Problems in Using Diagnosis in Child and Adolescent Mental Health Services Research

This paper presents results from a three-part study on diagnosis of children with affective and behavior disorders. We examined the reliability, discriminant, and predictive validity of common diagnoses used in mental health services research using a research diagnostic interview. Results suggest four problems: a) some diagnoses demonstrate internal consistency only slightly better than symptoms chosen at random; b) diagnosis did not add appreciably to a brief global functioning screen in predicting service use; c) low inter-rater reliability among informants and clinicians for six of the most common diagnoses; and d) clinician diagnoses differed between sites in ways that reflect different reimbursement strategies. The study concludes that clinicians and researchers should not assume diagnosis is a useful measure of child and adolescent problems and outcomes until there is more evidence supporting the validity of diagnosis.