ARTICLES
Test-Retest Reliability of the Preschool Age Psychiatric Assessment (PAPA)

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ABSTRACT

Objective

To examine the test-retest reliability of a new interviewer-based psychiatric diagnostic measure (the Preschool Age Psychiatric Assessment) for use with parents of preschoolers aged 2 to 5 years.

Method

A total of 1,073 parents of children attending a large pediatric clinic completed the Child Behavior Checklist 1 1/2-5. For 18 months, 193 parents of high scorers and 114 parents of low scorers were interviewed on two occasions an average of 11 days apart.

Results

Estimates of diagnostic reliability were very similar to those obtained from interviews with parents of older children and adults, with kappas ranging from 0.36 to 0.79. Test-retest intraclass correlations for DSM-IV syndrome scale scores ranged from 0.56 to 0.89. There were no significant differences in reliability by age, sex, or race (African American versus non-African American).

Conclusions

The Preschool Age Psychiatric Assessment provides a reasonably reliable standardized measure of DSM-IV psychiatric symptoms and disorders in preschoolers for use in both research and clinical service evaluations of preschoolers as young as 2 years old. J. AM. ACAD. Child Adolesc. Psychiatry, 2006;45(5):538-549

Section snippets

Description of the PAPA

Development of the PAPA began in 1998 and has been described in some detail elsewhere (Egger and Angold, 2004). A brief summary is presented here. The PAPA is a parent-report instrument based on the parent version of the Child and Adolescent Psychiatric Assessment (CAPA) for 9-18 year olds (Angold and Costello, 1995, Angold and Costello, 2000, Angold et al., 1995). Table 1 details the key features of the PAPA, including training, modes of administration, and the content of the PAPA modules.

Sample Characteristics

Demographic characteristics of the screened sample, the test-retest sample, and surrounding Durham County where the study was conducted are presented in Table 3.

African American parents were somewhat more likely to participate in the screening (92.5% African Americans agreed versus. 87.8% for non-African Americans; p = 0.007). There were no significant differences between screen refusers and subjects by gender, age, or Medicaid status.

Of the parents completing the PAPA, 92.7% (n = 289) were

DISCUSSION

Given the well-known decision biases that are inherent in unstructured psychiatric assessments (Achenbach, 1985, Angold, 2002, Tversky and Kahneman, 1974), there is no doubt that the development of standardized structured diagnostic assessments has been a significant advance. Indeed, the use of such assessments has become a necessary requirement for research, and their use has also been strongly advocated for clinical settings as well (Angold, 2002). It is also generally accepted that such

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  • Cited by (0)

    This project was supported by grants from the National Institute of Mental Health ( R01 MH-63670 and K23 MH-02016 ).

    The authors would like to thank our inteviewing team: Brian Small, Letitia Huger, Virginia Covington, Neal Townsend, Rachel Kudler, and kathryn Keicher, as well as the physicians, nurses, and staff at the Duke Childrenapos;s Primary Care Clinic and the families who participated in this study.

    Information about how to obtain the PAPA and to be trained in its administration can be found at http://devepi.duhs.duke.edu or by e-mailing jrogerspsych.duhs.duke.edu.

    Disclosure: Dr. Egger is the recipient of a Pfizer Faculty Scholars Award in Clinical Epidemiology. The other authors have no financial relationships to disclose.

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