Concordance Among Three Diagnostic Procedures for Identifying Depression in Children and Adolescents with EBD

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Abstract
Fifty children and adolescents with emotional and behavioral disorders (EBD) were assessed for depression and comorbid disorders using a structured interview, the Diagnostic Interview Schedule for Children (DISC), and a self-report measure of depression, the Mood and Feelings Questionnaire (MFQ). The resulting diagnoses and depression ratings were compared to those generated by experienced clinicians, and Kappa coefficients were derived from cross-tabulated frequencies of the DISC and clinician diagnoses. Diagnoses comparisons were made for 26 DSM-III-R categories and nine diagnostic classes. Diagnostic concordance was lowest for affective disorders, whereas higher concordance levels were identified for disruptive behavior and substance abuse disorders. Despite a sample with a high degree of comorbidity, 26% of the participants received no diagnosis on the DISC; however, the DISC generated a higher frequency and greater divergence of diagnoses per participant than did clinicians. The concordance among the three procedures was compared for affective disorders. MFQ total scores failed to discriminate individuals diagnosed with or without affective disorders by clinicians, but higher MFQ scores were obtained by the DISC for patients diagnosed with (versus without) affective disorders. MFQ scores did not discriminate individuals diagnosed with or without disruptive behavior or substance abuse disorders by either method. Overall, a higher level of concordance was observed between MFQ scores and DISC diagnoses than between either MFQ scores and clinician diagnoses or clinician and DISC diagnoses.

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