Pictorial Instrument for Children and Adolescents (PICA-III-R).

OBJECTIVE The Pictorial Instrument for Children and Adolescents (PICA-III-R) is presented as part of a comprehensive review of the tools used to diagnose psychiatric disorders in children and adolescents. METHOD The PICA-III-R's development, content, initial psychometric properties, and directions for use are described. RESULTS The PICA-III-R assesses all DSM-III-R Axis I psychiatric disorders in children aged 6 to 16 years, categorically (diagnosis present or absent) and dimensionally (range of severity). It comprises 137 pictures organized in modules that cover 5 diagnostic categories, including disorders of anxiety, mood, psychosis, disruptive behavior, and substance abuse. Its initial psychometric properties are promising, with good internal consistency, significant discriminative power for diagnoses, and sensitivity to changes. CONCLUSIONS Despite great interest expressed by child and adolescent psychiatrists, further testing has not been possible for practical reasons unrelated to the scientific importance of such work. Although it needs to be modified to follow DSM-IV criteria, the PICA-III-R can be of significant help to child and adolescent psychiatrists, for clinical as well as research diagnostic purposes. In addition, it can be used for the assessment of non-English-speaking or hearing/speech-impaired children.