Comparing the Diagnostic Accuracy of Five Instruments for Detecting Posttraumatic Stress Disorder in Youth

To compare diagnostic accuracy of five posttraumatic stress disorder (PTSD) measures in a large outpatient sample of youths aged 11 to 18 years

Understanding the relationship between co-occurring PTSD and MDD: Symptom severity and affect

How to best understand theoretically the nature of the relationship between co-occurring PTSD and MDD (PTSD+MDD) is unclear. In a sample of 173 individuals with chronic PTSD, we examined whether the data were more consistent with current co-occurring MDD as a separate construct or as a marker of posttraumatic stress severity, and whether the relationship between PTSD and MDD is a function of shared symptom clusters and affect components. Results showed that the more severe depressive symptoms found in PTSD+MDD as compared to PTSD remained after controlling for PTSD symptom severity. Additionally, depressive symptom severity significantly predicted co-occurring MDD even when controlling for PTSD severity. In comparison to PTSD, PTSD+MDD had elevated dysphoria and re-experiencing – but not avoidance and hyperarousal – PTSD symptom cluster scores, higher levels of negative affect, and lower levels of positive affect. These findings provide support for PTSD and MDD as two distinct constructs with overlapping distress components

Predictors and moderators of agreement between clinical and research diagnoses for children and adolescents.

Diagnoses play an important role in treatment planning and monitoring, but extensive research has shown low agreement between clinician-generated diagnoses and those from structured diagnostic interviews. However, most prior studies of agreement have not used research diagnoses based on gold standard methods, and research needs to identify characteristics of diagnostically challenging clients. This study examined agreement between youth diagnoses generated through the research-based LEAD (Longitudinal, Expert, and All Data) Standard to clinician diagnoses

Examining the validity of cyclothymic disorder in a youth sample: Replication and extension

Four subtypes of bipolar disorder (BP) – bipolar I, bipolar II, cyclothymia and bipolar not otherwise specified (NOS) – are defined in DSM-IV-TR. Though the diagnostic criteria for each subtype are intended for both adults and children, research investigators and clinicians often stray from the DSM when diagnosing pediatric bipolar disorder (PBD) (Youngstrom, 2009), resulting in a lack of agreement and understanding regarding the PBD subtypes

Patterns of therapeutic alliance: Rupture–repair episodes in prolonged exposure for posttraumatic stress disorder.

To better understand the role of therapeutic alliance in PTSD treatment, we examined patterns of and shifts in alliance. First, we identified individuals with repaired ruptures, unrepaired ruptures, and no ruptures in alliance. Then, we explored group differences in these alliance events for clients with common clinical correlates (i.e., co-occurring depression and childhood abuse history) and whether or not the presence of these events influenced treatment outcome

Generalizability of evidence-based assessment recommendations for pediatric bipolar disorder.

Bipolar disorder is frequently clinically diagnosed in youths who do not actually satisfy DSM-IV criteria, yet cases that would satisfy full DSM-IV criteria are often undetected clinically. Evidence-based assessment methods that incorporate Bayesian reasoning have demonstrated improved diagnostic accuracy, and consistency; however, their clinical utility is largely unexplored. The present study examines the effectiveness of promising evidence-based decision-making compared to the clinical gold standard. Participants were 562 youth, ages 5-17 and predominantly African American, drawn from a community mental health clinic. Research diagnoses combined semi-structured interview with youths’ psychiatric, developmental, and family mental health histories. Independent Bayesian estimates relied on published risk estimates from other samples discriminated bipolar diagnoses, Area Under Curve=.75, prs =.30. Agreement about an evidence-based assessment intervention “threshold model” (wait/assess/treat) had K=.24, pr=.81,

Reward Dysregulation and Mood Symptoms in an Adolescent Outpatient Sample

Research on bipolar spectrum disorders (BPSD) in adolescence has burgeoned in the last decade, but continued work is needed to identify endophenotypic markers associated with illness onset and course. The present study examined reward dysregulation – measured via the behavioral activation system (BAS) – as one putative marker of BPSD in adolescence. A diverse group of 425 outpatient adolescents between 11–17 years of age (52% male) completed the Behavioral Inhibition and Activation Scale (BIS-BAS) scale to measure reward dysregulation. Semi-structured interviews determined diagnoses and severity of mood symptoms. Parent-reported BAS was associated with increased symptoms of mania, and parent and adolescent-reported BAS were associated with symptoms of depression. Parent-reported BIS scores were associated with increased symptoms of mania. Results held independent of diagnostic status. Furthermore, parent BIS/BAS reports were stronger predictors for manic symptoms compared to adolescent-reports. Results extend work in adults with BPSD, suggesting a transdiagnostic association between reward dysregulation and mood symptom severity in adolescence

Internal Consistency and Associated Characteristics of Informant Discrepancies in Clinic Referred Youths Age 11 to 17 Years

In this study, we examined the internal consistency of informant discrepancies in reports of youth behavior and emotional problems and their unique relations with youth, caregiver, and family characteristics. In a heterogeneous multisite clinic sample of 420 youths (ages 11 to 17 years), high internal consistency estimates were observed across measures of informant discrepancies. Further, latent profile analyses identified systematic patterns of discrepancies, characterized by their magnitude and direction (i.e., which informant reported greater youth problems). Additionally, informant discrepancies systematically and uniquely related to informants' own perspectives of youth mood problems, and these relations remained significant after taking into account multiple informants' reports of informant characteristics widely known to relate to informant discrepancies. These findings call into the question the prevailing view of informant discrepancies as indicative of unreliability and/or bias on the part of informants' reports of youths' behavior

Distinguishing primary and secondary variants of callous-unemotional traits among adolescents in a clinic-referred sample.

The current study used model-based cluster analyses to determine if there are two distinct variants of adolescents (ages 11 - 18) high on callous-unemotional (CU) traits that differ on their level of anxiety and history of trauma. The sample (n = 272) consisted of clinic-referred youths who were primarily African-American (90%) and from low income families. Consistent with hypotheses, three clusters emerged, including a group low on CU traits, as well as two groups high on CU traits that differed in their level of anxiety and past trauma. Consistent with past research on incarcerated adults and adolescents, the group high on anxiety (i.e., secondary variant) was more likely to have histories of abuse and had higher levels of impulsivity, externalizing behaviors, aggression, and behavioral activation. In contrast, the group low on anxiety (i.e., primary variant) scored lower on a measure of behavioral inhibition. On measures of impulsivity and externalizing behavior, the higher scores for the secondary cluster only were found for self-report measures, not on parent-report measures. Youths in the primary cluster also were perceived as less credible reporters than youth in the secondary or cluster low on CU traits. These reporter and credibility differences suggest that adolescents within the primary variant may underreport their level of behavioral disturbance, which has important assessment implications

Informant Discrepancies in Clinical Reports of Youths and Interviewers' Impressions of the Reliability of Informants

In this study the authors examined whether discrepancies between parent and youth reports of the youth's emotional and behavioral functioning are related to interviewers' reliability ratings of parents and youths