Pakistan Journal of Psychological Research, 2013, Vol. 28, No.

2, 239-260

Risk and Protective Factors of Emotional and

Behavioral Problems in School Children: A
Prevalence Study
1
Sadia Saleem and Zahid Mahmood
University of Management and Technology2

A sample of 5053 school children (51% girls and 49% boys)

with the age range of 13-17 (M = 14.40, SD = 1.25) from 43
government schools in the city of Lahore were selected through
multistage sampling method. An indigenously developed
School Children Problems Scale (SCPS; Saleem & Mahmood,
2011) was used as a self report measure to determine the
prevalence of emotional and behavioral problems of children.
Going by the intensity measure on the total of SCPS 31%
participants fell in the severe category (one standard deviation
above the mean) of these 16% fell in the very severe category
(two standard deviations above the mean). By the frequency
count, 21% of the sample scored above the 90th percentile. The
most frequently reported problem was Anxiousness (16%)
followed by Feelings of Rejection (15%) and Academic
Problems (15%). Results are discussed in terms of the
manifestation of emotional and behavioral problems in school
children in traditional and collectivistic cultures, and their
relationship with social demographic factors was also explored.

Keywords: School children, prevalence, emotional and behavioral

problems.

The new trends and advancements in the field of psychology also

focused on emotional and behavioral problems of children and
adolescents (Wilmshurst, 2009). New classification systems and more
sophisticated assessment procedures were developed to identify
children with mental health problems (Scott, 2002). With the passage
of time the concept of mental illness was replaced by mental health,

Sadia Saleem and Zahid Mahmood, Department of Clinical Psychology,

University of Management and Technology C-II, Johar Town, Lahore 54770,
Pakistan.
Correspondence concerning this article should be addressed to Sadia Saleem,
Department of Clinical Psychology, University of Management and Technology
C-II, Johar Town, Lahore 54770, Pakistan. E-mail: dr.sadiasaleem@yahoo.com;
sadia.saleem@umt.edu.pk
240 SALEEM AND MAHMOOD

quality of life, and well-being of children (Park, 2004; Teachman,

2008).
In recent times, childhood and adolescent period is considered to
be very crucial, as this period of growth and development is
influenced by biological, physical, emotional, and social factors
(Nicolson & Ayers, 1997). Moreover, beside developmental changes,
children faces many parental and social pressures that also make this
period quite stressful and thereby rendering the child more vulnerable
to developing emotional, psychological, and behavioral problems
(Caspi, Taylor, Moffitt, & Plomin 2000; Rowling, 2006). These
problems might be manifested in terms of academic, emotional, social,
and psychological difficulties. Usually, these problems tend to fade
away in time but if persist, may lead to serious negative consequences
(Saluja et al., 2004; Slemming et al., 2010).
The problems faced by school children are usually referred to as
emotional and behavioral problems or afterwards the terms of
internalizing and externalizing problems (Achenbach & Edelbrock,
1978). Internalizing problems are referred to more over controlled
behaviors which include symptoms related to depression, anxiety,
social withdrawal, and somatic complains (Baker, Grant, & Morlock,
2008; Merrell, 2001). Externalizing problems are referred to more
under controlled and overt behaviors including aggression, acting out
tendencies, disruptive, defiant, and hyperactive behaviors (Merrell,
2003; Zahn-Waxler, Klimes-Dougan, & Slattery, 2000).
Throughout the world various epidemiological studies have been
carried out to look at the pattern, frequency, and prevalence of
emotional and behavioral problems in children and adolescents (e.g.,
Breton et al., 1999; Costello, Mustillo, Erkanli, Keeler, & Angold,
2003; Erol, Simsek, & Munir, 2010; Lau & Kan, 2010; Slade, 2007;
Slemming et al., 2010). For example, in order to determine the
prevalence rate of emotional and behavioral problems among Saudi
schoolchildren and adolescents, the Child Behavior Checklist (CBCL;
Achenbach & Rescorla, 2001) Parent-Form was used. The sample
consisted of 1313 children with the age range of 6-18 years. The
results showed that 8.30% adolescents were estimated to be disturbed
emotionally and behaviorally (Abdel-Fattah et al., 2004). It was also
found that the prevalence of internalizing problems was higher than
externalizing problems. In another prevalence study, Emami,
Ghazinour, Rezaeishiraz, and Richter (2007) studied 4599 adolescents
in Iran by using General Health Questionnaire (GHQ-12; Goldberg &
Williams, 1988). It was found that about 19.50% of the adolescents
scored above the cut-off point. Moreover, age and gender were found
to be significantly related with the mental health problems of
 EMOTIONAL AND BEHAVIORAL PROBLEMS 241

adolescents as girls were significantly higher on mental health than

boys and adolescents of 18 years old have more problems than
adolescents of 17 years.
Liu, Kurita, Sun, and Wang (1999) carried out a study on a
Chinese sample of 1695 children between the ages of 6-11 years.
Parents were used as informants on the Chinese version of CBCL
(Achenbach & Rescorla, 2001). Stratified-cluster sampling technique
was employed to select the sample. The results revealed that
according to parental ratings, overall prevalence of child
psychopathology was found to be about 17.20%. Boys showed more
problems than girls. Logistic Regression analysis showed that early
separation was found to be significant predictors of child
psychopathology. The risk factors included disturbed marital
relationship between parents and family conflict. Canino et al. (2004)
studied the prevalence of DSM-IV (1994) disorders in children and
adolescents. The sample consisted of 1886 children of 4-17 years of
age. A multistage sampling technique was used to select the sample.
Results indicated that the overall prevalence rate was found to be
19.80% with ADHD and ODD being the most frequently reported
disorders.
Barkmann and Schulte-Markwort (2005) studied the prevalence
of emotional and behavioral problems in children and adolescents in
Germany. Self report and parental rating on CBCL was used. The
sample consisted of 1950 children and adolescents of ages 4-18. The
prevalence rate was found to be between 10% to 18% in children and
adolescents. Elhamid, Howe, and Reading (2009) carried out a
prevalence study of emotional and behavioral problems in Egypt. The
sample consisted of 1186 children 6-12 years of age. The Strength and
Difficulties Questionnaire (SDQ; Goodman, 1997) was used and
parents and teachers were the informants. According to teachers,
34.70% of the children were showing abnormal behaviors; among
them 27.70% children were found to have conduct problems.
According to the parents’ ratings 20.60% children fell in abnormal
category with more frequently reported conduct and peer related
problems.
Roberts, Attkinsson, and Rosenblatt (1998) provided a
comprehensive and critical overview on the various studies of
prevalence of emotional and behavioral problems of children and
adolescents focusing on the methodological issues and current trends.
They reviewed 52 prevalence studies carried out in different parts of
the world on children’s and adolescents’ mental health problems. This
interesting review of diverse methods and designs revealed that the
prevalence rate of child psychopathology ranged from 1% to 51%
242 SALEEM AND MAHMOOD

with the mean of 15.80%. Roberts et al. (1998) have also identified
various factors that possibly influence the wide variations in the
prevalence rates of emotional and behavioral problems. These
included the use of different selection criteria of sample, varied
sample sizes, different information sources, the criteria of defining
problems and assessment procedures used in the assessment of the
mental health problems of children and adolescents.
Another possible source of variation in prevalence rates is the
use of assessment tools that may not be culturally sensitive and
linguistically appropriate (Canino et al., 2004). Cultural values and
social background of an individual play a vital role in shaping and
developing human behavior. Social values and norms to define what a
problem is may vary considerably from culture to culture (Marsella,
1988). The question of using different classification systems and
measurement procedures in various cultures was also raised. The
traditional assessment tools for psychological problems are generally
based on a standard set of definition, classification criteria, developed
in different languages and standardized on different populations. As a
result, these tools may have limited applicability and would add little
to the understanding of problematic behavior in different cultures
(Matsumoto, 2000). Therefore, it is difficult to have an accurate
estimation of emotional and behavioral problems comparable across
diverse set ups and cultures.
Despite, the large variation in prevalence rates, that fact remain
there that increasing number of children are reported to have
emotional and behavioral problems (Achenbach, Dumenci, &
Rescorla, 2002; Al-Gelban, 2007; Collishaw, Maughan, Goodman, &
Pickles, 2004). It is also widely acknowledged that if emotional and
behavioral problems remain unidentified or untreated, these may have
long lasting impact not only on various domains of functioning of
child’s life but also the families and society at large (e.g., Listug-
Lunde, Zevenbergen, & Petros, 2008; Okwumabua, Wong, & Duryea,
2003; Suveg, Zeman, Flannery-Schroeder, & Cassano, 2005) ranging
from poor school performance, sense of rejection, unemployment and
psychiatric problems in later years (e.g., Hughes, Lourea-Waddell, &
Kendall , 2008; Mash & Wolfe, 2005; Nock & Kazdin, 2002; Turner,
Finkelhor, & Ormrod, 2010).
Literature also identified many psychosocial factors that may
become risk factors for developing emotional and behavioral problems
of children (e.g., Muris, Mayer, Reinders, & Wesenhagen, 2011).
These risk factors not only increase the severity but also the
complexity of the problems. There is a wide range of predisposing
factors including age and gender of the child (Bilancia & Rescorla,
 EMOTIONAL AND BEHAVIORAL PROBLEMS 243

2010; Maikovich-Fong & Jaffee, 2010; Shaw, Dallos, & Shoebridge,

2009), parental educational status (e.g., Semke, Garbacz, Kwon,
Sheridan, & Woods, 2010; Silver, Measelle, Armstrong, & Essex,
2010), family system and family size (Luoma et al., 1999),
socioeconomic status (Slobodskaya & Akhmetova, 2010) and the
quality of parent-child relationship (Moss, Bureau, Béliveau, Zdebik,
& Lépine, 2009). To sum up, there are a number of associated risk
factors have been identified in the Western literature, yet it will be
important to note that how these factors operate in a collectivistic
culture like Pakistan. It is also evident from the literature that specific
cultural and socio demographic background of the child should also be
taken into account while determining the risk and protective factors of
child psychopathology in any community (Heitlich & Goodman,
2004).
In Pakistan, the population estimate of around 175 million, 32%
living in rural and 68% living in urban areas, with 43% of the
population being under 15 years (Federal Bureau of Statistics, 2011).
Awareness about the children and their mental health problems
remains neglected in this developing society. There is a dearth of
systematic studies to determine the pattern and the frequency of
emotional and behavioral problems of children and adolescents. This
lack of mental health services mirrors the lack of awareness and the
paucity of epidemiological data to provide the magnitude of the
problem. Very few systematic studies have been carried out in
Pakistan to address this crucial and important issue of emotional and
behavioral problems in children. For instance Javed, Kundi, and Khan
(1992) investigated the prevalence of emotional and behavioral
problems of children in Lahore by using Children’s Behavior
Questionnaire (Rutter, 1967). Teachers were used as informants and
the sample consisted of 225 children with the age range of 9-11 years.
The findings indicate that the most common problem was antisocial
behavior with the prevalence rate of 9.30%.
Syed, Hussein, and Mahmud (2007) provided the account of
emotional and behavioral problems amongst 5-11 years old school
children in Karachi. The sample consisted of 675 parents. The SDQ
(Goodman, 1997) parents’ version was used. It was found that 47% of
children were rated as normal, 19% as borderline, and 34% as
abnormal. As far as gender is concerned, parents reported no gender
difference on emotional, peer problems and prosocial except on
conduct problems where boys scored significantly higher than girls. In
another study, Syed, Hussein, and Haidry (2009) found the prevalence
of emotional and behavioral problems of children studying in primary
schools of Karachi. The parent and teacher versions of SDQ were
244 SALEEM AND MAHMOOD

used. Overall findings suggest that parents rated 34.40% children on

abnormal category whereas teacher rated 35.80% children on the
abnormal category. However, the above mentioned studies carried out
in similar culture are not comparable as they used different tools,
different populations, different informants and culturally alien tools to
assess emotional and behavioral problems faced by children).
In spite of this wide variation in the prevalence rates of
Emotional and Behavioral Problems (EBP) in children, psychological
studies have revealed that a sizable population in children and
adolescents do have issues relating to mental health functioning. The
roots of these problems lie in childhood experiences. Also, there is an
ample evidence to suggest that there is a need of early and timely
identification of mental health problems to avoid the complexities and
related dysfunctions in a child’s life. Therefore, in order to determine
the extent of emotional and behavioral problems, a large scale
prevalence study should be carried out with the self report as the
medium of information and using culturally sensitive and
psychometrically sound assessment procedures.
The aims and objectives of this study were, firstly to determine
the prevalence of emotional and behavioral problems of school
children. Secondly, to determine the risk and protective factors such as
age, gender, class, parental education, and family system for
developing emotional and behavioral problems of school children.

Method

Population

The study was carried out in the city of Lahore, the second
largest city of Pakistan and the provisional capital of the province of
Punjab. According to the demographical picture of Lahore, the
estimated population is about ten million, where 96% population is
Muslim and the rest 4% comprise Christianity, Hinduism, and
Sikhism (Federal Bureau of Statistics, 2011). The educational setup in
Pakistan consists of three parallel educational systems namely
government run schools, private schools and the madrassas (attached
to mosques, where formal education accompanied with religious
education). In order to maintain the homogeneity of the sample, only
the government schools were selected which accounted for almost
90% of school going children in Pakistan. These schools follow the
same curriculum, examination system, time table, exam schedule, and
medium of instruction i.e. Urdu (the national language of Pakistan).
 EMOTIONAL AND BEHAVIORAL PROBLEMS 245

Participants

In this research, total 50 schools were contacted (25 boys and 25

girls) from all the nine towns of Lahore, among them 43 gave
permission for data collection.
A multistage sampling technique was used to select the
participants. In the first stage, stratified sampling technique was used
for dividing the sample of government schools into two main strata
including boys and girls schools of Lahore. In the second stage, the
two main strata were further divided into three substrata according to
grade including 8th, 9th, and 10th with the age range of 13-17 years. At
the last stage, the participants were selected through systematic
random sampling where every 3rd child was selected from each grade.
Initially, the sample consisted of 5227 school children. Overall, 174
(3%) protocols were discarded on the basis of missing personal
information or incompletion of final protocol. In this way, the final
sample consisted of 5053 participants (boys 49% and girls 51%) of
grade 8th, 9th, and 10th. The mean age of the sample was 14.40 years
(SD = 1.25). The sample was collected from 43 mainstream
government schools of Lahore (19 boys and 24 girls).

Instruments

Demographic Performa. A demographic performa was

developed in the light of literature and those demographic variables
were added which were found to be associated with emotional and
behavioral problems. It includes age, gender, parental education,
parental occupation, number of siblings, and family type.

School Children Problems Scale. The emotional and

behavioral problems were measured through an indigenously
developed self-report measure School Children Problems Scale
(SCPS; for full detail see Saleem & Mahmood, 2011). Briefly, SCPS
was developed by using emic (Berry, 1989) and bottom up approach
(Achenbach & Rescorla, 2007), in three stages, that is, in the first
stage, presenting problems of 103 referred school children (45% boys
and 55% girls) were collected. In the second stage, 129 problems were
rated by 20 experienced school/clinical psychologists on their
frequency of occurrence in school children. One hundred nine
problems most frequently observed (90%) formed the basis of the
246 SALEEM AND MAHMOOD

SCPS. In the last stage, after pilot testing, SCPS with 109 items and a
4-point rating scale was standardized on a sample of 853 school
children selected through multistage sampling (51% girls and 49%
boys). The Principal Component Factor Analysis of SCPS resulted in
a six factor solution namely Anxiousness, Academic Problems,
Aggression, Withdrawal, Feelings of Rejection, and Somatic
Problems. Anxiousness contain 23 items e.g., “worrying”, “fear to
take initiative”, “fear of the unknown”, “unable to express”, “easily
get worried”, and “fearful”. The items denote to a generalized state of
apprehension marked by a fear of failure, overwhelming functioning
of the child. The second factor Academic Problems denoted to a lack
of interest and motivation in studies and absence of basic academic
skills e.g., “loss of interest in studies”, “inability to concentrate”, “lack
of confidence”, “fear of exams and failure”, and “carelessness”. The
third factor Aggression reflects a conduct that is offensive and
irritating towards others around e.g., “problems of loosing temper
easily”, “inability to sit still”, “use of abusive language”, “argues a
lot”, “teasing”, “interfering”, and “annoying others”. The fourth factor
Social Withdrawal denote to avoidance, lack of involvement in social
interaction with others around e.g., “avoiding friends”, “prefers to stay
quiet”, “irritability”, and “staying one place for long time”. The items
on Feelings of Being Rejected denote to a feeling of being unloved,
ignored or disliked specially by parents e.g., “feelings of being
rejected by teachers and parents”, “lack of parental interest in my
studies”, “no one cares for me”. The last factor is related to
psychosomatic symptoms often associated with stress, pressure and
tension e.g., “headache”, “feelings of nausea”, “panic”, “dizziness”,
“cold sweats”, and “tension”.
The SCPS was found to have acceptable psychometric properties.
The Cronbach Alpha was .92 and one week test-retest reliability was
.79. The split half reliability of SCPS was .89. A significant positive
correlation was found between SCPS and two broad band scales of
the Youth Self Report of CBCL (YSR; Achenbach & Rescorla, 2001),
with Internalizing Problems (r = .76) and with Externalizing Problems
(r = .70).

Procedure

Initially, 50 schools were contacted and brief description of the

aims of the current research was sent to them. Forty three school
authorities responded positively. Each school was personally visited
by the researchers for obtaining consent and school authorities were
 EMOTIONAL AND BEHAVIORAL PROBLEMS 247

informed about the aims and the objectives of the research and they
were assured that all the information would be kept confidential and
only be used for research purposes.
All the participants were given the choice whether they want to
participate in the present study or not. All those who agreed to
participate were assured that their information would be kept
confidential and it would not be shared with their school authorities.
All the participants then provided the final protocol for testing
comprising demographic information and SCPS. The instructions
were given in Urdu. It took about 20 minutes to complete the protocol.
After completion, each group was given about another 20 minutes for
asking any questions, feedback, and debriefing. It was also made sure
by the researcher to minimize the attrition rate and missing data. After
each testing, all the protocols returned by the participants were
checked for missing information.

Results

After data collection, all data was recorded properly with special
considerations given to privacy and confidentiality of the research
participants. Descriptive statistics were computed for the demographic
variables. Means and standard deviation were computed for all the six
subscales and total score of SCPS. Subscales and total scores were
compared for gender, age groups, and class. The association with
demographic variables with total SCPS score was examined using
Ordinal Logistic Regression.

Table 1
Means and Standard Deviations of Age, Number of Siblings, and
Parental Education (N=5053)

Variables M SD

Age 14.40 1.25

No. of siblings 3.71 1.73
Father education (years) 8.45 5.47
Mother education (years) 7.10 5.50

The Table 1 indicates that the mean age of the participants is

14.40 years (SD = 1.25). The average number of siblings of the
248 SALEEM AND MAHMOOD

current sample was 3.71 (SD = 1.73). As far as the parental education
is concerned, father’s education in terms of years of education the
mean was 8.45 (SD = 5.47) and for mother’s education mean was 7.10
(SD = 5.50). This Table helped in further categorization of the sample
in various demographic groups.

Table 2
Demographic Characteristics of the Participants (N= 5053)

Boys Girls Total

Variables
% % %
Gender 49 51 100
Grade
8th 32 34 33
th
9 41 33 37
10th 27 33 30
Age Groups ( in Years)
14 or less 45 66 55
15 or more 55 34 45
No. of siblings
3 or less 47 52 49
4 or more 53 48 51
Father ‘s Education (year)
0-5 (Primary) 35 23 29
6-10 (Matric) 39 31 35
10+(College) 26 46 36
Mother ‘s Education (year)
0-5 (Primary) 51 28 39
6-10 (Matric) 32 36 34
10+(College) 17 36 27
Mother ‘s Occupation
House wife 96 93 94
Working 4 7 6
Family System
Nuclear 74 61 67
Joint 26 39 33
Table 2 shows that slightly more girls (51%) than boys (49%)
participated in the current study. Table 2 also indicates that there were
 EMOTIONAL AND BEHAVIORAL PROBLEMS 249

predominantly more participants from 9th grade (37%) than from 8th
and 10th grades. The age groups were derived on the basis of means
and SD of the participants, it was found that there were more
participants in 14 or less category (55%) than 15 or more group
(45%). As far as the family size was concerned, there were slightly
more participants whose number of siblings was 4 or more (51%). The
Table 2 also showed that there were slightly more children whose
fathers’ education was college level or higher (36%). As far as
mother’s education was concerned 39% had completed 10 years of
schooling. There were more housewives (94%) than working.
Moreover, the greater portion of participants was living in nuclear
family system (67%) than in a joint family system.

Prevalence of Emotional and Behavioral Problems

In order to determine the prevalence of emotional and behavioral

problems, the raw frequencies of the sample falling in each of the 10th
percentile were calculated for six factors and the total score
respectively. The sample was also divided into four categories of
severity of emotional and behavioral problem scores according to
means and the standard deviations in the following manner. These
four categories are mild (2 SD below the mean), moderate (1 SD
below the mean), severe (1 SD above the mean), and very severe (2
SD above the mean).

Table 3
Distribution of Percentile Points on Total and Six Factors of SCPS
(N= 5053)
Factors

Agg
Percentile Anx Acad Withd Rej Som Total
III
Points I II IV V VI Score
<10 11 11 14 11 11 10 9
20 11 12 9 10 14 11 11
30 8 9 11 14 9 13 10
40 11 11 10 8 7 8 9
Continued….
250 SALEEM AND MAHMOOD

Factors

Agg
Anx Acad Withd Rej Som Total
Percentile III
I II IV V VI Score
Points
50 11 10 12 9 15 8 10
60 8 9 5 12 7 13 11
70 10 11 12 7 10 8 9
80 11 9 10 10 9 10 10
90 9 9 9 10 10 10 11
95 or Above 10 9 8 9 8 9 10

Note. Anx = Anxiousness; Acad = Academic; Agg = Aggression; Withd =

Withdrawal; Rej = Rejection; Som = Somatic

Table 3 revealed that if we consider 90th Percentile as cut off

point for severe disturbance of emotional and behavioral problems,
there are about 21% children reported to have severe emotional and
behavioral problems.

Table 4
Distribution of the Participants on Six Factors and Total Problems
Scores of SCPS (N = 5053)
Factors Mild Moderate Severe Very Severe
% % % %
Anxiousness 15 38 31 16
Academic 15 43 27 15
Aggression 19 36 32 13
Withdrawal 21 35 36 8
Rejection 25 38 22 15
Somatic 16 41 29 14
SCPS Total 16 37 31 16
Note. SCPS = School Children Problem Scale

The Table 4 indicated that about 16% of school children have

more serious emotional and behavioral problems which fall on the
“very severe” category. The results also revealed that if we consider
the “very severe” category only, most frequently reported emotional
and behavioral problems are anxiousness (16%), academic problems
(15%), and feeling of being rejected (15%). In other words about 16%
 EMOTIONAL AND BEHAVIORAL PROBLEMS 251

of the participants have shown serious emotional and behavioral

problems and also need clinical attention.

Risk and Protective factors of Emotional and Behavioral

Problems

The Ordinal Logistic Regression was carried out by using gender,

class, age, number of siblings, parental education, and family system
as potential predictors of emotional and behavioral problems in school
children. In the initial analysis, gender and class were found to be
significant; whereas age of the child, number of siblings, and parental
education were found to be non significant. Consequently, step by step
all the non significant variables were dropped from the analysis. In
this way, the final model included gender, class, and the family
system. The results of the final model are presented in Table 5.

Table 5
Ordinal Logistic Regression Analysis for Identifying Factors
Associated with the Four Categories of SCPS (N = 5053)
Odd 95% CI
Variables Β SE p
Ratio Lower Upper

Gender (Boys) *Girls .35 .09 1.42 1.18 1.70 .001

Grade (8th ) *10th .41 .09 1.55 1.02 1.84 .001

*Reference category in parentheses.

Findings of Table 5 indicate ordinal regression model, the

outcome variable i.e., emotional and behavioral problems of school
children was regressed on the two predictors, the Gender and the
Grade which were simultaneously entered in the model. Table 5
revealed that gender and grade were found significant predictors of
emotional and behavioral problems of the participants. In other words,
girls were at greater risk of developing emotional and behavioral
problems than boys. Educational level of the participants was also
found to be a significant predictor of emotional and behavioral
problems as going from 1, 2, to 3 (from 8th, 9th, and 10th class), we
expect children from 10th grade were more likely to have higher level
of emotional and behavioral problems.
Odds Ratios were used to indicate the extent of unique predictor
effect. The results revealed that odds of girls for having emotional and
252 SALEEM AND MAHMOOD

behavioral problems were 1.42 times than the odds of boys having
emotional and behavioral problems. While considering the effect of
educational class, children studying in 10th class are more likely to
have emotional and behavioral problems (Odd Ratio = 1.55) than
children of 8th class.

Discussion

As society was awakened by social and political changes, rapid

industrialization and mass education, interest in the welfare of
children has also increased (Wilmshurst, 2009). From an object of
exploitation, cheap labour fit to do dirty and dangerous jobs, the child,
as the father of tomorrow, started to be treated not as a minion but a
prized possession (Gelfand, Jenson, & Drew, 1997). Accordingly,
many psychological, social, and sociological theories highlighted the
importance of healthy growth and development (Berk, 2006). Most
theories posit that early experiences are among the most crucial
factors in the development of the child. Bad experiences would result
in anti social, immoral, and mentally unstable adulthood. Still children
were regularly subjected to abuse, neglect, coercion, inhuman
treatment, and they continue to suffer from deprivation of their
fundamental rights in large parts of the developed world and the most
of the developing world (Wenar & Kerig, 2000). The number of
children suffering from emotional behaviour problems became a
hallmark of the civilized society. However, researches showed an
incredulously wide variation in the prevalence rates of these problems
from 1%-50% (Roberts et al., 1998). The disparate results were
indicative more of a lack understanding of the issues involved,
appropriateness and subtlety of research techniques than a paucity of
research in this area.
Another alarming trend may be observed in many prevalence
studies is related to diagnosing children and adolescents with
psychological disorders (e.g., Ezpeleta, Keeler, Erkanli, Costello, &
Angold, 2001). Contrary to the prevalent trend, the current research
has focused on identifying the patterns, frequency and intensity of
emotional and behavioral problems in an urban sample of school
children. The problems faced by children and adolescents may be the
result of continuous growth and development where a child is
developing from every aspect having to face many challenges and
pressures (Buist, Dekovic, Meeus, & Van Aken, 2004; Rowling,
2006). So the problems faced by children may be of transitory nature
and tend to fade in time (Gelfand et al., 1997). Therefore, it is
 EMOTIONAL AND BEHAVIORAL PROBLEMS 253

premature, presumptuous, unfair and unethical to brand the child with

a psychological disorder instead of looking at the functioning level of
the child, as a part of the course of development. Hence, our approach
in this study is looking at the strengths rather than weaknesses,
symptoms rather than diagnosis, problems rather than disorders.
School Children Problems Scale (Saleem & Mahmood, 2011)
comprising six factors namely Anxiousness, Academic Problems,
Aggression, Social Withdrawal, Feeling of Rejection, and finally
Psychosomatic Problems. While the five factors Anxiousness,
Academic Problems, Aggression, Social Withdrawal and
Psychosomatic Problems were found to be consistent with the
problems reported in literature (e.g., Achenbach & Rescorla, 2001;
Reynolds & Kamphaus, 1992), while, Feeling of Rejection was found
to be peculiar for this sample. Keeping in view the Achenbach and
Rescorla’s (2001) conceptualization, Anxiousness, Social Withdrawal,
and Psychosomatic Problems can be considered as internalizing
problems and Aggression can be considered as the only externalizing
problem. It is very clear that the pattern of problems is more
internalizing than externalizing in Pakistani cultural context.
Prevalence rates were estimated in terms of intensity and
frequency. The first approach was based on describing scores on
SCPS on four categories namely “mild”, “moderate”, “severe” and
“very severe”. The second approach was based on the Achenbach’s
conceptualization (1991) of “clinical level” that the percentage of
sample scoring highest among the normative sample can be
determined if the child scores above the 90th Percentile for his/her age
and gender group. In Pakistani urbanized sample internalizing
problems such as Anxiousness, Withdrawn, Feelings of Rejection, and
Psychosomatic Problems were found to be far more common than
externalizing ones. More than 30% of the sample fell in 1 SD above
the mean and 16% 2 SD above the mean. Going by the frequency
count 21% scored at 90th percentile. These estimate conservative by
some standards, do show the high magnitude of the problems in
children in the sample. Girls and older children show significantly
higher rates as consistent with the previous studies (Bilancia &
Rescorla, 2010; Maikovich-Fong & Jaffee, 2010). Moreover,
Anxiousness was the most common problem reported by the
adolescents followed by a Feeling of Rejection and Academic
Problems. Quite surprisingly, Aggression, acknowledged as an
externalizing behaviour was much less overt and more irritating and
annoying. The aggression in school children in Pakistani cultural
context is more passive, subdued and indirect expression of anger than
reported in the Western studies (e.g., Achenbach & Rescorla, 2001).
254 SALEEM AND MAHMOOD

Such findings could be explained by the collectivistic, controlling, and

authoritarian culture that prevails in Pakistan (Saleem & Mahmood,
2011). Instead of free expression of emotions the culture demands,
restraint and respect leading to indirect expression of strong feelings.
The lack of opportunities for expression of feeling results in more
withdrawal as a safety measure, somatic problems, and of course
academic problems which could be construed as a part of an
internalizing problem.
The results of current research also found that girls and older
children (grade 10) were at greater risk of developing emotional and
behavioral problems. These findings are consistent with literature (e.g.
Angold et al., 2002; Emami et al., 2007; Kingery, Ginsburg, &
Alfano, 2007; Rescorla et al., 2007). Though in many developed
societies, girls are now getting their rights in urban population, more
opportunity for education, choice of career, freedom of expression and
equal rights to grow personally as well as academically.
Stewart et al. (1999) highlighted that in a traditional collectivistic
society like Pakistan religion plays a vital role in shaping the moral
values and way of living, girls are expected to confirm the social and
religious norms at large. Girls in our traditional family system are not
treated equally as boys. Girls must learn to obey their parents and
mainly responsible for maintaining family honor. All these familial
and societal expectations and pressure put girls at greater risk for
developing emotional and behavioral problems.

Suggestions for Further Research

In the course of analysis and discussion the following suggestions

are being made to overcome some of the limitations of this research
and further expand the scope of this seminal work. Firstly, as this
study was carried out only on urban children, it would be very useful
to carry out a parallel research for rural population to study the
divergence of emotional and behavioral problems in different regions
of Pakistan. Secondly, a similar study can be carried out for assessing
emotional behavioural problems using a triangular approach taking
into account views of a child, parents, and teachers in each case
bearing in mind that these three sources would produce different types
of information. Thirdly, as this study has taken into account only those
children who study in government run schools, a similar study can be
carried out to compare the emotional and behavioral problems of
children from private and madrassa school systems.
 EMOTIONAL AND BEHAVIORAL PROBLEMS 255

Conclusion and Implications

This current research focused on to determine the magnitude of

emotional and behavioral problems among children of mainstream
public run schools. This exploratory study found larger prevalence
rate with predominantly internalizing problems with girls and older
children at greater risk of developing emotional and behavioral
problems. As we can see that the contextual nature of any prevalence
would naturally result in some diverse and distinctive findings. Such
findings clearly suggest the type and focus of counseling that may
help these children to be organized as a matter of urgency.
Furthermore, this study will help teachers and parents for early
identification and timely interventions for children with problems.

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Received September 11, 2012

Revision received November 25, 2013