Maternal SSRI Use and Child Internalizing Behaviors

At 3 years and 12 years, maternal reports of internalising and anxiety problems in their children were obtained using the Child Behavior Checklist (CBCL) (for 1.5- to 5-year-olds²⁹ and 6- to 18-year-olds³⁰ ), a norm-referenced caregiver-completed rating scale that describes a child's functioning during the previous 6 months. All items are scored on a three-point Likert scale (0, not true; 1, somewhat or sometimes true; 2, very true or often true). All CBCL scales have a T-score mean of 50 and s.d. of 10 and different norms are provided for each gender across the age ranges of 6–11 years and 12–18 years. The CBCL yields a total problem score, externalising and internalising scores, and norm-referenced DSM-oriented scales, which include an anxiety problems scale. These DSM-oriented scales were created based on expert consensus of selected items from the CBCL and were developed to assist practitioners in the differential diagnostic process. The anxiety problems scale assesses symptoms of separation anxiety disorder, specific phobia and generalised anxiety disorder. There is substantial psychometric support for the various CBCL scales.^{30 ,31} For the current study, we used the internalising and anxiety problems T-scores, which are computed based on the gender and age of the child.
When their children were 6 years of age, mothers completed the MacArthur Health and Behavior Questionnaire (HBQ), which yielded measures of internalising, externalising, over-anxious and inattention behaviours. These measures were derived from the Ontario Child Health Study Measure, which maps onto items from the CBCL and DSM-III-R symptom criteria for internalising behaviours^{32 (link)} in children ages 4 to 8 years.^{33 (link)} We also used the Screen for Child Anxiety Related Emotional Disorders (SCARED),^{34 (link)} a child and parent self-report instrument, to compare the mother's report of anxiety with that of their child, to examine whether mothers treated with a prenatal SSRI over-reported internalising and anxiety behaviours in their children.