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Biomedical subjects

M A Fristad

Publications and source records attributed to M A Fristad.

At least 19 recordsLinked to original sources
PubMed2001

Suicidal behavior and parental psychopathology in hospitalized depressed children.

This study describes the suicidal behavior of hospitalized depressed children and assesses its relationship to psychopathology and suicidal behavior in their parents. Subjects were 58 consecutively hospitalized prepubertal children with a primary diagnosis of major depressive disorder (MDD), and 58 age- and gender-matched children hospitalized for psychiatric diagnoses other than a mood disorder. Clinical interviews and structured diagnostic instruments were reviewed to determine the children's suicidal behavior and their parents' history of psychopathology. Suicidal ideation, suicidal intent, suicidal plans, and suicide attempts were more frequent in MDD children compared to nondepressed children. When MDD and control samples were stratified as to presence of suicidal behavior in the child, psychopathology was high in parents from all subgroups. Intensity of suicidal behavior in the depressed and non-depressed children was not associated with an altered pattern of psychopathology in their parents. Hospitalized MDD children had increased suicidal behavior compared to inpatient psychiatric control children. However, suicidal behavior in the children was not associated with increased psychopathology or an altered pattern of psychopathology in their parents.

Adolescent↗
PubMed2001

Psychosocial interventions for suicidal children and adolescents.

This paper discusses the role of psychosocial intervention in the treatment of suicidal youth, summarizes the existing relevant literature, describes model programs for treating suicidal youth, and discusses efficacy-to-effectiveness issues in working with this population.

Adolescent↗
PubMed2001

Scaling structured interview data: a comparison of two methods.

OBJECTIVE: Although structured interviews are currently considered essential assessment strategies for conducting research, the data they generate are typically not used for purposes beyond making categorical determinations about diagnoses. Because of the need for dimensional scales to be used in conjunction with categorical data, two dimensional scales constructed from structured interviews are presented and examined. One scale, Behavior, Anxiety, Mood, and Other (BAMO), provides an overall score by summing the percentage of symptoms endorsed for each of 20 behavior, anxiety, mood, and other disorders found in the Diagnostic Interview for Children and Adolescents-Revised (DICA-R, DSM-III-R version). Another scale, DICA-SUM, is constructed by summing all endorsed symptoms on the interview. In this study the psychometric and pragmatic characteristics of BAMO and DICA-SUM are compared. METHOD: Data were obtained from 570 children (331 bereaved, 110 depressed, 129 community) aged 5 to 18 years (mean +/- SD = 11.3 +/- 3.2) who were interviewed as part of an ongoing longitudinal childhood bereavement study from 1987 to 1996. RESULTS: Discriminant and convergent validity with other child psychopathology measures are comparable for BAMO and DICA-SUM. However, BAMO more clearly conveys information regarding the approximate number of diagnoses endorsed. CONCLUSION: This study identified two methods of creating dimensional scales from structured interviews. Use of such dimensional scales might allow for improved comparison of results across studies.

Adolescent↗
PubMed2000

Children's Interview for Psychiatric Syndromes (ChIPS).

OBJECTIVE: To describe the development and summarize the psychometric properties of the Children's Interview for Psychiatric Syndromes (ChIPS). METHOD: ChIPS is a highly structured interview designed for use by trained lay interviewers in children aged 6-18 years. It screens for 20 Axis I disorders as well as psychosocial stressors. Questions use simple language and short sentence structure to enhance subject comprehension and cooperation. The interview is based on DSM-IV and results are presented in a concise, easy-to-interpret manner. There are both child and parent versions. The psychometric properties of each version were studied. RESULTS: A series of 5 studies has demonstrated the validity of the DSM-III, DSM-III-R, and DSM-IV versions of the ChIPS as well as the validity of the P-ChIPS (parent version). Administration time is relatively brief, averaging 49 minutes for inpatients, 30 minutes for outpatients, and 21 minutes for a community-based sample. CONCLUSIONS: ChIPS can be used as a screening instrument to maximize a clinician's efficiency, as a diagnostic instrument in clinical research, and as a training instrument to help mental health professionals learn psychiatric diagnosis. It can also be used in epidemiological research.

Adolescent↗
PubMed2000

Suicide-bereaved children and adolescents: II. Parental and family functioning.

OBJECTIVE: The current study extends the authors' earlier examination of suicide-bereaved (SB) children from the Grief Research Study, a longitudinal study of childhood bereavement after parental death, by examining the children's family history of psychopathology and family environment before and after death. METHOD: Twenty-six SB children, aged 5 to 17 years, and their 15 surviving parents were compared with 332 children bereaved from parental death not caused by suicide (NSB) and their 201 surviving parents in interviews 1, 6, 13, and 25 months after the death. RESULTS: Suicide completers evidenced more psychopathology than parents who died from reasons other than suicide. Contrary to expectations, surviving SB parents were not more impaired than NSB parents. Before the death, SB families were less stable than NSB families and relationships with the decreased SB parent were compromised. However, no differences were detected between groups in children's relationships with their surviving parents. Likewise, few differences were found in social support or changes in religious beliefs. CONCLUSIONS: SB children generally come from families with a history of psychopathology and substantial family disruption. However, surviving SB parents do not exhibit higher rates of psychopathology than other bereaved parents and many have positive relationships with their children.

Adolescent↗
PubMed1999

Suicide-bereaved children and adolescents: a controlled longitudinal examination.

OBJECTIVE: The current study examined emotional and behavioral sequelae in children who have experienced parental suicide by completing a secondary analysis of data from the Grief Research Study, a longitudinal study of childhood bereavement. METHOD: Twenty-six suicide-bereaved (SB) children, aged 5 to 17 years, were compared with 332 children bereaved from parental death not caused by suicide (NSB) in interviews 1, 6, 13, and 25 months after the death. Children's emotional reactions to the death, psychiatric symptomatology, and psychosocial functioning after the parent's death were determined. RESULTS: Grief emotions were common in both groups. SB children were more likely to experience anxiety, anger, and shame than NSB children. SB children were more likely to have preexisting behavioral problems and more behavioral and anxiety symptoms throughout the first 2 years compared with NSB children. Indices of depression, suicidality, and psychosocial functioning differed minimally between groups. CONCLUSIONS: SB children experience some "common" elements of bereavement. In addition, they demonstrate some lifetime risk factors as well as subsequent pathology that suggests a negative behavioral trajectory. As these cohorts have not yet passed through the age of risk, long-term follow-up is critical.

Adolescent↗
PubMed1998

Study I: development and criterion validity of the Children's Interview for Psychiatric Syndromes (ChIPS).

OBJECTIVE: To test the psychometric properties of the Children's Interview for Psychiatric Syndromes (ChIPS), a second-generation structured diagnostic interview designed to improve on the methodology provided by first-generation structured interviews, which have increased diagnostic reliability over unstructured clinical interviews. METHOD: Forty-two children hospitalized on a children's inpatient unit were administered the ChIPS and the Diagnostic Interview for Children and Adolescents (DICA). The level of agreement regarding syndrome presence or absence of 15 diagnoses according to the two instruments was assessed using a standard kappa coefficient or a rare kappa coefficient and percentage agreement. RESULTS: Agreement between the two instruments was significant (p < 0.05) for 13 of 14 diagnoses for which either kappa coefficient could be calculated. Percentage agreement was 98% and 100% for the remaining two diagnoses. ChIPS and DICA results also were compared with a psychiatrist's diagnoses. Sensitivity was 80% for ChIPS and 61% for DICA. Specificity was 78% for ChIPS and 87% for DICA. CONCLUSION: ChIPS is proposed as a valid measure of child psychopathology that offers advantages over existing interviews.

Child↗
PubMed1998

Study II: concurrent validity of the DSM-III-R Children's Interview for Psychiatric Syndromes (ChIPS).

OBJECTIVE: To test the concurrent validity of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) (DSM-III-R) revised Children's Interview for Psychiatric Syndromes (ChIPS). METHOD: In this study, the DSM-III-R revised ChIPS, the DSM-III-R revised Diagnostic Interview for Children and Adolescents (DICA-R-C), and clinicians' diagnoses were compared in 71 inpatients and outpatients 6 to 13 years of age using a standard kappa coefficient or a rare kappa coefficient and percentage agreement. RESULTS: High levels of agreement were found between the two interviews on all 14 syndromes analyzed (p < 0.05). ChIPS and DICA also had high levels of agreement with clinicians' diagnoses. When DSM-III-R revised ChIPS and DICA-R-C results were discrepant, ChIPS results were somewhat more likely than DICA-R-C results (48 % versus 38%) to agree with the clinician's diagnoses. CONCLUSION: ChIPS appears to be a valid assessment for screening children in inpatient and outpatient mental health facilities. It has the added benefit of being brief, with average administration time of 46 minutes for an inpatient sample and 36 minutes for an outpatient sample.

Adolescent↗
PubMed1998

Study III: development and concurrent validity of the Children's Interview for Psychiatric Syndromes--parent version (P-ChIPS).

OBJECTIVE: To assess concurrent validity for the newly developed parent version of the Children's Interview for Psychiatric Syndromes (P-ChIPS). METHOD: ChIPS and P-ChIPS were administered to 36 children 6 to 13 years of age and their parents. P-ChIPS results were compared with clinicians' diagnoses for 21 of those children. Either a standard or rare kappa coefficient and percentage agreement were used to assess concordance. Questions on P-ChIPS have a one-to-one correspondence with questions on the ChIPS, with the only change being from first to third person (e.g. "Have you ever . ." is replaced by "Has your child ever . . ."). RESULTS: There were moderate levels of agreement between the parent and child versions of the instrument, consistent with other reports of parent and child concordance on structured interviews in the literature. Likewise, there were moderate levels of agreement between the parent interview and clinician diagnoses, again consistent with other reports of parent and clinician concordance in the literature. Sensitivity averaged 87% across diagnostic categories, and average specificity was 76%. CONCLUSION: P-ChIPS has adequate psychometric properties for use in clinical settings.

Adolescent↗
PubMed1998

Study IV: concurrent validity of the DSM-IV revised Children's Interview for Psychiatric Syndromes (ChIPS).

OBJECTIVE: To determine validity of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) revised Children's Interview for Psychiatric Syndromes (ChIPS) in inpatient children and adolescents. METHOD: Participants were 47 psychiatric inpatients 6-12 (n = 23) and 12 to 18 years of age (n = 24). ChIPS was administered to all participants. The Diagnostic Interview for Children and Adolescents-Revised-Child Version (DICA-R-C) was administered to 40 participants. Discharge diagnoses were recorded for all participants. Kappas, low base rate kappas, and percentage agreement were used to assess diagnostic agreement between sources for 18 disorders. RESULTS: ChIPS/DICA-R-C kappas could not be calculated for two disorders because of 100% agreement on their absence. Fourteen of 16 kappas were significant (p < 0.05). The remaining 2 of 16 disorders had 98% agreement (kappax = 0.494, p < 0.157). When ChIPS results were compared with discharge diagnoses, sensitivity for each disorder averaged 70%, whereas specificity averaged 84%. When disagreements occurred between all three sources, ChIPS was somewhat more likely than DICA-R-C to agree with discharge diagnoses (27% versus 22%). Analysis were repeated for children and adolescents, then for boys and girls. Boys and children had fewer significant ChIPS and DICA-R-C kappa coefficients compared with girls and adolescents; this appeared to be related to the fewer number of diagnoses they endorsed. ChIPS/clinician agreement was similar for boys and girls as well as for children and adolescents. Administration time was less for ChIPS than for DICA-R-C (p < 0.08). CONCLUSION: Psychometric properties of the DSM-IV revised ChIPS compare favorably with that of other structured interviews. ChIPS appears to work well for adolescents as well as children.

Adolescent↗
PubMed1998

Study V: Children's Interview for Psychiatric Syndromes (ChIPS): psychometrics in two community samples.

OBJECTIVE: To determine sensitivity and specificity of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) revised Children's Interview for Psychiatric Syndromes (ChIPS) in nonclinical samples. METHOD: Participants were 40 children 6 to 18 years of age from a community sample (n = 22) or a bereaved sample 1 to 2 years following the death of a parent (n = 18). ChIPS and the Diagnostic Interview for Children and Adolescents (DICA-R-C) were administered in a Latin Square design. A consensus conference (CC) of child psychopathology experts determined presence or absence of syndromes or symptoms after reviewing assessment materials not including ChIPS. RESULTS: Sensitivity is commensurate with epidemiologic base rates (17.5% of participants endorsed at least one syndrome). Low base rate kappas and percentage agreement were calculated to determine agreement on symptom or syndrome endorsement for 20 disorders. For syndrome analyses, over half the kappas could not be calculated due to 100% agreement on absence. For symptom analyses, 3 of 20 kappas could not be calculated (100% agreement on absence). Eleven of ChIPS/DICA-R-C symptom kappas were significant (p < 0.04), 2 of 17 had 95% agreement (kappas, p < 0.08), and 4 of 17 had 97.5% agreement (kappas, p < 0.16). Thirteen of 17 ChIPS/CC symptom kappas were significant (p < 0.04), and 4 of 17 had 97.5% agreement (kappas, p < 0.16). CONCLUSION: ChIPS' psychometrics in nonclinical samples compares favorably with that of other structured interviews.

Adolescent↗
PubMed1998

Comparison of lithium dosage methods for preschool- and early school-age children.

OBJECTIVE: Lithium may be useful in the treatment of prepubertal children with bipolar disorder or aggressive conduct disorder. However, there are few dosage guidelines. This study compares two dosage methods reported for prescribing lithium to prepubertal children: (1) a weight-based dosing schedule and (2) a single-dose, kinetics-based method. METHOD: Lithium doses were calculated using each method and then compared with doses actually used in the clinical care of hospitalized children. RESULTS: No statistically significant differences were found between mean lithium dose estimates calculated by the two methods. Average lithium dose estimates for both kinetic and weight-based methods were less than the observed discharge doses. Differences were seen between the two methods for children weighing between 25 and 30 kg. CONCLUSIONS: The weight-based dosing schedule and the single-dose, kinetics-based methods for calculating lithium dose result in similar dosage estimates when applied to young children.

Analysis of Variance↗
PubMed1997

Use and abuse of the Children's Depression Inventory.

This study investigated current uses of the Children's Depression Inventory (CDI), a frequently cited self-report measure for children's depressive symptomatology. Recently published studies of "childhood depression" were reviewed: Half of them used the CDI. Of these studies, 68% did not use a clinical or structured interview to determine diagnostic status. When the CDI was used alone to assess depressive symptoms, 44% of studies referred to high CDI scorers as "depressed" without providing a clear cautionary statement (i.e., either stating that the CDI cannot be used to diagnose depression or clarifying limitations regarding generalization of findings from a nonclinical to a clinical sample). These results are similar to those previously published regarding the Beck Depression Inventory, and they suggest a need for caution in the administration and interpretation of results from self-report inventories for children's depressive symptoms.

Chi-Square Distribution↗
PubMed1995

Bipolar disorder in children: misdiagnosis, underdiagnosis, and future directions.

Bipolar disorder has not been well studied in prepubertal children, despite its potentially debilitating effects on growth and development. However, there have been case reports of mania in this age group dating back to Esquirol in the mid-19th century. Despite anecdotal case reports, explicit criteria to diagnose mania in children were not used until 1960. Since 1980 the DSM-III/DSM-III-R criteria have indicated adult criteria can be used to diagnose childhood mania, with some modifications to adjust for age differences. Bipolar disorder has not been frequently considered in the psychiatric differential diagnosis of children. However, if a diagnosis of mania is made, clinical rating scales can be used to rate the severity of manic symptoms and to monitor treatment. A manic child should be treated using a biopsychosocial approach. To date, lithium carbonate has been the most commonly used psychopharmacological treatment, but results have been variable. Additional research is needed, including double-blind, placebo-controlled studies to document the beneficial effects of mood-stabilizing medications. Also, diagnostic instruments should be refined to improve their utility. Finally, children at high risk for developing mania should be studied to identify predictors of bipolar disorder in children.

Adolescent↗
PubMed1995

Untoward effects of lithium treatment in children aged four through six years.

OBJECTIVE: To explore the relationship between lithium dose and serum lithium level on the occurrence of untoward or toxic effects of lithium in the treatment of 20 hospitalized aggressive and/or mood-disordered children aged 4 through 6 years. METHOD: Clinical and research records of 20 children treated with lithium according to an established inpatient protocol were reviewed. Side effects as reported by psychiatric staff were categorized by organ system affected and severity. RESULTS: During the initial 2 weeks of lithium treatment, 60% of the children manifested one or more types of side effects, most commonly central nervous system effects. Side effects were seen at doses of 25.6 to 52.1 mg/kg per day and at serum levels from 0.65 to 1.37 mEq/L. In general, adverse effects were associated with higher lithium doses and lithium levels and were most common during the first week of treatment. A potential interaction between concurrent infection and more severe side effects was seen. CONCLUSIONS: Side effects occur frequently in children aged 6 years and younger during the initiation phase of lithium treatment; are related to higher milligram per kilogram doses, higher serum lithium levels, and phase of treatment; and may be related to concurrent medical illness.

Aggression↗
PubMed1995

The Mania Rating Scale (MRS): further reliability and validity studies with children.

Empirical studies of prepubertal mania are scarce and are limited by a lack of assessment instruments. This study extended previous research on the Mania Rating Scale (MRS) in children. Psychometric properties of the MRS were examined in three new groups of prepubertal subjects: (1) 10 inpatients with bipolar disorder, (2) 10 inpatients with attention deficit hyperactivity disorder (ADHD), and (3) 10 outpatients with ADHD. Subjects were administered the MRS and other standard depression and hyperactivity measures. The MRS had adequate internal consistency (alpha = .80), convergent validity (r = .83, p < .0001), and divergent validity (no significant correlations with depression and hyperactivity ratings). Items assessing "classic" manic symptoms (e.g., elevated mood, increased sexual interest, pressured speech, racing thoughts) effectively discriminated the bipolar group from both comparison groups, while items assessing increased activity level and irritability did not. Results suggest that the MRS can be used with children.

Attention Deficit Disorder with Hyperactivity↗
PubMed1993

Psychosocial functioning in children after the death of a parent.

Eight weeks after the death of a parent, children from stable families (N = 38) were compared to depressed inpatients (N = 38) and normal children (N = 19). School behavior, interest in school, peer involvement, peer enjoyment, and self-esteem were similar for bereaved and normal children. Bereaved children functioned significantly better than depressed inpatients. As a group, the bereaved children from stable families did not experience significant, acute psychosocial dysfunction.

Adaptation, Psychological↗