[Diagnosis of expansive behavior in children: how do different observers assess in various situations?]

The present study addressed the question of the extent to which parental assessment of expansive behavior disorders can be validated by clinical assessment and how both types of assessment are correlated with behavior ratings by trained outside observers. The agreement between these different sources of information was analyzed in an unselected sample of 49 children aged 5 to 11 admitted to our inpatient unit for expansive behavior disorder. Most of the children met the clinical criteria for both attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD). With regard to diagnoses, there was good agreement between the parents' assessment and the clinical assessment made one week after admission. However, the parents rated ADHD as more severe than the clinicians did. Ratings of the children's overt behavior in two standardized situations (play situation, test situation) by trained outside observers had only weak correlations with the parental and clinical assessments. The only significant correlation was between the clinical assessment of hyperactivity and the behavior ratings. The contribution of the situational variability of the children's behavior to the low agreement between the different sources of information is discussed. Where feasible, multiple perspectives should be taken into consideration.