Making sense of informant disagreement for overanxious disorder

Anksiyete Bozukluğu Tanılı Ergenlerin Belirtileri Açısından Ergen-Ebeveyn Uyumu

Aim: Considering the role of the parent in the children and adolescent's access to treatment, it is important that the symptoms are adequately noticed by the parents. In this study, it was aimed to examine the adolescent-parent agreement in terms of symptoms of adolescents with anxiety disorder. Material and Method: 100 adolescents who applied to the child and adolescent psychiatry outpatient clinic and were diagnosed with anxiety disorder according to the DSM-5 diagnostic criteria were included in the study. In the study, the sociodemographic form and the Revised Child Anxiety and Depression Scale (RCADS) adolescent and parent form were used for data collection. Results: When the parent and adolescent forms of RCADS were compared, the adolescent scores were significantly higher than the parents in all subscales and scale total scores, except for the separation anxiety subscale. The ICC (95% CI) value between the parent and adolescent forms of RCADS ranged from 0.06 to 0.74. Conclusion: In our study, it was found that adolescents scored their symptoms higher than their parents, and the correlation between parent-child reporting was low-moderate. Age, gender, comorbidity, and parental psychopathology were among the factors affecting adolescent-parent agreement.

Does maternal psychopathology bias reports of offspring symptoms? A study using moderated non-linear factor analysis

BACKGROUND

Mood-state biases in maternal reports of emotional and behavioral problems in their children have been a major concern for the field. However, few studies have addressed this issue from a measurement invariance perspective.

METHODS

Using data from baseline assessment of the Adolescent Brain Cognitive Development (ABCD) study (n = 8,507 mother-child dyads; youth aged 9-11 years), we examined how dimensions of maternal psychopathology, including internalizing problems, were associated with indices of bias in reports of their children's dimensions of internalizing, externalizing, neurodevelopmental, detachment, somatoform psychopathology using moderated non-linear factor analysis. Moderated non-linear factor analyses examined multiple potential biases in maternal reports of youth psychopathology.

RESULTS

Across analyses, we found very small magnitudes of associations between dimensions of maternal psychopathology and biases in reports of child emotional and behavioral problems.

CONCLUSIONS

Based on these results, we find little psychometric evidence for maternal psychopathology biasing reports of child behavior problems.

Discrepancies between parent and child ratings of anxiety in children with autism spectrum disorder

Co-occurring anxiety is common in children with autism spectrum disorder (ASD). However, inconsistencies across parent and child reports of anxiety may complicate the assessment of anxiety in this population. The present study examined parent and child anxiety ratings in children with ASD with and without anxiety disorders and tested the association between parent-child anxiety rating discrepancy and ASD symptom severity. Participants included children aged 8-16 years in three diagnostic groups: ASD with co-occurring anxiety disorders (ASD + Anxiety; n = 34), ASD without co-occurring anxiety disorders (ASD; n = 18), and typically developing healthy controls (TD; n = 50). Parents and children completed ratings of child anxiety using the Multidimensional Anxiety Rating Scale. Patterns of parent and child anxiety ratings differed among the three groups, with parent ratings exceeding child ratings only in the ASD + Anxiety group. Parents reported higher levels of child anxiety in the ASD + Anxiety versus ASD group, whereas children reported comparable levels of anxiety in the two groups. Among children with ASD, ASD symptom severity was positively associated with the degree to which parent ratings exceeded child ratings. Results suggest that children with ASD and co-occurring anxiety disorders endorse some anxiety symptoms but may underreport overall levels of anxiety. In addition, ASD symptom severity might increase discrepancies in parent-child anxiety ratings. These findings suggest a unique and valuable role of child anxiety ratings and suggest that both parent and child anxiety ratings should be considered in light of children's ASD symptom severity and used to guide further assessment. Autism Res 2020, 13: 93-103. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Children with autism spectrum disorder (ASD) commonly experience anxiety; yet, their perceptions of their anxiety might differ from their parents' perceptions. This study found that, while children with ASD and anxiety disorders acknowledge some anxiety, their parents report them as having higher levels of anxiety. Also, child and parent perceptions of anxiety may differ more for children with more severe ASD symptoms. How these findings may guide research and clinical practice is discussed.

Is the focus of community-based mental health treatment consistent with adolescent psychiatric diagnoses?

Most adolescents do not receive effective mental health services. This may stem in part from infrequent use of evidence-based and multi-informant diagnostic assessments to guide clinical care. The primary purpose of the present study was to examine whether adolescent mental health diagnoses and suicidality, derived via evidence-based diagnostic interviews and assessments, correspond with reported "reason for treatment" received by adolescents. Secondarily, we examined the potential association between socio-economic status and the match between youth diagnoses and reasons for treatment. The influence of parent-adolescent agreement on diagnoses and reasons for treatment on findings was also explored. Using chi-square analyses, a significant association was found between youth diagnoses of mood disorders, disruptive behavior disorders, and suicidality, respectively, and a focus of treatment on these conditions per combined parent-adolescent report. The same was not true for youth anxiety, attention-deficit hyperactivity, or substance abuse disorders. Results of exploratory analyses suggest that these results are driven by adolescent, but not parent report. With regard to socio-economic status, there was a trend for those with higher incomes to report a treatment focus consistent with youth diagnoses, per combined parent-adolescent report. Results suggest that focus of mental health treatment received by adolescents in standard community-based care may not uniformly address all current disorders. Efforts are needed to disseminate multi-informant evidence-based assessments to enhance the quality and effectiveness of care.

Associations between Disorder-Specific Symptoms of Anxiety and Error-Monitoring Brain Activity in Young Children

Anxiety disorders are among the earliest emerging disorders and most common mental health problem across the lifespan. A common characteristic of individuals with anxiety is poor attentional and cognitive control. Therefore, researchers are interested in how cognitive functioning relates to anxiety in young children. In particular, research has demonstrated associations between anxiety and electrophysiological markers of cognitive control skills such as the error-related negativity (ERN). The nature of the anxiety-ERN relationship is not well understood, however. The purpose of the present study was to examine: 1) the association between the ERN and diagnostically-defined symptoms of different anxiety disorders; and 2) the extent to which disorder-specific symptoms of anxiety moderated the association between ERN and behavioral performance on a Go/No-Go task in a sample of 139 children 5-8 years of age (70 females and 69 males). Results suggest that more separation anxiety disorder (SAD) symptoms are associated with a smaller ΔERN, even after controlling for other anxiety disorder symptoms. Children with more SAD symptoms showed higher error rates and failed to exhibit the expected association between ΔERN and behavioral performance, suggesting ineffective error-monitoring in young children with SAD problems.

Predictors of parent-child agreement on child anxiety diagnoses on the ADIS-IV-C/P

Diagnostic agreement between parents' and children's reports on children's anxiety problems is notoriously poor; however, very few investigations have examined specific predictors of inter-rater agreement on child anxiety diagnoses. This study examined predictors of categories of parent and child diagnostic endorsement on the Anxiety Disorders Interview Schedule for Children-IV. One hundred eight children (ages 7-13) and their parents completed structured diagnostic interviews for non-OCD/PTSD anxiety diagnoses and paper and pencil measures of functioning and impairment in a variety of domains. Parent-child agreement was statistically significant for social phobia and separation anxiety disorder, but was overall poor for all anxiety diagnoses. Externalizing disorder status, family accommodation frequency, and child rated impairment in various domains differentially predicted informant discrepancies for different anxiety disorders. These data are among the first to suggest variables that may explain parent-child concordance.

Making Sense of Multiple Informants in Child and Adolescent Psychopathology

Behavior ratings and self-report measures of child and adolescent psychopathology are often used to explore the types and extent of psychological disorders in youth. Yet a review of the literature suggests that parent, teacher, and self-report of psychopathology are not generally highly correlated. Moreover, even among the same type of rater (e.g., parents), there is often very little concordance in ratings. Although there is a substantial literature related to the circumstances under which different informants can be expected to correlate, there is little to guide psychologists in clinical decision making. The present article briefly reviews issues related to both rater and child characteristics that affect the quality and utility of their ratings. The child characteristics of age, setting, and type of problem and the relationship of these to rating quality are highlighted. Last, suggestions are made about which rater should be given the most weight and when.

Major depression in the national comorbidity survey-adolescent supplement: prevalence, correlates, and treatment

OBJECTIVE

To present the 12-month prevalence of DSM-IV major depressive disorder (MDD) and severe MDD; to examine sociodemographic correlates and comorbidity; and to describe impairment and service use.

METHOD

Data are from the National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative survey of 10,123 adolescents aged 13 to 18 years that assesses DSM-IV disorders using the Composite International Diagnostic Interview (CIDI) Version 3.0. One parent or surrogate of each participating adolescent was also asked to complete a self-administered questionnaire.

RESULTS

Lifetime and 12-month prevalence of MDD were 11.0% and 7.5%, respectively. The corresponding rates of severe MDD were 3.0% and 2.3%. The prevalence of MDD increased significantly across adolescence, with markedly greater increases among females than among males. Most cases of MDD were associated with psychiatric comorbidity and severe role impairment, and a substantial minority reported suicidality. The prevalence of severe MDD was about one-fourth of that of all MDD cases; estimates of impairment and clinical correlates were of 2- to 5-fold greater magnitude for severe versus mild/moderate depression, with markedly higher rates for suicidal thoughts and behaviors. Treatment in any form was received by the majority of adolescents with 12-month DSM-IV MDD (60.4%), but only a minority received treatment that was disorder-specific or from the mental health sector.

CONCLUSION

Findings underscore the important public health significance of depression among US adolescents and the urgent need to improve screening and treatment access in this population.

Anxiety in youth in Flemish care: a multi-informant study

Purpose

– The purpose of this paper is to investigate the prevalence of anxiety in youngsters with emotional and behavioral disorders, and its relation to other problems, using different informants.

Design/methodology/approach

– Data were collected in a Flemish treatment center. Educators completed a Child Behavior Checklist (CBCL) for each child, teachers completed a Teacher Report Form (TRF), and youth themselves completed a Youth Self Report (YSR) and a Screen for Child Anxiety Related Emotional Disorders (SCARED).

Findings

– Analyses indicated an explicit presence of anxiety. A clear relation was found between anxiety symptoms and internalizing problem behavior on the YSR, whereas only a slight relationship was found with the CBCL, and practically no relationship was found with the TRF. Only few correlations between anxiety and externalizing problems were found. Finally, youth themselves indicated strong correlations between anxiety and thought problems, whereas educators indicated strong correlations between youths’ anxiety and social problems.

Originality/value

– Several studies describe professionals’ difficulties to get a comprehensive perceptions of youths’ problems. This paper provides detailed insights in the nature of the informant discrepancies.

Genetic and environmental causes of variation in adolescent anxiety symptoms: a multiple-rater twin study

Heritability estimates for adolescent anxiety vary across studies, partly depending on who is rating the symptoms. The goal of our study was to estimate genetic and environmental influences using a multi-informant design with responses from a population-based sample of adolescent twins, their mothers and their fathers (N=1394 families). Results from multivariate biometrical modeling indicated quantitative, but no qualitative sex differences in etiology. The best fitting model was an AE Common Pathway model, defining anxiety as a latent factor common to all informants. This model offers error free estimates of genetic and environmental influences explaining the latent factor variance. Variation in the latent factor was highly genetic, with heritability estimates of 65% for boys and 74% for girls. Non-shared environmental effects explained the remaining variance. In addition, there were significant rater-specific genetic and environmental effects for both sexes. The observed rater differences underline the importance of using several informants when studying adolescent anxiety.

Rethinking the mental health treatment skills of primary care staff: a framework for training and research

Health care reforms may offer several opportunities to build the mental health treatment capacity of primary care. Capitalizing on these opportunities requires identifying the types of clinical skills that the primary care team requires to deliver mental health care. This paper proposes a framework that describes mental health skills for primary care receptionists, medical assistants, nurses, nurse practitioners, and physicians. These skills are organized on three levels: cross-cutting skills to build therapeutic alliance; broad-based, brief interventions for major clusters of mental health symptoms; and evidence-based interventions for diagnosis specific disorders. This framework is intended to help inform future mental health training in primary care and catalyze research that examines the impact of such training.

Pre-adoption adversity and self-reported behavior problems in 7 year-old international adoptees

To further investigate the long-term impact of pre-adoption adversity on international adoptees, externalizing and internalizing symptoms were assessed using a self-report measure at school-age in addition to mothers' reports. The sample consisted of 95 adopted children and their mothers. Children's health and developmental status were assessed soon after arrival in their adoptive family. At age 7, the Dominic Interactive, a self-report measure, was used to evaluate externalizing and internalizing symptoms while mothers completed the CBCL. Children's self-reports were compared to their non-adopted peers'. Adopted children reported more symptoms of specific phobia than their peers. A significant correlation was found between mothers' and children's reports but only for externalizing symptoms. Self-reported symptoms were related to indices of nutritional and psychosocial deprivation at arrival, such as low height/age and weight/height ratios. Our results emphasize the importance of considering international adoptees' perception of their psychological adjustment and the long-term impact of early risk factors.

Multimethod, multi-informant agreement, and positive predictive value in the identification of child anxiety disorders using the SCAS and ADIS-C

The current study sought to provide practical information for the clinical use of child and parent reports of child anxiety symptoms by investigating agreement between parent, child, and clinician as well as the predictive value of this information. Examining 88 anxious children and their parents, the study compared agreement by correlating parent and child responses on the Spence Children's Anxiety Scale (SCAS); comparing parent and child responses to clinician data operationalized through continuous and dichotomous variables from the Anxiety Disorder Interview Schedule for Children; and examining the relative clinical utility of parent and child reports on the SCAS in terms of positive and negative predictive value. Results indicated that parent and child agreement on the SCAS was moderate to high for most anxiety disorder symptoms and that both were generally consistent with clinician impressions. Moreover, both child and parent provided unique information to the diagnostic process.

The role of genes and environment in shaping co-occurrence of DSM-IV defined anxiety dimensions among Italian twins aged 8-17

This study investigated the ultimate causes of co-variation between symptoms of four common DSM-IV anxiety dimensions - Generalized Anxiety, Panic, Social Phobia and Separation Anxiety disorder - assessed with the Italian version of the Screen for Child Anxiety-Related Emotional Disorders questionnaire in a sample of 378 twin pairs aged 8-17 from the population-based Italian Twin Register. Genetic and environmental proportions of covariance between the targeted anxiety dimensions were estimated by multivariate twin analyses. Genetic influences (explaining from 58% to 99% of covariance) and unique environmental factors were the sole sources of co-variation for all phenotypes under study. Genetic influences associated with different anxiety dimensions coincide remarkably, as indicated by genetic correlations ranging from 0.40 to 0.61, while unique environmental overlap is less substantial. Thus, while additive genetic effects are important in explaining why children report symptoms from multiple anxiety disorders, environmental idiosyncratic factors seem to play a marginal role in shaping the co-occurrence of different anxiety dimensions in childhood.

Parent-child agreement and prevalence estimates of diagnoses in childhood: direct interview versus family history method

Diagnostic information on children is typically elicited from both children and their parents. The aims of the present paper were to: (1) compare prevalence estimates according to maternal reports, paternal reports and direct interviews of children [major depressive disorder (MDD), anxiety and attention-deficit and disruptive behavioural disorders]; (2) assess mother-child, father-child and inter-parental agreement for these disorders; (3) determine the association between several child, parent and familial characteristics and the degree of diagnostic agreement or the likelihood of parental reporting; (4) determine the predictive validity of diagnostic information provided by parents and children. Analyses were based on 235 mother-offspring, 189 father-offspring and 128 mother-father pairs. Diagnostic assessment included the Kiddie-schedule for Affective Disorders and Schizophrenia (K-SADS) (offspring) and the Diagnostic Interview for Genetic Studies (DIGS) (parents and offspring at follow-up) interviews. Parental reports were collected using the Family History - Research Diagnostic Criteria (FH-RDC). Analyses revealed: (1) prevalence estimates for internalizing disorders were generally lower according to parental information than according to the K-SADS; (2) mother-child and father-child agreement was poor and within similar ranges; (3) parents with a history of MDD or attention deficit hyperactivity disorder (ADHD) reported these disorders in their children more frequently; (4) in a sub-sample followed-up into adulthood, diagnoses of MDD, separation anxiety and conduct disorder at baseline concurred with the corresponding lifetime diagnosis at age 19 according to the child rather than according to the parents. In conclusion, our findings support large discrepancies of diagnostic information provided by parents and children with generally lower reporting of internalizing disorders by parents, and differential reporting of depression and ADHD by parental disease status. Follow-up data also supports the validity of information provided by adolescent offspring.

Genetic and cultural transmission of antisocial behavior: an extended twin parent model

Considerable evidence from twin and adoption studies indicates that both genetic and shared environmental factors play a substantial role in the liability to antisocial behavior. Although twin and adoption designs can resolve genetic and environmental influences, they do not provide information about assortative mating, parent-offspring transmission, or the contribution of these factors to trait variation. We examined the role of genetic and environmental factors for conduct disorder (CD) using a twin-parent design. This design allows the simultaneous estimation of additive genetic, shared and individual-specific environmental effects, as well as sex differences in the expression of genes and environment in the presence of assortative mating and combined genetic and cultural transmission. A retrospective measure of CD was obtained from twins and their parents or guardians in the Virginia Twin Study of Adolescent Behavior Development and its Young Adult Follow up sample. Both genetic and environmental factors play a significant role in the liability to CD. Major influences on individual differences appeared to be additive genetic (38%-40%) and unique environmental (39%-42%) effects, with smaller contributions from the shared environment (18%-23%), assortative mating (-2%), cultural transmission (approximately 2%) and resulting genotype-environment covariance. This study showed significant heritability, which is slightly increased by assortative mating, and significant effects of primarily nonparental shared environment on CD.

Parent and teacher mental health ratings of children using primary-care services: interrater agreement and implications for mental health screening

OBJECTIVE

To examine interrater agreement when screening for child mental health problems during primary-care visits.

METHODS

Children aged 5 to 10 (n = 227) and one of their parents were systematically recruited from the waiting rooms of 15 primary-care sites located in Baltimore, Md; Washington, DC; and rural New York from 2002 to 2005. The parent and teacher of the child completed the Strengths and Difficulties Questionnaire to measure the child's emotions, behaviors, and functional impairment.

RESULTS

Parents and teachers identified a similar proportion of children as having high symptoms (25% vs 23%) and high impairment (27% vs 32%) but rarely agreed in their assessments of specific children. Parent ratings alone missed 52% of children rated by teachers as having both high symptoms and high impairment (kappa = 0.15). Only 6% of these discrepant visits were for mental health problems, making it unlikely that teacher reports would have been solicited.

CONCLUSIONS

Parent reports failed to detect half of school-aged children considered to be seriously disturbed by their teachers. Efforts to improve detection of mental health problems by using screening tools in primary care may require algorithms that help providers judge when to solicit teacher reports and how to interpret conflicting information from parents and teachers.

Genetic and environmental influences on anxiety dimensions in Italian twins evaluated with the SCARED questionnaire

This study explored the factorial structure of the Italian version of the Screen for Child Anxiety-Related Emotional Disorders questionnaire (SCARED), and investigated the contributions of genetic and environmental influences of individual variation of anxiety dimensions as reported in the SCARED. Three hundred and seventy-eight twin pairs aged 8-17 from the Italian Twin Registry filled in the SCARED through a mail survey. Four, distinct empirical factors, that corresponded closely to the original SCARED subscales of Generalized Anxiety (GAD), Panic (PD), Social Phobia (SP), and Separation Anxiety (SAD) disorder emerged from Exploratory Factor Analysis. The empirically derived scores were analyzed by structural equation modeling; moderate-to-high heritability, without age or sex differences, emerged for all dimensions with the exception of GAD, for which an age effect was found. The DSM-IV anxiety dimensions identified by the SCARED have a psychometric structure that can be replicated in the Italian culture, and are influenced at different extents by genetic and nonshared environmental determinants.

Determinants of multiple informant agreement on child and adolescent behavior

This study examined whether characteristics of behavioral items reported by parent and child are related to parent-child agreement. Data were collected from 20 judges rating 59 child behaviors on 11 dimensions hypothesized to affect parent-child agreement. Data from 675 parent-child dyads (85% female caregivers, 62% male children, aged 7-17) reporting on 59 child behaviors were used to examine agreement. Behavior characteristics accounted for 43% of variability in parent-child agreement. Three components, saliency to the parent, saliency to the child, and observability/willingness to report, contributed uniquely to prediction of agreement.

Evidence-Based Assessment of Anxiety and Its Disorders in Children and Adolescents

We provide an overview of where the field currently stands when it comes to having evidence-based methods and instruments available for use in assessing anxiety and its disorders in children and adolescents. Methods covered include diagnostic interview schedules, rating scales, observations, and self-monitoring forms. We also discuss the main purposes or goals of assessment and indicate which methods and instruments have the most evidence for accomplishing these goals. We also focus on several specific issues that need continued research attention for the field to move forward toward an evidence-based assessment approach. Finally, tentative recommendations are made for conducting an evidence-based assessment for anxiety and its disorders in children and adolescents. Directions for future research also are discussed.