Clinician,
Parent, and Teacher Contributions to Predictions of Outcomes for
Child Psychiatric Outpatients in the Netherlands
Mental health
evaluations of children typically include interviews with clinicians.
However, little is known about the contributions that clinicians'
interviews can make to predicting the subsequent outcomes of children's
problems. To identify predictive relations between clinicians'
ratings from the Semistructured Clinical Interview for Children
and Adolescents (SCICA) and subsequent outcomes, a Dutch child
psychiatrist, Dr. Robert Ferdinand, and his colleagues did 3-year
follow-ups (Time 2) of children who were initially evaluated at
a child psychiatric clinic when they were 6 to 12 years old (Time
1). The outcome data included reports of mental health services
being received by the child at Time 2; parents' wish for additional
professional help for the child at Time 2; school behavior problems
during the follow-up period; and police/judicial contacts during
the follow-up period. Significant predictive relations found for
SCICA observational scales (i.e., scales comprising problems observed
by clinicians) included the following: The SCICA Attention Problems
syndrome predicted outpatient and inpatient treatment, while the
SCICA Resistant syndrome predicted outpatient treatment, parents'
wish for professional help, and school behavior problems. Significant
predictive relations for SCICA scales comprising problems reported
by the children included the following: The SCICA Aggressive Behavior
syndrome predicted parents' wish for help, while the SCICA Anxious/Depressed
syndrome predicted police/judicial contacts. To determine whether
the clinicians' ratings added predictive information to parent
and teacher ratings, Ferdinand et al. then combined Time 1 SCICA,
CBCL, and TRF syndrome scores in testing predictive relations
to Time 2 outcomes. They found that the SCICA Aggressive Behavior
syndrome survived as the only significant predictor of parents'
Time 2 wish for professional help, whereas the SCICA Attention
Problems syndrome and CBCL Social Problems syndrome both survived
as significant predictors of Time 2 inpatient treatment. The CBCL
Social Problems syndrome and TRF Aggressive Behavior syndrome
both survived as significant predictors of Time 2 outpatient treatment.
The TRF Aggressive Behavior syndrome was the sole surviving predictor
of Time 2 school problems,. while the TRF Social Problems syndrome
was the sole surviving predictor of police/judicial contacts.
The authors concluded that their study "was the first that
found clinicians' ratings of self-reported and observed behaviors
in a semi-structured interview (SCICA) make an important and unique
contribution to the multiaxial assessment of problem behaviors,
based on longitudinal data" (p. 875). However, they also
pointed out that "The findings tell us that clinical assessment
should always be supplemented with information from parents and
teachers" (p. 873).
Reference:
Ferdinand, R.F., Hoogerheide, K.N., van der Ende, J., Heijmens
Visser, J., Koot, H.M., Kasius, M.C., & Verhulst, F.C. (2003).
The role of the clinician: three-year predictive value of parents'
teachers', and clinicians' judgment of childhood psychopathology.
Journal of Child Psychology and Psychiatry, 44, 867-876.
