators and clinicians with a strength-based assessment to identify important social
and emotional abilities in preschoolers. Our study replicates previous work on the PreBERS
with a new sample of children in Head Start programs. Whereas additional research is warranted to further evaluate the psychometric properties of the PreBERS and extend the development and evaluation of the assessment, our investigation provides information about the
PreBERS in another population of young children. We believe that these advancements with
the PreBERS indicate that the assessment may provide a useful and positive approach to
identify the emotional and behavioral abilities of young children, assist preschool practitioners in the development and implementation of needed intervention plans, and provide a
potential measure to monitor children’s behavioral and developmental progress.
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Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238-246.
Bentler, P. M., & Bonnett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance
structures. Psychological Bulletin, 88, 588-606.
Brown, W. H., Odom, S. L., & McConnell, S. R. (Eds.). (2008). Social competence of young children: Risk,
disability, and evidence-based practices (2nd ed.). Baltimore: Brookes.
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New York: Guilford Press.
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children at-risk for emotional or behavioral disorders: Issues, trends, and a call for action. Behavioral
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Cox, K. F. (2006). Investigating the impact of strength-based assessment on youth with emotional or behavioral
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