Disagreement between parent and adolescent reports of functional impairment
Disagreement between parent and adolescent reports of functional impairment
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DOI：
10.1111/j.1469-7610.2004.00217.x
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发表时间：
2004-02-01
影响因子：
7.6
通讯作者：
Robbins, JM
中科院分区：
文献类型：
--
作者：
Kramer, TL;Phillips, SD;Robbins, JM
目的：青少年的功能障碍作为诊断和服务资格的标准以及心理健康环境中治疗干预的目标变得越来越重要。本研究探讨了三个关键问题，在测量功能：1）父母和青少年之间的协议功能报告，2）解释不一致，和3）临床医生的功能评级与父母和青少年的报告相比。研究方法：父母和青少年之间的协议功能的报告估计使用卡帕统计和条件协议的样本中的258名青少年。在半结构化访谈（n = 43）中探讨了被调查者之间预期分歧的发生率和原因。方差分析计算的基础上，他们的协议或不同意的损害分类的父母-青少年对临床医生的评级。最后，独立的贡献，父母或青少年的损害报告对临床医生的功能评级进行了检查。结果：从12%到97%的问题报告的一个线人被否认的其他。对于与朋友的关系、同伴的违法行为和休闲活动等问题，一致性尤其差。平均而言，父母和青少年更有可能期望对方同意他们的评级，而不是不同意。不同意的原因包括：1）父母和青少年如何理解问题的差异; 2）父母对青少年行为缺乏认识; 3）对什么是有问题的阈值不同。结果还表明，临床医生认为只有父母报告的问题比只有青少年报告的问题更严重。结论：诊断，治疗计划和结果测量的影响进行了讨论。
Objective: Adolescents' functional impairment has become increasingly important as a criterion for diagnosis and service eligibility as well as a target of therapeutic intervention in mental health settings. This study examines three critical issues in measuring functioning: 1) agreement between parent and adolescent reports of functioning, 2) explanations for disagreement, and 3) clinicians' ratings of functioning compared with parent and adolescent reports. Methods: Agreement between parent and adolescent reports of functioning was estimated using the kappa statistic and conditional agreement in a sample of 258 adolescents. Rates of and reasons for expected disagreements between informants were explored in semi-structured interviews (n = 43). ANOVA was calculated for clinician ratings for parent-adolescent pairs categorized on the basis of their agreement or disagreement on impairment. Finally, the independent contribution of parents' or adolescents' reports of impairment on clinician ratings of functioning was examined. Results: From 12% to 97% of problems reported by one informant were denied by the other. Agreement was particularly poor for questions about relationships with friends, peers' delinquent behaviors, and leisure activities. On average, parents and adolescents were more likely to expect the other would agree with their ratings rather than disagree. Reasons for disagreement included: 1) differences in how parents and adolescents interpreted questions; 2) lack of parental awareness of adolescents' behaviors; and 3) different thresholds for what is considered problematic. Results also demonstrated that clinicians perceive problems reported only by parents as somewhat more serious than problems reported only by adolescents. Conclusions: Implications for diagnosis, treatment planning and outcomes measurement are discussed.