Psychometric properties of the Dominic Interactive in a large French sample

Original Research

Psychometric Properties of the Dominic Interactive ina Large French Sample

Taraneh Shojaei, MD1; Ashley Wazana, MD, FRCP

2; Isabelle Pitrou, MD, MSc

3;

Fabien Gilbert, MSc4; Lise Bergeron, PhD

5; Jean-Pierre Valla, MD

5;

Viviane Kovess-Masfety, MD, PhD6

Key Words: psychometrics, child psychiatry, school-aged children, questionnaire,mental health

The Canadian Journal of Psychiatry, Vol 54, No 11, November 2009 � 767

Objectives: To examine the psychometric properties of the Dominic Interactive (DI) in

school-aged children in a different cultural environment than Quebec.

Methods: In a large French region, 100 schools and 25 children (aged 6 to 11 years) per

school were randomly selected. Data were collected using self-administered questionnaires

to children (DI), parents (sociodemographic characteristics, mental health services use),

and teachers (child school achievement). DI psychometric properties were assessed by

examining: the distribution of each DI diagnosis; comorbidity between diagnoses; alpha

coefficients measuring internal consistency; and correlates of psychopathologies with

sociodemographic status and health care services use. Estimates of DI properties were

compared with those from a sample of community children in Quebec.

Results: Complete data were available for 1274 children (54.4%). The internal consistency

of each DI diagnosis of the French version was reasonable, with Cronbach’s alpha

coefficients ranging from 0.62 to 0.89. The psychometric properties and comorbidity were

consistent with the version from Quebec.

Conclusions: The satisfactory psychometric properties of the DI along with other

demonstrated advantages of this instrument (children enjoy the activity, parents approve of

it, and it is cost-effective) and its cultural adaptability support the consideration of the DI

for epidemiologic studies in diverse cultures.

Can J Psychiatry. 2009;54(11):767–776.

Clinical Implications

� The psychometric performances of the DI were satisfactory and consistent in the French andQuebec samples.

� Findings suggest the wider applicability of the DI to epidemiologic studies in diverse cultures.

Limitations

� The main limitation was the parents’ low response rate and Quebec study sample size.

� DI does not make straightforward Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition, (DSM-IV) diagnoses: it is only indicative of tendencies toward any DSM-IVdisorder.

Child mental health assessment requires input from several

informants usually parents, teachers, and children them-

selves.1–3 Reliance on parent or teacher reports, excluding the

child, is problematic.4 Parents may be influenced by their own

psychopathology, or may have limited information about

norms for children or variation in intellectual abilities.5,6 Simi-

larly, teachers may not have adequate opportunities to observe

the child in other settings or might have limited access to child

internalizing psychopathology.

Several studies reported that children aged as young as 5 or 6

years were capable of providing valid reports of depressed

mood and feelings.7–11 Few studies reported estimates of prev-

alence of child psychopathology using child self-report at a

young age (aged 6 years and older) as most instruments avail-

able are designed for children aged 9 years and older.12–15

Among the few self-report psychiatric instruments for

school-aged children, the Pictorial Instrument for Children

and Adolescents offered an attempt to assess DSM-III-R Axis

I psychiatric disorders in children aged 6 to 16 years using

drawings.16 Unfortunately, its development has been aban-

doned. Two recent studies have reported good evidence for

the reliability of young child (aged 5 years) self-report with

the structured Berkeley Puppet Interview5,17 but it is designed

for younger children and requires time and personnel

availability.

The DI is a self-report instrument for children aged as young

as 6 years, which is easy to administer in the general popula-

tion.18,19 Using 91 cartoon-based questions about symptoms

and strengths, probability diagnoses are generated for the

most prevalent DSM-IV psychopathologies.20 The original

version of the DI (Dominic-R) was a paper and pencil test

based on DSM-III-R criteria; the DI is a self-administered,

computerized version of the Dominic-R. DI was developed

and validated in Quebec originally in English and French, and

since has been translated into Spanish and German and has

been used in diverse settings and countries.19,21–24 The charac-

ter represented in the cartoon depicts the sex of the child

assessed, and can appear with a Caucasian (Dominic),

Hispanic (Gabi), African (Terry), or Asiatic (Ming) appear-

ance.19 In Europe, a French version has been adapted to the

French context through the modification of a few drawings

for a better acceptance.25 For example, the picture of Dominic

lying dead in a coffin was replaced by Dominic looking at a

grave in a cemetery to conform to norms in France, and the

French voice-over has been recorded with an accent from

France instead of from Quebec. More detailed information

on the instrument is available from the Dominic website.26

Several studies have reported on the performance of the orig-

inal Dominic-R. Reliability of the Dominic-R compared

favourably with that of other child assessment questionnaires

and was better than that of other structured interviews in

young children. Kappa values for the concordance between

Dominic-based diagnoses and clinical judgment-based

DSM-III-R diagnoses ranged from 0.64 to 0.88.18 The DI

computer version has been studied as well.23,25,27 In the

French version of the DI, internal consistency, as measured

by Cronbach’s alpha, ranged from 0.55 for SPh to 0.84 for

ADHD.25 Moderate to excellent internal consistency for each

DI diagnosis category has been reported for the Quebec

French version.28 Also it has been reported that the version

developed for African-American children (Terry) was a cul-

turally sensitive questionnaire with good reliability.22

Our study’s objective was to examine the psychometric prop-

erties of the DI computer version in a large regional French

sample and to compare the findings across 2 francophone

populations from different cultural backgrounds. To assess

the psychometric performances of the DI, we considered: the

distribution of each DI diagnosis; the comorbidity between

diagnoses; the internal consistency in our sample and that of a

convenience sample in Quebec; and the correlates of DI diag-

noses with known sociodemographic risk factors and health

care services use.

Methods

A cross-sectional survey was conducted from November

2004 to March 2005 in France’s south-eastern region of

Provence-Alpes-Côte d’Azur, with an estimated population

of 4 750 000 inhabitants.29 Key methodological aspects are

reported below; detailed methodology is reported exten-

sively in a previous paper.30

Participants

A stratified multistage probability sample was used to ensure

representativeness across schools of this area. The sampling

frame was the list of all primary schools: public and private,

urban and rural. Among the 100 primary schools randomly

selected, 99 accepted to participate. Twenty-five children

were randomly selected in each school, 5 from grades 1 to 5.

Contacts were attempted for 2341 children.

� La Revue canadienne de psychiatrie, vol 54, no 11, novembre 2009768

Original Research

Abbreviations used in this article

ADHD attention-deficit hyperactivity disorder

CD conduct disorder

DI Dominic Interactive

DSM Diagnostic and Statistical Manual of Mental Disorders

GAD generalized anxiety disorder

MDD major depressive disorder

ODD oppositional defiant disorder

SAD separation anxiety disorder

SPh specific phobia

The study design was approved by the French National Confi-

dentiality Committee. Participating parents received clear

information on the study, their written consent was manda-

tory, and anonymity was guaranteed.

Main Outcome Measures

Data were collected using questionnaires administered to 3

informants: parents (sociodemographic characteristics,

parental psychological distress, and health care services use);

children (DI)18; and teachers (child school achievement).

Measures of Child Psychopathology

The DI computer version allows screening for the following 7

disorders: SPh, MDD, SAD, GAD, ADHD, ODD, and CD. In

our study, children completed the DI at a computer station at

school, under the indirect supervision of a research assistant,

with 5 children in each session. During its administration, a

few introductory pictures familiarized the child with the soft-

ware. Colour cartoons and a voice-over depicted a child,

Dominic, in various daily life situations: at home, at school,

and with other children. The cartoons illustrated the abstract

emotional and behavioural content of DSM-IV

symptomatology. The voice-over describing the symptom

asked the child whether he or she feels or does what the child

in the picture is feeling or doing. Children responded by click-

ing on yes or no boxes, thus disclosing their own reactions

when they are faced with these situations. The children’s

answers were recorded on a floppy disk, leaving no informa-

tion on the computer’s hard drive.

Symptoms were scored as 0 for no and 1 for yes and were

summed for each of 7 diagnostic groups. An algorithm

assigned the child to 1 of the 3 diagnostic probability catego-

ries: likely absent, possible, and likely present using cut-off

points reported by Valla et al.19 For reporting purposes, and as

recommended by the author of the instrument, we considered

children in the category likely present as having one of the 7

screened disorders.

Correlates of Child Psychopathology

A range of child, family, and socioeconomic factors known to

correlate with psychiatric disorders were collected in parents’

questionnaires.21,24 The correlates between DI scales and

those variables were examined as an external validation strat-

egy. Child and family characteristics included age, sex, birth-

place, chronic medical conditions, stressful life events, and

family structure (single- or 2-parent). Parents’ characteristics

included educational level (highest educational level), aver-

age family income (as compared with the national poverty

standard of €646 per month per capita, that is, US$824,

Can$974), occupational activity, unemployment (at least one

parent), and psychological distress (using Mental Health 5, a

5-item subscale measuring psychological distress, part of a

generic quality-of-life instrument: Short Form 3631–33). Other

factors collected were school area profile (disadvantaged or

not, urban, or rural) and school status (public or private).

School achievement was assessed by teachers by comparing

children’s school performance to that of other classmates,

using a 5-point Likert scale (very low to very good).

DI Comparisons

To compare French DI internal consistency with the original

Quebec French version, we considered results from a conve-

nience sample of 453 children aged 6 to 11 years who were

randomly selected in schools of a suburban area of

Montreal.28 To compare the comorbid diagnoses, we consid-

ered results from the Quebec Child Mental Health Survey.21

The details of the respective methodologies are previously

published but not for the internal consistency.

Statistical Analysis

Prior to statistical analyses, each subject was assigned a

weight computed as the product of the inverse probability of

being selected in the survey. To examine the performances of

the computer version of the DI, we first described the statisti-

cal distributions of each DI diagnosis. To assess internal con-

sistency, we calculated Cronbach’s alpha coefficient for each

diagnostic category and compared them to the Quebec data

available. Finally, we examined the comorbidity between the

different DI diagnosis and the correlates of psycho-

pathologies with sociodemographic status and health care

services use using logistic regression models.

The statistical analyses were performed with STATA SE,

Version 9 (Stata Corporation, College Station, TX).

ResultsAmong the 2341 eligible children, 462 parents (19.7%) did

not accept to participate and 531 (22.7%) did not return the

questionnaire. Response rates to the DI and parent question-

naires were 75.5% (n = 1767) and 57.6% (n = 1348), respec-

tively. Completed data were available for 1274 children

(54.4%).

Sociodemographic characteristics of children included are

reported in Table 1.

Distributions of DI Symptom Score

Score distribution and cut-off points of the 7 DI symptom

scales are reported by sex in Figure 1. Most internalizing dis-

orders (SAD, GAD, and MDD) seemed to have a Gaussian

density distribution for both sexes. SPh was normally distrib-

uted in girls, contrary to boys. The 3 externalizing disorders

(CD, ODD, and ADHD) were approximated by an asymp-

totic distribution. Distributions were compared for the 2 age

categories (ages 6 to 8 years and 9 to 11 years) and showed no

difference (data not shown).

Psychometric Properties of the Dominic Interactive in a Large French Sample


Internal Consistency

The internal consistency (Table 2) measured by Cronbach’s

alpha coefficients was very good for internalizing and

externalizing disorders (� = 0.87 and � = 0.89, respec-

tively). SAD and SPh had the lowest internal consistency,

although fair (� = 0.62). In the Quebec sample, Cronbach’s

alpha coefficients were 0.90 and 0.89 for internalizing and

externalizing disorders, respectively, and 0.66 for SAD and

0.57 for SPh.

Comorbidity

According to the recommended cut-offs for the DI,19 25.4%

of children had at least one disorder, with no statistical signif-

icant difference between the sexes (26.9% for girls, com-

pared with 23.9% for boys, P = 0.30) and 10.6% had at least 2

diagnoses. The estimates ranged from 4.8% for MDD to

9.4% for SAD. The rate of SPh was higher in girls (10.8%,

compared with 5.5%, P < 0.001), while ADHD and CD were

significantly higher in boys (6.5%, compared with 3.6% for

ADHD; 8.6%, compared with 2.8% for CD, P � 0.001). The

likelihood of the association between internalizing disorders

(Table 3) ranged from OR 4.3 (95% CI 2.4 to 7.4, P � 0.001)

(MDD and SPh) to OR 23.5 (95% CI 14.1 to 39.3, P � 0.001)

(GAD and MDD). The strength of the association between

externalizing disorders ranged from OR 9.4 (95% CI 5.7 to

15.6, P � 0.001) (ODD and CD), OR 11.2 (95% CI 6.7 to

18.8, P � 0.001) (ADHD and CD), and OR 11.2 (95% CI 6.7

to 18.7, P � 0.001) (ADHD and ODD). There was a strong

overlap between externalizing disorders and MDD, with

odds ratios ranging from OR 8.5 (95% CI 4.9 to 14.6,

P � 0.001) (MDD and CD) to OR 19.7 (95% CI 11.5 to 33.6,

P < 0.001) (MDD and ADHD). The association was strong

between ADHD and GAD (OR 10.2, 95% CI 6.2 to 16.8,

P < 0.001), ODD and GAD (OR 13.7, 95% CI 8.5 to 22.1,

P � 0.001) and less important between externalizing disor-

ders and SAD (OR from 3.9 to 5.8, P < 0.001), externalizing

disorders and SPh (OR from 3.2 to 5.1, P � 0.001).

Correlates of Child Mental Health Problems

Internalizing and externalizing disorders were less frequent

in older children (aged 9 to 11 years) (OR 0.6, 95% CI 0.4 to

0.8, P � 0.001) (Table 4). Girls were more likely to have inter-

nalizing disorders (OR 1.4, 95% CI 1.1 to 2.0, P � 0.02), but

less likely to have externalizing disorders (OR 0.7, 95% CI

0.4 to 1.0, P � 0.03). Children born outside of France had a

2-fold higher rate of internalizing disorders (OR 2.1, 95% CI

1.1 to 4.0, P � 0.02). Teacher-reported low performance at

school was associated with an increase of OR 1.9 (95% CI 1.3

to 2.9, P � 0.01) and OR 2.8 (95% CI 1.7 to 4.4, P � 0.001) of

internalizing and for externalizing disorders, respectively.


Original Research

Table 1 Sociodemographic characteristics of aFrench regional sample of children aged 6 to 11years (n = 1274)

Variable n (%)

Child characteristics

Sex

Boys 636 (50.2)

Girls 638 (49.8)

Age, years

6–8 735 (59.2)

9–11 526 (40.8)

Family structure

2-parent 1109 (86.7)

Single-parent 165 (13.3)

Birthplace

France 1217 (95.5)

Outside of France 57 (4.5)

Socioeconomic characteristics

Demographic area

Rural 198 (7.6)

Urban 1076 (92.4)

Disadvantaged school area

No 1142 (89.5)

Yes 132 (10.5)

School status

Public 1110 (89.0)

Private 164 (11.0)

Parent characteristics

Responding parent

Mother 1049 (82.3)

Father 225 (17.7)

Parental education

<High school 462 (37.7)

�High school 801 (62.3)

Unemployment (at least 1

parent)

No 1106 (87.4)

Yes 152 (12.6)

Incomea

High 951 (81.7)

Low 200 (18.3)

aCompared with the national poverty standard of €646 per month percapita

High parental education was protective both for internalizing

and for externalizing disorders. Parental unemployment was

associated with an increased risk of 1.6-fold (95% CI 1.0 to

2.3, P � 0.03) of any psychopathology, whereas a parent being

an executive was a protective factor for internalizing and

externalizing disorders, compared with employees category.

No association was found for chronic conditions, stressful life

events, family structure, and parental psychological distress.

Both internalizing and externalizing disorders were associ-

ated with low performance at school as reported by the

teacher.

Correlates of Child Mental Services Contact

In the past 12 months, 150 children (11.8%) had contact with a

mental health service. Children with externalizing disorders

were more likely to have contact with a mental health profes-

sional (OR 3.2, 95% CI 2.0 to 5.0, P � 0.001) and the

association was statistically significant for boys (OR 3.5,

95% CI 2.0 to 6.2, P � 0.001) and girls (OR 2.4, 95% CI 1.1 to

5.4, P � 0.03). There was no overall association with internal-

izing disorders (OR 1.4, 95% CI 0.9 to 2.2, P � 0.13). Glob-

ally, boys were more likely to have contact with mental health

professionals than girls: OR 2.6, 95% CI 1.5 to 4.3, P � 0.01

and OR 1.1, 95% CI 0.6 to 2.0, P � 0.5, respectively. Boys

with internalizing disorders had increased services use

(OR 2.2, 95% CI 1.3 to 3.9, P � 0.01) and use was signifi-

cantly higher for GAD (OR 4.2, 95% CI 1.8 to 9.5, P � 0.001)

and MDD (OR 3.9, 95% CI 1.7 to 9.0, P � 0.001). For

externalizing disorders, the association was statistically sig-

nificant for ADHD (OR 2.6, 95% CI 1.2 to 5.8, P � 0.02), CD

(OR 3.9, 95% CI 2.0 to 7.7, P � 0.001), and ODD (OR 3.5,

95% CI 1.6 to 7.8, P � 0.01). In girls, mental health services



Table 2 Internal consistency (Cronbach alpha coefficient) of DI diagnosis according to age and sex in a Frenchregional sample of children aged 6 to 11 years (n = 1274) and Quebec sample (n = 453)

Total Aged 6–8 years Aged 9–11 years Boys Girls

Mental disorder

(number of items per

scale)

France

n = 1767

Canada

n = 453

France

n = 1009

Canada

n = 231

France

n = 742

Canada

n = 222

France

n = 903

Canada

n = 225

France

n = 864

Canada

n = 228

SPh (n = 9) 0.62 0.57 0.62 0.59 0.57 0.55 0.65 0.56 0.55 0.53

SAD (n = 8) 0.62 0.66 0.61 0.64 0.62 0.66 0.59 0.65 0.64 0.67

GAD (n = 15) 0.75 0.74 0.76 0.75 0.73 0.73 0.73 0.72 0.76 0.75

MDD (n = 20) 0.80 0.80 0.80 0.81 0.79 0.80 0.80 0.80 0.79 0.81

Internalizing disorders 0.87 0.90 0.88 0.90 0.85 0.89 0.87 0.89 0.87 0.89

ADHD (n = 19) 0.83 0.86 0.83 0.86 0.83 0.85 0.84 0.87 0.82 0.84

ODD (n = 9) 0.72 0.76 0.70 0.75 0.75 0.76 0.71 0.77 0.73 0.74

CD (n = 14) 0.80 0.74 0.82 0.78 0.77 0.67 0.83 0.79 0.71 0.63

Externalizing disorders 0.89 0.90 0.89 0.91 0.89 0.89 0.90 0.91 0.87 0.88

Table 3 Comorbidity between DI diagnoses in a French regional sample of children aged 6 to 11 years (n = 1274)using OR (95% CIs)

Mental health

disorder

SPh

n = 140

SAD

n = 165

GAD

n = 120

MDD

n = 84

ADHD

n = 91

ODD

n = 107

CD

n = 105

SPh — 4.4 (2.8–6.8) 6.5 (4.1–10.3) 4.3 (2.4–7.4) 3.2 (1.8–5.6) 3.9 (2.3–6.6) 5.1 (3.1–8.4)

SAD — 9.2 (6.0–14.2) 10.7 (6.6–17.5) 5.8 (3.5–9.4) 5.3 (3.3–8.4) 3.9 (2.4–6.3)

GAD — 23.5

(14.1–39.3)

10.2 (6.2–16.8) 13.7 (8.5–22.1) 3.8 (2.2–6.6)

MDD — 19.7

(11.5–33.6)

11.7 (6.9–19.9) 8.5 (4.9–14.6)

ADHD — 11.2 (6.7–18.7) 11.2 (6.7–18.8)

ODD — 9.4 (5.7–15.6)

CD —

— = OR 1


Original Research

Table 4 Child and family correlates of DI psychopathology scales in a French regional sample of children aged 6to 11 years (n = 1274) using OR (95% CIs)

Variable Internalizing disorders Externalizing disorders Any disorders

Child characteristics

Aged 9 to 11 years 0.5 (0.4–0.7) 0.8 (0.5–1.2) 0.6 (0.4–0.8)a

Sex

Boys 1 1 1

Girls 1.4 (1.1–2.0)b

0.7 (0.4–1.0)b

1.2 (0.9–1.5)

Birthplace

France 1 1 1

Outside of France 2.1 (1.1–4.0)b

1.8 (0.8–4.0) 2.0 (1.1–3.7)b

Stressful life events

0 or 1 1 1 1

�2 1.1 (0.8–1.6) 1.3 (0.8–2.1) 1.3 (0.9–1.8)

School achievement

High 1 1 1

Low 1.9 (1.3–2.9)c

2.8 (1.7–4.4)a

2.3 (1.6–3.3)a

Chronic physical illness

No 1 1 1

Yes 0.9 (0.6–1.4) 1.0 (0.6–1.6) 0.9 (0.6–1.3)

Parent and family characteristics

Family structure

2-parent 1 1 1

Single-parent 1.3 (0.8–2.0) 0.9 (0.5–1.6) 1.2 (0.8–1.7)

Parental education

Low 1 1 1

High 0.6 (0.4–0.8)a

0.6 (0.4–0.9)c

0.6 (0.4–0.7)a

Unemployment

No 1 1 1

Yes (at least 1 parent) 1.5 (0.9–2.3) 1.4 (0.8–2.4) 1.6 (1.0–2.3)b

Occupational activity

Employees 1 1 1

Agricultural, craft, and trade 0.8 (0.5–1.3) 0.6 (0.3–1.0) 0.8 (0.5–1.2)

Executives 0.4 (0.3–0.7) 0.5 (0.3–1.0)b

0.4 (0.3–0.7)a

Intermediate 0.8 (0.5–1.3) 0.5 (0.3–1.0)b

0.7 (0.4–1.0)

Manual workers 1.0 (0.6–1.8) 0.9 (0.4–1.8) 0.9 (0.5–1.6)

No activity 1.3 (0.8–2.3) 1.3 (0.7–2.4) 1.4 (0.9–2.3)

Parents’ psychological distress

No 1 1 1

Yes 1.1 (0.8–1.7) 1.5 (1.0–2.3) 1.4 (0.9–1.9)

All analyses are univariate.

aP < 0.001;

bP < 0.05;

cP < 0.01



Figure 1 Score distribution and cut-off points of the 7 DI symptom scales according to sex (n = 1274)

Legend

Dash lines indicate cut-off points and separate

probability diagnostic zones into 3:

– 1: likely absent

– 2: possible

– 3: likely present

use was significantly higher for MDD and ODD: OR 3.1, 95%

CI 1.1 to 8.8, P � 0.03 and OR 4.1, 95% CI 1.7 to 10.1, P �

0.01, respectively.

Discussion

Limitations

One limit comes from parents low response rate. To assess a

possible response bias, responding and nonresponding par-

ents were compared according to school area and status, and

child characteristics (age and sex), and did not reveal statisti-

cal differences. Despite this low response rate, it is important

to note that our study’s objective was to report data related to

the psychometric properties of the DI and not to provide prev-

alence rates of mental health disorders in the general popula-

tion. A second limit is related to the Quebec convenience

sample, whose size was limited to 453 children and used a

sampling strategy different from ours. In the Quebec survey,

children were randomly selected from the general population

and outpatients clinics; in the French sample, only children

from the general population were selected.

Third, the DI does not make straightforward DSM-IV diagno-

ses but rather DSM-IV–based diagnostic approximates. Con-

sequently the DI is only indicative of tendencies toward any

DSM-IV disorder. The DI does not collect information about

frequency, duration of symptoms, or age of onset because the

cognitive maturity of children aged 6 to 11 years limits their

comprehension of abstract concepts.18,34 To compensate for

the lack of severity assessment at the symptom level and the

lack of assessment of significant distress or impairment

accompanying the disorder, frequency and duration criteria

have been replaced with a cut-off point of increasing severity

at the disorder level. These differences between DI diagnostic

approximations and straightforward DSM-IV diagnoses limit

the instrument’s ability to diagnose children.

Main Findings

Our study reports on the psychometric properties of a child

instrument, the DI, in a large epidemiologic sample of French

children aged 6 to 11 years, by analyzing statistical distribu-

tions, internal consistency, and correlates of DI diagnosis.

Externalizing disorders were approximated by an asymptotic

distribution, whereas internalizing disorders seemed to have a

normal density distribution. These findings open up an inter-

esting research perspective to explain how children

self-report a normal level of internalizing symptoms, whereas

external disorders are reported in a different manner where no

or few symptoms is the norm. Interestingly, the distribution of

SPh in girls is a Gaussian curve, whereas it is an asymptotic

curve in boys, underlying the scarcity for boys. These results

can contribute substantively to establishing the norms of psy-

chiatric assessments of children.

Second, our paper establishes the consistency of the DI

across the francophone culture by comparing French and

Quebec DI psychometric properties. The internal consis-

tency coefficients were very similar to the Quebec sample,

with a Cronbach’s alpha of 0.90 both for externalized and for

internalized disorders. The lowest alpha coefficients were for

SAD (0.62) and SPh (0.62) as in the Quebec sample (0.66 and

0.57). The internal consistency estimates remained consis-

tent across age groups and sex as in the Quebec sample. The

main difference between French and Quebecois results was

for CD coefficients, which were higher in the French sample.

The comorbidity between externalizing and internalizing

disorders was similar to that from the Quebec Child Mental

Heal th Survey. Correlates of mental heal th

psychopathologies reported here (aged 6 to 8 years, low

school achievement, low parental education, parental unem-

ployment) are consistent with results of previous epidemio-

logic studies.35–37 The association between DI and such

theoretically related constructs as known sociodemographic

risk factors and services use further contribute to the validity

(face and external validity, and coherence) of this

self-reported instrument.38

Clinical Implications

The psychometric properties of the DI were satisfactory and

results were consistent with those of the Quebec sample. The

DI could then contribute more widely to the field of clinical

and epidemiologic assessment. In a clinical setting, it offers a

simple assessment specially designed for children aged 6 to

11 years that is both appealing to children and easy to use by

professional. At initial interview, the DI provides a system-

atic overview of the child’s symptoms as the child perceives

them. This offers an alternative to the often lengthy process

needed to build up a trustworthy relationship with the child.

The DI can be particularly helpful with questions that might

trigger uneasiness, provoke denial, or jeopardize the relation-

ship with the child, or for children who might find it difficult

to talk about sensitive topics, for example, suicidal thoughts.

Although the DI instrument does not replace clinical assess-

ment, it can provide a helpful and rapid screening of child

psychopathologies.

Moreover, the adaptation of the DI to different cultures is

very easy to implement. Contrary to most psychiatric instru-

ments, it only requires the translation of 91 short phrases ask-

ing if the child has experienced what the drawing is showing.

For this reason, the DI has been selected, together with parent

and teacher the Strengths and Difficulties Questionnaire, in a

current European project, whose main objective is to produce

a kit for measuring child mental health in Europe. The DI has

been translated for 5 of the 7 participating countries (Italy,


Original Research

Romania, Lithuania, Bulgaria, and Turkey); German and

Dutch versions were already available.

Psychometric performances have been assessed in other

versions of the DI as, for example, Terry, developed for

African-American children; test–retest reliability and internal

consistency were satisfactory, with intraclass correlations

coefficients ranging from 0.75 to 0.80, and Cronbach’s alpha

from 0.78 to 0.90.22 The instrument’s reliability and its easy

adaptability added to other advantages of the DI (children

enjoy the activity, parents approve of it, and it is cost-

effective) suggest its wider applicability in epidemiologic

studies in other cultures, especially for immigration studies

where children from diverse cultures could be compared with

the children living in the country of origin.

Conclusion

Performances estimated for each DI diagnosis were satisfac-

tory and psychometric properties were consistent in the

French and Quebec samples. In epidemiologic studies, DI

permits young children to achieve informant status and the

pictorial design allows transposition in diverse cultures and

languages. The satisfactory psychometric performances and

the adaptability of the DI to other cultures suggest its wider

applicability to epidemiologic studies in diverse cultures.

Funding and Support

Our research was funded by la Mutuelle d’Assurances des Eleves,Mutuelle d’Assurances des Instituteurs de France Foundation,Mutuelle Générale de l’Education Nationale Foundation for PublicHealth, Federation Nationale de la Mutualité Francaise and theRegional Directorate for Health and Social Affairs (DirectionRégionale des Affaires Sanitaires et Sociales) of theProvence-Alpes-Côte d’Azur region, France.

Acknowledgements

We are indebted to Dr Christine Chan-Chee, Dr Robert Goodman,French Ministry of Health and Social Affairs, French Ministry ofEducation, Provence-Alpes-Côte d’Azur Regional Directorate forHealth and Social Affairs, Aix-Marseille and Nice EducationalAuthority, as well as children, parents, teachers, and principals ofparticipating schools.

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Manuscript received November 2008, revised, and accepted February2009.1Public Health Practitioner, EA 4069 Paris Descartes University,Fondation MGEN pour la Santé Publique, Paris, France.2Assistant Professor, McGill University, Institute of Community andFamily Psychiatry; Montreal, Quebec; Child Psychiatrist, Jewish GeneralHospital, Montreal, Quebec.

3Public Health Practitionner, EA 4069 Paris Descartes University,Fondation MGEN pour la Santé Publique, Paris, France.4Statistician, EA 4069 Paris Descartes University, Fondation MGEN pourla Santé Publique, Paris, France.5Researcher, Department of Psychiatry, Rivière-des-Prairies Hospital,Fernand-Seguin Research Center, Université de Montréal, Montreal,Quebec.6Psychiatrist Head, EA 4069 Paris Descartes University Paris, France.Address for correspondence: Pr V Kovess, EA 4069 Paris DescartesUniversity, 15 rue de l’école de médecine 75270 Paris Cedex 06, France;[email protected]


Original Research

Résumé : Propriétés psychométriques du Dominique interactif dans un vaste

échantillon français

Objectifs : Examiner les propriétés psychométriques du Dominique interactif (DI) chez des enfants

d’âge scolaire dans un environnement culturel différent de celui du Québec.

Méthodes : Dans une grande région française, 100 écoles et 25 enfants (de 6 à 11 ans) par école ont

été choisis au hasard. Les données ont été recueillies par des questionnaires auto-administrés aux

enfants (DI), aux parents (caractéristiques sociodémographiques, utilisation des services de santé

mentale), et aux enseignants (rendement scolaire). Les propriétés psychométriques du DI ont été

évaluées en examinant : la distribution de chaque diagnostic du DI; la comorbidité entre les

diagnostics; les coefficients alpha mesurant la cohésion interne; et les corrélations des

psychopathologies avec le statut sociodémographique et l’utilisation des services de santé. Les

estimations des propriétés du DI ont été comparées avec celles d’un échantillon de la population

d’enfants du Québec.

Résultats : Des données complètes étaient disponibles pour 1274 enfants (54,4 %). La cohésion

interne de chaque diagnostic du DI de la version française était raisonnable, les coefficients alpha de

Cronbach allant de 0,62 à 0,89. Les propriétés psychométriques et de comorbidité concordaient

avec celles de la version québécoise.

Conclusions : Les propriétés psychométriques satisfaisantes du DI ainsi que d’autres avantages

démontrés de cet instrument (les enfants aiment l’activité, les parents l’approuvent, il est rentable) et

son adaptabilité culturelle soutiennent que le DI soit considéré pour des études épidémiologiques

dans diverses cultures.

Psychometric properties of the Dominic Interactive in a large French sample

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