Revision: Pilot Study of Nimh Diagnostic Interview Sched

Zahner, Gwendolyn

Abstract

There is a critical need for methodologic improvements of measures of child psychiatric disorders in clinical and epidemiologic research. Existing diagnostic instruments have demonstrated limited reliability and validity, especially with young children. NIMH is addressing these needs through its on-going development of the Diagnostic Interview Schedule for Children (DISC). The child and parent versions of this structured interview are currently being revised at Columbia University under contract to NIMH (Dr. David Shaffer, P.I.). This proposal requests funds to pilot Dr. Shaffer's recommended revisions in a community survey of pre-adolescent children. The proposed DISC pilot study will take place in the context of a larger on-going project, the New Haven Child Survey, an epidemiologic assessment of children's mental health needs, co-sponsored by the Yale Child Study Center and the State of Connecticut. Data collection for this needs assessment study will take place in New Haven, CT, during the school year 1985-1986. Incorporating a pilot study of the DISC in the New Haven Child Survey will facilitate NIMH's continuing efforts to develop this instrument by providing a thorough field trial in a pre-adolescent cohort. The New Haven Child Survey is designed with two stages of data collection. In the first stage, parents (primarily mothers) and teachers of a probability sample of 1200 New Haven children between the ages of 6 and 11 will complete questionnaires on children's emotional and behavioral symptoms and factors related to service utilization. In the second stage, a sub-sample of 75 high scorers and 75 average scorers on the symptom checklists will be identified, and child diagnostic interviews of children will be carried out with mothers and children as informants. Although these in-person interviews will employ the DISC, the second stage as it is presently designed does not permit a formal assessment of psychometric properties of the diagnostic instruments. To assess reliability and validity, funds are requested to modify the design of the second stage by 1) increasing the size of the second stage by an additional 75 children who have mild symptom elevations, and 2) supplementing the DISC with additional clinical measures. These modifications will permit analyses examining whether DISC revisions have resolved problems emerging from earlier field trials, including whether 1) DISC items discriminate between cases and non-cases, and 2) computer generated DISC diagnoses concur with clinician's diagnoses and other clinical measures of psychiatric disorders.