Psychiatry Research, 51:87-104 Elsevier 87 A New Pictorial Instrument for Child and Adolescent Psychiatry: A Pilot Study Monique Ernst, Katherine A. Godfrey, Raul I?. Silva, Enrique R. Pouget, and Joan Welkowitz Received November 19, 1992; revised version received July 9, 1993; accepted September 9, 1993, Abstract. A pictorial instrument was developed to assess psychopathology in children aged 6 to 16 years. Symptom pictures (n = 137) representing DSM-III- R criteria were organized into seven diagnostic subscales. Clarity of the pictures was assessed in 3 I normal children. Fifty-one psychiatric inpatient children completed the instrument using a 6-point visual analogue scale. Sensitivity to change was assessed in 15 children. The subscales’ internal consistencies (Cronbach’s a) ranged from 0.54 to 0.86. A canonical discriminant analysis among four diag- nostic groups achieved a Wilks’ A of 0.67 (p = 0.02). This instrument may be a valuable adjunct to psychiatric interviews in children. Key Words. Diagnosis, conduct disorder, childhood psychosis, depression, visual analogue scale. A new psychiatric instrument, based on pictures, was developed to assess childhood DSM-III-R disorders (American Psychiatric Association, 1987). This work was inspired by our previous study in adults (Ernst and Vingiano, 1989), for which we developed a 29-item pictorial psychiatric instrument to help screen those who do not speak English. The intent of the present project was to develop a diagnostic instrument with measures of severity for children rather than simply a screening test. At present, the available nonverbal psychiatric instruments used in children serve a very different function, such as evaluating internal conflicts or personality structures with projective tests (e.g., the Rorschach Test and the Thematic Apperception Test) or assessing cognitive function (e.g., the Peabody Picture Vocabulary Test and Raven’s Progressive Matrices). To our knowledge, the only test comparable is the “Levonn” instrument used in a recent study as a measure of level of distress in first and second graders exposed to violence (Martinez and Richters, 1993). This test was modeled after the instrument “Dominique,” which was created by Valla in Montreal. There are no published validation studies of these tests. Part of this work was presented as posters at the 37th Annual Meeting of the American Academy of Child and Adolescent Psychiatry (NR I IO), Chicago, IL, October 1990, and at the 144th Annual Meeting of the American Psychiatric Association (NR 108), New Orleans, LA, May 1991. Monique Ernst, M.D., Ph.D., was a research fellow at the Department of Psychiatry, New York University Medical Center, New York, NY. She is now in the Section on Clinical Brain Imaging, National Institute of Mental Health, Bethesda, MD. Katherine A. Godfrey, M.D., was a research fellow at the Department of Psychiatry, New York University Medical Center. She is now at the Department of Psychiatry, Mount Sinai Medical Center, New York, NY. Raul R. Silva, M.D., Enrique R. Pouget, and Joan Welkowitz, Ph.D., are in the Department of Psychiatry, New York University Medical Center, New York, NY. (Reprint requests to Dr. M. Ernst, Section on Clinical Brain Imaging, NIMH, NIH, Bldg. 10, Rm. 4N317,9000 Rockville Pike, Bethesda, MD 20892, USA,) 0165. I78 I I 94 I $07.00 0 1994 Elsevier Science Ireland Ltd