Using multiple datasets to examine youth psychiatric diagnosis

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DESCRIPTION (provided by applicant): Since the development of DSM-III in 1980, and through its subsequent revisions (DSM-III-R, DSM-IV), DSM criteria have become almost universally accepted as a basis for diagnosis in the mental health professions. Despite this broad acceptance, there is a paucity of empirical data available that support the highly specified diagnostic formations embodied in manual. The impact that adding, removing, or otherwise altering criteria may have on disorder prevalence, natural history, or associated impairment has not been well studied. There is little consensus on the issue of comorbidity and the extent to which this phenomenon represents misplaced diagnostic boundaries, responses to common antecedents, or causal linkages between disorders. Finally, and especially important to child psychiatry, there is relatively little information available about developmental differences in the expression and significance of DSM-defined disorders. The proposed project would compile and analyze a database of diagnostic and symptom data collected by 16 investigations of youth, all of which used a DSM- linked version of the DISC. The total database would have data on approximately 19,000 children and adolescents -- longitudinal data is available on approximately 14,000 of these. The specific analytic aims outlined in the proposal (examining the validity of diagnostic subtypes and specifiers; understanding diagnostic boundaries and comorbidity; justifying diagnostic thresholds; studying the appropriateness of individual symptom criteria; comparing dimensional and categorical definitions) address the most important and pressing diagnostic and classification issues facing the field and will inform the epistemological underpinnings of child and adolescent psychiatric nosology. In a cost-efficient, manner this project will afford a unique opportunity to address many questions that can only be answered with such a large aggregated dataset with well-defined samples assessed with a standardized, comprehensive and transparent methodology. The aggregated data will also represent an invaluable data resource for future research. PUBLIC HEALTH RELEVANCE: The DSM has become the established standard for psychiatric diagnosis but many of the categories and criteria specified in the manual have not been based upon or tested with empirical data. The proposed project will compile and analyze a database of diagnostic and symptom data on approximately 19,000 children and adolescents to address the validity of current and proposed diagnostic categories and criteria. The project will also provide an invaluable data resource for addressing research questions that require large samples assessed with a standardized, comprehensive and transparent methodology.