Lack of Correspondence Between Self- and Parent-Report on Structured Psychiatric Interviews of Adolescents with High-Functioning Autism Spectrum Disorders

Friday, May 18, 2012: 3:00 PM
Osgoode Ballroom East (Sheraton Centre Toronto)
1:30 PM
C. A. Mazefsky1, A. J. Hughes2, D. P. Oswald3 and J. E. Lainhart4, (1)3811 O'Hara, University of Pittsburgh, Pittsburgh, PA, (2)University of Pittsburgh, Pittsburgh, PA, (3)Commonwealth Autism Service, Richmond, VA, (4)Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT
Background:  The gold standard for diagnosing psychiatric disorders is to obtain information from multiple sources and achieve a consensus diagnosis. However, disagreement between sources is common and often a single source is used in research. Adolescent self-report results are frequently exclusively utilized over parent report in psychiatric research studies of typically-developing adolescents. This approach may not be best for even bright and verbal adolescents with ASD due to differences in emotional understanding, communication, and self-awareness that may impact their ability to self-report psychiatric symptoms. To date, studies of psychiatric comorbidity in ASD utilize a variety of methods for establishing diagnosis, and parent- and self-report on psychiatric interviews have not been directly compared to determine the degree of correspondence.

Objectives:  The study aimed to determine the degree of correspondence between self- and parent-report on a semi-structured psychiatric interview for adolescents with ASD.

Methods: Participants included 37 10 – 17 year old children with an ASD (confirmed with the ADOS and ADI-R) and without intellectual disability (mean FSIQ = 106). Current and lifetime comorbid psychiatric diagnoses were established via the Autism Comorbidity Interview, which is a modification of the Kiddie-Schedule for Affective Disorders and Schizophrenia. Lifetime and current diagnoses consistent with DSM-IV criteria were determined, as well as subsyndromal and subthreshold diagnoses which reflect milder variants.

Results:  Parent-report interviews resulted in substantially more current DSM-IV psychiatric diagnoses than self-report, with 42 diagnoses based on parent report compared to 8 diagnoses based on self-report. Diagnostic concordance was extremely low, with parent-child agreement for only 6 current DSM-IV diagnoses (14% of parent-reported diagnoses). When allowing for any level of diagnosis (e.g. collapsing subthreshold, subsyndromal, and DSM-IV) and not specifying a time frame (e.g. using lifetime scores), agreement improved, with parent-child agreement on 34% (33) of the 97 parent-reported diagnoses. For parent-reported major depression, results indicated 41% agreement (7/17) for any level lifetime diagnosis, which was the highest rate of agreement.

Conclusions: The results indicated very poor diagnostic agreement between parent- and self-report on a psychiatric interview. The findings were in stark contrast to research on typically-developing adolescents, revealing an opposite pattern of disagreement; namely, adolescent report among typically-developing populations results in higher rates of disorders than parent report, whereas the present findings revealed low to zero rates of disorders based on the self-report of adolescents with ASD despite high rates of psychiatric disorders based on parent-report.  Agreement for lifetime diagnoses at any level (e.g. subthreshold or higher) was better, suggesting that adolescents with ASD may be able to report on their psychiatric symptoms to a certain degree. Overall, the results imply caution should be exercised before dismissing concerns about a comorbid psychiatric disorder based on the adolescent’s self-report alone. Further, the best approach to research on psychiatric comorbidity in ASD may differ from typically-developing populations, in that parent report may be preferable to adolescent report data if only one source is utilized. However, obtaining information from multiple sources when determining a diagnosis is still preferable, particularly given the complex nature of differential diagnosis in ASD.

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