Parent and child contributions to diagnosis of mental disorder: Are both informants always necessary?

Objective: To examine the unique cases contributed by parent and child info rmants to diagnostic classification, with the goal of identifying those dia gnoses for which either or both informants are needed,Method: The authors e xamined survey data from the Methods for the Epidemiology of Child and Adol escent Mental Disorders (MECA) Study. a 4-community epidemiology survey of 9- to 17-year-old children and their parents, Parent-child dyads (1,285 pai rs) were independently interviewed by lay persons with the Diagnostic Inter view Schedule for Children; a subset of these pairs (n = 247) were also int erviewed by clinicians. Agreement between parents and children was examined with respect to levels of impairment, need for/use of services, and clinic ians' diagnoses. Results: Parents and children rarely agreed on the presenc e of diagnostic conditions, regardless of diagnostic type. Nonetheless, mos t child-only- and parent-only-identified diagnoses were similarly related t o impairment and clinical validation, with 2 exceptions: child-only-identif ied attention-deficit hyperactivity disorder (ADHD) and oppositional defian t disorder (ODD), Conclusions: Overall findings suggest that most "discrepa nt' diagnoses (those reported by one but not the other informant) reflect m eaningful clinical conditions. In some instances, however, diagnoses report ed by one but not the other informant should be treated with caution, as th ey may not reflect the full diagnostic condition (e.g., possibly child-only -identified ADHD or ODD). Further research is needed to determine the salie nce of child-only- or parent-only-reported cases.