Reliability of psychiatric diagnosis in referred adolescents

The authors report a reliability study of the DSM-III diagnostic system in a series of 393 adolescent referrals diagnosed by two clinicians over a period of 3 years. Overall reliability (kappa) was 0.59. However, most of the frequently used diagnoses had reliabilities of 0.7 or higher. Dysthymic, Adjustment, Overanxious and Avoidant Disorders showed poor diagnostic agreement (kappa below 0.4). The patterns of agreement across this and other studies suggest that diagnostic criteria for Affective, Anxiety and Adjustment Disorders are in need of further improvement.