Related Experiment Videos
Mental disorders in chronically ill children: case identification and parent-child discrepancy
1Center for Pediatric Psychiatry and Medicine, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213.
Insights
Parent and child agreement on mental health diagnoses is poor, impacting pediatric case identification. Physician recognition of child-reported disorders was higher in this study of pediatric patients.
Area of Science:
- Pediatric Health
- Child Psychology
- Psychiatry
Background:
- Primary care physicians are crucial for identifying and managing mental health disorders in children.
- Mental health is a significant concern for chronically ill children within pediatric care settings.
- Accurate case identification relies on understanding informant perspectives.
Purpose of the Study:
- To assess agreement between children and parents regarding mental disorders and informant impact on identification.
- To evaluate pediatrician agreement with child and parent reports of mental health issues in chronically ill children.
Main Methods:
- A study involving 112 children (ages 9-18) with chronic illnesses (cancer, cystic fibrosis, IBD, diabetes) and 35 healthy controls.
- Separate, standardized interviews with subjects and parents using structured interviews and computer algorithms for DSM-III-R diagnoses.
- Pediatrician questionnaires assessing the presence of mental disorders.
Main Results:
- Poor agreement was observed between children and parents on mental disorder presence in both groups.
- In medically ill children, parents identified more cases than children did; in healthy children, children reported more cases than parents.
- Physicians were more likely to recognize disorders identified by children.
Conclusions:
- The choice of informant significantly influences case identification and recognition in pediatric mental health.
- Discrepancies between child, parent, and physician reports highlight challenges in pediatric mental health assessment.
- Standardized diagnostic tools are essential, but informant variability requires careful consideration in clinical practice and research.
Abstract:
Children, like adults and parents, depend on primary care physicians to identify, treat, or refer those with mental disorders. Mental health concerns are also germane to the growing number of chronically ill children in pediatric care. This paper focuses on: 1) the level of agreement between children and parents about the presence of a mental disorder and the impact of informant on case identification; and 2) the extent to which pediatricians agree with reports by chronically ill children and/or their parents regarding such problems. The study sample includes 112 children, ages 9 to 18, with cancer, cystic fibrosis, inflammatory bowel disease, and insulin-dependent diabetes and a control group of 35 healthy subjects. Subject and a parent were interviewed separately using a highly standardized, structured interview that generates DSM-III-R diagnoses by computer algorithms. Pediatricians completed a questionnaire asking about the presence of any mental disorders. Agreement between parent and child was poor for both groups. In the medically ill group, more cases were identified by the parent interview than by child interview alone for all types of disorders. In contrast, children in the comparison group more often reported symptoms sufficient for a diagnosis than did their parents. The difference in prevalence between the two groups was significant only for the parent-identified cases, and physicians were more likely to recognize child-identified disorders. The choice of informant(s) has clear implications for case identification and case recognition in both clinical care and research in pediatric settings.