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The Great Smoky Mountains Study of Youth: Functional Impairment and Serious Emotional Disturbance

The Great Smoky Mountains Study of Youth: Functional Impairment and Serious Emotional Disturbance Abstract Background: Federal regulations require states to estimate the prevalence and incidence of serious emotional disturbance (SED) in children, defined as a DSMIII-R diagnosis in the presence of impaired functioning in 1 or more areas. We reviewed the published data on SED and examined rates and correlates of SED in an ongoing epidemiologic study of children. Methods: Rates of DSM-III-R disorders, functional impairment, and their co-occurrence (SED) were examined in a representative population sample of 9-, 11-, and 13-year-olds from a predominantly rural area of North Carolina. Three measures of functional impairment were used, and their interrelationship and impact on rates of SED were examined. Results: Serious emotional disturbance was identified in 4% to 8% of the study population, depending on the measure of impairment; the rate of DSM-III-R disorder ignoring impairment was 20.3%. One quarter of children identified as having SED on any measure were identified by all 3, and one half by 2 or more. Behavioral disorders, emotional disorders, and comorbidity were associated with a significant increase in the likelihood of SED; enuresis and tic disorders in the absence of comorbidity were not. Diagnosis and impairment made independent contributions to the increase in service use seen in children with SED. Poverty greatly increased the likelihood of SED. Conclusions: Specific areas of functional impairment should be examined when SED is assessed and treatment is planned. Plans to target mental health care resources to children with SED need to be accompanied by efforts to ensure access to those resources. References 1. American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition . Washington, DC: American Psychiatric Association; 1994. 2. Substance Abuse and Mental Health Services Administration (notices). Federal Register >. (May 20) , 1993;58:29425. 3. Rutter M, Graham P. Psychiatric disorder in 10- and 11-year-old children . Proc R Soc Med . 1966;59:382-387. 4. Zahner GEP, Pawelkiewicz W, DeFrancesco JJ, Adnopoz J. Children's mental health service needs and utilization patterns in an urban community: an epidemiologic assessment . J Am Acad Child Adolesc Psychiatry . 1992;31:951-960.Crossref 5. Shaffer D, Gould MS, Brasic J, Ambrosini PJ, Fisher PW, Bird HR, Aluwahlia S. A Children's Global Assessment Scale (CGAS) . Arch Gen Psychiatry . 1983;40:1228-1231.Crossref 6. Shaffer D, Fisher PW, Dulcan M, Davies M, Piacentini J, Schwab-Stone M, Lahey BB, Bourdon K, Jensen P, Bird H, Canino G, Regier D. The NIMH Diagnostic Interview Schedule for Children (DISC 2.3): description, acceptability, prevalences, and performance in the MECA Study . J Am Acad Child Adolesc Psychiatry . 1996;35:865-877.Crossref 7. Offord DR, Boyle MH, Szatmari P, Rae-Grant NI, Links PS, Cadman DT, Byles JA, Crawford JW, Munroe-Blum H, Byrne C, Thomas H, Woodward CA. Ontario Child Health Study, II: six-month prevalence of disorder and rates of service utilization . Arch Gen Psychiatry . 1987;44:832-836.Crossref 8. Sanford MN, Offord DR, Boyle MH, Peace A, Racine YA. Ontario Child Health Study: social and school impairments in children aged 6 to 16 years . J Am Acad Child Adolesc Psychiatry . 1992;31:60-67.Crossref 9. Costello EJ, Angold A, Burns BJ, Stangl DK, Tweed DL, Erkanli A, Worthman CM. The Great Smoky Mountains Study of Youth: goals, design, methods, and the prevalence of DSM-III-R disorders . Arch Gen Psychiatry . 1996;53:1129-1136.Crossref 10. Achenbach TM, Edelbrock C. Manual for the Child Behavior Checklist and Child Behavior Profile . Burlington, Vt: University of Vermont; 1983. 11. Angold A, Prendergast M, Cox A, Harrington R, Simonoff E, Rutter M. The Child and Adolescent Psychiatric Assessment (CAPA) . Psychol Med . 1995;25:739-753.Crossref 12. Farmer EMZ, Angold A, Burns BJ, Costello EJ. Reliability of self-reported service use: test-retest consistency of children's responses to the Child and Adolescent Services Assessment (CASA) . J Child Fam Stud . 1994;3:307-325.Crossref 13. Hodges K, Bickman L, Ring-Kurtz S, Rieter M. Multidimensional measure of level of functioning for children and adolescents . In: Algarian A, Friedman R, eds. A System of Care for Children's Mental Health: Expanding the Research Base . Tampa, Fla: Research Training Center for Children's Mental Health; 1991: 149-154. 14. Angold A, Costello EJ. A test-retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C) . Psychol Med . 1995;25:755-762.Crossref 15. World Health Organization. International Classification of Impairments, Disabilities, and Handicaps: A Manual of Classification Relating to the Consequences of Disease . Geneva, Switzerland: World Health Organization; 1980. 16. Shah BV, Folsom RE, LaVange LM, Wheeless SC, Boyle KE, Williams RL. SUDAAN Software for the Statistical Analysis of Correlated Data: Statistical Methods and Mathematical Algorithms Used in SUDAAN . Research Triangle Park, NC: Research Triangle Institute; 1995. 17. American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987. 18. Bird HR, Canino G, Rubio-Stipec M, Gould MS, Ribera J, Sesman M, Woodbury M, Huertas-Goldman S, Pagan A, Sanchez-Lacay A, Moscoso M. Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico: the use of combined measures . Arch Gen Psychiatry . 1988;45:1120-1126.Crossref 19. Costello EJ, Costello AJ, Edelbrock C, Burns BJ, Dulcan MK, Brent D, Janiszewski S. Psychiatric disorders in pediatric primary care: prevalence and risk factors . Arch Gen Psychiatry . 1988;45:1107-1116.Crossref 20. Bird HR, Yager TJ, Staghezza B, Gould MS, Canino G, Rubio-Stipec M. Impairment in the epidemiological measurement of childhood psychopathology in the community . J Am Acad Child Adolesc Psychiatry . 1990;29:796-803.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

The Great Smoky Mountains Study of Youth: Functional Impairment and Serious Emotional Disturbance

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References (21)

Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1996.01830120077013
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Federal regulations require states to estimate the prevalence and incidence of serious emotional disturbance (SED) in children, defined as a DSMIII-R diagnosis in the presence of impaired functioning in 1 or more areas. We reviewed the published data on SED and examined rates and correlates of SED in an ongoing epidemiologic study of children. Methods: Rates of DSM-III-R disorders, functional impairment, and their co-occurrence (SED) were examined in a representative population sample of 9-, 11-, and 13-year-olds from a predominantly rural area of North Carolina. Three measures of functional impairment were used, and their interrelationship and impact on rates of SED were examined. Results: Serious emotional disturbance was identified in 4% to 8% of the study population, depending on the measure of impairment; the rate of DSM-III-R disorder ignoring impairment was 20.3%. One quarter of children identified as having SED on any measure were identified by all 3, and one half by 2 or more. Behavioral disorders, emotional disorders, and comorbidity were associated with a significant increase in the likelihood of SED; enuresis and tic disorders in the absence of comorbidity were not. Diagnosis and impairment made independent contributions to the increase in service use seen in children with SED. Poverty greatly increased the likelihood of SED. Conclusions: Specific areas of functional impairment should be examined when SED is assessed and treatment is planned. Plans to target mental health care resources to children with SED need to be accompanied by efforts to ensure access to those resources. References 1. American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition . Washington, DC: American Psychiatric Association; 1994. 2. Substance Abuse and Mental Health Services Administration (notices). Federal Register >. (May 20) , 1993;58:29425. 3. Rutter M, Graham P. Psychiatric disorder in 10- and 11-year-old children . Proc R Soc Med . 1966;59:382-387. 4. Zahner GEP, Pawelkiewicz W, DeFrancesco JJ, Adnopoz J. Children's mental health service needs and utilization patterns in an urban community: an epidemiologic assessment . J Am Acad Child Adolesc Psychiatry . 1992;31:951-960.Crossref 5. Shaffer D, Gould MS, Brasic J, Ambrosini PJ, Fisher PW, Bird HR, Aluwahlia S. A Children's Global Assessment Scale (CGAS) . Arch Gen Psychiatry . 1983;40:1228-1231.Crossref 6. Shaffer D, Fisher PW, Dulcan M, Davies M, Piacentini J, Schwab-Stone M, Lahey BB, Bourdon K, Jensen P, Bird H, Canino G, Regier D. The NIMH Diagnostic Interview Schedule for Children (DISC 2.3): description, acceptability, prevalences, and performance in the MECA Study . J Am Acad Child Adolesc Psychiatry . 1996;35:865-877.Crossref 7. Offord DR, Boyle MH, Szatmari P, Rae-Grant NI, Links PS, Cadman DT, Byles JA, Crawford JW, Munroe-Blum H, Byrne C, Thomas H, Woodward CA. Ontario Child Health Study, II: six-month prevalence of disorder and rates of service utilization . Arch Gen Psychiatry . 1987;44:832-836.Crossref 8. Sanford MN, Offord DR, Boyle MH, Peace A, Racine YA. Ontario Child Health Study: social and school impairments in children aged 6 to 16 years . J Am Acad Child Adolesc Psychiatry . 1992;31:60-67.Crossref 9. Costello EJ, Angold A, Burns BJ, Stangl DK, Tweed DL, Erkanli A, Worthman CM. The Great Smoky Mountains Study of Youth: goals, design, methods, and the prevalence of DSM-III-R disorders . Arch Gen Psychiatry . 1996;53:1129-1136.Crossref 10. Achenbach TM, Edelbrock C. Manual for the Child Behavior Checklist and Child Behavior Profile . Burlington, Vt: University of Vermont; 1983. 11. Angold A, Prendergast M, Cox A, Harrington R, Simonoff E, Rutter M. The Child and Adolescent Psychiatric Assessment (CAPA) . Psychol Med . 1995;25:739-753.Crossref 12. Farmer EMZ, Angold A, Burns BJ, Costello EJ. Reliability of self-reported service use: test-retest consistency of children's responses to the Child and Adolescent Services Assessment (CASA) . J Child Fam Stud . 1994;3:307-325.Crossref 13. Hodges K, Bickman L, Ring-Kurtz S, Rieter M. Multidimensional measure of level of functioning for children and adolescents . In: Algarian A, Friedman R, eds. A System of Care for Children's Mental Health: Expanding the Research Base . Tampa, Fla: Research Training Center for Children's Mental Health; 1991: 149-154. 14. Angold A, Costello EJ. A test-retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C) . Psychol Med . 1995;25:755-762.Crossref 15. World Health Organization. International Classification of Impairments, Disabilities, and Handicaps: A Manual of Classification Relating to the Consequences of Disease . Geneva, Switzerland: World Health Organization; 1980. 16. Shah BV, Folsom RE, LaVange LM, Wheeless SC, Boyle KE, Williams RL. SUDAAN Software for the Statistical Analysis of Correlated Data: Statistical Methods and Mathematical Algorithms Used in SUDAAN . Research Triangle Park, NC: Research Triangle Institute; 1995. 17. American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987. 18. Bird HR, Canino G, Rubio-Stipec M, Gould MS, Ribera J, Sesman M, Woodbury M, Huertas-Goldman S, Pagan A, Sanchez-Lacay A, Moscoso M. Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico: the use of combined measures . Arch Gen Psychiatry . 1988;45:1120-1126.Crossref 19. Costello EJ, Costello AJ, Edelbrock C, Burns BJ, Dulcan MK, Brent D, Janiszewski S. Psychiatric disorders in pediatric primary care: prevalence and risk factors . Arch Gen Psychiatry . 1988;45:1107-1116.Crossref 20. Bird HR, Yager TJ, Staghezza B, Gould MS, Canino G, Rubio-Stipec M. Impairment in the epidemiological measurement of childhood psychopathology in the community . J Am Acad Child Adolesc Psychiatry . 1990;29:796-803.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Dec 1, 1996

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