• We investigated the prevalence of DSM-III disorders in 792 children aged 11 years from the general population and found an overall prevalence of disorder of 17.6% with a sex ratio (boys-girls) of 1.7:1. The most prevalent disorders were attention deficit, oppositional, and separation anxiety disorders, and the least prevalent were depression and social phobia. Conduct disorder, overanxious disorder, and simple phobia had intermediate prevalences. Pervasive disorders, reported by more than one source, had an overall prevalence of 7.3%. Examination of background behavioral data disclosed that children identified at 11 years as having multiple disorders had a history of behavior problems since 5 years of age on parent and teacher reports. Fifty-five percent of the disorders occurred in combination with one or more other disorders, and 45% as a single disorder.

DSM-III disorders in preadolescent children. Prevalence in a large sample from the general population.

https://psycnet.apa.org/journals/bul/101/3/443.pdf

On the distinction between attentional deficits/hyperactivity and conduct problems/aggression in child psychopathology.

Two experiments investigated the development and pathology of inhibitory control in children. Inhibitory control was investigated with the stop-signal paradigm, which is based on a formal theory of inhibition and directly measures the mechanism of inhibition. The ability to inhibit developed little after Grade 2, but subjects with attention deficit disorder with hyperactivity (ADDH) showed deficient inhibitory control. Their deficient inhibitory control was attributable to the subgroup of ADDH subjects with pervasive hyperactivity who had a more severe inhibitory deficit than did the situational hyperactive subgroup, the normal group, and the pathological controls. These studies reflect the utility of the stop-signal paradigm as a measure of inhibitory control. The concept of inhibitory control is central in theories of child development and in the definition and explanation of psychopathological disorders of childhood—in particular, of attention deficit disorder with hyperactivity (ADDH; Douglas, 1983; Kogan, 1983; Milich & Kramer, 1984). Inhibitory control is one of several processes that perform the executive functions of the cognitive system. These functions determine how various mental processes (e.g., encoding, recognition, retrieval) will work together in the performance of a task. Children need executive control to choose, construct, execute, and maintain optimal strategies for performing a task, as well as to inhibit strategies that become inappropriate when goals or task demands change or errors occur (Logan, 1985). Deficient inhibitory control is revealed by impulsive behaviors such as responding before the task is understood, answering before sufficient information is available, allowing attention to be captured by irrelevant stimuli (i.e, distractibility), or failing to correct obviously inappropriate responses. Poorly developed inhibitory control might account for impulsive behaviors of younger children and of children with various types of psychopathology. Despite the importance of inhibitory control in theories of child development and psychopathology, no widely accepted

/pdf/impulsivity-and-inhibitory-control-in-normal-development-and-1h9azpo3fn.pdf

Impulsivity and Inhibitory Control in Normal Development and Childhood Psychopathology

Fifty-nine child and adolescent psychotic patients (mean onset age 13.9, range 7-17, 83% 13 + years) had history and outcome studied using diagnoses confirmed at follow-up after 1 to 16 years (mean, 5 years). There were no differences in sex ratio, socioeconomic status, age of onset, and symptoms, but bipolar patients (N = 23) were often misdiagnosed as schizophrenic, had a better outcome, and a 50% homotypic family history. Schizophrenic subjects (N = 30) were more abnormal premorbidly, and only 17% were well at follow-up. Schizoaffective disorder was unreliable, infrequent, and more severe. Premorbid adjustment and IQ were the best predictors of outcome. Differences from the adult disorders were only quantitative. Careful follow-up of psychotic patients is needed to detect diagnostic errors.

Childhood and adolescent schizophrenic, bipolar, and schizoaffective disorders: a clinical and outcome study.

Objective The aim of the study was to examine the interrater and parent-child agreement for the major child anxiety disorders. Method One hundred sixty-one children and their parents underwent a semistructured interview (Anxiety Disorders Interview Schedule for Children). To increase external validity, clinicians did not receive specific, extensive training in diagnosing anxiety disorders apart from their standard qualifications. The design of the study allowed for calculation of agreement between raters based on information obtained from the parents alone, from the child alone, or through combined information from both the parents and child, and for calculation of agreement between information obtained from the parents and information obtained from the child. Results Levels of interrater agreement either as principal or additional diagnoses were moderate to strong for all of the major childhood anxiety disorders (K values .59 to .82). In contrast, parent-child agreement was poor for most diagnostic categories (K values .11 to .44). Conclusions The data indicate that, despite the fact that parents and their children do not demonstrate strong agreement, the DSM-III-R childhood anxiety disorders can be reliably diagnosed by pairs of general clinicians using structured interviews.

Reliability of the DSM-III-R Childhood Anxiety Disorders Using Structured Interview: Interrater and Parent-Child Agreement

A total of 195 admissions to a child psychiatric inpatient unit were diagosed independently by two to four clinicians on the basis of case presentations at the first wardround after admission. The DSM HI as a whole and the major categories were of high or acceptable reliability, though a few were clearly unreliable. The results are generally consistent with other studies. Unlike other studies, the subcategories were examined and found to vary widely in reliability both as a whole across the system and within parent major categories, throwing considerable doubt upon their utility. The results indicate the need both for improved diagnostic datagathering techniques in child psychiatry and for more betterdesigned studies of reliability and, most necessarily, of validity.

R. James Methven

Papers

The interrater reliability of DSM III in children.