News about recent DAWBA developments

As described below, the DAWBA’s age range has been expanded both upwards and downwards; the assessment has been broadened; the information collected now covers DSM-5 as well as DSM-IV and ICD-10; and there are options for automated feedback to respondents and session by session monitoring.

Early years DAWBA
The lower age limit for a DAWBA assessment is now 24 months rather than 5 years. The assessment is as similar as possible to the “standard” 5-17 year assessment in order to facilitate valid comparisons, but differs from the standard version has changed in several key respects:

• • References to “school”, “classroom” and “teacher” have been modified to allow for the diversity of preschool placements.

• • Assessing the impact of any domain of preschool psychopathology includes asking whether the difficulties have affected the child’s ability to attend playgroups, daycare, preschool or nursery, and enquiry about effects on parents’ own routines and behaviour.

• • New sections cover eating, sleeping, toileting and attachment disorders.

• An initial pilot study of the Early Years DAWBA was carried out in 2010 funded by the Department of Health. This demonstrated that the early years DAWBA was acceptable to respondents, and had a similarly high ability to distinguish high and low risk samples as the standard DAWBA (report submitted to DH; paper based on an expanded set of comparisons in preparation).

Adult DAWBA
The upper age limit has been increased from 17 to 65. The assessment is as similar as possible to the “standard” 5-17 version to facilitate valid comparisons, but has been changed in several key respects:

• • Reflecting the difference in life stage, the interview asks about “work and study” rather than “study”; and asks not about impact on “home life” but about “getting along with the people you are closest to (e.g. family, partner)”

• • The psychiatric assessment of adults has traditionally relied mainly on self-report, and there is a DAWBA self-report for adults. Drawing on the child psychiatric tradition of using multiple informants to achieve a more rounded view, the adult DAWBA also provides informant interviews about adults, accepting a wider range of possible informants than the standard DAWBA, including partners, friends, siblings and grown-up children.

• The adult DAWBA has been widely adopted, particularly for studies of transition to adulthood, and in places where youth services see both adolescents and young adults. Anecdotally, the interview functions well, but formal psychometric studies have yet to reach publication. Since the standard DAWBA works well up to age 17, and since the adult version is roughly 95% identical, it would be surprising if the adult DAWBA does not turn out to have similar psychometric properties, particularly for younger adults.

DSM-5:

• • The standard DAWBA has always collected information suitable for generating both DSM-IV and ICD-10 diagnoses, backed up by computer algorithms related to both these classifications. The DSM-5 DAWBA is now available for piloting in English.

• • Some of the new sections are controversial, and the opportunity to assess DMDD (Disruptive Mood Dysregulaiton Disorder), BDD (Body Dysmorphic Disorder) and other DSM-5 disorders will be welcomed by many clinicians, but feared by others. Researchers with doubts about the new diagnostic system may nevertheless be pleased to use the DAWBA for prevalence and validity studies.

• • Data will continue to be collected for ICD-10 and DSM-IV criteria, so no one will be forced to abandon a favourite classifications or lose backwards compatibility.

• Translations of DSM-5 sections from English to other DAWBA languages will start in 2015. If you are interested in being involved in this, please contact using the email address shown below.

Improved coverage of behaviours sometimes linked to developmental or intellectual disabilities: The DAWBA is generally suitable for diagnostic assessments of children and adolescents with Intellectual disabilities (ID). The standard diagnostic modules are generally applicable for those with mild to moderate ID, as well as for many with severe ID. For example, the module on autism spectrum disorders is relevant across the ID spectrum. However, there are some behaviours that are relatively rare in the general population but much commoner among those with ID (with or without autism or other developmental disorders). This applies to stereotypic movement disorders – sometimes involving self-injury – and a range of specific problems. These are now covered by a new DAWBA module.

Automated feedback to respondents: Clinics and research studies can now opt for respondents to be asked, at the end of the online interview, whether they want immediate computerized feedback based on their answers – no respondent gets this feedback unless they have asked for it. The computerized feedback provides an easy to read summary of the findings from the SDQ and DAWBA assessments and helps people search for relevant books, websites, helplines and local services.

Feedback from youthinmind always talks about probabilities rather than certainties, for example saying that on the basis of the information provided, the individual is in the average, slightly raised, high or very high probability bands for a particular type of difficulty. If the computer banding seems out of keeping with the parents’ own sense of whether their child has a problem, they are told that the fault may well lie with the computer rather than with their intuitions.

While some parents find the automated feedback and linked information sufficient for their needs, others want to turn to specialist advice. This is not discouraged in any way; indeed, the website’s directory of services makes it easier to find an appropriate source of advice. There is no evidence this leads to inappropriate demands on services. When piloted with parents as part of a study funded by the Department of Health, the computerized feedback was generally perceived as helpful or neutral, but some respondents experienced it as impersonal or slightly upsetting.

After any assessment, individual feedback to respondents from skilled professionals is clearly desirable. However, there are two circumstances in which research and clinical teams commonly use automated feedback as well as, or instead of, individual feedback:

• • Some clinics are so busy that there is a long wait between first assessment and being seen for individual feedback. Automated feedback that provides links to self-help resources may then help families keep going and reduce dissatisfaction with the wait.

• Some researchers are not in a position to offer any other sort of feedback – often the case with large surveys. Researchers into physical health generally accept that they have an ethical duty to let subjects know if they have previously undetected problems such as hypertension or diabetes. Surprisingly, mental health researchers have not always felt the same duty, even though they deal with problems that are generally treatable, impairing and sometimes potentially life threatening. The feedback developed by youthinmind for parents, teachers and youths who have completed the SDQ and/or DAWBA can be useful for research projects lacking the resources or expertise to provide detailed individual feedback

Session by session monitoring: The DAWBA now includes the option for SxS – a quick and universally relevant session-by-session monitoring system that draws on the success of the widely used and well-validated Strengths and Difficulties Questionnaire (SDQ). To read more about this, click on www.sdqinfo.org/SxS