Multi-Informant Assessment of Temperament in Children With Externalizing Behavior Problems

We examined the criterion validity of parent and self-report versions of the Junior Temperament and Character Inventory (JTCI) in children with high levels of externalizing problems. The sample included 412 children (206 participants and 206 siblings) participating in a family study of attention and aggressive behavior problems. Criterion validity analyses included (a) correlations between temperament scales and emotional and behavioral scales and (b) correlations between temperament and intelligence and achievement scales. Temperament scales displayed strong convergent and discriminant validity. Across informants and samples, JTCI scales assessing novelty seeking and harm avoidance discriminated between internalizing and externalizing problems. Reward dependence, persistence, cooperativeness, and self-directedness displayed similar patterns of negative relations to emotional and behavioral scales and positive relations to intelligence, achievement, and competence.     

Trait and State Variance in Multi-Informant Assessments of ADHD and Academic Impairment in Spanish First-Grade Children

Objective. We examined the stable trait and variable state components of ADHD-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and academic impairment (AI) dimensions using mothers’, fathers’, primary and secondary teachers’ ratings of children’s behavior at home and school. We also examined between-informant agreement with regard to trait and state components. Method. Mothers, fathers, primary and secondary teachers rated HI, IN, and AI in N = 758 Spanish first grade children (55% boys) over three measurement occasions across 12 months. Results. Latent state-trait analyses revealed that mothers’, fathers’, and primary teachers’ (but not secondary teachers’) ratings reflected more trait variance for ADHD-HI (M = 73%), ADHD-IN (M = 74%), and AI (M = 76%) than occasion-specific variance (M = 27%, M = 26%, and M = 24%, respectively). Fathers’ ratings shared a meaningful level of trait variance with mothers’ ratings of ADHD-HI and ADHD-IN (range 78% to 82%), whereas primary and secondary teachers’ ratings shared lower levels of trait variance with mothers’ ratings (range 41% to 63%). The trait components of fathers’, primary teachers’, and secondary teachers’ ratings of AI showed high levels of convergence with mothers’ ratings (88%, 70%, and 59% respectively). Conclusions. ADHD symptom reports reflect both trait (48 to 86%) and state (14 to 53%) variance components. The lower amount of shared variability between home and school suggests the setting-specificity of trait and state components of ADHD symptoms. Our findings indicate that ADHD symptom reports may reflect context-specific traits, suggesting the importance of differentiating and targeting ADHD behaviors across different settings.     

Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016

The purpose of this study is to estimate the national prevalence of parent-reported attention deficit/hyperactivity disorder (ADHD) diagnosis and treatment among U.S. children 2–17 years of age using the 2016 National Survey of Children’s Health (NSCH). The NSCH is a nationally representative, cross-sectional survey of parents regarding their children’s health that underwent a redesign before the 2016 data collection. It included indicators of lifetime receipt of an ADHD diagnosis by a health care provider, whether the child currently had ADHD, and receipt of medication and behavioral treatment for ADHD. Weighted prevalence estimates were calculated overall and by demographic and clinical subgroups (n = 45,736). In 2016, an estimated 6.1 million U.S. children 2–17 years of age (9.4%) had ever received an ADHD diagnosis. Of these, 5.4 million currently had ADHD, which was 89.4% of children ever diagnosed with ADHD and 8.4% of all U.S. children 2–17 years of age. Of children with current ADHD, almost two thirds (62.0%) were taking medication and slightly less than half (46.7%) had received behavioral treatment for ADHD in the past year; nearly one fourth (23.0%) had received neither treatment. Similar to estimates from previous surveys, there is a large population of U.S. children and adolescents who have been diagnosed with ADHD by a health care provider. Many, but not all, of these children received treatment that appears to be consistent with professional guidelines, though the survey questions are limited in detail about specific treatment types received. The redesigned NSCH can be used to annually monitor diagnosis and treatment patterns for this highly prevalent and high-impact neurodevelopmental disorder.     

Predicting Therapeutic Effects of Psychodiagnostic Assessment Among Children and Adolescents Participating in Randomized Controlled Trials

This study explored predictors of improvement after completing a psychodiagnostic screening assessment but before randomization among youth who participated in two pilot randomized controlled trials of omega-3 supplementation and Individual-Family Psychoeducational Psychotherapy (PEP). Ninety-five youth (56.8% male, 61.1% White) ages 7–14 with mood disorders completed screening and baseline assessments (including Clinical Global Impressions–Improvement [CGI-I], Children’s Depression Rating Scale–Revised, Young Mania Rating Scale), then were randomized into a 12-week trial of omega-3, PEP, their combination, or placebo. Between screening and randomization, 35.8% minimally improved (CGI-I = 3), 12.6% much improved (CGI-I < 3), totaling 48.4% improved. Caregiver postsecondary education (p = .018), absence of attention-deficit/hyperactivity disorder (p = .027), and lower screen depression severity (p = .034) were associated with CGI-I. Caregiver postsecondary education (p = .020) and absence of a disruptive behavior diagnosis (p = .038) were associated with depression severity improvement. Prerandomization improvement moderated treatment outcomes: Among youth who improved prerandomization, those who received PEP (alone or with omega-3) had more favorable placebo-controlled depression trajectories due to a lack of placebo response. This open-label trial of psychodiagnostic assessment provides suggestive evidence that psychodiagnostic assessment is beneficial, especially for those with depression and without externalizing disorders. Prerandomization improvement is associated with better placebo-controlled treatment response. Future research should test alternative hypotheses for change and determine if less intensive (shorter and/or automated) assessments would provide comparable results.     

Evidence-Based Assessment of Autism Spectrum Disorders in Children and Adolescents

This article reviews evidence-based criteria that can guide practitioners in the selection, use, and interpretation of assessment tools for autism spectrum disorders (ASD). As Mash and Hunsley (2005) discuss in this special section, evidence-based assessment tools not only demonstrate adequate psychometric qualities, but also have relevance to the delivery of services to individuals with the disorder (see also Hayes, Nelson, & Jarrett, 1987). Thus, we use what is known about the symptoms, etiologies, developmental course, and outcome of ASD to evaluate the utility of particular assessment strategies and instruments for diagnosis, treatment planning and monitoring, and evaluation of outcome. The article begins with a review of relevant research on ASD. Next we provide an overview of the assessment process and some important issues that must be considered. We then describe the components of a core (minimum) assessment battery, followed by additional domains that might be considered in a more comprehensive assessment. Domains covered include core autism symptomatology, intelligence, language, adaptive behavior, neuropsychological functions, comorbid psychiatric illnesses, and contextual factors (e.g., parent well-being, family functioning, quality of life). We end with a discussion of how well the extant literature meets criteria for evidence-based assessments.     

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.     

Toward Guidelines for Evidence-Based Assessment of Depression in Children and Adolescents

We aim to provide a starting point toward the development of an evidence-based assessment of depression in children and adolescents. We begin by discussing issues relevant to the diagnosis and classification of child and adolescent depression. Next, we review the prevalence, selected clinical correlates, course, and treatment of juvenile depression. Along with some general considerations in assessment, we discuss specific approaches to assessing depression in youth (i.e., interviews, rating scales) and briefly summarize evidence on the reliability and validity of a few selected instruments. In addition, we touch on the assessment of several other constructs that are important in a comprehensive evaluation of depression (i.e., social functioning, life stress, and family history of psychopathology). Last, we highlight areas in which further research is necessary and conclude with some broad recommendations for clinical practice given the current state of the knowledge.     

Evidence-Based Assessment of Attention Deficit Hyperactivity Disorder in Children and Adolescents

This article examines evidence-based assessment practices for attention deficit hyperactivity disorder (ADHD). The nature, symptoms, associated features, and comorbidity of ADHD are briefly described, followed by a selective review of the literature on the reliability and validity of ADHD assessment methods. It is concluded that symptom rating scales based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994), empirically and rationally derived ADHD rating scales, structured interviews, global impairment measures, and behavioral observations are evidence-based ADHD assessment methods. The most efficient assessment method is obtaining information through parent and teacher rating scales; both parent and teacher ratings are needed for clinical purposes. Brief, non-DSM based rating scales are highly correlated with DSM scales but are much more efficient and just as effective at diagnosing ADHD. No incremental validity or utility is conferred by structured interviews when parent and teacher ratings are utilized. Observational procedures are empirically valid but not practical for clinical use. However, individualized assessments of specific target behaviors approximate observations and have both validity and treatment utility. Measures of impairment that report functioning in key domains (peer, family, school) as well as globally have more treatment utility than nonspecific global measures of impairment. DSM diagnosis per se has not been demonstrated to have treatment utility, so the diagnostic phase of assessment should be completed with minimal time and expense so that resources can be focused on other aspects of assessment, particularly treatment planning. We argue that the main focus of assessment should be on target behavior selection, contextual factors, functional analyses, treatment planning, and outcome monitoring.     

The Effects of Stimulant Medication and Training on Sports Competence Among Children With ADHD

The current study examined the relative efficacy of behavioral sports training, medication, and their combination in improving sports competence among youth with attention deficit/hyperactivity disorder (ADHD). Participants were 73 youth (74% male; 81% Hispanic) between the ages of 5 and 12 diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed.) ADHD enrolled in a Summer Treatment Program (STP). The study consisted of a 2 (medication: methylphenidate, placebo) × 2 (sports training: instruction and practice, recreational play) between-groups design and was conducted over a 3-week period during the STP. Sports training was conducted with a novel sport, badminton, to limit previous sport knowledge and to differentiate it from concurrent sports training that occurred within the STP. Objective and subjective measures of sports skills, knowledge, and behavior were collected. Results indicated that, relative to recreational play, brief sports training improved observed and counselor-rated measures of sports competence including sports skills, knowledge, game awareness, effort, frustration, and enjoyment. During sports training, medication incrementally improved children’s observed rule following behavior and counselor-rated sportsmanship relative to placebo. In the absence of sports training, medication improved behavior, effort, and sport knowledge. Training in sports skills and rules produced the largest magnitude effects on sports-related outcomes. Therefore, skills training, rather than medication alone, should be used in conjunction with behavioral intervention to teach sports to youth with ADHD. It is recommended that medication be used only as an adjunct to highly structured sports skills training for youth who display high rates of negative behavior during sports activities.     

青少年自我伤害行为的常用评估方法

本文综述了国外评估青少年自我伤害行为的6种工具,分别是自杀观念问卷(SIQ)、筛查问卷(SQ)、贝克自杀观念量表(BSI)、自我毁损的功能评估(FASM)、自我伤害想法和行为访谈表(SITBI)和自我伤害的内隐联想测验(I-AT),对它们的各自的评估范围、功能、内容和不足进行了逐一的介绍。     

Advancing Assessment of Children and Adolescents: Commentary on Evidence-Based Assessment of Child and Adolescent Disorders

This article addresses the following cross-cutting issues evident in the special section of this issue: (a) current diagnoses do not provide adequate validity criteria; (b) the heterogeneity and comorbidity of target problems raise taxonomic challenges; (c) accurate assessment requires integration of multisource data; (d) developmental variations must be accommodated; (e) appropriate norms are needed; and (f) categorical and quantitative approaches are not incompatible. Less evident in the special section articles but equally important are the need to cope with multicultural issues, avoid premature closure regarding diagnostic labels, assess caregivers, and standardize broad-spectrum assessment procedures. Studies and use of evidence-based treatment (EBT) should be linked to evidence-based assessment (EBA) to advance both EBT and EBA.     

Upgrading the Science and Technology of Assessment and Diagnosis: Laboratory and Clinic-Based Assessment of Children With ADHD

Reviews the usefulness of clinic-based and laboratory-based instruments and paradigms for diagnosing attention deficit hyperactivity disorder (ADHD) and monitoring treatment effects. Extant literature examining the performance of normal children and those with ADHD on an extensive range of neurocognitive tests, tasks, and experimental paradigms indicates that particular types of instruments may be more reliable than others with respect to detecting between-group differences. We review task parameters that may distinguish the more reliable from less reliable instruments. The value of clinic-based and laboratory-based instruments for monitoring treatment response in children with ADHD is questionable when evaluated in the context of ecologically relevant variables such as classroom behavior and academic functioning. We present a general conceptual model to highlight conceptual issues relevant to designing clinic-based and laboratory-based instruments for the purposes of diagnosing and monitoring treatment effects in children with ADHD. Application of the model to currently conceptualized core variables indicates that attention and impulsivity-hyperactivity may represent correlative rather than core features of the disorder. We discuss implications of these findings for designing the next generation of clinic-based and laboratory-based instruments.     

Assessment of Social Anxiety in Children and Adolescents With Autism Spectrum Disorder

Despite the high prevalence of social anxiety in individuals with autism spectrum disorder (ASD), there is little agreement on how to best assess such problems in this population. To inform evidence‐based assessment, we conducted a comprehensive review of research that has assessed social anxiety in children and adolescents with ASD without co‐occurring intellectual disability. Although some evidence in support of the reliability of existing measures exists, there are concerns about inflated estimates of the co‐occurrence of social anxiety because of symptom overlap with ASD diagnostic criteria, and the diagnostic sensitivity of existing measures is questionable. Recommendations for clinical assessment of social anxiety in this population and future directions for research on this topic, including the development of new measures, are provided.     

Correlates of Psychological Distress Among Mothers of Children and Adolescents with Hemophilia and HIV Infection

Evaluated the correlates of mood state (psychological distress)in a multisite study of two groups: (a) mothers of HIV–positivechildren and adolescents with hemophilia (n=91), and (b) mothersof HIV –negative children and adolescents with hemophilia(n=92). Socioeconomic status, quality of family relationshipsupport, and frequency of negative life events accounted forsignificant variance in Total Mood Disturbance (psychologicaldistress) as measured by the Profile of Mood States in the overallsample. Severity of hemophilia was unrelated to distress. Asignificant interaction between HIV status and frequency ofstressful life events indicated that this variable related morestrongly to distress among mothers of HIV–infected childrenand adolescents with hemophilia than among mothers of HIV–negativechildren with hemophilia. Findings suggest that the presenceof HIV infection in their children and adolescents may hightenthe impact of negative life events on the psychological distressexperienced by these mothers.     

Children With ADHD Show Impairments in Multiple Stages of Information Processing in a Stroop Task: An ERP Study

This study investigated the role of impaired inhibitory control as a factor underlying attention deficit hyperactivity disorder (ADHD). Children with ADHD and typically developing children completed an animal Stroop task while electroencephalogram (EEG) was recorded. The lateralized readiness potential and event-related brain potentials associated with perceptual and conflict processing were analyzed. Children with ADHD were slower to give correct responses irrespective of congruency, and slower to prepare correct responses in the incongruent condition. This delay could result from enhanced effort allocation at earlier processing stages, indicated by differences in P1, N1, and conflict sustained potential. Results suggest multiple deficits in information processing rather than a specific response inhibition impairment.     

Assessment of Stimulant Response in ADHD Children Using a Refined Multimethod Clinical Protocol

Describes a rigorous multimethod protocol for evaluating individual children's response to stimulant medication in the clinical setting. This protocol represents a refinement of previously reported methods (Barkley, Fischer, Newby, & Breen, 1988) with a large sample of clinic-referred children (N = 161) with Attention Deficit Hyperactivity Disorder (ADHD). Children complete 1 week each on a low dose of Ritalin (.2 mg/kg bid–i.e., twice daily), a higher dosage of Ritalin (.4 mg/kg bid), and a lactose placebo. Medication sequence is randomized and double blind. Each week, multiple questionnaire ratings by parents and teachers are obtained, and 30 min of in-clinic testing is conducted. Our data indicate a statistically significant medication response on most measures, as well as a significant difference between the low and moderate doses on some measures.