Scales Assessing Child and Adolescent Psychopathology Lack Cross-Cultural Validity

Researchers find few existing "psychopathology scales" are appropriate for global utilization.


A recent study published in Transcultural Psychiatry investigated whether child and adolescent psychopathology assessment scales are valid across cultures. Stevanovic and colleagues found that none of the evaluated scales have strong enough evidence for cross-cultural utility in their current formats.

“The overall evidence suggests that few of the pediatric psychopathology scales evaluated in the present review have strong evidence for cross-cultural validity, which suggests that cross-cultural comparison of childhood psychopathology using currently available scales should be a cautious exercise.”

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This study comes at a particularly pertinent time, as psychopathology is increasingly recognized as a global burden to nation states. Global attention directed towards the epidemiology and characteristics of child and psychopathology encourages the development of varying assessment scales. Although cross-cultural differences have been shown to implicate varying prevalence rates and distinct manifestations of childhood psychopathology, the researchers point out that many of the 103 identified scales for assessing childhood psychopathology are being utilized across the globe.

Global identification and treatment of mental health distress is commonly understood to be a worthwhile and positive endeavor. However, the authors maintain that not all mental health distress is the same, specifically questioning how many of the over 100 scales encompass cross-cultural validity. They highlight a few of the many potential sources for differences across cultures including economic, social, and cultural factors, distinctively employed evaluation methods, ranging levels of child development, and incongruent expressions of psychopathology. The Centre for Addiction and Mental Health (CAMH) identified the deficiency of valid cross-cultural research and has suggested it as a top priority on the research agenda.

To measure cross-cultural validity, the authors aimed at comparing assessment scales cross-culturally by examining if its factorial structures are invariant across cultural groups. Through a systematic review of data, the following two questions were addressed: “How many of the scales have been tested for cross-cultural validity?” and “How many, of those that have been tested, have been found to have cross-cultural validity and at what level of evidence?”

“Answering these questions cannot only guide cross-cultural CAMH researchers around the world on the suitability of available scales for such research, but can also set future directions for cross-cultural validation of CAMH scales,” the researchers write.

The authors conducted a literature review with the eligibility criteria that (a) the sample strictly include children/adolescents, (b) the scale be evaluated for measurement invariance across a minimum of two cultural groups, and (c) the method and results of measurement invariance testing be detailed. In effort to examine the suitability of the CAMH scales, cross-cultural comparisons were identified based on their recorded measurement invariance, which identifies if the same concept is being measured across varying groups.

They found that only 26 out of the 100 scales published before 2006 had “some data about cross-cultural measurement invariance,” but that none show strong-evidence for cross-cultural validity. A few had moderate levels of measurement invariance, potentially making them eligible for cross-cultural comparative studies. The rest were deemed weak or completely lacking measurement invariance. Only 11 scales that contained measurement invariance data were translated to another language version.

“This review found that there has been limited testing for measurement invariance across cultural/ethnic groups of scales used to assess pediatric psychopathology, either in their original or translated versions.”

Stevanovic and colleagues note that they reviewed articles published in English which may exclude relevant data published in other languages. More research is warranted that would incorporate other methods and broader populations, as the authors acknowledge their studies were based on migrant ethnic groups and not ethnic minorities in their host country.

“In summary, this review showed that there has been limited testing for cross-cultural measurement invariance of scales for child and adolescent psychopathology and available data are insufficient to draw conclusions regarding their cross-cultural validity,” the authors write. “Nevertheless, more replication studies are needed with available scales that will either consider different language versions or use more rigorous methods for measurement invariance testing.”

As we continue to utilize western-developed scales cross-culturally, the authors have found we cannot scientifically depend upon them, something that practitioners and diagnosticians should consider, especially within current push to understand the “disease burden” of psychopathology among children internationally.



Stevanovic, D., Jafari, P., Knez, R., Franic, T., Atilola, O., Davidovic, N., … & Lakic, A. (2017). Can we really use available scales for child and adolescent psychopathology across cultures? A systematic review of cross-cultural measurement invariance data. Transcultural Psychiatry, 54(1), 125-152. (Link)


  1. I do so hope the “grown ups” in the “mental health” field will some day stop defaming and torturing little children. The DSM disorders were debunked in 2013, by no less than the head of the National Institute for Mental Health, it’s now 2017.

    Why is the “mental health industry” still even utilizing the scientifically invalid DSM “bible”? It’s a classification system of the iatrogenic illnesses that can be created with the psychiatric drugs, not a classification system of real diseases. Please stop harming innocent children, psychiatry.

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  2. As usual, they miss the point. The reason they lack “cross-cultural validity” is because the scales are “measuring” cultural constructs loaded with bias. Naturally, different cultures have different biases, so the “tests” look different if you run them in another cultural milieu. The real answer it to stop pretending they are “measuring” anything real, and remember that “psychopathology,” as academic as that word makes it seem, is almost completely a matter of cultural values, and is, therefore, not measurable as a “real” quantity.

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