Wendy Reich

Development of a structured psychiatric interview for children: agreement between child and parent on individual symptoms.

To test the reliability of childrens reporting as compared with that of their mothers, a highly structured psychiatric diagnostic interview was used with 307 subjects, ages 6 through 16. Another interviewer gave each mother a similar interview about the child. Responses of each mother-child pair to 168 questions were compared using the kappa statistic. Highest agreement was found on questions concerning symptoms that are concrete, observable, severe, and unambiguous. Mothers tended to report significantly more behavioral symptoms, and children more subjective symptoms. Reasons for low kappas and asymmetrical reporting of symptoms are discussed.

Validation of a Brief Quantitative Measure of Autistic Traits: Comparison of the Social Responsiveness Scale with the Autism Diagnostic Interview-Revised

Studies of the broader autism phenotype, and of subtle changes in autism symptoms over time, have been compromised by a lack of established quantitative assessment tools. The Social Responsiveness Scale (SRS—formerly known as the Social Reciprocity Scale) is a new instrument that can be completed by parents and/or teachers in 15–20 minutes. We compared the SRS with the Autism Diagnostic Interview-Revised (ADI-R) in 61 child psychiatric patients. Correlations between SRS scores and ADI-R algorithm scores for DSM-IV criterion sets were on the order of 0.7. SRS scores were unrelated to I.Q. and exhibited inter-rater reliability on the order of 0.8. The SRS is a valid quantitative measure of autistic traits, feasible for use in clinical settings and for large-scale research studies of autism spectrum conditions.

Diagnostic Interview for Children and Adolescents (DICA)

OBJECTIVE To describe the evolution of the Diagnostic Interview for Children and Adolescents (DICA) as well as the goals of the instrument and the issues surrounding its use. METHOD Administration procedures, psychometric properties, and comparisons with other measures are reviewed. RESULTS The DICA, once considered a structured interview, can now be used in a semistructured format. It displays good reliability and works well with younger children. CONCLUSION The DICA is a useful measure for both research and clinical settings, and it provides a reliable tool for assessing psychiatric information in children and adolescents.

Reliability, validity, and Parent-Child Agreement Studies of the Diagnostic Interview for Children and Adolescents (DICA)

The Diagnostic Interview for Children and Adolescents (DICA) is a structured interview for school-age children, patterned after the National Institute of Mental Health Diagnostic Interview Schedule (DIS) and based on the DSM-III criteria. An inter-interview reliability study of the child version (DICA-C) was determined by interviewing 27 psychiatric inpatients, 7 to 17 years of age. Using the kappa statistic for multiple major diagnostic categories, the results demonstrated high reliability. A comparison of the DICA-C diagnoses with the hospital discharge diagnoses for validation of the DICA-C showed that in 81.5% of the cases, the clinicians were in agreement with the DICA-C diagnoses. The DICA-C resulted in more diagnoses per child compared with the hospital discharge diagnoses. The results are discussed in view of the different methods of evaluation. Parent-child agreement based on the DICA-C and DICA-P interview in 84 outpatients. 7 to 17 years of age, and their mothers showed a good to moderate agreement in most DSM-III diagnostic categories. Taken together, these data suggest that the DICA-C is a reliable and valid instrument for either clinical or research purposes.

Latent Class and Factor Analysis of DSM-IV ADHD: A Twin Study of Female Adolescents

OBJECTIVE In an attempt to validate the current DSM-IV criteria for attention-deficit/hyperactivity disorder (ADHD) in females and to determine whether symptoms are continuously distributed or categorically discrete, the authors performed factor and latent class analysis on ADHD symptom data from a large general population of adolescent female twins (1,629 pairs). METHOD A structured diagnostic assessment of DSM-IV ADHD was completed with at least one parent of 1,629 pairs by telephone. ADHD symptoms from 1,549 pairs were subjected to latent class and factor analysis. RESULTS Latent class and factor analyses were consistent with the presence of separate continuous domains of inattention (ATT), hyperactivity-impulsivity (H-I), and combined ATT with H-I problems. Severe latent classes corresponding to the predominantly inattentive, predominantly hyperactive-impulsive, and combined types were identified with lifetime prevalence estimates of 4.0%, 2.2%, and 3.7%, respectively. Membership in the severe ATT class predicted academic problems, family problems, and referral to health care providers. Membership in the H-I and combined classes also predicted impaired social relationships. CONCLUSIONS These results suggest that DSM-IV ADHD subtypes can be thought of as existing on separate continua of inattention, hyperactivity-impulsivity, and combined type problems. Membership in any of there severe ADHD latent classes did not preclude academic excellence, but it was associated with different types of impairment and health care-seeking behavior. These data have implications in the areas of diagnosis, classification, treatment, and research.

Prenatal Smoking Exposure and Dopaminergic Genotypes Interact to Cause a Severe ADHD Subtype

BACKGROUND In utero exposure to smoking and alcohol are common risk factors that have been associated with attention-deficit/hyperactivity disorder (ADHD) in human beings and animal models. Furthermore, molecular studies have focused on the association between ADHD and DNA polymorphisms in dopamine pathway-related genes. We examined the joint effects of genetic and prenatal substance exposures on DSM-IV and population-defined subtypes of ADHD. METHODS Logistic regression was used to assess the relationship between ADHD subtypes, DAT1 and DRD4 polymorphisms, and prenatal substance exposures in a birth-record sample of male and female twin pairs, aged 7-19 years. RESULTS Interactions between prenatal exposure to smoking and variations in the DAT1 and DRD4 loci were observed in children with either the DSM-IV or population-defined ADHD combined subtypes. The odds of a diagnosis of DSM-IV combined subtype was 2.9 times greater in twins who had inherited the DAT1 440 allele and who were exposed, than in unexposed twins without the risk allele. The OR was 2.6 in the population-defined subtype. Odds ratios for the DRD4 seven-repeat allele were 3.0 (2.8) in the population-defined (DSM-IV) combined ADHD subtypes. The OR for exposed children with both alleles was 9.0 (95% confidence interval=2.0-41.5) for the population-defined combined subtypes. CONCLUSIONS Results indicate that smoking during pregnancy is associated with specific subtypes of ADHD in genetically susceptible children.

Investigating psychopathological consequences of a disaster in children: a pilot study incorporating a structured diagnostic interview

ABSTRACT This paper reports on a pilot study examining the reactions of children to a disaster of severe flooding in a circumscribed area of rural Missouri. Both parents and children were interviewed separately approximately 1 year after the flood using parallel versions of a structured diagnostic interview designed to identify children with DSM-III diagnoses. The results document the importance of interviewing children directly. Children reported more anxiety symptoms than parents reported for their children. Although symptoms of posttraumatic stress were reported, none of the children met full criteria for the disorder. Children most likely to be adversely affected were those with a preexisting disorder and those with parents who also reported a high number of symptoms in themselves.

Psychopathology in children of alcoholics

OBJECTIVE To assess psychopathology in 125 and 158 children who are offspring of alcoholic and control parents. METHOD Parents and children were interviewed by means of structured interviews. Parents were interviewed about themselves and about their children. Teacher reports were obtained. A total of 158 young people ages 6 to 18 years were in the study, although some of the analyses use only 125. RESULTS Children of alcoholic parents showed higher rates of oppositional and conduct disorders but not attention deficit disorder. Children of alcoholic parents did not have significantly higher rates of depression, but they may be at risk for anxiety. These children also showed increased incidence of alcohol and other substance use but not abuse or dependence as defined by DSM-III. Few differences were detected with respect to self-esteem and achievement tests among the groups. There were no differences in the rates of psychopathology between offspring of alcoholic versus antisocial parents. CONCLUSION These data indicate that children of alcoholics exhibit high rates of psychopathology and may be at risk specifically for oppositional and conduct disorders but not for depression. There are few differences between alcoholics and controls with respect to self-esteem and achievement tests.

Contributions of parental alcoholism, prenatal substance exposure, and genetic transmission to child ADHD risk: a female twin study

BACKGROUND Genetic influences have been shown to play a major role in determining the risk of attention-deficit hyperactivity disorder (ADHD). In addition, prenatal exposure to nicotine and/or alcohol has also been suggested to increase risk of the disorder. Little attention, however, has been directed to investigating the roles of genetic transmission and prenatal exposure simultaneously. METHOD Diagnostic telephone interview data from parents of Missouri adolescent female twin pairs born during 1975-1985 were analyzed. Logistic regression models were fitted to interview data from a total of 1936 twin pairs (1091 MZ and 845 DZ pairs) to determine the relative contributions of parental smoking and drinking behavior (both during and outside of pregnancy) as risk factors for DSM-IV ADHD. Structural equation models were fitted to determine the extent of residual genetic and environmental influences on ADHD risk while controlling for effects of prenatal and parental predictors on risk. RESULTS ADHD was more likely to be diagnosed in girls whose mothers or fathers were alcohol dependent, whose mothers reported heavy alcohol use during pregnancy, and in those with low birth weight. Controlling for other risk factors, risk was not significantly increased in those whose mothers smoked during pregnancy. After allowing for effects of prenatal and childhood predictors, 86% of the residual variance in ADHD risk was attributable to genetic effects and 14% to non-shared environmental influences. CONCLUSIONS Prenatal and parental risk factors may not be important mediators of influences on risk with much of the association between these variables and ADHD appearing to be indirect.

Suicide attempts in an adolescent female twin sample.

OBJECTIVE To examine suicide attempts in an epidemiologically and genetically informative youth sample. METHOD 3,416 Missouri female adolescent twins (85% participation rate) were interviewed from 1995 to 2000 with a telephone version of the Child Semi-Structured Assessment for the Genetics of Alcoholism, which includes a detailed suicidal behavior section. Mean age was 15.5 years at assessment. RESULTS At least one suicide attempt was reported by 4.2% of the subjects. First suicide attempts were all made before age 18 (and at a mean age of 13.6). Major depressive disorder, alcohol dependence, childhood physical abuse, social phobia, conduct disorder, and African-American ethnicity were the factors most associated with a suicide attempt history. Suicide attempt liability was familial, with genetic and shared environmental influences together accounting for 35% to 75% of the variance in risk. The twin/cotwin suicide attempt odds ratio was 5.6 (95% confidence interval [CI] 1.75-17.8) for monozygotic twins and 4.0 (95% CI 1.1 -14.7) for dizygotic twins after controlling for other psychiatric risk factors. CONCLUSIONS In women, the predisposition to attempt suicide seems usually to manifest itself first during adolescence. The data show that youth suicide attempts are familial and possibly influenced by genetic factors, even when controlling for other psychopathology.