Clinician, Parent, and Teacher Contributions to Predictions of Outcomes for Child Psychiatric Outpatients in the Netherlands

Mental health evaluations of children typically include interviews with clinicians. However, little is known about the contributions that clinicians’ interviews can make to predicting the subsequent outcomes of children’s problems.

To identify predictive relations between clinicians’ ratings from the Semistructured Clinical Interview for Children and Adolescents (SCICA) and subsequent outcomes, a Dutch child psychiatrist, Dr. Robert Ferdinand, and his colleagues did 3-year follow-ups (Time 2) of children who were initially evaluated at a child psychiatric clinic when they were 6 to 12 years old (Time 1). The outcome data included reports of mental health services being received by the child at Time 2; parents’ wish for additional professional help for the child at Time 2; school behavior problems during the follow-up period; and police/judicial contacts during the follow-up period. Significant predictive relations found for SCICA observational scales (i.e., scales comprising problems observed by clinicians) included the following: The SCICA Attention Problems syndrome predicted outpatient and inpatient treatment, while the SCICA Resistant syndrome predicted outpatient treatment, parents’ wish for professional help, and school behavior problems.

Significant predictive relations for SCICA scales comprising problems reported by the children included the following: The SCICA Aggressive Behavior syndrome predicted parents’ wish for help, while the SCICA Anxious/Depressed syndrome predicted police/judicial contacts. To determine whether the clinicians’ ratings added predictive information to parent and teacher ratings, Ferdinand et al. then combined Time 1 SCICA, CBCL, and TRF syndrome scores in testing predictive relations to Time 2 outcomes.

They found that the SCICA Aggressive Behavior syndrome survived as the only significant predictor of parents’ Time 2 wish for professional help, whereas the SCICA Attention Problems syndrome and CBCL Social Problems syndrome both survived as significant predictors of Time 2 inpatient treatment. The CBCL Social Problems syndrome and TRF Aggressive Behavior syndrome both survived as significant predictors of Time 2 outpatient treatment. The TRF Aggressive Behavior syndrome was the sole surviving predictor of Time 2 school problems, while the TRF Social Problems syndrome was the sole surviving predictor of police/judicial contacts.

The authors concluded that their study “was the first that found clinicians’ ratings of self-reported and observed behaviors in a semi-structured interview (SCICA) make an important and unique contribution to the multiaxial assessment of problem behaviors, based on longitudinal data” (p. 875). However, they also pointed out that “The findings tell us that clinical assessment should always be supplemented with information from parents and teachers” (p. 873).

Reference: Ferdinand, R.F., Hoogerheide, K.N., van der Ende, J., Heijmens Visser, J., Koot, H.M., Kasius, M.C., & Verhulst, F.C. (2003). The role of the clinician: Three-year predictive value of parents’, teachers’, and clinicians’ judgment of childhood psychopathology. Journal of Child Psychology and Psychiatry, 44, 867-876.