Structured Diagnostic Interviews. In: Ollendick TH, King NJ, Yule W, editors. International Handbook of Phobic and Anxiety Disorders in Children and Adolescents. Boston: Springer US; 1994. pp. 293-315. [DOI: 10.1007/978-1-4899-1498-9_15]

Very low-level prenatal mercury exposure and behaviors in children: the HOME Study

BACKGROUND

Mercury is toxic to the developing brain, but the lowest concentration associated with the development of behavior problems is unclear. The purpose of this study was to examine the association between very low-level mercury exposure during fetal development and behavior problems in children.

METHODS

We used data from 389 mothers and children in a prospective pregnancy and birth cohort study. We defined mean prenatal mercury concentration as the mean of total whole blood mercury concentrations in maternal samples collected at 16- and 26-weeks of gestation, delivery, and neonatal cord blood samples. We assessed parent-reported child behavior up to five times from two to 8 years of age using the Behavioral Assessment System for Children (BASC-2). At 8 years of age, we assessed self-reported child anxiety using the Spence Children's Anxiety Scale (SCAS). We used multiple linear mixed models and linear regression models to estimate the association between mean prenatal mercury concentrations and child behavior and anxiety, respectively.

RESULTS

The median prenatal total blood mercury concentrations was 0.67 μg/L. Overall, we did not find statistically significant associations between mean prenatal mercury concentrations and behavior problems scores, but a 2-fold increase in mercury concentrations at 16-weeks gestation was associated with 0.83 point (95% CI: 0.05, 1.62) higher BASC-2 anxiety scores. Maternal and cord blood mercury concentrations at delivery were associated with parent-reported anxiety at 8 years.

CONCLUSION

We found limited evidence of an association between very-low level prenatal mercury exposure and behaviors in children, with an exception of anxiety.

Research Review: Test-retest reliability of standardized diagnostic interviews to assess child and adolescent psychiatric disorders: a systematic review and meta-analysis

BACKGROUND

A better understanding of factors contributing to the observed variability in estimates of test-retest reliability in published studies on standardized diagnostic interviews (SDI) is needed. The objectives of this systematic review and meta-analysis were to estimate the pooled test-retest reliability for parent and youth assessments of seven common disorders, and to examine sources of between-study heterogeneity in reliability.

METHODS

Following a systematic review of the literature, multilevel random effects meta-analyses were used to analyse 202 reliability estimates (Cohen's kappa = ҡ) from 31 eligible studies and 5,369 assessments of 3,344 children and youth.

RESULTS

Pooled reliability was moderate at ҡ = .58 (CI 95% 0.53-0.63) and between-study heterogeneity was substantial (Q = 2,063 (df = 201), p < .001 and I²  = 79%). In subgroup analysis, reliability varied across informants for specific types of psychiatric disorder (ҡ = .53-.69 for parent vs. ҡ = .39-.68 for youth) with estimates significantly higher for parents on attention deficit hyperactivity disorder, oppositional defiant disorder and the broad groupings of externalizing and any disorder. Reliability was also significantly higher in studies with indicators of poor or fair study methodology quality (sample size <50, retest interval <7 days).

CONCLUSIONS

Our findings raise important questions about the meaningfulness of published evidence on the test-retest reliability of SDIs and the usefulness of these tools in both clinical and research contexts. Potential remedies include the introduction of standardized study and reporting requirements for reliability studies, and exploration of other approaches to assessing and classifying child and adolescent psychiatric disorder.

Assessment Practices and Issues with School-refusing Children

School refusal is a complex and heterogeneously determined and experienced behaviour problem. Due to its complexity and heterogeneity, a multimethod and multisource approach to assessment is required. The approach is described as a hypothesis-testing approach which uses developmentally sensitive and empirically validated procedures. Clinical-behavioural interviews, structured diagnostic interviews, self-reports, reports of significant others, self-monitoring, and behavioural observations are recommended. Issues associated with these procedures are reviewed.

Current Issues in the Assessment of Anxiety in Children and Adolescents: A Developmental Perspective

This paper describes some of the current problems with the assessment of children's anxiety. The main assessment methods — structured clinical interview and self-report — often have problems with validity and reliability while less frequently used measures such as physiological recording, behavioural observation, and thought-listing also have their attendant difficulties. Possible ways of reducing some of these problems using a developmental perspective are discussed.

Factor structure of the Children's Behavior Questionnaire in children with Williams syndrome

To examine the factor structure of temperament in 5-10-year-olds with Williams syndrome, an exploratory factor analysis was conducted on the responses of parents of 192 children on the children's behavior questionnaire. Four factors were identified. Two corresponded to factors reported for typically developing children: effortful control and extraversion/surgency and two corresponded to the temperament constructs of withdrawal/inhibition and irritability/frustration and activity, observed in typically developing infants. Parents of 109 of the 192 participants also completed the anxiety disorders interview schedule, parent version. Children with an anxiety disorder other than specific phobia differed significantly from children without an anxiety disorder on all factors except extraversion/surgency. Children with attention deficit hyperactivity disorder (ADHD) differed significantly from children without ADHD on effortful control and extraversion/surgency.

Prevalence and Prediction of Disorders in Early Childhood: A Community Study

This article examines the prevalence and prediction of internalising and externalising disorders from temperament and parenting in children aged 4 to 6 years (N = 491). Children were assessed via parent and teacher reports over 14 months and clinical interviews with parents were included at follow-up, along with parent and teacher reports of behavioural and emotional difficulties. Prevalence rates for internalising disorders (8.7%) were higher than for externalising disorders (5.8%), and internalising rates were similar to that found for older children in the same city. Accuracy of prediction of disorders, as well as overall behavioural and emotional difficulties, was low to moderate, and externalising problems were better predicted than internalising problems. The results highlight that while psychological disorders can be predicted from measures of temperament in infancy, the accuracy is too low to recommend these children receive selective prevention and treatment programs.

Brief Cognitive-Behavioural Therapy for Children with Anxiety Disorders: Initial Evaluation of a Program Designed for Clinic Settings

Four anxiety disordered 8- to 11-year-old children and their parents participated in a shortened version of an efficacious cognitive–behavioural program for anxiety in children, designed to reflect therapy conditions found in usual clinical practice. A modified multiple-baseline design was used that combined clinic setting pragmatics with a necessary level of methodological protection. For ongoing evaluation, weekly measures of the child's trait anxiety and coping ability were obtained from the child and parents. In addition, a battery of measures was used to evaluate outcomes following treatment and at two follow-up intervals. Emphasising increased parent involvement and earlier exposure sessions, the program was found to lead to marked changes in child functioning. In particular, all children showed improvement on self-report, parent report, and independent clinician's ratings over the course of treatment. Moreover, scores on relevant indices were all within a nondeviant range following intervention, and all four children no longer qualified for an anxiety diagnosis at posttreatment and at 3- and 12-month followup. Findings are discussed in terms of implementation and evaluation in practice settings (e.g., critical components of treatment, use of pragmatic single case designs). Suggestions for future research include testing the effectiveness of this brief program on a large and diverse sample of children. Additional research is also required to find out to what extent increased parent involvement and earlier exposure sessions enhance the impact of treatment in the larger context of addressing features of the research-practice gap. Overall, findings provide preliminary support for the effectiveness of a brief cognitive–behavioural program for treating anxiety disorders in children, along with an evaluation strategy, compatible with some of the needs of service delivery settings.

The Diagnostic Interview Schedule for Children, Adolescents, and Parents: Initial Reliability and Validity Data

This study evaluated the psychometric properties of the Diagnostic Interview Schedule for Children, Adolescents and Parents (DISCAP; Holland & Dadds, 1995), for DSM-IV anxiety disorders in children and adolescents. Two studies were conducted to examine the reliability and validity of the DISCAP. In the first study, the DISCAP and the Youth Self Report (YSR; Achenbach, 1991c) were administered to 120 nonclinical adolescents aged 12 through to 14 years. In the second study, the DISCAP and Child Behaviour Checklist (CBCL; Achenbach, 1991b) were administered to parents of 57 clinical children and adolescents aged 6 through to 16 years. Inter-rater reliability data was collected, and both concurrent and discriminant validity of the DISCAP were assessed against the YSR and CBCL. Inter-rater agreements for primary diagnoses were high, and rating scale data supported the concurrent and discriminant validity of the DISCAP diagnoses. Results suggest that the DISCAP can be used to facilitate reliable and valid diagnoses of childhood anxiety disorders.

Anxiety disorders in children with williams syndrome, their mothers, and their siblings: implications for the etiology of anxiety disorders

This study examines the prevalence of anxiety disorders in children with Williams syndrome (WS), their sibling closest in age, and their mothers as well as the predictors of anxiety in these groups. The prevalence of anxiety disorders was assessed and compared to that in the general population. Children with WS had a significantly higher prevalence of specific phobia, generalized anxiety disorder (GAD), and separation anxiety in comparison to children in the general population. While mothers had a higher prevalence of GAD than population controls, the excess was accounted for by mothers who had onset after the birth of their WS child. The siblings had rates similar to the general population. This pattern of findings suggests the presence of a gene in the WS region whose deletion predisposes to anxiety disorders. It is also worthwhile to investigate relations between genes deleted in WS and genes previously implicated in anxiety disorders.

Prevalence of psychiatric disorders in 4 to 16-year-olds with Williams syndrome

The prevalence of a range of DSM-IV psychiatric disorders in a sample of 119 4-16-year-old children with Williams syndrome (WS) was assessed using a structured diagnostic interview with their parents. Most children (80.7%) met criteria for at least one DSM-IV diagnosis. The most prevalent diagnoses were Attention Deficit/Hyperactivity Disorder (ADHD; 64.7%) and Specific Phobia (53.8%). There was a significant shift in Predominant Type of ADHD as a function of CA, from Combined for the youngest group (ages 4-6 years) to Inattentive for the oldest group (ages 11-16 years). The prevalence of Generalized Anxiety Disorder (GAD) increased significantly with age. These findings are another step toward defining the behavioral phenotype of WS.

Evidence-Based Assessment of Anxiety and Its Disorders in Children and Adolescents

We provide an overview of where the field currently stands when it comes to having evidence-based methods and instruments available for use in assessing anxiety and its disorders in children and adolescents. Methods covered include diagnostic interview schedules, rating scales, observations, and self-monitoring forms. We also discuss the main purposes or goals of assessment and indicate which methods and instruments have the most evidence for accomplishing these goals. We also focus on several specific issues that need continued research attention for the field to move forward toward an evidence-based assessment approach. Finally, tentative recommendations are made for conducting an evidence-based assessment for anxiety and its disorders in children and adolescents. Directions for future research also are discussed.

Post-traumatic stress disorder in maltreated youth: a study of diagnostic comorbidity and child factors

The study of post-traumatic stress disorder (PTSD) in maltreated youth has received increased attention, though extensive comparisons to maltreated youth without PTSD and administrations of anxiety-based structured diagnostic interviews remain needed. We examined maltreated youth with or without PTSD using structured diagnostic interviews and standardized child self-report measures. We hypothesized that maltreated youth with PTSD, compared to their peers without PTSD, would experience significantly greater duration of abuse, diagnostic comorbidity, PTSD symptomatology, dysfunctional family environment, and avoidant coping styles. Results indicated that the group with PTSD did indeed experience significantly greater duration of abuse, diagnostic comorbidity, and PTSD symptomatology, though less so dysfunctional family environment or avoidant coping styles. The presence of a mood or anxiety disorder was highly predictive of PTSD in this sample. Results are discussed within the context of evolving etiological and maintenance models of PTSD in maltreated youth.

Psychometric properties of the Spence Children's Anxiety Scale with young adolescents

The psychometric properties of the Spence Children's Anxiety Scale (SCAS) were examined with 875 adolescents aged 13 and 14 years. This self-report measure was designed to evaluate symptoms relating to separation anxiety, social phobia, obsessive-compulsive disorder, panic-agoraphobia, generalized anxiety, and fears of physical injury. Results of confirmatory and exploratory factor analyses supported six factors consistent with the hypothesized subtypes of anxiety. There was support also for a model in which the first-order factors loaded significantly on a single second-order factor of anxiety in general. The internal consistency of the total score and sub-scales was high, and 12-week test-retest reliability was satisfactory. The SCAS correlated strongly with a frequently used child self-report measure of anxiety and significantly, albeit at a lower level, with a measure of depression.

Sexually Abused Children Suffering From Post-traumatic Stress Disorder: Assessment and Treatment Strategies

Child sexual abuse is a highly prevalent problem that frequently occasions the onset of post-traumatic stress disorder in the victimized youngster. This selective review addresses recent advances in the assessment and treatment of sexually abused children with post-traumatic stress disorder. Firstly, we outline the diagnostic criteria for post-traumatic stress disorder and significant moderating variables in the development of post-traumatic stress disorder. Secondly, we address the clinical assessment of post-traumatic stress disorder in sexually abused children, recommending a developmentally sensitive, multi-informant approach. Thirdly, we consider a family-wide cognitive-behavioural treatment framework for sexually abused children with post-traumatic stress disorder that involves both child and non-offending caregivers. Fourthly, we examine the results of recent evaluation studies supportive of cognitive-behavioural therapy in the treatment of sexually abused children. Lastly, we consider conclusions for clinical practice and directions for future research.

Etiology of childhood phobias: current status of Rachman's three pathways theory

Despite advances in the assessment and treatment of childhood phobias, little is known about their etiology. Rachman has proposed that phobias are acquired through three different pathways: direct conditioning, modeling or instructions/information. We evaluate the empirical support for Rachman's theory in relation to the origins of childhood phobias. Although we find support for Rachman's theory, a number of methodological and theoretical issues are emphasized. For example, insufficient attention has been given to the reliability and validity of retrospective subject reports on the acquisition of childhood phobias. Also some findings on the origins of childhood fears and phobias are more consistent with a nonassociative account of phobia onset, thus providing an interesting challenge to Rachman's theory.