Mark Sanford

Integrating Assessment Data from Multiple Informants

OBJECTIVE To examine the consequences for measurement of child psychiatric disorder (conduct and oppositional disorders) of not integrating the data on the same individual from different informants compared with integrating the information from parents and teachers, using three different strategies. METHOD Data for the study came from problem checklist assessments done by parents and teachers of children aged 6 to 16 years (N = 1,134) selected with known probability from a general population sample and from structured interviews obtained in a stratified random subsample (n = 251). RESULTS As expected, parent-teacher agreement was low. The pattern of associated features of disorder was found to vary markedly in parent-identified compared with teacher-identified disorder. Furthermore, combining informants had the disadvantage of masking the distinctive patterns of associated features noted in informant-specific disorders. Finally, by treating disorder as informant-specific, the internal properties of the measure are not generally inferior to those obtained by combining informants in various ways. CONCLUSION Child psychiatric disorders should be conceptualized as informant-specific phenomena.

Outcome, prognosis, and risk in a longitudinal follow-up study.

This study reports the results of a 4-year follow-up of a community sample of children who were ages 4 to 12 in 1983 at the first wave of data collection. Results on outcomes revealed that conduct disorder showed the greatest stability especially from late childhood to early adolescence. In multivariate analyses, both family dysfunction and problems getting along with others significantly predicted the persistence of one or more psychiatric disorders 4 years later, and low income predicted one or more psychiatric disorders among children free of disorder 4 years earlier. The implications of the results for the child psychiatric field, especially prevention, are discussed.

Evaluation of the Diagnostic Interview for Children and Adolescents for Use in General Population Samples

This article presents evaluative data on the use of the Diagnostic Interview for Children and AdolescentsRevised (DICAR) to classify DSM-IIIR disorders in the general population. Data for the analyses came from a probability sample (N=251) of parentchild/adolescent dyads aged 6 to 16 separately administered the DICAR on two occasions, 10 to 20 days apart, by trained lay interviewers and child psychiatrists. Data are presented on prevalence,testretest reliability, parentchild/adolescent agreement, and trained lay interviewerchild psychiatrist agreement. High prevalences of oppositional defiant disorder derived from parent assessments and overanxious disorder and dysthymia derived from adolescent assessments suggest that these disorders may be overidentified. Interview data provided by 6 to 11year olds to classify the internalizing disorders were too unreliable to be useful. Agreement between parentchild/adolescent dyads was generally low while agreement between trained lay interviewerschild psychiatrists was generally high.

Predicting the One-Year Course of Adolescent Major Depression

OBJECTIVE To identify specific clinical and social functioning variables that predict persistence of major depression over a 1-year period of follow-up. METHOD The sample consisted of 67 adolescents with major depression, drawn from consecutive referrals to psychiatric clinics in a defined, geographic catchment area. Clinical interviews and questionnaires measuring behaviors, symptoms, and social functioning were administered to both the adolescent and a parent at inception and at follow-up. Discriminant function analyses were used to identify inception variables that predicted clinical course independent of severity of depressive symptoms and global functioning. RESULTS At 1-year follow-up, major depression remitted in 66% of subjects. Persisters were characterized at inception as older, more likely to have substance use or anxiety disorders, less involved with fathers, and less responsive to mothers discipline compared with remitters. The effect of these prognostic factors was independent of symptom severity and global functioning. CONCLUSION These variables appear to reflect perpetuating and ameliorating factors influencing the short-term course of major depression. The findings suggest that treatments for adolescent depression that aim to enhance parent-adolescent relationships, and that specifically target coexisting disorders, should be evaluated for effectiveness.

Identifying Thresholds for Classifying Childhood Psychiatric Disorder: Issues and Prospects

OBJECTIVE To evaluate empirically the implications of choosing different thresholds to classify conduct disorder and attention-deficit hyperactivity disorder for estimating prevalence, test-retest reliability of measurement, and informant (parent/teacher) agreement and for evaluating comorbidity and associated features of disorder. METHOD Data for the study came from problem checklist assessments done by parents and teachers of children aged 6 to 16 years (N = 1,229) selected with known probability from a general population sample and from structured interviews obtained in a stratified, random subsample (n = 251). RESULTS Estimates varied widely depending on the rationale used to set thresholds. Percent prevalence went from 0.1 to 39.2; kappa estimates of test-retest reliability went from .19 to .82. Parent-teacher agreement based on kappa went from .0 to .38. Relative odds between disorder and associated features varied twofold. CONCLUSION Use of different rationales to set thresholds for classifying childhood psychiatric disorder in the general population has profound implications for what we learn about the epidemiology of childhood disorder.

Evaluation of the Original Ontario Child Health Study Scales

This article presents evaluative information on the use of the original Ontario Child Health Study scales to serve as ordinal-level measures of conduct disorder, hyperactivity and emotional disorder among children in the general (non clinic) population. Problem checklist assessments were obtained from parents and teachers of children aged six to 16 and youth aged 12 to 16 drawn from a general population (n = 1,751); and a mental health clinic sample (n = 1,027) in the same industrialized, urban setting. The results showed that the original OCHS scales possess adequate psychometric properties to be used as ordinal-level measures of disorder. Correlations between individual items and their hypothesized scales were very strong, indicating convergent validity, while correlations between the same items and other (non hypothesized) scales were lower, indicating discriminant validity. Item analyses indicated that individual scale items possess both convergent and discriminant validity. Although the scales were skewed to the positive end of the continuum, they demonstrated good internal consistency (all estimates ≥ 0.74) and test-retest (all estimates ≥ 0.65) reliability. Finally, three different validity analyses confirmed hypotheses about how the original OCHS scales should perform if they provide useful measures of disorder.

Ontario child health study : social and school impairments in children aged 6 to 16 years

This study reports on informant-specific prevalence rates and the relationship with psychiatric disorder of social and school impairments in a community sample of children, 6 to 16 years of age, in Ontario. Prevalence rates ranged from less than 1% to over 18% depending on informant, and there was a low level of agreement between informants. Although impairments were strongly related to psychiatric disorder, there were many children with impairments and no psychiatric disorder or psychiatric disorder with no impairments. Implications of these results are discussed.

Parental expressed emotion in depressed adolescents: prediction of clinical course and relationship to comorbid disorders and social functioning

BACKGROUND High expressed emotion (EE) predicts worse clinical course for a number of disorders. High EE is more frequent in parents of disordered children than normal controls. It is uncertain whether EE and its components are disorder-specific, whether EE is more closely related to parent characteristics or child characteristics, and whether EE predicts clinical course independently of clinical variables that reflect severity of disorder. EE has not been investigated in adolescent depression. METHOD The 57 participants in this study were a sub-sample of a longitudinal study of the clinical course of depression. Adolescents and parents were recruited from consecutive referrals to all psychiatric outpatient clinics and inpatient units in a geographic catchment area. The association between EE and one-year clinical outcome of major depressive disorder was tested and associations between EE and characteristics of the adolescent, the parent, and the family were examined. RESULTS EE was independent of socio-demographic characteristics, comorbid diagnoses, and parental depression. High EE was associated with worse adolescent social functioning according to either adolescent or parent report. High EE was associated with the presence of more depression symptoms. Low EE predicted major depression remission in participants without comorbid attention-deficit/hyperactivity disorder (ADHD), but this association was not independent of the association between social functioning and depression remission. CONCLUSIONS The findings indicate a need to examine possible protective effects of low EE. Relationships between EE, social functioning, and depression persistence and remission require further examination.

Pathways into the Work Force: Antecedents of School and Work Force Status

OBJECTIVE The study aim was to identify risk factors for specific pathways into the work force using data from the Ontario Child Health Study Follow-up. METHOD Potential predictor variables were derived from data collected in 1983 on adolescents aged 13 to 16 years. The subjects were followed up 4 years later and the school/work force outcome was determined. Bivariate and multivariate statistical analyses were used to identify variables with a strong independent association with this outcome. RESULTS Subjects in the work force were four times more likely than those attending school to have come from a low-income family and at least two times more likely to have a family background of low maternal education, to have failed a grade, or to have used substances heavily during early adolescence. Subjects with two or more of these risk factors were likely to be in part-time work or unemployed. CONCLUSIONS Preventive interventions should be targeted at children from poor families, or who fail at school, or show early onset of substance abuse and other deviant behaviors. Studies are needed to further elucidate the relationship between these risk factors and pathways into the work force and beyond.

The Effect of School Culture on Adolescent Behavioural Problems: SelfEsteem, Attachment to Learning, and Peer Approval of Deviance as Mediating Mechanisms

Adopting a social ecological perspective, this study examined the role of adolescent personality and social traits as mediating mechanisms linking school culture with adolescent behavioural problems. Data were obtained from the self-reports of 1,100 grade nine students attending four southern Ontario high schools. Structural equation model results revealed that student exposure to an unfavourable school culture (marked by perceptions of low teacher and classmate support, student conflict, unfair school rules and disciplinary practices, and low student autonomy in school decision-making and affairs) was positively associated with low attachment to learning and peer approval of deviance each of which were positively associated with disciplinary problems, conduct disorder, oppositional-defiant disorder, attention-deficit hyperactivity, and substance use. Low self-esteem emerged as a significant mediator in two models. Significant direct effects of school culture were found for most outcomes. Discussion focused on the significance of study findings for future program development and research.