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Relation of symptom-induced impairment with other illness parameters in clinic-referred youth

Authors

  • Kenneth D. Gadow,

    Corresponding author
    1. Department of Psychiatry and Behavioral Sciences, Stony Brook University, New York, NY, USA
    • Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York NY USA

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  • Aaron J. Kaat,

    1. Nisonger Center and Department of Psychology, The Ohio State University, Columbus, OH, USA
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  • Luc Lecavalier

    1. Nisonger Center and Departments of Psychology and Psychiatry, The Ohio State University, Columbus, OH, USA
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  • Conflict of interest statement: potential conflict declared, see Acknowledgements.

Abstract

Objective

To examine the relation of caregiver ratings of psychiatric symptom-induced impairment with number and severity of symptoms and informant agreement in consecutive child psychiatry outpatient referrals.

Methods

Parents and teachers completed a broadband DSM-IV-referenced rating scale with disorder-specific impairment for 636 youth (6–18 years). Illness parameters included impairment, number and severity of symptoms, and their combination (symptom + impairment) as well as categorical (cut-off) and dimensional scoring.

Results

Agreement between impairment and other illness parameters showed considerable variation as a function of type of parameter, disorder, and informant, but to lesser extent age and gender. Many youth who met impairment cut-off for specific disorders did not meet symptom cut-off. Conversely, most youth who met symptom cut-off were impaired. Symptom cut-off evidenced greater convergence with impairment cut-off than combined symptom + impairment cut-offs. Severity of impairment was moderately to highly correlated with number and severity of symptoms. Parents' and teachers' ratings indicated little disorder-specific agreement about youth who met impairment cut-off, symptom cut-off, or combined symptom + impairment cut-off. Therefore, sole reliance on one informant greatly underestimates the pervasiveness of impairment.

Conclusion

Findings are consistent with the notion that each illness parameter represents a unique conceptual construct, which has important clinical and research implications.

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