Showing papers by "Michael Rutter published in 1968"

The Reliability and Validity of the Psychiatric Assessment of the Child: I. Interview with the Child

Abstract: A half-hour diagnostic psychiatric interview was described for use with 7- to 12-year-old children. Four studies of reliability and validity were reported. Inter-rater reliability was examined by having children interviewed by one psychiatrist while a second psychiatrist observed without taking part. At the end of the interview, without any discussion, both psychiatrists independently made separate ratings of the child's psychiatric state. Re-test reliability was examined by having a further series of children interviewed twice, once by each author, with an interval of 1 to 30 days between the interviews. Validity was tested by comparing the interview findings for a randomly selected sample of the general population and a sample of children judged to have psychiatric disorder on the basis of information from teachers and parents. The interviewing psychiatrist knew only the child's name and age and was unaware of the selection group from which the child was drawn. A short psychiatric interview with a child was found to be a reasonably sensitive diagnostic instrument which could give rise to reliable and valid judgments on whether the child exhibited any psychiatric disorder. However, on the whole, individual ratings on specific aspects of behaviour proved to be less reliable than the overall psychiatric diagnosis. There were also marked differences in the reliability and usefulness of the various specific ratings. Depression proved to be a more difficult item than anxiety to rate reliably, but both were found to be reasonably efficient in the differentiation of the child with psychiatric disorder. The child's attention or persistence on cognitive tasks was also rated fairly reliably, and proved to be a surprisingly good indicator of psychiatric disorder. The child's emotional responsiveness at interview and the relationship he formed with the psychiatrist could be rated reliably, and these items also effectively differentiated children with psychiatric disorder from "control" children in the general population. Some of the inferences involved in the diagnostic process were examined in relation to the assessment of anxiety. It was shown, for example, that whereas fidgetiness is commonly taken to be an indicator of anxiety this assumption is frequently misleading. Tension and tremulousness were also less useful indicators of anxiety than tearfulness, an anxious expression and preoccupation with anxiety topics at interview. The main uses and limitations of the interview have been briefly discussed. It is concluded that the interview with the child (aged 7 to 12 years) forms a useful part of the diagnostic procedure in child psychiatry.

Organic brain dysfunction and child psychiatric disorder.

Abstract: The total population of 11,865 children of compulsory school age resident on the Isle of Wight was studied to determine the prevalence of epilepsy, cerebral palsy, and other neurological disorders. With the use of reliable methods, children selected from screening of the total population were individually studied by means of parental interviews and questionaries, neurological examination and psychiatric assessment of each child, information from school teachers, and perusal of the records of hospitals and other agencies. The association between organic brain dysfunction and psychiatric disorder was studied by comparing the findings in the children with epilepsy or with lesions above the brain stem (cerebral palsy and similar disorders) with those in (1) a random sample of the general population, (2) children with lesions below the brain stem (for example, muscular dystrophy or paralyses following poliomyelitis), and (3) children with other chronic physical handicaps not involving the nervous system (for example, asthma, heart disease, or diabetes).Psychiatric disorders in children with neuro-epileptic conditions were five times as common as in the general population and three times as common as in children with chronic physical handicaps not involving the brain. It was concluded, on the basis of a study of factors associated with psychiatric disorder, that the high rate of psychiatric disorder in the neuro-epileptic children was due to the presence of organic brain dysfunction rather than just the existence of a physical handicap (though this also played a part). However, organic brain dysfunction was not associated with any specific type of disorder. Within the neuro-epileptic group the neurological features and the type of fit, intellectual/educational factors, and socio-familial factors all interacted in the development of psychiatric disorder.