Sherlock Holmes and child psychopathology assessment approaches: The case of the false-positive

Objective: To explore the relative value of various methods of assessing ch ildhood psychopathology, the authors compared 4 groups of children: those w ho met criteria for one or more DSM diagnoses and scored high on parent sym ptom checklists, those who met psychopathology criteria on either one of th ese two assessment approaches alone, and those who met no psychopathology a ssessment criterion. Method: Parents of 201 children completed the Child Be havior Checklist (CBCL), after which children and parents were administered the Diagnostic Interview Schedule for Children (version 2.1). Children and parents also completed other survey measures and symptom report inventorie s. The 4 groups of children were compared against "external validators" to examine the merits of "false-positive" and "false-negative" cases. Results: True-positive cases (those that met DSM criteria and scored high on the CB CL) differed significantly from the true-negative cases on most external va lidators. "False-positive" and "false-negative" cases had intermediate leve ls of most risk factors and external validators. "False-positive" cases wer e not normal per se because they scored significantly above the true-negati ve group on a number of risk factors and external validators. A similar but less marked pattern was noted for "false-negatives," Conclusions: Findings call into question whether cases with high symptom checklist scores despit e no formal diagnoses should be considered "false-positive." Pending the av ailability of robust markets for mental illness, researchers and clinicians must resist the tendency to reify diagnostic categories or to engage in ar cane debates about the superiority of one assessment approach over another.