Validation of the Diagnostic Infant and Preschool Assessment in a Danish, trauma-exposed sample of young children

	Total N= 62,n(%)	Mental health clinics N= 19,n(%)	Regional Children Centre N= 33,n(%)	Women’s shelter and network for victims of IPS N= 10,n(%)
Gender
Male	33 (53.2)	11 (57.9)	18 (54.5)	4 (40.0)
Female	29 (46.8)	8 (42.1)	15 (45.5)	6 (60.0)
Age
Median	5.1	5.3	5.3	3.5
Lower quartile	3.9	4.5	4.0	2.4
Median quartiles	5.1	5.5	5.3	3.5
Upper quartiles	6	6.6	6	4.3
Minimum-maximum	1.5-6.9	2-6.9	1.8-6.9	1.5-6.2
Number of traumas
Median	3	2	3	2.5
Lower quartile	2	2	2	2
Median quartiles	3	2	3	2.5
Upper quartiles	4	3	4	3
Minimum-maximum	1-8	1-7	1-8	1-4

1 Note.IPV, intimate partner stalking. Children whose caregivers were recruited from women’s shelters and from the network of victims of intimate partner stalking are grouped together because the children from both recruitment places had all witnessed varying types of intimate partner violence

TABLE 2.

Child experiences of trauma as reported by caregivers during the DIPA

Trauma type	n(%)
Hospitalization or invasive medical procedures	37 (59.7)
Witnessed violence	32 (51.6)
Physical abuse	24 (38.7)
Sexual abuse	11 (17.7)
Accidental burning	8 (12.9)
Traffic accident	7 (11.3)
Kidnapped	4 (6.5)
Attacked by animal	4 (6.5)
Near drowning	2 (3.2)
Man-made disasters (fires, wars, etc.)	1 (1.6)
Natural disasters (hurricane, tornado, flood, etc.)	0 (0.0)
Other^a	49 (79.0)

1 Note. n= 59. DIPA, Diagnostic Infant and Preschool Assessment.^aThe category of “Other trauma” included reports of stalking, psychological violence, neglect, placing in foster care or other acute separation from primary caregiver, parental mental disorder and severely problematic divorce

TABLE 3.

Frequency of symptoms and fulfillment of diagnostic criteria based on the DIPA

Disorder	N	n(%) of sample meeting diagnostic criteria DSM-IV	n(%) of sample meeting diagnostic criteria ICD-10	n(%) of sample meeting diagnostic criteria RDC-PA
PTSD	62	9 (14.5)	17 (27.4)	30 (48.4)^a
Re-experience		51 (82.3)	27 (43.5)	51 (82.3)
Avoidance		12 (19.4)	28 (45.2)	37 (59.7)
Hyperarousal		42 (67.7)	38 (66.7%)	42 (67.7)
MDD	62	–	–	9 (14.5)
ADHD	60	–	7 (11.7)
Inattentive subtype		12 (19.4)	–	–
Hyperactivity subtype		9 (15.0)	–	–
ODD	60	13 (21.7)	6 (10.0)	–
CD	60	7 (11.7)	6 (10.0)	–
SAD	60	16 (26.7)	16 (26.7)	–
RAD	59
Inhibited subtype		5 (8.5)	–	5 (8.5)
Disinhibited subtype		7 (11.9)	–	6 (10.2)
Sleep disorder	62	–	–	–
Sleep onset dyssomnia		–	–	29 (46.8)
Night waking dyssomnia		–	–	24 (38.7)

1 Note.DIPA, Diagnostic Infant and Preschool Assessment; PTSD, posttraumatic stress disorder; MDD, major depressive disorder; ADHD, attention deficit hyperactivity disorder; ODD, oppositional defiant disorder; CD, conduct disorder; SAD, separation anxiety disorder; RAD, reactive attachment disorder; RDC-PA, Research Diagnostic Criteria – Preschool Age. The number of children who displayed enough symptoms to fulfill the diagnostic criteria for ICD-10 ADHD were the same with and without impairment. aPTSD according to the RDC-PA is the same as the PTSD alternative algorithm

TABLE 4.

Internal consistency and distribution of scores on the DIPA scales and subscales without impairment

Modules	N	α	No. of items	Median	Lower quartile	Median quartile	Upper quartile	Minimum-maximum	Skewness (SE)	Kurtosis (SE)
PTSD
Re-experience	59	0.69	9	2	1	2	4	0-8	0.58 (0.31)	−0.51 (0.61)
Avoidance	59	0.54	7	1	0	1	2	0-5	0.70 (0.31)	−0.46 (0.61)
Hyperarousal	59	0.64	6	2	1	2	4	0-6	−0.04 (0.31)	−1.33 (0.61)
Total	59	0.82	22	7	3	7	10	0-16	0.19 (0.31)	−0.85 (0.61)
MDD	59	0.86	23	0	0	0	5	0-11	1.25 (0.31)	0.32 (0.61)
ADHD
Inattentive	57	0.87	9	2	0	2	5	0-9	0.62 (0.32)	−0.99 (0.62)
Hyperactivity	57	0.87	9	2	0	2	4.5	0-9	0.82 (0.32)	−0.52 (0.62)
Total	57	0.90	18	5	1	5	8.5	0-18	0.69 (0.32)	−0.44 (0.62)
ODD	57	0.81	9	2	0	2	4	0-9	0.95 (0.32)	0.00 (0.62)
CD	57	0.70	15	0	0	0	1	0-7	2.30 (0.32)	5.86 (0.62)
SAD	57	0.86	10	1	0	1	3	0-9	1.31 (0.32)	0.62 (0.62)
RAD
Inhibited	56	0.71	5	1	0	1	2	0-5	1.46 (0.32)	1.77 (0.63)
Disinhibited	56	0.80	3	0	0	0	1	0-3	1.93 (0.32)	2.54 (0.63)
Total	56	0.82	8	1	0	1	2	0-8	1.68 (0.32)	2.46 (0.63)
Sleep disorder	59	0.62	2	1	0	1	2	0-2	0.30 (0.31)	−1.55 (0.61)

TABLE 5.

Scores on the SDQ

Scale	α	Mean (SD)	Median	Lower quartile	Median quartile	Upper quartile	Minimum-maximum	Skewness (SE)	Kurtosis (SE)
Total difficulties	0.76	15.27 (6.0)	15	11	15	19	1-27	−0.13 (0.31)	−0.47 (0.61)
Conduct problems	0.51	3.36 (1.8)	3	2	3	5	0-7	−0.08 (0.31)	−0.67 (0.61)
Emotional symptoms	0.65	4.44 (2.4)	4	2	4	6	0-10	0.18 (0.31)	−00.88 (0.61)
Hyperactivity	0.89	5.17 (3.2)	5	2	5	8	0-10	−0.06 (0.31)	−01.21 (0.61)
Peer problems	0.24	2.31 (1.6)	2	1	2	4	0-6	0.41 (0.31)	−00.61 (0.61)
Prosocial behavior	0.73	7.29 (2.1)	8	6	8	9	0-10	−0.87 (0.31)	1.10 (0.61)
Impact supplement	0.74	2.10 (.3)	2	0	2	3	0-9	1.05 (0.31)	1.00 (0.61)

1 Note.N= 59. SDQ, Strengths and Difficulties Questionnaire

TABLE 6.

Spearman’s rho correlations between number of symptoms in DIPA modules and the SDQ Total Difficulties scale and subscales

	SDQ Total Difficulties	SDQ conduct problems	SDQ emotional symptoms	SDQ hyperactivity	SDQ peer problems	SDQ prosocial behavior
PTSD total	0.38**	0.25	0.54**	0.14	0.09	−0.15
Re-experience	0.21	0.01	0.44**	0.03	0.04	−0.08
Avoidance	0.21	0.26*	0.28*	0.08	0.04	−0.19
Hyperarousal	0.35**	0.23	0.45**	0.10	0.12	−0.04
MDD	0.47**	0.43**	0.48**	0.20	0.16	−0.29*
ADHD total	0.64**	0.50**	0.03	0.76**	0.24	−0.16
Inattentive	0.60**	0.45**	0.11	0.69**	0.15	−0.22
Hyperactive	0.53**	0.41**	−0.05	0.69**	0.24	−0.14
ODD	0.56**	0.60**	0.30*	0.39**	0.13	−0.33*
CD	0.51**	0.54**	0.11	0.42**	0.23	−0.36**
SAD	0.23	0.08	0.50**	−0.02	0.13	0.03
RAD total	0.56**	0.55**	0.11	0.53**	0.16	−0.25
Inhibited	0.56**	0.56**	0.19	0.46**	0.16	−0.29
Disinhibited	0.26	0.23	−0.18	0.42**	0.04	−0.07
Sleep disorder	0.44**	0.30**	0.42**	0.19	0.25	0.01

1 Note. N= 59. DIPA, Diagnostic Infant and Preschool Assessment; SDQ, Strengths and Difficulties Questionnaire; PTSD, posttraumatic stress disorder; MDD, major depressive disorder; ADHD, attention deficit hyperactivity disorder; ODD, oppositional defiant disorder; CD, conduct disorder; SAD, separation anxiety disorder; RAD, reactive attachment disorder. *p< 0.05; **p< 0.01

TABLE 7.

Linear model of predictors of the SDQ emotional subscale, with 95% bias corrected and accelerated confidence interval

	b (bCI)	SEB	β	p
Step 1
Constant	2.64 (1.46, 3.73)	.55		.001
DIPA PTSD	0.27 (0.13, 0.42)	.07	.50	.001
Step 2
Constant	2.64 (1.44, 3.73)	.57		.001
DIPA PTSD	0.27 (0.12, 0.41)	.08	.50	.001
No. of non-PTSD disorders	0.01 (−0.37, 0.37)	.19	.01	.958

1 Note.SDQ, Strengths and Difficulties Questionnaire; DIPA, Diagnostic Infant and Preschool Assessment; PTSD, posttraumatic stress disorder.

R²=0.25 (p< .001) for Step 1; ΔR²=.00 (p= .966) for Step 2

TABLE 8.

Linear model of predictors of the SDQ Total Difficulties scale, with 95% bias corrected and accelerated confidence interval

	b (bCI)	SEB	β	p
Step 1
Constant	9.96 (4.33, 16.18)	3.00		.006
Age	1.06 (−0.92, 2.13)	0.58	.23	.065
Step 2
Constant	8.67 (3.12, 14.90)	2.98		.008
Age	0.83 (−0.35, 1.85)	0.56	.18	.143
DIPA PTSD	0.37 (0.04, 0.71)	0.17	.28	.033
Step 3
Constant	10.13 (4.78, 16.03)	2.88		.002
Age	0.24 (−0.90, 1.26)	0.57	.05	.670
DIPA PTSD	0.23 (−0.10, 0.53)	0.16	.17	.154
No. of non-PTSD disorders	2.13 (1.10, 3.17)	0.54	.47	.001

1 Note.SDQ, Strengths and Difficulties Questionnaire; DIPA, Diagnostic Infant and Preschool Assessment; PTSD, posttraumatic stress disorder.

Confidence intervals and standard errors based on 1,000 samples.

R²= .05 (p= .077) for Step 1; ΔR²= .07 (p= .033) for Step 2; ΔR²= 0.19 (p< .001) for Step 3

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DOI: https://doi.org/10.21307/sjcapp-2019-007 | Journal eISSN: 2245-8875

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Language: English

Page range: 39 - 51

Published on: Aug 19, 2019

Published by: Center for Evidence-based Psychiatry

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Diagnostic interview,

preschool children,

psychological trauma,

internal consistency,

psychometry

Related subjects:

Medicine,

Basic medical science,

Basic medical science, other

© 2019 Sille Schandorph Løkkegaard, Mette Elmose, Ask Elklit, published by Center for Evidence-based Psychiatry
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 7 (2019): Issue 1 (January 2019)