Clinical Assessment of Child and Adolescent Personality and ...

340chapter 15 integrating and interpreting assessment informationmost important and most difficult part ofthe evaluation is the integration of thisinformation into a clear case formulationthat answers the referral questions andpoints the way to the most appropriateintervention.Although we discuss integrating informationacross multiple domains of functioningand across multiple assessment techniques,a main focus of this chapter is on integratinginformation from different informants.This is a particularly difficult endeavorbecause one is theoretically obtaining thesame information on a child’s adjustmentfrom different sources. One might expectthat there would be a high degree of correlationbetween information provided bydifferent informants. Unfortunately, thisis not the case. A large body of researchhas indicated that there are generally quitesmall correlations between different informantsproviding the same type of information(Achenbach, McConaughy, & Howell,1987; De Los Reyes & Kazdin, 2005).One explanation for this low rate ofagreement between informants is that differentpeople see a child in different settings.That is, the low correlations betweeninformants may reflect real differences ina child’s behavior across different settings.The meta-analysis conducted by Achenbachet al. (1987) provides some support forthis possibility. Across the 119 studies thatthey reviewed, the average correlation inratings between informants who see a childin different settings (e.g., parent/teacher)was .28. In contrast, the average correlationbetween informants who see a childin the same setting (e.g., pairs of parents orpairs of teachers) was .60. This substantialincrease in agreement between informantswho see a child in the same setting providesevidence that the lack of informant agreementreflects, at least in part, real situationalvariability in children’s behavior.Konold, Walthall, and Pianta (2004)also provide evidence to support the contentionthat much of the cross-informantdisagreement is due to situational specificbehaviors in children across settings. Specifically,these authors obtained parent andteacher ratings of young children’s behavior.They reported that the general formand factor loadings for the ratings werevery similar across mother, father, andteacher ratings, even though the correlationsamong the ratings from each informantwere fairly low. Thus, the low levelof agreement appeared to be more likelydue to situation-specific behavior, than dueto the manner in which the behaviors weremeasured.This situational variability has importantimplications for clinical assessments.It suggests that to make sense of informationon a child’s emotional and behavioralfunctioning, a clinical assessor must alsoassess the contextual demands that mightinfluence a child’s behavior and, thereby,account for the discrepant information oneis obtaining. For example, a clinical assessormight be quite puzzled over a teacher’sreport of significant problems of inattention,disorganization, and hyperactivityat school, when it appears to be in starkcontrast to only minimal problems beingreported by a child’s parent. However, furtherassessment of the home context mayindicate that the parents do not put manydemands for sustained attention, organization,or sitting still on the child at home. Asa result, the behaviors are not problematicin this setting.Another important aspect of the lack ofagreement between informants is determiningthe level of analysis at which agreement isbeing measured. Individual behaviors tendto show less consistency across informantsthan broader dimensions or composites ofmultiple behaviors. A good example of thisphenomenon comes from a study by Biederman,Keenan, and Faraone (1990). In aclinic sample of children and adolescents,the average correlation between parent andteacher reports of individual symptoms ofAttention-Deficit Hyperactivity Disorder