Problems in Using Diagnosis in Child and Adolescent Mental Health Services Research

Abstract

This paper presents results from a three-part study on diagnosis of children with affective and behavior disorders. We examined the reliability, discriminant, and predictive validity of common diagnoses used in mental health services research using a research diagnostic interview. Results suggest four problems: a) some diagnoses demonstrate internal consistency only slightly better than symptoms chosen at random; b) diagnosis did not add appreciably to a brief global functioning screen in predicting service use; c) low inter-rater reliability among informants and clinicians for six of the most common diagnoses; and d) clinician diagnoses differed between sites in ways that reflect different reimbursement strategies. The study concludes that clinicians and researchers should not assume diagnosis is a useful measure of child and adolescent problems and outcomes until there is more evidence supporting the validity of diagnosis.DOI:10.2458/azu_jmmss_v3i1_bickman

A preliminary evaluation: Demographic and clinical profiles and changes in functioning in children receiving psychosocial rehabilitation

“…The findings of the present study substantiate previous research which suggests that the child's demographic characteristics, such as gender, age, and ethnicity, are not associated with treatment responses (Anderson et al, 2008;Bickman et al, 2002;Dalsgaard et al, 2002;Rosenblatt & Furlong, 1998;Southam-Gerow et al, 2001;Walrath et al, 2001). Prior research (Jacobs et al, 2008) has revealed that the presence of internalizing disorders were associated with poorer response to treatment in children with ED.…”

“…Similarly, Walrath and colleagues (2001) found boys and girls with ED did not differ in their mental health functioning after receiving partnership system of care services. Further support for the insignificant impact of age on treatment support was found in Bickman, Andrade, and Lambert (2002) study of 125 children with ED who received specialty home-based services akin to CPSR.…”

Innovations in Practice: Further evidence on the effectiveness of the strengths and difficulties added value score as an outcome measure for child and adolescent services

“…Alternative approaches to these norm-based trajectories come with their own difficulties. We could attempt to characterise dose-response relationships to see if more treatment sessions leads to greater improvement (Bickman, Andrade, & Lambert, 2002). However, this kind of observational study is prone to bias as duration of attendance may be positively or negatively correlated to surrogate factors affecting outcome.…”

Challenges Surrounding the Diagnosis of Autism in Children

“…The differentiation problems posed by the presence of comorbidities in children and adolescents with mental health issues, for instance, is illustrated in Bickman et al study. 152 A large percent (40%) of their sample's comorbid condition test scores were practically inseparable from the suspected disorder test result making identification of a single primary diagnosis that characterizes the child's problems exceedingly difficult. Furthermore, in an editorial to a special issue, 153 the authors note that, although in children 3-5 in particular, comorbidity is the rule rather than the exception, when an NDD is suspected, children will be seen by one specialist at a time despite the frequent presence of additional problems in this age group.…”