Why are we here at the clinic? Parent–child (dis)agreement on referral problems at outpatient treatment entry.

Abstract

Do clinic-referred children and their parents agree on the problems for which treatment is undertaken? The authors asked 381 outpatient-clinic-referred children and their parents to list, independently, the child's target problems. Of the parent-child pairs, 63% failed to agree on even a single problem. When problems were grouped into broad categories (e.g., delinquent, withdrawn), more than a third of the pairs still failed to agree on a single broad problem area. Parent-child agreement was higher for externalizing than for internalizing problem categories (though poor for both). Low parent-child agreement may help explain the poor outcomes often reported for clinic-based child therapy. Most episodes of child mental health care are initiated by a parent, who identifies problems for which the child needs help (Kazdin, 1989; Stanger & Lewis, 1993; Weisz et al., 1988). The agenda for the therapy that follows tends to be shaped to a significant degree by the parent's report and focused on problems the parent has identified. In cases in which parent and child perceive the same problems, the process may work well, with parent and child working toward common therapy goals. However, when parent and child disagree about the problems for which help is needed, their ability to work toward common treatment goals may be undermined. Which of these two scenarios is more common: parent-child agreement or disagreement regarding referral problems? To our knowledge, the question has not been addressed in research published to date. Although little is known about parent-child agreement on treatment referral problems (i.e., the problems for which treatment is

Agreement between youth-reported and parent-reported psychopathology in a referred sample

“…In contrast, parent-youth concordance concerning the externalizing scale of the CBCL and YSR revealed moderate agreement. These findings are consistent with previous studies comparing parent reports and youth self-reports of adolescent emotional and behavioral problems [5,12,23,43]. In line with existing research, the level of parent-adolescent concordance was higher for the externalizing scale than for the internalizing scale [8,34].…”

Preliminary validation of a self-efficacy scale for child functioning despite chronic pain (child and parent versions)

“…While the parent self-efficacy scale was not related to child reports of self-esteem, and somatic and emotional symptoms, this finding does not contradict any previously published research, as these hypotheses have not been previously tested. In fact, previous research has demonstrated that youth internalizing symptoms are likely to be overlooked by adults, particularly during adolescence (Yeh and Weisz, 2001;Martin et al, 2004). Consequently, it may be that our finding should be expected since the patients are making assessments of symptoms and self-efficacy based on internal perceptions of symptoms and thoughts, and the parents are doing so from their observations of external behavior.…”

Informant Discrepancies in the Assessment of Childhood Psychopathology: A Critical Review, Theoretical Framework, and Recommendations for Further Study.

“…problems (e.g., aggressive behavior; anxiety/depression) to target during treatment (Yeh & Weisz, 2001). Moreover, when considering therapists' perceptions along with those of parents and children, even greater levels of discrepancy are found.…”