Parent-Rating and Self-Report Measures in the Psychiatric Assessment of Adolescents

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INTRODUCTION

For the assessment of child and adolescent psychiatric disorders, the clinical diagnosis based on information collected and observations made in the interview with the child or adolescent and others (e.g., parents, teachers), is considered indispensable, and the reliability of the diagnosis may be high when explicit diagnostic criteria are applied, e.g., DSM-III (Grove et al., 1981; Strober, Green, & Carlson, 1981). Other measures of psychiatric pathology such as parent-completed questionnaires and the self-report scales have been used extensively as screening instruments in epidemiological research (Bird et al., 1991), in the evaluation of large samples of subjects in lieu of a clinical assessment (Brodzinsky, Radice, Hoffman & Merkler, 1987; Verhulst, Althans, & Versluis-Den Beiman, 1990) and in the assessment of treatment effects (Rapoport & Conners, 1985).

The clinical diagnosis, based on a classification scheme such as the DSM-III (American Psychiatric Association, 1980) and the scores of parent-completed behavior questionnaires such as the Revised Behavior Problem Checklist (Quay & Peterson, 1987) or the Child Behavior Checklist (Achenbach & Edelbrock, 1983), ideally should closely reflect similar emotional and behavioral difficulties of a particular child. This, however, does not always occur because the two measures represent different constructs. The psychiatric diagnosis is based on a categorical taxonomy which has emerged from clinical observations while the questionnaires measure dimensions which have been developed with the aid of rating scales and statistical procedures. The agreement between the clinical diagnoses made by clinicians and scores from parent-completed questionnaires has often been reported to be inconsistent and discrepant (Weisseman et al., 1987; Klein, 1991). However, substantial convergence may be achieved between the clinical diagnoses and the parent-completed questionnaires (Weinstein et al., 1990) if the former are made with the aid of a structured interview such as the Diagnostic Interview Schedule for Children (Costelo et al., 1984) which is based on a clinical taxonomy scheme such as DSM-III (American Psychiatric Association, 1980).

The self-report questionnaires for children and, to a lesser extent, for adolescents have also been used for research purposes although the reliability of some of these measures has at times, been questioned. This applies to two measures used extensively in child psychiatry: the Revised Children's Manifest Anxiety Scale (RCMAS) (Reynolds & Richmond, 1978) and the Children's Depression Inventory (CDI) (Kovacs & Beck, 1977). For example, the agreement between parent and child self-assessment measures of anxiety (RCMAS) has been low (Johnson & Melamed, 1979; Reynolds, Anderson, & Bartell, 1985) and the level of agreement between parents and children for depression (CDI) has varied from significant (Knight, Hemsley, & Waters, 1988) to nonsignificant (Saylor, Baskin, Furey, & Kelly, 1984; Reynolds et al., 1985; Kazdin, 1989).

Considering the potential inadequacies in assessing psychopathology when using a single source of information, it has been recommended that for a reliable assessment, data should be collected from more than one source such as parents, teachers, and child (Bird et al., 1991).

While there are several published reports of studies regarding the assessment of psychiatric disorders in children and young adolescents, there is little published research on the assessment of older adolescents using information from various sources. The present study examines the assessment of older adolescents (16 years and older) using three sources of diagnostic data--the psychiatric assessment and clinical diagnosis made by psychiatrists, a parent-rating scale, and self-measures. The study specifically addresses the question of agreement between the clinical diagnoses and the parent and self-measures. …