Relationship between the family APGAR and behavioral problems in children
W. D. Smucker, B. G. Wildman, T. R. Lynch and M. C. Revolinsky
Department of Family Medicine, Summa Health System, Akron, Ohio, USA.
OBJECTIVES: To assess the use of the Family APGAR instrument as a
supplement to usual clinical methods for the detection of psychosocial
problems in children and to evaluate the relationship between the Family
APGAR and physician diagnosis and elevated Child Behavior Checklist (CBCL)
scores. DESIGN: Cross-sectional. SETTING: Ambulatory care center of a
community-based, university-affiliated family medicine training program.
SUBJECTS: One hundred fifty-two parents of children aged 3 to 16 years.
MAIN OUTCOME MEASURES: Family functioning was considered poor if Family
APGAR scores were 5 or less. For the CBCL, sum total T scores greater than
the 90th percentile for nonreferred children were considered clinically
significant. Physicians used a checklist to indicate the presence of
psychosocial problems or family dysfunction. RESULTS: Agreement between the
Family APGAR scores and the physician's detection of child psychosocial
problems was weak (kappa = 0.23). There was no relationship between the
Family APGAR scores and physician perception of family dysfunction (kappa =
-0.05). Although agreement between the Family APGAR and CBCL
classifications was weak (kappa = 0.20), families with low Family APGAR
scores were more than twice as likely to have children with clinically
significant CBCL scores than those with higher scores (risk ratio = 2.08;
95% confidence interval = 1.02 to 4.24). CONCLUSIONS: The relationships
among the Family APGAR and CBCL scores and physician detection of child
psychosocial problems were weak. Child psychosocial problems were more than
twice as likely to be present when the Family APGAR score was low. These
findings suggest that family functioning is related to child psychosocial
problems, but that the Family APGAR may not improve screening for child
psychosocial problems.
