The Diagnostic Interview of Children and Adolescents for Parents of Preschool and Young Children: Psychometric Properties in the general Population

Abstract

There is a need for reliable and well-validated diagnostic measures for studying psychopathology in preschool and young children. The goal is to study the psychometric properties of the Diagnostic Interview for Children and Adolescents for Parents of Preschool and Young Children (DICA-PPYC) in the general population. A sample of 852 Spanish school children, aged 3 to 7 years, were randomly selected and screened for a double phase design. A total of 251 families were interviewed with the DICA-PPYC and 244 participated in a test–retest design. Different measures of psychopathology and functional impairment were also administered. Test–retest agreement with a mean interval of 8.8 days ranged from excellent to slight (kappa from 1 to 0.39) for DSM-IV-TR and from good to fair (kappa from 0.77 to 0.49) for Research Diagnostic Criteria-Preschool Age diagnoses. Attenuation between test and retest was not significant for the prevalence of diagnoses, although it was significant for the number of externalising and total symptoms in the interview. The diagnoses converged moderately with the CBCL and Dominic scores. The presence of diagnoses in the DICA-PPYC significantly differentiated preschoolers and young children who had used mental health services, were more impaired, and presented more severe psychopathology measured by dimensional scales. The DICA-PPYC is a reliable and valid semi-structured interview schedule for preschool and young children, and can serve to advance the knowledge and mental health care of this population.

Introduction

A standard procedure for deriving categorical diagnoses is using structured diagnostic interviews. Angold et al. (2007) have indicated that a great deal of work has been done with diagnostic interviews for children and adolescents. They stress that the current need is to extend the range of structured assessments to include younger ages. Some of the most developed diagnostic interviews have extensive preschool versions. They consist of modifications of the original interviews that have been adapted for young children in wording and with appropriate questions to determine childhood manifestations of the psychiatric disorders. In some cases the introduction of new diagnoses is deemed essential as is the modification of the algorithms. The Preschool Age Psychiatric Assessment (PAPA) (Egger and Angold, 2004) represents an excellent effort for assessing psychopathology in this age group. The PAPA is an interviewer-based schedule for children from 2 to 5 years old based on the Child and Adolescent Psychiatric Assessment (Angold and Costello, 2000). A test–retest study with 307 parents of 2- to 5- year-old children receiving paediatric primary care showed slight to good agreement (Byrt, 1996) for diagnoses and good reliability for the assessment of impairment. These levels are similar to those obtained in the most accepted interviews for children and adults (Egger, et al., 2006). Birmaher et al. (2009), using the K-SADS-PL (Kaufman et al., 1997) in a sample of 204 children of bipolar parents and community controls, aged 2 to 5 years, showed high inter-rater reliability based on seven audiotaped cases, good convergent and discriminant validity with dimensional measures, good predictive intake diagnosis at 2- year follow-up, and agreement with PAPA diagnoses based on 14 subjects with a limited range of symptoms. The DISC-IV-YC (Lucas et al., 1998), a structured interview, was developmentally modified to address age-appropriate manifestation of symptoms and the life experiences of preschoolers. Luby et al. (2002), using this schedule, validated the DSM-IV major depression criteria modified for preschool children. The Diagnostic Infant and Preschool Assessment (Scheeringa and Haslett, 2010) for 1- to 6- year-old children, showed slight to good test–retest reliability in seven of the most common DSM-IV disorders in a sample of 50 outpatients.

Recently, there has been important growth in the study of psychopathology in preschool and young children (Egger et al., 2006, Egger and Angold, 2006, Angold and Egger, 2007, Lavigne et al., 2009). A key issue in this field has been whether or not categorical definitions of the diagnostic systems could be applied reliably to this age group. Some researchers suggest that standard DSM-IV criteria, when applied to preschoolers and young children, are not always sufficiently sensitive to ascertain symptomatic children and propose developmentally appropriate criteria for determining psychopathology in young children (Luby et al., 2002, Luby et al., 2003, Wakschlag et al., 2010). This is the case of the proposal of the Research Diagnostic Criteria—Preschool Age (RDC-PA) (Task Force on Research Diagnostic Criteria: Infancy Preschool, 2003) that was designed to “fill a gap in the knowledge of how to reliably diagnose psychiatric disorders in children from zero through five years of age” (p. 1).

Further work on the development of these instruments is essential for the advancement of the field. There is a need for reliable and well-validated structured and semi-structured diagnostic measures with a different range of disorders, ages, degree of structure, or period assessed, for understanding and studying preschool psychopathology in different populations. The goal of this study is to assess the feasibility of the Diagnostic Interview for Children and Adolescents for Parents of Preschool and Young Children (DICA-PPYC) through a test–retest design and the analysis of the convergence of the results with other criteria. Even considering available schedules, there is a rationale for the development of a new interview such as the DICA-PPYC. In comparison with other interviews, disorders are assessed in a lifetime timeframe. The DICA-PPYC extends the range to incorporate 3- to 7- year-olds. Regarding the degree of structure, it is an intermediate schedule situated between the most classical semi-structured interviews (PAPA, K-SADS-PL) and the structured ones (DISC-IV-YC). It is syndrome organised and it covers a wide range of disorders. Also, the only schedule available in Spanish (American Spanish) is the DISC-IV-YC, which is a structured schedule; there is no structured or semi-structured diagnostic interview adapted for the Spanish preschool population. Finally, availability of this instrument would provide a useful comparison for DICA studies of older children, and the possibility of progression from preschool to older child assessments in follow-up studies for clinicians and researchers using this instrument. This study represents the first research to be done on preschool and young child disorders with a semi-structured diagnostic interview in a general population of Spanish children.