Nicole Smolla

The Dominic-R: A Pictorial Interview for 6- to 11-Year-Old Children

OBJECTIVE To review the Dominic-R and the Terry questionnaires, respectively, for white and African-American children, both DSM-III-R-based, and more recent DSM-IV-based computerized versions. METHOD Five papers describing the development, content, validation studies, and establishment of the diagnostic cutpoints of these instruments are reviewed. The instruments are pictorial, fully structured, and designed to assess mental disorders in children 6 to 11 years of age. Symptom descriptions complement the visual stimulus, providing better information-processing than visual or auditory stimuli alone. Cognitive immaturity of young children bars frequency, duration, and age-of-onset measurements, restricting correspondence with DSM criteria. DSM-IV (computerized versions) and DSM-III-R (paper versions) disorders being assessed include specific (simple) phobias, separation anxiety, generalized anxiety (overanxious), depression/dysthymia, attention-deficit hyperactivity, oppositional defiant, and conduct disorder. RESULTS Test-retest reliability of symptoms and symptom scores and criterion validity against clinical judgment support the visual-auditory combination of stimuli to assess child mental health. CONCLUSION Intended for clinical, epidemiological, and screening purposes, these instruments are short and simple. Although it only approximates DSM-III-R and DSM-IV criteria, the pictorial format permits young children to be reliable informants about their mental health.

Attachment and behavior problems in middle childhood as reported by adult and child informants

The predictive relation between attachment and mother, teacher, and self-reported psychopathology was examined for a diverse socioeconomic status French Canadian sample of 96 children. Attachment classifications were assigned on the basis of reunion behavior with mother when the children were approximately 6 years old, and child problem behavior was assessed 2 years later using the Child Behavior Checklist (mother report), the Social Behavior Questionaire (teacher report), and the Dominic Questionnaire (child self-report). Results indicated that both insecure/ambivalent and insecure/controlling children children were rated higher than secure children on a composite measure of externalizing problems. Concerning internalizing problems, only the controlling group was significantly higher on both a composite adult (teacher and mother) and self-report measure of internalizing problems. Analyses of clinical cutoff scores showed that only the controlling group had a significantly greater likelihood of overall problem behavior than other children.

Correlates of Mental Disorders in the Quebec General Population of 6 to 14-Year Olds

Previous epidemiological studies of correlates of child and adolescent mental disorders in the general population have focused more on child/adolescent and socioeconomic/sociodemographic characteristics than on family characteristics. Moreover, there are no generally accepted methods to analyze and interpret correlates. The purpose of the Quebec Child Mental Health Survey in this regard was twofold: (1) to identify correlates of DSM-III-R internalizing and externalizing disorders according to informant (youth, parent, teacher), for three age groups (6–8, 9–11, and 12–14 years), including relevant family characteristics not considered in previous studies; and (2) to interpret the relative importance of risk indicators by ranking correlates according to strength and consistency of association across age groups. Logistic regression models suggest the inconsistency of correlates across informants. The ranking of correlates reveals that individual and family characteristics make a more important contribution than do socioeconomic characteristics, thereby supporting the relevance of proximal variables in the development of psychopathology.

Pre-Adoption Adversity and Self-Reported Behavior Problems in 7 Year-Old International Adoptees

To further investigate the long-term impact of pre-adoption adversity on international adoptees, externalizing and internalizing symptoms were assessed using a self-report measure at school-age in addition to mothers’ reports. The sample consisted of 95 adopted children and their mothers. Children’s health and developmental status were assessed soon after arrival in their adoptive family. At age 7, the Dominic Interactive, a self-report measure, was used to evaluate externalizing and internalizing symptoms while mothers completed the CBCL. Children’s self-reports were compared to their non-adopted peers’. Adopted children reported more symptoms of specific phobia than their peers. A significant correlation was found between mothers’ and children’s reports but only for externalizing symptoms. Self-reported symptoms were related to indices of nutritional and psychosocial deprivation at arrival, such as low height/age and weight/height ratios. Our results emphasize the importance of considering international adoptees’ perception of their psychological adjustment and the long-term impact of early risk factors.

Development and reliability of a pictorial mental disorders screen for young adolescents

Objective: To report psychometric data from preliminary studies of the Adolescent Dominic (AD), a pictorial screen for the most frequent Axis I youth mental disorders. Methods: We created 113 picture items based on DSM-III-R diagnostic criteria and assessed them for comprehension (sample 1, n = 114; sample 2, n = 40) and reliability (sample 3, n = 128) in a group of adolescents aged 12 to 16 years living in the community. We used the kappa statistic to estimate test–retest reliability of symptoms, criteria and diagnoses, and intraclass correlation coefficients (ICCs) for symptom and criterion scores. We assessed internal consistency of symptom scores with the alpha coefficient. Results: For symptoms, 54.4% of kappas were higher than 0.60, while only 2% were poor. ICCs for symptom scores yielded higher values (0.81 to 0.89) than for criterion scores (0.51 to 0.86). Internal consistency of symptom scores ranged from 0.52 to 0.83. Kappas for diagnoses ranged from 0.52 to 0.76. Conclusions: Symptom reliability compared favourably with data from other assessment interviews of youth mental disorders. Following these positive results, a computerized DSM-IV version of the AD has focused on the assessment of symptoms and is currently being tested for reliability and criterion validity.

Ethical issues concerning participants in community surveys of child and adolescent mental disorders

Objective: Considering that a literature review yielded limited information on ethical issues concerning participants in child and adolescent mental health community surveys, the authors identify and discuss some of these issues. Method: First, the authors present the ethical principles set forth by the National Council on Bioethics in Human Research (NCBHR) and evoked by the 1998 Tri-Council Policy Statement, underscoring their importance as guidelines for establishing ethical standards for research with children. Second, they describe the general objectives and currently preferred methods of child psychiatric surveys. Third, they discuss issues pertaining to the validity and innocuousness of structured interview guides, the limitations of parental authorization and childrens assent, and the complexity of clinical interventions based on ethical grounds. Conclusions: The authors emphasize the importance of developing empirical knowledge regarding the questions raised and bringing the social stakeholders concerned into the debate.

Reliability, validity, and clinical use of the Dominic Interactive: a DSM-based, self-report screen for school-aged children.

Objectives: As no single informant can be considered the gold standard of child psychopathology, interviewing of children regarding their own symptoms is necessary. Our study focused on the reliability, validity, and clinical use of the Dominic Interactive (DI), a multimedia self-report screen to assess symptoms for the most frequent Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, mental disorders in school-aged children. Methods: A sample of 585 children aged 6 to 11 years from the community and psychiatric clinics was used to analyze the internal consistency, the test-retest estimate of reliability, and the criterion-related validity of the DI against the referral status. In addition, cross-informant correlation coefficients between this instrument (child report) and the Child Symptom Inventory (parent report) were explored in a subsample of 292 participants. Results: For the total sample, Cronbach alpha coefficients ranged from 0.63 to 0.91. Test–retest kappas varied from 0.42 to 0.62 for categories based on cut-off points, except for specific phobias. Intraclass correlation coefficients ranged from 0.70 to 0.81 for symptom scales. The DI discriminated between referred and nonreferred children in psychiatric clinics for all symptom scales. Significant cross-informant correlation coefficients were higher for the externalizing symptoms (0.35 to 0.48) than the internalizing symptoms (0.14 to 0.27). Conclusions: Findings of our study reasonably support adequate psychometric properties of the DI. This instrument offers a developmentally sensitive screening method to obtain unique information from young children about their mental health problems in front-line services, psychiatric clinics, and research settings.

Reliability, Validity, and Clinical Utility of the Dominic Interactive for Adolescents–Revised A DSM-5–Based Self-Report Screen for Mental Disorders, Borderline Personality Traits, and Suicidality

Objectives: The Dominic Interactive for Adolescents–Revised (DIA-R) is a multimedia self-report screen for 9 mental disorders, borderline personality traits, and suicidality defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This study aimed to examine the reliability and the validity of this instrument. Methods: French- and English-speaking adolescents aged 12 to 15 years (N = 447) were recruited from schools and clinical settings in Montreal and were evaluated twice. The internal consistency was estimated by Cronbach alpha coefficients and the test-retest reliability by intraclass correlation coefficients. Cutoff points on the DIA-R scales were determined by using clinically relevant measures for defining external validation criteria: the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, the Beck Hopelessness Scale, and the Abbreviated-Diagnostic Interview for Borderlines. Receiver operating characteristic (ROC) analyses provided accuracy estimates (area under the ROC curve, sensitivity, specificity, likelihood ratio) to evaluate the ability of the DIA-R scales to predict external criteria. Results: For most of the DIA-R scales, reliability coefficients were excellent or moderate. High or moderate accuracy estimates from ROC analyses demonstrated the ability of the DIA-R thresholds to predict psychopathological conditions. These thresholds were generally capable to discriminate between clinical and school subsamples. However, the validity of the obsessions/compulsions scale was too low. Conclusions: Findings clearly support the reliability and the validity of the DIA-R. This instrument may be useful to assess a wide range of adolescents’ mental health problems in the continuum of services. This conclusion applies to all scales, except the obsessions/compulsions one.