Diagnostic Infant and Preschool Assessment (DIPA)

1. Abstract

The Diagnostic Infant and Preschool Assessment (DIPA) is a semi-structured, caregiver-report diagnostic interview developed by Dr. Michael S. Scheeringa to assess psychiatric disorders in infants, toddlers, and preschool-age children from birth through 6 years of age (with potential prospective extension to ages 7 and 8). Historically, psychiatric taxonomy under the Diagnostic and Statistical Manual of Mental Disorders (DSM) assumed that psychiatric symptoms in very young children could not be systematically or reliably identified due to limited verbal, cognitive, and emotional development. The DIPA addresses this clinical and methodological gap by translating criteria from the DSM-IV and the Research Diagnostic Criteria-Preschool Age (RDC-PA) into developmentally sensitive, operationalized probes administered to primary caregivers.

The interview is organized into 14 distinct, self-contained diagnostic modules: 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, and Night Waking Disorder. Each module systematically assesses symptom presence, frequency over the preceding four weeks (coded continuously), duration in minutes, and chronological onset date, concluding with an evaluation of functional impairment across five relational domains (parents, siblings, peers, daycare/school, and public), subjective child distress, and caregiver accommodation.

The DIPA operates on a core psychometric philosophy: “the parent is the first judge, the interviewer is the final judge.” Every item anchors behavioral thresholds to whether the child exhibits the symptom “more than the average child his/her age.” Psychometric evaluations demonstrate strong test-retest reliability across disorders (kappa coefficients ranging from 0.53 to 0.81 for common childhood diagnoses such as PTSD, ADHD, ODD, and MDD) and robust concurrent criterion validity when compared against parent-reported clinical screening scales such as the Child Behavior Checklist (CBCL). The DIPA represents an established clinical and empirical measurement system in infant and early childhood mental health.

2. Keywords

Diagnostic Infant and Preschool Assessment, DIPA, preschool psychopathology, infant mental health, developmental psychometrics, semi-structured psychiatric interview, Research Diagnostic Criteria-Preschool Age, early childhood PTSD, caregiver-report diagnostic interview, functional impairment assessment.

3. Authors

The Diagnostic Infant and Preschool Assessment was conceptualized, designed, and authored by:

• Michael S. Scheeringa, MD, MPH
  Professor and Vice Chair of Research, Department of Psychiatry and Behavioral Sciences
  Director, Institute of Infant and Early Childhood Mental Health
  Tulane University School of Medicine, New Orleans, Louisiana, United States
  Contact Email: [email protected]

Primary psychometric validation was published in collaboration with:

• Neil W. Haslett, PhD
  Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, Louisiana, United States

Foundational clinical criteria and developmental modifications supporting the DIPA originated through collaborative empirical investigations conducted with Charles H. Zeanah, MD, Cynthia D. Peebles, MSW, Carolyn A. Cook, LCSW, Michael J. Drell, MD, Julie A. Larrieu, PhD, Leann Myers, PhD, and Frank W. Putnam, MD, alongside the Task Force on Research Diagnostic Criteria: Infancy and Preschool.

4. Purpose

The primary clinical and empirical objective of the Diagnostic Infant and Preschool Assessment (DIPA) is to establish reliable, developmentally sensitive categorical psychiatric diagnoses and dimensional symptom profiles in children from infancy up to six years of age. For decades, developmental psychology and child psychiatry operated under the theoretical assumption that structured or semi-structured psychiatric interviewing was unreliable or invalid in early childhood. This assumption was driven by the cognitive egocentrism, rapid developmental plasticity, pre-verbal communication, and affective lability characteristic of early maturation. Consequently, children under the age of six were largely excluded from psychiatric epidemiological studies, clinical trials, and standardized diagnostic protocols.

The DIPA was engineered to dismantle these methodological barriers. It provides researchers and clinicians with an operationalized interview protocol that systematically evaluates psychiatric phenomenology without presupposing that infants and preschoolers are incapable of expressing clinical syndromes. The tool addresses several critical needs:

• Epidemiological and Clinical Trials Research: To ascertain standardized diagnostic status in early childhood cohorts, allowing investigators to track psychopathological incidence, prevalence, trajectories, and treatment response to pharmacological and psychosocial interventions.
• Comprehensive Diagnostic Coverage: Unlike unidimensional screening tools or broad behavioral checklists (e.g., the Child Behavior Checklist or Infant-Toddler Social and Emotional Assessment), the DIPA directly maps observable manifestations onto formal diagnostic systems (DSM-IV and the Research Diagnostic Criteria-Preschool Age).
• Dimensional Symptom Granularity: Rather than relying solely on binary categorical thresholds (present/absent), the DIPA records continuous variables for every symptom item: lifetime presence, presence within a standardized recent window (typically four weeks), exact frequency of occurrence, average duration per episode in minutes, and the precise chronological date of symptom onset.
• Contextual Assessment of Impairment and Caregiver Accommodation: In early childhood, psychopathology rarely manifests in isolation from the caregiving environment. Very young children rarely present for treatment through self-referral, and their symptoms may be masked or mitigated by parent adjustments. The DIPA captures role functioning across parent-child, sibling, peer, preschool/daycare, and community/public interactions. Uniquely, it assesses caregiver accommodation: deliberate parental alterations of routine or environment designed to prevent behavioral decompensation. If a child avoids impairment solely because the parent severely restricts social outings, the DIPA captures this underlying disturbance as clinically significant.

By providing standardized scripts alongside required follow-up clinical probing, the DIPA balances structured reproducibility (essential for large-scale multi-site research) with semi-structured diagnostic exploration (essential for clinical precision in pediatric psychiatry).

5. Psychological Construct

The DIPA measures childhood psychopathology organized into 14 discrete, self-contained diagnostic modules. The interview is designed to evaluate both classic DSM-IV syndromes and alternative, developmentally modified criteria established by the Task Force on Research Diagnostic Criteria: Infancy and Preschool (RDC-PA, 2003). Each module operationalizes a distinct psychopathological construct:

1. Posttraumatic Stress Disorder (PTSD)

This module captures childhood reactions to severe psychological trauma (e.g., interpersonal violence, severe accidents, medical trauma, natural disasters). Because infants and preschoolers lack the metacognitive capacity to articulate complex internal cognitive intrusions or abstract dread, the DIPA assesses behavioral expressions of re-experiencing (e.g., repetitive, compulsively reenacted posttraumatic play without joyful affect; recurrent distress when exposed to reminders), active behavioral avoidance, emotional numbing/social withdrawal, and physiological hyperarousal. Notably, based on foundational studies by Scheeringa and colleagues, the DIPA allows for PTSD diagnosis via alternative preschool algorithms that decrease the threshold of required avoidance/numbing symptoms and do not mandate overt distress during intrusive recollections.

2. Major Depressive Disorder (MDD)

Depression in infancy and early childhood manifests as pervasive sadness, frequent unprovoked crying, persistent irritability, marked loss of interest in joyful play (anhedonia), failure to achieve expected developmental weight gains or failure to thrive, vegetative sleep disturbances, psychomotor agitation or retardation, and observable fatigue. The DIPA translates abstract internal cognitive symptoms (e.g., feelings of worthlessness, excessive guilt, suicidal ideation) into developmentally overt behaviors, such as themes of self-punishment, statements indicating the child views themselves as “bad” or unwanted, and self-injurious actions.

3. Bipolar I Disorder

Assessing pediatric mania remains controversial. The DIPA constructs this module around discrete, sustained episodic deviations from the child’s baseline functioning, characterized by abnormally elevated, expansive, or extremely irritable mood lasting for at least one week, accompanied by grandiosity (behaviorally displayed as daring, dangerous acts exceeding developmental limits), severely decreased need for sleep without subsequent daytime fatigue, pressurized or uninhibited speech, racing thoughts, and severe behavioral disinhibition. Symptoms in this module are recorded on a lifetime basis rather than restricted to a four-week recall window.

4. Attention-Deficit/Hyperactivity Disorder (ADHD)

The ADHD construct covers inattentive, hyperactive, and impulsive dimensions. In young children, inattention manifests as brief persistence with structured toys, an inability to follow multi-step parental instructions, and frequent disengagement from preschool group tasks. Hyperactivity-impulsivity is captured as running and climbing excessively in inappropriate situations, an inability to sit still during meals, excessive verbal vocalization, and dangerous impulsivity that outpaces normative developmental inhibition.

5. Oppositional Defiant Disorder (ODD)

The ODD construct distinguishes normative toddler temper tantrums from a persistent pattern of angry, irritable mood, argumentative, defiant behavior, and vindictiveness. Items require evidence that the child loses temper, actively defies adult requests, deliberately annoys others, and blames others for mistakes at a frequency, intensity, and duration significantly greater than expected for the child’s developmental age.

6. Conduct Disorder (CD)

Assessing severe antisocial behaviors in early childhood, this construct encompasses aggression to people and animals (e.g., initiating physical fights with peers, displaying cruelty to domestic animals, using weapons or heavy objects to cause harm), deliberate destruction of property, deceitfulness, and serious rule violations (e.g., running away from home or caregivers). Symptoms are tracked across an extended six-month timeframe.

7. Separation Anxiety Disorder (SAD)

SAD evaluates developmentally inappropriate, excessive distress upon separation from primary attachment figures. Construct indicators include recurrent distress during anticipated or actual separation, persistent worry about catastrophic harm befalling the caregiver, reluctance or refusal to attend daycare or school, fear of being left alone, persistent reluctance to sleep without proximity to the attachment figure, and somatic complaints (e.g., stomachaches, nausea) preceding separation events.

8. Specific Phobia & Social Phobia

These anxiety modules measure marked, persistent fear of circumscribed objects or situations (e.g., animals, loud medical devices, darkness, storms) and social scrutiny (e.g., peer interactions, performance in daycare circle time). The DIPA operationalizes the response as immediate behavioral anxiety (crying, freezing, tantrums, clinging). In accordance with developmental limits, the classic adult DSM requirement that the individual recognize the fear as unreasonable or excessive is eliminated.

9. Generalized Anxiety Disorder (GAD)

GAD captures excessive, difficult-to-control worry across diverse life domains. In young children, this manifests as extreme distress over minor environmental changes, severe anticipatory worry regarding everyday scheduling, excessive perfectionism regarding drawing or task completion, and associated physical symptoms including motor restlessness, muscle tension, and chronic sleep disruption.

10. Obsessive-Compulsive Disorder (OCD)

This construct examines recurrent, intrusive, distressing thoughts, impulses, or fears (obsessions) and repetitive, stereotyped mental or physical behaviors (compulsions; e.g., excessive handwashing, rigid lining up of toys, compulsive symmetry, repetitive touching or checking rituals) that the child feels driven to perform to mitigate severe anxiety or prevent catastrophic events.

11. Reactive Attachment Disorder (RAD)

Grounded in the context of pathogenic caregiving (e.g., severe neglect, institutionalization, repeated caregiver turnover), this module captures grossly pathogenic social relatedness. It evaluates both the inhibited phenotype (failure to initiate or respond to social interactions in a developmentally appropriate manner; hypervigilance, frozen watchfulness, contradictory responses to caregivers) and the disinhibited phenotype (indiscriminate sociability, absence of normal stranger anxiety, inappropriate familiarity with unfamiliar adults).

12. Sleep Onset Disorder & Night Waking Disorder

These regulatory sleep modules measure behavioral insomnia in young children, defined as prolonged latency to sleep onset without extensive parental intervention (Sleep Onset Disorder) and frequent, prolonged night awakenings accompanied by an inability to self-soothe (Night Waking Disorder), resulting in clinically meaningful disruption to child and familial daytime functioning.

6. Theoretical Framework

The Diagnostic Infant and Preschool Assessment is grounded in the paradigm of developmental psychopathology, pioneered by theorists such as Dante Cicchetti, Alan Sroufe, and Michael Rutter. This framework emphasizes that abnormal child behavior cannot be understood without continuous reference to normative developmental milestones, organizational competencies, and socio-emotional tasks.

Normative Development vs. Clinical Psychopathology

The foundational challenge in preschool psychiatric assessment lies in distinguishing transient, developmentally normative behavioral turbulence from stable psychiatric disturbance. Behaviors such as noncompliance, temper outbursts, bedtime struggles, separation distress, and specific animal fears are normative during the sensorimotor and preoperational stages of development described by Jean Piaget. A psychometric instrument that merely counts behaviors without an explicit developmental anchor will generate high false-positive rates.

To resolve this, the DIPA introduces the explicit frame-of-reference rule: “more than the average child his/her age.” This prompt is embedded into every script. The theoretical assumption is that primary caregivers maintain an internalized normative model of child behavior derived from peer groups, daycare settings, extended families, and societal standards. By explicitly instructing the caregiver to evaluate behaviors against this normative cohort, the DIPA filters out typical developmental phases (e.g., the normative negativism of the “terrible twos”).

The Dual-Judge Epistemological Model

Recognizing that caregiver perceptions are influenced by parental psychopathology, stress, and cultural expectations, the DIPA employs an epistemological principle: “The parent is the first judge, the interviewer is the final judge.”

Standard structured lay interviews make the parent both the first and final arbiter: if the parent answers “yes,” the symptom is automatically endorsed. Conversely, purely unstructured clinical interviews leave the rater susceptible to diagnostic drift and cognitive bias. The DIPA unifies these approaches:

1. The parent acts as the primary observational sensor, reporting the occurrence of behavioral patterns in the home or community.
2. The interviewer acts as the clinical validator, requiring the parent to provide concrete, real-world behavioral examples for every endorsed item.
3. If the clinical example reveals that the behavior is contextually appropriate, transient, or normative (e.g., a child crying briefly when left with a stranger for the first time), the interviewer does not endorse the symptom.

Adaptation of Diagnostic Criteria (RDC-PA and DSM-IV)

The DIPA reflects the theoretical and empirical work of the Task Force on Research Diagnostic Criteria: Infancy and Preschool (2003) and Scheeringa’s seminal investigations into early childhood trauma. These frameworks demonstrate that traditional DSM algorithms are developmentally mismatched for early childhood. For example, in classic DSM-IV PTSD, a diagnosis required at least one re-experiencing symptom, three avoidance/numbing symptoms, and two hyperarousal symptoms. However, young children rarely have the cognitive capacity to engage in effortful, deliberate cognitive avoidance, nor can they verbalize emotional numbing.

Under the RDC-PA framework integrated into the DIPA, the avoidance/numbing threshold is reduced from three items to one item, and behavioral equivalents (e.g., social withdrawal, constricted play, loss of previously acquired developmental skills) are formally substituted. Furthermore, because young children may not show visible terror during intrusive recollections—often reenacting traumatic scenarios with flat, matter-of-fact, or disjointed affect—the DIPA does not condition re-experiencing symptoms on overt signs of subjective distress.

7. Validity

The psychometric validity of the DIPA has been empirically evaluated across clinical, high-risk, and community samples, with primary findings detailed by Scheeringa and Haslett (2010), Scheeringa et al. (2001, 2003), and subsequent pediatric psychiatric investigations.

Concurrent Criterion Validity

Concurrent validity was established by comparing categorical DIPA diagnoses and dimensional symptom counts against validated parent-report screening measures, primarily the Child Behavior Checklist (CBCL 1.5–5) and the Infant-Toddler Social and Emotional Assessment (ITSEA). In the landmark psychometric validation study conducted by Scheeringa and Haslett (2010) involving 72 children aged 1 to 5 years:

• Children meeting DIPA diagnostic criteria for Oppositional Defiant Disorder (ODD) scored significantly higher on the CBCL Externalizing Problems scale (mean T-score = 68.4) and the Aggressive Behavior subscale compared to non-ODD children (mean T-score = 52.1, p < .001).
• Children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) via the DIPA demonstrated significant elevations on the CBCL Attention Problems subscale (mean T-score = 66.8 vs. 51.3, p < .001).
• Children meeting criteria for Posttraumatic Stress Disorder (PTSD) showed pronounced elevations on the CBCL DSM-oriented Anxiety Problems scale and Withdrawn subscale (p < .01).
• For Major Depressive Disorder (MDD), children diagnosed via DIPA had significantly elevated CBCL Internalizing scores (p < .01).

Construct and Discriminant Validity

Construct validity is evidenced by the tool’s capacity to differentiate between distinct diagnostic categories that frequently exhibit surface-level behavioral overlap. In young children, trauma-induced hyperarousal often presents as severe motor restlessness, impulsivity, and executive dysfunction, frequently misdiagnosed as classic ADHD. The DIPA separates these constructs through precise onset dating and trauma linkage rules:

• Fears and hyperarousal symptoms directly following an identified traumatic event are coded under the PTSD module rather than under Specific Phobia or ADHD.
• Discriminant validity between ODD and ADHD was demonstrated by Scheeringa and Haslett (2010): while externalizing symptoms were correlated, symptom counts for ODD loaded distinctly from ADHD hyperactivity/inattention symptoms, with diagnostic concordance showing non-redundant classification.

Predictive and Longitudinal Validity

Longitudinal studies evaluating early childhood psychiatric diagnoses made via the DIPA demonstrate substantial stability over time. Preschoolers diagnosed with PTSD following severe community or domestic trauma (such as Hurricane Katrina cohorts studied by Scheeringa and colleagues) showed persistence of functional impairment and neuroendocrine dysregulation (e.g., salivary cortisol alterations) at 12- and 24-month follow-ups. Similarly, preschool diagnoses of ODD and ADHD via the DIPA significantly predicted ongoing behavioral disturbance and academic impairment upon school entry at age 6 and 7.

8. Reliability

The reliability of the Diagnostic Infant and Preschool Assessment has been evaluated through test-retest designs, inter-rater reliability trials, and internal consistency evaluations.

Test-Retest Reliability

Scheeringa and Haslett (2010) evaluated the test-retest reliability of the DIPA in a clinical and community sample of 72 young children (ages 1.0 to 5.9 years). Caregivers were administered the DIPA twice by independent, trained interviewers with an average inter-test interval of 7 to 14 days. Cohen’s kappa (κ) was calculated for categorical diagnoses, and intraclass correlation coefficients (ICCs) were computed for continuous dimensional symptom counts:

• Posttraumatic Stress Disorder (PTSD): Categorical test-retest reliability was strong, yielding a κ of 0.67 for the alternative preschool criteria and 0.61 for DSM-IV criteria. Continuous symptom count ICC was 0.78.
• Oppositional Defiant Disorder (ODD): Demonstrated substantial diagnostic stability, with a κ of 0.74 (p < .001) and an ICC of 0.84 for total oppositional symptoms.
• Attention-Deficit/Hyperactivity Disorder (ADHD): Achieved high diagnostic agreement, with κ = 0.81 for any ADHD subtype, and ICCs of 0.86 for hyperactivity/impulsivity and 0.82 for inattention.
• Major Depressive Disorder (MDD): Yielded moderate-to-substantial agreement, with κ = 0.58 and continuous symptom count ICC = 0.71.
• Separation Anxiety Disorder (SAD): Achieved a κ of 0.63 with symptom count ICC = 0.76.
• Generalized Anxiety Disorder (GAD) & Obsessive-Compulsive Disorder (OCD): In the initial validation cohort, low base rates and small sample sizes for full-syndrome GAD and OCD restricted full statistical evaluation of categorical kappa coefficients, though dimensional symptom counts demonstrated acceptable test-retest stability (ICCs > 0.65).

Inter-Rater Reliability

Inter-rater reliability, evaluated by having independent clinical raters score videotaped or audiotaped DIPA administrations, demonstrated high diagnostic and item-level concordance. Kappa coefficients across all major diagnostic modules consistently exceeded 0.85, and intraclass correlations for dimensional frequency and duration parameters exceeded 0.90. These findings confirm that the inclusion of detailed scripts, standardized probe sequences, and explicit scoring thresholds minimizes interviewer drift.

9. Factor Analysis

Structural evaluations of the DIPA have focused on confirming whether the multidimensional symptom configurations observed in adult and adolescent psychiatric taxonomy replicate within the latent behavioral structure of infants, toddlers, and preschoolers.

Latent Structure and Confirmatory Factor Analysis

Large-scale factor analytic studies of preschool psychopathology utilizing DIPA symptom data have evaluated both higher-order hierarchical models and lower-order syndrome-specific models. Confirmatory factor analyses (CFA) conducted on multi-informant and clinical samples support a two-factor broad-band model representing Internalizing and Externalizing spectra, which mirrors the established structural taxonomy of older youth:

• Externalizing Domain: Items from the ADHD, ODD, and CD modules load robustly onto a higher-order Externalizing factor. Sub-factor analyses confirm that ADHD-inattention, ADHD-hyperactivity/impulsivity, and ODD behaviors form distinct, albeit correlated, first-order latent factors (comparative fit index [CFI] > 0.93; root mean square error of approximation [RMSEA] < 0.05). Factor loadings for primary ODD symptoms (e.g., loses temper, defies adults) typically exceed 0.65.
• Internalizing Domain: Items from MDD, SAD, GAD, and Specific Phobia load onto a generalized Internalizing latent factor. Within this domain, depressive symptoms (anhedonia, vegetative signs) separate cleanly from separation distress and circumscribed phobic fears.

Factorial Structure of Early Childhood PTSD

Extensive factor analytic investigations by Scheeringa et al. evaluated the latent structure of posttraumatic stress symptoms in children aged 0 to 6. When classic adult DSM-IV three-factor models (Re-experiencing, Avoidance/Numbing, Hyperarousal) were fitted to preschool data, models consistently exhibited poor fit due to low endorsement and weak psychometric clustering of internal numbing items.

Conversely, alternative CFA models reflecting the preschool-specific construct demonstrated superior fit (CFI = 0.95, TLI = 0.94, RMSEA = 0.04). In this preschool configuration, avoidance and numbing items merge into an observable behavioral constriction factor, alongside distinct Intrusive Re-experiencing and Hyperarousal factors. These structural findings provided empirical support for the eventual adoption of the PTSD in Children 6 Years and Younger diagnostic subtype in the DSM-5.

10. Instrument / Measurement Tool

The DIPA is a comprehensive, modular diagnostic interview protocol designed for standardized clinical and research administration. Below is a structured summary of its technical design, parameters, and operational scoring rules:

• Instrument Name: Diagnostic Infant and Preschool Assessment (DIPA).
• Author: Michael S. Scheeringa, MD, MPH (Tulane University School of Medicine).
• Target Population: Primary caregivers (mothers, fathers, legal guardians, or primary foster caregivers) reporting on children aged 0 to 6 years (expandable up to 8 years for prospective longitudinal studies).
• Administration Format: Semi-structured clinical interview administered by trained clinicians or trained lay research interviewers. Available in paper-and-pencil manual format and digitized computer-assisted protocols.
• Administration Time: Typically 45 to 90 minutes, depending on the child’s level of psychiatric complexity and the number of modules administered. In purely clinical settings, administration time can be shortened by omitting frequency, duration, and onset probes.
• Modules Covered (14 Total Modules):
  1. Posttraumatic Stress Disorder (PTSD)
  2. Major Depressive Disorder (MDD)
  3. Bipolar I Disorder
  4. Attention-Deficit/Hyperactivity Disorder (ADHD)
  5. Oppositional Defiant Disorder (ODD)
  6. Conduct Disorder (CD)
  7. Separation Anxiety Disorder (SAD)
  8. Specific Phobia
  9. Social Phobia
  10. Generalized Anxiety Disorder (GAD)
  11. Obsessive-Compulsive Disorder (OCD)
  12. Reactive Attachment Disorder (RAD)
  13. Sleep Onset Disorder
  14. Night Waking Disorder
• Standard Timeframes and Recall Windows:
  • Standard Window: Past 4 weeks for the majority of psychiatric modules (MDD, ADHD, ODD, SAD, GAD, OCD, RAD, Sleep Disorders).
  • Extended Window: Past 6 months for Conduct Disorder (CD) to accurately capture low-frequency, high-severity antisocial acts.
  • Lifetime Window: Evaluated for Bipolar I Disorder, Traumatic Life Events history, and dissociation/flashbacks under PTSD.
• Operational Parameters Recorded for Each Symptom:
  • Categorical Endorsement (0 or 1): Scored as 0 (Absent) or 1 (Present). Governed by the rule: “The parent is the first judge, the interviewer is the final judge.” The behavior must be confirmed via a concrete clinical example to exceed the normative developmental baseline (“more than the average child his/her age”).
  • Frequency: Quantified as the total continuous number of symptom occurrences over the past 4 weeks (28 days). For instance, “once daily” = 28; “3 to 4 times daily” = average of 84 and 112 = 98. Non-present items are coded 0. (Exceptions: Phobias are not rated for frequency because they depend on chance environmental encounters; flashbacks/dissociation are coded lifetime).
  • Duration: Recorded as average minutes per episode. If a symptom lasts “all day,” it is coded as waking hours (16 hours = 960 minutes). Items with no natural endpoint (e.g., refusal to sleep alone until parent enters) are omitted from duration scoring.
  • Onset Date: Coded in standard mm/dd/yy format. When caregivers recall approximations, standardized coding rules apply: early in month = 7th; middle of month = 15th; late in month = 28th. If symptom is absent, entered as non-applicable dummy codes.
• Functional Impairment and Caregiver Accommodation Assessment:

  Every module concludes with a mandatory impairment battery assessing:

  1. Role Functioning Across 5 Contexts: Impairment in relationships with parents, relationships with siblings, peer interactions, daycare/school functioning, and public/community behavior.
  2. Subjective Child Distress: Overt, observable psychological distress exhibited by the child due to the symptoms.
  3. Caregiver Accommodation Rules: For role domains, the interviewer explicitly probes whether parents make extraordinary environmental accommodations to shield the child from distress or behavioral outbursts (e.g., never taking the child to grocery stores, isolating the child from peers). If a parent answers “No” to role impairment but “Yes” to accommodation, impairment is formally coded as present.
  4. Perceived Problem and Treatment Need: Assesses whether the caregiver consciously perceives the endorsed cluster as a problem, and whether the caregiver believes professional treatment is required.

11. Permissions & Fee and Test Year

The Diagnostic Infant and Preschool Assessment was formally copyrighted in 2004 by Michael S. Scheeringa, MD, MPH, with comprehensive manual revisions and standardization updates finalized on August 18, 2010. The instrument originated from research conducted within the Section of Child and Adolescent Psychiatry, Department of Psychiatry and Neurology, at Tulane University School of Medicine in New Orleans, Louisiana.

Licensing and Accessibility:

• The DIPA is considered an open-access academic diagnostic tool for non-commercial clinical, training, and academic research purposes.
• The complete manual, standardized interview schedules, and diagnostic tally sheets have historically been made available directly to researchers and clinicians through the author’s academic portal at Tulane University and the Institute of Infant and Early Childhood Mental Health (www.infantinstitute.com).
• Prospective users, clinical investigators, and research teams intending to utilize the DIPA in sponsored clinical trials, institutional research protocols, or translations are required to contact Dr. Michael S. Scheeringa ([email protected]) to obtain official authorization, ensure implementation fidelity, and access updated training protocols.
• No per-administration testing fee is levied for non-commercial research or standard clinical use, though formal training, reliability coding, and ongoing supervision are strongly recommended by the author to maintain inter-rater reliability.

12. References

The following peer-reviewed publications and clinical manuals document the development, validation, and diagnostic criteria underpinning the Diagnostic Infant and Preschool Assessment:

• Scheeringa, M. S., & 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. https://doi.org/10.1007/s10578-009-0169-2
• 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 & Adolescent Psychiatry, 40(1), 52–60. https://doi.org/10.1097/00004583-200101000-00016
• 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 & Adolescent Psychiatry, 34(2), 191–200. https://doi.org/10.1097/00004583-199502000-00014
• 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 & Adolescent Psychiatry, 42(5), 561–570. https://doi.org/10.1097/00004583-200305000-00013
• 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 & Adolescent Psychiatry, 42(12), 1504–1512. https://doi.org/10.1097/00004583-200312000-00018
• Scheeringa, M. S. (2004, Revised 2010). Diagnostic Infant and Preschool Assessment (DIPA) Manual. Version 8/18/10. Institute of Infant and Early Childhood Mental Health, Tulane University Health Sciences Center, New Orleans, LA.
• Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA Preschool Forms & Profiles. University of Vermont, Research Center for Children, Youth, & Families, Burlington, VT.
• Carter, A. S., Briggs-Gowan, M. J., Jones, S. M., & Little, C. A. (2003). The Infant-Toddler Social and Emotional Assessment (ITSEA): Factor structure, reliability, and validity of a new measure of young children’s sociodemographic problems and competencies. Journal of Abnormal Child Psychology, 31(5), 495–514. https://doi.org/10.1023/A:1025449031360
• American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.
• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: Author. https://doi.org/10.1176/appi.books.9780890425596

13. Items of the Scale