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A Symptom-Level Examination of Parent–Child Agreement in the Diagnosis of Anxious Youths

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ABSTRACT

Objective

To examine parent–child agreement, at the symptom level, in the assessment of anxiety in youths. Differences between agreement at the diagnostic and symptom levels were explored as well as differences in agreement across symptom categories. Differences in the direction of disagreement across symptom categories were also examined.

Method

Participants were 98 children, 7 to 14 years old (54 boys) who met diagnostic criteria for separation anxiety disorder, social phobia, or generalized anxiety disorder and their parents. Diagnostic and symptom data were obtained using the Anxiety Disorders Interview Schedule for Children and Parents.

Results

Parent–child agreement at the symptom level was stronger than agreement at the diagnostic level for all three disorders. Parent–child agreement was stronger for observable symptoms than for unobservable symptoms and weaker for school-based symptoms than for non–school-based symptoms. In cases of discrepant symptom reports, the direction of disagreement varied according to the type of symptom.

Conclusions

These findings buttress the need for a multi-informant approach in the assessment of childhood anxiety. Further, given the low parent–child agreement at the symptom level in the assessment of child anxiety, clinicians may do well to consider employing the “or rule” at the symptom level when integrating discrepant reports.

Section snippets

Participants

Participants included 98 children meeting criteria for an anxiety diagnosis (SAD, SP, or GAD) and their parents (98 mothers, 84 fathers). Participants (consecutive admissions) sought treatment from the Child and Adolescent Anxiety Disorders Clinic at Temple University. Criteria for exclusion were use of antianxiety medication, child IQ below 80, and psychotic symptoms. Comorbid conditions were included. Patients (54 boys) were 7.5 to 14.0 years old (mean 10.2, SD = 1.8). The majority were white

Diagnostic Versus Symptom Agreement

Phi coefficients indicating the associations between parent and child reports at the diagnostic and symptom levels are presented in Table 1, as well as corresponding κ values and percentage of agreement indices. All four diagnostic ϕ coefficients were negative, indicating that the association between parent and child reports within each disorder and across all three disorders showed more disagreement than agreement. In contrast, all four symptom ϕ coefficients were found to be positive,

DISCUSSION

This study explored parent–child agreement at the symptom level, within the diagnostic model, in the assessment of SAD, SP, and GAD and found that for all three disorders, parent–child agreement at the symptom level was stronger than parent–child agreement at the diagnostic level. As in previous research (e.g., Choudhury et al., 2003; Grills and Ollendick, 2003), agreement at the diagnostic level was poor. Consistent with previous research (e.g., Herjanic and Reich, 1982), the strength of

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    This study was supported in part by NIMH research grants MH59087 and MH60653 .

    Article Plus (online only) materials for this article appear on the Journal's Web site: www.jaacap.com.

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