In the context of the development of prototypic assessment instruments in the areas of cognition, personality, and adaptive functioning, the issues of standardization, norming procedures, and the important psychometrics of test reliability and validity are evaluated critically. Criteria, guidelines, and simple rules of thumb are provided to assist the clinician faced with the challenge of choosing an appropriate test instrument for a given psychological assessment. Clinicians are often faced with the critical challenge of choosing the most appropriate available test instrument for a given psychological assessment of a child, adolescent, or adult of a particular age, gender, and class of disability. It is the purpose of this report to provide some criteria, guidelines, or simple rules of thumb to aid in this complex scientific decision. As such, it draws upon my experience with issues of test development, standardization, norming procedures, and important psychometrics, namely, test reliability and validity. As I and my colleagues noted in an earlier publication, the major areas of psychological functioning, in the normal development of infants, children, adolescents, adults, and elderly people, include cognitive, academic, personality, and adaptive behaviors (Sparrow, Fletcher, & Cicchetti, 1985). As such, the major examples or applications discussed in this article derive primarily, although not exclusively, from these several areas of human functioning.

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Guidelines, Criteria, and Rules of Thumb for Evaluating Normed and Standardized Assessment Instruments in Psychology.

Cognitive therapy of depression: pretreatment patient predictors of outcome.

Objective To describe the National Institute of Mental Health Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV) and how it differs from earlier versions of the interview. The NIMH DISC-IV is a highly structured diagnostic interview, designed to assess more than 30 psychiatric disorders occurring in children and adolescents, and can be administered by "lay" interviewers after a minimal training period. The interview is available in both English and Spanish versions. Method An editorial board was established in 1992 to guide DISC development and ensure that a standard version of the instrument is maintained. Preliminary reliability and acceptability results of the NIMH DISC-IV in a clinical sample of 84 parents and 82 children (aged 9-17 years) drawn from outpatient child and adolescent psychiatric clinics at 3 sites are presented. Results of the previous version in a community sample are reviewed. Results Despite its greater length and complexity, the NIMH DISC-IV compares favorably with earlier versions. Alternative versions of the interview are in development (the Present State DISC, the Teacher DISC, the Quick DISC, the Voice DISC). Conclusions The NIMH DISC is an acceptable, inexpensive, and convenient instrument for ascertaining a comprehensive range of child and adolescent diagnoses.

NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, Differences From Previous Versions, and Reliability of Some Common Diagnoses

I propose that the ways people respond to their own symptoms of depression influence the duration of these symptoms. People who engage in ruminative responses to depression, focusing on their symptoms and the possible causes and consequences of their symptoms, will show longer depressions than people who take action to distract themselves from their symptoms. Ruminative responses prolong depression because they allow the depressed mood to negatively bias thinking and interfere with instrumental behavior and problem-solving. Laboratory and field studies directly testing this theory have supported its predictions. I discuss how response styles can explain the greater likelihood of depression in women than men. Then I intergrate this response styles theory with studies of coping with discrete events. The response styles theory is compared to other theories of the duration of depression. Finally, I suggest what may help a depressed person to stop engaging in ruminative responses and how response styles for depression may develop.

Responses to depression and their effects on the duration of depressive episodes.

The Functioning and Well-Being of Depressed Patients

• The existing literature on the reliability of psychiatric diagnosis falls into two periods, the earlier reporting low reliability and the latter reporting much higher figures. The reasons for this trend are examined in the context of a discussion of the design of diagnostic reliability studies. The problems of research design and execution in studies of diagnostic reliability are reviewed, and statistical problems are examined. Solutions to many of these problems are suggested, including recommendations of appropriate reliability coefficients and data analyses.

Reliability studies of psychiatric diagnosis. Theory and practice.

Although ‘ ‘double depression ‘ ‘-major depressive disorder superimposed on an underlying chronic depression-is a f requent phenomenon, the concept has not been well formulated clinically and has rarely been described in the research literature. The authors found that 1) 26% of 101 patients who met the criteria for major depressive disorder had an underlying chronic depressive disorder of at least 2 years’ duration, 2) “recovery” ratesfor patients with superimposed depression differed greatly depending on whether recovery was defined as recovery from the major depressive disorder only or recovery from both disorders, and 3) patients with superimposed depression relapsed at a significantly higher rate immediately after recovery from the acute episode of depression than did patients without superimposed depression.

"Double depression": superimposition of acute depressive episodes on chronic depressive disorders.

• Regression models and life tables were used to describe the phenomenon of recovery from major depressive disorder for 101 patients in a naturalistic study in which treatment was not controlled by the investigators. Time to recovery from the onset of the episode was protracted, as only about 50% of patients recovered by one year. Annual rates of recovery then declined steadily to 28% in the second year, 22% in the third year, and 18% in the fourth year. In contrast, speed of recovery from entry into the study was more rapid, and 63% of patients recovered by four months. The recovery rates were about 20% each month for the first four months and then declined sharply for the remaining months of the one-year follow-up. Several clinical variables were statistically significant predictors of recovery when measured from entry into the study: superimposition of the acute episode on a chronic underlying depression, acuteness of onset of the depression, and severity of depression for the subgroup of patients without superimposed illness.

Recovery in Major Depressive Disorder: Analysis With the Life Table and Regression Models

• With the use of life tables to describe time while patients were well and subsequent rates of relapse for 75 patients after their recovery from an episode of major depressive disorder in a naturalistic study, a high risk of relapse was detected shortly after recovery. Twenty-four percent of patients relapsed within 12 weeks at risk, and 12% of patients relapsed within four weeks at risk. The presence of an underlying chronic depression and three or more previous affective episodes predicted a statistically significant increase in the rate of relapse. These data were used to develop an exponential model of relapse probability for a subgroup of the study population.

Relapse in Major Depressive Disorder Analysis With the Life Table

It is important to determine the reliability of lifetime diagnosis in a nonpatient population, for this type of diagnostic data and this type of sample are used in many genetic, epidemiological, and nosological studies. We examined the reliability of lifetime diagnosis when the Schedule for Affective Disorders and Schizophrenia-Lifetime Version and Research Diagnostic Criteria were used to interview ill and well relatives of probands in the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression. Subjects were interviewed three times, so data are available concerning both short- and long-interval test-retest reliability. Short-interval test-retest reliability was excellent for both diagnoses and symptoms. Reliability was also quite high in the long-interval test-retest study. We conclude that it is possible to make lifetime diagnoses reliably in a nonpatient population.

Robert W. Shapiro

Papers

Reliability studies of psychiatric diagnosis. Theory and practice.

"Double depression": superimposition of acute depressive episodes on chronic depressive disorders.

Recovery in Major Depressive Disorder: Analysis With the Life Table and Regression Models

Relapse in Major Depressive Disorder Analysis With the Life Table

Reliability of lifetime diagnosis. A multicenter collaborative perspective