Announcements 1. Clinical treatment writing assignment Choose a topic—some child problem (e.g. sleep problem, ADHD, autism, etc.) Choose a topic—some child problem (e.g. sleep problem, ADHD, autism, etc.) Research the treatments for that problem. Can use a variety of sources but need to document and cite. Research the treatments for that problem. Can use a variety of sources but need to document and cite. From the perspective of a parent, choose the treatment that you would prefer if your child had this problem. Justify and explain your choice. From the perspective of a parent, choose the treatment that you would prefer if your child had this problem. Justify and explain your choice. Proofread carefully! Look for typos, grammar errors, consider organization of paper, need intro. paragraph and conclusion. Proofread carefully! Look for typos, grammar errors, consider organization of paper, need intro. paragraph and conclusion. Cite references using APA style. Cite references using APA style. 2.Parent interview – bring your results to next class

Classification We have Diagnostic & Statistical Manual (DSM-IV-TR) We have Diagnostic & Statistical Manual (DSM-IV-TR) Why have such a system? Why have such a system? 1. Communication 2. Summarize 3. Identify treatment strategies 4. Facilitate research 5. Etiology/prognosis

Potential problems with classification 1. Stigma Self-fulfilling prophecy Self-fulfilling prophecy 2. Overlook important factors 3. Labeling effects 4. Focus on weaknesses 5. Lose information **importance of person-first language

Approaches to classification 1. Empirical Approach 2. Clinical Approach Empirical Approach relies on factor analysis relies on factor analysis No initial assumptions about which symptoms go together No initial assumptions about which symptoms go together No initial assumptions about what diagnostic categories exist No initial assumptions about what diagnostic categories exist

Empirical Approach Example: our very own Milich et al. (1982) Example: our very own Milich et al. (1982) 90 boys 90 boys Trained judges to rate boys on behavioral symptoms (see overhead) Trained judges to rate boys on behavioral symptoms (see overhead) Factor analysis revealed 3 factors Factor analysis revealed 3 factors Example: Achenbach’s Child Behavior Checklist Example: Achenbach’s Child Behavior Checklist Rating scale of 100 most commonly reported problems Rating scale of 100 most commonly reported problems 8 factors (see overhead) with some variability 8 factors (see overhead) with some variability

General Information on Categorization Based on Achenbach Based on Achenbach Two broad categories Two broad categories Externalizing – undercontrolled Externalizing – undercontrolled Internalizing – overcontrolled Internalizing – overcontrolled Good reliability and validity evidence Good reliability and validity evidence Narrow band factors Narrow band factors Often specific to age, gender, and setting Often specific to age, gender, and setting Some debate: e.g. anxiety vs. depression Some debate: e.g. anxiety vs. depression

Strengths of empirical classification 1. Avoids bias to which clinicians are susceptible 2. Quantitative approach to decision making 3. Allows for evaluation of differing perspectives

Limitations of empirical approach 1. Implementation 2. Limitations of data going into factor analysis 3. Does not identify rare disorders

Clinically Derived systems Relies on experts in the field Relies on experts in the field Experts use their clinical observations Experts use their clinical observations Some compromise involved Some compromise involved Example: DSM systems Example: DSM systems Symptom based Symptom based

DSM systems Strengths: Strengths: 1. Breadth of coverage 2. Operational criteria 3. Includes exclusionary criteria 4. No attempt to identify etiology Weaknesses Weaknesses 1. Fails to recognize interactions with environment 2. Some poor operational definitions e.g. “often” 3. Lacks developmental framework 4. All or nothing approach

DSM-IV Attempted to integrate empirical and clinical approaches Attempted to integrate empirical and clinical approaches Used experts but also Used experts but also Used literature reviews Used literature reviews Field trials Field trials

Writing Assignment Briefly describe the next study to be done following Milich et al. (1992). Why would you do this study? Describe the design of the study. What would this study tell us and why is this important?