The Youth Online Diagnostic Assessment (YODA): Validity of a New Tool to Assess Anxiety Disorders in Youth

Abstract

This study developed an online diagnostic tool for anxiety disorders in youth, and evaluated its reliability and validity amongst 297 children aged 6–16 years (Mage = 9.34, 46% male). Parents completed the online tool, the Youth Online Diagnostic Assessment (YODA), which is scored either using a fully-automated algorithm, or combined with clinician review. In addition, parents and children completed a clinician-administered diagnostic interview and self-report measures of internalizing and externalizing symptoms and wellbeing. The fully-automated YODA demonstrated relatively weak agreement with the diagnostic interview for identifying the presence of any anxiety disorder and specific anxiety disorders, apart from separation anxiety (which had moderate agreement). The clinician-reviewed YODA showed better agreement than fully-automated scoring, particularly for identifying the presence of any anxiety disorder. The YODA demonstrated good agreement with parent-reported measures of symptoms/interference. The YODA offers a fully or largely automated method to determine the presence of anxiety disorders in youth, with particular value in situations where low-resource assessments are needed. While it currently requires further research and improvement, the YODA provides a promising start to the development of such a tool.

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Notes

  1. 1.

    A version reflecting DSM-5 criteria and a youth-report YODA are also being developed.

  2. 2.

    The same pattern of results emerged for correlations between symptom and interference measures and number of anxiety disorders across both tools [i.e., using YODA algorithm, YODA clinician-review and ADIS (parent-only or combined report)].

References

  1. 1.

    Rapee RM, Schniering CA, Hudson JL (2009) Anxiety disorders during childhood and adolescence: origins and treatment. Annu Rev Clin Psychol 5:311–341. https://doi.org/10.1146/annurev.clinpsy.032408.153628

    Article  PubMed  Google Scholar 

  2. 2.

    Higa-McMillan CK, Francis SE, Rith-Najarian L, Chorpita BF (2016) Evidence base update: 50 years of research on treatment for child and adolescent anxiety. J Clin Child Adolesc Psychol 45:91–113. https://doi.org/10.1080/15374416.2015.1046177

    Article  PubMed  Google Scholar 

  3. 3.

    Ewing DL, Monsen JJ, Thompson EJ, Cartwright-Hatton S, Field A (2015) A meta-analysis of transdiagnostic cognitive behavioural therapy in the treatment of child and young person anxiety disorders. Behav Cognit Psychother 43:562–577. https://doi.org/10.1017/S1352465813001094

    Article  Google Scholar 

  4. 4.

    James AC, James G, Cowdrey FA, Soler A, Choke A (2013) Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004690.pub3

    Article  PubMed  Google Scholar 

  5. 5.

    Merikangas KR, He J-p, Burstein M, Swendsen J, Avenevoli S, Case B et al (2011) Service utilization for lifetime mental disorders in U.S. adolescents: results of the national comorbidity survey-adolescent supplement (NCSA). J Am Acad Child Adolesc Psychiatry 50:32–45

    Article  Google Scholar 

  6. 6.

    Lawrence D, Johnson S, Hafekost J, de Haan BK, Sawyer M, Ainley J, Zubrick SR (2015) The mental health of children and adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. https://www.health.gov.au/internet/main/publishing.nsf/Content/9DA8CA21306FE6EDCA257E2700016945/$File/child2.pdf

  7. 7.

    Pennant ME, Loucas CE, Whittington C, Creswell C, Fonagy P, Fuggle P et al (2015) Computerised therapies for anxiety and depression in children and young people: a systematic review and meta-analysis. Behav Res Ther 67:1–18

    Article  Google Scholar 

  8. 8.

    Podina IR, Mogoase C, David D, Szentagotai A, Dobrean A (2016) A meta-analysis on the efficacy of technology mediated CBT for anxious children and adolescents. J Rat-Emot Cogn-Behav Ther 34:31–50

    Article  Google Scholar 

  9. 9.

    Rooksby M, Elouafkaoui P, Humphris G, Clarkson J, Freeman R (2015) Internet-assisted delivery of cognitive behavioural therapy (CBT) for childhood anxiety: systematic review and meta-analysis. J Anxiety Disord 29:83–92. https://doi.org/10.1016/j.janxdis.2014.11.006

    Article  PubMed  Google Scholar 

  10. 10.

    Lyneham HJ, Rapee RM (2005) Agreement between telephone and in-person delivery of a structured interview for anxiety disorders in children. J Am Acad Child Adolesc Psychiatry 44:274–282

    Article  Google Scholar 

  11. 11.

    March S, Spence SH, Donovan CL, Kenardy JA (2018) Large-scale dissemination of internet-based cognitive behavioral therapy for youth anxiety: Feasibility and acceptability study. J Med Internet Res 20:e234. https://doi.org/10.2196/jmir.9211

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Silverman WK, Albano AM (1996) The anxiety disorders interview schedule for children for DSM-IV: Child And Parent Versions. Psychological Corporation, San Antonia

    Google Scholar 

  13. 13.

    Shaffer D, Fisher P, Lucas CP, Dulcan MK (2000) Schwab-stone ME. NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 39:28–38

    Article  Google Scholar 

  14. 14.

    Goodman R, Ford T, Richards H, Gatward R, Meltzer H (2000) The development and well-being assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry Allied Discip 41:645–655

    Article  Google Scholar 

  15. 15.

    Kaufman J, Birmaher B, Brent D, Rao U, Ryan N (1996) The schedule for affective disorders and schizophrenia for school-age children. University of Pittsburgh Medical Center, Pittsburgh

    Google Scholar 

  16. 16.

    Silverman W, Ollendick TH (2005) Evidence-based assessment of anxiety and its disorders in children and adolescents. J Clin Child Adolesc Psychol 34:380–411

    Article  Google Scholar 

  17. 17.

    Leffler JM, Riebel J, Hughes HM (2015) A review of child and adolescent diagnostic interviews for clinical practitioners. Assessment 22:690–703

    Article  Google Scholar 

  18. 18.

    Frick PJ, Lilienfeld SO, Ellis M, Loney B, Silverthorn P (1999) The association between anxiety and psychopathy dimensions in children. J Abnorm Child Psychol 27:383–392

    Article  Google Scholar 

  19. 19.

    Jensen PS, Watanabe HK, Richters JE, Roper M, Hibbs ED, Salzberg AD, Liu S (1996) Scales, diagnoses, and child psychopathology: II. Comparing the CBCL and the DISC against external validators. J Abnorm Child Psychol 24:151–168

    Article  Google Scholar 

  20. 20.

    Weems CF, Feaster DJ, Horigian VE, Robbins MS (2011) Parent and child agreement on anxiety disorder symptoms using the DISC predictive scales. Assessment 18:213–216

    Article  Google Scholar 

  21. 21.

    Newman MG, Consoli A, Taylor CB (1997) Computers in assessment and cognitive behavioral treatment of clinical disorders: anxiety as a case in point. Behav Ther 28:211–235. https://doi.org/10.1016/S0005-7894(97)80044-5

    Article  Google Scholar 

  22. 22.

    Elford R, White H, Bowering R, Ghandi A, Maddiggan B, St John K et al (2000) A randomized, controlled trial of child psychiatric assessments conducted using videoconferencing. J Telemed Telecare 6:73–82

    Article  Google Scholar 

  23. 23.

    Ko SJ, Wasserman GA, McReynolds LS, Katz LM (2004) Contribution of parent report to voice DISC-IV diagnosis among incarcerated youths. J Am Acad Child Adolesc Psychiatry 43:868–877. https://doi.org/10.1097/01.chi.0000128788.03192.fa

    Article  PubMed  Google Scholar 

  24. 24.

    Wasserman GA, McReynolds LS, Lucas CP, Fisher P, Santos L (2002) The voice DISC-IV with incarcerated male youths: prevalence of disorder. J Am Acad Child Adolesc Psychiatry 41:314–321. https://doi.org/10.1097/00004583-200203000-00011

    Article  PubMed  Google Scholar 

  25. 25.

    West P, Sweeting H, Der G, Barton J, Lucas C (2003) Voice DISC identified DSM-IV disorders among 15-year olds in the West of Scotland. J Am Acad Child Adolesc Psychiatry 42:941–949. https://doi.org/10.1097/01.CHI.0000046907.27264.E4

    Article  PubMed  Google Scholar 

  26. 26.

    Hayes MA, McReynolds LS, Wasserman GA (2005) Paper and voice MAYSI-2 format comparability and concordance with the voice DISC-IV. Assessment 12:395–403. https://doi.org/10.1177/1073191105280359

    Article  PubMed  Google Scholar 

  27. 27.

    Steenhuis M, Serra M, Minderaa RB, Hartman CA (2009) An internet version of the diagnostic interview schedule for children (DISC-IV): correspondence of the ADHD Section with the paper-and-pencil version. Psychol Assess 21:231–234. https://doi.org/10.1037/a0015925

    Article  PubMed  Google Scholar 

  28. 28.

    Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E et al (1998) The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33

    Google Scholar 

  29. 29.

    Goodman R (2003) Online child and adolescent mental health surveys can be good enough. Soc Psychiatry Psychiatr Epidemiol 48:1317–1325. https://doi.org/10.1007/s00127-013-0658-2

    Article  Google Scholar 

  30. 30.

    Grills AE, Ollendick TH (2003) Multiple informant agreement and the Anxiety Disorders Interview Schedule for Parents and Children. J Am Acad Child Adolesc Psychiatry 42:30–40

    Article  Google Scholar 

  31. 31.

    Rapee RM, Barrett PM, Dadds MR, Evans L (1994) Reliability of the DSM-III-R childhood anxiety disorders using structured interview: interrater and parent-child agreement. J Am Acad Child Adolesc Psychiatry 33:984–992

    Article  Google Scholar 

  32. 32.

    Rapee RM, Lyneham HJ, Wuthrich V, Chatterton M-L, Hudson JL, Kangas M, Mihalopoulos C (2017) Comparison of stepped care delivery against a single, empirically validated CBT program for anxious youth: a randomized clinical trial. J Am Acad Child Adolesc Psychiatry 56:841–848

    Article  Google Scholar 

  33. 33.

    Iverach L, Jones M, McLellan LF, Lyneham HJ, Menzies RG, Onslow M, Rapee RM (2016) Prevalence of anxiety disorders among children who stutter. J Fluen Disord 49:13–28. https://doi.org/10.1016/j.jfludis.2016.07.002

    Article  Google Scholar 

  34. 34.

    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  35. 35.

    Ford T, Goodman R, Meltzer H (1999) The British child and adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders. J Am Acad Child Adolesc Psychiatry 42:1203–1211

    Article  Google Scholar 

  36. 36.

    Spence SH (1998) A measure of anxiety symptoms among children. Behav Res Ther 36:545–566

    Article  Google Scholar 

  37. 37.

    Nauta MH, Scholing A, Rapee RM, Abbott M, Spence SH, Waters A (2004) A parent-report measure of children’s anxiety: psychometric properties and comparison with child-report in a clinic and normal sample. Behav Res Ther 42:813–839. https://doi.org/10.1016/S0005-7967(03)00200-6

    Article  PubMed  Google Scholar 

  38. 38.

    Angold A, Costello EJ, Messer SC, Pickles A, Winder F, Silver D (1995) The development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res 5:237–249

    Google Scholar 

  39. 39.

    Goodman R (1997) The strengths and difficulties questionnaire—a research note. J Child Psychol Psychiatry 38:581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x

    Article  PubMed  Google Scholar 

  40. 40.

    Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40:1337–1345

    Article  Google Scholar 

  41. 41.

    Lyneham HJ, Sburlati ES, Abbott MJ, Rapee RM, Hudson JL, Tolin D, Carlson SE (2013) Psychometric Properties of the Child Anxiety Life Interference Scale (CALIS). J Anxiety Disord 27:711–719

    Article  Google Scholar 

  42. 42.

    McHugh ML (2012) Interrater reliability: the Kappa statistic. Biochem Med 22:276–282

    Article  Google Scholar 

  43. 43.

    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  Google Scholar 

  44. 44.

    Reynolds S, Wilson C, Austin J, Hooper L (2012) Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev 32:251–262. https://doi.org/10.1016/j.cpr.2012.01.005

    Article  Google Scholar 

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Acknowledgements

We would like to thank the research staff and clinicians who worked on this project, and the families who participated.

Funding

This research was supported by National Health and Medical Research Council Grant APP1027556.

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Correspondence to Lauren F. McLellan.

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McLellan, L.F., Kangas, M., Rapee, R.M. et al. The Youth Online Diagnostic Assessment (YODA): Validity of a New Tool to Assess Anxiety Disorders in Youth. Child Psychiatry Hum Dev 52, 270–280 (2021). https://doi.org/10.1007/s10578-020-01007-3

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Keywords

  • Anxiety disorders
  • Internet
  • Assessment
  • Diagnosis