Improving estimation of the prognosis of childhood psychopathology; combination of DSM-III-R/DISC diagnoses and CBCL scores.

OBJECTIVE: To compare the predictive validity of the clinical-diagnostic and the empirical-quantitative approach to assessment of childhood psychopathology, and to investigate the usefulness of combining both approaches. METHOD: A referred sample (N = 96), aged 6 to 12 years at initial assessment, was followed up across--on average--a period of 3.2 years. It was assessed to what extent DISC/DSM-III-R diagnoses--representing the clinical-diagnostic approach, and CBCL scores--representing the empirical-quantitative approach, predicted the following signs of poor outcome: outpatient/inpatient treatment, or parents' wish for professional help for the child at follow-up, disciplinary problems in school, and police/judicial contacts. RESULTS: Both diagnostic systems added significantly to the prediction of poor outcome, and neither of the two systems was superior. Use of both systems simultaneously provided the most accurate estimation of the prognosis, reflected by the occurrence of future poor outcome. Even diagnostic concepts that are generally regarded as relatively similar, such as ADHD (DSM) and attention problems (CBCL), or conduct disorder (DSM) and delinquent behavior (CBCL), appeared to differ in their ability to predict poor outcome. CONCLUSIONS: The present study supports the use of the empirical-quantitative approach and the clinical-diagnostic approach simultaneously, both in research and in clinical settings, to obtain a comprehensive view of the prognosis of psychopathology in children.

The role of the clinician: three-year predictive value of parents', teachers' and clinicians' judgment of childhood psychopathology.

BACKGROUND: The present study investigated the differential predictive value of parents', teachers', and clinicians' reports of psychopathology for poor outcome in children referred to a child psychiatric outpatient clinic. METHOD: A referred sample (N = 96), aged 6 to 12 years at initial assessment, was followed up after a mean interval of 3.2 years. Data on parent- and teacher-reported problem behavior (Child Behavior Checklist and Teacher's Report Form), and clinician-reported observations and self-reports during a semi-structured clinical interview (SCICA), were linked to outcome measures assessed with a parent questionnaire, including outpatient and inpatient treatment at Time 2, parent's wish for professional help for the child, school problems, and police/judicial contacts. RESULTS: Information from all three informants (clinicians, parents, and teachers) predicted measures of poor outcome after three years. Clinicians' ratings on the SCICA predicted all five outcome measures. Independent of CBCL and TRF scores, SCICA scores predicted parental wish for help and inpatient treatment. CONCLUSIONS: The present study was the first to report that clinician's ratings of self-reported and observed behaviors in a semi-structured interview (SCICA) make an important unique contribution to the multiaxial assessment of problem behaviors.

Predicting change in psychopathology in youth referred to mental health services in childhood or adolescence.

BACKGROUND: Little evidence is available on factors associated with persistence and change of psychopathology, and little is known about the predictive value of factors regarding change once problem behaviours exist. This study aims to evaluate change in level of scores of empirically derived problem patterns and to study factors that influence this change for children and adolescents referred to mental health services. METHOD: A referred sample (N = 1,652), aged 4 to 18 years at initial assessment, was followed up after a mean interval of 6.2 years. We used standardised information from parents, teachers and subjects, including the CBCL, YSR and TRF at both assessments. RESULTS: Subjects at follow-up scored significantly above the expected mean norm scores, although for most scores improvement was found. The strongest predicting factor for time 2 psychopathology was the corresponding time 1 score, odds ratios ranging from 1.6 to 21.7. Males and children older at intake improved more than females and younger children, respectively. CONCLUSIONS: Few child, family and treatment-related factors had additional predictive value over and above earlier psychopathology, and their contribution to the prediction of outcome was small. Findings indicate continuity of behavioural and emotional problems in clinically referred children and adolescents, and these problems should be viewed as chronic conditions. Girls referred for behavioural and emotional problems may form a group especially at risk for poor outcome.