Combining discrepant diagnostic information from multiple sources: are complex algorithms better than simple ones?

Methodological issues in psychopathology research

We present an overview of methodological issues involved in conducting psychopathology research, including conceptual, analytic, and interpretive considerations. Research issues germane to structured diagnostic interviewed, comorbidity of mental disorders, and ascertainment and sampling are reviewed. Further, the problem of specificity (with respect to disorder, to differential deficit, and to time) is discussed. Specific issues concerning risk vs protective factors, conducting research with special populations, and the continuity of abnormal and normal functioning are highlighted. Finally, various analogue strategies (human subclinical syndromes, experimental study of "pathological" processes in normals, animal models, and computer simulations) are critiqued. Our review documents many of the impressive methodological developments that have emerged in this field, and we hope our review stimulates additional research that exploits recent methodological advances.

Distorted self-perceptions: divergent self-reports as statistical outliers in the multimethod assessment of children's social-emotional adjustment

The influence of statistical outliers among older children's self-reports was investigated in the context of a multitrait-multimethod validation of the Weinberger Adjustment Inventory (Weinberger, 1991). Self, teacher, and peer ratings in 6th-grade classrooms (N = 155) provided evidence of the convergent and discriminant validity of distress (i.e., anxiety, depression, low self-esteem, and low well-being) and self-restraint (i.e., impulse control, suppression of aggression, consideration of others, and responsibility) as superordinate dimensions of adjustment. However, a few children were statistical outliers whose self-reports starkly contradicted others' perceptions. These nonrepresentative cases notably affected the validity coefficients for the entire sample and seemed to identify children with potentially clinically significant distortions in their self-perceptions.

Epidemiology of childhood disorders in a cross-cultural context

The present report summarizes the epidemiologic research on childhood psychopathology that has been carried out in different cultural settings over the past 15 years from either an empirical or a diagnostic perspective. Prevalence and risk factor findings are summarized and contrasted. Some controversies surrounding cross-cultural research are discussed and methodological recommendations applicable to cross-cultural epidemiologic research are provided.

Developmental change in attention-deficit hyperactivity disorder in boys: a four-year longitudinal study

One hundred six clinic-referred boys meeting criteria for DSM-III-R attention-deficit hyperactivity disorder (ADHD) (mean age 9.4 years) were assessed annually for 4 years using structured interviews of multiple informants. Hyperactivity-impulsivity symptoms declined with increasing age, but inattention symptoms did not. Rather, inattention declined only from the first to the second assessment and remained stable thereafter in boys of all ages. The rate of decline in hyperactivity-impulsivity symptoms was independent of the amount and type of treatment received. Boys who still met criteria for ADHD in Years 3 and 4 were significantly younger, more hyperactive-impulsive, and more likely to exhibit conduct disorder in Year 1 than boys who no longer met criteria in Years 3 and 4.

Antisocial behavior, somatization, and sensation-seeking behavior in mothers of clinic-referred children

OBJECTIVE

The relationship between antisocial behavior and somatization was studied in a sample of mothers of clinic-referred, school-age children. The goal was to overcome some of the methodological limitations of past research in this area and to provide a preliminary test of the theory that these disorders share a common substrate: a tendency toward behavioral disinhibition.

METHOD

Structured diagnostic interviews and an objective personality measure were used to assess antisocial behavior and somatization in a sample of 90 biological mothers (mean age 34 years) of children referred to an outpatient mental health clinic. A rating scale measure of sensation-seeking behavior was used as a measure of behavioral disinhibition. Structured interviews were used to assess a history of antisocial behavior in the children and their biological fathers.

RESULTS

Results indicated a link between somatization and antisocial behavior both within individuals and across generations. This intergenerational link could not be solely accounted for by assortative mating between women with somatization and antisocial men. Both somatization and antisocial behavior were correlated with scores on the sensation seeking scale.

CONCLUSIONS

These findings are consistent with the theory that antisocial behavior and somatization are related syndromes and that behavioral disinhibition may be a common predisposition that underlies both.

DSM-IV field trials for the disruptive behavior disorders: symptom utility estimates

OBJECTIVE

We tested the predictive utility of symptoms for proposed DSM-IV definitions of the disruptive behavior disorders using indices corrected for symptom and diagnosis base rates.

METHOD

The field trials sample consisted of 440 clinic-referred youths who were consecutive referrals to a heterogeneous group of mental health clinics. Multiple informants were interviewed to determine the presence of symptoms and diagnoses.

RESULTS

Some symptoms which were either not in DSM-III or DSM-III-R, or were modifications of DSM-III-R symptoms, had greater diagnostic efficiency than did several existing symptoms. Symptom utility estimates were generally similar for different ages and genders, although some interesting age and sex trends emerged for a few symptoms.

CONCLUSIONS

The results supported the inclusion of more restricted definitions of "lying" and "truancy" to increase their association with a conduct disorder diagnosis and they supported the elimination of "swearing" in the oppositional defiant disorder criteria. In addition to their relevance for developing optimal criteria for DSM-IV, these results can aid DSM-IV users by providing a useful guide to the relative efficiency of individual symptoms based on data from a large heterogeneous clinic population.

An epidemiological study of disorders in late childhood and adolescence--I. Age- and gender-specific prevalence

Developmental aspects of psychiatric disorders may be inferred from patterns of age differences in prevalence. Age-specific prevalences are provided for nine disorders in a general population sample of ages 10-20. Age and gender patterns for several disorders suggest developmental stage-associated risks. These include oppositional disorder in both genders and conduct disorder and major depression in girls. Major depression shows a pattern suggestive of a role for the onset of puberty. The prevalence of one or more disorders did not differ by age or gender. However, the pattern of specific diagnoses varied greatly by both age and gender.

Sensitivity of the Diagnostic Interview Schedule for Children, 2nd edition (DISC-2.1) for specific diagnoses of children and adolescents

OBJECTIVE

The sensitivity of the Diagnostic Interview Schedule for Children, second edition (DISC-2.1) was examined for certain "rare" disorders: eating disorders, major depressive episode, obsessive compulsive disorder, psychosis, tic disorders, and substance use disorders.

METHOD

Subjects recruited from specialized centers were interviewed with the DISC-2.1; the centers' diagnoses served as the criterion measure.

RESULTS

Overall the DISC showed good to excellent sensitivity (range = 0.73 to 1.0). Used alone, the DISC-P (parent interview) was generally more sensitive than the DISC-C (child interview). Areas for additional instrument revision were identified. Recommendations about informant choice by diagnosis are offered.

CONCLUSIONS

The strategy used in this study was useful for assessing the DISC's sensitivity for these disorders. Additional work examining specificity of the DISC remains to be done. The DISC should prove a useful adjunct in clinical settings given the ease and relatively low cost of administration.

The Diagnostic Interview Schedule for Children-Revised Version (DISC-R): III. Concurrent criterion validity

OBJECTIVE

To examine the concurrent criterion validity of the Revised Diagnostic Interview Schedule for Children (DISC-R), a structured lay-administered instrument designed for use in community studies, under conditions designed to provide strict controls for information and method variance.

METHOD

The DISC-R was compared with a semistructured clinical interview that covered a similar information base as the DISC-R, used standardized ratings to record symptom information, and, similar to the DISC-R, was scored by DSM-III-R-based computerized diagnostic algorithms. Subjects were 74 child and adolescent clinic attendees and their adult custodians.

RESULTS

Overall, moderate levels of agreement were found between DISC-R and clinician-generated diagnoses; these findings were tempered, however, by the fact that the validation interview was less reliable than the DISC-R.

CONCLUSIONS

Although these findings provide preliminary support for the use of the DISC-R, they cast some doubt on the adequacy of clinician-generated diagnoses as validation criteria and suggest that alternate approaches to the assessment of validation should be pursued.