Chapter 5 Classification, Assessment, and Intervention Bilge Yağmurlu PSYC 430 Developmental Psychopathology

Assessment of Psychopathology Developmental approach aims to advance our understanding in relation to developmental tasks and processes Assessment must take into account indivdual differences that occur within developmental periods Patterns that persist vs change Copyright 2009 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved.

Terminology Sign Symptom Syndrome Classification Diagnosis

Terminology Etiology (aetiology, aitiology) Prognosis Comorbidity Epidemiology

Assessment Value of assessment: Ability to identify characteristics important for decision making Different procedures and sources of data: Interviews Structured diagnostic interviews Interviews are organized to provide information for diagnosis (DSM) Projective tests: ideographic portraits Tabulations of overt behaviors Personality inventories

Taxonomic Targets for Assessment Which characteristics will be assessed? Reliably assessable Valid indices of variables that play key roles in diagnosis

Are Assessment Procedures Perfect? Variability in a measure’s results over brief intervals Test-retest Inter-rater reliability Different informants (modest corr) Assessment procedures Questionnaires Observation Targeted time intervals

Approaches to Conceptualize Child Psychopathology Types of Problem Behaviors Enumerates symptoms Dimensions Symptom clusters Categories Diagnostic criteria

Empirically Based Paradigm Starts with data obtained on specific problems, analysis Frequency and intensity ratings Correlations, factor analysis, cluster “Bottom up”

Empirically Based Paradigm Cross-Informant Syndrome (multi informants) Constructs Parents: CBCL Teachers: TRF Child: YSR Constructs: Aggressive beh,attention problems, delinquent beh, social problems anxious/depressed, somatic complaints, thought problems, & withdrawn

“Syndromes” or symptom clusters Undercontrolled Other-directed Overcontrolled Inner-directed Common dimensions Withdrawn Social problems Delinquent behavior Aggressive behavior Somatic complaints Thought problems Attention problems Anxious/depressed

Empirically Based Paradigm Norm-referenced profiles Separate norms for each gender within each developmental level E.g., aggressive behavior is more frequent, cut-off score is different Even if the child does not meet criteria for a particular disorder (for eg. ADHD), the child may score higher than the norm for that gender or age (developmental level)

DSM Approach Assessment procedures Each category reflects a taxonomic construct and involves explicit criteria How are criteria deriven? Not deriven by data from assessment procedures Negotiated among the committees Field trials: affect some criteria and cutpoints but did not base the constructs in DSM Assessment procedures Diagnostic interviews

DSM Diagnostic Interviews Diagnostic Interview Schedule for Children-Child Version (DISC-C) DISC-P Test-retest reliability Large test-retest attenuation effect Problem of threshold Yes-No

DSM Diagnostic Interviews Test-retest reliability: Problem of threshold Difficulty in understanding Breton et al. (1995): 9 year-olds understand 16% of questions for depression 11 year-olds 31%

Major Depressive Disorder (MDD) Depressed or irritable mood Loss of interest or pleasure Weight changes Sleep problems Motor agitation or retardation Loss of energy Feeling worthless or guilty Poor concentration Thoughts of death or suicide Need 5 symptoms in the same 2-week period

Structured Diagnostic Interviews Child & Adolescent Psychiatric Assessment (CAPA) Interviewer based: has a major role in clearing information of behaviors and feelings relevant to each symptom (DISC: more respondent based) 400 pages and 300 pages glossary Disadvantages

Diagnostic Efficiency Determining indicators which maximize our diagnostic “hits” which minimize our diagnostic “misses” true positive false positive true negative false negative

Classification Systems ICD: International Classification of Diseases WHO DSM APA DC: Diagnostic Classification 0-3 National Center for Clinical Infant Programs Multi-axial system Desgined from a developmental perspective

Intervention Prevention Treatment Figure 5-3 demonstrates how intervention overlaps

Treatment Individual Alterations according to developmental level Group Play Psychodynamic and client-centered Family therapy/Parenting interventions Context-related Pharmacological