Diagnostic Infant and Preschool Assessment

Submitted by mholliday on Tue, 02/26/2013 - 10:42

Overview

Acronym: 
DIPA
Author(s): 
Scheeringa, M.S.
Citation: 

Scheeringa MS, Haslett, N (2010).  The reliability and criterion validity of the Diagnostic Infant and Preschool Assessment: A new diagnostic instrument for young children.  Child Psychiatry & Human Development, 41, 3, 299-312.

Obtain(Email/Website): 
It may be downloaded for free from the Tulane Institute of Infant and Early Childhood Mental Health website at http://www.infantinstitute.com/. Click on the Measures and Manuals link on the home page.
Cost: 
Free
Copyrighted: 
Yes
Measure Description: 

The DIPA is an interview of caregivers for children from nine months to six years old. It covers symptoms in thirteen diagnostic categories in self-contained modules that have disorder-specific functional impairment ratings - posttraumatic stress disorder (PTSD), major depression disorder (MDD), bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder, separation anxiety disorder (SAD), specific phobia, social phobia, generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), reactive attachment disorder, and sleep disorders.  The symptoms are linked to the DSM-IV criteria (and will be modified when the DSM-5 is released).

Domain(s) Assessed : 
Trauma Exposure/Reminders
Traumatic Stress
Anxiety/Mood (Internalizing Symptoms)
Externalizing Symptoms
Psychosocial Functioning
Age Range: 
0-6
Measure Type: 
General Assessment
# of Items: 
517 items, including 186 items for PTSD. The number of items and the interview length may be shortened by omitting the items for onset, frequency and duration of individual symptoms.
Measure Format: 
Semi-structured Interview
Average Time to Complete (min): 
60-180 depending upon the number of symptoms endorsed and brevity of the respondent.
Reporter Type: 
Parent/Caregiver
Average Time to Score (min): 
N/A. Items are endorsed while the interview is conducted.
Periodicity: 
The DIPA should be administered as needed to evaluate for symptoms or the diagnosis of PTSD.
Response Format: 
DomainScalesSample Items
PTSD SymptomsRe-experiencing"Does s/he have intrusive memories of the trauma? Does s/he bring it up on his/her own?"
 Avoidance"Does s/he try to avoid any things or places that might remind him/her of the trauma? I mean, can you tell that s/he is trying to avoid a reminder before s/he becomes upset?"
 Hyperarousal"Has s/he been more "on the alert" for bad things happening than before the trauma? I mean, does s/he look over her shoulder, looking out for danger?"
 Functional Impairment"Do (symptoms) substantially 'get in the way' of how s/he gets along with you, interfere in your relationship, or makes you feel upset or annoyed?"
Materials Needed: 
Paper/Pencil
Sample Item(s): 

Mixed format response. Most answers are yes/ no format. Other questions ask for dates, frequency, or duration of symptoms. Some items request answers from a range of scores.

Information Provided: 
Diagnostic Info DSM IV
Other Information Provided: 
The traumatic events screen provides yes/no endorsements of 12 types of traumatic events; for each type it provides date of first occurence, date of last occurence, and the number of times it occured. Results of the DIPA include endorsements of symptoms in yes/ no replies, dates, frequencies and some scored responses. An optional one-page tally sheet allows interviewers to follow DSM-IV algorithms to determine diagnoses.

Training

Administration Training: 
Other
Other Administration Training: 
Training can be helpful. For non-clinician, research assistants training is required.

Parallel/Alternate Forms

Parallel Form: 
No
Alternate Form: 
No
Different Age Forms: 
No
Altered Version Forms: 
No

Psychometrics

Clinical Cutoffs: 
No
Reliability: 
Type:Time PeriodStatisticsMinMaxAvg
Test-retest11 daysIntraclass correlation Coefficients (ICC)0.24 OCD0.87 PTSD
Test-retest11 daysCohen's Kappa (k)0.38 ODD0.66 MDD
References for Reliability: 

Scheeringa, M,. Haslett, N. (2010) The reliability and Criterion Validity of the Diagnostic Infant and Preschool Assessment: A New Diagnostic Instrument for Young Children. Child Psychiatry and Human development. 41, 299-312.

              Test-Retest reliability NOTES:

             Intraclass Correlation Coefficients (ICC) reliability statistics are out of 7 disorders tested (ADHD, ODD, MDD, PTSD, SAD, GAD, OCD).

             In regards to PTSD, reliabilities were calculated for four different PTSD outcomes: DSM-IV without the criterion of impairment, the PTSD alternative algorithm (PTSD-AA) with the criterion of impairment, PTSD-AA without the criterion of impairment, and functional impairment alone (there were insufficient cases to calculate reliabilities for DSM-IV with the criterion of impairment). The PTSD-AA was developed as a more developmentally appropriate, reliable and valid criteria for preschoolers than the DSM-IV (Scheeringa et al, 1995, 2001, 2003). The individual results are below:

 

 kICC
DSM IV without impairment0.370.87
PTSD-AA without impairment0.56m/a
PTSD-AA without impairment0.670.87
Functional impairment alone0.420.38

*Scheeringa & Haslett, 2010

For the other disorders, the reliabilities of continuous measures (ICC’s) were large (r > 0.50) for ADHD-inattentive, ADHD-hyperactive, ODD, and SAD. The ICC’s for MDD and GAD were medium (0.30 < r < 0.50). The ICC for OCD was small (0.10 < r < 0.30). The sample was not highly symptomatic with the disorders that had medium and small reliabilities, which may explain those lower reliabilities. The median ICC was 0.69, and mean was 0.61.

For disorder with impairment, the reliabilities of categorical diagnoses (kappa’s) were substantial (kappa 0.6–0.8) for one disorder (MDD), fair to good (kappa 0.4–0.6) for four disorders (ADHD-inattentive, ADHD-hyperactive, PTSD-AA, and SAD), and poor (kappa

0–0.4) for one (ODD). No cases of OCD with impairment were diagnosed by the one set of interviewers, so kappa’s could not be computed. The median kappa was 0.53, and mean was 0.52.

Content Validity Evaluated: 
Yes
References for Content Validity: 

             The DIPA PTSD module was developed from the Posttraumatic Stress Disorder Semi Structured Interview and Observational Record for Young Children (PTSDSSI) (Scheeringa et al, 1995, 2001, 2003).  The symptoms in the PTSD module were derived empirically from assessment of actual trauma-exposed and symptomatic young children in this series of studies.

Construct Validity Evaluated: 
Yes
Construct Validity: 
Validity TypeNot knownNot foundNonclincal SamplesClinical SamplesDiverse Samples
Convergent/Concurrentx
Discriminantx
Sensitive to Changex
Intervention Effectsx
Longitudinal/Maturation Effectsx
Sensitive to Theoretically Distinct Groupsxx
Factorial Validityx
References for Construct Validity: 

Scheeringa, M., Peebles, C., Cook, C. & Zeahan, C (2001). Toward establishing procedural, criterion, and discriminant validity for PTSD in early childhood. Journal of the American Academy of Child and Adolescent Psychiatry. 40(1), 52-60.

 Scheeringa, M., Zeanah, C., Drell, M. & Larrieu, J. (1995). Two approaches to the diagnosis of PTSD in infancy and early childhood. Journal of the American Academy of Child and Adolescent Psychiatry. 34(2), 191-200.

 Scheeringa, M., Zeanah, C. Meyers, L. & Putnam, F. (2003). New findings on alternative criteria for PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(5), 561-570.

 

Criterion Validity Evaluated: 
Yes
References for Criterion Validity: 

Scheeringa, M,. Haslett, N. (2010) The Reliability and Criterion Validity of the Diagnostic Infant and Preschool Assessment: A New Diagnostic Instrument for Young Children. Child Psychiatry and Human development. 41, 299-312.

Predictive Validity: In a 2-year prospective longitudinal study, PTSD diagnoses were made at baseline using the ancestor of the DIPA PTSD module - the PTSDSSI.  These diagnoses significantly predicted degree of functional impairment and PTSD diagnoses 2 years later (Scheeringa, Zeahan, Meyers & Putnam, 2005).

Concurrent Validity: clinical sample

NOTES:

            The seven disorders that were tested in the psychometric study of the DIPA were evaluated for validity against the Child Behavior Checklist (CBCL). Continuous scores of the number of symptoms of each disorder were compared to the t-scores of relevant CBCL scales with Pearson correlations. For the PTSD module of the DIPA, the comparison scale used was a fifteen item ad hoc PTSD scale (Wolfe, Gentile, & Wolfe, 1989) because there is no PTSD scale in the CBCL. The presence of categorical disorders was compared to the recommended t-score = 65 cutoffs for relevant CBCL scales.  These comparisons were made separately for interviews administered by clinicians and research assistants.

For categorical variables, kappas were good for ODD and SAD, and mixed for PTSD-AA and ADHD.  Kappa reliabilities were poor for MDD, GAD, and OCD largely because of very low base rates.   

For continuous variables, correlations were acceptable for ADHD, ODD, and poor for the rest.  The poor correlation for PTSD was thought to be due to the fact that the CBCL was not designed to measure PTSD.  The PTSD scale derived from the CBCL items was an ad hoc scale.  

 nk Cliniciank RAPearson r clinicianPearson r RA
PTSD-AA480.200.480.240.15
ADHD-inattentive490.290.480.500.56
ADHD-hyperactive470.230.550.440.59
ODD470.440.530.530.55
MDD44-0.080.070.120.05
SAD460.530.480.570.52
GAD44-0.09n/a-0.090.03
OCD440.06-0.040.32-0.19

     Notes: Data from Scheering & Haslett, 2010. RA = research assistant

 

 

Overall Psychometric Limitations: 

Data for inter-rater reliability, internal consistency, and parallel reliability are not available.  Sensitivity and specificity are not known as generally there is no gold standard for a diagnosis in psychiatry.

Population Information

Population Used For Measure Development: 

The DIPA was developed from a precursor, the Posttraumatic Stress Disorder Semi Structured Interview and Observational Record (PTSDSSI).  The symptoms for the PTSDSSI were developed empirically by evaluating actual young children who had been exposed to trauma and were symptomatic  (Scheeringa, Zeanah, Drell & Larrieu, 1995).  Modifications to the PTSDSSI were based on studies using clinical samples (Scheeringa, Peebles, Cook & Zeanah, 2001) and a nonclinical sample (Scheeringa, Zeanah, Myers & Putnam, 2003).

The reliability and validity of the DIPA was assessed using a clinical sample of fifty children recruited through a state run mental health clinic for birth to five-year old children (Scheeringa & Haslett, 2010).

Measure has demonstrated evidence of reliability and validity in which populations?: 
Physical Abuse
Sexual Abuse
Medical Trauma
Witness Death
Natural Disaster
Domestic Violence
Community Violence
Kidnapping/Hostage
War/Combat
Accidents
Assault

Pros & Cons/References

Pros: 

- The PTSD module includes a traumatic events screen that provides thorough coverage of the number of times each type of event occurred, plus the first and last dates.

- The DIPA covers symptoms necessary to evaluate for DSM-IV and alternative diagnostic criteria for PTSD (such as the PTSD-AA).

- This measures accounts for disorder specific functional impairment, which is absent from many other questionnaires or scales.

- The DIPA uses developmentally appropriate language and symptoms for caregivers of the 0-6 year old population.

- The DIPA is thorough yet concise – the comprehensive interview includes 13 self-contained modules for specific disorders in 47 pages and 517 questions.

- The tally sheet provides a quick way to determine the number of symptoms endorsed in each disorder and whether diagnoses have been met.

- The interview was designed for either clinical or research work.

- Free.

 

Cons: 

-The main study of the psychometrics of the DIPA was limited by the size and character of the sample: 50 participants, no child younger then 1.6 years old, largely low socioeconomic status and minority population (Scheeringa & Haslett, 2010).

- Data for inter-rater reliability, internal consistency, and parallel reliability are not available for the DIPA. 

-More research is needed to gather additional data, and replication of the current findings is needed with larger and more diverse samples.

 

Author Comments : 

The author of the DIPA has read this review and was given the opportunity to make edits.

 

References: 

Scheeringa, M,. Haslett, N. (2010) The reliability and criterion validity of the Diagnostic Infant and Preschool Assessment: A new diagnostic instrument for young children. Child Psychiatry and Human development. 41(3), 299-312.

Scheeringa, M., Peebles, C., Cook, C. & Zeanah, C (2001). Toward establishing procedural, criterion, and discriminant validity for PTSD in early childhood. Journal of the American Academy of Child and Adolescent Psychiatry. 40(1), 52-60.

Scheeringa, M., Zeanah, C., Drell, M. & Larrieu, J. (1995). Two approaches to the diagnosis of PTSD in infancy and early childhood. Journal of the American Academy of Child and Adolescent Psychiatry. 34(2), 191-200.

Scheeringa, M., Zeanah, C. Meyers, L. & Putnam, F. (2003). New findings on alternative criteria for PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(5), 561-570.

Scheeringa, M., Zeanah, C., Myers, L. & Putnam, F. (2005). Predictive validity in a prospective follow-up of PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry. 44 (9), 899-906.

Wolfe V., Gentile C., & Wolfe D. (1989). The impact of sexual abuse on children: a PTSD formulation. Behavioral Therapy 20, 215–228

 
The DIPA has been used and cited in the following articles:

De Young, A., Kenardy, J. & Cobham, V. (2011). Diagnosis of posttraumatic stress disorder in preschool children. Journal of Clinical Child & Adolescent Psychology. 40 (3), 1-10

DeYoung A, Kenardy J, Cobham V, Kimble R (2012).  Prevalence, comorbidity, and course of trauma reactions in young burn-injured children.  Journal of Child Psychology and Psychiatry 53,1,56-63.  Follow-up of DeYoung et al., 2011.

Gleason, M., Zeanah, C. & Dickstein, S. (2010). Recognizing young children in need of mental health assessment: development and preliminary validity of the Early Childhood Screening Assessment. Infant Mental Health Journal. 31(3), 335-357

Developer of Review: 
Ashley Albarado
Editor of Review: 
Dr. Michael Scheeringa
Last Updated: 
Thu, 03/07/2013
0