The Delivery of Diagnosis by Child Psychiatrists: Process Characteristics and Correlates of Distress

Abstract

We describe the attitudes of child psychiatrists toward diagnosis delivery (DD) and explore potential stressful factors associated with the process. Eighty Israeli child psychiatrists completed a questionnaire on their perceptions of DD of schizophrenia, autism spectrum disorder (ASD), and attention deficit/hyperactivity disorder (ADHD). We also conducted semi-structured in-depth interviews with 12 child psychiatrists who were asked to share their personal experience with DD. The questionnaire responses revealed that child psychiatrists perceived schizophrenia and ADHD as the most and least severe disorders, respectively, and its treatment as being ineffective and effective, respectively. They expressed negative perceptions toward DD of schizophrenia and positive perceptions toward DD of ADHD. The results of linear regressions revealed that some factors predicted distress accompanying DD in all three diagnoses, such as lack of professional experience, negative perceptions of DD, and the effect of parents' attitudes of opposition to the diagnosis. The interviews revealed that DD was often described by psychiatrists as an emotional experience and that the psychiatrists' age, and whether the psychiatrists identified more with the child or the parent, affected their attitude toward DD. Lastly, the psychiatrists expressed feelings of loneliness in the procedure of DD and their wish to share and reflect on their experiences with others. These findings may contribute to a better understanding of the clinically important topic of DD in child psychiatry that has not been adequately addressed and help deal with psychiatrists' challenges in this task.

A mixed‐method systematic review of the perspectives of young people, carers and professionals on psychiatric diagnosis in childhood and adolescence

“…Three qualitative (Koehne et al, 2013; O'Connor & McNicholas, 2020; Papadopoullos et al, 2022), three quantitative (Courtney & Makinen, 2016; Griffiths, 2011; Laurenssen et al, 2013) and two mixed methods (Brand‐Gothelf et al, 2021; Vickers et al, 2022) studies supported this theme. The question of whether a diagnosis accurately reflects a person's psychological state is evident in studies across all groups of participants (YP, primary caregivers, and professionals).…”

“…This sense of failing the patient is also apparent in diagnosing professionals. Brand-Gothelf et al (2021) show that professionals will try to alter how they deliver a diagnosis towards against feelings of failure. Staniford and Lister (2021, p.248) where YP are growing a sense of identity as is developmentally appropriate (Erikson, 1968).…”

“…This theme was supported by three qualitative(Kelly et al, 2018;Koehne et al, 2013;Papadopoullos et al, 2022) and one mixed method(Brand-Gothelf et al, 2021) study Papadopoullos et al (2022). identified that psychiatrists usually feel that their decision would 'trump' the patient's input, despite discussions about personcentredness.…”

“…Whether a psychiatric diagnosis contributed to people's understanding and perception of themselves was discussed across five studies; four qualitative(O'Connor & McNicholas, 2020;Papadopoullos et al, 2022;Staniford & Lister, 2021;Viduani et al, 2022), and one mixed methods study(Brand-Gothelf et al, 2021).O'Connor and McNicholas (2020) reported that YP and caregivers often feel relieved due to their diagnosis. Some studies (O'Connor & McNicholas, 2020; Viduani et al, 2022) also found that being given a diagnosis supported other people in understanding the YP, 'Mum seemed to, all of a sudden seemed to have some sort of huge idea of what actually I'm going through…I was just used to her kind of not really understanding me' (O'Connor & McNicholas, 2020, p.17).…”

Parental perception of the process of communicating a diagnosis of autism spectrum disorder in the Republic of Croatia

“…In addition to the information that professionals provide to parents verbally, they also (often unknowingly) provide a wealth of information through nonverbal communication. Professionals also experience stress when they communicate such a diagnosis (Brand-Gothelf et al, 2021), which suggests that it is important to work on the training of these professionals.…”