Misdiagnosis of affective disorders in adolescents

Gi, Keitner

doi:10.1176/ajp.139.11.1527a

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“…Relationship Between Adverse Childhood Experience Survey Items and Psychiatric Disorders of error inherent in psychiatric diagnostic formulation, overdiagnosis of some disorders, [31][32][33] and the issues attending misdiagnosis, 13,34 particularly in children, 35 any opportunity to add precision is imperative. The diagnoses made were not associated with high endorsement of or correlation with the ACE items.…”

Section: Original Research and Contributionsmentioning

confidence: 99%

Relationship Between Adverse Childhood Experience Survey Items and Psychiatric Disorders

Cawthorpe

Marriott

Paget

et al. 2018

TPJ

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Context: Developmental psychopathology theory suggests a relationship between early childhood adversity and mental disorder.Objective: To examine the relationship between the specific items on the Adverse Childhood Experiences (ACE) survey and the International Classification of Diseases, Tenth Revision (ICD-10) categories of psychiatric diagnoses in a pediatric sample.Design: The sample included patients enrolled in the Child and Adolescent Addiction Mental Health and Psychiatry Program with both a completed ACE survey and at least 1 diagnosis of record (per admission). These criteria yielded 2 samples for each sex (ACE survey item frequencies and values in collapsed and multiple-admission groups). Data were analyzed employing tetrachoric correlation, hierarchical regression, and polychoric factor analysis.Results: Hierarchical regression analysis identified that ICD-10 diagnostic categories, except for substance disorders, were not consistently related to ACE total score and tended to reduce the magnitude of the ACE total score in the multiple-admission group. Tetrachoric correlation revealed very low (< 0.4) positive and negative correlations between ICD-10 categories and ACE items in both multiple-admission and collapsed sample groups. Polychoric factor analysis indicated that the ACE survey items and the ICD-10 categories for both sexes were independent, with only the diagnostic ICD-10 category substance disorders being marginally associated with the ACE items factor for females. Conclusion:The nominal relationship between ACE items and ICD-10 diagnostic categories indicates the need to include ACE assessment in advance of differential diagnosis and implementation of conventional mental health interventions for children and adolescents. METHODS This research was conducted underThe University of Calgary Research Ethics Board approval (REB15-1057). Staff training on the collection of the ACE survey, the details of data collection, storage, and retrieval, as well as the relationship of ACE scores to clinical and demographic variables have been described. 1 This article focuses on the relationship of individual ACE survey items to psychiatric diagnoses of record. For each separation from service, where applicable, at least 1 and often several psychiatric diagnoses assigned by the attending resident or psychiatrist were recorded in each patient's file and entered into the electronic Regional Access and Intake System (RAIS).

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