Can standardized diagnostic assessment be a useful adjunct to clinical assessment in child mental health services? A randomized controlled trial of disclosure of the Development and Well-Being Assessment to practitioners.

PURPOSE: While research demands standardized diagnostic assessments as an indication of sufficient methodological rigour, there is debate about their application to clinical practice. The Development and Well-Being Assessment (DAWBA) provides a structured assessment of psychiatric disorder. Since it can be completed on-line, it could be used by Child and Adolescent Mental Health Services with few additional demands on staff. Access to the standardized diagnostic information as an adjunct to clinical assessment could reduce the number of appointments spent on assessment, free up practitioner time to work on engagement and improve clinical outcomes by increasing the accuracy of assessment and thus access to the appropriate evidence-based treatment. METHOD: Randomized controlled trial of the disclosure of the DAWBA to the assessing practitioner (n = 117) versus assessment at normal (n = 118) and analysed by "intention to disclose". RESULTS: Exposure to the DAWBA may increase agreement between the DAWBA and practitioners about some anxiety disorders, but detected no other statistically significant increased agreement for other disorders, nor a reduced need for further assessment, the number of difficulties recognised or influence on outcomes. CONCLUSIONS: The results may be explained by the inadequacy of the DAWBA, lack of statistical power to detect any effects that were present or a reluctance of some practitioners to use the DAWBA in their assessment. Future research might benefit from exploring the use of the DAWBA or similar assessments as a referral rather than an assessment tool, and exploring how practitioners and parents experience and use the DAWBA and what training might optimise the utility of the DAWBA to clinical practice.

Five-year predictive validity of DSM-IV conduct disorder research diagnosis in 4(1/2)-5-year-old children.

OBJECTIVE: This longitudinal study of a non-referred, population-based sample tested the 5-year predictive validity of the DSM-IV conduct disorder (CD) research diagnosis in children 4(1/2)-5 years of age. METHOD: In the E-Risk Study, a representative birth cohort of 2,232 children, mothers were interviewed and teachers completed mailed questionnaires to assess children's past 6-month CD symptoms. A follow-up assessment was conducted when children were 10 years old. RESULTS: CD-diagnosed 5-year-olds were significantly more likely than controls to have behavioural and educational difficulties at age 10. Increased risk for age-10 educational difficulties persisted after controlling for age-5 IQ and ADHD diagnosis. Although the majority of CD-diagnosed 5-year-olds had no CD symptoms at age 10, findings suggest that these "remitted" children continued to experience behavioural and educational problems 5 years later despite their apparent remission from CD. CONCLUSIONS: DSM-IV CD symptoms validly identify preschool-aged children who continue to have behavioural and educational problems in middle-childhood.

What do parents and carers think about routine outcome measures and their use? A focus group study of CAMHS attenders.

Currently service user involvement in routine outcomes monitoring has been minimal, particularly in Children's services. There needs to be a more sustained effort to involve service users because of the valuable information that they could provide for service development and improvement. Focus groups were conducted with service users, including parents, carers and young people from a London CAMHS. Their views were elicited on routine outcomes monitoring in general, three specific approaches and suggestions about what else might be important to capture when measuring outcomes. The focus groups raised a number of issues pertinent to routine outcomes monitoring in general, including the reliability of answers, the need for the measures to reflect more than just a tick-box approach and that different people will have different perspectives. Analysis also focused on feedback about the three specific measures discussed. It is important that service users are involved in the process of outcome measurement, from the development of measures, to their application in therapeutic encounters and in service development. Outcome monitoring needs to become a more collaborative process in order that services are measuring what service users think is important, as most would agree that a service should deliver the outcomes that its users want to see.

Sex differences in brain maturation as measured using event-related potentials.

Little is known about how sex influences functional brain maturation. The current study investigated sex differences in the maturation of event-related potential (ERP) amplitudes during an auditory oddball task (N = 170; age = 6-17 years). Performance improved with age. N200 amplitude declined with age: parietal sites showed earlier development than temporal and frontal locations. Girls showed greater bilateral frontal P300 amplitude development, approaching the higher values observed in boys during childhood. After controlling for age, right frontal P300 amplitude was associated with reaction time in girls. The findings demonstrate sex differences in ERP maturation in line with behavioral and neuroimaging studies.

Epilepsy and intellectual disability: does epilepsy increase the likelihood of co-morbid psychopathology?

Although epilepsy is particularly common among people with intellectual disability (ID) it remains unclear whether it is associated with an increased likelihood of co-morbid psychopathology. We therefore investigated rates of mental health problems and other clinical characteristics in patients with ID and epilepsy (N = 156) as compared to patients with ID but no epilepsy (N = 596). All participants were consecutive referrals to specialist mental heath services. Specialist clinicians agreed on the mental health diagnoses by applying ICD-10 clinical criteria using information gained from interviews with key informants and the patients. Bivariate and multivariate analyses showed that patients with epilepsy were more likely to live in residential housing and have severe ID in line with previous evidence. However, the presence of epilepsy was not associated with an increased likelihood of co-morbid psychopathology. On the contrary, rates of mental health problems, including schizophrenia spectrum, personality and anxiety disorders, were significantly lower among patients with epilepsy. The results are discussed in the context of mood-stabilizing and other psychotropic effects of anti-epileptic drugs in adults with ID and epilepsy, as well as possible diagnostic overshadowing.