Diagnostic Interview For Children Research Articles

Case Control Study of Chronic Fatigue in Pediatric Patients

To determine the demographic characteristics, medical features, psychological profile, and natural history of children with chronic fatigue. Case control study. Pediatric Infectious Diseases Clinic of Kosair Children's Hospital, 1990 to 1992. Forty-four patients referred for persistent fatigue were evaluated. Twenty patients participated in a psychological study; 20 healthy controls of similar age and gender were recruited from community pediatric practices and 20 matched depressed controls were recruited from university psychiatry services (subjects were treated as groups in the analyses). Demographic data were obtained for all referred patients. Those with fatigue for at least 2 months and no alternative diagnosis received a detailed history, physical, and battery of laboratory tests (complete blood count, sedimentation rate, chemistry panel, chest X-ray thyroid stimulating hormone, thyroxine, anti-nuclear antibodies, urinalysis, immunoglobulins, and Epstein-Barr virus (EBV), toxoplasma, and cytomegalovirus serologies). Psychological study participants completed the following: background structured interview; Kaufman Brief Intelligence Test; Children's Depression Inventory; Child Behavior Checklist; Youth Self Report; Diagnostic Interview for Children and Adolescents-Revised; mail-in follow-up survey. The median age of fatigue patients was 14.3 years; 60% were female, 96% white, and 87% from the mid/upper socioeconomic status (SES). Fatigue patients were demographically similar to 21 patients referred for infectious mononucleosis (IM) but were older than other clinic patients (P < .0001). White race (P = .0568) and mid/upper SES (P = .0403) were over-represented among fatigue patients compared to patients referred for other diagnoses. Of 36 patients meeting criteria for further study, 5 had an IM-like illness including evidence of recent EBV infection. For the remaining 31 patients, clinical and laboratory evaluations were unrevealing. Psychological study subjects reported marked declines in quality-of-life and scored high on measures of internalizing, withdrawal, and social isolation. Nine met diagnostic criteria for depression, although depressive symptoms were not as prominent as those reported by depressed controls. Fatigue subjects scored higher on somatization than both control groups. The follow-up survey indicated symptomatic improvement in most patients. Chronic fatigue was a common reason for referral, with over-representation of white children from mid/upper SES. After exclusion of EBV-associated IM, screening laboratory tests were not helpful in establishing specific organic diagnoses. Whereas the natural history was favorable, chronic fatigue resulted in major quality-of-life changes and was associated with significant levels of psychosocial distress. Psychological evaluation is warranted in these patients, as some may have treatable psychological conditions. Given the absence of proved medical therapies, psychosocial interventions to improve quality-of-life should be studied.

Demographic and Clinical Features of Obsessive-Compulsive Disorder in Children and Adolescents

To describe the demography, symptomatology, and comorbidity of 31 clinically referred children and adolescents with obsessive-compulsive disorder. The patients were assessed in an outpatient clinic for lifetime psychopathology with the Diagnostic Interview for Children and Adolescents. The child and adolescent version of the Yale-Brown Obsessive Compulsive Scale (CY-BOCS) was used to group obsessive-compulsive symptoms and rate symptom severity. Demographic, medical, developmental, academic, and behavioral information was recorded by the parents in the Yale Children's Inventory and the Child Behavior Checklist. The male-female ratio was approximately 3:2. Most patients had had multiple obsessions and compulsions that had changed over time. The CY-BOCS correlated highly with another measure of obsessive-compulsive behavior, but not with any of the Child Behavior Checklist scales. Symptom severity was influenced by an interaction between gender and age at onset of the illness. More than 80% of the subjects had other lifetime psychiatric diagnoses. The results provide further evidence that obsessive-compulsive disorder is a chronic, severe illness in children and adolescents that is often associated with other forms of psychopathology. The data support the concurrent and discriminant validity of the CY-BOCS.

Reading disability and hyperactivity disorder: Evidence for a common genetic etiology

In order to assess the genetic etiology of comorbid reading disability and attention deficit hyperactivity disorder (ADHD), reading performance and hyperactivity data (Diagnostic Interview for Children and Adolescents [DICA]; Herjanic, Campbell, & Reich, 1982) from 61 identical and 43 same‐sex fraternal twin pairs tested in the Colorado Reading Project were subjected to multiple‐regression analysis (DeFries & Fulker, 1985, 1988). Results suggest that approximately 45% of the proband deficit in reading is due to genetic factors that also influence hyperactivity. Moreover, heritable variation accounted for 70% of the observed covariance between the reading and hyperactivity measures. Thus, comorbid reading disability and ADHD (as measured by parental ratings on the DICA) is due, at least in part, to heritable influences.

The mediating role of anxiety in self-reported somatic complaints of depressed adolescents

This study examined the mediating role of anxiety in the self-reports of somatic complaints in 96 depressed adolescent inpatients. Sixty-four subjects with major depressive episodes and comorbid anxiety disorders (MDE-A) determined from the Diagnostic Interview for Children and Adolescents--Revised (DICA-R) reported significantly more somatic complaints than 32 adolescents having major depressive episodes without comorbid anxiety (MDE). An analysis of covariance demonstrated that, with anxiety symptoms controlled, MDE and MDE-A groups did not differ significantly in somatic complaints. A hierarchical multiple-regression analysis revealed that, with demographic and anxiety symptoms controlled, depressive symptoms did not contribute to the explanation or prediction of somatic complaints. The results suggest that anxious, but not depressive symptoms, are independently associated with somatic complaints. The results are discussed in light of new affective models of psychopathology.

CHILDREN OF PEOPLE WITH SOMATIZATION DISORDER

Objective: The author investigated psychopathology, suicidal behavior, child abuse, somatization, and health care utilization in 34 children with a parent who has somatization disorder (SD-P) and two comparison groups: 41 children with a somatizing parent (SOM) (fewer symptoms than required for diagnosis of SD-P), and 30 pediatrically ill controls (CON). Method: Child and parent versions of the Diagnostic Interview for Children and Adolescents were scored for diagnosis and symptom counts in specified categories. Medical records were obtained and abstracted. Results: Children of SD-P had significantly more psychiatric disorders and suicide attempts than did children of SOM or the CON. SD-P and CON had significantly more unexplained physical symptoms that SOM. SD-P showed a trend toward more hospitalizations and experienced significantly more maltreatment. Conclusions: Children of SD-P are at significant risk in several respects. Clinical implications of these findings include a need for awareness and cooperation among general psychiatrists, primary care physicians, and child and adolescent psychiatrists to facilitate detection and treatment of these children's problems.

A validation study of the problem-oriented screening instrument for teenagers (POSIT)

The Problem-Oriented Screening Instrument for Teenagers (POSIT) is a 139-item questionnaire designed to identify substance abuse and related problems. The reliability and validity of the POSIT were studied in adolescents referred to an assessment service for evaluation of substance use problems. Convergent and divergent validity were examined using the Personal Experience Inventory, the Diagnostic Interview for Children and Adolescents, and the Adolescent Diagnostic Interview. Scales measuring problems assessed by both the POSIT and the criterion measures were moderately to highly correlated. Those measuring dissimilar domains were slightly correlated or were not significantly related. The findings highlight the strengths and limitations of the POSIT, and suggest the need for further research on screening tests designed specifically for substance-involved youth.

Comorbidity of conduct disorder and personality disorders in an incarcerated juvenile population

Youths with conduct disorder extract an inordinate amount of time and money from the U.S. judicial system and taxpayers, yet studies pertaining to this population have been few. This study was undertaken to examine the co-occurrence of personality disorders and conduct disorder in a group of incarcerated children and adolescents and to raise the issue of the possibility of antisocial personality disorder in persons under the age of 18 years. One hundred incarcerated juvenile offenders aged 11-17 years were randomly selected and then interviewed with the Diagnostic Interview for Children and Adolescents--Revised and the Structured Clinical Interview for DSM-III-R Personality Disorders to establish their psychiatric diagnoses. Eighty-seven percent of the group met the criteria for conduct disorder. Among those diagnosed as having conduct disorder, the only comorbid personality disorder that was present with significant frequency was antisocial personality disorder. The other comorbid personality disorder diagnoses that appeared most frequently were the borderline, narcissistic, paranoid, passive-aggressive, and dependent types. Borderline personality disorder was observed more frequently in the females than in the males with conduct disorder. The findings suggest that by using DSM-III-R criteria for adult personality disorders, one finds a considerable number of personality disorders in a young population with conduct disorder. The findings also show that youths manifest signs of antisocial personality disorder before they are 18 years of age, raising the question of how age should be incorporated into the diagnosis of personality disorder as DSM-IV is being prepared.

Behavioral Changes in Pediatric Intensive Care Units

• Objective. —The purposes of this study were to compare the frequency and severity of manifestations of anxiety, depression, delirium, and withdrawal in pediatric patients hospitalized in intensive care unit vs ward settings and to evaluate the impact of preexisting psychopathologic disorders on the expression of these symptoms. Research Design. —Prospective patient series. Setting. —Tertiary care pediatric center. Patients. —Forty-three subjects aged 6 to 17 years hospitalized in either the pediatric or cardiovascular intensive care unit (n = 18) or on the general wards (n = 25) were recruited to participate. Subjects were excluded if their parents were unavailable for diagnostic interview or if they could not answer interview questions themselves. Selection Procedures. —Consecutive sample. Interventions. —None. Measurements and Results. —The Hospital Observed Behavior Scale, developed for this study, was used to describe objectively subjects' manifestations of anxiety, depression, delirium, and withdrawal. The Diagnostic Interview for Children and Adolescents and Diagnostic Interview for Children and Adolescents-Parents were used to determine the presence of preexisting psychopathologic disorders. As measured by the Hospital Observed Behavior Scale, subjects in the intensive care unit exhibited apprehension, anxiety, detachment, sadness, and weeping more often than did patients in the ward. Behavior was also significantly influenced by severity of illness, duration of hospitalization, number of previous hospitalizations, and presence of a preexisting anxiety or mood disorder. We found the Hospital Observed Behavior Scale to have good interrater reliability. Conclusions. —Our data indicate that critically ill children in the intensive care unit, children with prolonged or repeated hospitalizations, and children with preexisting anxiety and mood disorders are at greater risk than other hospitalized pediatric patients for psychological trauma and/or behavior problems that may warrant psychiatric intervention. The Hospital Observed Behavior Scale is a reliable tool to quantitate behaviors in hospitalized children. ( AJDC . 1992;146:375-379)

Attention deficit disorder in reading-disabled twins: evidence for a genetic etiology.

In order to assess the genetic etiology of attention deficit hyperactivity disorder (ADHD), the basic regression model for the analysis of selected twin data (DeFries & Fulker, 1985, 1988) was fitted to questionnaire data (DICA: Diagnostic Interview for Children and Adolescents; Herjanic, Campbell, & Reich, 1982) for 37 identical and 37 fraternal twin pairs tested in the Colorado Reading Project. Results of this analysis suggest that ADHD is highly heritable. Moreover, adjusting DICA scores for either IQ or reading performance differences did not substantially change parameter estimates. In future analyses of larger data sets, distinguishing between possible subtypes of attentional problems (e.g., ADD with or without hyperactivity) may facilitate tests of more searching etiological questions.

Language Disorders in Disruptive Behavior Disordered Homicidal Youth

Eight homicidal youths were assessed for language disorders and psychiatric diagnoses using a battery of standardized language tests and the Diagnostic Interview for Children and Adolescents. Both language disorders and Diagnostic and Statistical Manual III-R psychiatric diagnoses were present in all subjects.

Clinical characteristics and psychiatric comorbidity in children with trichotillomania.

Ten children with trichotillomania (hair pulling) were systematically evaluated with structured psychiatric interviews and rating scales assessing anxiety, depression, life events, self-esteem, and family functioning. Six of the subjects met diagnostic criteria for overanxious disorder on the Diagnostic Interview for Children and Adolescents--Revised--Child or Adolescent Version and/or Diagnostic Interview for Children and Adolescents--Revised--Parent Version. Two met the criteria for dysthymia, including one of the subjects with overanxious disorder. No children reported associated obsessions or compulsions. Only one subject experienced tension before hair pulling and relief associated with hair pulling. The DSM-III-R criteria for trichotillomania, which currently require an increasing sense of tension before hair pulling and gratification with hair pulling, may be overly restrictive and in need of redefinition. Additional research with increased sample size is necessary to define diagnostic criteria for trichotillomania and clarify its relationship with other psychiatric diagnoses.

Psychiatric Comorbidity and Response to Two Doses of Methylphenidate in Children with Attention Deficit Disorder

ABSTRACT In a large, heterogeneous sample (N = 182) of children with attention deficit disorder (ADD), the prevalences of additional DSM-III diagnoses were determined using the Diagnostic Interview for Children and Adolescents (DICA). More than half the children had additional DSM-III psychiatric diagnoses. Oppositional disorder and anxiety/mood disorders were the most frequent diagnoses. White male children with ADD were selected into four contrast groups based on comorbidity: ADD children with no additional diagnosis (neither), with anxiety or depression (ANX/DEP), with oppositional or conduct disorder (OPP/CON), and with both ANX/DEP and OPP/CON diagnoses (both). ADD children who had both ANX/DEP and OPP/CON were significantly more improved on a high dose (0.6 mg/kg bid) than a low dose (0.3 mg/kg bid), but ADD boys in the other diagnostic groups responded as well to both doses. There was no evidence that ADD children with comorbid emotional or disruptive behavior disorders respond any less well to psychostimulants than other ADD children. However, there is a concern for those children who have the comorbid combination of (1) ADD, (2) an additional externalizing disorder (disruptive behavior disorder), and (3) an internalizing disorder (a mood or anxiety disorder). These children may not respond to low clinical doses of psychostimulants, but may respond well at higher doses. Children's self-ratings on the DICA may provide important clinical data concerning stimulant dosing which are not provided by teacher or parent ratings. We found no evidence that ADD children with comorbid emotional disorders respond any less well to a psychostimulant than ADD children without emotional comorbidity.

Diagnostic Utility of the Beck Depression Inventory with Adolescent Psychiatric Outpatients and Inpatients

The utility of the Beck Depression Inventory (BDI) for differentiating adolescents with depressive disorders from adolescents with non affective psychiatric disorders was examined using a sample of 93 psychiatric outpatients and 26 inpatients. The Diagnostic Interview for Children and Adolescents (DICA) was administered to establish the patients' diagnosis. Psychiatric diagnoses were made by experienced clinicians who used all available information on the patient. The BDI scores discriminated between patients with depressive disorders and patients with non affective psychiatric disorders. This differentiation was true for boys and girls, outpatients and inpatients. The classification accuracy of the instrument was 75% at thresholds of 11 and 16 on the scale. The results indicate that the BDI is a useful instrument for screening for depression in adolescents, and can also be used in conjunction with other tests. However, the BDI by itself is inadequate to establish a diagnosis of depression.

Posttraumatic Stress Disorder among Children Clinically Diagnosed as Borderline Personality Disorder

Using the Diagnostic Interview for Children and Adolescents, Revised Version (DICA-C-R), the authors evaluated 19 children ages 7 to 14 who had recently been clinically diagnosed as borderline personality disorder by DSM-III-R criteria. The results reveal that 78.9% of these children reported significant traumatic experiences, with 36.8% fitting DICA-C-R criteria for posttraumatic stress disorder. These findings raise the possibility that a diagnosis of borderline personality in childhood can often represent posttraumatic stress disorder.

Depression in inner city adolescents attending an adolescent medicine clinic

Interviews of 70 healthy inner city adolescents attending an adolescent medicine clinic, using the Diagnostic Interview for Children and Adolescents (DICA), revealed that 13% met criteria for current major depressive disorder. Lifetime diagnoses of major depression were found in 30% of the subjects, with many describing recurrent episodes and chronic residual symptoms. Depression in inner city adolescents represents a serious problem that may be best first detected in a medical setting.

Pilot Study of Anxiety and Depression in Prepubertal Children

Early detection of anxiety and depression is important because of the relationship between these disorders, suicide and other problems (i.e. social, phobias, learning problems). This study screened prepubertal students in a school setting for symptoms of anxiety and depression using self-report measures (Revised Children's Manifest Anxiety Scale and the Children's Depression Inventory). Controls and children who scored high on measures of anxiety or depression or both were interviewed with their parents and were tested using the Diagnostic Interview for Children and Adolescents (computer version) and the Peabody Individual Achievement Test. Initial results indicated that anxiety is more prevalent in prepubertal children than depression. The correlation between different diagnostic measurements used in this project was calculated. A correlation was found between low scores of self-esteem and high scores of anxiety and depression on self-reports. It is concluded that self-report measures are good screening tools.

Dexamethasone suppression test and depressive symptoms in bereaved children: a preliminary report

Eighteen bereaved children and adolescents were assessed using the dexamethasone suppression test (DST) and the Diagnostic Interview for Children and Adolescents 4 weeks following parental death. Thirty-nine percent had a positive (nonsuppressed) DST. DST-positive subjects reported more DSM-III-R depressive symptoms (6.3 +/- 2.9 vs. 3.9 +/- 2.7, means +/- SD) than DST-negative subjects. Most frequently reported symptoms included dysphoria, loss of interest, sleep disturbance, appetite disturbance, psychomotor disturbance, and morbid and suicidal ideation. Post-dexamethasone cortisol levels were significantly correlated with the total number of depressive symptoms and suicidal ideation.

The frequency and significance of additional self-reported psychiatric diagnoses in children with attention deficit disorder

The frequency of additional self-reported diagnoses in a large, heterogeneous sample of attention deficit disorder (ADD) children (N = 182) was determined using the Diagnostic Interview for Children and Adolescents (DICA). Over half the children had additional DICA diagnoses, with oppositional disorder and anxiety/mood disorders the most frequent. ADD boys with internalizing-type diagnoses had lower verbal IQs and arithmetic scores and performed more poorly on attention tasks than those without; parents also rated them more adversely. Those with externalizing-type diagnoses were rated as more aggressive by teachers and had sociopathic, thrill-seeking profiles on paper-pencil self-ratings. Over 40% of the children were dyslexic or slow learners but they had no higher rate of DICA diagnoses than those who read adequately.

Parent-based Diagnosis of Attention Deficit Disorder Predicts a Diagnosis Based on Teacher Report

The literature evaluating agreement between parent and teacher reports on symptoms of attention deficit disorder (ADD) has repeatedly shown only modest correlations between these two sources of information. A more relevant statistic to this clinical issue, however, is the positive predictive power, the conditional probability that diagnostic criteria will be met by teacher's report if that diagnosis has been made based on parental report. In a population of 43 children (ages 4 to 17) satisfying clinical criteria for DSM-III ADD, parents and teachers independently completed them module on ADD derived from the Diagnostic Interview for Children and Adolescents. Although correlations for individual symptoms were low to moderate, there was a 90% probability that the teacher report would result in a positive diagnosis given a positive parent diagnosis, indicating a very high probability that, in clinically referred children, a clinical diagnosis of ADD based on parent report will be corroborated by a teacher report.

Utility of the Beck Depression Inventory with Clinic-Referred Adolescents

This study reports on the utilization of the Beck Depression Inventory (BDI) and the Diagnostic Interview for Children and Adolescents (DICA) in a sample of 100 clinic referred adolescents. Results indicate that the BDI efficiently identified and differentiated depressed from nondepressed adolescents. In addition, greater levels of depressive symptomatology and depressive disorder were found in girls. Reasons for these general sex differences are discussed, and it is concluded that a psychological explanation appears more promising than existing biological explanations.