IQ as a moderator of outcome in severity of children's mental health status after treatment in outpatient clinics.

BACKGROUND: Psychotherapy is an effective treatment for mental health disorders, but even with the most efficacious treatment, many patients do not experience improvement. Moderator analysis can identify the conditions under which treatment is effective or whether there are factors that can attenuate the effects of treatment. METHODS: In this study, linear mixed model analysis was used to examine whether the Full Scale IQ (FSIQ), Performance IQ (PIQ) and Verbal IQ (VIQ) on the Wechsler Intelligence Scale for Children - Third Edition, moderated outcomes in general functioning and symptom load. A total of 132 patients treated at three outpatient child and adolescent mental health services (CAMHS) were assessed at three different time points. The Children's Global Assessment Scale (CGAS) and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) were used to measure the severity of impairments in general functioning and symptom load. IQ was assessed at the start of treatment. RESULTS: Moderator analysis revealed that the FSIQ × time interaction predicted changes in CGAS scores (p < .01), and that the PIQ × time interaction predicted changes in HoNOSCA scores (p < .05). The slopes and intercepts in HoNOSCA scores covaried negatively and significantly (p < .05). The same pattern was not detected for the CGAS scores (p = .08). CONCLUSIONS: FISQ and PIQ moderated change in general functioning and symptom load, respectively. This implies that patients with higher IQ scores had a steeper improvement slope than those with lower scores. The patients with the highest initial symptom loads showed the greatest improvement, this pattern was not found in the improvement of general functioning.

IQ as a predictor of clinician-rated mental health problems in children and adolescents.

OBJECTIVE: Previous studies indicate that low IQ is a substantial risk factor for developing mental health problems. Based on these results, we hypothesized that IQ may predict some of the variance in clinician-rated severity of children's mental health problems measured with the Children's Global Assessment Scale (CGAS) and Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). The other aims of this study were to examine if there was any difference in the predictive ability of the different IQ scores of the Wechsler Intelligence Scale for Children, Third edition (WISC-III) and to examine if parent-rated measure of child mental health problems could predict the scores on CGAS and HoNOSCA after controlling for IQ, age, and gender. METHODS: In this study, 132 patients at three outpatient clinics in North Norway were assessed with the parent version of the Strength and Difficulties Questionnaire (SDQ), HoNOSCA, CGAS, and with the WISC-III. RESULTS: Hierarchical regression analyses were conducted with HoNOSCA and CGAS as dependent variables. Demographics, WISC-III IQ scores, and SDQ were entered as independent variables. The model with HoNOSCA as the dependent variable predicted 25% of the total variance. The WISC-III full-scale IQ predicted an additional 6% of the variance. The analyses with CGAS as the dependent variable gave no significant results. CONCLUSION: When a patient has a high HoNOSCA score, an intelligence test in addition to an evaluation of symptoms on mental health should be considered. Future research ought to examine whether HoNOSCA's ability to detect change might be affected by patients IQ.

Agreement on Web-based Diagnoses and Severity of Mental Health Problems in Norwegian Child and Adolescent Mental Health Services.

OBJECTIVE: This study examined the agreement between diagnoses and severity ratings assigned by clinicians using a structured web-based interview within a child and adolescent mental health outpatient setting. METHOD: Information on 100 youths was obtained from multiple informants through a web-based Development and Well-Being Assessment (DAWBA). Based on this information, four experienced clinicians independently diagnosed (according to the International Classification of Diseases Revision 10) and rated the severity of mental health problems according to the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and the Children's Global Assessment Scale (C-GAS). RESULTS: Agreement for diagnosis was κ=0.69-0.82. Intra-class correlation for single measures was 0.78 for HoNOSCA and 0.74 for C-GAS, and 0.93 and 0.92, respectively for average measures. CONCLUSIONS: Agreement was good to excellent for all diagnostic categories. Agreement for severity was moderate, but improved to substantial when the average of the ratings given by all clinicians was considered. Therefore, we conclude that experienced clinicians can assign reliable diagnoses and assess severity based on DAWBA data collected online.

The strengths and difficulties questionnaire as a screening instrument for norwegian child and adolescent mental health services, application of UK scoring algorithms.

BACKGROUND: The use of screening instruments can reduce waiting lists and increase treatment capacity. The aim of this study was to examine the usefulness of the Strengths and Difficulties Questionnaire (SDQ) with the original UK scoring algorithms, when used as a screening instrument to detect mental health disorders among patients in the Norwegian Child and Adolescent Mental Health Services (CAMHS) North Study. METHODS: A total of 286 outpatients, aged 5 to 18 years, from the CAMHS North Study were assigned diagnoses based on a Development and Well-Being Assessment (DAWBA). The main diagnostic groups (emotional, hyperactivity, conduct and other disorders) were then compared to the SDQ scoring algorithms using two dichotomisation levels: 'possible' and 'probable' levels. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (ORD) were calculated. RESULTS: Sensitivity for the diagnostic categories included was 0.47-0.85 ('probable' dichotomisation level) and 0.81-1.00 ('possible' dichotomisation level). Specificity was 0.52-0.87 ('probable' level) and 0.24-0.58 ('possible' level). The discriminative ability, as measured by ORD, was in the interval for potentially useful tests for hyperactivity disorders and conduct disorders when dichotomised on the 'possible' level. CONCLUSIONS: The usefulness of the SDQ UK-based scoring algorithms in detecting mental health disorders among patients in the CAMHS North Study is only partly supported in the present study. They seem best suited to identify children and adolescents who do not require further psychiatric evaluation, although this as well is problematic from a clinical point of view.