Anthony J. Costello

Validity of the NIMH Diagnostic Interview Schedule for Children: A comparison between psychiatric and pediatric referrals

The NIMH Diagnostic Interview Schedule for Children (DISC) was used to evaluate 40 psychiatric referrals aged 7–11 and 40 pediatric referrals matched for age, sex, race, and socioeconomic status. Each parent and child was interviewed separately using parallel versions of the interview, DISC-P and DISC-C, and parents completed the Child Behavior Checklist (CBCL). The psychiatric referrals had more psychiatric diagnoses and higher symptom scores than the pediatric referrals. Parent reports discriminated better between the criterion groups than child reports. In both groups, mild oppositional behavior and fears were commonly reported by parents, whereas mild separation anxiety, fears, and dysthymia were commonly reported by children. Attention deficit disorder, conduct disorder, and affective disorders were much more common among psychiatrically referred children. There was an association (x2=37.1, p < 001) between abnormally high CBCL scores and diagnoses derived from the interview with the parent, but the association between the CBCL and the child interview was not significant. Over all, the results support the validity of the DISC-P, and to a lesser extent that of the DISC-C, in discriminating psychiatric from pediatric referrals, at the level of both symptoms and severe diagnoses, but not at the mild/moderate level of diagnosis.

The Pediatrician as Gatekeeper to Mental Health Care for Children: Do Parents' Concerns Open the Gate?

Data from a study of children seen for pediatric care in a Health Maintenance Organization are used to examine factors which influence the likelihood that a pediatrician will identify a psychiatric problem and refer an identified child to a mental health specialist for further evaluation and treatment. Parental level of distress, family psychiatric history, and discussion of parental concerns with the pediatrician were found to be important. Characteristics of the service delivery system which may impede appropriate identification and referral are discussed. Implications for participation of child and adolescent psychiatrists in the training of pediatricians are presented.

Developing an efficient clinical information system for a comprehensive psychiatric institute: II. Initial evaluation form

This paper describes the objectives, design, organization, content, evaluation, and implementation of the initial evaluation form, first component of a comprehensive psychiatric institute’s clinical information system. Major features of this effort are the involvement of a large number of clinicians in the form’s development, the use of complementary narrative and standardized components, the use of an expanded DSM-III multiaxial diagnostic format, pilot testing with over 1,000 patients, the evaluation of the form’s usefulness and interrater reliability, the form’s computerization, facilitating data retrieval and coordination with other institutional data bases, and the form’s monitoring.

The Prevalence of Attention Deficit Disorders in a Rural Midwestern Community Sample of Nine-Year-Old Children

The authors interviewed 114 9-year-old children and their parents from a midwestern rural community population using the Diagnostic Interview Schedule for Children (DISC) and DISC-Parent (DISC-P). Four boys (4%) were diagnosed as having attention deficit disorder with hyperactivity (ADDH) by DISC and 14 children (9 boys, 5 girls) (12%) by DISC-P. Only two children received ADDH diagnosis by DISC and DISC-P. Several other DSM-III diagnoses were present in the ADDH group as well as in children with other DSM-III diagnoses. The sample size was not large enough to make adequate comparisons with previous estimates of prevalence.

Expectancy bias in behavioral observations of therapeutic outcome: An experimental analysis of treatment and halo effects

Abstract Because of high reliabilities and the belief that behavioral observation is an objective and precise method with which to evaluate therapeutic change, clinical researchers are increasingly relying upon observational ratings in treatment outcome studies. The primary objective of this investigation was to examine expectancy biases and gender effects using micro-, midi- and macro-dimensions of adjustment. S s were assigned to two treatment experimental manipulations in which they were led to believe that the S s to be rated were either in need of and about to receive treatment, or that they had successfully completed treatment. In addition, raters were given another expectancy bias to assess potential halo effects in which ratees were identified as either well-adjusted or poorly-adjusted. Using a Latin-square counterbalanced design, 30 highly trained and reliable raters conducted the ratings within the various experimental conditions. The results revealed numerous ‘treatment’ and ‘halo’ bias effects across both specific and global behavioral measures of adjustment and social interaction, all in the expected direction. There were several significant gender effect differences. However, no significant bias × sex interaction effects were observed. The findings are discussed with specific recommendations for controlling for these potential methodological confounds in clinical research.

Data Systems in Child Psychiatry: Present Status and Future Promise

The authors assess the advantages and disadvantages of data systems in child psychiatry. After careful review of this topic, the authors conclude that the use of standardized collection of clinical data, computer storage of those data, standardized methods of documentation of treatment offered, and standardized methods of documentation of outcome will all be used increasingly in the future.