Clinician-assigned and parent-report questionnaire-derived child psychiatric diagnoses: Correlates and consequences of disagreement

The objectives of this study were to determine (a) if child characteristics relate to disagreement between clinician-assigned diagnoses and diagnoses derived from parent-report questionnaire, which were available to clinicians, and (b) if disagreement predicts subsequent number of clinic visits attended. This study evaluated the odds of agreement versus disagreement for internalizing and externalizing problems as a function of child age, gender, race, public-aid status, symptom severity, and impairment among 900 children (3-19 years) in a large, urban, child psychiatry clinic. A mixed-effects regression approach was used to evaluate the relationship between disagreement and visit attendance. Internalizing problem disagreement was more likely for children who were males, older, less symptomatic, and receiving Medicaid. Externalizing problem disagreement was more likely for children who were female, older, less impaired, and less symptomatic. Internalizing disagreement predicted significantly fewer visits; externalizing disagreement did not. Clinician-parent disagreement about the nature of child problems may have clinical consequences, especially for internalizing disorders. Attention to child characteristics that predict agreement may diminish discrepancies and reduce attrition from treatment.