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Biomedical subjects

D Cicchetti

Publications and source records attributed to D Cicchetti.

At least 55 records · Page 3Linked to original sources

Differentiating pervasive developmental disorder not otherwise specified from autism and language disorders.

Features useful in distinguishing children with pervasive developmental disorder (PDD) from those with autism or language disorder were developed from a retrospective chart review using groups of children with PDD-NOS and MA- and sex-matched autistic and language-disordered groups. Charts were reviewed using a list of 80 items compiled from various sources. Items that had adequate interrater reliability and significantly discriminated the PDD-NOS cases from the language-disordered or autistic cases were then evaluated using a second set of cases and signal detection methods. Fewer items significantly discriminated cases with autism from those with PDD-NOS as compared to cases with language disorder. Clinical implications are discussed.

Autistic Disorder↗

Toward an ecological/transactional model of community violence and child maltreatment: consequences for children's development.

In recent decades it has become increasingly apparent that violence affects a significant proportion of families in the United States (Bureau of Justice Statistics 1983). Violence, in fact, is becoming a defining characteristic of American society. A recent comparison of the rates of homicide among 21 developed nations indicates that the United States has the highest homicide rate in the world, and its rate is more than four times higher than the next highest rate (Fingerhut and Kleinman 1990). What is even more alarming is the high incidence of violent death and injury for children and adolescents in the United States. Acts of violence are the cause of death for over 2000 children between the ages of 0 and 19 years each year, and more than 1.5 million children and adolescents are abused by their adult caretakers each year (Christoffel 1990).

Child↗

Re-examining handedness in schizophrenia: now you see it--now you don't.

The present study was designed to examine patterns of handedness across tasks (i.e., those requiring less vs. greater skill) and over time (initially and 1 month later) in 72 schizophrenic patients and 105 normal controls. Two important methodologic advances were introduced: (1) two handedness tasks, varying in skill level (simple vs. complex); and (2) the addition of a retest on both tasks, 1 month later. Results show a higher incidence (43%) of mixed handedness in the schizophrenic sample than in normal controls (14.3%) on tasks requiring less precision in performance. Similar results were obtained when schizophrenic patients were retested 1 month later, RI = .88. When the more demanding set of tasks was presented, the frequency of mixed handed schizophrenics dropped by 50% at initial testing. Despite these findings, there was no evidence for stability of change over time. For example, each of the most extreme shifters at Time 1 was fully lateralized 1 month later.

Adult↗

Characteristics of youths identified from a psychiatric case register as first-time users of services.

OBJECTIVE: The study examined associations between sociodemographic factors and first-time use of mental health services by children and adolescents, including whether the patterns differ by age at first treatment contact. METHODS: The authors examined sociodemographic characteristics of 4,949 youths listed on a psychiatric case register in Monroe County, New York, who were under age 19 when first seen for public mental health treatment between 1987 and 1989. Data on race and type of insurance for patients in the county's four catchment areas were compared with 1980 census data. Insurance was categorized as public (such as Medicaid) or private and was used as a proxy for socioeconomic status. RESULTS: Both minority and publicly insured youths of low socio-economic status were overrepresented in the treatment population in relation to their numbers in the county, although publicly insured youths from the poorest catchment area were underrepresented in the treatment population. Among children (ages five to 12) in the treatment population, males outnumbered females by 2 to 1, but among adolescents (ages 13 to 18), the numbers were similar. Among minority groups, children receiving first-time mental health services were more likely to have public insurance. Minority adolescents were somewhat more likely to be privately than publicly insured.

Adolescent↗

The Positive and Negative Syndrome Scale and the Brief Psychiatric Rating Scale. Reliability, comparability, and predictive validity.

In a psychiatric rehabilitation study, 154 concurrent ratings were performed using the 30-item Positive and Negative Syndrome Scale (PANSS) and the 18-item Brief Psychiatric Rating Scale (BPRS). Although both instruments had excellent interrater reliability, the PANSS was consistently better: on the 18 symptom items the two instruments share, the PANSS had higher intraclass r's on 14; for the syndromes, the PANSS was higher than the BPRS on positive, negative, and total. Weighted Kappas comparing shared items revealed that most were not interchangeable, with only three coefficients in the excellent range. However, syndrome scale scores were very highly correlated and resulted in similar classification for negative schizophrenia. Ten of the 12 items of the PANSS not included in the BPRS had low zero-order correlations with BPRS items, which suggests that they measure symptoms distinct from those measured by the BPRS and should add to clinical predictive power. This proved true in our study of rehabilitation of patients with schizophrenia. PANSS symptom ratings explained up to 55% of the variance on seven measures of work performance, whereas the BPRS had lower predictive power on six of the seven measures. We concluded that the PANSS may be superior to the BPRS in clinical research on schizophrenia and that most BPRS items are not interchangeable with identically named PANSS items.

Adult↗

Detection of dissociative disorders in psychiatric patients by a screening instrument and a structured diagnostic interview.

OBJECTIVE AND METHOD: Diagnosis and treatment of the dissociative disorders may be delayed for many years because of difficulties in detecting patients at high risk for dissociative disorders. This study investigates the utility of the Dissociative Experiences Scale (DES), a self-report instrument for dissociative experiences, in detecting patients at high risk for dissociative disorders. The clinician-administered Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D) was used as the diagnostic standard, and 36 outpatients with mixed diagnoses and nine normal subjects were evaluated for the presence and absence of a dissociative disorder. DES scores were then compared. RESULTS: Results indicate that a DES cutoff score of 15-20 yields good to excellent sensitivity and specificity as a screening instrument. However, for higher cutoff points the sensitivity can be much lower. CONCLUSIONS: Thus, although the DES can be used to identify some high-risk patients, they should be further evaluated with such diagnostic instruments as the SCID-D or by in-depth clinical follow-up.

Adult↗

The child-psychoanalytic play interview: a technique for studying thematic content.

Child psychoanalysts have long viewed play as a reflection of children's inner lives and have used the themes children represent in play for diagnostic and therapeutic work. Given the central role children's play has for clinical work, few studies have addressed play empirically. This paper presents a technique for studying the thematic content of children's play as it emerges during a play session with a child analyst. We report the steps involved in developing this investigative technique and describe the interobserver agreement among four rates using the technique with videotaped play sessions. Implications for future research using such an approach are discussed.

Fantasy↗

Self-concept, motivation, and competence among preschoolers from maltreating and comparison families.

Maltreated children are at risk for impaired cognitive and school functioning. In this study, the role that home environment, self-concept, and mastery motivation play in this relation was investigated. Thirty-six preschool children and their mothers, representing three family backgrounds (12 low-income maltreating, 12 low-income comparison, 12 middle-income comparison), were assessed in a preschool/home study. Children from maltreating families scored lower than their peers on several measures of cognitive and physical competence and on ratings of motivation. At the same time, these children significantly overrated their physical competence, and self-ratings of competence and acceptance tended to be higher (and less realistic) than those of their low-income peers. An overall difference in developmental quality of the home environment of maltreating families was largely accounted for by socioeconomic status (SES), but the tendency of these homes to be less clean and safe remained significant even after SES was controlled. Various aspects of the home environment were associated with superior task performance, but not with motivation or self-perceptions. Whereas the general home environment may affect competence, relationship factors implicated in maltreatment may be more important in shaping self-concept and motivation.

Achievement↗

Childhood comorbidity of anxiety/affective disorders and behavior disorders.

Considerable data have been reported concerning comorbidity of various individual psychiatric disorders in children within the diagnostic supradomains of affect/anxiety disorders and behavior disorders as well as between these supradomains. To further examine such comorbidity, 35 psychiatrically hospitalized children were studied in terms of the prevalence of comorbidity, demographic and cognitive characteristics, adaptive functioning and maladaptive behaviors. The prevalence of comorbid behavior + affect/anxiety disorders exceeded 50% of the samples. Children with such comorbidity were similar to children with Behavior only diagnoses in terms of demographic and cognitive characteristics but differed in terms of adaptive functioning and maladaptive behaviors.

Anxiety Disorders↗

Do object relations deficits distinguish BPD from other diagnostic groups?

Two independent samples that met DSM-III criteria for borderline personality disorder (BPD) were found to have similar patterns of object relations deficits as measured by group means and percentage of high scoring subjects on the four subscales of the Bell Objects Relation (OR) Inventory. Statistical comparison of the composite BPD group with affective, schizoaffective, and schizophrenic groups revealed that the pattern of OR deficits in BPD was significantly different from each of the other diagnostic groups. On the basis of scores from the Alienation subscale alone, BPD subjects could be distinguished from the other diagnostic groups with 77-82% predictive accuracy. The role of object relations deficits in BPD is discussed, along with potential contributions of the Bell OR Inventory to diagnostic efficiency.

Adult↗