A Model for Diagnosing Mental Health Problems in the Young

By Melissa Murray

Estimates suggest that 15 percent to 20 percent of children and adolescents in the United States suffer from mental health disorders ranging from anxiety and depression to attention deficit hyperactivity disorder and conduct disorder. Many of these children go untreated. Now, researchers in child and adolescent psychiatry at P&S have assembled a battery of standardized tests and interviews that will enable children with mental health disorders and their parents to receive a comprehensive mental health diagnostic evaluation with a considerable amount of precision, at a relatively low cost. Children are seen at the Ruane Diagnostic Unit (RDU) at Babies & Children’s Hospital. Analogous to the type of comprehensive medical examinations available in other medical disciplines, the RDU battery consists of half a day of assessments and interviews for children and their parents. The cost for the session, $130, is covered by Medicaid and other insurance. The RDU was established to be the ‘one-stop’ shop in terms of children’s mental health evaluation, providing in a half day what typically takes a month or more. “Recognizing that a child is suffering from a serious mood or mental health disorder and getting that child seen by a mental health professional can be a daunting and expensive venture for parents,” says Dr. Laura Mufson, clinical psychologist and the unit’s director. “Our intent with the unit is to expedite clinical decisions that would lead to high quality care.” According to Dr. Mufson, eliminating these barriers also provides additional treatment motivation for parents and children. For example, some disorders, like depression, are time-limited phenomena. If a comprehensive diagnosis takes three months, the patient’s mood and attitude can be very different from the first visit to the last. As time goes on, patients become less interested in getting help and may abandon the process. “We are really a unique diagnostic triage unit that will get children to an appropriate treatment clinic faster with a more thorough assessment,” says Dr. Richard Gaines, assistant professor of clinical psychology in psychiatry and director of pediatric psychiatry services. “By training lay people to function in conjunction with highly skilled professionals, we are able to provide a high quality workup without the associated high cost.” The primary measurement tool in the battery is the Diagnostic Interview Schedule for Children (DISC). Developed at P&S with support from the National Institute of Mental Health, DISC is a computerized interview that enables a full psychiatric diagnostic profile to be developed on children and adolescents without a skilled (and expensive) examination by a psychiatrist or other clinician. DISC ensures that all children are asked about all symptoms in an organized way that will result in a comprehensive diagnostic assessment. Results of DISC are scored and printed by a computer program, and the diagnosis is confirmed by a clinician. The testing begins with the initial phone call and screening to gather the child’s symptoms. During the half-day battery, the child and parent are seen simultaneously. Both parent and child complete DISC plus a number of tests to establish a behavioral profile of the child’s functioning, a parent’s own psychiatric symptoms, and family demographics. Following completion of the assessment instruments, the child has a brief interview with a clinician who confirms a diagnosis and rules out any at-risk situation or active suicidality. Patients are then referred to one of several pediatric psychiatry programs at Babies & Children’s Hospital. Patients who qualify for and are interested in participating in an active research protocol are referred to the Child Psychiatry Research Center at New York State Psychiatric Institute. Since January 1998, RDU has seen 96 children and referred 86 to treatment or research clinics. With the computerized battery, records and test results are available immediately to the clinic where the child is referred or to researchers at the Child Psychiatry Research Center. “This sophisticated diagnostic battery saves valuable clinician time and money and allows the child to forgo additional evaluation visits over a protracted period of time,” says Dr. Gaines. RDU consists of Dr. Mufson, two part-time psychologists, and three lay interviewers who administer the testing. The unit was created and is supported by philanthropists William and Joy Ruane, who also sponsor the New York State Psychiatric Institute’s Joy and William Ruane Center for the Early Identification and Treatment of Children with Mood Disorders. In addition to the staffing and operations of the unit, the Ruanes supported extensive renovations at Babies & Children’s so testing could be completed conveniently in one area.

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