TY - JOUR
T1 - Predictors and moderators of agreement between clinical and research diagnoses for children and adolescents
AU - Jensen-Doss, Amanda
AU - Youngstrom, Eric A.
AU - Youngstrom, Jennifer Kogos
AU - Feeny, Norah C.
AU - Findling, Robert L.
N1 - Publisher Copyright:
© 2014 American Psychological Association.
PY - 2014
Y1 - 2014
N2 - Objective: Diagnoses play an important role in treatment planning and monitoring, but extensive research has shown low agreement between clinician-generated diagnoses and those from structured diagnostic interviews. However, most prior studies of agreement have not used research diagnoses based on gold standard methods, and researchers need to identify characteristics of diagnostically challenging clients. This study examined agreement between youth diagnoses generated through the research-based LEAD (Longitudinal, Expert, and All Data) standard to clinician diagnoses. Method: Participants were 391 families seeking outpatient community mental health services for youths ages 6-18 (39.1% female, 88.2% African American). Youths and parents completed research interviews and clinic diagnoses were extracted from clinic records. LEAD diagnoses synthesized results of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (KSADS-PL) and the youth's developmental, family, and psychiatric history. Results: Agreement between the LEAD and chart diagnoses was low, not exceeding "poor" agreement for most diagnostic categories (κs = .10 -.46, median = .37). Disagreement was largely driven by missed diagnoses, although clinicians also did assign extra diagnoses for some clients. Fewer diagnostic errors occurred when the youth's clinical picture was more clear (e.g., high or low symptom severity, lower comorbidity), when the youth was older, when the family was higher functioning, and when the parent had more depression. However, youth and family characteristics explained very little of the variability in diagnostic errors. Conclusions: Results support the need to investigate strategies to improve clinician diagnostic accuracy.
AB - Objective: Diagnoses play an important role in treatment planning and monitoring, but extensive research has shown low agreement between clinician-generated diagnoses and those from structured diagnostic interviews. However, most prior studies of agreement have not used research diagnoses based on gold standard methods, and researchers need to identify characteristics of diagnostically challenging clients. This study examined agreement between youth diagnoses generated through the research-based LEAD (Longitudinal, Expert, and All Data) standard to clinician diagnoses. Method: Participants were 391 families seeking outpatient community mental health services for youths ages 6-18 (39.1% female, 88.2% African American). Youths and parents completed research interviews and clinic diagnoses were extracted from clinic records. LEAD diagnoses synthesized results of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (KSADS-PL) and the youth's developmental, family, and psychiatric history. Results: Agreement between the LEAD and chart diagnoses was low, not exceeding "poor" agreement for most diagnostic categories (κs = .10 -.46, median = .37). Disagreement was largely driven by missed diagnoses, although clinicians also did assign extra diagnoses for some clients. Fewer diagnostic errors occurred when the youth's clinical picture was more clear (e.g., high or low symptom severity, lower comorbidity), when the youth was older, when the family was higher functioning, and when the parent had more depression. However, youth and family characteristics explained very little of the variability in diagnostic errors. Conclusions: Results support the need to investigate strategies to improve clinician diagnostic accuracy.
KW - Clinical decision making
KW - Diagnosis
KW - Diagnostic agreement
KW - Structured diagnostic interviews
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U2 - 10.1037/a0036657
DO - 10.1037/a0036657
M3 - Article
C2 - 24773574
AN - SCOPUS:84925680144
SN - 0022-006X
VL - 82
SP - 1151
EP - 1162
JO - Journal of Consulting and Clinical Psychology
JF - Journal of Consulting and Clinical Psychology
IS - 6
ER -