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Identifying Thresholds for Classifying Childhood Psychiatric Disorder: Issues and Prospects

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ABSTRACT

Objective

To evaluate empirically the implications of choosing different thresholds to classify conduct disorder and attention-deficit hyperactivity disorder for estimating prevalence, test-retest reliability of measurement, and informant (parent/teacher) agreement and for evaluating comorbidity and associated features of disorder.

Method

Data for the study came from problem checklist assessments done by parents and teachers of children aged 6 to 16 years (N = 1,229) selected with known probability from a general population sample and from structured interviews obtained in a stratified, random subsample (n = 251).

Results

Estimates varied widely depending on the rationale used to set thresholds. Percent prevalence went from 0.1 to 39.2; κ estimates of test-retest reliability went from .19 to .82. Parent-teacher agreement based on κ went from .0 to .38. Relative odds between disorder and associated features varied twofold.

Conclusion

Use of different rationales to set thresholds for classifying childhood psychiatric disorder in the general population has profound implications for what we learn about the epidemiology of childhood disorder.

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This work was supported by funds from the National Health Research and Development Program (grant 6606-3760-42) and the Ontario Ministry of Community and Social Services and was carried out by the Child Epidemiology Unit, Department of Psychiatry, McMaster University, and the Child and Family Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario. When this work was done, Dr. Boyle was supported by a William T. Grant Foundation Faculty Scholar Award; Dr. Offord by a National Health Scientist Award, Health and Welfare Canada; Dr. Szatmari by a Research Fellowship, Ontario Mental Health Foundation; and Dr. Fleming by a NARSAD Young Investigator Award. The authors thank the Hamilton Board of Education, particularly Mr. Keith Reilly and Mr. Owen Jackson; principals and teachers of the Board; and parents and students for their help in this project.

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