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


METHODS
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 (κs = .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.
Department of Psychology, University of Miami.
Amanda
A
Jensen-Doss
Department of Psychology, University of North Carolina at Chapel Hill.
Eric A
EA
Youngstrom
Department of Psychology, University of North Carolina at Chapel Hill.
Jennifer Kogos
JK
Youngstrom
Department of Psychological Sciences, Case Western University.
Norah C
NC
Feeny
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University.
Robert L
RL
Findling
D000293:Adolescent; D002648:Child; D003156:Community Mental Health Services; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis; D003866:Depressive Disorder / Q000175:diagnosis; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D001523:Mental Disorders / Q000175:diagnosis*; D010290:Parents / Q000523:psychology; D012106:Research; D012189:Retrospective Studies