Validity of structured clinical evaluations in adolescents with conduct and substance problems

Objective: To determine discriminative and convergent validity for certain structured diagnostic assessments among adolescents with conduct and substa nce problems. Method: Patients were 87 adolescents (both genders) in treatm ent for conduct and substance problems. Most controls (n = 85; both genders ) came from patients' neighborhoods. Assessments included Diagnostic Interv iew Schedule for Children, Composite International Diagnostic instrument-Su bstance Abuse Module, Child Behavior Checklist, and others. Patients' data guided clinical care. Results: Youths' self-reports significantly discrimin ated patients from controls in DSM-IV conduct and substance use disorders ( CD, SUD) and in numerous associated measures. CD and SUD symptoms correlate d strongly. However, some patients apparently minimized symptoms. Youths' s elf-reports did not discriminate patients from controls in attention-defici t/hyperactivity disorder (ADHD) or major depression (MDD). Parent informati on raised prevalence rates of ADHD and MDD, which then discriminated patien ts from controls. However, patients and parents usually disagreed on MDD an d ADHD diagnoses. Conclusions: Despite some dissimulation, patients' self-r eports of CD and SUD correlated highly and had superb discriminative validi ty, making them useful for treatment and research. Self-reports of ADHD and MDD, apparently lacking discriminative validity, are less useful. Parent r eports improve these discriminations but present additional problems.