Cross-informant ratings on emotional and behavioral problems in Nepali adolescents: A comparison of adolescents’ self-reports with parents’ and teachers’ reports

Sirjana Adhikari; Jasmine Ma; Suraj Shakya; Per Håkan Brøndbo; Bjørn Helge Handegård; Anne Cecilie Javo

doi:10.1371/journal.pone.0303673

Peer Review History

Original SubmissionOctober 31, 2023
26 Jan 2024 Decision Letter - Laura Hannah Kelly, Editor PONE-D-23-34622Cross-informant correlations on emotional and behavioral problems in Nepali adolescents. Do problems reported by adolescents differ from those reported by their parents and teachers?PLOS ONE Dear Dr. Adhikari, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Mar 10 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following financial disclosure: "Sirjana Adhikari (SA) received funding for the study from the NORPART 2018/10039 project (“Collaboration in Higher Education in Mental Health between Nepal and Norway”) and Child Workers In Nepal (CWIN-Nepal). " Please state what role the funders took in the study. If the funders had no role, please state: ""The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."" If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. 3. We are unable to open your Supporting Information file [Supporting information (S1)_Sirjana Adhikari.sav]. Please kindly revise as necessary and re-upload. 4. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Additional Editor Comments: The reviewers have raised a number of concerns that need attention. They request additional information on the emotional and behavioral problem indicators as well as some further analysis, including a comparison of assessments between parents and teachers. Please also expand on research limitations. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: 1. In the abstract, results, and conclusion, similarities can be acknowledged. The author may include recommendations in the conclusion. 2. The introduction section of the full paper lacks a statement of the problem for the current study. 3. In line 136, the third aim employs the word "exploring," which appears to be more qualitative in nature. This word should be reframed. 4. Cronbach's alpha should be mentioned in the Youth Self Report, Child Behavior Checklist, and Teacher’s Report Form. 5. Please use a more appropriate term in line 481; instead of "mental symptoms," it should be reframed. 6. Strengths and recommendations should be emphasized more in terms of further research scope in the conclusion section. 7. Negative results can also be included in the discussion section. Reviewer #2: The manuscript delves into a pertinent theme and is well articulated. However, it falls short of being entirely groundbreaking, especially given its focus on a specific population of Nepalese adolescents. This aspect wasn't adequately addressed in the data discussion. Moreover, the clinical implications of the observed low agreement among adolescents, their parents, and teachers concerning emotional and behavioral problems require further exploration. The statistical analyses conducted are appropriate and align with the study's objectives, albeit being relatively straightforward (t-test, correlation, and regression). I suggest including descriptive analyses of emotional and behavioral problem indicators to comprehend the percentage of the sample classified as normal, borderline, or clinical. Additionally, a comparison of assessments between parents and teachers regarding adolescents' emotional and behavioral problems is recommended. Teachers, with their close interaction and potential to observe changes, are crucial in mental health referrals. Lastly, it's noteworthy that the question about serious life events/trauma used in the regression analysis was formulated by the authors and is not part of a validated questionnaire, potentially weakening the analysis. The manuscript is written in clear and cohesive language. However, I recommend organizing the text more integratively, emphasizing the interrelation among the various aspects considered in the study. This would facilitate a more comprehensive discussion. Out of the 65 references cited, only 23 have been published in the last five years. Furthermore, several references lack complete data, such as DOIs. Providing this information is crucial to facilitating readers' access to the cited documents. I recommend ensuring that all references, including DOIs, are complete to enhance the comprehensiveness and accessibility of the bibliography. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0303673.r001
Revision 1
9 Mar 2024 Author Response Response to the Reviewers’ comments Dear Reviewers, We would like to thank you for reviewing our manuscript. Your comments and questions have been valuable in improving the quality of our paper. We have revised the manuscript according to your advice, to the best of our knowledge. References have been revised accordingly. We have also done additional proofreading, correcting some words and sentences, but without changing the meanings and not adding any more information to the text. Below, we have given our answers to your comments one by one. In doing so, we have referred to the corresponding lines in our revised manuscript with track changes (see Revised manuscript with track changes). Reviewer #1 Reviewer’s comment 1. In the abstract, results, and conclusion, similarities can be acknowledged. The author may include recommendations in the conclusion. Our Response: Thank you for the suggestion. We have now revised the conclusion part of the abstract, including implications for clinical practice – see lines 46-52. Reviewer’s comment 2. The introduction section of the full paper lacks a statement of the problem for the current study. Our Response: Thank you for the comment. We have now included the statement of problems for the current study, see the last paragraph of the introduction, lines 131 – 132, 138-145. Reviewer’s comment 3. In line 136, the third aim employs the word "exploring," which appears to be more qualitative. This word should be reframed. Our Response Thank you for the suggestion. We agree and have now changed the word “exploring” to “examining”, see line 149. Reviewer’s comment 4. Cronbach's alpha should be mentioned in the Youth Self Report, Child Behavior Checklist, and Teacher’s Report Form. Our Response: Thank you for the suggestion. We have added Cronbach’s alpha for the syndrome scales of the Child Behavior Checklist/6-18 years, and Teacher’s Report Form/6-18 years, in lines 217-221. In addition, for the reader's convenience and to provide a comprehensive overview of the psychometric properties of the syndrome scales across different measures, we have included a compiled table of Cronbach's alpha values, see lines 230-235. Reviewer’s comment 5. Please use a more appropriate term in line 481; instead of "mental symptoms," it should be reframed. Our Response: Thank you for the comment. We have now used “mental health problems” instead of “mental symptoms” in the corresponding line (see line 597). Reviewer’s comment 6. Strengths and recommendations should be emphasized more in terms of further research scope in the conclusion section. Our Response: Thank you for the comment. We have rearranged and extended the limitation part in the “ Strengths and Limitations” paragraph, see lines 606-663. Further, we have moved the recommendations for further research from the Strengths and Limitations part to a new paragraph called “Future research” to emphasize our recommendations, see lines 660-667. Reviewer’s comment 7. Negative results can also be included in the discussion section. Our Response: Thank you for the comment. We have now included negative findings in the discussion section in lines 530-532 “It should be mentioned that in the present study, we did not find any impact other factors, such as the age of the adolescents and the experience of negative/traumatic life events on cross-informant discrepancies”, and also in lines 588-589 as “However, the teacher-adolescent discrepancies were not associated with adolescents’ experience of family stress/conflicts.” Reviewer #2 Reviewer’s comment The manuscript delves into a pertinent theme and is well articulated. However, it falls short of being entirely groundbreaking, especially given its focus on a specific population of Nepalese adolescents. This aspect wasn't adequately addressed in the data discussion. Moreover, the clinical implications of the observed low agreement among adolescents, their parents, and teachers concerning emotional and behavioral problems require further exploration. Our Response: Thank you for your comments. In the Strengths and Limitations part of the Discussion section, we have argued that the study is the first large-scale study of its kind in Nepal, that it was conducted in many districts in different parts of the country, and that the participation rate was exceptionally high, in lines 600-605. However, we have commented more as to the limitations of the study sample, see lines 606-633. Further, we have commented more on the clinical implications of the low cross-informant agreement in the Clinical Implications part of the Discussion section, see lines 634-659. Reviewer’s comment The statistical analyses conducted are appropriate and align with the study's objectives, albeit being relatively straightforward (t-test, correlation, and regression). I suggest including descriptive analyses of emotional and behavioral problem indicators to comprehend the percentage of the sample classified as normal, borderline, or clinical. Additionally, a comparison of assessments between parents and teachers regarding adolescents' emotional and behavioral problems is recommended. Teachers, with their close interaction and potential to observe changes, are crucial in mental health referrals. Our Response: Thank you for the comments. We agree that examining the prevalences of adolescent EBPs by presenting data from the YSR, CBCL, and TRF might be of interest. However, we chose to compare the mean scores (magnitude of problems) only, as Nepali norms do not yet exist, and the estimates would be based on available American norms. As the validity of our findings when using the American norms might be questionable as to relevant cut-off points, we decided to use the raw scores (mean scores) that are independent of cultural norms. Hopefully, future studies may provide appropriate norms for Nepali children and adolescents. Another thing is that if we extend the study to include prevalence tables and comments/discussion about those findings as well, it might make the study less focused on its main topic, i.e., the cross-informant correlations. We would like to inform you that in our preceding paper on self-reported EBPs among school-going adolescents in Nepal published in 2023 (same sample), we already presented adolescent-reported prevalences and percentages classified as normal, borderline, and clinical, and for all problem scales (Adhikari S, Ma J, Shakya S, Brøndbo PH, Handegård BH, Javo AC. Self-reported emotional and behavioral problems among school-going adolescents in Nepal - A cross-sectional study. PLOS ONE. 2023;18(6):e0287305. doi: 10.1371/journal.pone.0287305. PMID: 37352299). The reason for not including a parent-teacher comparison of adolescent EBPs is that we wanted to avoid replication. A previous paper by Ma and colleagues had already examined parents’ and teacher’s reports for the wider age group of children and adolescents (6-18 years), which also included the present study sample of adolescents (Ma, J., Mahat, P., Brøndbo, P.H. et al.: Teacher reports of emotional and behavioral problems in Nepali schoolchildren: to what extent do they agree with parent reports? BMC Psychiatry 22, 584 (2022). https://doi.org/10.1186/s12888-022-04215-4). Reviewer’s comment Lastly, it's noteworthy that the question about serious life events/trauma used in the regression analysis was formulated by the authors and is not part of a validated questionnaire, potentially weakening the analysis. Our Response: Thank you for rightly pointing out that limitation. We now mentioned that in the limitations section, lines 623-627. Reviewer’s comment The manuscript is written in clear and cohesive language. However, I recommend organizing the text more integratively, emphasizing the interrelation among the various aspects considered in the study. This would facilitate a more comprehensive discussion. Our Response: Thank you for your constructive feedback. We have now reorganized the Discussion section to improve text integration. The first paragraph now includes the comparison of mean scores of parents, teachers, and the adolescents themselves. The next paragraph focuses on correlations. Instead of two separate discussions under separate headings, one about the parent-adolescent agreement and one about the teacher-adolescent agreement, we have now merged the discussions under one common heading (see lines 369-446). Reviewer’s comment Out of the 65 references cited, only 23 have been published in the last five years. Furthermore, several references lack complete data, such as DOIs. Providing this information is crucial to facilitating readers' access to the cited documents. I recommend ensuring that all references, including DOIs, are complete to enhance the comprehensiveness and accessibility of the bibliography. Our Response: Thank you for the comment. We have now completed the bibliography section with all required data, such as DOI, wherever applicable. We also have added a few new references in the text (lines 67, 104, 404, 439, 612) and the references (lines 719-726, 785-789, 856-859, 868-870, 920-922. Attachments Attachment Submitted filename: Response to Reviewer.docx https://doi.org/10.1371/journal.pone.0303673.r002
3 Apr 2024 Decision Letter - Harikrishnan U, Editor PONE-D-23-34622R1Cross-informant correlations on emotional and behavioral problems in Nepali adolescents. Do problems reported by adolescents differ from those reported by their parents and teachers?PLOS ONE Dear Dr. Adhikari, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by May 18 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Harikrishnan U, Ph.D Guest Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #3: Title Modification is required Scientific Rationale for Selecting Six Students from Each Grade Explanation of Statistical Analysis: Utilizing the intraclass correlation coefficient (ICC) instead of Pearson's correlation coefficient can offer several advantages, particularly in research contexts involving multiple raters or repeated measurements. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #3: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: COMMENTS.docx https://doi.org/10.1371/journal.pone.0303673.r003
Revision 2
26 Apr 2024 Author Response Response to Reviewer Reviewer’s comment Overall, it is a well-conducted study. Our response Thank you for the positive comment. . Reviewer’s comment Cross-informant correlations on emotional and behavioral problems in Nepali adolescents. Do problems reported by adolescents differ from those reported by their parents and teachers? The title requires modification. Our response Thank you for the comment. We have changed the title to a more appropriate one now.: “Cross-informant ratings on emotional and behavioral problems in Nepali adolescents: comparison of adolescents’ self-reports with parents’ and teachers’ reports”. See lines 1-3 in the manuscript. Reviewer’s comment Based on the population distribution of the three main ecological/geographical regions of Nepal, sixteen districts were selected (three from the Mountains region, six from the Middle Hills region, six from the Terai region, and the Kathmandu district) Any sampling procedure used for the selection of district. In the methodology section, the sampling procedure appears to be weak; utilizing multistage sampling or probability proportionate to size sampling would have been more robust. Our response Thank you for pointing out possible weaknesses of the sampling procedure used to select districts. We selected districts as we selected schools using a purposive sampling method based on accessibility and feasibility. We have now clarified it in the manuscript and explained the reasons for choosing this method in lines 157-160. We acknowledge that the random selection of districts and schools using probability sampling would have been more robust. However, this was a large, countrywide study that required an extensive amount of time and money to accomplish. Therefore, we chose the purposive sampling technique for cost-effectiveness and ease of data collection and travel. Nevertheless, we randomly selected the students from each grade using simple random sampling. As we recognize that purposive sampling to select districts and schools was a limitation of our study, we have also added a few more lines about it in the limitation section, lines 520-522. Reviewer’s comment Six adolescents (three boys and three girls aged 11-18 years) from each grade level (grades 6-10) were randomly selected using random number tables, regardless of caste/ethnicity or other background variables. The overall participation rate was 99.2% for the adolescent sample and parent sample, and 99.1% for the teacher sample. What scientific rationale supports the selection of only six students from each grade? Our response We selected six students only from each grade for a couple of reasons. One reason was that some government schools in Nepal, mostly in rural areas, have very few students (less than 10 students per class), whereas private schools usually have more students per class. To ensure an equal number of students from both government and private schools, we decided on a smaller number of students from each grade. Another reason was to keep the burden of filling out the TRF reasonable for teachers, who would have to answer more than 150 questions per student. An additional reason to keep the number of students per classroom low was our concern about the dependency of scores from clustering of students within classrooms when the same teacher informs about multiple students. Sampling many students within a classroom increases the design effect, and thus reduces the potential benefit of increased within-classroom sample size. Reviewer’s comment Statistical analysis The researcher opted for Pearson's correlation but employing the intraclass correlation coefficient (ICC) would have been more advantageous. COMMENTS Using the intraclass correlation coefficient (ICC) instead of Pearson's correlation coefficient can indeed be more appropriate in certain research contexts, particularly when dealing with data that involve multiple raters or measurements on the same subjects. Pearson's correlation coefficient measures the strength and direction of the linear relationship between two variables. It assumes independence of observations and is primarily used for assessing the relationship between two continuous variables. On the other hand, the ICC is a statistical measure used to assess the reliability and consistency of measurements made by multiple observers or raters, or by the same observer or rater on different occasions. It is particularly useful in situations where there is a need to quantify the agreement or reliability among different raters or between different measurements made on the same subjects. In research settings where there are multiple raters providing ratings or measurements on the same set of subjects, ICC provides a more robust measure of reliability compared to Pearson's correlation coefficient. It takes into account both systematic and random variations in the data and provides a measure of consistency or agreement among the raters or measurements. Therefore, if the researcher is dealing with data that involve multiple raters or repeated measurements, using ICC would likely provide a more appropriate measure of reliability compared to Pearson's correlation coefficient. However, the choice between these two measures ultimately depends on the specific research question and the nature of the data being analyzed. Our response Thank you for the comment. We acknowledge that using the intraclass correlation coefficient (ICC) instead of Pearson's correlation coefficient would have been more advantageous if the focus of the study was on assessing the reliability of the measurements. In a situation where the raters view the adolescent from the same angle (for example in an observational situation or from a video recording) using the same set of items, it would be more natural to report reliability. However, in the specific context of our study which primarily focused on examining the agreement among different informants, such as teachers, parents, and adolescents, who view the child’s behavior in different settings and from different “angles”, we believe that reporting Pearson’s correlation remains the more appropriate choice. Furthermore, the study employed three different measures, namely the Youth Self-Report (YSR), Child Behavior Checklist (CBCL), and Teacher's Report Form (TRF), each with distinct sets of items tailored to capture adolescents' emotional and behavioral problems from different perspectives. Although ICC does not explicitly assume homogeneity of items within different measures, the interpretation can be influenced when the items are markedly different across measures, such as in the YSR, CBCL, and TRF. Therefore, we chose an alternative measure of agreement, such as Pearson's correlation coefficient, which we believe is more appropriate for our study. Attachments Attachment Submitted filename: Response to Reviewer.docx https://doi.org/10.1371/journal.pone.0303673.r004
30 Apr 2024 Decision Letter - Harikrishnan U, Editor Cross-informant ratings on emotional and behavioral problems in Nepali Adolescents: a comparison of adolescents’ self-reports with parents’ and teachers’ reports PONE-D-23-34622R2 Dear Dr. Adhikari, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Harikrishnan U, Ph.D Guest Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0303673.r005

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