Neurodevelopmental Disorder, Disruptive

Neurodevelopmental Disorder, Disruptive, or Impulse-Control disorder Conduct Disorder

Assessment Instruments

There is a complex relationship among neuro-developmental disorder, conduct disorder and disruptive disorder. Nevertheless these disorders are assessed using different tools.

Disruptive or impulse-Control Disorder

The Disruptive or impulse-Control disorder is assessed by Structured Clinical Interview for Kleptomania (SCI-K). The SCI-K is designed to diagnose kleptomania using the DSM-IV criteria.

Structured Clinical Interview for Kleptomania (Impulsive Control Disorder)

Impulsive control disorders are common and functionally impairing. They are relevant across varied research and clinical settings.  One of the structured clinical interviews for diagnosis of disorders of impulsivity is the SCI-K. The SCI-K is used for the diagnosis of kleptomania (stealing). It is a semi-structured interview consisting of 9 problems, along with follow-up questions based on the DSM-IV diagnostic criteria. The probes examine recurrent failure to resist impulses, recurrent impulses to steal, stealing items not for financial reasons, relief after stealing, increasing tension prior to stealing, stealing not associated with taking revenge or expressing anger, stealing is not committed in response to hallucinations, stealing is not better explained by anti-social personality disorder, and stealing is not explained by maniac episode (Grant et al. 2006).

The SCI-K can be used to measure patient response to treatment. Grant (2002) studied subjects undergoing pharmacological treatment for kleptomania. The findings demonstrated a remarkable decrease in kleptomania SAS scores from baseline to the completion of treatment

Reliability

The SCI-K demonstrates good validity and reliability in diagnosing kleptomania in people presenting with impulsive control disorders, especially kleptomania. Grant et al. (2006) examined internal consistency in a population sample of adults seeking psychotherapy (pharmacotherapy) for kleptomania. Overall, the SCI-K showed excellent internal consistency as evidenced by Cronbach’s α=0.96. The measure demonstrated excellent internal consistency for the 5 inclusionary items (Cronbach’s α =0.93) and for the 4 exclusionary items (Cronbach’s α=0.98). The SCI-K also shows good classification accuracy (Grant et al., 2006).

Validity

Grant et al (2006) examined classification accuracy in a sample of outpatients (n=46) receiving treatment at the impulse disorder specialty clinic. Clinical judgment centered on the DSM-IV criteria for kleptomania acted as a reference on which to evaluate the SCI-K.  The tool demonstrated good specificity (.94) and sensitivity (.90). The tool accurately classified 81% of the true cases.

Limitations

The findings from the study done by Grant et al (2006) suggest good validity and strong internal consistency, and enough classification accuracy. However, the psychometric data for Structured Clinical Interview for Kleptomania are limited. The validity and reliability of the references on which the tool is judged (clinical impressions and self-reports) are yet to be established. Future research is required to support the validity and reliability of the SCI-K in non-patient and patient study samples.

Neuro-Developental Disorder

The neuro-developental disorder is screened by early symptomatic syndromes eliciting neurodevelopmental clinical examinations (ESSENCE-Q). The ESSENCE-Q is used to screen neurodevelopment problems in children (Hatakenaka et al., 2017).). It is a brief-one-page, 12-item questionnaire with response options of Yes, A little, and No. it is designed for screening questionnaire used for earlier identification of a wide variety of neurodevelopmental problems.

Reliability and Validity

ESSENCE-Q demonstrates good validity and reliability in diagnosing attention-deficit/hyperactivity disorder, and autism spectrum disorder, and intellectual developmental disorder. Hatakenaka et al. (2016) examined the reliability of ESSENCE-Q in children under six years referred for developmental problems. The measure demonstrated good internal consistency and psychometric properties as evidenced by Cronbach’s α =0.82, specificity=o.53, and sensitivity =0.94. This suggests that the ESSENCE-Q is a good instrument for screening early identification of neurodevelopmental disorders.

Limitations

The ESSENCE-Q is used for primary screening for the purpose of early identification. Therefore, it is not used for diagnosis because its emphasis is on sensitivity not specificity.

Conduct Disorder

The conduct disorder is assessed by the Delinquent Activities Scale. The Delinquent Activities Scale (DAS) is designed to measure conduct disorder based on the indicators like age of onset and symptom severity (Reavy, Stein, Quina, K., & Paiva, 2014).

Reliability and Validity

Reavy, Stein, Paiva, Quina, and Rossi (2012) used DAS to examine delinquency and substance use of incarcerated adolescents. The results indicated predictive and concurrent incremental validities of general, alcohol-involved, and marijuana-involved delinquent activities. Internal consistencies were between .653 and .834. DAS has good predictive and concurrent validity. This suggests that DAS provides reasonable approach for the assessment of adolescent delinquency.

Limitation

DAS are used to examine delinquent behavior in children and adolescents. Attempts have not been made to use this instrument on adults.

References

Grant, J.E., & Kim, S.W. (2002). An open-label study of naltrexone in the treatment of kleptomania. Journal of Clinical Psychiatry, 63(4), 349-356

Grant, J.E., Kim, S.W., & McCabe, J. (2006). A Structured Clinical Interview for Kleptomania (SCI-K): Preliminary validity and reliability testing. International Journal of Methods in Psychiatric Research, 15(2), 83-94

Hatakenaka, Y. et al. (2017). ESSENCE-Q – used as a screening tool for neurodevelopmental problems in public health checkups for young children in south Japan. Neuropsychiatric Disease Treatment, 13: 1271–1280

Hatakenaka, Y., Fernell, E., Sakaguchi, M., Ninomiya, H., Fukunaga, I., & Gillberg, C. (2016). ESSENCE-Q – a first clinical validation study of a new screening questionnaire for young children with suspected neurodevelopmental problems in south Japan. Neuropsychiatric Disease and Treatment, 12, 1739–1746.

Reavy, R., Stein, L. A., Paiva, A., Quina, K., & Rossi, J. S. (2012). Validation of the delinquent activities scale for incarcerated adolescents. Addictive behaviors, 37(7), 875–879

Reavy, R., Stein, L.A., Quina, K., & Paiva, A.L. (2014). Assessing Conduct Disorder: A New Measurement Approach. Journal of Correct Health Care, 20(1): 4–17.

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