Journal of Abnormal Child Psychology

, Volume 23, Issue 1, pp 45–65

Diagnosis, assessment, and comorbidity in psychosocial treatment research

  • Thomas M. Achenbach
Article

Abstract

This paper identifies problems in prevailing terminology and conceptual models that may hinder research on treatment. To avoid the multiple meanings of diagnosis,the term assessmentis used in reference to identifying the distinguishing features of individual cases, while taxonomyis used to designate the grouping of cases according to their distinguishing features. Treatment research requires clear specification of the behavioral/emotional problems and competencies targeted for intervention. Artifactual comorbidity can be avoided by specifying treatment targets at several levels, including competencies, specific problems, syndromes, profiles of syndrome scores, and global problem scores. To select subjects for treatment research and to evaluate outcomes, multisource data can be coordinated by using a cross-informant computer program, taxonomic decision tree, and averaging of multisource standard scores.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Achenbach, T. M. (1991a).Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  2. Achenbach, T. M. (1991b).Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  3. Achenbach, T. M. (1991c).Manual for the Teacher's Report Form and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  4. Achenbach, T. M. (1991d).Manual for the Youth Self-Report and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  5. Achenbach, T. M. (1993).Empirically based taxonomy: How to use syndromes and profile types derived from the CBCL/4-18, TRF, and YSR. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  6. Achenbach, T. M., Bird, H. R., Canino, G. J. Phares, V., Gould, M., & Rubio-Stipec, M. (1990). Epidemiological comparisons of Puerto Rican and U.S. mainland children: Parent, teacher, and self reports.Journal of the American Academy of Child and Adolescent Psychiatry, 29, 84–93.PubMedGoogle Scholar
  7. Achenbach, T. M., Hensley, V. R., Phares, V., & Grayson, D. (1990). Problems and competencies reported by parents of Australian and American children.Journal of Child Psychology and Psychiatry, 31, 265–286.PubMedGoogle Scholar
  8. Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity.Psychological Bulletin, 101, 213–232.PubMedGoogle Scholar
  9. Achenbach, T. M., Verhulst, F. C., Baron, G. D., & Akkerhuis, G. W. (1987). Epidemiological comparisons of American and Dutch children: I. Behavioral/emotional problems and competencies reported by parents for ages 4 to 16.Journal of the American Academy of Child and Adolescent Psychiatry, 26, 317–325.PubMedGoogle Scholar
  10. American Psychiatric Assocation. (1968).Diagnostic and statistical manual of mental disorders (2nd ed.), Washington, DC: Author.Google Scholar
  11. American Psychiatric Association. (1980).Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
  12. American Psychiatric Association. (1987).Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.Google Scholar
  13. American Psychiatric Association. (1994).Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  14. Berkson, J. (1946). Limitations of the application of fourfold table analysis to hospital data.Biometrics Bulletin, 2, 47–53.Google Scholar
  15. Bird, H. R., Gould, M. S., & Staghezza, B. (1992). Aggregating data from multiple informants in child psychiatry epidemiological research.Journal of the American Academy of Child and Adolescent Psychiatry, 31, 78–85.PubMedGoogle Scholar
  16. Costello, A. J., Edelbrock, C., Dulcan, M. K., Kalas, R., & Klaric, S. H. (1984).Report on the Diagnostic Interview Schedule for Children (DISC). Pittsburgh, PA: University of Pittsburgh, Department of Psychiatry.Google Scholar
  17. Fombonne, E. (1991). The use of questionnaires in child psychiatry research: Measuring their performance and choosing an optimal cut-off.Journal of Child Psychology and Psychiatry, 32, 677–693.PubMedGoogle Scholar
  18. Guzé, S. (1978). Validating criteria for psychiatric diagnosis: The Washington University approach. In M. S. Akiskal & W. L. Webb (Eds.),Psychiatric diagnosis: Exploration of biological predictors. New York: Spectrum.Google Scholar
  19. Kendall, P. C., & Morris, R. J. (1991). Child therapy: Issues and recommendations.Journal of Consulting and Clinical Psychology, 6, 777–784.Google Scholar
  20. Mattison, R., Cantwell, D. P., Russell, A. T., & Will, L. (1979). A comparison of DSM-II and DSM-III in the diagnosis of childhood psychiatric disorders.Archives of General Psychiatry, 36, 1217–1222.PubMedGoogle Scholar
  21. Mezzich, A. C., Mezzich, J. E., & Coffman, G. A. (1985). Reliability of DSM-III vs. DSM-II in child psychopathology.Journal of the American Academy of Child Psychiatry, 24, 273–280.PubMedGoogle Scholar
  22. Overall, J. E., & Hollister, L. E. (1979). Comparative evaluation of research diagnostic criteria for schizophrenia.Archives of General Psychiatry, 36, 1198–1205.PubMedGoogle Scholar
  23. Shaffer, D. (1992).Diagnostic Interview Schedule for Children, Version 2.3. New York: Columbia University, Division of Child Psychiatry.Google Scholar
  24. Stanger, C., Fombonne, E., & Achenbach, T. M. (1994). Epidemiological comparisons of American and French children: Parent reports of problems and competencies for ages 6–11.European Child and Adolescent Psychiatry, 3, 16–29.Google Scholar
  25. Steingard, R., Biederman, J., Doyle, A., & Sprich-Buckminster, S. (1992). Psychiatric comorbidity in attention deficit disorder: Impact on the interpretation of Child Behavior Checklist results.Journal of the American Academy of Child and Adolescent Psychiatry, 31, 449–454.PubMedGoogle Scholar
  26. Verhulst, F. C., Akkerhuis, G. W., & Althaus, M. (1985). Mental health in Dutch children: (I) A cross-cultural comparison.Acta Psychiatrica Scandinavica, 72 (Suppl. 323).Google Scholar
  27. Verhulst, F. C., Prince, J., Vervuurt-Poot, C., & de Jong, J. B. (1989). Mental health in Dutch children: (IV) Self-reported problems for ages 11–18.Acta Psychiatrica Scandinavica, 80 (Suppl. 356).Google Scholar
  28. Walker, J. L., Lahey, B. B., Russo, M. F., Christ, M. A. G., McBurnett, K., Loeber, R., Stouthamer-Loeber, M., & Green, S. M. (1991). Anxiety, inhibition, and conduct disorder in children: I. Relations to social impairment.Journal of the American Academy of Child and Adolescent Psychiatry, 30, 187–191.PubMedGoogle Scholar
  29. Weinstein, S. R., Noam, G. G., Grimes, K., Stone, K., & Schwab-Stone, M. (1990). Convergence of DSM-III diagnoses and self-reported symptoms in child and adolescent inpatients.Journal of the American Academy of Child and Adolescent Psychiatry, 29, 627–634.PubMedGoogle Scholar
  30. Werry, J. S., Methven, R. J., Fitzpatrick, J., & Dixon, H. (1983). The interrater reliability of DSM-III in children.Journal of Abnormal Child Psychology, 11, 341–354.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Thomas M. Achenbach
    • 1
  1. 1.Department of PsychiatryUniversity of VermontBurlingtonUSA

Personalised recommendations