Development of Emotional and Behavioral Problems Scale for Adolescents

The major objective of this study was to develop an indigenous tool to assess emotional and behavioral problems for adolescents in Pakistan. The study consisted on two phases where in the Phase I, an indigenous scale was developed by generating the item pool of 136 items on the basis of semi-structured interviews (n = 28) with adolescents following internalizing/ externalizing problems framework by Achenbach and Edelbrock (1991). The interviews were analyzed by using thematic analysis technique and consequently 136 items were formulated on the basis of extracted themes. The scale comprising 136 items was administered in try out study after the content validity estimated by the experts from relevant field. In phase 2 the scale was administered on the sample of 1120 adolescents from government and private educational institutes for the purpose of establishing the psychometric properties of the scale. Exploratory factor analysis (n = 560) was fixed at 8 factors structure including 54 items. Confirmatory factor analysis (n = 560) resulted in 8 confirmed factors consisting of 32 items. The Cronbach alpha of the scale was α (.92). It is concluded that the locally developed scale can be used to screen out the adolescents with emotional and behavioral problems so that they can refer to further assessment or counselling services.

Adolescence is a significant and relatively troublesome phase of development, characterized by extreme emotional responses, increased risk-taking, and impulsive behaviors (Rescorla et al., 2019; Steinberg, 2001), along with neurobiological circuits that play a role in emotional and behavioral regulation (Benner et al., 2022). Adolescents experience a variety of obstacles and challenges during this crucial transitional period from childhood to adulthood, particularly shifting physical growth, role identification, pressure to live up to family expectations, and becoming independent members of society (Benner et al., 2022). They may be more likely to experience emotional and behavioral problems because of intense challenging circumstances and constantly shifting social and emotional expectations (Cappa et al., 2012). The majority of these concerns frequently go away with time, but some could lead to real psychological, physical, social, cultural, or even intellectual problems if not managed appropriately (Clark & Watson, 2016). It is important to acknowledge these problems since they call for strong conflict resolution and preventative measures. If they are not addressed, they may develop into the primary cause of stress in later life for teenagers, their families, and those close to them (Grossman & Ehrenreich-May, 2020). Therefore, the current research was conducted with the objective of developing an instrument in Urdu language for measuring emotional and behavioral problems in adolescents between the age ranges of 11 and 19 years. Items were developed in Urdu language which make it easily comprehendible for majority of the adolescents.

Emotional and Behavioral Problems
Developmental psychology's primary focus continues to be on emotional and behavioral problems that are related to a teen's developmental stage (Cappa et al., 2012). “Mental health difficulties with primary indicators involving inner emotions as opposed to outer conduct” is how emotional problems are described (Sondhi, 2007, p. 34). As opposed to inner feelings and emotions, the definition of behavioral difficulties is mental health problems with principal indicators involving outer behaviors (Schrauben & Dean, 2019). Emotional problems can be defined when as mental health issues with primary indications involving inner emotions as in opposition to the outward behavior (Thackery & Harris, 2003).
Numerous researches have shown that adolescents' emotional health and social competencies have a key role in influencing their adaptive behaviors, social interactions, academic performance, and their future life in general (Ward et al., 2019). More specifically, emotional and social ability deficiencies impede learning opportunities and sound companionship with or without handicaps; frequently, these deficiencies have a negative impact on their mental health as adults (Davidson et al., 2015;   Farina & Belacchi, 2022). Likewise, the academic presentation is poor and the scholastic accomplishment of adolescents with emotional difficulties and behavioral unsettling is altogether lower than the normal age (Cappa et al., 2012; Fox et al., 2008; Rafiq et al., 2022). Adolescents’ emotional and challenging behaviors influence their families and society (Furr, 2020). Empirical evidence suggests that a significant number of adolescents experience emotional issues and behavioral difficulties (Shahrivar et al., 2008).
Identification of people with emotional and behavioral issues is widely stressed by health organizations, academic experts, and researchers (Repetti et al., 2002).Valid and trustworthy tools and processes are necessary for the identification and diagnosis of young people with mild or severe emotional and behavioral disorders (Hu et al., 2012). These tools and approaches must be effective and practical in terms of acquiring information that can aid in making decisions regarding the emotional and behavioral states of young people (Clark & Watson, 2016; Grossman & Ehrenreich-May, 2020). The necessary instruments must have acceptable levels of validity and reliability and be able to be controlled, scored, and understood by researchers and practitioners. Additionally, as the environment has an impact on the identification, diagnosis, and interpretation of emotional and behavioral difficulties, the useful tools must be consistent with the social and cultural context of the people (Saleem & Mehmood, 2011).

Internalizing and Externalizing Problems Framework
The internalizing and externalizing difficulties are a well-established split of problematic behaviors in the field of child psychology and psychiatry (Achenbach & Edelbrock, 1991). The internalizing and externalizing difficulties framework is a dimensional classification system that was first conceptually generated, who has enjoyed a fruitful legacy for a significant stretch of time in the fields of adolescent psychology and psychiatry (Achenbach  et al., 2001). As characterized by (Achenbach et al., 2001), internalizing indications allude to issues including psychosomatic complaints, social withdrawal, anxiety, and depression, while externalizing manifestations engage in aggressive and delinquent practices (Achenbach & Ruffle, 2000).
Given that it directs researchers working on the description, classification, etiologies, hidden character traits, and therapy of adolescence and juvenile psychological maladjustments, this paradigm is quite valuable (Hofmann & Hinton, 2014; Shahrivar et al., 2008). The most regarded systems may be those that are well examined in the study of problematic behaviors and disorders in teenagers. Problematic behaviors that are internalized include social inhibition, shyness, depression, anxiety, and other similar traits. These problems are more subtle and, hence, more challenging to identify and assess than externalizing concerns, which are readily apparent and more overt in nature (Williams et al., 2009).

Need of Emotional and Behavioral Problems Scale (EBPS)
Several valid and reliable assessment tools of emotional and behavioral problems among adolescents have already been developed in Western culture. The Strength and Difficulty Questionnaire (SDQ;  Goodman, 1997)  is one of the concise questionnaire comprising of 25 items gathered into 5 sub-scales featuring hyperactivity, conduct issues, peer and emotional issues, and lack of pro-social behaviors (Ngo et al., 2020). There are various versions of it for guardians and instructors covering an age range of 4–16 years. Youth Self-report (YSR) is another widely used assessment instrument for problem behaviors (Achenbach et al., 2001). It is utilized in much of the research conducted in various developed and developing nations to measure the emotional and behavioral difficulties of adolescents (Shaikh & Shinde, 2018; Steinberg, 2001). This valid and reliable assessment tool involves 112 items evaluating two broad categories called internalizing and externalizing issues.
Despite the fact that it can be accepted that some pathological practices (for example, psychoses & the rest of the organic disorders) might be introduced in an almost universal way among distinctive cultures and are basically labeled as abnormal by everyone, behavioral practices (e.g., neurotic issues, emotional & behavioral issues) are bound to be the consequence of humans’ own encounters, familial environment, and social and cultural frameworks (Cohen et al., 2010) (Saleem & Mehmood, 2011). Besides, whether such practices are considered normal or abnormal depends on social and cultural judgments in which they occur and are noticed, instead of the target behaviors themselves (Grossman & Ehrenreich-May, 2020). Concerns about the use of screening and evaluation tools created in incompatible cultures with different languages and phenomenological encounters arise from such stark disparities in cultural experiences, psychological manifestations, and psychological experiences (Karamat et al., 2022). These evaluation methods and techniques could produce unreliable results, which would call into doubt the reliability of the study (Kelley-Quon et al., 2019).
Other points derived from empirical research that doubt these instruments include diverse meaning and relevancy of same construct in different cultures. Many psychological constructs are exceptionally relevant to one culture however not in any manner in other culture. If researchers use the tools and instruments developed solely in Western culture, they may not have some vital data compatible with non-Western societies. The utilization of non-native instruments in Pakistan may lead towards misinterpretation of the issues and construct under investigation and may likewise misguide the professionals and practitioners to draw preventive and treatment plans. Along these lines, a great deal of literature is currently emphasizing the significance of cultural interpretation, meaning, and explanation of mental constructs (Bhasin & Vamsikrishna, 2022; Spruit et al., 2020).
The above given discussion provides a solid rationale for the development of an instrument that can measure the emotional and behavioral difficulties in Pakistani teenagers. As familial, social and cultural norms and values exceptionally impact the development and reforming behaviors of the individuals that are consistent with the familial values, obedience standards and blind conformity to authority figures. However, some systematic endeavors have been made to assess the psychological issues of school and college going teenagers in the cultural setting of Pakistan. Thus, the intentions of this study are to recognize the experiences, expressions and demonstration of emotional and behavioral issues of adolescents inside Pakistani cultural setting by developing a reliable, valid and promising scale for this reason.

Objectives
Objectives of the study are to:

1. Develop an indigenous assessment tool for measuring emotional and behavioral problems of adolescents (11-19 years).
2. Establish psychometric properties of the newly developed scale for measuring emotional and behavioral problems of adolescents.

Method

The current study comprised of two phases. In Phase I, Emotional and Behavior Problem Scale was developed. In Phase II, psychometric properties of the newly developed scale were established.

Phase I: Development of Emotional and Behavioral Problems Scale (EBPS)
Phase I consisted of four steps. In the first step, items were generated on the basis of field interview and literature review. Expert evaluation of items was done at the second step of Phase I. At the third step, a tryout study was conducted.

Step 1: Generation of Item Pool
Item pool was generated using mixed method approach including literature review and thematic analysis of semi-structured interview conducted with adolescents. The interviews were conducted with 28 adolescents (14 boys & 14 girls) from 4 schools through convenience sampling technique. The participants’ age ranged between 11 to 19 years (M = 15.6 years of boys; M = 14.9 years of girls).  These participants were selected based on the teachers’ observations who reported these adolescents being in jeopardy for emotional and behavioral issues. An interview protocol was prepared by reviewing the literature and studying emotional and behavioral problems in detail and prepared open-ended questions. Some of the sample questions were: Explain your ability to pay attention; how do you express your aggression; comment on your pain sensitivity; and how will you describe your social relations.
The interview was conducted individually after written institutional approval and verbal consent of the participants. On average, it took 30 minutes for each interview. Further, the interview was conducted in Urdu Language by following Achenbach and Edelbrock, (1991) internalizing/externalizing problems framework and responses were documented or recorded depending upon the informants’ preference. By following the literature on emotional and behavioral problems among adolescents some themes are highlighted such as anxiety, interpersonal relationship issues, feeling of loneliness etc. Later, this data were analyzed by using the thematic analysis following six steps proposed by Braun and Clark (as cited in Clark & Watson, 2016). Consequently, emerged themes were named as anxiousness, depressive symptoms, interpersonal problems, defiance and delinquency, psychosomatic complainants, poor self-image, aggression, loneliness, rejection feeling, hyperactivity, and psychomotor retardation.
In short 136 items were generated on the basis of above-mentioned themes for assessment of the emotional and behavioral problems of adolescents.

Step 2: Content Validity through Experts’ Evaluation
A list of 136 items was generated as an initial form of EBPS and was presented to a panel of 5 experts (3 PhD & 2 MPhil in Psychology). The purpose of content validity was to obtain experts’ view about each generated item in term of measuring the emotional and behavioral issues of adolescents. Experts rated the relevance of each item by describing it on a 4-point Likert-type scale based on the suitability of every item with reference to the theme, clarity of wording and selection of words ranging from 1 (not relevant) to 4 (entirely relevant). Content Validity Ratio (CVR) was calculated manually by utilizing following formula of Cohen et al. (2010):
CVR: ne - (N/2)/ N/2
Where, ne = total number of experts divided by the number of experts   saying item essential; N= total numbers of experts on the penal and the numeric value of content validity ratio is determined by Lawshe table.

Table1
Content Validity Ratio of Items Following the Stance by Cohen et al. (2010; N=5)

Table 1 indicates the CVR of 136 items. The CVR indicated the entirely relevant, moderately relevant, relatively relevant and not relevant value of items identified by the 5 experts. The entirely relevant CVR ranges as 113 items with the range (3.8-4); 17 items ranged in 3.5-3.79 as moderately relevant and 6 items with range 2.83-3.49 as relatively relevant items. Experts retained 136 items in the initial form of EBPS which was used at tryout step.

Step 3: Tryout
The tryout of initial form comprised of 136 items was administered on 28 adolescents (4 from each grade & 14 each of both genders) from schools and colleges of Gujrat to evaluate the item comprehension and words suitability for general understanding of adolescents. The participants aged between 11-19 years were approached at school and college after taking their consent. They were selected for tryout step based on their teachers’ reporting about some symptoms of emotional and behavioral patterns.  They were informed about the purpose of tryout and were instructed in Urdu language. The participants were requested to complete the form in accordance to the emotional and behavioral problems they were experiencing from past 6 months. The identity of participants was kept confidential. Keeping in view the queries, it was decided to explain the queries with same words in the field administration e.g., nausea to be explained as state of discomfort in stomach and sensations of wanting to throw up. Similarly, examples of social events such as birthday parties, wedding event or school functions etc. would be described. There were some frequently asked questions e.g., meaning of nausea and examples of social events. Every query was responded with the same meaning of words. At tryout step, the Cronbach’ Alpha reliability was α = .94 indicating an excellent internal consistency (Draguns & Tanaka-Matsumi, 2003). In results, no item was excluded in tryout phase.

Phase II: Exploratory Factor Analysis (EFA)

The initial form of EBPS comprised of 136 items was administered on 1120 participants to establish the psychometric properties of EBPS. Exploratory factor analysis and confirmatory factor analysis were carried out on two independent data sets of 560 participants in each. Before conducting EFA, item total correlation of each item was calculated. Items with correlation .3 and below were deleted on the basis of the criteria provided by Loiacono et al. (2002). Therefore remaining 59 items with the item total correlation .4 and above were finalized for EFA. EFA was performed to explore the basic structure of EBPS.

Sample

By using multi-staged stratified sampling technique, 560 participants, age ranging from 11 to 19 years (280 boys & 280 girls) enrolled from grade 6th to 12th were selected from government and private schools and colleges of Gujrat. At stage 1, target population of adolescents was divided into two strata of school and college adolescents. At stage 2, the schools and colleges were divided in further sub-strata of government and private institutions. At stage 3, the schools and colleges were further divided into grade levels from 6th to 12th. At last stage, the grades were further divided into two strata of boys and girls.
The participants having any kind of physical disability or psychological illness were excluded from the study.

Table 2
Frequencies and Percentages of Demographic Variables of Participants for EFA (N = 560)

Table 2 indicates that participant’s gender, institution type and grades categories show an equal presentation in the sample. However, more participants belong to the nuclear family system.

Instruments
In field administration, the demographic form and initial form of EBPS were used.

Demographic Form
The demographic form comprised of the demographic variables of institution type, gender, residential area, family system, age, grade, birth-order, father’s qualification, mother’s qualification and monthly family income.

Initial Form of EBPS
Initial list of Emotional and Behavioral Problems Scale was used to assess emotional and behavioral problems in adolescents. It consisted of 59 items based on 5-point Likert-type scale.

Procedure
After getting permission from school and college principals, initial form of EBPS was administered on adolescents. After a brief introduction about the objectives of the research, written consent was taken from adolescents. They were asked to give response to each stated item as per their perception, feelings, behaviors and cognitions which they were experiencing in the last 6 months. Administration was done in group of 8 to 10 adolescents. On average, the administration took 20-25 minutes to complete the final form of EBPS. The ethical principle of consent and confidentiality were maintained throughout the research by the researcher. Respondents were also informed about their right to withdraw from the research at any time. In order to maintain confidentiality, they were assigned ID numbers.

Results
Frequencies and percentages of different demographic variables were obtained. The factors of the newly developed scale were identified through exploratory factor analysis. Before Exploratory Factor Analysis, sampling adequacy test was also run. Kaiser-Meyer-Olkin (KMO) measure indicated sample adequacy for 59 items which were retained after deleting the items having correlation .3 and below. For EFA only those 59 items were retained which have total item correlation from .4 and above. The KMO value was .90 (Kaiser, 1970) revealed that value of KMO above .80 falls in the category of meritorious and has significant level of adequacy (Kaiser & Rice, 1974). Bartlett’s test of sphericity indicated χ2 value of 20232.771 (p < .001) which indicates that the R-matrix factorability and EBPS data set is suitable for exploratory factor analysis.

Table 3
Factor Loading on Emotional and Behavioral Problem Scale Using Varimax   Rotation (N = 560)