Psychiatric diagnostic interviews for children and adolescents: a comparative study

Area of Science:

• Child and Adolescent Psychiatry
• Psychometric Assessment
• Clinical Research Methodology

Background:

• Accurate psychiatric diagnosis in youth is crucial for effective treatment and research.
• Different interview styles, including respondent-based, interviewer-based, and expert judgment, yield varying diagnostic rates.
• Understanding these differences is essential for selecting appropriate assessment tools in pediatric mental health.

Purpose of the Study:

• To compare the diagnostic yield and agreement of three distinct psychiatric interview styles for youth: the Diagnostic Interview Schedule for Children (DISC), the Child and Adolescent Psychiatric Assessment (CAPA), and the Development and Well-Being Assessment (DAWBA).
• To evaluate the suitability of each interview style for different research and clinical applications.

Main Methods:

• A study involving 646 youth (aged 9-16) recruited from pediatric clinics, with roughly equal gender and ethnic representation.
• Participants were randomly assigned to undergo two of the three interviews (DISC, CAPA, DAWBA) in a counterbalanced order.
• Interviews focused on depressive disorders, anxiety disorders, oppositional defiant disorder, conduct disorder, and attention-deficit/hyperactivity disorder, administered over two sessions with parent and child participation.

Main Results:

• The Development and Well-Being Assessment (DAWBA) identified significantly fewer diagnoses (17.7%) compared to the Diagnostic Interview Schedule for Children (DISC) (47.1%) and the Child and Adolescent Psychiatric Assessment (CAPA) (32.4%).
• Agreement between interview pairs varied, with DAWBA-DISC showing 0.13-0.48, DISC-CAPA 0.21-0.61, and CAPA-DAWBA 0.23-0.48.
• Cases identified solely by DAWBA had higher parent-reported questionnaire scores, suggesting potentially greater symptom severity in this subgroup.

Conclusions:

• The DAWBA is a shorter option, potentially identifying more severe cases, making it suitable for clinical trials where detailed data examination is less critical.
• The DISC and CAPA require similar training and length, and are preferable when minimizing false-negative diagnoses is essential, such as in genetic case-control studies or detailed symptom analysis.