Diagnostic Assessment in Child and Adolescent Psychopathology
The field of psychiatry has come a long way since we made diagnoses by our instincts and since every odd child received the label of childhood schizophrenia. The Diagnostic and Statistical Manual has provided the field with clear-cut criteria for different disorders, but those criteria need to be joined to a scientific method for assessing symptoms. This edited volume brings together leading authorities on the use of interviews, rating instruments, and biological measures that have been developed or refined to do that.
The text is composed of four sections, the first of which provides an in-depth examination of measures used for assessing general pathology. Setting the stage and providing some of the basic issues for the entire textbook are chapters on structured interviews, now called respondent-based interviews; on semistructured interviews, now called interviewer-based interviews; and general child behavior rating scales. The chapter on interviewer-based interviews has a wonderfully graphic depiction of the differences between the large number of these instruments.
The next section discusses measures for assessing specific disorders—disruptive behaviors, mood and anxiety disorders, and pervasive developmental and communication disorders. The chapters provide detailed psychometric properties of a large number of instruments. This section may be the most difficult to read if you are unfamiliar with many of the measures, but it is extremely useful for the researcher.
The chapters in this section could have been improved by some uniformity in their structure. The one on disruptive behavior problems takes a nice lead in providing both a table that gives some of the basic properties of the rating scales and an appendix covering where to obtain additional information on the scales discussed. Unfortunately, the other chapters do not follow this format. The chapter on anxiety and mood disorders regrettably limits itself to self-rating instruments and thus leaves out some important instruments such as the Children's Depression Rating Scale and the CY-BOCS for obsessive-compulsive disorder. None of the chapters discuss instruments for rating tic symptoms.
Section 3 addresses many important aspects of assessment, including family history, retrospective recall, and cultural, racial, and socioeconomic influences on assessment. It also incorporates a chapter on the evaluation of functional impairment. These are crucial elements for any researcher, but clinicians picking up this text will also find this section extremely useful and well written. The final section discusses both the uses and potential pitfalls of sleep, neuroendocrine, and neurochemical measures. These chapters are rather technical and probably will be of more use to biological researchers than to clinicians.
Although Diagnostic Assessment in Child and Adolescent Psychopathology may have been compiled with the researcher in mind, it should be on the bookshelf of anyone working in the field. For the student, it is a reference book to be pulled out when trying to understand the complexities of assessment. For the clinician, it will aid in deciding what rating scales may be useful in the evaluation and treatment of children. The text provides a window onto the complexities of obtaining useful information from different informants about children with different kinds and levels of pathology.
Dr. Hirsch is assistant professor of clinical psychiatry and deputy director of the New York University Child Study Center. Dr. Koplewicz is professor of clinical psychiatry and director of the center.
