561253

research-article2014
ASMXXX10.1177/1073191114561253AssessmentLeffler et al.

Review
Assessment

A Review of Child and Adolescent

1­–14
© The Author(s) 2014
Reprints and permissions:
Diagnostic Interviews for Clinical sagepub.com/journalsPermissions.nav
DOI: 10.1177/1073191114561253

Practitioners asm.sagepub.com

Jarrod M. Leffler1, Jordanna Riebel2, and Honore M. Hughes2

Abstract
The publication of the DSM-5 poses a challenge for many interview instruments due to the changes for many of the
diagnoses. Six of the more widely used and studied interview instruments (structured and semistructured) were reviewed
with a focus on usefulness for the practicing clinician and researcher. Use of these types of assessment procedures can
facilitate the accuracy of diagnoses given by potentially reducing clinician bias. Each interview instrument varied in its
strengths and characteristics related to amount of flexibility associated with administration of items; breadth of coverage
of diagnoses based on DSM-IV; time required for administration; presence of screening items or modular format; and
psychometric support for its reliability and validity, as well as amount of training required for use, and costs associated
with acquiring and learning the format. Recommendations were made regarding the utilization of different instruments for
specific diagnostic questions along with future recommendations for enhancing the format and utility of these instruments,
especially in relation to the publication of the DSM-5.

Keywords
diagnostic interviews, children, adolescents, assessment, clinical judgment

The primary purposes of this article are to provide a critical
review of select child and adolescent diagnostic interview
instruments that may appeal to researchers and clinicians
based on completion time, training necessary for mastery,
ease of materials and cost; to discuss strengths and weak-
nesses of particular interviews for various child and adoles-
cent difficulties; and to offer suggestions to child and
adolescent mental health providers regarding clinical utili-
zation in their practice. Secondarily, it is hoped that this
information and these recommendations are useful to clini-
cal researchers as well. Previous articles addressing these
instruments typically compared only two to three measures,
and were less descriptive in their details about real-world
utilization for clinical application, because the authors
focused more on the instruments’ richness for research pur-
poses. With the update to the American Psychiatric
Association’s (APA) Diagnostic and Statistical Manual
(DSM) taxonomy, this appears to be a natural time to revisit
these instruments as it is apparent that the symptom presen-
tation and other diagnostic criteria for some disorders have
been updated and are no longer consistent with current
diagnostic interviews (APA, 2013b). Clarification about
these differences is provided to help researchers and clini-
cians who are considering implementing these diagnostic
interviews in their practice and to facilitate research regard-
ing enhancing and updating the specific interviews.
Assessing for psychopathology in children and adoles-
cents is a complex process requiring a breadth of informa-
tion that includes historical and current data as they relate
to the individual and his or her various systems. In addi-
tion, there is the need to conceptualize the individual ideo-
graphically as well as nomothetically, taking into account
his or her overall psychological functioning. This informa-
tion is utilized to evaluate whether, and to what degree, the
individual is experiencing substantial mental health symp-
toms and resulting impairment consistent with a defined
diagnosis.
Diagnostic clarity is an important goal, leading to
informed treatment recommendations and accurate commu-
nication among providers, clients, and other professionals.
Although research indicates that clinicians often do not
agree on specific diagnoses (Galanter & Patel, 2005), diag-
nostic agreement and clarity can be enhanced when it is
approached in a methodical manner (Ely, Graber, &
Croskerry, 2011).
1
Mayo Clinic, Rochester, MN, USA
2
Saint Louis University, St. Louis, MO, USA
Corresponding Author:
Jarrod M. Leffler, Department of Psychiatry & Psychology, Mayo Clinic,
200 First Street SW, Rochester, MN 55905, USA.
Email: leffler.jarrod@mayo.edu

Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015

2 Assessment 
One way to systematically evaluate a child’s psychologi-
cal difficulties is to use a diagnostic interview. Many inter-
view instruments have been developed to evaluate the
mental health of children and adolescents (Frick, Barry, &
Kamphaus, 2010; Marin, Rey, & Silverman, 2013).
Diagnostic interviews are valuable for all clinicians and
researchers because the information they provide are an
important part of the evaluation process. Furthermore, uti-
lizing a structured or semistructured diagnostic interview
framework that provides prompts and probes for mental
health symptoms has been found to aid in increasing diag-
nostic reliability (Edelbrock & Costello, 1984).
Historically, child and adolescent clinical interviews
consisted of gathering symptom specific information from
parents, often mothers; however, this process resulted in
low to moderate reliability for frequency and presentation
of behaviors requiring subjective report (Edelbrock &
Costello, 1984). Graham and Rutter enhanced the utility of
this process by developing an interview strategy that used
direct interviews of the child as well as the parent about the
presentation of atypical and impairing behaviors, emotions,
and interpersonal interactions. Thus, the interview was also
a diagnostic tool rather than simply as part of therapy
(Graham & Rutter, 1968; Rutter & Graham, 1968). In addi-
tion to incorporating the youth’s report into the diagnostic
interview, early approaches increased the structure and spe-
cialization of the interview to decrease the impact of clini-
cal judgment and broaden the range and utilization of these
measures (Edelbrock & Costello, 1984).
Benefits and Drawbacks of Types of
Interviews
Clinical interviews provide a template for asking questions
and gathering information about presentation of symptoms
and impairment related to various disorders. There are basi-
cally three approaches to clinical interviewing: structured,
semistructured, and unstructured methods. Each of these
approaches differs in how much flexibility is allowed for
the clinician in guiding the interview. The greater the struc-
ture, the more agreement there is between interviewers on
the presence or absence of particular symptoms as well as
higher agreement on specific diagnoses. Structured inter-
view methods provide exact wording of questions that fol-
low a precise sequence with specific rules for scoring and
coding responses. Clinicians have limited flexibility to
interject their opinion or ask clarifying follow-up questions.
The aim of this approach is to limit clinical judgment and
reduce bias. As a result, these types of interviews are also
referred to as “respondent-based.”
In contrast, semistructured methods provide some guide-
lines for the interviewer but still allow for flexibility. For
example, interviewers have fewer restrictions on how they
phrase a question and may ask the same item in various
Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015
ways to accommodate a respondent’s understanding of the
item. There is also more likely to be an opportunity to score
responses in a flexible manner (e.g., using a Likert-type for-
mat vs. yes/no). Therefore, these interviews are referred to
as “interviewer-based.” Due to this somewhat looser ques-
tioning and coding format, multiple interviewers may reach
different outcomes in terms of diagnoses.
By design, the unstructured clinical interview does not
consist of rules or guidelines for scoring responses. This
open-ended approach is historically most common, relies
on the clinician’s knowledge base, and typically does not
result in consistency between interviews regarding question
structure or phrasing. It also results in the least amount of
agreement between clinicians regarding diagnoses.
Clinicians’ educational and professional experience, as well
as theoretical orientation influence how content areas are
covered as well as the flow of this approach. As a result, this
approach is subject to the possibility that informal heuris-
tics and cognitive biases may result in clinical errors (Frick
et al., 2010).
In 2005, a special series was compiled in the Journal of
Clinical Child & Adolescent Psychology addressing evi-
dence-based assessment of child and adolescent disorders.
The goal of this series was to move toward an equivalent to
the evidence-based treatment task force and identify what
constitutes evidence-based assessment (Mash & Hunsley,
2005). Articles in that series discussed the merits and short-
comings of diagnostic interviews, and endorsed their inte-
gration into the assessment of childhood disorders (e.g.,
depression, conduct disorder, anxiety, bipolar; Klein,
Dougherty, & Olino, 2005; McMahon & Frick, 2005;
Silverman & Ollendick, 2005; Youngstrom, Findling,
Youngstrom, & Calabrese, 2005, respectively).
Moreover, comorbid disorders such as anxiety and
depression are frequently a concern for many youth, includ-
ing those with externalizing difficulties, since comorbidity
is the rule rather than the exception in child disorders.
Therefore, a more systematic diagnostic interview could
lend additional clinical clarity, resulting in more accurate
treatment recommendations. Also related to evidence-based
assessment, in an article identifying future directions for
evidence-based assessment, Youngstrom (2013) identified
the merits of integrating results of a structured or semistruc-
tured diagnostic interview for childhood disorders into
evaluations if screening and risk factors indicate a moderate
probability of psychopathology with a low to moderate
level of risk factors.
However, many clinicians do not use semistructured or
structured interviews as part of the diagnostic process based
on a number of reasons. Frick et al. (2010) discuss several
that are commonly voiced: (a) the time-consuming nature
of the interview format and the fact that for some childhood
diagnoses, there is no incremental validity added (e.g.,
attention deficit hyperactivity disorder [ADHD]; Pelham,
Leffler et al. 3
Fabiano, & Massetti, 2005; Wolraich et al., 2003); (b) diag-
nostic interviews rely on DSM-based criteria, which for
some diagnoses have strong empirical support, while others
have weak support; (c) reporter biases must be considered,
similar to paper-and-pencil measures; and (d) structured
interviews do not provide for norm-referenced comparisons
regarding behaviors indicated as problematic.
Despite these concerns, there are a number of reasons
clinicians might want to use more structured forms of inter-
viewing. Informal heuristics (i.e., mental shortcuts) that cli-
nicians develop are useful and adaptive; however, they can
also result in cognitive errors (Croskerry, 2002). Therefore,
diagnostic interviews with structured, science-based items
can be utilized as a tool to assist in minimizing the impact
of these shortcuts on interviewing and diagnostic decision
making, similar to an analytical approach to decision mak-
ing (Croskerry, 2009; Ely et al., 2011). Despite guidelines
and rules that direct structured and semistructured inter-
views, there is still the possibility of clinical shortcuts,
biases, and diagnostic errors (Croskerry, 2009). However,
with the clinician’s awareness of and attention to these
potential decision-making pitfalls, the information gleaned
from a reliably conducted diagnostic interview provides
clinically relevant information beyond the unstructured
approach to gathering information regarding the client’s
history and symptom presentation. For example, research
indicates moderate agreement between standardized
research interviews (Ezpeleta et al., 1997; Lewczyk,
Garland, Hurlburt, Gearity, & Hough, 2003) as well as
decreased diagnostic variability with the implementation of
semistructured and structured diagnostic interviews and
measures (Galanter & Patel, 2005; Hughes et al., 2000;
Piacentini et al., 1993).
Other advantages mentioned by Frick et al. (2010)
regarding the use of structured interviews for assistance
with diagnostic decision making include the following: (a)
clinicians can use them to help ascertain the initiation and
duration of behavioral/emotional difficulties, (b) temporal
sequencing of different types of problems can be obtained,
(c) level of impairment caused by the behaviors can also be
estimated, (d) the interview guide can be a useful training
tool for inexperienced clinicians, and (e) the correspon-
dence between the assessment techniques and diagnostic
criteria can be enhanced.
This review focuses briefly on the characteristics of six
published structured and semistructured interview instru-
ments based on the DSM that are available to researchers
and clinicians. Tables 1 and 2 provide an overview of major
characteristics of the interviews, plus reliability and valid-
ity, as available. In addition, the review offers suggestions
regarding the use of the different interview systems for
various disorders and questions of differential diagnosis, as
well as ideas related to potential changes to these and other
diagnostic interviews based on the DSM-5. Personality
Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015
disorders are not included in this review, due to the fact that
there is some controversy over diagnosing personality dis-
orders in adolescents (e.g., Laurenssen, Hutsebaut,
Feenstra, Van Busschback, & Luyten, 2013). In addition,
personality disorders in general in the DSM-5 are under
review, given the alternative system (Section III) that has
been proposed.
Review of Interview Instruments
Child and Adolescent Psychiatric Assessment
The Child and Adolescent Psychiatric Assessment (CAPA;
Angold & Costello, 1995) is a semistructured interview
designed to assess psychiatric diagnoses in children of
ages 9 to 18 years. The CAPA focuses on the 3 months
prior to the interview as the primary period in question.
The CAPA is administered by a trained interviewer and
can be completed in 1.5 hours. The interview includes an
assessment of psychosocial impairment and clinical rat-
ings of behaviors observed in the interview. There are also
two alternative forms for different ages: the Preschool Age
Psychiatric Assessment for preschool aged children and
the Young Adult Psychiatric Assessment for youth of ages
18 years and older. The CAPA is appropriate for use in
clinical and epidemiological research (Angold & Costello,
2000).
There are several advantages to utilizing the CAPA in an
evaluation. The CAPA measures a wide range of ages, con-
sists of options for multiple reporters including child/ado-
lescent self-report, relates directly to DSM-IV diagnostic
categories, and is available in both English and Spanish ver-
sions. In addition, the CAPA covers a wide range of psycho-
pathology with the exception of pervasive developmental
disorders. The CAPA is unique in its coverage of sleep dis-
order symptoms, constipation, and somatization disorders.
In addition, it includes selective mutism and trichotilloma-
nia similar to the DISC-IV. It also includes cyclothymia in
its mood disorder section. Like the Schedule for Affective
Disorders and Schizophrenia for Children (K-SADS), it
provides a comprehensive review of symptoms and diagno-
ses related to psychotic disorders. Likert-type scales that
allow for symptom severity ratings are used. The CAPA is
also in modular form so that particular sections can be
administered apart from the rest of the interview (Angold &
Costello, 2000).
Shortcomings of the CAPA include that it is time-con-
suming to administer and that its administration requires
clinical training as well as a letter of copyright approval.
The above points are identified on Duke University Health
Systems Website (devepi.duhs.duke.edu/capa.html), which
details the instrument. Training typically requires 1 to 2
weeks of classroom work and 1 to 2 weeks of practice, with
the cost of training approximately $600 per trainee plus
4 Assessment 

Table 1.  General Characteristics of Interview Instruments.

Characteristics Barkley Instrument CAPA ChIPS DISC-IV K-SADS-PL 2009 MINI-KIDS

Informant Parent Parent and child Parent or child Parent or child Parent and child Parent or child
Parent version US CAPA, 9-18 P-ChIPS, 6-18 DISC-IV, 6-17 K-SADS-PL 2009, MINI-KID-P, 6-17
(age) 6-18
Youth version N/A CAPA, 9-18 ChIPS, 6-18 DISC-IV, 9-17 N/A MINI-KID, 13-17
(age)
Reliability N/A κ = 0.55 to 1.00a,b Concurrent 0.43 to 0.96o; PV κ = 0.77 to 1.00e,f 0.41 to 0.42; 0.64 to
validityj,k,l,m,n 0.75; 0.81 to 1.00p
Test–retest κ = 0.5 to 0.9a,b 0.25 to 0.92o; CV κ = 0.63 to 0.67e,f  
ICC ChIPS vs.K-SADS- MINI-KID vs.
PL; κ = 0.18, 0.2 K-SADS-PL; κ =
to 0.39, 0.42 to 0.41 to 0.87p
0.60, 0.66j
Validity Construct validityd; Concurrent validityf;  
CAPA vs. DISC; Convergent
κ = 0.61c and divergent
validityg,h,i
Format S SS S S SS S
Item UnS; Read verbatim Read verbatim Read verbatim Read verbatim Prompts to choose Read verbatim
administration with options with option for from
for additional additional inquiries
inquiries
Question format CE CE and OE CE CE CE and OE CE
Response style Y/N Likert Y/N Y/N Likert Y/N

Note. CAPA = Child and Adolescent Psychiatric Assessment; ChIPS = Children’s Interview for Psychiatric Syndromes; DISC IV = Diagnostic Interview Schedule for Children
Version IV; K-SADS-PL = Schedule for Affective Disorders and Schizophrenia for School-Aged Children Present and Lifetime Version; MINI-KIDS = Mini-International
Neuropsychiatric Interview for Children and Adolescents; CS = clinical setting; R = research; CE = close-ended; OE = open-ended; Y = yes; N = no; UnS = unspecified; S =
structured; SS = semistructured; N/A = not applicable; CV = child version; PV = parent version.
a = Angold and Costello (1995); b = Costello, Angold, March, and Fairbank (1998); c = Angold et al. (2012); d = Costello et al. (1998); e = Ambrosini (2000); f = Kaufman
et al. (1997); g = Birmaher et al. (2009); h = Achenbach (1991); i = Gadlow and Sprafkin (2000); j = Swenson et al. (2007); k = Welner, Reich, Herjanic, Jung, and Amado
(1987); l = Fristad, Glickman, et al. (1998); m = Teare, Fristad, Weller, Weller, and Salmon (1998); n = Fristad, Cummins, et al. (1998); o = Shaffer, Fisher, Lucas, Dulcan, and
Schwab-Stone (2000); p = D. V. Sheehan et al. (2010).

$2,000 fixed costs. Certification by a qualified CAPA
trainer is also required before using the CAPA in the field
(Angold & Costello, 2000).
Schedule for Affective Disorders and
Schizophrenia for School-Aged Children Present
and Lifetime Version
The Schedule for Affective Disorders and Schizophrenia for
School Aged Children (K-SADS; 1978 unpublished manual
from J. Puig-Antich and W. Chambers; The Schedule for
Affective Disorders and Schizophrenia for School-Aged
Children: Kiddie-SADS; Kaufman et al., 1997) is a semis-
tructured interview used with children of ages 6 to 18 years
and their parents. The K-SADS-PL 2009 Working Draft
(Axelson, Birmaher, Zelazny, Kaufman, & Gill, 2009) is the
most current version and covers pervasive developmental
disorders as well as refined items for bipolar disorders. The
K-SADS is currently viewed as the standard for research
regarding bipolar youth and includes a mania module that
has been validated down to age 5 (National Institute of
Mental Health, 2001). The original version of the K-SADS
was designed to be a downward extension of the adult mea-
sure, the Schedule for Affective Disorders and Schizophrenia
(SADS; Endicott & Spitzer, 1978) and is widely used to
assess childhood mood disorders. Importantly, the K-SADS
allows for flexibility in its administration.
There are three versions of the K-SADS that are compat-
ible with the DSM-III and DSM-IIIR. The Present Episode
version (K-SADS-PE) assesses current episodes (within the
past year) of psychopathology. The Epidemiologic version
(K-SADS-E) assesses psychopathology that has occurred
over the course of the youth’s lifetime. The Present and
Lifetime version (K-SADS-PL) assesses current and life-
time history of psychopathology and includes an 82-item
screening interview. The K-SADS-PL covers most major
DSM-III and DSM-IV diagnoses applicable to this age
group. The K-SADS-PL is appropriate for use in epidemio-
logical research, but may lack sensitivity in evaluating
treatment response because it utilizes a 4-point, 0 to 3,
Likert scoring method for diagnoses and symptoms and
does not include a broad assessment of symptom severity
(Ambrosini, 2000).
The K-SADS-PL uses a modular interviewing tech-
nique. This format introduces screening questions and sub-
sequent symptom skip-outs of nonsignificant intensity,
both of which help shorten the administration time. The
screening interview assesses key symptoms of current and

Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015

Leffler et al. 5

Table 2.  Usability Characteristics of Interview Instruments.

Characteristic Barkley instrument CAPA ChIPS DISC-IV K-SADS-PL MINI-KIDS

Developed 1997 2000 2000 1979 1996 1998

Revised N/A 2008 N/A 1997 Multiple versions of 2009
KSADS (2009)
Cost of and $35.00 Information available $59.00; In Ranges from $150 to Free for download Free for
access to through the addition $2,000 per computer and use if specific download and
manual and Developmental manual has installation; Child criteria met; use if specific
scoring Epidemiology interview and Parent: $50.00 Information criteria met
materials Center, Duke manual and plus shipping and available through
University Medical scoring forms handling University of
Center Pittsburg
Administration 20-30 60-120 20-50 90-120 90 15-50
time (minutes)
Accommodations English version English and Spanish English, Spanish/ English and Spanish English version English and
versions Brazilian, and versions; Alternative Spanish versions
Portuguese versions: Present
State DISC, Teacher
DISC, Quick DISC,
Voice DISC
Rater Lay person Bachelor’s degree Trained lay Lay person Trained Trained lay
qualifications plus training person; results professional person; results
program should be should be
reviewed by reviewed by a
a licensed licensed clinician
clinician
Training None Required Suggested; Strongly Required Suggested
training can recommended; 1-2
be completed days for computer
using assisted program,
administration 4-5 days for paper-
manual and-pencil version

Note. CAPA = Child and Adolescent Psychiatric Assessment; ChIPS = Children’s Interview for Psychiatric Syndromes; DISC IV = Diagnostic Interview Schedule for Children
Version IV; K-SADS-PL = Schedule for Affective Disorders and Schizophrenia for School-Aged Children Present and Lifetime Version; MINI-KIDS = Mini-International
Neuropsychiatric Interview for Children and Adolescents; N/A = not applicable.

past episodes of 20 different diagnostic areas. The admin-
istration of the K-SADS-PL takes approximately 1.25
hours for each parent and child (total time 3 hours), and
administration process is similar across all versions of the
K-SADS-PL. The different components of the K-SADS-PL
are described comprehensively by Kaufman et al. (1997)
and Ambrosini (2000).
There are several advantages to selecting the K-SADS-PL
for use. It covers a broad range of psychopathology with the
exception of autism spectrum disorders and has a modular
format. It also measures a wide range of ages, relates
directly to DSM-IV diagnostic categories, uses the same
scale for both screening and assessment, and consists of
options for multiple reporters including child/adolescent
self-report. In addition, the K-SADS-PL is available online
and at no additional cost.
In contrast, there are several disadvantages to administer-
ing the K-SADS-PL. It is time-consuming to administer, tak-
ing approximately 90 to 120 minutes, and is designed
primarily for affective disorders and schizophrenia. These
concerns and others are presented in Table 2. In addition, the
administration and interpretation require clinical training and
expertise and should be administered by a trained interviewer.
As such, the instrument may not be suitable for use in a clini-
cal setting by an untrained clinician.
Children’s Interview for Psychiatric Syndromes
The Children’s Interview for Psychiatric Syndromes
(ChIPS) is a structured interview that covers 20 DSM-IV
Axis I disorders and is appropriate for children between 6
and 18 years of age (Weller, Weller, Rooney, & Fristad,
1999a, 1999b). There are both parent and child versions that
differ with regard to the pronouns and verbiage used, but
show no change in structure or format of items. Overall, the
questions use simple language and short sentence structure
to enhance subject comprehension and cooperation. In addi-
tion to questions related to diagnoses, there is an introduc-
tion section that gathers brief background information and a
section for evaluating psychosocial stressors such as emo-
tional, physical, and sexual abuse and neglect in both the
parent and child version. The interview can be administered
by trained lay interviewers (Rooney, Fristad, Weller, &
Weller, 1999).

Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015

6 Assessment 
Rathman Fuller provided a thorough review of the ChIPS
(2008 unpublished thesis from S. Rathman Fuller, A com-
parison of diagnostic interviews for children). The ChIPS
implements a branching format with the initial items in a
section representing screening questions (Rooney et al.,
1999). These questions consist of items frequently endorsed
by youth experiencing the specific disorder. This format
allows the examiner to ask only a few items per disorder; if
the items are not positively endorsed, then the examiner is
able to move to the next disorder, thus increasing the effi-
ciency of the interview time. If there is a positive endorse-
ment on the screening item, then the examiner asks the
subsequent items. The final items in each section ask about
onset, duration, and impairment.
The interview begins with collecting background infor-
mation in the introduction and proceeds to the diagnostic
section that starts off with ADHD and ends with schizo-
phrenia. Each section begins with cardinal symptoms that
are considered rule-in items for each disorder. Symptoms in
each disorder are consistent with DSM-IV symptom criteria.
Each disorder has a set number of rule-in items, which pro-
vides for brevity if the disorder is not present. The interview
ends with a review of psychosocial stressors.
Weller, Weller, Fristad, Rooney, and Schecter (2000)
noted a number of advantages to the ChIPS, including that
it is designed to be used by the trained lay interviewer. Items
use simple language and short sentence structure to enhance
engagement and comprehension, the administration time is
relatively brief (e.g., 21-49 minutes) and the results are pre-
sented in a concise and easy to understand format.
Additionally, it occasionally provides a bank of two or three
more specific questions per symptom, which are asked if
the preceding question in that bank is reported as not pres-
ent. Shortcomings of the ChIPS include that it provides lim-
ited diagnostic breadth, covering only 20 disorders.
Additionally, it was developed as a screening instrument
and thus may over-identify symptom presentation com-
pared with diagnostic presentation (Rooney et al., 1999).
Diagnostic Interview Schedule for Children
Version IV
The Diagnostic Individual Schedule for Children–IV
(DISC-IV; Shaffer et al., 2000) is a highly structured, stan-
dardized interview schedule with versions for both children
and parents. It is based on the DSM-IV (APA, 1994) and
ICD-10 (International Classification of Diseases-10th
Version; World Health Organization, 1993) criteria and cov-
ers more than 30 psychiatric diagnoses that occur in children
and adolescents. The DISC-IV is designed to assess for the
presence of symptoms occurring within both the past 12
months and the past 4 weeks. The parent version of the
instrument is used for parents with children of ages 6 to 17
years and the self-report is used for youth of ages 9 to 17
Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015
years. Both the parent and the child versions cover the same
range of behaviors and symptoms, although a small number
of questions in the parent interview are not in the child inter-
view. A computerized version is also available (C-DISC).
The questions on the DISC-IV are brief and straightforward,
thus increasing cooperation and comprehension.
The interview is composed of a modular format that
begins with an introductory section that includes demo-
graphic information and an instructional section. The
remainder of the interview is organized into six modules,
each containing related diagnoses. It then concludes with an
optional “whole-life” module that assesses whether or not a
child or adolescent has ever met criteria for a diagnostic
disorder at some point in their life (Shaffer et al., 2000).
There are many advantages to using the DISC-IV. First,
this interview is highly structured and, as such, offers a
greater potential for interrater reliability and standardiza-
tion. The DISC-IV is also comprehensive and covers a wide
range of diagnostic criteria, although it can be given in
modular format. In addition, the DISC-IV is available in
both English and Spanish versions and can be administered
by lay interviewers after only a minimal training period.
Last, there is also a computerized version of the DISC-IV,
the C-DISC-4.0. Using a computer-assisted program greatly
reduces training time, interviewer error, and eliminates data
entry costs. It also allows clinicians to assess symptoms
occurring in the past 12 months and past 4 weeks in the core
interview and then has the option for a “whole-life” module
after the core interview is complete.
One major shortcoming of the DISC-IV is that, similar to
other respondent-based interviews, the DISC-IV format
does not allow an interviewer to address invalid responses
and to assess for atypical presentations, since it is based
strictly on DSM-IV and ICD-10 criteria and is highly struc-
tured. In addition, given its breadth, it also is quite time-
consuming (90-120 minutes).
Mini-International Neuropsychiatric Interview for
Children and Adolescents
The Mini-International Neuropsychiatric Interview for
Children and Adolescents (MINI-KID; D. Sheehan, Shytle,
Milo, Janavs, & Lecrubier, 2009) is a structured, psychiatric
interview used for children of ages 6 to 17 years old, which
is designed to assess psychiatric disorders from the DSM-IV
and the ICD-10 in a way that is comprehensive and concise.
This interview is a downward extension of the adult version
of the interview (MINI), which has been validated against
other diagnostic interviews (i.e., the Structured Clinical
Interview for DSM-III-R and the World Health Organization
designed Composite Internal Diagnostic Interview). Similar
to the adult version, the MINI-KID is organized into diag-
nostic modules. The instrument utilizes branching tree
logic, wherein two to four screening questions are asked for
Leffler et al. 7
each disorder. If the screening questions are positively
endorsed, additional symptom questions are given for the
particular disorder. All questions are presented in a yes/no
format. The instrument can be given to parent and youth
together or separately. There is also a parent-only version of
the MINI-KID-P (D. V. Sheehan et al., 1998).
There are several advantages of using the MINI-KID.
First, with an administration time of 15 to 50 minutes, it has
the advantage of being a short and accurate instrument to
diagnose 23 Axis I disorders. In addition, the MINI-KID
uses language that is easy for children and adolescents to
understand. Within the mood disorders section, questions
are provided for the past 2 weeks/current episode and past
episode. Specific questions for psychotic disorder and mood
disorders with psychotic features are provided. Questions
addressing adjustment disorder, Tourette’s and tic disorders,
as well as screening for pervasive developmental disorders
are provided. Items are included to address ruling out medi-
cal, organic, or drug causes for disorders. Another benefit of
the MINI-KID is that it includes a well-validated suicide
module (D. V. Sheehan et al., 2010). The module contains
14 categorical yes/no questions addressing current and life-
time suicidal ideation (passive and active), suicidal intent
and plans, suicidal acts, suicide attempts, and self-injurious
behavior. There are also three additional questions that
address frequency and intensity of current suicidal intent
(D. V. Sheehan et al., 2010).
There are also a number of disadvantages of the MINI-
KID, including the fact that it utilizes the same screening
question for multiple purposes. For example, a behavior
that does not reflect a symptom but more likely addresses
level of impairment is used as a rule-in for three different
disorders: attention deficit hyperactivity disorder, opposi-
tional defiant disorder, and conduct disorder. Regarding the
depression section, multiple symptoms are asked within the
same prompt (i.e., depressed or irritable; change in appetite,
trouble sleeping) with only one place to code yes or no.
While this addresses the presentation of a symptom, it does
not allow for clinical clarity regarding whether the mood
was depressed or irritable or whether there was an increase
or decrease in appetite. Within the mania section, the term
“hyper” (despite a definition of its multiple meanings) may
potentially confound responses. Moreover, the presence of
a separate dysthymia section in addition to the major depres-
sive episode section results in repetition of questions. Some
combination of the two sections would be more efficient
and would not jeopardize clinical information gathering, as
other diagnostic interviews are structured this way (e.g.,
ChIPS, K-SADS-PL). Such a combination might be more
efficient when the instrument is revised. Additionally, in the
mania section there is no direction on coding the presenta-
tion of Bipolar Disorder Not Otherwise Specified (NOS);
however, there is a place to indicate the presentation of this
disorder under the overview of disorders on page 2.
Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015
Barkley Interview: Review of DSM-IV Childhood
Disorders
Due to the fact that clinicians may experience limited time
and financial resources to adopt one of the previous instru-
ments into their practice, we review another instrument that
is available for purchase; however, few studies guide its
use. The Review of DSM-IV Childhood Disorders (Barkley,
1997) is a questionnaire that includes 15 disorders and con-
sists of items adapted from the DSM-IV (APA, 1994) that
are incorporated into a structured clinical interview tem-
plate. The items are provided as questions answered in a
yes/no format, mirror those of the DSM-IV classification
system, and as such, this measure offers a number of advan-
tages. Because this instrument reflects the DSM-IV, it has
been a useful measure for clinicians to gather information
about the presentation of childhood disorders and is a cost
effective approach to clinical interviewing. It is also embed-
ded in a clinical interview template that focuses on the
youth’s development and psychosocial history, which
allows it to flow more naturally for the clinician.
Additionally, each section leads with a specific time frame
required for each disorder. It is also widely available at a
lower cost compared with the other measures reviewed.
Disadvantages include limited research on this measure; at
the time of this publication, no studies were found investi-
gating the validity or reliability of the Review of DSM-IV
Childhood Disorders.
Comparisons and Considerations
Coverage
All of the measures explicitly evaluate the presentation of
the following 13 DSM-IV disorders: ADHD (inattentive,
hyperactive/impulsive, and combined type), oppositional
defiant disorder, conduct disorder, major depressive disor-
der, dysthymic disorder, bipolar I and II disorder, general-
ized anxiety disorder, separation anxiety, specific phobia,
and social phobia. The Barkley instrument provides screen-
ing items for disorders that are explicitly covered in the
other five instruments plus obsessive–compulsive disorder
and schizophrenia/psychosis. Additional disorders covered
by the six instruments in a less consistent manner are pre-
sented in Table 3.
Considerations
Many diagnostic interviews exist and are available to clini-
cians, lay persons, and researchers; the level of training
required, ease of access to the instrument, symptom cover-
age, and formats vary. Additional considerations in select-
ing an interview that would meet the need of the clinical
question at hand include its cost, the time necessary for
training, and its style (e.g., structured or semistructured).
8 Assessment 

Table 3.  Disorders Covered in Addition to 13 Initially concerns. Screening sections are included in the MINI-KID,
Reviewed Disorders. the K-SADS-PL, and the ChIPS. Many include a section on
Barkley K-SADS-PL MINI- stressors, which is likely to be very useful with the elimina-
Diagnosis DSM-IV-TR instrument CAPA ChIPS DISC-IV 2009 KIDS tion of the five-axis system in DSM-5. If clinicians are inter-
Anxiety disorders ested in a computerized structured interview, the DISC-IV
 Panic − + − + + + would be useful. That interview format also is one of the
 OCD − + + + + + most comprehensive. All six of the instruments reviewed
 Agoraphobia − − − + + +
 PTSD − + + + + +
have enough promise that clinicians and researchers should
Behavior disorders invest the time and energy needed to develop them to, fit in
  Disruptive behavior + + − + + − with DSM-5 or ICD-10. In many ways the DISC-IV seems
NOS
like it has much to offer: it is very comprehensive, is com-
Developmental disorders
 Asperger’s − − − − + S puterized, and is aligned with ICD-10, which according to
 Autism − − − − + − some sources (G. J. Neimeyer, personal communication,
 Tourette’s/tics S + − + + − August 4, 2013) could be the way the field moves in the near
 Pica − − − + − −
 Trichotillomania − + − + − −
future. If clinicians want a briefer interview format, the
  Selective mutism − + − + − − ChIPS or Barkley instrument both seem to be quite useful.
Eating disorders Table 4 provides clinicians and researchers a decision-
 Anorexia − + + + + + making rubric to select an instrument most consistent with
 Bulimia − + + + + +
Elimination disorders
their needs. For example, the table covers important areas to
 Enuresis/Encopresis − + + + + − consider when choosing an interview measure such as
Mood disorders breadth, time, cost, ease of materials, whether the measure is
  Depressive disorder − − − − + − available on a computer, and so forth. The decision-making
NOS
  Mood disorder NOS − − − − − − rubric can be expanded as necessary by individual provider
  Mania/Bipolar I + + + + + + depending on their clinical and research needs. For instance,
  Hypomania/Bipolar II − + + + + + a provider may be interested in the organization of disorders
  Bipolar NOS − − − − + −
 Cyclothymia − + − − + −
within the measure. More specifically, when working with
Additional disorders youth with mood disorders, researchers or clinicians may
  Adjust disorder − + − − + + want the measure to start with those disorders or have those
 Substance − + + + + + disorders in close proximity to the front of the measure. In
 Psychosis − + + + + +
 Schizophrenia − + − + + ^
that case, the K-SADS-PL or MINI-KID may be rated with
Psychosocial + + + + + − a 1.0 and measures with mood disorders in the middle may
functioning/ be rated 0.5, those with mood disorders at the end would be
development or
stressors rated 0.25 and those with limited coverage of mood disor-
ders may be rated as 0. Another example would be that a
Note. CAPA = Child and Adolescent Psychiatric Assessment; ChIPS = Children’s clinician may be comfortable with limited coverage, thus
Interview for Psychiatric Syndromes; DISC IV = Diagnostic Interview Schedule
for Children Version IV; GAD = Generalized Anxiety Disorder; K-SADS-PL 2009 = breadth would not be a major consideration for selection.
Schedule for Affective Disorders and Schizophrenia for School-Aged Children In terms of differential diagnostic questions, structured
Present and Lifetime 2009 working draft version; MINI-KIDS = Mini-International
Neuropsychiatric Interview for Children and Adolescents; NOS = not otherwise interviews may be more helpful with some diagnoses, and
specified; OCD = obsessive–compulsive disorder; PTSD = posttraumatic stress not as much with others. Difficult differential diagnoses,
disorder; S = screening items. + = covered; − = not covered; ^ = content present
for thought content, speech, and disorganized/catatonic behavior, which are rated
such as ADHD with depression versus bipolar, is one exam-
based on clinician’s judgment but not formally evaluated. ple in which it would likely be worth the clinician’s time to
spend the 60 minutes assessing for those problems and
likely comorbidities. For other difficulties, structured inter-
When implementing one of these measures, service pro- views may not be incrementally helpful (e.g., ADHD with
viders should bear in mind the population with whom they oppositional defiant disorder; Pelham et al., 2005).
work and the diagnoses most germane to their typical cli- Related to treatment planning, all of the instruments
ents, as not all interviews cover the same range of diagnoses, assess for a breadth of mental health disorders in youth, all
nor the same diagnosis with the same types of items. but the MINI KIDS have supplemental questions about
Moreover, for the assessment process, each interview instru- stressors.
ment has its strengths and weaknesses, as mentioned above.
For example, the MINI-KID provides a very detailed evalu- DSM-5 Impact on Diagnostic
ation of suicidal ideation and the K-SADS-PL has a compre-
hensive review of psychosis and other disorders when
Interviews
supplements are considered. The CAPA contains a posttrau- Changes from DSM-IV-TR to DSM-5 (APA, 2013a) will
matic stress disorder (PTSD) module and covers pediatric have an impact on the diagnosis of a number of disorders in

Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015

Leffler et al. 9

Table 4.  Diagnostic Interview Decision-Making Rubric.

Features

Measure Breadth1 Computer2 Cost3 Ease of materials4 Language5 Time6 Training7 Total Score^
Barkley instrument 0 (45%) 0 0.25 0.5 0 1.0 1.0 2.75 0.39
CAPA 0.5 (82%) 1.0 0.5 0.5 0 0.25 0 2.75 0.39
ChIPS 0.25 (61%) 0 0 0.25 0.5 1.0 1.0 3.0 0.40
DISC-IV 0.5 (82%) 1.0 0 0.5 0.25 0 0.25 2.50 0.36
K-SADS-PL 0.5 (89%) 0 0.5 0.5 0 0.25 0 1.75 0.25
MINI-KIDS 0.25 (66%) 0 0.5 0.5 0.25 1.0 1.0 3.50 0.50

^Score = Total divided by number of features considered.

Interpretation of the Score:
^The closer the Score is to 1, the more likely the measure will be a favorable tool to the professional. High scores (.50 and above) for each feature are
in bold font for quick review.
1. Breadth
Full coverage: covers 100% of diagnoses included in DSM-IV disorders usually first diagnosed in infancy, childhood or adolescents, all mood and anxiety
disorders, substance use, and psychosis = 1. Partial coverage: covers 80% to 99% of DSM-IV disorders usually first diagnosed in infancy, childhood or
adolescents, all mood and anxiety disorders, substance use, and psychosis = 0.5. Limited coverage: covers 50% to 84% of DSM-IV disorders usually first
diagnosed in infancy, childhood or adolescents, all mood and anxiety disorders, substance use, and psychosis = 0.25. Insufficient coverage: covers <50%
of DSM-IV disorders usually first diagnosed in infancy, childhood or adolescents, all mood and anxiety disorders, substance use, and psychosis = 0.
2. Computer (Technology)
Interview can be entered and scored in a computer program = 1.0. No computer program is available to enter or score the interview = 0.
3. Cost
Free to access online and use = 1.0. Free to access online but requires approval for use = 0.5. ≤$75.00 to purchase = 0.25. >$75.00 to purchase and
use or utilizes one time use scoring sheets that need to be repurchased = 0.
4. Ease of materials
Electronic: tablet or hand held device entry = 1.0. Paper/hardcopy: one booklet/packet that provides prompts and scoring = 0.5. Paper/hardcopy: two
booklets/packets that provide prompts and scoring = 0.25. Paper/hardcopy: more than two booklets/packets required for prompts and scoring = 0.
5. Language
In 6 or more languages = 1.0. Provided in 3 to 5 languages = 0.5. In 2 languages = 0.25. English only = 0.
6. Completion time
≤45 minutes = 1.0. 46-60 minutes = 0.5. 61-90 minutes = 0.25. ≥91 minutes = 0.
7. Training
No formal training required beyond reading supporting material = 1. Training required can be completed online with no fee = 0.5. Training required
can be completed online with an associated fee = 0.25. Training required and requires attendance away from office and associated fee = 0.

children and adolescents and, subsequently, on the current
diagnostic interviews. Therefore, a highlight of some of the
major changes in the DSM-5 is discussed in this review.
Considerations for updating current youth (ages ≤ 18) inter-
view measures are presented in Table 5. If the disorder in
Table 5 was not covered in the current measure, a sugges-
tion for adding the disorder was provided.
consistent with DSM-5’s criteria for autism spectrum disor-
der. Another example of collapsed diagnoses includes sub-
stance use disorder, which is a combination of the
DSM-IV-TR’s substance abuse and substance dependence
disorders. Five of the six interview schedules will need to
respond to the change; the Barkley instrument is the only
one that currently does not include substance use.

Collapsing of Disorders Expansion of Disorders

Some disorders have been revised by combining multiple
disorders into a single illness. The most notable example is
autism spectrum disorder, which encompasses the previous
DSM-IV autistic disorder, Asperger’s disorder, childhood
disintegrative disorder, and pervasive developmental disor-
der NOS. Furthermore, the DSM-5 includes various speci-
fiers to help clinicians and researchers describe individual
differences in autism spectrum disorder symptom presenta-
tion. These changes will influence two of the reviewed
instruments. The K-SADS-PL covers both Asperger’s dis-
order and Autism and the MINI-KID has screening items
for Asperger’s disorder, both will need to be modified to be
By contrast, some disorders have been split into independent
disorders. For example, DSM-IV-TR’s Reactive Attachment
Disorder included the subtypes “emotionally withdrawn/
inhibited” and “indiscriminately social/disinhibited.” In the
DSM-5, each subtype was elevated to a separate disorder.
However, none of the instruments previously included items
to assess for reactive attachment disorder. These diagnoses
would seem to be important to include in future revisions of
each of the interview instruments, given the fact that in insti-
tutionalized and maltreated samples of young children, they
occur relatively frequently (Lyons-Ruth, Zeanah, Benoit,
Madigan, & Mills-Koonce, 2014).

Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015

10 Assessment 

Table 5.  Updates to Child and Adolescent Clinical Interviews for PTSD, there are now four symptom clusters as opposed
for DSM-5. to three. Additionally, the diagnostic thresholds for PTSD
Barkley K-SADS-PL MINI- have been lowered for children and adolescents, and sepa-
DSM-5 diagnosis instrument CAPA ChIPS DISC-IV 2009 KID rate criteria have been added for children of age 6 years or
Anxiety disorders younger. Similarly, these modifications will need to be
 Panic + * + * * * made for all of the interview formats except the Barkley
  Social anxiety disorder * * * * * * instrument, since the latter does not include PTSD.
  Specific phobia N/C N/C N/C N/C N/C N/C
  Separation anxiety ^ ^ ^ ^ ^ ^
Some disorders have included the addition of new speci-
disorder fiers and subtypes, to which the authors of each of the
Bipolar and related disorders instruments will need to respond for accuracy and align-
  Mania/bipolar I ^, * ^, * ^, * ^, * ^, * ^, *
ment with the new criteria. For example, the specifier “with
  Hypomania/bipolar II + ^, * ^, * ^, * ^, * ^, *
Depressive disorders limited prosocial emotions” has been added to conduct dis-
 DMDD + + + + + + order for children displaying a callous and unemotional
  Major depressive * * * * * * interpersonal style.
disorder
 Premenstrual + + + + + +
dysphoric disorder
  Persistent depressive ^, * ^, * ^, * ^, * ^, * ^, *
New Diagnoses and Changes in Grouping
disorder (dysthymia)
Disruptive, impulse control, and conduct disorders
Several new disorders have been added, such as disruptive
  Conduct disorder * * * * * * mood dysregulation disorder and premenstrual dysphoric
 IED + + + + + + disorder. As a result of these changes, diagnostic interviews
 ODD /, * /, * /, * /, * /, * /, *
currently do not explicitly cover some disorders. However,
Elimination disorders
 Enuresis/encopresis + N/C N/C N/C N/C + until revisions aligning with the above changes are made,
Feeding and eating disorders some sections of the current diagnostic interviews could be
 Pica + + + ^,* + + implemented flexibly to address some of these changes. Due
 Anorexia + ^, * ^, * ^, * ^, * ^, *
to the importance of the disruptive mood dysregulation dis-
 Bulimia + ^, * ^, * ^, * ^, * ^, *
Neurodevelopmental disorders order for an improved understanding of mood disorders, it is
 ADHD − − − − − − highly recommended that authors of the instruments include
  Autism spectrum + + + + ^ ^ the criteria for this disorder in their revisions. Specific DSM-
disorder
 Tourette’s/tic ^, / ^, / + ^, / ^, / +
5 diagnostic criteria for disruptive mood dysregulation dis-
disorders order would dictate that items addressing irritability and
Obsessive–compulsive and related disorders temper outbursts, plus symptoms of mania/hypomania,
 OCD + ^, * ^, * ^, * ^, * ^, *
 Trichotillomania + ^ + ^ + +
oppositional defiant disorder, and intermittent explosive dis-
Trauma- and stress-related disorders order, as well as age of symptom onset, duration, and level
 PTSD + −, ^ −, ^ −, ^ −, ^ −, ^ of impairment in multiple settings will need to be addressed,
 RAD + + + + + + at a minimum, to assess for the presentation of the disorder.
Additional disorders
 Schizophrenia + ^ ^ ^ ^ ^
For example, Brotman et al. (2006) identified ways to
  Substance use + ^ ^ ^ ^ ^ assess for severe mood dysregulation, which is the basis for
disruptive mood dysregulation disorder, using items from
Note. ADHD = attention deficit hyperactivity disorder; CAPA = Child and
Adolescent Psychiatric Assessment; ChIPS = Children’s Interview for Psychiatric
the depression, oppositional/conduct, sleep problems,
Syndromes; DISC IV = Diagnostic Interview Schedule for Children Version IV; hyperactivity/ADD, hypomania, and mania sections of the
DMDD = disruptive mood dysregulation disorder; GAD = generalized anxiety CAPA. This will benefit both clinicians and researchers.
disorder; IED = intermittent explosive disorder; K-SADS-PL 2009 = Schedule
for Affective Disorders and Schizophrenia for School-Aged Children Present Another major change is that some disorders are no lon-
and Lifetime 2009 Working Draft Version; MINI-KID = Mini-International ger grouped together (e.g., anxiety disorders no longer
Neuropsychiatric Interview for Children and Adolescents; N/C = no change
required; N/I = not currently included but could be considered; OCD = obsessive– include obsessive–compulsive disorder, PTSD, and acute
compulsive disorder; ODD = oppositional defiant disorder; PTSD = posttraumatic stress disorder). It seems that it will not be difficult to sepa-
stress disorder; RAD = reactive attachment disorder; + = not currently included
and should be considered ; − = update age range; / = update symptom duration;
rate the disorders that used to be grouped with other mani-
^ = update symptom items; * = update specifiers/descriptors. festations of anxiety. Additionally, the Not Otherwise
Specified descriptor has been removed and replaced with
Other Specified or Unspecified.
Change in Criteria and Specifies
Symptom criteria for some disorders have been changed or
added, requiring varying degrees of modification for the
Directions for Future Developments
instruments. For example, the age of onset for ADHD has Specifically related to updates to the interview formats,
been extended from age 7 to 12 years, and is a change that with the increase of students’ and young professionals’ uti-
will be needed for each of the six instruments. In addition, lization of electronic resources and databases (R. M. Patel,

Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015

Leffler et al. 11
2001), it will be important to employ the interview ques-
tions in this format. An additional benefit to diagnostic
interviews in an electronic format is that an individual’s
response is usually scored “yes” or “no,” and the presenta-
tion of an item or prompt is dependent on previous
responses. With accurate technological programming, a
decision tree of prompts can be developed for questions and
respondents (e.g., parents, youth, and other informants) can
complete these measures prior to an office visit in a cost-
and time-saving approach to patient care. Results could be
tabulated and a report generated for the provider prior to
meeting the patient.
Use of technology has many potential benefits and, as
such, will likely be incorporated into the next revisions of
the instruments. Information gathered from the face-to-face
sessions, such as developmental abilities and mental status,
could be integrated with the computer results from the
structured interview to facilitate conceptualization. By uti-
lizing technology with diagnostic interviews that provide
symptom counts and severity of impairment along with nor-
mative data regarding prevalence for a specific population,
these data could serve double duty in providing clinical
information for diagnostic purposes and for ongoing out-
come measurement. Utilization of high technology strate-
gies (e.g., computers and electronic tablets) can influence
and build on low technology strategies (e.g., paper-and-
pencil rating scales; V. L. Patel, Kaufman, & Arocha, 2002)
to improve clinical decision making.
Early versions of diagnostic interviews were praised for
implementing standardized approaches to specific content
area and symptoms, using prespecified categories and
scales for coding responses, broadening the focus on pheno-
type, interviewing the youth, and integrating parent and
youth versions of interviews (Edelbrock & Costello, 1984).
Future measures should continue to build on this foundation
and consider (a) the use of high technology strategies to
enhance the efficiency and effectiveness of clinical inter-
views, (b) options of brief versions for screening or ongoing
follow-up, (c) expansion of diagnostic areas (e.g., autism
spectrum disorders, somatoform disorders, panic disorder,
and drilling down in broad areas such as mood disorders, in
particular, to include all possible diagnostic options), and
(d) deciding which nosology the measure will incorporate
(e.g., DSM, ICD, or efforts by other entities such as the
National Institute of Mental Health). Moreover, updating
the interview content and format to elicit information about
the individual’s and family’s strengths, barriers for the indi-
vidual and system to engage in treatment, and burden of
illness would be clinically helpful.
In general, with the recent publication of the DSM-5
(APA, 2013b), the instruments reviewed do not represent
the most up-to-date methods for diagnostic interviewing.
This is a major consideration for all of the diagnostic inter-
views. Despite the publication of the DSM-5, the underly-
ing reliability and validity of the instruments reviewed
Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015
remains consistent. However, to continue to demonstrate
utility in research and clinical settings these instruments
will need to be updated and validated against the new DSM-
5 criteria. Another consideration is that other organizations
have expressed criticisms regarding the methodological
process and development of the disorders within this clas-
sification system. Additionally, a major research institution
and funding source for research, the National Institute of
Mental Health, has stated it is no longer considering the use
of the DSM classification system in its research efforts
(Insel, 2013). These changes, in combination with alterna-
tive diagnostic systems (e.g., the possible use of the
International Classification of Disorders published by the
World Health Organization), may cloud the future of cur-
rent diagnostic instruments, and prompt the development of
totally new interview tools to assist with diagnosis.
Barriers to implementing clinical tools and strategies
have included cost, access, and training (Aarons, 2004;
Aarons, Wells, Zagursky, Fettes, & Palinkas, 2009;
Damschroder et al., 2009). To address these specific barri-
ers with regard to the diagnostic interviews, it would be
helpful for publishers of these tools to make them available
to clinicians at a reasonable cost with a level of training that
is not burdensome. One example is the ChIPS, which pro-
vides an administration manual designed to prepare clini-
cians and mental health paraprofessionals to administer the
interview. The manual covers background information on
the development of the ChIPS and consists of detailed
instructions for conducting the interview and recording
responses, along with criteria for assessing responses and
illustrative case studies. An additional step to assist with
encouraging and promoting interrater reliability would be
to include training vignettes with response items for clini-
cians to calibrate their reliable use of the diagnostic inter-
view. Enhancing these training cases with explanations of
the scoring rational along with pitfalls and pearls of wisdom
when using the diagnostic interview could improve the clin-
ical utility of the measure. However, adding these training
tools will likely affect the overall cost of the materials, but
would offer a more focused training option.
Summary
Previous reviews of interview measures have outlined strat-
egies for incorporating structured diagnostic interviews into
a reliable and effective clinical interview process, taking
into account additional data and information gathering tech-
niques (Jenkins, Youngstrom, Washburn, & Youngstrom,
2011; Quinn & Fristad, 2004). One approach to increasing
the success and reliability of implementing diagnostic inter-
views is to collect a bio-psycho-social-cultural history with
attention to the areas previously highlighted. Once this
information is gathered, the specific questions and informa-
tion gleaned from the diagnostic interview can be placed
within the historical context of the client. This approach is a
12 Assessment 
soft version of combining the intuitive and analytical
approach (Croskerry, 2009) to decision making. The current
review provides readers with recommendations regarding
the use of different diagnostic interviews for specific diag-
nostic and assessment questions as well as a decision-mak-
ing rubric for selecting which measures are most appropriate
for utilization given the unique features of each. These
structured or semistructured interviews can then be utilized
to enhance the process of diagnostic decision making and
treatment planning.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
References
Aarons, G. A. (2004). Mental health provider attitudes toward
adoption of evidence-based practice: The Evidence-Based
Practice Attitude Scale (EBPAS). Mental Health Services
Research, 6(2), 61-74.
Aarons, G. A., Wells, R. S., Zagursky, K., Fettes, D. L., &
Palinkas, L. A. (2009). Implementing evidence-based practice
in community mental health agencies: A multiple stakeholder
analysis. American Journal of Public Health, 99, 2087-2095.
doi:10.2105/AJPH.2009.161711
Achenbach, T. M. (1991). Integrative guide for the CBCL/4-18,
YSR and TRF profiles. Burlington: University of Vermont.
Ambrosini, P. J. (2000). Historical development and present sta-
tus of the schedule for affective disorders and schizophrenia
for school-age children (K-SADS). Journal of the American
Academy of Child & Adolescent Psychiatry, 39, 49-58.
doi:10.1097/00004583-200001000-00016
American Psychiatric Association. (1994). Diagnostic and statis-
tical manual of mental disorders (4th ed.). Washington, DC:
Author.
American Psychiatric Association. (2013a). Diagnostic and sta-
tistical manual of mental disorders (5th ed.). Arlington, VA:
Author.
American Psychiatric Association. (2013b). Highlights of changes
from DSM-IV-TR to DSM-5. Retrieved from http://www.
dsm5.org/Documents/changes%20from%20dsm-iv-tr%20
to%20dsm-5.pdf
Angold, A., & Costello, E. J. (1995). A test-retest reliability study
of child-reported psychiatric symptoms and diagnoses using
the Child and Adolescent Psychiatric Assessment (CAPA-C).
Psychological Medicine, 25, 755-762.
Angold, A., & Costello, E. J. (2000). The Child and Adolescent
Psychiatric Assessment (CAPA). Journal of the American
Academy of Child & Adolescent Psychiatry, 39, 39-48.
doi:10.1097/00004583-200001000-00015
Angold, A., Erkanli, A., Copeland, W., Goodman, R., Fisher, P.
W., & Costello, E. J. (2012). Psychiatric diagnostic interviews
Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015
for children and adolescents: A comparative study. Journal of
the American Academy of Child & Adolescent Psychiatry, 51,
506-517. doi:10.1016/j.jaac.2012.02.020
Axelson, D., Birmaher, B., Zelazny, J., Kaufman, J., & Gill, M.
K. (2009). K-SADS-PL: 2009 working draft. Retrieved from
http://www.psychiatry.pitt.edu/sites/default/files/Documents/
assessments/KSADS-PL_2009_working_draft_full.pdf
Barkley, R. A. (1997). Defiant children: A clinician’s manual for
assessment and parent training (2nd ed.). New York, NY:
Guilford Press.
Birmaher, B., Ehmann, M., Axelson, D. A., Goldstein, B. I.,
Monk, K., Kalas, C., . . .Brent, D. A. (2009). Schedule for
affective disorders and schizophrenia for school-age children
(K-SADS-PL) for the assessment of preschool children—
A preliminary psychometric study. Journal of Psychiatric
Research, 43, 680-686. doi:10.1016/j.jpsychires.2008.10.003
Brotman, M. A., Schmajuk, M., Rich, B. A., Dickstein, D.
P., Guyer, A. E., Costello, E. J., . . .Leibenluft, E. (2006).
Prevalence, clinical correlates, and longitudinal course of
severe mood dysregulation in children. Biological Psychiatry,
60, 991-997. doi:10.1016/j.biopsych.2006.08.042
Costello, E. J., Angold, A., March, J., & Fairbank, J. (1998).
Life events and post-traumatic stress: The development of
a new measure for children and adolescents. Psychological
Medicine, 28, 1275-1288.
Croskerry, P. (2002). Achieving quality in clinical decision mak-
ing: Cognitive strategies and detection of bias. Academic
Emergency Medicine, 9, 1184-1204.
Croskerry, P. (2009). A universal model of diagnostic reason-
ing. Academic Medicine, 84, 1022-1028. doi:10.1097/
ACM.0b013e3181ace703
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R.,
Alexander, J. A., & Lowery, J. C. (2009). Fostering imple-
mentation of health services research findings into practice:
A consolidated framework for advancing implementation sci-
ence. Implementation Science, 4, 50. doi:10.1186/1748-5908-
4-50
Edelbrock, C., & Costello, A. J. (1984). Structured psychiatric
interviews for children and adolescents. In G. Goldstein & M.
Hersen (Eds.), Handbook of psychological assessment (pp.
276-290). New York, NY: Pergamon.
Ely, J. W., Graber, M. L., & Croskerry, P. (2011). Checklists to
reduce diagnostic errors. Academic Medicine, 86, 307-313.
doi:10.1097/ACM.0b013e31820824cd
Endicott, J., & Spitzer, R. L. (1978). A diagnostic interview: The
schedule for affective disorders and schizophrenia. Archives
of General Psychiatry, 35, 837-844.
Ezpeleta, L., de la Osa, N., Domenech, J. M., Navarro, J. B.,
Losilla, J. M., & Judez, J. (1997). Diagnostic agreement
between clinicians and the Diagnostic Interview for Children
and Adolescents—DICA-R—in an outpatient sample. Journal
of Child Psychology and Psychiatry, 38, 431-440.
Frick, P. J., Barry, C. T., & Kamphaus, R. W. (2010). Clinical
assessment of child and adolescent personality and behavior
(3rd ed.). New York, NY: Springer.
Fristad, M. A., Cummins, J., Verducci, J. S., Teare, M., Weller,
E. B., & Weller, R. A. (1998). Study IV: Concurrent validity
of the DSM-IV revised Children’s Interview for Psychiatric
Syndromes (ChIPS). Journal of Child and Adolescent
Psychopharmacology, 8, 227-236.
Leffler et al. 13
Fristad, M. A., Glickman, A. R., Verducci, J. S., Teare, M.,
Weller, E. B., & Weller, R. A. (1998). Study V: Children’s
Interview for Psychiatric Syndromes (ChIPS): Psychometrics
in two community samples. Journal of Child and Adolescent
Psychopharmacology, 8, 237-245.
Gadlow, K. D., & Sprafkin, J. (2000). The Early Childhood
Inventory-4: Screening manual. Stony Brook, NY: Checkmate
Plus.
Galanter, C. A., & Patel, V. L. (2005). Medical decision making:
A selective review for child psychiatrists and psychologists.
Journal of Child Psychology and Psychiatry, 46, 675-689.
doi:10.1111/j.1469-7610.2005.01452.x
Graham, P., & Rutter, M. (1968). The reliability and validity of
the psychiatric assessment of the child: II. Interview with the
parent. British Journal of Psychiatry, 114, 581-592.
Hughes, C. W., Rintelmann, J., Mayes, T., Emslie, G. J., Pearson,
G., & Rush, A. J. (2000). Structured interview and uniform
assessment improves diagnostic reliability. Journal of Child
and Adolescent Psychopharmacology, 10, 119-131.
Insel, T. (2013). Director’s blog: Transforming diagnosis.
Retrieved from http://www.nimh.nih.gov/about/direc-
tor/2013/transforming-diagnosis.shtml
Jenkins, M. M., Youngstrom, E. A., Washburn, J. J., &
Youngstrom, J. K. (2011). Evidence-based strategies improve
assessment of pediatric bipolar disorder by community prac-
titioners. Professional Psychology, 42, 121-129. doi:10.1037/
a0022506
Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci,
P., . . .Ryan, N. (1997). Schedule for Affective Disorders and
Schizophrenia for School-Age Children–Present and Lifetime
Version (K-SADS-PL): Initial reliability and validity data.
Journal of the American Academy of Child & Adolescent
Psychiatry, 36, 980-988. doi:10.1097/00004583-199707000-
00021
Klein, D. N., Dougherty, L. R., & Olino, T. M. (2005). Toward
guidelines for evidence-based assessment of depression in chil-
dren and adolescents. Journal of Clinical Child & Adolescent
Psychology, 34, 412-432. doi:10.1207/s15374424jccp3403_3
Laurenssen, E. M. P., Hutsebaut, J., Feenstra, D. J., Van
Busschback, J. J., & Luyten, P. (2013). Diagnosis of per-
sonality disorder in adolescents: A study of psychologists.
Child and Adolescent Psychiatry and Mental Health, 7, 3.
doi:10.1186/1753-2000-7-3
Lewczyk, C. M., Garland, A. F., Hurlburt, M. S., Gearity, J., &
Hough, R. L. (2003). Comparing DISC-IV and clinician diag-
noses among youths receiving public mental health services.
Journal of the American Academy of Child & Adolescent
Psychiatry, 42, 349-356. doi:10.1097/00004583-200303000-
00016
Lyons-Ruth, K., Zeanah, C. H., Benoit, D., Madigan, S., & Mills-
Koonce, W. R. (2014). Disorder and risk for disorder during
infancy and toddlerhood. In E. J. Mash & R. A Barkley (Eds.),
Child psychopathology (3rd ed., pp. 673-736). New York,
NY: Guilford Press.
Marin, C. E., Rey, Y., & Silverman, W. K. (2013). Interviews.
In B. D. McLeod, A. Jensen-Doss, & T. Ollendick (Eds.),
Diagnostic and behavioral assessment in children and ado-
lescents (pp. 103-132). New York, NY: Guilford Press.
Mash, E. J., & Hunsley, J. (2005). Evidence-based assessment of
child and adolescent disorders: Issues and challenges. Journal
Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015
of Clinical Child & Adolescent Psychology, 34, 362-379.
doi:10.1207/s15374424jccp3403_1
McMahon, R. J., & Frick, P. J. (2005). Evidence-based assessment
of conduct problems in children and adolescents. Journal
of Clinical Child & Adolescent Psychology, 34, 477-505.
doi:10.1207/s15374424jccp3403_6
National Institute of Mental Health. (2001). Research roundtable
on prepubertal bipolar disorder. Journal of the American
Academy of Child & Adolescent Psychiatry, 40, 871-878.
Patel, R. M. (2001). How the internet is altering medical journal-
ism and education. Academic Psychiatry, 25, 134-142.
Patel, V. L., Kaufman, D. R., & Arocha, J. F. (2002). Emerging
paradigms of cognition in medical decision-making. Journal
of Biomedical Informatics, 35, 52-75.
Pelham, W. E. Jr., Fabiano, G. A., & Massetti, G. M. (2005).
Evidence-based assessment of attention deficit hyperactiv-
ity disorder in children and adolescents. Journal of Clinical
Child & Adolescent Psychology, 34, 449-476. doi:10.1207/
s15374424jccp3403_5
Piacentini, J., Shaffer, D., Fisher, P., Schwab-Stone, M., Davies,
M., & Gioia, P. (1993). The Diagnostic Interview Schedule
for Children-Revised Version (DISC-R): III. Concurrent cri-
terion validity. Journal of the American Academy of Child &
Adolescent Psychiatry, 32, 658-665. doi:10.1097/00004583-
199305000-00025
Quinn, C. A., & Fristad, M. A. (2004). Defining and identifying
early onset bipolar spectrum disorder. Current Psychiatry
Reports, 6, 101-107.
Rooney, M. T., Fristad, M. A., Weller, E. B., & Weller, R. A. (1999).
Children’s interview for psychiatric syndromes: Administration
manual. Arlington, VA: American Psychiatric Press.
Rutter, M., & Graham, P. (1968). The reliability and validity of
the psychiatric assessment of the child: I. Interview with the
child. British Journal of Psychiatry, 114, 563-579.
Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-
Stone, M. E. (2000). NIMH Diagnostic Interview Schedule
for Children Version IV (NIMH DISC-IV): Description, dif-
ferences from previous versions, and reliability of some com-
mon diagnoses. Journal of the American Academy of Child
& Adolescent Psychiatry, 39, 28-38. doi:10.1097/00004583-
200001000-00014
Sheehan, D., Shytle, D., Milo, K., Janavs, J., & Lecrubier, Y.
(2009). MINI International Neuropsychiatric Interview for
Children and Adolescents: English Version 6.0. Tampa:
University of South Florida.
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P.,
Janavs, J., Weiller, E., . . .Dunbar, G. C. (1998). The Mini-
International Neuropsychiatric Interview (M.I.N.I.): The
development and validation of a structured diagnostic psychi-
atric interview for DSM-IV and ICD-10. Journal of Clinical
Psychiatry, 59(Suppl. 20), 22-33.
Sheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon,
Y., Rogers, J. E., . . .Wilkinson, B. (2010). Reliability and
validity of the Mini International Neuropsychiatric Interview
for Children and Adolescents (MINI-KID). Journal of Clinical
Psychiatry, 71, 313-326. doi:10.4088/JCP.09m05305whi
Silverman, W. K., & Ollendick, T. H. (2005). Evidence-based
assessment of anxiety and its disorders in children and ado-
lescents. Journal of Clinical Child & Adolescent Psychology,
34, 380-411. doi:10.1207/s15374424jccp3403_2
14 Assessment 
Swenson, L. P., Esposito-Smythers, C., Hunt, J. I., Hollander, B.
L., Dyl, J., Rizzo, C. J., . . .Spirito, A. (2007). Validation of
the Children’s Interview for Psychiatric Syndromes (ChIPS)
with psychiatrically hospitalized adolescents. Journal of the
American Academy of Child & Adolescent Psychiatry, 46,
1482-1490. doi:10.1097/chi.0b013e31814cef0e
Teare, M., Fristad, M. A., Weller, E. B., Weller, R. A., & Salmon,
P. (1998). Study I: Development and criterion validity of the
Children’s Interview for Psychiatric Syndromes (ChIPS).
Journal of Child and Adolescent Psychopharmacology, 8,
205-211.
Weller, E. B., Weller, R. A., Fristad, M. A., Rooney, M. T., &
Schecter, J. (2000). Children’s Interview for Psychiatric
Syndromes (ChIPS). Journal of the American Academy of Child
& Adolescent Psychiatry, 39, 76-84. doi:10.1097/00004583-
200001000-00019
Weller, E. B., Weller, R. A., Rooney, M. T., & Fristad, M. A.
(1999a). Children’s Interview for Psychiatric Syndromes
(ChIPS). Washington, DC: American Psychiatric Press.
Weller, E. B., Weller, R. A., Rooney, M. T., & Fristad, M. A.
(1999b). Children’s Interview for Psychiatric Syndromes–
Parent Version (P-ChIPS). Washington, DC: American
Psychiatric Press.
Downloaded from asm.sagepub.com at Stockholm University Library on August 23, 2015
Welner, Z., Reich, W., Herjanic, B., Jung, K. G., & Amado, H.
(1987). Reliability, validity, and parent-child agreement stud-
ies of the Diagnostic Interview for Children and Adolescents
(DICA). Journal of the American Academy of Child &
Adolescent Psychiatry, 26, 649-653. doi:10.1097/00004583-
198709000-00007
Wolraich, M. L., Lambert, W., Doffing, M. A., Bickman, L.,
Simmons, T., & Worley, K. (2003). Psychometric properties of
the Vanderbilt ADHD diagnostic parent rating scale in a referred
population. Journal of Pediatric Psychology, 28, 559-567.
World Health Organization. (1993). The ICD-10 classification of
mental and behavioral disorders: Clinical descriptions and
diagnostic guidelines. Geneva, Switzerland: Author.
Youngstrom, E. A. (2013). Future directions in psychological
assessment: Combining evidence-based medicine innova-
tions with psychology’s historical strengths to enhance util-
ity. Journal of the American Academy of Child & Adolescent
Psychiatry, 42, 139-159. doi:10.1080/15374416.2012.736358
Youngstrom, E. A., Findling, R. L., Youngstrom, J. K., &
Calabrese, J. R. (2005). Toward an evidence-based assess-
ment of pediatric bipolar disorder. Journal of the American
Academy of Child & Adolescent Psychiatry, 34, 433-448.
doi:10.1207/s15374424jccp3403_4