Disagreement between parent and adolescent reports of functional impairment

Teresa L. Kramer · Michael B. Hargis · Terri L. Miller · Barbara J. Burns · James M. Robbins

132 citations0/0 files storedJournal of Child Psychology and Psychiatry

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Child and Adolescent Psychosocial and Emotional Development Psychology and Mental Health Mental Health Research Topics

Abstract

OBJECTIVE: Adolescents' functional impairment has become increasingly important as a criterion for diagnosis and service eligibility as well as a target of therapeutic intervention in mental health settings. This study examines three critical issues in measuring functioning: 1) agreement between parent and adolescent reports of functioning, 2) explanations for disagreement, and 3) clinicians' ratings of functioning compared with parent and adolescent reports. METHODS: Agreement between parent and adolescent reports of functioning was estimated using the kappa statistic and conditional agreement in a sample of 258 adolescents. Rates of and reasons for expected disagreements between informants were explored in semi-structured interviews (n = 43). ANOVA was calculated for clinician ratings for parent-adolescent pairs categorized on the basis of their agreement or disagreement on impairment. Finally, the independent contribution of parents' or adolescents' reports of impairment on clinician ratings of functioning was examined. RESULTS: From 12% to 97% of problems reported by one informant were denied by the other. Agreement was particularly poor for questions about relationships with friends, peers' delinquent behaviors, and leisure activities. On average, parents and adolescents were more likely to expect the other would agree with their ratings rather than disagree. Reasons for disagreement included: 1) differences in how parents and adolescents interpreted questions; 2) lack of parental awareness of adolescents' behaviors; and 3) different thresholds for what is considered problematic. Results also demonstrated that clinicians perceive problems reported only by parents as somewhat more serious than problems reported only by adolescents. CONCLUSIONS: Implications for diagnosis, treatment planning and outcomes measurement are discussed.

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References

1977The Measurement of Observer Agreement for Categorical Data 1991Manual for The Child Behavior Checklist/4-18 and 1991 Profile 1987Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity.1991Manual for the Youth Self-Report and 1991 profile 1983A Children's Global Assessment Scale (CGAS)2000NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, Differences From Previous Versions, and Reliability of Some Common Diagnoses 2004The Use of Psychological Testing for Treatment Planning and Outcomes Assessment 1995The Child and Adolescent Psychiatric Assessment (CAPA)

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