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Biomedical subjects

D Lachar

Publications and source records attributed to D Lachar.

At least 19 recordsLinked to original sources
PubMed2001

New subscales for an anchored version of the Brief Psychiatric Rating Scale: construction, reliability, and validity in acute psychiatric admissions.

Attending psychiatrists completed an anchored version of the 18-item Brief Psychiatric Rating Scale (BPRS-A) based on admission and evaluation information on a total of 2,921 adult patients treated at 1 public sector acute psychiatric teaching hospital. Exploratory factor analysis was applied to a 6-month sample to construct 4 nonoverlapping subscales: Resistance, Positive Symptoms, Negative Symptoms, and Psychological Discomfort. Confirmatory factor analysis compared these new subscales to 3 other published subscale models using a second 6-month sample. Internal consistency, rater influence, and interrater agreement were estimated in separate studies. Discriminant validity was explored by comparison of diagnosis-based samples. Application of the BPRS-A as a debriefing instrument in the study of symptomatic change and the multiple challenges inherent in psychometric study of such a rating scale in realistic hospital practice are discussed.

Adult↗
PubMed2001

The brief psychiatric rating scale for children (BPRS-C): validity and reliability of an anchored version.

OBJECTIVE: Because the accuracy of problems reported by referred children may be compromised by their academic, cognitive, or motivational limitations, clinician rating forms may contribute to the accurate assessment of youth adjustment. One such measure, the 21-item Brief Psychiatric Rating Scale for Children (BPRS-C), received psychometric study to estimate its potential contribution to the measurement of symptom dimensions. BPRS-C reliability and concurrent validity were calculated for youths who were receiving psychiatric services within a medical school department. METHOD: Five hundred forty-seven children aged 3 to 18 years were rated by faculty or trainees; a subsample of 90 was concurrently rated by two observers. BPRS-C psychometric performance was demonstrated through interrater agreement, factor analysis, and multivariate analyses of variance across seven diagnosis-based groups. RESULTS: Although items and scales demonstrated substantial reliability and concurrent validity, item factor analysis revealed a few apparent errors in item-to-scale assignment. These errors were minimized by the use of three new second-order factor-derived scales: Internalization, Developmental Maladjustment, and Externalization. CONCLUSIONS: The BPRS-C can be easily integrated into academic clinical practice and is a reliable and valid method of child description. Additional study of three new BPRS-C factor scales and the application of the BPRS-C to the quantification of clinician observation of child symptomatic status are warranted.

Adolescent↗
PubMed2001

Assessing predictive factors for extended hospitalization at acute psychiatric admission.

OBJECTIVE: This study examined whether information obtained early in the hospitalization process can be used to assess a patient's need for extended care. METHODS: A sample of 2,430 inpatients who were admitted to a state psychiatric facility during a one-year index period (January through December 1997) were randomly assigned to a primary sample or a replication sample. Data were collected on demographic characteristics and history of previous hospitalization. The Brief Psychiatric Rating Scale-Anchored Version (BPRS-A) was administered to patients within 48 hours of admission, and four new subscales derived from ratings of newly admitted patients were calculated. Univariate and multivariate analyses were conducted to identify factors associated with whether a patient was discharged to the community or transported to another hospital for extended care. RESULTS: A discriminant analysis of the data correctly identified 70 percent of the patients who were referred for continued hospitalization and 80 percent of the patients who were discharged to the community. The main correlates of the need for extended inpatient services were, in descending order, scores on the BPRS-A resistance subscale, the number of previous referrals for extended hospitalizations, and scores on the BPRS-A positive symptoms and psychological discomfort scales. CONCLUSIONS: BPRS-A subscale scores should be considered to be at least as good as more traditional measures in predicting length of hospitalization.

Adult↗
PubMed2001

The Personality Inventory for Youth: validity and comparability of English and Spanish versions for regular education and juvenile justice samples.

In this study we examined the comparability of the Personality Inventory for Youth (PIY; Lachar & Gruber, 1993, 1995)--Spanish version to its English counterpart among bilingual Mexican American male and female high school students (n = 120), and among incarcerated bilingual Mexican American male adolescents (n = 52). Results indicated that language (English vs. Spanish) was not associated with a significant effect on the PIY scales or subscales for male adolescents in the juvenile justice facility, but was associated with a marginal effect for regular education adolescents; more specifically, regular education students completing the PIY in Spanish reported somewhat lower levels of symptoms than those completing the English version. Also, incarcerated males obtained significantly higher scores than regular education males on all 9 clinical and 19 out of 24 clinical subscales. Overall, the results of this study suggest that both language versions of the PIY may be applied usefully in the study and treatment of a variety of problems relevant to juvenile populations. Additional findings are discussed.

Adolescent↗
PubMed2000

Psychological functioning in children and adolescents with Sturge-Weber syndrome.

Previous studies of individuals with Sturge-Weber syndrome have focused on the medical aspects of this syndrome, but little has been known about the affective and behavioral correlates. We collected psychological and medical data from parents and teachers for 79 children and adolescents with Sturge-Weber syndrome and a group of their siblings. We also obtained the results of intellectual assessment for a subset of the Sturge-Weber syndrome group. The young people with Sturge-Weber syndrome exhibited more problems than the group of siblings across a number of behavioral domains: intellectual/academic, social skills, mood, and compliance. Those children most at risk for psychological problems were those with lower levels of intellectual functioning, those with seizure disorders, and those with more frequent seizures. Larger port-wine stains were also associated with an increase in mood and social problems but only for older children. Increased age was not associated with lower levels of intellectual or academic functioning, but mood and social problems were more common in older children.

Achievement↗
PubMed2000

Patterns of behavioral adjustment and maladjustment in mental retardation: comparison of children with and without ADHD.

A variety of behavioral and emotional problems have been associated with attention deficit disorder with hyperactivity (ADHD) in children of average intellect. In contrast, little is known about concomitant behavioral and emotional problems in children with ADHD and mental retardation. In this study, we used the Personality Inventory for Children-Revised to assess the behavioral adjustment of 48 children with mental retardation and ADHD compared to that of 47 children with mental retardation without ADHD. The ADHD group had significantly more symptoms of depression, family conflict, noncompliance, anxiety, hyperactivity, inadequate social skills, and academic problems. Results are strongly suggestive of significant behavioral and emotional problems in children with ADHD and mental retardation, thus mirroring the pattern associated with ADHD in the general school-age population.

Adolescent↗
PubMed1999

Use of BPRS-A percent change scores to identify significant clinical improvement: accuracy of treatment response classification in acute psychiatric inpatients.

Use of Brief Psychiatric Rating Scale [Overall J.E., Gorham D.R., 1988. The Brief Psychiatric Rating Scale (BPRS): recent developments in ascertainment and scaling. Psychopharmacology Bulletin 24, 97-99] percent change scores (PCSs) to measure treatment effects may be problematic because two different item-weighting systems (0-6 and 1-7) have been employed to represent the seven rating options and PCSs have demonstrated sensitivity to the item-weighting system used. This study compared the ability of a range of BPRS total scale PCS categories generated by both item-weighting procedures to predict estimates of clinical improvement in a large (N = 1415) heterogeneous acute sample of adult psychiatric inpatients. Results revealed significant differences between the two scaling systems in the proportion of patients classified into categories of PCS symptom improvement. Additional analysis suggested different optimal predictive PCS classifications for each item-weighting system: > 19% for 1-7 and > 39% for 0-6. Guidelines for BPRS publications are presented to facilitate study interpretation and replication. In light of their demonstrated limitations, it is suggested that the use of BPRS PCSs to measure treatment effects be reconsidered.

Adolescent↗
PubMed1999

Performance of the Personality Inventory for Youth validity scales.

Response sets as well as cognitive and academic deficits compromise the validity of child and adolescent self-report of emotional adjustment. Three studies using clinical and asymptomatic samples of 4th to 12th grade students detail applications of the four validity scales of the Personality Inventory for Youth (PIY), namely, (a) Validity (VAL) a scale of six highly improbable statements, (b) Inconsistency (INC) consisting of pairs of highly correlated statements, (c) Dissimulation (FB) constructed of statements that were infrequent and characteristic of intentional distortion, and (d) Defensiveness (DEF) an extension of the Lie scale of the parent-report Personality Inventory for Children. The effects of minimizing, malingering, and random response sets on the PIY validity scales are reported. The importance of such validity scales derived from child and adolescent response is discussed.

Adolescent↗
PubMed1997

Tourette's syndrome and psychopathology in a child psychiatry setting.

UNLABELLED: Prior investigations of psychopathology among children with Tourette's syndrome (TS) have rarely used child psychiatry samples and sophisticated personality instruments. OBJECTIVE: To produce an objectively derived composite TS personality profile and to determine the rate of particular problems in a TS psychiatry sample compared with children with out TS from the same clinical practice. METHOD: Children (n = 33) referred to child psychiatrists because of emotional and behavior problems who were subsequently also found to meet DSM-III-R criteria for TS were assessed by the Personality Inventory for Children. RESULTS: Children with TS expressed high rates of psychopathology overall (composite 2.7 SD elevated) with depression, anxiety, and peculiar behavior having the highest values; depression occurred most frequently (73%), and attention-deficit hyperactivity disorder (55%) was no more common than among comparison group children and conduct problems (18%) were rarer. "Depression, anxiety, tension, and excessive worry" were characteristic of the actuarially derived modal TS personality. CONCLUSIONS: The prevalence and manifestations of psychopathology of children with TS in a child psychiatry practice are not identical with those reported in the literature. Child psychiatrists should be particularly vigilant of depressive symptoms and expect to encounter relatively few conduct problems compared with children without TS. Establishing "local prevalence rates" for children with TS seeking psychiatric evaluation can help guide the diagnostician and make diagnosis more assured.

Adolescent↗
PubMed1997

Effects of intraventricular hemorrhage and hydrocephalus on the long-term neurobehavioral development of preterm very-low-birthweight infants.

Measures of intelligence, neuropsychological functions, academic skills, and behavioral adjustment were obtained at school-age from children born preterm with no hydrocephalus (N=29), arrested hydrocephalus (N=19), and shunted hydrocephalus (N=17), and a term comparison group (N=23). Most children also received concurrent neurological examinations and MRI brain scans. Results revealed significantly poorer neurobehavioral development in all four domains in preterm children with shunted hydrocephalus. Despite abnormal MRI findings in virtually all children with arrested hydrocephalus, significant differences between preterm children with arrested hydrocephalus and those with no hydrocephalus were largely in areas involving attentional and academic skills. Preterm children with no hydrocephalus tended to show poorer motor development relative to term children. Neurological abnormalities were restricted to children with spasticity in the arrested (N=2) and shunted (N=10) groups. These results highlight the importance of separating cases according to residual neurological and neuroimaging abnormalities in accounting for variations in the neurobehavioral development of preterm, low-birth-weight infants.

Adaptation, Psychological↗
PubMed1996

Behavioral outcomes after pediatric closed head injury: relationships with age, severity, and lesion size.

This study investigated the behavioral outcomes and adaptive functioning of 138 children with mild to severe closed head injury in the 6- to 16-year age range. Each child was evaluated with the Personality Inventory for Children-Revised. A subset of this sample (n = 77) received the Vineland Adaptive Behavior Scales. Results revealed little evidence for group differences based on severity of closed head injury on scales associated with psychopathology on the Personality Inventory for Children-Revised. However, children with severe closed head injury were viewed as experiencing more difficulties than children with mild-moderate closed head injury on those components of the Personality Inventory for Children-Revised most closely associated with cognitive functions. In addition, on the Vineland Adaptive Behavior Scales, severely injured children had lower scores on the Communication and Socialization scales than children with mild-moderate injury. Relationships between the size of frontal and extrafrontal lesions from concurrent magnetic resonance imaging and behavioral outcomes were not apparent. This study suggests that outcome measures assessing adaptive behavior and cognitive functions are more sensitive to severity of closed head injury than parent-based scales of internalizing and externalizing psychopathology.

Adolescent↗
PubMed1995

Effects of methylphenidate in HIV-related depression: a comparative trial with desipramine.

This report is a randomized, double-blind, comparative trial of desipramine with the psychomotor stimulant methylphenidate. Twenty HIV antibody-positive patients with depressive symptoms were randomly assigned to either drug. After individual dose titration, the mean daily dose of desipramine was 150 mg. and methylphenidate 30 mg. daily. The differences in responses between desipramine and methylphenidate were not statistically significant on various measures of depression. The antidepressant effect of methylphenidate did not occur any faster than that of desipramine. Both significantly reduced depressive and anxious symptomatology over the blinded portion of the treatments. Thus, methylphenidate relieves depressive symptomatology with efficacy similar to that of desipramine, offering an alternative to patients who are unable to tolerate standard tricyclic antidepressant therapy. The dopaminergic effects of methylphenidate are likely to mediate its antidepressant effects.

Adult↗
PubMed1993

Development of the Personality Inventory for Youth: a self-report companion to the Personality Inventory for Children.

This research explored the ability of parent-informant Personality Inventory for Children (PIC; Lachar, 1982) questionnaire items to form the foundation for self-report scales. An iterative rational and internal consistency approach using 585 clinical protocols constructed nine nonoverlapping clinical scales. Twenty-four complementary subscales were also constructed through scale item analysis. Acceptable estimates of scale reliability and internal consistency were established in substantial, diverse normal and clinical samples. Personality Inventory for Youth scales effectively separated normal and clinical protocols. Age and sex effects were investigated as were correlations with parent-informant PIC scales. Follow-up research includes the development of validity and adjustment screening scales, as well as the collection of diverse psychometric and clinical rating data to advance scale construct validity.

Adolescent↗
PubMed1992

Clinical validity of a Personality Inventory for Children (PIC) profile typology.

We evaluated the validity of a profile typology for the Personality Inventory for Children (PIC), a parent-informant measure of child psychiatric status. For referred children, we studied (a) the convergence of PIC profile types with diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., American Psychiatric Association, 1980) and (b) the incremental validity of the PIC over diagnoses in the prediction of symptom ratings completed by teachers and clinicians. We found a high diagnosis-PIC correspondence only for developmentally disordered children; the overlap for children with emotional-conduct problems was poor. For the latter group, however, the correlation of diagnoses with symptom ratings was low, but the incremental validity of the PIC over diagnoses was high. We discuss the use of this profile typology in the clinical evaluation of children and present a case example.

Child↗
PubMed1989

Developmental trends in memory and metamemory in children with attention deficit disorder.

Examined the development of memory strategy knowledge and spontaneous use of strategy by 6- to 12-year-old boys with ADD-H. Metamemory knowledge of 12 ADD-H boys, unmedicated for study participation, and 12 matched control Ss was compared using a structured interview. Use of categorization was assessed using free recall of word lists differing in category composition (acoustic vs semantic categories) and list organization (clustered by category vs unclustered). Interview data indicated no difference between groups in development of metamemory knowledge. Analysis of free recall performance showed that ADD-H Ss were less likely than controls to benefit from that knowledge when strategy was less salient and involved effortful reorganization of stimuli (p less than .05). The results were consistent with a production deficiency. Developmental trends and implications for remediation are discussed.

Attention↗
PubMed1987

Respondent psychopathology and interpretive accuracy of the Personality Inventory for Children: the evaluation of a "most reasonable" assumption.

This study investigates the relationship between maternal psychopathology and the validity of the Personality Inventory for Children (PIC). Specifically, we tested the hypothesis that psychopathology in the parent informant limits the ability of the resulting scale scores to predict actuarially derived descriptions of child emotional and behavior disorders. Mothers of 223 children and adolescents who had been referred for an evaluation to a child psychiatry service completed the PIC. These mothers also completed the Minnesota Multiphasic Personality Inventory (MMPI). The sample of mothers and their children was divided into two subsamples according to the mother's MMPI profile: within normal limits and clinically elevated. Nineteen factor dimensions scores derived from these separate behavior rating forms served as external criteria. Analyses indicated that maternal psychopathology, as represented by MMPI scale elevations, did not moderate or limit the predictive accuracy of PIC scales.

Adolescent↗
PubMed1987

Assessment of PIC and MMPI scales in adolescent psychosis: a caution.

This study investigated the sensitivity of two frequently used multidimensional instruments--the Personality Inventory for Children (PIC) and the Minnesota Multiphasic Personality Inventory (MMPI)--in assessing psychotic states in adolescents. This issue arose as a result of the fact that the PSY scale on the PIC was constructed and cross-validated only on samples of children between the ages of 5 and 12 years. T-score comparisons between psychotic and nonpsychotic samples were performed, as well as Pearson correlations between PIC Psychosis (PSY) and MMPI Schizophrenia (Sc) scale T-scores. T-score comparisons indicated no significant differences between the groups on either PSY or Sc. A nonsignificant relationship between PSY and Sc scale elevations was also found. These results suggest the need for a profile-analytic approach to PIC and MMPI interpretation in identifying psychotic symptomatology in adolescents rather than PSY or Sc T-score elevation in isolation.

Adolescent↗