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Biomedical subjects

J M Plapp

Publications and source records attributed to J M Plapp.

At least 19 recordsLinked to original sources
PubMed2000

Family environment in attention deficit hyperactivity, oppositional defiant and conduct disorders.

OBJECTIVE: This study aims to ascertain whether there were differences in family environment among patients with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder and conduct disorder. METHOD: The records of 233 patients, selected for high or low scores on a scale that taps ADHD symptoms, were reviewed by three clinicians who made DSM-IV diagnoses and rated the family environment with the Global Family Environment Scale (GFES). Self-report data obtained from the parent and child versions of the Child Behaviour Checklist were also used. The quality of the family environment was then compared between the various diagnostic groups. RESULTS: A poorer family environment was associated with conduct disorder and oppositional defiant disorder and predicted a worse outcome (e.g. admission to a non-psychiatric institution, drug and alcohol abuse). Quality of the family environment did not vary according to ADHD diagnosis or gender. CONCLUSIONS: There seems to be no association between the quality of the family environment and a diagnosis of ADHD among referred adolescents. However, there is an association with conduct disorder. Interventions that improve family environment in the early years of life may prevent the development of conduct problems.

Adolescent↗
PubMed1999

Parental satisfaction and outcome: a 4-year study in a child and adolescent mental health service.

OBJECTIVE: The aim of this paper is to examine the facets of parental satisfaction and its relationship with clinician-rated outcome in a child and adolescent mental health service. METHOD: Patients (n = 1278) consecutively assessed between 1992 and 1996 were included in the study. When treatment ended, clinicians rated the outcome of the intervention and parents were asked to complete a satisfaction questionnaire. RESULTS: Sixty-nine per cent of cases were rated by clinicians as having a positive outcome. Outpatients were more likely to be given a positive rating than inpatients. Satisfaction questionnaires were returned by 40% of parents; 76% of these were mostly or very satisfied. Satisfaction scores increased with the number of outpatient sessions attended but did not differ between inpatients and outpatients. There was a significant but small agreement (27% better than chance) between clinicians' rating of outcome and parental satisfaction. Level of agreement varied according to service provided and the number of sessions attended. While rates of positive outcome increased over the study period, ratings of satisfaction were stable. CONCLUSIONS: Overall, ratings of satisfaction were comparable with those reported in other studies. Variations in concordance between parents and clinicians show that outcome and satisfaction, although related, are different constructs influenced by different factors depending on the services provided. Focusing on specific aspects of satisfaction, as opposed to global measures, may be more useful for services, although such undertakings must be supported with efforts to improve clinical outcomes.

Adolescent↗
PubMed1997

A global scale to measure the quality of the family environment.

BACKGROUND: Simple, reliable measures of the quality of the environment in which a child was reared that can be used in clinical research and practice are lacking. METHOD: The reliability and validity of a global scale to retrospectively appraise the quality of that environment were examined. Fifty-three clinicians from 4 centers in Australia and 1 in Hong Kong, People's Republic of China, used the scale to rate 7 case vignettes; 4 clinicians rated 20 medical records, and 49 rated 211 subjects after clinical interviews. RESULTS: Interrater reliability (intraclass correlation coefficient) was 0.82 (time 1) and 0.84 (time 2) for case vignettes, 0.90 for medical records, and 0.89 for clinical interviews. Consistency in time was high (r = 0.91). Lower ratings, indicative of a less adequate environment, were associated with a clinical diagnosis of oppositional defiant or conduct disorder. CONCLUSIONS: Our simple-to-use scale appears to measure reliably a relevant clinical construct and fills a gap among the instruments available. Ratings may be useful as a cost-effective index to consider in outcome studies, when examining response to treatment, or in other clinical research.

Adolescent↗
PubMed1995

Inter-rater reliability of global assessment of functioning in a clinical setting.

Four studies on the inter-rater reliability of a proposed Axis V version for DSM-IV and of the CGAS involving 162 child and adolescent patients and 20 clinicians showed moderate agreement (intraclass correlation: 0.53-0.66). This was comparable to previous versions of Axis V, but lower than that reported for the CGAS. More detailed description of anchor points did not increase reliability nor there were differences in agreement when rating current or previous functioning.

Achievement↗
PubMed1994

Child and adolescent psychiatric services: case audit and patient satisfaction.

A system for the monitoring and review of a large number of cases seen for assessment and outpatient treatment by a multidisciplinary child and adolescent psychiatric service is described. The system permits monitoring of all cases to closure, and clinical review of treatment for those cases whose outcomes are judged unsatisfactory by the treating clinician. It also allows monitoring of those cases in which there was patient dissatisfaction with the service, as expressed in a patient satisfaction questionnaire. The system of review has gained the acceptance of the clinical team, who are involved in its continued improvement.

Adolescent↗
PubMed1990

Quality of perceived parenting in oppositional and conduct disordered adolescents.

In order to ascertain whether there was a relationship between parenting style and the development of conduct (CD) and oppositional (OD) disorder, the authors compared ratings on a self-report measure of perceived parenting (Parental Bonding Instrument) by normal adolescents (N = 62) and by adolescents with CD (N = 62) or OD (N = 49). No differences were found between the CD and OD groups. However, there were significant differences between the clinical groups and the normal control group: adolescents with CD or OD perceived their parents as more overprotective and less caring.

Adolescent↗
PubMed1989

Reliability of psychiatric diagnosis in referred adolescents.

The authors report a reliability study of the DSM-III diagnostic system in a series of 393 adolescent referrals diagnosed by two clinicians over a period of 3 years. Overall reliability (kappa) was 0.59. However, most of the frequently used diagnoses had reliabilities of 0.7 or higher. Dysthymic, Adjustment, Overanxious and Avoidant Disorders showed poor diagnostic agreement (kappa below 0.4). The patterns of agreement across this and other studies suggest that diagnostic criteria for Affective, Anxiety and Adjustment Disorders are in need of further improvement.

Adolescent↗
PubMed1988

Validity of Axis V of DSM-III and other measures of adaptive functioning.

In order to address validity issues which have not been adequately explored in the existing literature on Axis V, the authors compared ratings on this axis with ratings on three other measures of adaptive functioning (Social Competence, premorbid and present) in a diagnostically heterogeneous group of 195 referred adolescents. It was found that correlations amongst the measures were moderate, except between premorbid and present functioning, which was high. Axis V was found to be comparable with a measure of premorbid functioning while Social Competence was similar to present functioning.

Adolescent↗
PubMed1988

DSM-III axis IV revisited.

Clinicians have traditionally inquired about stressful life events preceding the onset of a psychiatric disorder. Axis IV of DSM-III attempted to improve on this by suggesting that a wide range of events be considered and that the information obtained be integrated into a global rating of severity. After reviewing recent evidence, the authors suggest that this process might result in ratings with lower reliability than expected. They also discuss some of the methodological difficulties in this field and explore directions for further research.

Humans↗
PubMed1987

Reliability of the psychosocial axes of DSM-III in an adolescent population.

Three psychosocial variables were rated independently by two clinicians for 140 adolescent referrals to a psychiatric unit. Overall, intraclass correlations for DSM-III Axis IV, Axis V and a psychosocial adversity index (PSAI) were respectively 0.44, 0.58 and 0.68. The main source of unreliability is probably the operational definitions, rather than their application by clinicians; indices similar to the PSAI may be preferable.

Adaptation, Psychological↗
PubMed1987

Sources of unreliability of DSM-III Axis IV.

Lists of stressors recorded for 159 adolescents and rated by two judges showed poor agreement on stressor identification but good concordance for the most severe stressor identified for each patient. Good agreement was also found for a short checklist of chronic stressors. When individual stressors were rated by four judges for 27 patients, global Axis IV ratings were largely determined by the rating of the most severe event. Those results suggest that Axis IV can be made more reliable and easier to use by concentrating on the identification of severe events.

Adolescent↗