Predictors and moderators of agreement between clinical and research diagnoses for children and adolescents.

Abstract

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 research needs 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 (κ = .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.

The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research

“…Consequently, agreement between clinicians about the presence or absence of PBD in a particular case is poor. 100,101 Agreement also tends to be worse around CycD and OS-BRD, 23,102 which is unfortunate given that these may be more common than BD-I. 1,66 …”

“…113,114 Checklists can improve diagnostic decision making in a range of clinical settings, as well as measuring treatment response. 90,100–102 …”

Progress in diagnosis and treatment of bipolar disorder among children and adolescents: an international perspective

“…One study presented case vignettes to UK and US clinicians and found that US clinicians were more likely to diagnose mania in complex cases though there was agreement regarding classical mania 18. In a study evaluating the agreement between the research and the clinical diagnoses in a paediatric mental health clinic, BPD was underdiagnosed in the clinical setting when compared with the research standard 19. Training in cognitive debiasing and evidence-based decision tools (ie, nomograms) help to improve assessment of BPD (w9, w10).…”

Comparing the Diagnostic Accuracy of Five Instruments for Detecting Posttraumatic Stress Disorder in Youth

“…Despite practice parameters recommending that clinicians evaluate potential traumatic events and PTSD (Cohen et al, 2010), evidence suggests that clinical diagnoses frequently miss more than half of PTSD diagnoses that would be identified via more structured approaches to assessment (Jensen-Doss, Youngstrom, Youngstrom, Feeny, & Findling, 2014; Rettew et al, 2009; Wolfe, 2007). The current study is the first to compare directly the diagnostic accuracy of five potential diagnostic scales for pediatric PTSD.…”