Christopher P. Lucas

The DISC Predictive Scales (DPS): Efficiently Screening for Diagnoses

OBJECTIVE To derive and test a series of brief diagnosis-specific scales to identify subjects who are at high probability of meeting diagnostic criteria and those who may safely be spared more extensive diagnostic inquiry. METHOD Secondary data analysis of a large epidemiological data set (n = 1,286) produced a series of gate and contingent items for each diagnosis. Findings were replicated in a second retrospective analysis from a residential care sample (n = 884). The DISC Predictive Scales (DPS) were then used prospectively as a self-report questionnaire in two studies, in which parents (n = 128) and/or adolescents (n = 208) had subsequent diagnostic interviewing with the Diagnostic Interview Schedule for Children or the Schedule for Affective Disorders and Schizophrenia for School-Age Children. RESULTS All analyses showed that gate item selection was valid and that any missed cases were due solely to inconsistent reports on the same questions. Screening performance of the full scales was shown to be good, and substantial reductions in scale length were not associated with significant changes in discriminatory power. CONCLUSIONS The DPS can accurately determine subjects who can safely be spared further diagnostic inquiry in any diagnostic area. This has the potential to speed up structured diagnostic interviewing considerably. The full DPS can be used to screen accurately for cases of specific DSM-III-R disorders.

The Voice DISC-IV With Incarcerated Male Youths: Prevalence of Disorder

OBJECTIVES (1) To accurately assess rate of psychiatric disorder in incarcerated juveniles, and (2) to examine the feasibility of using a self-administered, comprehensive structured psychiatric assessment with those youths. METHOD In 1999-2000, 292 recently admitted males in secure placement with New Jersey and Illinois juvenile justice authorities provided self-assessments by means of the Voice Diagnostic Interview Schedule for Children-IV, a comprehensive, computerized diagnostic instrument that presents questions via headphones. RESULTS Assessments were well tolerated by youths, staff, and parents; 92% of approached youths agreed. Rates of disorder were comparable to prior diagnostic assessment studies with interviewers. Beyond expectable high rates of disruptive and substance use disorders, youths reported high levels of anxiety and mood disorders, with over 3% reporting a past-month suicide attempt. Youths with substance use disorder were significantly more likely to be incarcerated for substance offenses than were youths with no disorder or those with other, non-substance use disorders. CONCLUSIONS Although the study identified rates of disorder generally comparable to those of prior investigations, some differences, understandable in the context of measurement variations, are apparent. Those variations offer recommendations for mental health assessment practices for youths in the justice system that would include using a comprehensive self-report instrument, pooling across parent and youth informants for certain disorders, focusing on current disorder, and flexibility regarding consideration of impairment.

Gender Differences in Adolescents in Residential Treatment

Gender differences for adolescents in residential care were examined for a sample of 2,067 youths in a large residential facility. At admission, female youths were more troubled than male youths, as shown in significantly higher Diagnostic Interview Schedule for Children (DISC) diagnoses and comorbidity rates, higher internalizing and externalizing Child Behavior Checklist scores, and significantly higher Suicide Prevention Scale hopelessness, negative self-evaluation, and suicide ideation scores. Girls had higher rates of depressive and anxiety diagnoses on the DISC at both admission and 1 year. Both genders demonstrated significant reductions in both externalizing and internalizing problem behaviors over the first year in the program. Girls had significantly higher rates of internalizing problem behavior but showed a significantly greater reduction in these behaviors than did boys. At departure, girls were rated as being more successful than boys by clinical staff. Youths did not differ by gender in their behavior on a 6-month follow-up success scale. Implications for prioritizing research addressing the needs of female adolescents in residential care are discussed.

Screening for Emergent Risk and Service Needs among Incarcerated Youth: Comparing Maysi-2 And Voice Disc-Iv.

OBJECTIVE To examine associations between the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) and Diagnostic Interview Schedule for Children-Present State Voice Version (DISC-IV) and the extent to which they overlap in identifying youths with mental health concerns. METHOD Among 325 New Jersey and South Carolina correctional youths, associations were examined using receiver operating characteristic analyses and logistic regression (binomial and multinomial). RESULTS MAYSI-2 subscales generally mapped best onto homotypic DISC-IV disorders; however, many subscales mapped almost as well onto heterotypic disorders. Alcohol/Drug Use and Suicide Ideation, respectively, identified youths reporting substance disorder and recent attempt; other subscales did not identify parallel DISC-IV disorders as well. CONCLUSIONS MAYSI-2 identifies some DISC-IV disorders better than others. Lack of overlap may result from MAYSI-2s combining diagnostic constructs into single subscales. Substantial percentages of disordered youths were not identified by corresponding subscales. In systems with multiple avenues of referral, the MAYSI-2 is a useful intake screen, but its utility as the sole means for identifying diagnoses for treatment purposes is limited. The authors differentiate between screening for emergent risk and service needs, recommending best practices for a comprehensive approach to mental health assessment among justice youth.

External Validity of Conduct and Oppositional Defiant Disorders Determined by the NIMH Diagnostic Interview Schedule for Children

We administered the Diagnostic Interview Schedule for Children (DISC) two times to a group of youth (222 boys, 147 girls) entering residential care, once at their time of entry and once 1 year later. We then compared their DISC outcomes on Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD) against changes in independent direct observations of diagnostically relevant behavior obtained over the course of that year. Results from hierarchical linear modeling analyses showed significant discriminative relationships between results from the DISC and the independent observations. Specifically, observations of symptomatic behaviors (CD or ODD) decreased for youth who met diagnostic criteria at the first administration of the DISC but not at the second, increased for youth who did not meet criteria at the first administration but did at the second, and did not change for youth who met criteria at both administrations. These results extend the data on the validity of the DISC and support continued research efforts to determine its clinical utility.

Comparing the Validity of Clinician-Generated Diagnosis of Conduct Disorder to the Diagnostic Interview Schedule for Children

Clinician diagnoses of conduct disorder (CD) were compared to the diagnoses of CD generated by a structured interview against an observed criterion. Participants were 534 youth from a large residential program in the Midwest for delinquent youth. Rates of in-program CD behaviors were gathered from staff observations of the youth over a 9-month time period. Youth diagnosed with CD by the Diagnostic Interview Schedule for Children (DISC) displayed significantly more CD behaviors in the first 6 months of treatment compared to both youth without an externalizing disorder and youth diagnosed with CD by a clinician. Youth diagnosed with CD by a clinician had rates of CD identical to youth without an externalizing disorder. Clinicians may have weighted contextual information more heavily, as this group was significantly more likely to have an arrest record. Results support the use of structured interviews and provide evidence that typical clinician diagnoses may lack adequate validity.

Informant-Based Determinants of Symptom Attenuation in Structured Child Psychiatric Interviews

Informant-related determinants of item attenuation, that is, the drop-off in symptom endorsement rates at retest, were examined in an enriched community subsample of 245 parent–child pairs drawn from the National Institute of Mental Health Methods for Epidemiology of Child and Adolescent Mental Disorders Study. Youngsters and their parents were interviewed with the Diagnostic Interview Schedule for Children (Version 2.3; DISC-2.3) on two occasions with a mean test–retest interval of 12 days. Item attenuation rates were high for both informants, with adults failing to confirm 42% and children 58% of baseline responses at retest. Stepwise regressions revealed that item attenuation at DISC-P retest was higher for adult informants who were younger, and who reported on older and less impaired children. On the DISC-C, attenuation was higher for children who were less impaired, rated as doing worse in school, and who had a longer test–retest interval. These results are broadly consistent with past studies examining the determinants of attenuation and test–retest reliability and have implications for the design and use of structured diagnostic instruments.

Preventive Intervention for Anxious Preschoolers and Their Parents: Strengthening Early Emotional Development.

The high prevalence and early onset of anxiety disorders have inspired innovative prevention efforts targeting young at-risk children. With parent–child prevention models showing success for older children and adolescents, the goal of this study was to evaluate a parent–child indicated preventive intervention for preschoolers with mild to moderate anxiety symptoms. Sixteen children (ages 3–5) and at least one of their parents participated in Strengthening Early Emotional Development (SEED), a new 10-week intervention with concurrent groups for parents and children. Outcome measures included clinician-rated and parent-rated assessments of anxiety symptoms, as well as measures of emotion knowledge, parent anxiety, and parental attitudes about children’s anxiety. Participation in SEED was associated with reduced child anxiety symptoms and improved emotion understanding skills. Parents reported decreases in their own anxiety, along with attitudes reflecting enhanced confidence in their children’s ability to cope with anxiety. Reductions in child and parent anxiety were maintained at 3-month follow-up. Findings suggest that a parent–child cognitive-behavioral preventive intervention may hold promise for young children with mild to moderate anxiety. Improvements in parent anxiety and parental attitudes may support the utility of intervening with parents. Fostering increased willingness to encourage their children to engage in new and anxiety-provoking situations may help promote continued mastery of new skills and successful coping with anxiety.

The test-retest reliability and screening efficiency of DISC Predictive Scales-version 4.32 (DPS-4.32) with Chinese children/youths

IntroductionThe DISC Predictive Scales-4.32 (DPS-4.32) were short-forms of the Diagnostic Interview Schedule for Children-IV (DISC-IV).MethodThe psychometric properties of DPS-4.32 were tested on two Chinese samples: a clinic sample of 83 children/youths, and a community sample of 541 youths.ResultsBoth Parent and Youth DPS-4.32 exhibited good-to-excellent test-retest reliability. Their screening efficiency was examined respectively against DSM-IV diagnoses of the full-length Parent and Youth DISC-IV. Results indicated large AUCs (Area under Receiver—Operating Charateristic Curve), as well as high sensitivity, specificity, and negative predictive values, supporting the capability of DPS-4.32 to differentiate cases from noncases.ConclusionDPS-4.32 held promise as efficient short-forms of DISC-IV, screening DSM-IV diagnoses. They were also applicable to the Chinese population, demonstrating their cross-cultural applicability.

Diagnostic screening with incarcerated youths: comparing the DPS and Voice DISC

In the first examination in a juvenile justice setting, associations between the DISC Predictive Scales (DPS) and the Voice Diagnostic Interview Schedule for Children in identifying mental health concerns were investigated. Assessment center youth (N = 195) completed computerized versions of both instruments. Psychometric properties and logistic regression estimates for diagnostic clusters were examined, and DPS summary subscales to derive cut points for incarcerated youths were created. DPS consistently identified higher percentages of youths. At the cluster level, there was considerable concordance, with agreement higher for the same diagnostic constructs, even after statistical adjustment. Summary subscale cut points identified ≥ 82% of disordered youths. Given recommendations for universal screening in corrections, the DPS offers advantages over existing screens as a component of mental health assessment.