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Objective: To compare examples of three styles of psychiatric interviews for youth: the Diagnostic Interview Schedule for Children (DISC) ("respondent-based"), the Child and Adolescent Psychiatric Assessment (CAPA) ("interviewer-based"), and the Development and Well-Being Assessment (DAWBA) ("expert judgment")., Method: Roughly equal numbers of males and females of white and African American ethnicity, aged 9 to 12 and 13 to 16 years, were recruited from primary care pediatric clinics. Participants (N = 646) were randomly assigned to receive two of the three interviews, in counterbalanced order. Five modules were used: any depressive disorder, anxiety disorders, oppositional defiant disorder, conduct disorder, and attention-deficit/hyperactivity disorder. At two sessions about 1 week apart, parent and child completed one of two interviews plus five screening questionnaires., Results: When interviewed with the DAWBA, 17.7% of youth had one or more diagnoses, compared with 47.1% (DISC) and 32.4% (CAPA). The excess of DISC diagnoses was accounted for by specific phobias. Agreement between interview pairs was 0.13 to 0.48 for DAWBA-DISC comparisons, 0.21 to 0.61 for DISC-CAPA comparisons, and 0.23 to 0.48 for CAPA-DAWBA comparisons. DAWBA-only cases were associated with higher parent-report questionnaire scores than DISC/DAWBA cases, but equivalent child-report scores., Conclusions: The DAWBA is shorter and cases were probably more severe, making it a good choice for clinical trials, but the user cannot examine the data in detail. The DISC and CAPA are similar in length and training needs. Either would be a better choice where false-negative results must be avoided, as in case-control genetic studies, or when researchers need to study individual symptoms in detail., (Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: The differentiation hypothesis posits that the underlying liability distribution for psychopathology is of low dimensionality in young children, inflating diagnostic comorbidity rates, but increases in dimensionality with age as latent syndromes become less correlated. This hypothesis has not been adequately tested with longitudinal psychiatric symptom data., Methods: Confirmatory factor analyses of DSM-IV symptoms from seven common Axis I syndromes--major depression, generalized anxiety, separation anxiety, social anxiety, attention deficient hyperactivity, conduct, and oppositional defiant disorders--were conducted longitudinally, from ages 9 to 16, using the general-population Great Smoky Mountains Study sample., Results: An eight-syndrome model fit well at all ages, and in both genders. It included social anxiety, separation anxiety, oppositional defiant, and conduct syndromes, along with a multidimensional attention deficit-hyperactivity syndrome (i.e., inattention, hyperactivity, and impulsivity) and a unidimensional major depression/generalized anxiety syndrome. A high degree of measurement invariance across age was found for all syndromes, except for major depression/generalized anxiety. Major depression and generalized anxiety syndromes slightly diverged at age 14-16, when they also began to explain more symptom variance. Additionally, correlations between some emotional and disruptive syndromes showed slight differentiation., Conclusions: Marked developmental differentiation of psychopathology, as implied by the orthogenetic principle, is not a prominent cause of preadolescent and adolescent psychiatric comorbidity.

Context: In a natural experiment in which some families received income supplements, prevalence of adolescent behavioral symptoms decreased significantly. These adolescents are now young adults., Objective: To examine the effects of income supplements in adolescence and adulthood on the prevalence of adult psychiatric disorders., Design: Quasi-experimental, longitudinal., Population and Setting: A representative sample of children aged 9, 11, or 13 years in 1993 (349 [25%] of whom are American Indian) were assessed for psychiatric and substance use disorders through age 21 years (1993-2006). Of the 1420 who participated in 1993, 1185 were interviewed as adults. From 1996, when a casino opened on the Indian reservation, every American Indian but no non-Indians received an annual income supplement that increased from $500 to around $9000., Main Outcome Measures: Prevalence of adult psychiatric disorders and substance use disorders based on the Diagnostic and Statistical Manual of Mental Disorders in 3 age cohorts, adjusted for age, sex, length of time in the family home, and number of Indian parents., Results: As adults, significantly fewer Indians than non-Indians had a psychiatric disorder (106 Indians [weighted 30.2%] vs 337 non-Indians [weighted 36.0%]; odds ratio [OR], 0.46; 95% confidence interval [CI], 0.30-0.72; P = .001), particularly alcohol and cannabis abuse, dependence, or both. The youngest age-cohort of Indian youth had the longest exposure to the family income. Interactions between race/ethnicity and age cohort were significant. Planned comparisons showed that fewer of the youngest Indian age-cohort had any psychiatric disorder (31.4%) than the Indian middle cohort (41.7%; OR, 0.43; 95% CI, 0.24-0.78; P = .005) or oldest cohort (41.3%; OR, 0.69; 95% CI, 0.51-0.94; P = .01) or the youngest non-Indian cohort (37.1%; OR, 0.66; 95% CI, 0.48-0.90; P = .008). Study hypotheses were not upheld for nicotine or other drugs, or emotional or behavioral disorders. The income supplement received in adulthood had no impact on adult psychopathology., Conclusion: Lower prevalence of psychopathology in American Indian youth following a family income supplement, compared with the nonexposed, non-Indian population, persisted into adulthood.

The purpose of this prospective, naturalistic study was to examine the relationships between suicide attempts and contemporaneous psychiatric disorders, and developmental changes in these relationships from adolescence to young adulthood. The sample consisted of 180 adolescents, 12-19 years of age at hospitalization, repeatedly assessed for up to 13 years (n = 1,825 assessments). Semistructured psychiatric diagnostic instruments were administered at repeated assessments to assess psychiatric disorders and suicide attempts. After controlling for demographic variables and prehospitalization suicide attempts, most contemporaneous psychiatric disorders (major depressive disorder [MDD], dysthymic disorder, generalized anxiety disorder [GAD], panic disorder, attention-deficit/hyperactivity disorder [AD/HD], conduct disorder, and substance use disorder [SUD]) were related to increased risk of attempts. The relationship between suicide attempts and MDD, GAD, AD/HD, and SUD strengthened as participants got older. MDD, dysthymic disorder, GAD, and panic disorder were more commonly associated with repeat than 1st-time suicide attempts. In sum, most major psychiatric disorders are associated with increased risk for suicide attempts, but the strength of the relationships between these disorders and attempts changes over the course of development.

Background: Few longitudinal studies of child and adolescent psychopathology have examined the links between specific childhood anxiety disorders and adolescent psychiatric disorder. In this paper we test the predictive specificity of separation anxiety disorder (SAD), overanxious disorder (OAD), generalized anxiety disorder (GAD), and social phobia., Methods: Data come from the Great Smoky Mountains Study (GSMS). A representative population sample of children--ages 9, 11, and 13 years at intake--was followed to age 19. Diagnoses of both childhood (before age 13 years) and adolescent psychiatric disorders (age 13 to 19 years) were available from 906 participants., Results: Childhood SAD predicted adolescent SAD, whereas OAD was associated with later OAD, panic attacks, depression and conduct disorder (CD). GAD was related only to CD. Social phobia in childhood was associated with adolescent OAD, social phobia, and attention-deficit/hyperactivity disorder (ADHD)., Conclusions: Anxiety disorders in childhood are predictors of a range of psychiatric disorders in adolescence. It appears that children meriting a well-defined diagnosis are missed by the current rules for the diagnosis of GAD. Future studies should examine whether OAD deserves reconsideration as a nosological entity.

Objective: To examine the test-retest reliability of a new interviewer-based psychiatric diagnostic measure (the Preschool Age Psychiatric Assessment) for use with parents of preschoolers aged 2 to 5 years., Method: A total of 1,073 parents of children attending a large pediatric clinic completed the Child Behavior Checklist 1 1/2-5. For 18 months, 193 parents of high scorers and 114 parents of low scorers were interviewed on two occasions an average of 11 days apart., Results: Estimates of diagnostic reliability were very similar to those obtained from interviews with parents of older children and adults, with kappas ranging from 0.36 to 0.79. Test-retest intraclass correlations for DSM-IV syndrome scale scores ranged from 0.56 to 0.89. There were no significant differences in reliability by age, sex, or race (African American versus non-African American)., Conclusions: The Preschool Age Psychiatric Assessment provides a reasonably reliable standardized measure of DSM-IV psychiatric symptoms and disorders in preschoolers for use in both research and clinical service evaluations of preschoolers as young as 2 years old.

Background: This longitudinal community study assessed the prevalence and development of psychiatric disorders from age 9 through 16 years and examined homotypic and heterotypic continuity., Methods: A representative population sample of 1420 children aged 9 to 13 years at intake were assessed annually for DSM-IV disorders until age 16 years., Results: Although 3-month prevalence of any disorder averaged 13.3% (95% confidence interval [CI], 11.7%-15.0%), during the study period 36.7% of participants (31% of girls and 42% of boys) had at least 1 psychiatric disorder. Some disorders (social anxiety, panic, depression, and substance abuse) increased in prevalence, whereas others, including separation anxiety disorder and attention-deficit/hyperactivity disorder (ADHD), decreased. Lagged analyses showed that children with a history of psychiatric disorder were 3 times more likely than those with no previous disorder to have a diagnosis at any subsequent wave (odds ratio, 3.7; 95% CI, 2.9-4.9; P<.001). Risk from a previous diagnosis was high among both girls and boys, but it was significantly higher among girls. Continuity of the same disorder (homotypic) was significant for all disorders except specific phobias. Continuity from one diagnosis to another (heterotypic) was significant from depression to anxiety and anxiety to depression, from ADHD to oppositional defiant disorder, and from anxiety and conduct disorder to substance abuse. Almost all the heterotypic continuity was seen in girls., Conclusions: The risk of having at least 1 psychiatric disorder by age 16 years is much higher than point estimates would suggest. Concurrent comorbidity and homotypic and heterotypic continuity are more marked in girls than in boys.

Objectives: To identify age-related trajectories of obesity from childhood into adolescence, and to test the association of these trajectories with the development of psychiatric disorders (conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, substance abuse, depression, and anxiety)., Methods: White children (N = 991) 9 to 16 years old from the Great Smoky Mountains Study, a representative sample of rural youth, were evaluated annually over an 8-year period for height, weight, psychiatric disorder, and vulnerabilities for psychiatric disorder. Longitudinal analyses on the repeated measures data were conducted using developmental trajectory models and generalized estimating equation models., Results: Obesity was 3 to 4 times more common than expected from national rates using Centers for Disease Control and Prevention 2000 criteria. Four developmental trajectories of obesity were found: no obesity (73%), chronic obesity (15%), childhood obesity (5%), and adolescent obesity (7%). Only chronic obesity was associated with psychiatric disorder: oppositional defiant disorder in boys and girls and depressive disorders in boys., Conclusions: In a general population sample studied longitudinally, chronic obesity was associated with psychopathology.

Background: The Caring for Children in the Community Study examined the prevalence of DSM-IV psychiatric disorders and correlates of mental health service use in rural African American and white youth., Methods: Four thousand five hundred youth aged 9 to 17 years from 4 North Carolina counties were randomly selected from school databases. Parents completed telephone questionnaires about their children's behavior problems. A second-stage sample of 1302 was identified for recruitment into the interview phase of the study, and 920 (70.7%) of these were successfully interviewed at home using the Child and Adolescent Psychiatric Assessment and related measures of service use., Results: Weighted back to general population estimates, 21.1% of youth had 1 or more DSM-IV psychiatric disorders in the past 3 months. Prevalence was similar in African American (20.5%) and white (21.9%) youth. The only ethnic difference was an excess of depressive disorders in white youth (4.6% vs 1.4%). Thirteen percent of participants (36.0% of those with a diagnosis) received mental health care in the past 3 months. White youth were more likely than African American youth to use specialty mental health services (6.1% vs 3.2%), but services provided by schools showed very little ethnic disparity (8.6% vs 9.2%). The effect of children's symptoms on their parents was the strongest correlate of specialty mental health care., Conclusions: In this rural sample, African American and white youth were equally likely to have psychiatric disorders, but African Americans were less likely to use specialty mental health services. School services provided care to the largest number of youths of both ethnic groups.

Objectives: To examine whether suicidal intent and medical lethality of past suicide attempts are predictive of future attempts, the association between intent and lethality, and the consistency of these characteristics across repeated attempts among youth. Method: Suicide attempts in a 15-year prospective study of 180 formerly psychiatrically hospitalized adolescents (M[subscript age at hospitalization] = 14.83; 51% female; 80% Caucasian) were characterized with the Subjective Intent Rating Scale and Lethality of Attempt Rating Scale. Anderson-Gill recurrent events survival models and generalized estimating equations were used to assess predictive validity. Generalized linear models were used to examine stability of characteristics across attempts. Results: Neither intent nor lethality from the most recent attempt predicted future attempts. The highest level of intent and most severe lethality of attempts during the follow-up predicted subsequent attempts, but the degree to which highest intent and most severe lethality contributed to prediction after considering methods of suicide attempts, past number of attempts, or psychiatric diagnoses was mixed. Across successive attempts, there was little consistency in reported characteristics. Intent and lethality were related to each other only for attempts occurring in early adulthood. Conclusions: Highest intent and lethality were better predictors of future attempts than intent and lethality of the most recent attempt. However, these characteristics should be considered as predictors only within the context of other factors. For youth, clinicians should not infer true intent from the lethality of attempts, nor assume that characteristics of future suicide attempts will be similar to those of previous attempts. (Contains 2 tables.)

This study describes changes over a 36-month period in the lives of children of probationers who were subjects of reports of maltreatment. Data on a nationally representative sample of reported victims of maltreatment were used to examine probationer-parents' contact with the criminal justice system, and concurrent changes in their children's households, risk exposure, and emotional and behavioral problems. Results show that 36 months after coming in contact with the child welfare system, about 40% of probationer's children no longer lived with their probationer-parents. During the same period, children's exposure to risk (i.e., parental substance abuse, mental illness, and domestic violence) dropped markedly; however, there was an upward trend in the prevalence of child emotional and behavioral problems. These problems ultimately declined among very young children, but persisted among elementary school age children. Further prospective studies are needed to better understand the confluence of factors affecting the outcomes of probationers' children.