The Children’s Depression Inventory (CDI) is a self-reporting test that helps in measuring the level of depression among children diagnosed with depression. Carrying out the measure is important because it helps in deciding the best intervention measures for the children suffering from depression. The test also helps in improving their educational achievement, peer relationship, and self-esteem. The test discriminates between dysthymic disorder and major depressive disorder among children and helps physicians differentiate between the disorders and other different psychiatric conditions. This paper will focus on the history and development of the test, test administration, reliability, validity, clinical and research utility, and issues with special populations. Finally, the paper will provide suggestions for improving the test and future research.
History and Development of the Test
The CDI was introduced by Maria Kovacs, an American clinical psychologist in 1979. It was developed through the advancement of the Beck Depression Inventory (BDI) of 1967, which is used for adults. Since the introduction of CDI in healthcare, it has been accepted by healthcare professionals. The use of BDI to access the stress levels among adults diagnosed with depression led to the increased need for the introduction of a similar test that could be used for youths and children. The development of CDI went through four phases. The first phase started in March 1975, and children were used as subjects to derive it. The other three phases were revisions, and the final version was published in 1979 (Foa, Franklin, & March 2010) .
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Initially, the test was developed for English-speaking children in America, aged between eight years old and seventeen years old. The skills that were needed in order to take the test were vocabulary comprehension and the lowest reading levels. After some advancement in the test, children aged seven years old were included in the test. Currently, the CDI has gone through various language translations, making it possible to be used among multiple children worldwide. The manual of CDI includes information concerning norms, item development, and psychometrics. The manual also contains charts relating to constructs and reliability. The scales are also provided in the manual, including sample tests and tables of information and data. The directions for administering the test are easy to follow and clear. Also, the information about the time that should be taken to complete the test and guidelines for scoring are detailed, clear, and easy to understand. The recommended time to complete the test is less than 15 minutes, while the scoring time should be between five and ten minutes (Foa, Franklin, & March, 2010) .
Test Administration and construction
The CDI was developed to identify symptoms associated with depression and to differentiate between psychiatric disorders and depression among children. It can also be applied as an instrument for monitoring changes in depression among diagnosed children. The items of CDI have three statements each, and during the administration, a child is asked to choose one answer that relates to his or her feelings over the last two weeks. Within the assessment, there are five subscales that are applied in measuring various components of depression: Anhedonia (decreased ability or inability to experience joy), Ineffectiveness (inability or lack of motivation to complete various tasks), Negative self-esteem (believing that you are poor in everything), Negative mood (anger or irritability), and interpersonal problems (problem with making and maintaining close relationships). The test is popular because it very easy to administer and score and so a child with reading capability can easily administer it (Smarr & Keefer, 2011) .
The results of the test can only be interpreted by a professional who is trained concerning its properties. Obtaining the results of the test is meaningless if it is not interpreted by a professional. Therefore, parents need to seek professional help to understand the results of the test. However, the CDI can be good in determining the presence of symptoms of depression, but it is not good for identifying their severity. Parents need to discuss a follow-up assessment with the doctor in order to obtain the best treatment for their children. Moderate to severe symptoms may respond well to psychotherapy and medication, while milder symptoms may require self-care and support (Smarr & Keefer, 2011) .
Reliability
The CDI has perfect psychometric properties, meaning that its measures are accurate are reliable when the correct procedures are followed. Some studies claim that the test is inappropriate for children experiencing reading problems. The CDI was successfully tested on a large group of children in the United States, which represented the whole population of children. Other studies have proved that the CDI is reliable in testing depression among children. In a particular study, Cronbach's alpha was applied to achieve reliability measures. In a group of up to nine studies, the alpha measures were identified as 0.71-0.89, which showed good internal consistency. This proves that the CDI adequately measured depressive symptoms. Consequently, in another group of up to 16 studied, the alpha measures were 0.38–0.87. In terms of the short factor subscales, the reliability measures regarding internal consistency were 0.59–0.68 (Wu & Yao, 2010) .
Most studies, including those of Kovacs, have shown high to moderate reliability. A study conducted by Kuder-Richardson (2013) of internal consistency obtained results showing high reliability (Adamson & Prion, 2013) . While correlating the CDI and its factors with other similar psychological tests for children or youths, studies show a high to moderate correlation , while some studies have shown that there are no correlations in some specific areas (Adamson & Prion, 2013) .
Validity
CDI’s validity has been well established and supported by various studies. Also, discriminant validity and construct validity have been established. Maria Kovacs applied experimental design to achieve discriminant validity between normal and clinical cases. Some studies have shown discriminant validity in CDI, while others haven't. Most studies concerning CDI have shown that both the short version and the full version of CDI are valid instruments when applied in screening children diagnosed with depression. However, professionals in a pediatric setting are expected to conduct diagnostic assessments to determine any false positives after the test. Criterion-related studies support CDI because it correlates with various measures of depression and anxiety. Some evidence associated with the validity of CDI has been described as mixed. CDI has shown validity by differentiating between samples of children and non-clinical children (Roelofs & van Breukelen, 2010) .
Clinical and Research Utility
Depression among children and youths in the United States is a major cause of disability. Depressed children and teenagers are often associated with functional impairments regarding their performance at work or school, including their interactions with peers and families. The affected youths can also experience a negative effect on developmental trajectories. Depression among children and teenagers is associated with depression recurrence in adulthood and increased risk for suicide attempts, suicidal ideation, and suicide completion (Stockings & Patton, 2015) .
The CDI has, over time, become a widely used measure for depression among children and youths. CDI has a long research history, which has made the psychological research community to trust it. The CDI is well known for its ease of administration and scoring, making it possible for anyone with reading capabilities to administer it. There is also evidence of validity association with internalizing symptoms. The identification of depressive symptoms among the children and youths helps clinicians determine response to intervention. The CDI is one of the good measures that can be used in identifying depressive symptoms, but it not considered as the best when it comes to identifying their severity. Therefore, parents need to seek a doctor's advice for the best treatment for their children (Stockings & Patton, 2015) .
Just like any other self-report assessments for measuring depression among children, the CDI has its own limitations. For instance, children have different sophistication in terms of understanding and reporting of their emotions, unlike the adults. Therefore, their responses may reflect a wrong emotional state. Consequently, children are most likely to provide answers they believe are desired rather than answers that reflect their actual feelings, unlike adults. It is advisable to account for and at the same time, consider more information concerning the child instead of entirely relying on CDI test scores to make final decisions. Any person with reading capabilities can administer the CDI. Still, caution should be taken when it comes to interpretations because trained professionals are the ones who can only provide the correct interpretation (Allgaier & Schulte-Körne, 2012) .
Issues with Special Populations
Many children face various medical illnesses such as diabetes, obesity, allergies, cancer, asthma, and epilepsy, which are increasing in prevalence. The high incidence of chronic diseases is associated with high exposure to a sedentary lifestyle, unhealthy diets, and toxic stress. Up to twenty million children in the U.S have a chronic illness. The medical condition affects their social and emotional wellbeing, thus increasing their stress levels and that of their families. Illness characteristics like fatigue or pain and the associated treatments like steroid medication can affect the participation of the children in school, which may lead to social isolation and academic difficulties. In addition, children with chronic diseases often face bullying by their peers, which can increase psychological distress among them (Bernstein & Soren, 2013) .
Children with chronic medical illness or comorbid psychopathology, including other pediatric subpopulations, are associated with more prevalence of depressive problems compared to the general population. Children with such kinds of medical conditions are categorized into special populations, and they are often targeted for CDI. Specificity and sensitivity in outpatient groups or psychiatric inpatient are often similar, but the predictive value will be much high due to the high prevalence of depression (Bernstein & Soren, 2013) .
Various studies have suggested that special population individuals often experience some emotional difficulties due to psychological reactions to various diagnoses, including the related stressors. Attitudes that are illness-related negatively affect psychological adjustment and coping style among the individuals and may represent symptoms of depression. Chronic diseases often mirror depression symptoms. Therefore, it is necessary to use CDI measures on such individuals in order to determine the psychometric properties of CDI and clinical utility among the special populations (Bernstein & Soren, 2013) .
Suggestions for Improving the Test and Future Research
The test should have some systems in place which will ensure accurate diagnosis, treatment, including appropriate follow-up. Treatment options for depression are behavioral, collaborative, pharmacologic, and multimodal care models. Inadequate monitoring and support may result in harm and treatment failures. Having adequate systems in place helps clinical staff in ensuring that if the test turns positive, appropriate diagnosis and treatment and proper care is provided to the patient.
Many researchers have ignored the accuracy of the CDI among children and adolescents. Large high quality, controlled trials should be identified to help in order to identify various effects of screening on the long term and intermediate outcomes. Future studies should also focus on the use of the test on individuals with comorbid disorders. Children and youths with chronic diseases most often have comorbid conditions, and this may affect screening accuracy.
References
Adamson, K. A., & Prion, S. (2013). Reliability: measuring internal consistency using Cronbach's α. Clinical Simulation in Nursing, 9(5), e179-e180.
Allgaier, A. K., & Schulte-Körne, G. (2012). Is the Children's Depression Inventory Short version a valid screening tool in pediatric care? A comparison to its full-length version. Journal of psychosomatic research, 73(5), 369-374.
Bernstein, C. M., & Soren, K. (2013). Mental health issues in adolescents and young adults with type 1 diabetes: prevalence and impact on glycemic control. Clinical Pediatrics, 52(1), 10-15.
Foa, E. B., Franklin, M. E., & March, J. (2010). Development and validation of a child version of the obsessive-compulsive inventory. Behavior Therapy, 41(1), 121-132.
Roelofs, J. B., & van Breukelen, G. (2010). Norms and screening utility of the Dutch version of the Children's Depression Inventory in clinical and non-clinical youths. Psychological Assessment, 22(4), 866.
Smarr, K. L., & Keefer, A. L. (2011). Measures of depression and depressive symptoms. Beck depression Inventory ‐ II (BDI ‐ II), center for epidemiologic studies depression scale (CES ‐ D), geriatric depression scale (GDS), hospital anxiety and depression scale (HADS), and patient health Questionnaire ‐ 9 (PHQ ‐ 9) , Arthritis care & research, 63(S11), S454-S466.
Stockings, E. D., & Patton, G. (2015). Symptom screening scales for detecting the major depressive disorder in children and adolescents: a systematic review and meta-analysis of reliability, validity, and diagnostic utility. Journal of affective disorders, 174, 447-463.
Wu, W. F., & Yao, S. Q. (2010). Reliability and validity of the Chinese version of the Children's Depression Inventory. Chinese Mental Health Journal.
