Diagnostic Infant and Preschool Assessment (DIPA)

Abstract

The Diagnostic Infant and Preschool Assessment (DIPA) is a comprehensive, criterion-based diagnostic instrument designed as a semi-structured interview for caregivers of children ranging from infancy up to six years of age. Developed by Michael S. Scheeringa, MD, MPH, the DIPA is structured into self-contained modules, covering symptoms necessary to establish a DSM-IV diagnosis for a wide range of psychiatric disorders relevant to early childhood. Its design allows for the assessment of symptoms even in infants, challenging the assumption that certain criteria cannot be detected in younger populations. A core feature is the explicit assessment of functional impairment for each disorder module, consistent with DSM guidelines.

Keywords

Diagnostic Infant and Preschool Assessment, DIPA, Michael S. Scheeringa, preschool mental health, early childhood diagnosis, caregiver interview, DSM-IV, psychometric properties, PTSD, developmental psychopathology.

Authors

Michael S. Scheeringa, MD, MPH

Purpose

The primary purpose of the Diagnostic Infant and Preschool Assessment (DIPA) is to serve as a reliable and valid diagnostic instrument for assessing a broad spectrum of DSM-IV psychiatric syndromes in young children, specifically those aged six years and younger, extending down to below one year of age. While primarily designed for this age range, the instrument is structured to be easily adaptable for use with older children (7- or 8-year-olds) to maintain prospective continuity in research or clinical settings.

The instrument is designed to ensure complete coverage of all relevant symptomatology, making it highly valuable in both large-scale research surveys and clinical practice. For clinical use, interview time can be streamlined by omitting detailed frequency, duration, and onset questions, focusing instead on the categorical presence of symptoms and associated impairment.

Construct

The DIPA measures the presence and severity of symptoms corresponding to 14 specific psychiatric disorders as defined by the DSM-IV criteria. Each disorder is contained within a self-contained module, presenting symptoms in the exact order listed in the DSM-IV for ease of reference and scoring. Furthermore, each module explicitly measures functional impairment resulting from the symptoms, a critical diagnostic component.

The DIPA incorporates specialized scoring rules and phrasing intended to accommodate the developmental differences inherent in diagnosing young children. Notably, the philosophy emphasizes that “the parent is the first judge, the interviewer is the final judge,” requiring interviewers to obtain concrete examples to endorse a symptom. The instrument also aligns with the Research Diagnostic Criteria-Preschool Age (RDC-PA) for specific diagnoses like PTSD, Reactive Attachment Disorder, and sleep disorders, offering developmentally-sensitive alternative criteria.

Validity

The DIPA has demonstrated published psychometric properties, including concurrent criterion validity. A study conducted by Scheeringa and Haslett (2010) specifically examined the criterion validity of the DIPA across seven disorders in children aged 1 to 5 years: PTSD, Major Depressive Disorder (MDD), Attention-Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Separation Anxiety Disorder (SAD), Generalized Anxiety Disorder (GAD), and Obsessive Compulsive Disorder (OCD). The instrument exhibited adequate criterion validity properties, although the sample size was too limited to fully test GAD and OCD symptoms.

Furthermore, the development of the DIPA relied on prior research establishing procedural, criterion, and discriminant validity for specific disorders, such as PTSD in early childhood (Scheeringa et al., 1995; 2001; 2003), which contributed to the instrument’s overall diagnostic utility in this sensitive age group.

Reliability

The test-retest reliability of the DIPA has been formally established and published (Scheeringa & Haslett, 2010). This reliability was assessed in a research context covering seven core disorders (PTSD, MDD, ADHD, ODD, SAD, GAD, and OCD) in children between one and five years old. The results confirmed that the DIPA possesses adequate properties for diagnostic consistency over time, suggesting that repeated administrations yield similar diagnostic outcomes when conditions are stable.

Factor Analysis

As the Diagnostic Infant and Preschool Assessment (DIPA) is a modular, criterion-based diagnostic interview designed to map directly onto the categorical diagnoses provided by the DSM-IV, traditional factor analysis exploring latent dimensional structures across the entire measure is not typically performed or applicable in the same way as with dimensional rating scales. The focus is on the clustering of symptoms within pre-defined diagnostic modules (e.g., PTSD module, MDD module) to meet established diagnostic thresholds.

Instrument

Test Type: Diagnostic Semi-Structured Interview

Format: Caregiver/Parent Interview (administered by a trained interviewer, clinician or lay researcher)

Language Available: English (Original)

Population Group: Caregivers of Young Children

Age Group: Infancy to 6 years (expandable to 7 or 8 years)

Population Details: The instrument is designed to address the unique challenges of diagnosing psychopathology in infants and preschool children, where symptoms may manifest differently than in older populations.

Test Methodology: The DIPA employs a semi-structured interview format. Interviewers are required to read scripted probes exactly as written (a structured element) but must follow up with extensive probing and free-lance questions to obtain specific examples, thus making the interview semi-structured overall. Scoring criteria emphasize that symptoms must be judged as occurring “more than the average child his/her age.”

Keywords

DIPA, diagnostic interview, early childhood mental health, Scheeringa, psychopathology, DSM-IV diagnosis, clinical assessment, functional impairment, RDC-PA, test-retest reliability.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected]

Correspondence Address: Institute of Infant and Early Childhood Mental Health Section of Child and Adolescent Psychiatry Department of Psychiatry and Neurology, School of Medicine Tulane University New Orleans, LA

Permissions & Fee and Test Year

Copyright Year: 2004 (Version 8/18/10).

The DIPA manual and instrument are often made available for research and clinical use. The original PDF can be downloaded here: Download Diagnostic Infant and Preschool Assessment (DIPA)

Reference’s

Scheeringa MS, Haslett, N (2010). The reliability and criterion validity of the Diagnostic Infant and Preschool Assessment: A new diagnostic instrument for young children. Child Psychiatry & Human Development, 41, 3, 299-312.

Scheeringa, M. S., Peebles, C. D., Cook, C. A., & Zeanah, C. H. (2001). Toward establishing procedural, criterion, and discriminant validity for PTSD in early childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 40(1), 52-60.

Scheeringa, M. S., Zeanah, C. H., Drell, M. J., & Larrieu, J. A. (1995). Two approaches to the diagnosis of posttraumatic stress disorder in infancy and early childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 34(2), 191-200.

Scheeringa, M. S., Zeanah, C. H., Myers, L., & Putnam, F. W. (2003). New findings on alternative criteria for PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(5), 561-570.

Task Force on Research Diagnostic Criteria: Infancy and Preschool. (2003). Research diagnostic criteria for infants and preschool children: The process and empirical support. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1504-1512.

Items of the Diagnostic Infant and Preschool Assessment (DIPA)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

• Posttraumatic stress disorder (PTSD)
• Major depressive disorder (MDD)
• Bipolar I disorder
• Attention-deficit/hyperactivity disorder (ADHD)
• Oppositional defiant disorder (ODD)
• Conduct disorder (CD)
• Separation anxiety disorder (SAD) Specific phobia
• Social phobia
• Generalized anxiety disorder (GAD)
• Obsessive compulsive disorder (OCD)
• Reactive attachment disorder (RAD)
• Sleep onset disorder
• Night waking disorder