Jarrod M. Leffler

A Review of Child and Adolescent Diagnostic Interviews for Clinical Practitioners

The publication of the DSM-5 poses a challenge for many interview instruments due to the changes for many of the diagnoses. Six of the more widely used and studied interview instruments (structured and semistructured) were reviewed with a focus on usefulness for the practicing clinician and researcher. Use of these types of assessment procedures can facilitate the accuracy of diagnoses given by potentially reducing clinician bias. Each interview instrument varied in its strengths and characteristics related to amount of flexibility associated with administration of items; breadth of coverage of diagnoses based on DSM-IV; time required for administration; presence of screening items or modular format; and psychometric support for its reliability and validity, as well as amount of training required for use, and costs associated with acquiring and learning the format. Recommendations were made regarding the utilization of different instruments for specific diagnostic questions along with future recommendations for enhancing the format and utility of these instruments, especially in relation to the publication of the DSM-5.

Implementation of Multi-Family Psychoeducational Psychotherapy for Childhood Mood Disorders in an Outpatient Community Setting

Despite advances in evidence-based treatments (EBTs), research suggests these interventions are not utilized in practice settings. This study examined implementation of multi-family psychoeducational psychotherapy (MF-PEP), an EBT for childhood mood disorders, in two outpatient community clinics. Fifteen community therapists facilitated MF-PEP. Twenty community clinicians referred 40 children ages 8-12 with mood disorders and their parents who participated in MF-PEP. Preliminary descriptive findings based on observations and self-report questionnaires demonstrated implementation outcomes of acceptability, adoption, appropriateness, feasibility, implementation cost, penetration, and sustainability of MF-PEP at these clinics. Parents also demonstrated significant improvement in knowledge of mood disorders posttreatment. Preliminary results support implementation of MF-PEP in practice settings and suggest community-based MF-PEP may be associated with improvement in clinical outcomes.

Diagnosing disruptive mood dysregulation disorder: Integrating semi-structured and unstructured interviews

The newest iteration of the Diagnostic and Statistical Manual–fifth edition (DSM-5), is the first to include the diagnosis of disruptive mood dysregulation disorder (DMDD). The assessment and diagnosis of psychopathology in children are complicated, particularly for mood disorders. Practice can be guided by the use of well-validated instruments. However, as this is a new diagnosis existing instruments have not yet been evaluated for the diagnosis of DMDD. This study seeks to provide a method for using existing structured interview instruments to assess for this contemporary diagnosis. The Children’s Interview for Psychiatric Syndromes (ChIPS) and the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) are reviewed and existing items consistent with a diagnosis of DMDD are identified. Finally, a case is presented using both measures and applying the theoretical items identified to illustrate how one might use these measures to assess DMDD. Limitations and future directions are discussed.

How Well Do We Understand the Long-term Health Implications of Childhood Bullying?

Abstract Once dismissed as an innocuous experience of childhood, bullying is now recognized as having significant psychological effects, particularly with chronic exposure. Victims of bullying are at risk for a number of psychiatric disturbances, and growing evidence suggests that the pathophysiological effects of bullying, as with other forms of trauma and chronic stress, create additional health risks. We review the literature on the known sequelae of bullying, including psychiatric and physiological health effects, with a focus on implications for the victim. In addition, since it is now well established that early and chronic exposure to stress has a significant negative impact on health outcomes, we explore the implications of this research in relation to bullying and victimization in childhood. In particular, we examine how aspects of the stress response, via epigenetic, inflammatory, and metabolic mediators, have the capacity to compromise mental and physical health, and to increase the risk of disease. Research on the relevant mechanisms associated with bullying and on potential interventions to decrease morbidity is urgently needed.

The compatibility of clinical child mental health treatment and evidence-based treatment protocols.

Few children with mental health problems receive evidence-based psychotherapy, partly because of unsuccessful dissemination of evidence-based treatments (EBTs). Previous research suggests that the length and structure of EBT protocols for anxiety disorders may impede their adoption in community practice. To examine the potential discrepancy between EBT protocols and clinical practice across disorders, we examined patient diagnoses and average length of treatment for childhood psychiatric disorders in a regional medical center where child and adolescent patients from the community have access to mental health care. The findings suggest that although a large portion of youth seeking mental health care presented with symptoms consistent with those addressed by common evidence-based psychotherapy protocols, less than half of these patients ever met with a therapist and less than 10% of those attended a sufficient number of sessions to complete a full treatment protocol. These results underscore the need to develop brief and flexible EBT protocols, such as modular treatments, that introduce essential elements early in the course of treatment. (PsycINFO Database Record

An Uncontrolled Pilot Study of an Integrated Family-Based Partial Hospitalization Program for Youth With Mood Disorders

ABSTRACT There are many outpatient interventions for treating youth with mood disorders and their families. Despite the severity of impairment related to mood disorders, there is little research on the effectiveness of intensive outpatient or partial hospitalization programs that implement evidence-based treatment components for youth with mood disorders. A preliminary review of an innovative program, the Child and Adolescent Integrated Mood Program (CAIMP), that incorporates evidenced-based intervention within the service model of a partial hospitalization program for youth ages 9–18 is provided. Structured clinical interviews, broad-based assessment measures, and clinician-reported functioning scales were implemented to gather preliminary data. A brief description is included regarding the clinical setting, CAIMP treatment components, and pilot data. Favorable treatment outcomes post-CAIMP, including a reduction in inpatient hospitalization, are explored. Posttreatment clinical improvement was noted, and inpatient psychiatric hospital admissions decreased after completing CAIMP. Pilot data are favorable for CAIMP when providing treatment for youth with severe mood disorders and their caregivers. This intervention shows promise for being an important addition to the treatment options for youth with severe mood disorders and their families and is worthy of further evaluation. Providers have this clinical takeaway: Preliminary data suggest providing a partial hospitalization program specifically designed for mood disorders that engages both caregivers and youth with severe mood disorders has clinical benefit.

Integrating Board Certification Expectations and Examination Practice Into Clinical Child and Pediatric Psychology Training Programs

ABSTRACT Recent trends in the field suggest that it may be an ideal time for clinical psychology training programs to consider integrating American Board of Professional Psychology certification components into their training programs. Training programs are already required to evaluate and document trainees’ competencies, and the field of clinical psychology is increasing its emphasis on board certification. Nonetheless, the process of board certification appears daunting and anxiety provoking to both recent and experienced professionals. Providing trainees with experience in board certification experiences is likely to increase their skill and comfort with case presentations, writing professional statements, and oral examinations. Experience in programs with this approach suggests that these components can be utilized to evaluate competencies with minimal to moderate increases in time commitments from both faculty and trainees. Further research evaluating strategies to increase trainees’ participation and success with board certification is warranted.