A Reliability Study of Psychiatric Diagnosis in Childhood and Adolescence

Freeman, Michael

doi:10.1111/j.1469-7610.1971.tb01049.x

Cited by 35 publications

(5 citation statements)

References 19 publications

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“…One of the most pervasive complaints about traditional adult taxonomies is that they are unreliable. The meager existing evidence on similar taxonomies of childhood disorders also indicates mediocre reliability, with Freeman (1971) reporting 59% agreement and Rutter et al (1975) reporting 67% agreement among child psychiatrists who used standardized case history materials to classify children in terms of broad diagnostic categories. The contribution of inconsistencies within diagnosticians to unreliability is indicated by Freeman's finding that when his psychiatrists were given the same materials to judge again after a 3-month interval, their second diagnosis agreed with their first in only 72% of the cases.…”

Section: Reliability and Stability Of Syndrome Ratingsmentioning

confidence: 99%

“…Like those of the GAP system, the categories of the DSM-H are based on mixtures of theoretical inferences and generalized descriptions of behavior, with no procedures for operationalizing them. The reliability of both systems is mediocre, with agreement between diagnosticians averaging about 60% for major categories, such as psychotic versus neurotic disorders, and considerably less for specific disorders within these categories (Freeman, 1971;Sandifer, Pettus, & Quade, 1964;Tarter, Templer, & Hardy, 1975). Agreement averaging 67 c /o has been achieved by English child psychiatrists who classified case histories according to the major syndromes of the International Classification of Diseases and the Multi-axial Classification drafted by the World Health Organization (Rutter, Shaffer, & Shepherd, 1975).…”

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confidence: 99%

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The classification of child psychopathology: A review and analysis of empirical efforts.

Achenbach¹,

Edelbrock²

1978

Psychological Bulletin

1,288

657

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Empirically derived syndromes of child behavior problems are reviewed, and those having counterparts in two or more studies are identified. A distinction between broad-band and narrow-band syndromes seems warranted because many syndromes derived from first-order factor analyses can be subsumed by a few second-order factors. Broad-band Undercontrolled and Overcontrolled syndromes and narrow-band Aggressive, Delinquent, Hyperactive, Schizoid, Anxious, Depressed, Somatic, and Withdrawn syndromes were found in diverse samples of disturbed children. Two other broad-band and six other narrow-band syndromes were found in a few studies. Test-retest reliabilities and stabilities of syndrome scores were more adequate than interrater reliabilities, which increased with the degree of similarity between the types of raters and between the types of situations in which they saw subjects. Cross-instrument and cross-population consistencies corroborated some empirically derived syndromes, but the lack of independent criteria for categorizing disturbed children makes it difficult to establish criterion-referenced validity. Because categorization of children by syndromes has been limited primarily to the broad-band undercontrolled-overcontrolled dichotomy, more efforts are needed to translate syndromes into categories for use by practitioners as well as researchers. It is concluded that further work in this area is likely to benefit disturbed children only if it is more systematically linked to the existing mental health system and to efforts at reforming this system.The study of psychopathology in children and Statistical Manual (DSM) were Adjusthas long lacked a coherent taxonomic frame-ment Reaction and Childhood Schizophrenia, work within which training, treatment, epi-Adult categories of the DSM could be apdemiology, and research could be integrated, plied to children, but a national survey Not only were children's disorders omitted showed that 70% of the children seen in from the system that originally formed the psychiatric clinics were either unclassified or basis for psychiatric taxonomy (Kraepelin, were classified as having adjustment reactions 1883) but, even until 1968, the only cate- (Rosen, Bahn, & Kramer, 1964). gories provided for children in the American Although there were a few early efforts to Psychiatric Association's (1952) Diagnostic develop differentiated taxonomies of childhood disorders (e.g., Jenkins & Glickman, 1946), it was not until the 1960s that theThe authors wish to thank Sue Fleisher for her need for SUch a S y Stem WaS aCUtelv fdt ; many contributions to this work; Howard Moss and Efforts to meet this need took a variety of Sally Ryan for performing reliability checks on forms. Following the psychiatric tradition of the categorization of syndromes; and Roger Slash-formulating classifications through consensual field, Gale Inoff, Lovick Miller, and John Weisz . , , ,-, , ., ._, "__" for critically reading the manuscript. committee work, the Group for the Advance-Requests for reprints should be sen...

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Section: Reliability and Stability Of Syndrome Ratingsmentioning

confidence: 99%

mentioning

confidence: 99%

The classification of child psychopathology: A review and analysis of empirical efforts.

Achenbach¹,

Edelbrock²

1978

Psychological Bulletin

1,288

657

View full text Add to dashboard Cite

show abstract

“…However, like the DSM, its categories consist of narrative mixtures of description and inference formulated by committees of psychiatrists rather than being operationally defined on the basis of empirical research. Interjudge reliability is no better than for the adult categories of the DSM (Freeman, 1971).…”

Section: Diagnostic Classificationmentioning

confidence: 90%

Psychopathology of childhood: Research problems and issues.

Achenbach¹

1978

Journal of Consulting and Clinical Psychology

109

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It is argued that research on child psychopathology would benefit from reducing the influence of adult treatment models and from applying a developmental perspective to clinical research on children. Specific methodological problems are discussed, including the assessment of subject characteristics; the use of replicable and generalizable diagnostic classifications; the effects of situational specificity and developmental variance on measures of children's behavior; the need to avoid pathological biases in judging children; relationships among correlation, causation, and prediction in a developmental context; problems in measuring change; and the effects of age, cohort, and time of measurement, as well as fallacies in drawing longitudinal conclusions from cross-sectional data. Outstanding research needs are also identified, including the need to devise and use wellstandardized measures; the need to evaluate interactions between subject and treatment variables in outcome research; the need for long-term follow-ups of children identified as being at risk; the need for cumulative programmatic research; and the need to link research more closely to service systems.Research on child psychopathology has traditionally been treated like a stepchild for whom no one assumes full responsibility. Despite clinical emphasis on the childhood roots of adult disorders, psychopathology has been studied far more intensively in adults than in children. Furthermore, research on psychopathology in children has been unduly shaped by a mental health system in which clients must adopt a patientlike role. This system may not 'be entirely unjustified for adults, but it engenders assumptions that are certainly inappropriate for children.First, children rarely have realistic conceptions of psychopathology and mental health services. Second, both the judgment that a child needs help and the initiative requiredThe author is grateful to Craig Edelbrock, Gale Inoff, and John Weisz for their critical readings of the manuscript.

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“…Research consistently indicates that when individuals are diagnosed by independent clinicians, the resulting rates of agreement are extremely low. Studies in which the diagnoses of independent practitioners are compared for the same clients produce rates of agreement ranging from .20 to .67 (Freedman, 1971;Sandifer, Pettus, & Quade, 1964). Even if reliable diagnoses are made, the descriptions provided by the classification systems provide limited information about useful treatments, the prognosis, or the expected course of the disorder (Achenbach & Edelbrock, 1978;Harris, 1979;Rich, 1982).…”

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confidence: 97%

Dimensions of Students' Behavior Disorders: An Alternative to Medical Model Classification Practices

Schloss

1985

Diagnostique

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Traditional medical oriented classification schemes have been criticized for their limited reliability and validity. The major deficiency of these approaches is their failure to produce treatmentrelevant information. This paper discusses an alternative approach to classifying students' behavior disorders. The approach considers the topography of deviant behaviors, the degree of exceptionality, the nature of deviance, and events influencing the deviance. The proposed approach is discussed in the context of developing and monitoring education/treatment programs.

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A Reliability Study of Psychiatric Diagnosis in Childhood and Adolescence

Cited by 35 publications

References 19 publications

The classification of child psychopathology: A review and analysis of empirical efforts.

The classification of child psychopathology: A review and analysis of empirical efforts.

Psychopathology of childhood: Research problems and issues.

Dimensions of Students' Behavior Disorders: An Alternative to Medical Model Classification Practices

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