Kenneth D. Gadow

Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples

This study compares DSM-IV symptoms in children (ages 6 to 12 years) with pervasive developmental disorder (PDD), clinic controls, and community-based samples. Parents/teachers completed the Child Symptom Inventory–4 for four samples: PDD (N= 284/284) and non-PDD psychiatric clinic referrals (N= 189/181) and pupils in regular (N= 385/404) and special (N= 61/60) education classes. The PDD group received higher symptom severity ratings than the regular education group, but was similar to the non-PDD clinic sample. Screening prevalence rates were highest for ADHD, ODD, and generalized anxiety disorder. PDD subtypes exhibited differentially higher rates of psychiatric symptoms. The magnitude of rater and gender differences in symptom severity ratings was modest. Clinic-referred children with PDD exhibit a pattern of psychiatric symptoms highly similar to nonPDD clinic referrals. Although much additional research is needed on comorbidity, these symptoms have important treatment implications.

Symptoms of Depression and Anxiety in Pediatric Epilepsy Patients

Summary: Purpose: We assessed rates of symptoms of anxiety and depression among pediatric patients with epilepsy.

Psychiatric Symptoms in Preschool Children with PDD and Clinic and Comparison Samples

AbstractObjective: This study describes and compares the severity of DSM-IV symptoms in preschool children with diagnosed pervasive developmental disorder (PDD), clinic controls, and two community-based samples. Method: Parents (/and teachers) completed the early child inventory-4 (ECI-4), a DSM-IV-referenced rating scale for four samples: PDD (n = 172/160) and nonPDD psychiatric clinic referrals (n = 135/101) and youngsters in regular (n = 507/407) and special (n = 64/140) early childhood programs. Children ranged in age from 3 to 5 years old. Results: With the exception of conduct problems, the PDD group generally received higher symptom severity ratings than the regular early childhood group, but the pattern of differences compared with the other two groups often varied by type of symptom and informant. Teachers rated the PDD and nonPDD clinic groups as having equally severe ADHD and oppositional defiant disorder symptoms. Teachers rated the PDD group as having more severe anxiety and depression symptoms than parents. The Asperger group was rated by both informants as more oppositional than the autism and PDDNOS subgroups. Teachers rated males in the regular early childhood sample as having more severe ADHD and aggressive symptoms than females, but this was not the case for the PDD sample. Conclusion: Preschoolers with PDD exhibit more severe DSM-IV psychiatric symptoms than children in regular and special early childhood programs, and to some extent nonPDD psychiatric referrals. The concept of comorbidity warrants further exploration, as does informant-specific syndromes as validators of diagnostic constructs.

Teacher Reports of DSM-IV ADHD, ODD, and CD Symptoms in Schoolchildren

OBJECTIVE To examine the prevalence of DSM-IV symptoms of attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder and age, gender, and comorbidity differences between ADHD subtypes. METHOD Teachers completed a DSM-IV-referenced symptom inventory for 3,006 schoolchildren aged between 3 and 18 years. RESULTS The screening prevalence rate of ADHD behaviors was 15.8%; rates for individual subtypes were 9.9% for inattentive, 2.4% for hyperactive-impulsive, and 3.6% for combined. The inattentive type was relatively uncommon in preschool children (3.9%), whereas the hyperactive-impulsive type was least common in teenagers (0.8%). Screening prevalence rates were higher for African-American (39.5%) than white (14.2%) students, but did not vary significantly (p < .05) as a function of geographic region or socioeconomic status. ADHD subtypes were rated as more impaired than the non-ADHD group on most measures and were easily differentiated on the basis of comorbid symptoms, social skills impairment, and special education services. CONCLUSIONS The findings of this and similar studies show relatively high convergence for the prevalence of ADHD behaviors and differences between ADHD subtypes.

Further evidence of reliability and validity of the Child Symptom Inventory-4: Parent checklist in clinically referred boys.

Examined reliability and validity of the parent version of the Child Symptom Inventory (CSI-4) in 247 boys between 6.0 and 10 years 11 months old referred for evaluation of behavioral and emotional problems. The CSI-4 is a behavior rating scale whose items correspond to the symptoms of disorders defined by the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994). Results indicated satisfactory internal consistency reliability, test-retest reliability, and temporal stability over a 4-year period for most symptom categories. CSI-4 ratings converged and diverged in a theoretically consistent pattern with respective scales of the Child Behavior Checklist (CBCL; Achenbach, 1991a) and the Diagnostic Interview for Children and Adolescents-Revised-Parent Version (DICA-P; Reich, Shayka, & Taibleson, 1991). Discriminant validity was established in that boys with specific DICA-P diagnoses received significantly higher corresponding CSI-4 parent symptom ratings than boys not so diagnosed. Clinical utility (sensitivity, specificity, positive predictive power, negative predictive power) was evaluated for screening cutoffs based on categorical (DSM-IV) and dimensional (normative distribution of Symptom Severity scores) scoring methods.

DSM-IV symptoms in community and clinic preschool children

OBJECTIVE To describe and compare ratings of psychiatric symptoms in community and clinic samples (ages 3-6 years) using a DSM-IV-referenced rating scale. METHOD Parent (/and teacher) ratings were obtained for community (N = 531/398) and special education (N = 64/140) samples (1995-1997) and an outpatient clinic (N = 224/189) sample (1994-1996). RESULTS Age and socioeconomic status were only minimally (r< 0.20) correlated with ratings of psychopathology. The most commonly endorsed symptom categories were attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, anxiety disorder, conduct disorder (teacher), and pervasive developmental disorder (clinic). Groups were easily differentiated by the rate and severity of symptoms (clinic > special education > community). Males generally received higher scores than females (especially teacher ratings). Children with ADHD symptoms had higher ratings of impairment (developmental deficits) than the non-ADHD group. CONCLUSIONS Although these findings share a number of similarities with studies of older children, there are also differences that attest to the uniqueness of this age group.

Differences between preschool children with ODD, ADHD, and ODD+ADHD symptoms

BACKGROUND This study examines differences between children (ages 3 to 6 years) who have the symptoms of oppositional defiant disorder (ODD) with or without attention-deficit/hyperactivity disorder (ADHD), ADHD alone, and a nonODD/ADHD comparison group. Parent (N=595) and teacher (N=538) ratings were obtained for children attending the same community early childhood programs and for youngsters evaluated in an outpatient clinic (N=224) using a DSM-IV-referenced rating scale. RESULTS Differences between symptom groups varied depending on how they were configured (teacher versus parent ratings) and setting (clinic versus community). In general, the ODD+ADHD group received the highest (and the comparison group the lowest) ratings of severity for the symptoms of other disorders, difficulties with peers, and developmental deficits. Moreover, the clinical impact of comorbidity was largely additive. Differences between youngsters with ODD versus ADHD symptoms were most apparent for teacher-defined groups in the community sample and parent-defined groups in the clinic sample. CONCLUSIONS Collectively, these findings provide preliminary evidence for the notion that ODD and ADHD may constitute distinct clinical entities in preschool-aged children and suggest that informant may be an important consideration in the formulation of diagnostic criteria.

DSM-IV Internal Construct Validity: When a Taxonomy Meets Data

The use of DSM-IV based questionnaires in child psychopathology is on the increase. The internal construct validity of a DSM-IV based model of ADHD, CD, ODD, Generalised Anxiety, and Depression was investigated in 11 samples by confirmatory factor analysis. The factorial structure of these syndrome dimensions was supported by the data. However, the model did not meet absolute standards of good model fit. Two sources of error are discussed in detail: multidimensionality of syndrome scales, and the presence of many symptoms that are diagnostically ambiguous with regard to the targeted syndrome dimension. It is argued that measurement precision may be increased by more careful operationalisation of the symptoms in the questionnaire. Additional approaches towards improved conceptualisation of DSM-IV are briefly discussed. A sharper DSM-IV model may improve the accuracy of inferences based on scale scores and provide more precise research findings with regard to relations with variables external to the taxonomy.

A DSM-IV–Referenced Screening Instrument for Preschool Children: The Early Childhood Inventory-4

OBJECTIVE To examine the validity of the Early Childhood Inventory-4 (ECI-4), a parent and teacher rating scale designed to screen for DSM-IV emotional and behavioral disorders. METHOD The convergent, divergent, and discriminant validity and clinical utility of the ECI-4 was studied in a sample of 224 consecutive referrals (3-6-year-old children) to a child psychiatric outpatient clinic. RESULTS The ECI-4 demonstrated adequate criterion validity for the most common disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder, pervasive developmental disorder) when compared with data-based psychiatric diagnoses and correlated well with relevant scales of the Child Behavior Checklist, Teachers Report Form, and Inattention/Overactivity With Aggression (IOWA) Conners. CONCLUSION The ECI-4 appears to be a useful screening measure for certain disorders in clinically referred children, but continued research is needed to determine its value in other settings (e.g., school and community), and its validity with other measurement methodologies.

A DSM-IV-referenced, adolescent self-report rating scale.

OBJECTIVE To examine the reliability and validity of the Youths Inventory-4 (YI-4), a DSM-IV-referenced self-report rating scale. METHOD Youths (N = 239) aged between 11 and 18 years who were clinically evaluated between 1996 and 1999 completed the YI-4, and 79% completed at least one additional self-report. Parents and teachers completed a companion measure. A second sample (N = 47) was retested 2 weeks after an initial evaluation. RESULTS The YI-4 demonstrated satisfactory internal consistency (alpha values = .66-.87) and test-retest reliability (r values = 0.54-0.92), convergent and to lesser extent divergent validity with other self-report measures, and discriminant validity by differentiating children with and without diagnosed attention-deficit/hyperactivity disorder, conduct disorder, substance use, generalized anxiety disorder, or major depressive disorder. Youth-parent (r values = 0.05-0.50) and youth-teacher (r values < 0.18) agreement was generally modest. CONCLUSIONS These findings provide preliminary support for the clinical utility of the YI-4 for symptom assessment in referred youths.