Clinical Assessment of Child and Adolescent Personality and ...

chapter 15 integrating and interpreting assessment information343Box 15.2An Attempt to Develop Rules for Combining Multiple Sources of Information onChildhood PsychopathologyThe struggle to develop standardized methodsof integrating information from multipleinformants is exemplified in an article by Reichand Earls (1987). These researchers set out todevelop “a replicable strategy to make psychiatricdiagnoses when reports are obtainableindependently from parents and children” (p.601). The authors clearly state that the goalwas not to achieve perfect parent-child agreementbut to learn how to evaluate these differentsources of information. The followingis a summary (see appendix of research articlefor full criteria) of the decision tree used bythese authors to make diagnoses according tothe DSM-III (American Psychiatric Association,1980). We present this approach not somuch as a recommended decision tree, but asan example of strategies that assessors havedeveloped to resolve the problem of discrepantinformation.1. Attention-Deficit Disorder(a) Minimum of eight symptoms fromparent report, at least six symptomsfrom child report, and an age of onsetbefore 7.(b) Evidence of impairment in schoolfrom teacher’s report either of significantinattention, disruptive behavior,academic underachievement, or peerdifficulties.(c) If parent reports six or seven symptomsand child report shows four or five,diagnosis can be made with compellingevidence from teacher.2. Oppositional Disorder(a) Minimum of two symptoms from bothparent and child and a report of at least6 months duration.(b) Teacher indicates a pattern of negativeand defiant behavior.3. Conduct Disorder(a) Two or more symptoms from eitherparent or child.(b) Confirmation of antisocial behaviorfrom at least one other source.4. Major Depression(a) For children over 13, a diagnosis canbe made from child report alone if (1)child reports dysphoric mood or anhedoniafor 2 weeks or longer; (2) at leastfour vegetative symptoms from DSM-III criteria are present for 2 weeks orlonger; (3) there is evidence of impairment,such as grades dropping, irritability,social withdrawal, etc.(b) A diagnosis of depression would normallynot be made by parents reportalone unless child report was justunder threshold.5. Separation Anxiety and Overanxious Disorder(a) Diagnosis can be made from eitherparent or child report alone only if theother informant provides some evidenceof anxiety and/or depressive symptoms.Source: Reich, W., & Earls, E. (1987). Rules for making psychiatric diagnoses in children on the basis ofmultiple sources of information: Preliminary strategies. Journal of Abnormal Child Psychology, 15, 601–616.assessment information either in clinicalpractice or in clinical research (see alsoSmith, 2007).Piacentini, Cohen, and Cohen (1992)provide an interesting discussion on developingideal weighing systems for combininginformation across multiple informants.These authors label systems in which onesource of information is weighed moreheavily than others (e.g., teachers’ reportof inattention given more weight than parents’report) as complex schemes. In contrast,simple schemes are those where informationfrom all sources is weighed equally. These