Evidence-based assessment/Step 6: Add focused, incremental assessments

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Prescription: Add Focused, Incremental Assessments[edit | edit source]

Overview[edit | edit source]

There are scales that can help differentiate between types of anxiety disorders[1] (A. R. Van Meter et al., in press). For example, if oppositional defiant disorder, PTSD, and bipolar disorder were all contending hypotheses for a case, the clinician might explore the likelihood of each diagnosis using a different set of DLRs on the nomogram. The Achenbach Externalizing score might be interpreted with regard to the probability of ODD, but replaced by the Parent 10 item Child Mania Rating Scale[2] for the purpose of evaluating the bipolar hypothesis, and by the Child PTSD Screening Scale for PTSD (You et al., 2015). The CPSS and CMRS would not need to be given routinely due to the rarity of their target conditions in most settings (Rettew et al., 2009), but they would be more helpful than the CBCL for cases that have risk factors or other findings raising concerns.

As costs come down and technology makes it more feasible to interpret the information rapidly[3], physiological measures are likely to play an increasing role at this stage of the evaluation process[4]. Although they would need to show large effect sizes to be useful in isolation for diagnosis[5], it is more likely that will be able to offer meaningful incremental validity[6].

Rationale[edit | edit source]

Logic within a Diagnostic Framework SnNOut and SpPIn mnemonics. Discussion of predictive powers. Examples. Why we don't recommend universal screening for bipolar and other rare conditions.

Incremental Validity Discussions


Cost and Utility Paper and online versus imaging and blood tests.

Steps to put into practice[edit | edit source]

Tables and figures[edit | edit source]

References[edit | edit source]

  1. You, D. S., Youngstrom, E. A., Feeny, N. C., Youngstrom, J. K., & Findling, R. L. (2015). Comparing the diagnostic accuracy of five instruments for detecting posttraumatic stress disorder in youth. Journal of Clinical Child & Adolescent Psychology, 1-12.
  2. Henry, D. B., Pavuluri, M. N., Youngstrom, E., & Birmaher, B. (2008). Accuracy of brief and full forms of the Child Mania Rating Scale. Journal of clinical psychology, 64(4), 368-381.
  3. De Los Reyes, A., Augenstein, T. M., Aldao, A., Thomas, S. A., Daruwala, S., Kline, K., & Regan, T. (2013). Implementing Psychophysiology in Clinical Assessments of Adolescent Social Anxiety: Use of Rater Judgments Based on Graphical Representations of Psychophysiology. Journal of Clinical Child & Adolescent Psychology. doi: 10.1080/15374416.2013.859080
  4. De Los Reyes, A., & Aldao, A. (2014). Introduction to the special section. Toward implementing physiological measures in clinical child and adolescent assessments. Journal of Clinical Child & Adolescent Psychology.
  5. Youngstrom, E. A., & Reyes, A. D. L. (2015). Commentary: moving toward cost-effectiveness in using psychophysiological measures in clinical assessment: validity, decision making, and adding value. Journal of Clinical Child & Adolescent Psychology, 44(2), 352-361.
  6. Haynes, S. N., & Lench, H. C. (2003). Incremental validity of new clinical assessment measures. Psychological Assessment, 15(4), 456-466.