Interviewing Children: Development of the Dutch version of the Semistructured Clinical Interview for Children and Adolescents (SCICA) and testing of the psychometric properties

Psychopathology in children and adolescents can be an enormous source of concem because of interference with the developmental process in the growing child. Understanding of the nature and causes of child and adolescent psychiatric disorder, accompanied by increases in therapeutic efficacy, can help to enlarge the power of effective prevention and intervention (Rutter, 1988). In endeavors to expand knowledge of the nature and causes of emotional and behavioral disorders in children and adolescents the diagnostic process plays an important role. The diagnostic process comprises two essential elements, assessment and taxonomy. In the assessment process, distinguishing features in behaviors and emotions of individuals are identified. Various instmments and procedures can be used in this process to identify the distinguishing features of each individual case. The grouping of these cases according to their distinguishing features (similarities and differences) is accounted for by the concept of taxonomy. In the taxonomic process constmcts are generated by grouping distinguishing features on hierarchical levels of defining characteristics such as individual problems (symptoms), symptom aggregates (syndromes) or etiological factors

Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth

As hospital beds are scarce, and emergency admissions to a psychiatric ward are major life-events for children and adolescents, it is essential to have insight into the decision-making process that leads to them. To identify potentially modifiable factors, we, therefore, studied the contextual and clinical characteristics associated with the voluntary and compulsory emergency admission of minors. We used registry data (2008–2017) on 1194 outpatient emergencies involving children aged 6–18 who had been referred to the mobile psychiatric emergency service in two city areas in The Netherlands. Demographic and contextual factors were collected, as well as clinical characteristics including diagnoses, psychiatric history, Global Assessment of Functioning (GAF), and the Severity of Psychiatric Illness (SPI) scale. Logistic regression analyses were used to identify factors that predict voluntary or compulsory admission. Of 1194 consultations, 227 (19.0%) resulted in an admission, with 137 patients (11.5%) being admitted voluntarily and 90 (7.5%) compulsorily. Independently of legal status, the following characteristics were associated with admission: severity of psychiatric symptoms, consultation outside the patient’s home, and high levels of family disruption. Relative to voluntary admission, compulsory admission was associated with more severe psychiatric problems, higher suicide risk, and prior emergency compulsory admission. Two potentially modifiable factors were associated with psychiatric emergency admission: the place where patients were seen for consultation, and the presence of family problems. Psychiatric emergency admissions may be reduced if, whenever possible, minors are seen in their homes and if a system-oriented approach is used

Improving estimation of the prognosis of childhood psychopathology; combination of DSM-III-R/DISC diagnoses and CBCL scores [IF: 2.7]

Objective: To compare the predictive validity of the clinical-diagnostic and the empirical-quantitative approach to assessment of childhood psychopathology, and to investigate the usefulness of combining both approaches. Method: A referred sample (N=96), aged 6 to 12 years at initial assessment, was followed up across - on average - a period of 3.2 years. It was assessed to what extent DISC/DSM-III-R diagnoses - representing the clinical-diagnostic approach, and CBCL scores - representing the empirical-quantitative approach, predicted the following signs of poor outcome: outpatient/inpatient treatment, or parents' wish for professional help for the child at follow-up, disciplinary problems in school, and police/judicial contacts. Results: Both diagnostic systems added significantly to the prediction of poor outcome, and neither of the two systems was superior. Use of both systems simultaneously provided the most accurate estimation of the prognosis, reflected by the occurrence of future poor outcome. Even diagnostic concepts that are generally regarded as relatively similar, such as ADHD (DSM) and attention problems (CBCL), or conduct disorder (DSM) and delinquent behavior (CBCL), appeared to differ in their ability to predict poor outcome. Conclusions: The present study supports the use of the empirical-quantitative approach and the clinical-diagnostic approach simultaneously, both in research and in clinical settings, to obtain a comprehensive view of the prognosis of psychopathology in children. © Association for Child Psychology and Psychiatry, 2004

Heritability of attention problems in children II: longitudinal results from a study of twins age 3 to 12.

this paper we present data of large samples of twin families, with an equal number of girls and boys. The well-known gender difference with boys displaying more OA and AP was observed at each age. Even at the age of 3, boys display more OA problems than girls. Clinical studies have indicated that severe problem behavior can be identified in very young children (see for review, Campbell, 1995; Keenan & Wakschlag, 2000; Shaw, Owens, Giovannelli, & Winslow, 2001) and that the onset of ADHD is during the pre-school period (Barkley, Fisher, Edelbrock, & Smallish, 1990; Table 6 Top part includes percentages of total variances (diagonal) and covariances (off-diagonal) explained by additive genetic, genetic dominance, and unique environmental components based on best fitting models. Percentages for boys and girls are reported below and above diagonal, respectively. Lower part includes correlations calculated for additive genetic, genetic dominance, and unique environmental sources of variance between different ages. Correlations for boys and girls are reported below and above diagonal, respectively Relative proportions of variance and covariance BoysnGirls A% D% E% OA 3 AP 7 AP 10 AP 12 OA 3 AP 7 AP 10 AP 12 OA 3 AP 7 AP 10 AP 12 OA 3 50n41 73 79 75 22n33 17 13 14 28n26 10 8 11 AP 7 59 33n57 50 53 31 39n16 31 28 10 28n27 19 19 AP 10 86 31 41n48 47 6 51 31n25 32 8 18 28n27 21 AP 12 71 24 31 40n54 16 55 45 30n18 13 21 24 30n28 Correlations between different ages BoysnGirls ADE OA 3 AP 7 AP 10 AP 12 OA 3 AP 7 AP 10 AP 12 OA 3 AP 7 AP 10 AP 12 OA 3 1.00 .60 .66 .57 1.00 .30 .16 .20 1.00 .15 .12 .14 AP 7 .57 1.00 .62 .57 .41 1.00 .99 1.00 .15 1.00 .46 .41 AP 10 .68 .56 1.00 .61 .08 .94 1.00 1.00 .11 .42 1.00 .50 AP 12 .49 .42 .53 1.00 .20 .98 .99 1.00 .14 .45 .58 1.00 ..

Addressing aggression in the residential setting for juveniles with mild intellectual disability through training in non-violent resistance

Background Levels of aggression are high in residential settings for juveniles with Mild Intellectual Disability (MID). As a result, treatment is less effective, aggression causes injury, traumatic experiences and longer inhabitation for juveniles. Additionally, inpatient aggression has been linked to burnout and stress among group workers, which has negative consequences such as less job satisfaction or poorer work performance Objective Therefore, it is crucial to diminish aggressive incidents in these settings and to find a way for staff how to respond to aggression properly. Methods As there is no intervention method which tackles all of the referred problems efficiently, a new method Non-violent Resistance for MID was introduced into three residential settings for juveniles with MID, in a quasi-experimental stepped wedge design. Reports of aggressive incidents were assessed seven times before, during and after the training in NVR-MID on group level. Multilevel analyses were carried out in order to assess the development of the aggressive incidents over time. Results Aggressive incidents decreased significantly in time during and after training in NVR-MID, this decrease is seen in all three institutions. Thus, regardless of resident's age, gender or IQ, NVR-MID seemed successful in diminishing aggressive incidents. Furthermore, a significant interaction effect was found between institution and time, indicating that regardless if incidents of aggression were relatively high at baseline, decrease in incidents was similar to institutions where incidents were relatively low on baseline. Conclusions Implementing NVR-MID into residential settings for juveniles with MID and comorbid behavioral problems might help to decrease aggressive incidents

Improvement of group climate in a residential setting for juveniles with mild intellectual disability through training of staff in Non-Violent Resistance

Background An open group climate is essential in successful residential care for juveniles with mild intellectual disability (MID). This study examined whether non-violent resistance, adapted for MID (NVR-MID), stimulates an open group climate in time. Method NVR-MID was implemented in three residential settings in The Netherlands, in a quasi-experimental stepped wedge design. In total, 124 clients with MID (M-age = 16.39 [SD = 4.95], 49.9% male) participated. Group climate was assessed seven times with the Group Climate Inventory for Children or the Group Climate Inventory-Revisited (GCI-R), during a total of 20 months. Results Open group climate scores increased in all three institutions; effect size was medium. Clients with lower IQs experienced group climate as more positive compared to clients with higher IQs. Effects were similar for both groups. Conclusions As NVR-MID appeared to contribute to a positive experienced group climate, it might be advisable to implement NVR-MID on larger scale.New methods for child psychiatric diagnosis and treatment outcome evaluatio

Improving Work Climate in a Residential Setting for Juveniles with Mild Intellectual Disability through Training of Staff in Non-violent Resistance

In residential settings for juveniles with Mild Intellectual Disability (MID) employees have to face tough work conditions, because of frequent aggressive incidents Eventually, this might result in a negative work climate, high staff-turnover and absenteeism. In turn, it hampers a positive therapeutic environment for youngsters. A method that may endorse a better work climate is Non-violent Resistance (NVR). As earlier research suggests that the residential NVR, adjusted for juveniles with MID, is successful in diminishing aggressive incidents and improving group climate, we hypothesize that NVR-MID will be also effective in enhancing work climate. We investigated the perception of work climate by staff of three residential settings before, during and after implementation of NVR-MID. Work climate was assessed both quantitatively and qualitatively. Outcomes were subsequently integrated. Quantitative data was collected using the Living Group Working Climate Inventory (LGWCI). Multilevel analyses were carried out to analyse the development of work climate over time. Qualitative data were collected via semi-structured interviews with NVR-MID trained staff and analysed through qualitative coding. Quantitative results showed that Job Satisfaction decreased after NVR-MID implementation. However, within qualitative reports, staff members experienced a positive influence on work climate of NVR-MID.New methods for child psychiatric diagnosis and treatment outcome evaluatio

Relevance of Molecular Profiling in Patients With Low-Grade Endometrial Cancer

IMPORTANCE: Patients with low-grade (ie, grade 1-2) endometrial cancer (EC) are characterized by their favorable prognosis compared with patients with high-grade (ie, grade 3) EC. With the implementation of molecular profiling, the prognostic relevance of tumor grading might lose attention. As most patients present with low-grade EC and have an excellent outcome, the value of molecular profiling for these patients is unclear. OBJECTIVE: To determine the association of molecular profiling with outcomes among patients with low-grade EC. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included a multicenter international European cohort of patients diagnosed with EC between 1994 and 2018, with a median follow-up of 5.9 years. Molecular subgroups were determined by next-generation sequencing using single-molecule molecular inversion probes and by immunohistochemistry. Subsequently, tumors were classified as polymerase epsilon (POLE)-altered, microsatellite instable (MSI), tumor protein p53 (TP53)-altered, or no specific molecular profile (NSMP). Patients diagnosed with any histological subtypes and FIGO (International Federation of Gynecology and Obstetrics) stages of EC were included, but patients with early-stage EC (FIGO I-II) were only included if they had known lymph node status. Data were analyzed February 20 to June 16, 2022. EXPOSURES: Molecular testing of the 4 molecular subgroups. MAIN OUTCOMES AND MEASURES: The main outcome was disease-specific survival (DSS) within the molecular subgroups. RESULTS: A total of 393 patients with EC were included, with a median (range) age of 64.0 (31.0-86.0) years and median (range) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 29.1 (18.0-58.3). Most patients presented with early-stage (290 patients [73.8%]) and low-grade (209 patients [53.2%]) disease. Of all patients, 33 (8.4%) had POLE-altered EC, 78 (19.8%) had MSI EC, 72 (18.3%) had TP53-altered EC, and 210 (53.4%) had NSMP EC. Across all molecular subgroups, patients with low-grade EC had superior 5-year DSS compared with those with high-grade EC, varying between 90% to 100% vs 41% to 90% (P < .001). Multivariable analysis in the entire cohort including age, tumor grade, FIGO stage, lymphovascular space invasion, and the molecular subgroups as covariates found that only high-grade (hazard ratio [HR], 4.29; 95% CI, 2.15-8.53; P < .001), TP53-altered (HR, 1.76; 95% CI, 1.04-2.95; P = .03), and FIGO stage III or IV (HR, 4.26; 95% CI, 2.50-7.26; P < .001) disease were independently associated with reduced DSS. CONCLUSIONS AND RELEVANCE: This cohort study found that patients with low-grade EC had an excellent prognosis independent of molecular subgroup. These findings do not support routine molecular profiling in patients with low-grade EC, and they demonstrate the importance of primary diagnostic tumor grading and selective profiling in low-grade EC to increase cost-effectiveness