John E. Richters

The NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study: background and methodology.

OBJECTIVE A collaborative study was conducted to develop methods for surveys of mental disorder and service utilization in unscreened population-based samples of children and adolescents. METHOD Probability household samples of youths 9 through 17 years of age were selected at four sites and interviews were conducted with a total of 1,285 pairs of youths and their adult caretakers in their homes. Lay interviewers administered a computer-assisted version of the NIMH Diagnostic Interview Schedule for Children Version 2.3 and structured interviews to assess demographic variables, functional impairment, risk factors, service utilization, and barriers to service utilization. RESULTS More than 7,500 households were enumerated at four sites, with enumeration response rates above 99%. Across sites, 84% of eligible youth-caretaker pairs were interviewed for about 2 hours each. Ninety-five percent of both youths and caretakers found the interview to be acceptable enough to recommend to a friend. CONCLUSIONS These findings indicate that large-scale epidemiological surveys of mental disorders and mental health service use involving lengthy interviews in the homes of unscreened population-based samples of youths and their adult caretakers are acceptable to the community and can achieve good response rates. The other reports in this Special Section address the reliability and validity of the various survey instruments and other key findings.

Violent communities, family choices, and children's chances: An algorithm for improving the odds

Data are presented concerning the early predictors of adaptational success and failure among 72 children attending their 1st years of elementary school in a violent Washington, D.C., neighborhood. Adaptational failures were defined as those children who were doing poorly or failing in school and rated by their parents as suffering clinically significant levels of behavior problems. Adaptational successes were defined as children whose performance as students was rated in the average to excellent range and whose parent-rated levels of behavior problems were within the normal range. Despite the fact that these children were being raised in violent neighborhoods, had been exposed to relatively high levels of violence in the community, and were experiencing associated distress symptoms, community violence exposure levels were not predictive of adaptational failure or success. Instead, adaptational status was systematically related to characteristics of the childrens homes. More specifically, the childrens chances of adaptational failure rose dramatically as a function of living in unstable and/or unsafe homes. Moreover, it was not the mere accumulation of environmental adversities that gave rise to adaptational failure in these children. Rather, it was only when such adversities contaminated or eroded the stability and/or safety levels of the childrens homes that the odds of their adaptational failure increased. We argue that this erosion of the quality of the childs microsystem (i.e., family) by adversities and pressures in the exosystem (i.e., community) is not an inevitable process. Although not yet well understood, it is a process over which families have and must exercise control. The implications of these data for improving childrens chances of physical, psychological, and academic survival in violent neighborhoods are considered.

NIMH Collaborative Multisite Multimodal Treatment Study of Children with ADHD: I. Background and Rationale

OBJECTIVE The National Institute of Mental Healths recently initiated 5-year, multisite, multimodal treatment study of children with attention-deficit hyperactivity disorder (MTA) is the first major clinical trial in its history focused on a childhood mental disorder. This article reviews the major scientific and clinical bases for initiating the MTA. METHOD A selective review of the literature is presented in the service of describing the estimated prevalence of ADHD among children and adolescents, its core clinical features, evidence concerning psychopharmacological and psychosocial treatment effects, and related research issues and trends leading to the development of the MTA. RESULTS Despite decades of treatment research and clinical practice, there is an insufficient basis for answering the following manifold question: under what circumstances and with what child characteristics (comorbid conditions, gender, family history, home environment, age, nutritional/metabolic status, etc.) do which treatments or combinations of treatment (stimulants, behavior therapy, parent training, school-based intervention) have what impacts (improvement, stasis, deterioration) on what domains of child functioning (cognitive, academic, behavioral, neurophysiological, neuropsychological, peer relations, family relations), for how long (short versus long term), to what extent (effect sizes, normal versus pathological range), and why (processes underlying change)? CONCLUSIONS The important scientific, clinical, and public health issues nested within this manifold question provide both the impetus and scaffolding for the MTA.

The Hubble hypothesis and the developmentalist' s dilemma

Developmental psychopathology stands poised at the close of the 20th century on the horns of a major scientific dilemma. The essence of this dilemma lies in the contrast between its heuristically rich open system concepts on the one hand, and the closed system paradigm it adopted from mainstream psychology for investigating those models on the other. Many of the research methods, assessment strategies, and data analytic models of psychologys paradigm are predicated on closed system assumptions and explanatory models. Thus, they are fundamentally inadequate for studying humans, who are unparalleled among open systems in their wide ranging capacities for equifinal and multifinal functioning. Developmental psychopathology faces two challenges in successfully negotiating the developmentalists dilemma. The first lies in recognizing how the current paradigm encourages research practices that are antithetical to developmental principles, yet continue to flourish. I argue that the developmentalists dilemma is sustained by long standing, mutually enabling weaknesses in the paradigms discovery methods and scientific standards. These interdependent weaknesses function like a distorted lens on the research process by variously sustaining the illusion of theoretical progress, obscuring the need for fundamental reforms, and both constraining and misguiding reform efforts. An understanding of how these influences arise and take their toll provides a foundation and rationale for engaging the second challenge. The essence of this challenge will be finding ways to resolve the developmentalists dilemma outside the constraints of the existing paradigm by developing indigenous research strategies, methods, and standards with fidelity to the complexity of developmental phenomena.

Scales, diagnoses, and child psychopathology: II. Comparing the CBCL and the DISC against external validators

Using a multimethod multistage screening procedure, the authors interviewed 201 parents and their children with the Diagnostic Interview Schedule for Children (DISC 2.1). In addition, parents completed the Child Behavior Checklist (CBCL) and other survey measures, while their children completed self-report scales. Receiver operating characteristic (ROC) analyses were done to determine optimal cutpoints on the CBCL, referenced to DISC diagnostic “caseness.” DISC diagnoses, DISC “stem” symptoms, CBCL scores, and CBCL ROC-cutpoints were compared against “external validators,” in order to determine the comparative advantages of each approach for assessing child psychopathology. Overall findings suggest that the controversies about “best” assessment strategies may be artificial: When both assessment approaches are compared using similar methods, they are reasonably comparable. However, highly specific diagnostic categories may show fewer relationships with external validators and may therefore need more systematic validational studies.

Developmental considerations in the investigation of conduct disorder

The papers in this special issue attest to the theoretical and empirical advances that have been made in understanding the epidemiology, subtypes, etiology, neuropsychology, psychobiology, course, consequences, prevention, and treatment of conduct disorder (CD) (see also Kazdin, 1987; Loeber, 1990; Loeber & Stouthamer-Loeber, 1986; Moffitt, 1990; Patterson, 1982; Robins, 1991; White, Moffitt, Earls, Robins, & Silva, 1990). A number of theoretical conceptualizations have been forwarded in an attempt to comprehend this complex form of disorder in children. Such divergence in thinking indicates that the topic of CD has evolved into an active and significant domain of inquiry. To date, however, there has been no unifying theoretical framework for bringing conceptual clarity to the diverse perspectives represented in the study of conduct disorder. Although existing work within particular disciplines and subdisciplines has provided substantial contributions to our understanding of CD, these accounts typically have not considered the broader matrix of complex and evolving biological, cognitive, socioemotional, representational, and social-cognitive capacities of the developing child. As a consequence, disparate theoretical formulations are often too narrow in focus to address the range of processes and mechanisms that will be necessary to explain adequately how and why manifestations of CD emerge, change overtime and are influenced by childrens developmental levels.

Empirical Classification of Infant-Mother Relationships from Interactive Behavior and Crying during Reunion.

Multiple discriminant function analysis (MDFA) was conducted with data from 255 Strange Situations conducted and scored by Ainsworth and her colleagues. Cross-validated discriminant functions and classification weights were obtained, allowing attachment classifications (A, B, C) to be assigned directly from scores on interactive behavior and crying during reunion episodes. In the past, classification agreement within laboratories has often been used as a training criterion. Unfortunately, this does not insure that classification criteria agreed upon within a laboratory are comparable across laboratories, nor does it insure that agreed upon criteria will yield the same classifications that would have been assigned by the researchers who developed the scoring system. The present results enable researchers who have mastered the scoring systems for reunion behavior and crying to obtain attachment classifications directly from scores on these variables. Alternatively, this procedure may be used to guide the training of, and validate classification decisions by, local judges.

Time-dependent changes in positively biased self-perceptions of children with attention-deficit/hyperactivity disorder: A developmental psychopathology perspective

This study examined changes in the degree of positive bias in self-perceptions of previously diagnosed 8- to 13-year-old children with attention-deficit/hyperactivity disorder (ADHD; n = 513) and comparison peers (n = 284) over a 6-year period. The dynamic association between biased self-perceptions and dimensional indices of depressive symptoms and aggression also were considered. Across the 6-year time span, comparison children exhibited less bias than children with ADHD, although a normative bolstering of social self-views during early adolescence was observed. Decreases in positive biases regarding social and behavioral competence were associated with increases in depressive symptoms over time, whereas increases in levels of positively biased self-perceptions in the behavioral (but not social) domain were predictive of greater aggression over time. ADHD status moderated the dynamic association between biases and adjustment. Finally, evidence indicated that there was a bidirectional relationship between biases and aggression, whereas depressive symptoms appeared to inversely predict later bias.

Risk and protective factors in the development of psychopathology: Beyond diathesis: toward an understanding of high-risk environments

During the formative years of the high-risk-for-schizophrenia movement, researchers devoted most of their attention to isolating early patterns of maladjustment and deviance among high-risk offspring. Their primary research agenda was to develop an understanding of those deficits, with an eye toward tracing them to later functioning and ultimately to diagnostic status. In more recent years there has been increased interest in and enthusiasm for examining protective factors: the environmental resources available to and the adaptive strengths characteristic of those high-risk children who do not show early signs of deviance. Whether this newer interest reflects a broadening of focus consistent with the seminal writings of Garmezy (1971, 1976, 1981, 1983) and others, or more accurately represents a displacement or misplacement of interest in factors responsible for early deviance, is a question with important implications for the future directions of high-risk research. At the heart of this question is unsettling evidence throughout the high-risk literature of blurred distinctions between the concepts of risk, vulnerability, and maladjustment, and between risk reducers and protective factors. It is no less true in high-risk research than in other domains of inquiry that important answers often are obscured by the ways we frame our questions. And as we hope to demonstrate in this chapter, there is much to be gained through maintaining conceptual clarity in our thinking about and usage of these terms. We begin by reviewing briefly the origins and current status of research concerning the etiology of schizophrenia and related disorders among the offspring of schizophrenic parents. Our goal is to highlight some of the methodological and conceptual issues that have shaped the nature and direction of this research.

Expressed Emotion: Toward Clarification of a Critical Construct

The most useful and productive concepts in psychopathology are often the ones we understand the least well. This has always been true of such concepts as stress, resilience, and protective factors, and it is no less true of the expressed emotion (EE) construct, a relatively recent addition to the list. Operationally, EE is a measure of the extent to which the relative of a psychiatric patient talks about the patient in a critical, hostile, or emotionally overinvolved way during a semistructured clinical interview. Although the precise nature of the EE construct is not well understood, it is widely believed to reflect an underlying critical and/or negative attitude of the family member toward the patient that expresses itself in daily interactions. Empirical support for this assumption is provided by the results of several laboratory-based studies showing that high levels of EE are associated with more negative patient-relative interactions (Hahlweg et al., 1989; Hooley, 1986; Hooley, 1990; Hooley & Hahlweg, 1986; Kuipers, Sturgeon, Berkowitz, & Leff, 1983; Miklowitz, Goldstein, Falloon, & Doane, 1984; Mueser et al., 1993; Strachan, Leff, Goldstein, Doane, & Burtt, 1986).