Mental Health Diagnoses among Children being seen for Child Health Supervision Visits: Typical Practice and DSM-PC Diagnoses
BACKGROUND
The Surgeon General's Action Agenda (2001) advocates for child mental health check-ups. The AAP published the Diagnostic and Statistical Manual for Primary Care (DSM-PC) (Wolraich, Ed., 1996) to help pediatricians make mental health diagnoses. Academy guidelines (Stein, Ed., 2002) call for recognition of mental health problems during routine child health supervision. We developed a computerized parent questionnaire to facilitate DSM-PC diagnoses as part of the Child Health and Development Interactive System (CHADIS). CHADIS/DSM-PC is now validated for disorder (Sturner, Morrel, and Howard, 2003a) and the new problem and variation categories (Sturner, Morrel, and Howard, 2003b).
OBJECTIVE
1. To describe the kinds of mental health problems documented by pediatricians during the course of child health supervision and the DSM-PC diagnoses made on the same children by CHADIS/DSM-PC.
2. To estimate the prevalence of DSM-PC diagnoses among inner city children.
DESIGN / METHODS
A convenience sample of 100 inner city children (aged 3 - 12) was seen by 8 pediatricians for child health supervision visits in 2 University affiliated community pediatric clinics. Following each visit CHADIS/DSM-PC was administered to the child s caretaker. Mental health diagnostic information documented on the clinic s standard encounter forms was noted by 2 reliable coders. DSM-PC diagnoses were obtained from the CHADIS/DSM-PC.
RESULTS
CHADIS/DSM-PC identified a disorder diagnosis in 27%; problem: 28%; variation: 21% and 23% without any diagnosis. These rates are similar to other surveys of disorder (e. g., Shaffer, et. al., 1996) and measures of parental concern (e. g., Sturner, et. al., 1980). Pediatricians used a DSM-IV disorder label in 13% and informal diagnostic labels in another 10%. 7% were newly recognized: 3% disorder; 4% informally labeled. One DSM-PC problem/variation diagnosis was made (speech problem). Thirty-two different diagnoses were made by CHADIS/DSM-PC whereas 3 different formal diagnostic labels were newly recognized by the pediatricians (Encopresis, Enuresis, and Speech Problem).
CONCLUSIONS
This study provides the first estimation of prevalence of DSM-PC diagnoses in children. It also illustrates the shift in pediatric orientation needed to implement DSM-PC and fulfill the Surgeon General s call for child mental health check-up visits . CHADIS-DSM-PC shows promise as part of the solution.
DISCLOSURE
No information to disclose.
Sturner, R., Morrel, T., & Howard, B. J., Mental Health Diagnoses among Children being seen for Child Health Supervision Visits: Typical Practice and DSM-PC Diagnoses. Pediatric Academic Society. Abstract in Pediatric Research, 441. 2004.
