Preliminary Validation of the DSM-PC
PURPOSE
To assess the validity of an attempt to operationalize the new DSM-PC categories of "Problem" and "Developmental Variation" through comparison with another measure of child problem behavior and with assessments of psychiatric disorder
METHODS
A computerized parent inventory (DSM-PC component of the Child Health and Development Interactive System or DSM-PC/CHADIS) asks parents to identify concerns from a list and then prioritize them. Parents then respond to a series of questions related to their highest prioritized concerns and follow an algorithm designed to determine if symptoms meet criteria for disorder, problem or developmental variation. Caregivers of children (aged 6 – 17, mean = 10) completed the DSM-PC/CHADIS and were assessed for disorder through a computerized parent version of the Diagnostic Interview for Children and Adults (DICA; Reich, 2000) administered in counterbalanced order. The caregivers also completed the Child Behavior Checklist (CBCL; Achenbach and Rescorla, 2001) and the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997). Participants (N = 100) were caregivers of children (56 boys, 44 girls) being seen for a routine check-up (37%), DBP consult (36%) recruited without a scheduled appointment (27%) and were 74% Caucasian and 24% African-American in a clinic serving 60% Medicaid population.
RESULTS
In a stepwise regression, a child’s DSM-PC/CHADIS score that included scores for both disorder and problem level diagnoses but not variation level diagnoses was a stronger predictor of CBCL Total score than DSM-PC/CHADIS scores that either also took into account variation level diagnoses or did not take into account problem level diagnoses (Beta = .76, p<.001). Compared with the DICA, no child diagnosed with DSM-PC developmental variation only was found to have a disorder according to the DICA and only two children in the problem category (diagnosis = sadness problem and diagnosis = hyperactive/impulsive problem) were shown to have a DICA disorder (diagnosis = simple and/or social phobia for both cases) and one child in the no diagnosis category was shown to have a DICA disorder (diagnosis = elimination disorder). Compared to the SDQ, CHADIS never diagnosed a problem or disorder if the caregiver indicated that there were no overall difficulties with emotions, concentration, behavior, or being able to get along with other people on the SDQ.
CONCLUSIONS
These results support the DSM-PC manual theoretical definitions for both "developmental variation" and "problem." When parents raise concerns that fall into the developmental variation category, the clinician can be confident that the behaviors are "within the range of expected behaviors for the age" and significant psychopathology is not being overlooked. Children described in the category of DSM-PC problem do comprise a group with a significant amount of problem behavior but individually these children rarely will warrant a diagnosis of mental disorder. Additional studies are needed to validate the new constructs of DSM-PC developmental variation and problem but this first study provides encouraging results and also offers a practical way to expedite the clinical diagnostic process and further research.
Sturner, R. Howard, B. J., & Morrel, T. Preliminary Validation of the DSM-PC. Society of Developmental-Behavioral Pediatrics. Abstract in Journal of Developmental & Behavioral Pediatrics, 393-394, 2003.
