Comparing the CASI-4R and the PGBI-10 M for Differentiating Bipolar Spectrum Disorders from Other Outpatient Diagnoses in Youth

We compared 2 rating scales with different manic symptom items on diagnostic accuracy for detecting pediatric bipolar spectrum disorder (BPSDs) in outpatient mental health clinics. Participants were 681 parents/guardians of eligible children (465 male, mean age = 9.34) who completed the Parent General Behavior Inventory-10-item Mania (PGBI-10 M) and mania subscale of the Child and Adolescent Symptom Inventory-Revised (CASI-4R). Diagnoses were based on KSADS interviews with parent and youth. Receiver operating characteristic (ROC) analyses and diagnostic likelihood ratios (DLRs) determined discriminative validity and provided clinical utility, respectively. Logistic regressions tested for incremental validity in the CASI-4R mania subscale and PGBI-10 M in predicting youth BPSD status above and beyond demographic and common diagnostic comorbidities. Both CASI-4R and PGBI-10 M scales significantly distinguished BPSD (N = 160) from other disorders (CASI-4R: Area under curve (AUC) = .80, p < 0.0005; PGBI-10 M: AUC = 0.79, p < 0.0005) even though scale items differed. Both scales performed equally well in differentiating BPSDs (Venkatraman test p > 0.05). Diagnostic likelihood ratios indicated low scores on either scale (CASI: 0–5; PGBI-10 M: 0–6) cut BPSD odds to 1/5 of those with high scores (CASI DLR- = 0.17; PGBI-10 M DLR- = 0.18). High scores on either scale (CASI: 14+; PGBI-10 M: 20+) increased BPSD odds about fourfold (CASI DLR+ = 4.53; PGBI-10 M DLR+ = 3.97). Logistic regressions indicated the CASI-4R mania subscale and PGBI-10 M each provided incremental validity in predicting youth BPSD status. The CASI-4R is at least as valid as the PGBI-10 M to help identify BPSDs, and can be considered as part of an assessment battery to screen for pediatric BPSDs.     

Parent and child agreement on anxiety disorder symptoms using the DISC predictive scales

Growing recognition of the negative impact of anxiety disorders in the lives of youth has made their identification an important clinical task. Multiple perspective assessment (e.g., parents, children) is generally considered a preferred method in the assessment of anxiety disorder symptoms, although it has been generally thought that disagreement between parent and youth ratings of the child's emotions is common. This study examined parent and child reports of the child's anxiety disorder symptoms using the Diagnostic Interview Schedule for Children-Predictive Scales (DISC-PS) in a clinic-referred sample of substance using adolescents. Parents and adolescents (N = 480) who were referred for substance abuse treatment were screened for anxiety disorder symptoms using the DISC-PS at pretreatment. Results suggest similar (low) levels of agreement between the parent report and child report versions as found with other anxiety symptom and anxiety disorder measures. Findings provide data on multi-informant agreement and highlight issues in the use of the DISC-PS to identify anxiety problems in youth.     

Parent and Child Agreement for Acute Stress Disorder,Post-Traumatic Stress Disorder and other Psychopathology in a Prospective Study of Children and Adolescents Exposed to Single-Event Trauma

Examining parent-child agreement for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) in children and adolescents is essential for informing the assessment of trauma-exposed children, yet no studies have examined this relationship using appropriate statistical techniques. Parent-child agreement for these disorders was examined by structured interview in a prospective study of assault and motor vehicle accident (MVA) child survivors, assessed at 2–4 weeks and 6 months post-trauma. Children were significantly more likely to meet criteria for ASD, as well as other ASD and PTSD symptom clusters, based on their own report than on their parent’s report. Parent-child agreement for ASD was poor (Cohen’s κ = −.04), but fair for PTSD (Cohen’s κ = .21). Agreement ranged widely for other emotional disorders (Cohen’s κ = −.07–.64), with generalised anxiety disorder found to have superior parent-child agreement (when assessed by phi coefficients) relative to ASD and PTSD. The findings support the need to directly interview children and adolescents, particularly for the early screening of posttraumatic stress, and suggest that other anxiety disorders may have a clearer presentation post-trauma.     

Comorbidity of Anxiety and Depression in Children and Adolescents: An Integrative Review

Much evidence exists documenting the comorbidity of anxiety and affective disorders in youth. Furthermore, comorbidity appears to have serious implications both in terms of severity of impairment and course of disorder. Despite this, little is known about the meaning behind the high rate of co-occurrence of anxiety and depression in children and adolescents. Several conditions exist that may give rise to comorbidity. Specifically, two disorders may be comorbid when there is a high rate of symptom overlap between the disorders, when one underlying construct is split into two separate disorders, when the disorders share common risk or etiological factors, or because one disorder causes or increases the risk of developing the second disorder. The present paper examines each of these explanations as they relate to the comorbidity of anxiety and depression in youth.     

The psychiatric inpatient treatment of children and youth in general hospitals

National attention has recently focused on the mental health needs and services of children and youth. The lack of outpatient services and their coordination has been noted, as well as the consequent press towards inpatient care. We describe the inpatient treatment of children and adolescents (ages 0-18) in short-term, non-Federal general hospitals in 1980. Nationally, 128,300 children were treated for mental disorders in general hospitals at an estimated cost of over $1.5 billion. Compared to adults, children were more likely to be treated in scatter beds (vs. specialty units); have a diagnosis of mental disorder (vs. alcohol/drug disorder); stay much longer; and pay with commercial insurance. Previous work focusing on psychiatric units of general hospitals identified less than 40% of the total episodes, a figure very similar to that for adults. The majority of psychiatric inpatient episodes for children and youth in the United States takes place in short-term general hospitals. Community psychologists need to be aware of national trends in inpatient care and be involved in the development and promulgation of alternative models of care.     

Responses to Conflict and Cooperation in Adolescents with Anxiety and Mood Disorders

This study examined patterns of behavioral and emotional responses to conflict and cooperation in adolescents with anxiety/mood disorders and healthy peers. We compared performance on and emotional responses to the Prisoner’s Dilemma (PD) game, an economic exchange task involving conflict and cooperation, between adolescents with anxiety/depressive disorders (A/D) (N=21) and healthy comparisons (n = 29). Participants were deceived to believe their co-player (a pre-programmed computer algorithm) was another study participant. A/D adolescents differed significantly from comparisons in patterns of play and emotional response to the game. Specifically, A/D participants responded more cooperatively to cooperative overtures from their co-players; A/D girls also reported more anger toward co-players than did comparison girls. Our findings indicate that A/D adolescents, particularly females, respond distinctively to stressful social interchanges. These findings offer a first step toward elucidating the mechanisms underlying social impairment in youth with internalizing disorders. This research was supported by the Intramural Research Program of the NIH, NIMH.     

Phenomenology of Clinic-Referred Children and Adolescents with Oppositional Defiant Disorder and Comorbid Anxiety

This study examined profiles of clinic-referred youth with co-morbid oppositional defiant disorder (ODD) and anxiety disorders (ADs) compared to youth with ODD without ADs. One hundred and twenty seven clinic-referred youth with ODD (ages 7–14, 85.6 % Caucasian) were assessed through a multi-method, multi-informant approach. Global functioning, ODD symptom impairment, child internalizing symptoms, caregiver distress, and parent-child relationship quality were explored to test group differences based on AD diagnosis. Youth with ODD and comorbid ADs generally had higher levels of global impairment, internalizing symptoms, caregiver distress, and parent-child relationship problems as compared to youth with ODD only. These findings, which generally suggest greater impairment in the group of youth with ODD/AD, offer support for the presence of distinct clinical features in youth with ODD/AD compared to youth with ODD alone. Such findings may have important implications for assessment and treatment of ODD in youth. For example, interventions to target broader child internalizing symptoms, caregiver distress, and parent-child relationships may be particularly important in youth with ODD/AD profiles.     

Psychiatric Symptom Impairment in Children with Autism Spectrum Disorders

The general aim of this study was to examine the relation of psychiatric symptom-induced impairment with other common parameters of mental health in children with autism spectrum disorder (ASD). Prevalence rates are used to illustrate the implications of different criteria for caseness. Parents/teachers completed DSM-IV-referenced rating scales for 6–12 year old children with ASD (N?=?115), the majority of whom were boys (86 %). Most children were rated by parents (81 %) or teachers (86 %) as being socially or academically impaired by symptoms of at least one psychiatric disorder. The most common impairing conditions (parent/teacher) were attention-deficit/hyperactivity disorder (67 %/71 %), oppositional defiant disorder (35 %/33 %), and anxiety disorder (47 %/34 %), and the combined rates based on either informant were generally much higher. Agreement between symptom cutoff and impairment cutoff was acceptable for most disorders. A larger percentage of youth were impaired by psychiatric symptoms than met symptom cutoff criteria, and the discrepancy between impairment cutoff and clinical cutoff (impairment cutoff plus symptom cutoff) was even greater. Impairment was moderately to highly correlated with both number and severity of symptoms. Parents’ and teachers’ ratings indicated little agreement as to whether a child was impaired. Findings for youth with ASD were similar to non ASD child psychiatry outpatient referrals, but clearly different in several ways from comparable studies of community-based samples.     

Assessing Psychiatric Symptoms in Youth Affected by HIV: Comparing a Brief Self-Administered Rating Scale with a Structured Diagnostic Interview

Brief psychiatric assessment tools are needed for evaluating children affected by HIV for emotional and behavioral problems. We compared a self-administered symptom rating scale (CASI-4R) to a semi-structured diagnostic interview (DICA-P) in 136 U.S. children affected by HIV. Agreement and performance measures for the two instruments were computed for attention deficit hyperactivity disorder, depression, anxiety, and disruptive behavior. Correlations and regression analyses were conducted to compare the two instruments, and to evaluate their associations with social, academic, and global function. Higher CASI-4R symptom severity scores were associated with DICA diagnoses (p?<?0.02 for all disorders). Agreement (κ) between DICA diagnoses and CASI-4R Clinical Cutoffs (which incorporated symptoms and impairment) was low to moderate (0.19–0.40 for all disorders). Thirty-two percent of cases with a DICA diagnosis were identified by the CASI-4R Clinical Cutoff (sensitivity), yet over 90% of DICA-negative cases were negative by the CASI-4R (specificity). Sensitivity was higher using CASI-4R Severity Score thresholds based on median scores compared to the DICA diagnoses. The presence and severity of psychiatric symptoms and impairment were associated with poorer academic, social, and global function. The CASI-4R symptom checklist can be used to inexpensively screen youth affected by HIV for emotional and behavioral problems, although it is important that there be appropriate mental health evaluation follow-up.     

Reward Dysregulation and Mood Symptoms in an Adolescent Outpatient Sample

Research on bipolar spectrum disorders (BPSD) in adolescence has burgeoned in the last decade, but continued work is needed to identify endophenotypic markers associated with illness onset and course. The present study examined reward dysregulation—measured via the behavioral activation system (BAS)—as one putative marker of BPSD in adolescence. A diverse group of 425 outpatient adolescents between 11 and 17 years of age (52 % male) completed the Behavioral Inhibition and Activation Scale (BIS-BAS) scale to measure reward dysregulation. Semi-structured interviews determined diagnoses and severity of mood symptoms. Parent-reported BAS was associated with increased symptoms of mania, and parent and adolescent-reported BAS were associated with symptoms of depression. Parent-reported BIS scores were associated with increased symptoms of mania. Results held independent of diagnostic status. Furthermore, parent BIS/BAS reports were stronger predictors for manic symptoms compared to adolescent-reports. Results extend work in adults with BPSD, suggesting a transdiagnostic association between reward dysregulation and mood symptom severity in adolescence.     

The influence of race and ethnicity on psychiatric diagnoses and clinical characteristics of children and adolescents in children's services

This study examined the influence of race and ethnicity on psychiatric diagnoses and clinical characteristics of 1,189 children and adolescents participating in the federally funded Comprehensive Community Mental Health Services for Children and Their Families Program. Results showed that after controlling for age, gender, functional impairment, and socioeconomic status, there were significant race and ethnicity effects on diagnosis and clinical characteristics. Black and Native Hawaiian youth were more likely than White youth to be diagnosed with disruptive behavioral disorders. Hispanic and Native Hawaiian youth were less likely than White youth to be diagnosed with depression or dysthymia. Black, Asian American, and Native Hawaiian youth were rated as exhibiting less internalizing behavior problems than White youth. Implications for research, practice, and policy are discussed.     

The Importance of Assessing Impairment Associated With Limited Prosocial Emotions

Limited prosocial emotions (LPE) are characterized by a lack of remorse or guilt, callousness/lack of empathy, being unconcerned about performance, and shallow/deficient affect. While previous research has largely focused on the presence or absence of LPE in youth, there is considerable evidence that symptom presence/absence and symptom impairment are separable dimensions, where impairment often is found to play a significant, unique role in assessing child psychopathology. The current study utilized a newly developed questionnaire with the purpose of exploring its psychometric properties and better understand the dual and potentially differential role LPE symptom presence and LPE-related impairment have in youth. Mothers (n = 265) of children (M_age = 8.04, SD = 2.07) completed questionnaires assessing LPE impairment, LPE symptoms, externalizing disorder symptoms, and functional impairment. Results demonstrated strong support for the psychometric properties of the newly developed measure of LPE impairment. Importantly, LPE-related impairment uniquely predicted all impairment domains above-and-beyond the effects of LPE symptoms, oppositional defiant disorder, and CD symptoms (as well as child age and sex covariates). Moreover, youth in the top 25th percentile on both LPE symptoms and LPE-related impairment (compared to youth only in the top 25th percentile in LPE symptoms) had greater mean externalizing symptoms and functional impairment. The preliminary evidence provided suggests researchers and clinicians may benefit from assessing both LPE symptoms and LPE-related impairment when attempting to identify youth with high levels of conduct problem symptoms and/or psychosocial impairment. Future research should aim to replicate and expand our findings to other clinical populations.     

Investigating the Impact of Strength-Based Assessment on Youth with Emotional or Behavioral Disorders

The trend toward adopting a strengths approach to mental health practice with children and adolescents amounts to a paradigm shift from an emphasis on diagnosing disorders to tapping child capacities and assets toward the achievement of treatment goals. While the potential value and challenges associated with this shift has received ample attention in the literature, minimal research has been conducted to assess the benefits and barriers related to the use of strength-based strategies with youth. Utilizing an experimental design, this author examined the impact of strength-based assessment using the Behavioral and Emotional Rating Scale (BERS) with seriously emotionally or behaviorally disturbed children and adolescents. Results revealed that child functioning outcomes were significantly better for youth who received BERS-guided assessment versus the usual deficit-based assessment protocol only when the treating therapist reported an orientation toward service that reflects highly strength-based attitudes and practices. Furthermore, high adherence to the strength-based assessment protocol was associated with significantly higher parent satisfaction with services and lower rates of missed appointments. These findings highlight the importance of accounting for practitioner effects and treatment fidelity in future studies of strength-based practice effectiveness.     

Childhood Social Withdrawal,Interpersonal Impairment,and Young Adult Depression: A Mediational Model

Building on interpersonal theories of depression, the current study sought to explore whether early childhood social withdrawal serves as a risk factor for depressive symptoms and diagnoses in young adulthood. The researchers hypothesized that social impairment at age 15 would mediate the association between social withdrawal at age 5 and depression by age 20. This mediational model was tested in a community sample of 702 Australian youth followed from mother’s pregnancy to youth age 20. Structural equation modeling analyses found support for a model in which childhood social withdrawal predicted adolescent social impairment, which, in turn, predicted depression in young adulthood. Additionally, gender was found to moderate the relationship between adolescent social impairment and depression in early adulthood, with females exhibiting a stronger association between social functioning and depression at the symptom and diagnostic level. This study illuminates one potential pathway from early developing social difficulties to later depressive symptoms and disorders.     

Youth-caregiver Agreement on Clinical High-risk Symptoms of Psychosis

Early identification of individuals who will go on to develop schizophrenia is a difficult endeavor. The variety of symptoms experienced by clinical high-risk youth make it difficult to identify who will eventually develop schizophrenia in the future. Efforts are being made, therefore, to more accurately identify at-risk individuals and factors that predict conversion to psychosis. As in most assessments of children and adolescents, however, both youth and parental report of symptomatology and resulting dysfunction are important to assess. The goals of the current study were to assess the extent of cross-informant agreement on the Structured Interview for Prodromal Symptoms (SIPS), a widely-used tool employed to determine clinical high-risk status. A total of 84 youth-caregiver pairs participated. Youth and caregiver raters displayed moderate overall agreement on SIPS-rated symptoms. Both youth and caregiver ratings of youth symptomatology contributed significantly to predicting conversion to psychosis. In addition, youth age and quality of youth-caregiver relationships appear to be related to cross-informant symptom ratings. Despite differences on individual SIPS domains, the majority of dyads agreed on youth clinical high-risk status. Results highlight the potential clinical utility of using caregiver informants to determine youth psychosis risk.     

Evaluating anxiety and depression symptoms in children and adolescents with prior mild traumatic brain injury: Agreement between methods and respondents

Psychological functioning can be adversely impacted after a mild traumatic brain injury (mTBI) and may be a potential target for intervention. Despite the use of symptom ratings or structured diagnostic interview to assess long-term anxiety and depression symptoms in children and adolescents post-injury, no known studies have considered the agreement between different assessment methods and between respondents. The objectives of this study were to investigate the agreement between symptom ratings and structured diagnostic interview and between children and parents’ symptom reporting. Participants (N = 33; 9–18 years old) were recruited from the Emergency Department and assessed on average 22.8 months (SD = 5.6) after their mTBI. Anxiety and depression symptoms were evaluated via subscales of a questionnaire (Behavior Assessment System for Children) and parts of a computerized structured diagnostic interview (generalized anxiety disorder and major depressive episode; Diagnostic Interview Schedule for Children – C-DISC-IV) administered individually to children and their parents. Results showed that the inter-method agreement to identify high levels of anxiety and depression was moderate to perfect in children while it was lower in parents. Although a similar percentage of participants with elevated anxiety or depression were identified by both children and parents, the agreement between youth and parents was variable, ranging from poor to good for anxiety and poor to moderate for depression. These results highlight the importance of collecting youth and parents’ reports of anxiety and depression symptoms and considering potential discrepancies between informants’ answers.     

Inconsistent Self-Report of Delinquency by Adolescents and Young Adults with ADHD

The purpose of the current study was to test the ability of adolescents and young adults with childhood ADHD to reliably self-report delinquency history. Data were examined from the Pittsburgh ADHD Longitudinal Study (PALS), a follow-up study of children diagnosed with ADHD between 1987 and 1996. Self-report of lifetime delinquency history was compared to concurrent parent-report and to self-report 1 year later. Participants included 313 male probands and 209 demographically similar comparison individuals without ADHD. Results indicated that adolescents and young adults with childhood ADHD were more likely than comparison participants to fail to report delinquent acts reported by a parent and to recant acts they endorsed 1 year earlier. This trend was most apparent for acts of mild to moderate severity. After controlling for several covariates, current ADHD symptom severity and parent-report of the participant’s tendency to lie predicted reporting fewer delinquent acts than one’s parent. Current ADHD symptom severity also predicted more recanting of previously endorsed acts. Based on these findings, several recommendations are made for the assessment of delinquency history in adolescents and young adults with childhood ADHD.     

Anorexia nervosa and brain tumor in a 14-year-old girl

A 14-year-old girl with anorexia nervosa (AN) was found to have an intracranial neoplasm. Atypical psychological symptoms prompted further evaluation, including electroencephalogram and neuroimaging, which revealed a sellar and suprasellar mass. This patient had an eating disorder and a brain tumor, which appear to be two unrelated conditions. However, it remains unclear how each affected the other. The diagnosis of AN, like all other psychiatric disorders, requires that possible medical etiologies and coexisting medical problems be excluded. AN and other eating disorders are particularly difficult to diagnose in children and adolescents because they often do not present in the manner typical of adults. Perceptual and cognitive disturbances associated with AN are difficult to evaluate because children and adolescents normally change over time as they progress through different stages of development. Therefore, it is particularly important to evaluate for the presence of medical conditions when a diagnosis of an eating disorder is made in a child or adolescent.     

Equine-Facilitated Psychotherapy With Children and Adolescents: An Update and Literature Review

During the past several years, there has been a large increase in the number of studies of equine-facilitated psychotherapy (EFP) with children and adolescents. However, due to the diversity of methods, samples, and publication types represented in the literature, it may be difficult for EFP practitioners to synthesize the existing research into useful guidelines and treatment recommendations for patients. This article summarizes and tabulates investigation findings by methods, theoretical underpinnings, and treatment populations. This review of 47 recent publications suggests that EFP is a useful modality with children and adolescents. In the large majority of reviewed papers, benefits were found for a variety of presenting problems and disorders. The most often studied populations were “at-risk” youth and children with an Autism Spectrum Disorder diagnosis. Recommendations for counselors and directions of future EFP research are made.     

Assessing psychological inflexibility: the psychometric properties of the Avoidance and Fusion Questionnaire for Youth in two adult samples

The current study examined whether the Avoidance and Fusion Questionnaire for Youth (AFQ-Y; L. A. Greco, W. Lambert, & R. A. Baer, 2008), a self-report measure of psychological inflexibility for children and adolescents, might be useful for measuring psychological inflexibility for adults. The psychometric properties of the AFQ-Y were examined using data from a college student sample (N = 387) and a clinical sample of patients with anxiety disorders (N = 115). The AFQ-Y, but not the Acceptance and Action Questionnaire-II (AAQ-II; F. W. Bond et al., in press), demonstrated a reading level at or below the recommended 5th or 6th grade reading level. The AFQ-Y also demonstrated adequate reliability (internal consistency), factorial validity, convergent and discriminant validity, and concurrent validity predicting psychological symptoms. Moreover, the AFQ-Y showed incremental validity over the AAQ-II in predicting several psychological symptom domains. Implications for the assessment of psychological inflexibility are discussed.