Comparing DISC-IV and clinician diagnoses among youths receiving public mental health services

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 42; no. 3; p. 349
• Main Authors: Lewczyk, Caroline M, Garland, Ann F, Hurlburt, Michael S, Gearity, James, Hough, Richard L
• Format: Journal Article
• Language: English
• Published: United States 01.03.2003
• Subjects: Adolescent; Attention Deficit and Disruptive Behavior Disorders - diagnosis; Attention Deficit and Disruptive Behavior Disorders - epidemiology; Attention Deficit and Disruptive Behavior Disorders - therapy; Attention Deficit Disorder with Hyperactivity - diagnosis; Attention Deficit Disorder with Hyperactivity - epidemiology; Attention Deficit Disorder with Hyperactivity - therapy; Child; Community Mental Health Services - utilization; Diagnostic and Statistical Manual of Mental Disorders; Humans; Predictive Value of Tests; Prevalence; Public Health
• ISSN: 0890-8567
• DOI: 10.1097/00004583-200303000-00016

To compare the prevalence and agreement of diagnoses based on Diagnostic Interview Schedule for Children Version IV (DISC-IV) and clinician assignment for youths receiving public mental health services between 1996 and 1997 and to examine potential predictors of diagnostic agreement. Participants included 240 youths aged 6-18 years. Past-year prevalence rates and kappa statistics were calculated for four diagnostic categories: anxiety, mood, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorders (DBD). Potential predictors of diagnostic agreement were examined with logistic regression analysis. The prevalence of ADHD, DBD, and anxiety disorders was significantly higher based on the DISC-IV, while the prevalence of mood disorders was significantly higher based on clinician assignment. Diagnostic agreement was poor overall. The kappa values ranged from -0.04 for anxiety disorders to 0.22 for ADHD. Significant predictors of agreement varied by diagnosis and included symptom severity, comorbidity, youth age and gender, and school-based problem identification. Consistent with previous findings of poor diagnostic agreement between structured interviews and clinicians, these results call for a better understanding of factors affecting diagnostic assignment across different methods. This is especially important if researchers continue to use structured interviews to determine prevalence, establish diagnosis-based treatment guidelines, and disseminate evidence-based treatments to community mental health settings.