Nov. 1, 2011 Clinicians often face the challenge of trying to make sense of conflicting reports from parents, teachers, and children about a child's behavioral problems. However, a better understanding of the source and nature of these disagreements may provide important information that could improve treatment and outcomes. A group of articles in the current issue of Journal of Child and Adolescent Psychopharmacology, a peer-reviewed journal published by Mary Ann Liebert, Inc., explores this challenging clinical dilemma.
The special section, "Information Variance and Its Diagnostic Implications," includes an editorial and five articles that focus on either discordant information between parents and teachers or between parents and offspring and how clinicians should proceed in the face of these conflicting reports. Guest Editors Gabrielle Carlson, MD (Stony Brook University School of Medicine, NY), and Eric Youngstrom, PhD (University of North Carolina at Chapel Hill) note that "disagreement between informants was more the rule than the exception." They suggest that clinicians view this disagreement as "additional information" rather than a problem and use this information to help determine the credibility of each informant's report. "This has implications for treatment engagement, adherence, and ultimately outcomes," they conclude.
Two articles take a close look at the implications of disagreements between parents and teachers: David Rettew, MD (University of Vermont College of Medicine, Burlington, and Erasmus University Medical Center, Rotterdam, The Netherlands) and colleagues' report, "When Parent and Teach Don't Agree: The Tracking Adolescents' Individual Lives (TRAILS) Study," looks at behaviors that occur at home only, at school only, or in both settings among a community-based sample; while the paper entitled "Diagnostic Implications of Informant Disagreement for Manic Symptoms," authored by Gabrielle Carlson, MD and Joseph Blader, PhD, draws on patients seen at an outpatient clinic for symptoms of mania observed either only by a parent or by both parent and teacher.
Conflicting reports by parents and offspring is the focus of three articles, and the samples derive from families seeking services from an outpatient mental health clinic. Eric Youngstrom, PhD, and colleagues consider the question of who has greater credibility, parent or child, in the article "Informants Are Not All Equal: Predictors and Correlates of Clinician Judgments About Caregiver and Youth Credibility." Whether discrepancies in reporting influence clinicians' ratings of parent and child credibility is evaluated in the report by Andres De Los Reyes, PhD (University of Maryland at College Park) and co-authors on "Informant Discrepancies in Clinical Reports of Youths and Interviewers' Impressions of the Reliability of Informants." The article by Andrew Freeman (University of North Carolina at Chapel Hill) and co-workers, "Is Caregiver-Adolescent Disagreement Due to Differences in Thresholds for Reporting Manic Symptoms?" assesses whether the severity of a manic disorder affects the differences in how caregivers and teens describe the symptoms.
"Clinicians have long known that parents and children have very different perceptions about how a child is behaving or what they are feeling. In this issue, guest-edited by Drs. Carlson and Youngstrom, we are presented with multiple studies that clarify this dilemma. These studies improve the diagnosis and advance our understanding and treatment of children with psychiatric disorders," says Harold S. Koplewicz, MD, Editor-in-Chief of Journal of Child and Adolescent Psychopharmacology, and President, Child Mind Institute, New York, NY.
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