Stability/change of DSM diagnoses among children and adolescents assessed at a university hospital: a cross-sectional cohort study.
OBJECTIVE
This study's aim was to examine changes or stability of DSM diagnoses in children and adolescents over the period from childhood to young adulthood and to discuss the instability in DSM diagnoses from a developmental perspective.


METHODS
We used cross-sectional cohort design to assess the congruence of DSM diagnoses in children and adolescents who had a diagnostic assessment at least twice as inpatient and/or outpatient at a university hospital from age 5 to 22. Data analysis was conducted using kappa statistics


RESULTS
The hospital computerized database consisted of 264 patients who were born from 1983 to 1985 and had had a diagnostic assessment at least twice over a 17-year period. The highest percentages of stable cases were of Mood disorders and Psychosis. Behavioural disorders and Anxiety disorders had lower percentages of stable cases but significant Kappa values suggesting fewer cases were stable but also fewer new cases were added. Substance related disorders had very low percentages and non-significant Kappa value. When divided into three groups based on the delay between first and second diagnosis, stability of diagnosis degraded sharply with time.


CONCLUSIONS
The results of this study show poor stability for all diagnoses, however the trend seemed to follow that reported in previous literature where moods disorders and schizophrenia showed more stability than other diagnoses. Explanations are provided for the results. A well-designed prospective longitudinal study utilizing structured diagnostic interviews to assign DSM-IV TR diagnosis from child hood to adulthood would improve the reliability of diagnoses and perhaps time for crystallization of psychopathology and clarification into more discrete diagnostic entities.
Ghazan-shahi
Sassan
S
Department of Psychiatry, Queen's University, Kingston, Ontario. 6sg36@queensu.ca
Roberts
Nasreen
N
Parker
Kevin
K