[Developing a decision tool: indicating care for mild intellectual disability]. / Ontwikkeling decision tool voor een lichte verstandelijke beperking: zorg aan de juiste doelgroep.

BACKGROUND: Children and youth with an intellectual disability and psychiatric problems are a complex group. By identifying clients who require highly specialized mental health care at an early stage, it is expected that the provided care can be utilized more effectively, there will be less non-response and clients will more efficiently receive the most appropriate care. AIM: To develop a decision tool which can identify clients who need highly specialized care at an early stage. METHOD: A review of the literature and qualitative research methods were used, including a Delphi study to get consensus on criteria that could be used as indicators for highly specialized care. These criteria were included in a decision tool, followed by validation of these criteria by testing them on the population of the Banjaard, a mental health care setting for young people with intellectual disability and psychiatric problems. RESULTS: Ten criteria emerged from the Delphi method that were seen to be predictive of the need for highly specialized care. After applying these criteria to the Banjaard population, it appeared that three or more criteria reliably identified clients needing highly specialized care (sensitivity 76.5% and specificity 75.6%). CONCLUSION: The decision tool developed in the current study is a reasonable instrument for identifying clients who could benefit from highly specialized mental health care.

[Care for adolescents with an autism spectrum disorder and an intellectual disability]. / Zorg voor adolescenten met autisme en een verstandelijke beperking.

BACKGROUND: Due to an experienced gap in care for adolescents with an autism spectrum disorder (ASD) and an intellectual disability (ID), an interdisciplinary outpatient clinic was initiated by child- and adolescent psychiatry services together with intellectual disability physicians in the Rotterdam region in 2017. AIM: Evaluation of the ASD-ID outpatient clinic. METHOD: A retrospective chart review study of the first year of the ASD-ID outpatient clinic was performed. The care specific traits of the adolescents who visited the ASD-ID outpatient clinic, their health care costs and the effect of the ASD-ID outpatient clinic on both the health care costs and the patient outflow was compared to the traits of the adolescents of the autism outpatient clinic. RESULTS: 32 adolescents who were referred to the ASD-ID outpatient clinic were comparable to 204 adolescents of the autism outpatient clinic in age (mean 16.5 years) and gender (75% male). They had 39% more DSM-IV classifications, were in care 3.7 years longer and had 44% more health care costs. After visiting the ASD-ID outpatient clinic, 50% of the adolescents were transferred within a year and 100% within three years to a intellectual disability physician. CONCLUSION: Adolescents with ASD and ID are a group with a substantial demand for care who deserve specific attention. An integrated ASD-ID outpatient clinic contributes to this demand.

The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents.

BACKGROUND: We estimated the 6-month prevalence of psychiatric disorders among Dutch adolescents, using standardized, internationally available, and replicable assessment procedures, and assessed sex differences and comorbidity of diagnoses. METHODS: In phase 1, the parent, self-report, and teacher versions of the Child Behavior Checklist screened a sample representative of 13- to 18-year-olds from the Dutch general population. In phase 2, the parent (P) and child (C) versions of the Diagnostic Interview Schedule for Children (DISC) provided DSM-III-R diagnoses for a selected subsample of 780 subjects. RESULTS: The prevalence of any disorder was 21.5% for the DISC-C and 21.8% for the DISC-P. There was little overlap between subjects identified as having a disorder by the DISC-P and the DISC-C; only 4% met the criteria for any disorder on both. The most common disorders were simple phobia, social phobia, and conduct disorder. The most frequent comorbid diagnoses were anxiety and mood disorders. CONCLUSIONS: Although prevalences of more than 21% for DISC-C- and DISC-P-derived diagnoses seem high, many adolescents with DSM-III-R diagnoses functioned quite well. The prevalence of any DSM-III-R diagnosis based on the DISC-C or DISC-P, in combination with the criterion for a definite case, was 7.9%.

Epidemiological comparisons of American and Dutch adolescents' self-reports.

OBJECTIVE: To determine the cross-cultural applicability of self-reports of adolescents' problems and competencies. METHOD: Youth Self-Reports (YSRs) were completed by 803 American and 803 Dutch nonreferred adolescents matched by gender, age, and socioeconomic status. RESULTS: Comparisons revealed that American adolescents reported many more problems than did Dutch adolescents. This finding contrasts sharply with the American/Dutch similarities in parents' and teachers' reports of children's problem behaviors. Competence scores also were much higher for the American than the Dutch sample. CONCLUSIONS: Cutpoints for discriminating the normal and the clinical range of YSR scores need to be adjusted to local norms for the Dutch sample. Cultural factors may be responsible for the cross-national differences.

Associations between different diagnostic approaches for child and adolescent psychopathology.

OBJECTIVE: To test the convergence between the empirical-quantitative approach of the Child Behavior Checklist (CBCL) and the clinical-diagnostic approach of the DSM. METHOD: The parent version of the NIMH Diagnostic Interview Schedule for Children (DISC), version 2.3, was administered after completion of the CBCL for 231 children and adolescents consecutively referred to an outpatient mental health clinic. RESULTS: Of the subjects with a DSM-III-R diagnosis, 60% scored in the clinical range of the CBCL total problem score. The Withdrawn scale predicted affective and anxiety disorders. The Somatic Complaints scale predicted anxiety and mood disorders and Attention Deficit Hyperactivity Disorder. The Anxious/Depressed scale predicted anxiety and mood disorders and, to a lesser extent, disruptive behavior disorders. The Social Problems scale predicted Oppositional Defiant Disorder. The Attention Problems scale was the only significant predictor of "pure" Attention Deficit Hyperactivity Disorder (ADHD). The Aggressive Behavior scale predicted several disruptive behavior disorders, and Major Depression. The Delinquent Behavior scale was strongly associated with Conduct Disorder. CONCLUSIONS: Empirically based CBCL scale scores and DISC-P based DSM-III-R diagnoses converged. However, both approaches do not converge to a degree that one approach can replace the other. Instead, combining both approaches may be valuable by adding information from one approach that is not captured by the other.