Utility of behavior ratings by examiners during assessments of preschool children with attention-deficit/hyperactivity disorder.

This study examines the clinical utility of behavior ratings made by nonclinician examiners during assessments of preschool children with Attention-Deficit/Hyperactivity Disorder (AD/HD). Matched samples of children with (n = 127) and without (n = 125) AD/HD were utilized to test the internal, convergent, concurrent, and incremental validity of ratings completed by examiners on the Hillside Behavior Rating Scale (HBRS). Results indicated that HBRS ratings were internally consistent, possessed sufficient interrater reliability, and were significantly associated with parent and teacher reports of AD/HD when controlling for age, gender, intelligence, and symptoms of other psychopathology. HBRS ratings also were significantly associated with other measures of functioning, and provided a significant increment in the prediction of impairment over parent and teacher report alone. These findings suggest that behavioral ratings during testing provide a unique source of clinical information that may be useful as a supplement to parent and teacher reports.

Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children.

OBJECTIVE: Little is known about the validity of the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children. Moreover, the results of the DSM-IV field trials raised concerns that inclusion of the new predominantly hyperactive-impulsive type of ADHD in DSM-IV might increase the likelihood of the diagnosis being given to active but unimpaired preschool and primary school children. METHOD: The validity of DSM-IV criteria for each subtype of ADHD was evaluated in 126 children, aged 4 through 6 years, and 126 matched comparison children. Probands and controls were classified by using structured diagnostic interviews of the parent and a DSM-IV checklist completed by the teacher. RESULTS: Children who met DSM-IV criteria for each subtype of ADHD according to parent and teacher reports differed consistently from controls on a wide range of measures of social and academic impairment, even when other types of psychopathology and other potential confounds were controlled. CONCLUSIONS: When diagnosed by means of a structured diagnostic protocol, all three DSM-IV subtypes of ADHD are valid for 4- through 6-year-old children in the sense of identifying children with lower mean scores on measures of adaptive functioning that are independently associated with ADHD.

Gender differences in the diagnosis of mental disorders: conclusions and controversies of the DSM-IV.

One of the more controversial issues in terms of mental disorder diagnoses has been their differential sex prevalence. The conclusions provided in the 4th edition of the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders were derived from systematic reviews of the research literature. However, this research is perhaps complicated by common sources of error. Two sources, in particular, are emphasized here: biases in sampling and biases within the diagnostic criteria themselves. The potential for such biases is illustrated for a wide variety of mental disorder diagnoses, and suggestions for research to address them are provided.

Gender differences in adolescent psychiatric outpatient substance use: associated behaviors and feelings.

OBJECTIVE: To investigate gender differences in substance use and associated high-risk behaviors and feeling states in 220 adolescent psychiatric outpatients. METHOD: One hundred seven females and 113 males with a mean age of 15.6 (SD +/- 1.4), seen in a tertiary care center adolescent psychiatry clinic, completed scales tapping substance use and associated feelings and behaviors. Approximately half had used nicotine and alcohol, one third had used marijuana, and 10% reported narcotic use. RESULTS: Conduct disorder behavior, suicidality, and impulsivity scale scores decreased with age in females while marijuana use, conduct disorder behavior, and Hypophoria scale scores increased with age in males. Alcohol use in males, as contrasted with females, correlated more significantly with other substance use and high-risk behaviors. Suicidality tended to correlate more with polysubstance use in females and with sexual behaviors in females only. Substance use correlated with the Impulsivity and Need scale scores in males and scores on the Sociopathy scale in females. CONCLUSIONS: Substance use in males correlates with high-risk behaviors and is associated with feelings of impulsivity and need. Substance use correlates with self-destructive behaviors and sociopathic feelings in females. There is evidence of more persistent high-risk behaviors, including substance use, in males than in females.