Abstracts of Staff Publications
aSpring 2002
Oppositional defiant disorder with onset in preschool years: longitudinal stability and pathways to other disorders
JV Lavigne, C Cicchetti, RD Gibbons, HJ Binns, L Larsen, C Devito
Journal of the American Academy of Child & Adolescent Psychiatry 2001;40:1393–1400
Objective: To examine the stability and change in oppositional defiant disorder (ODD) with onset among preschool children in a pediatric sample.
Method: A total of 510 children aged 2–5 years were enrolled initially in 1989–1990 (mean age, 3.42 years); 280 participated in five waves of data collection over a period of 48 to 72 months (mean wave 5 age, 8.35 years). Test batteries varied by age, but they included the Child Behavior Checklist, developmental evaluation, Rochester Adaptive Behavior Inventory, and a play session (before age 7 years) and a structured interview (Diagnostic Interview for Children and Adolescents, parent and child versions) at ages 7+ years. Consensus diagnoses were assigned by using best-estimate procedures.
Results: Wave 1 single-diagnosis ODD showed a significant relationship with both single-diagnosis ODD and single-diagnosis attention-deficit hyperactivity disorder (ADHD) at subsequent waves, but not with single-diagnosis anxiety or mood disorders. Single-diagnosis ODD at wave 1 was associated with later comorbidity of ODD/ADHD, ODD/anxiety, and ODD/mood disorders. Stability across waves 2 through 5 was moderate to high for comorbid ODD/ anxiety and ODD/ADHD, low to moderate for single-diagnosis ODD and single-diagnosis mood disorder, and low for mood disorder, single-diagnosis ADHD, and single-diagnosis anxiety disorder.
Conclusions: Preschool children with ODD are likely to continue to exhibit disorder, with increasing comorbidity with ADHD, anxiety, or mood disorders.
Sample core competencies in child and adolescent psychiatry training: a starting point
S Sexson, J Sargent, B Zima, E Beresin, S Cuffe, M Drell, T Dugan, G Fox, WJ Kim, K Matthews, C Sylvester, K Pope
Academic Psychiatry 2001; 25:201–213, December 2001
In an effort to improve the preparedness of residents to address health care needs, the Accreditation Council for Graduate Medical Education mandated that all Residency Review Committees (RRCs) incorporate the general competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice into their requirements. In response, the Psychiatry RRC mandated that child and adolescent psychiatry programs develop one competency for each of the six areas, effective January 1, 2001. To assist in this effort, the Work Group on Training and Education of the American Academy of Child and Adolescent Psychiatry has developed sample core competencies for each area. These samples are meant to serve as potential models for consideration by training programs as they develop criteria tailored to their program’s unique resources and needs.
Anxiety and depression in mothers of children undergoing bone marrow transplant: symptom prevalence and use of the Beck Depression and Beck Anxiety Inventories as screening instruments
S Manne, N Nereo, K DuHamel, J Ostroff, S Parsons, R Martini, S Williams, L Mee, S Sexson, J Lewis, SJ Vickberg, WH Redd
Journal of Consulting and Clinical Psychology 2001, 69(6):1037–1047
This study examined anxiety and depressive symptoms among 115 mothers of children undergoing bone marrow transplant and evaluated the ability of the Beck Anxiety Inventory (BAI; A.T. Beck, N. Epstein, et al., 1988) and the Beck Depression Inventory (BDI; A.T. Beck, 1978) to serve as screening tools for assessing generalized anxiety disorder (GAD), panic disorder (PD), and major depressive disorder (MDD). Mothers with BAI or BDI scores greater than or equal to 14 were administered a structured clinical interview. An additional 20% were randomly selected for interview to determine whether the scale cutoff was an accurate screening method. Among the 64 mothers interviewed, 20% received at least 1 of 3 diagnoses. Although the BAI did not demonstrate predictive accuracy in assessing GAD and PD, the BDI did in assessing MDD. The results suggest that a subset of mothers may have an anxiety or depressive disorder and that investigators should use caution before using BAI as a screening instrument for anxiety disorder.
Practice parameter for the use of stimulant medications in the treatment of children, adolescents and adults
LL Greenhill, S Pliszka, MK Dulcan and the Work Group on Quality Issues
J Am Acad Child Adolesc Psychiatry 2002 February Supplement; 41(2):26S–49S
This practice parameter describes treatment with stimulant medication. It uses an evidence-based medicine approach derived from a detailed literature review and expert consultation. Stimulant medications in clinical use include methylphenidate, dextroamphetamine, mixed-salts amphetamine, and pemoline. It carries FDA indications for treatment of attention-deficit/hyperactivity disorder and narcolepsy.
The DISC Predictive Scales (DPS): efficiently screening for diagnoses
CP Lucas, H Zhang, P Fisher, D Shaffer, D Regier, WE Narrow, K Bourdon, MK Dulcan, G Canino, M Rubio-Stipec, BB Lahey, P Friman
Journal of the American Academy of Child & Adolescent Psychiatry 2001;40:443–449
Objective: To derive and test a series of brief diagnosis-specific scales to identify subjects who are at high probability of meeting diagnostic criteria and those who may safely be spared more extensive diagnostic inquiry.
Method: Secondary data analysis of a large epidemiological data set (n=1,286) produced a series of gate and contingent items for each diagnosis. Findings were replicated in a second retrospective analysis from a residential care sample (n=884). The DISC Predictive Scales (DPS) were then used prospectively as a self-report questionnaire in two studies, in which parents (n=128) and/or adolescents (n=208) had subsequent diagnostic interviewing with the Diagnostic Interview Schedule for Children or the Schedule for Affective Disorders and Schizophrenia for School-Age Children.
Results: All analyses showed that gate item selection was valid and that any missed cases were due solely to inconsistent reports on the same questions. Screening performance of the full scales was shown to be good, and substantial reductions in scale length were not associated with significant changes in discriminatory power.
Conclusions: The DPS can accurately determine subjects who can safely be spared further diagnostic inquiry in any diagnostic area. This has the potential to speed up structured diagnostic interviewing considerably. The full DPS can be used to screen accurately for cases of specific DSM-IV-R disorders.
