How valuable are parents' opinions for identifying children with psychiatric problems?

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Abstract

BACKGROUND

A considerable proportion of children and adolescents have a psychiatric disorder, but they usually depend on the adults around them to identify the problem. At present, psychiatric conditions in young patients are often overlooked.

OBJECTIVE

To investigate whether parental concerns about their child's emotions or behavior can be used to predict a psychiatric disorder.

DESIGN AND INTERVENTION

The present analysis includes data on 10,438 children aged 5-15 years who were sampled from the 1999 Child Benefit register in the UK. Diagnoses of psychiatric disorders according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) were obtained using the Development and Well-Being Assessment instrument. In addition, parents were interviewed with the Strengths and Difficulties Questionnaire-a screening questionnaire that evaluates the extent of behavioral symptoms and assesses the impact of these symptoms at home, at school and with peers. Parents were also asked whether their child had problems in any of the following psychological areas: 'hyperactivity', 'behavioral problems' or 'emotional problems'. Furthermore, information was collected on whether teachers had complained about the child's concentration, activity level or impulsiveness.

OUTCOME MEASURES

Positive predictive value (PPV), negative predictive value (NPV), specificity and sensitivity of parental responses to a few simple questions for predicting a child's psychiatric illness.

RESULTS

In total, 9.5% of parents stated that their child had psychological difficulties, with 5.5% reporting behavioral problems, 4.1% reporting emotional problems and 3.4% reporting hyperactivity; 2.9% of parents reported problems in more than one area. Nearly half of the children whose parents expressed concern had a DSM-IV psychiatric disorder; the PPV of parental concerns was 47.2% (95% CI 44.1-50.3%), and the sensitivity was 47.8% (95% CI 44.7-51.0%). Children whose parents expressed concern tended to have significant psychological difficulties even if they were not diagnosed with a psychiatric disorder, as indicated by Strengths and Difficulties Questionnaire symptoms and impact scores of 13.9 (SD 5.3) and 0.9 (SD 1.4), respectively; by comparison, children whose parents stated no concern had scores of 7.5 (SD 4.9) and 0.2 (SD 0.7), respectively. Parents were most accurate at identifying conduct disorders, followed by attention deficit hyperactivity disorders (ADHDs) and emotional disorders (sensitivities 53.0% [95% CI 48.5-57.4%], 35.3% [95% CI 29.2-41.9%] and 27.1% [95% CI 23.1-31.5%], respectively). The predictive power for identifying children with a hyperactivity disorder was markedly increased if both parents and teachers reported concern (PPV 62.1% [95% CI 51.0-72.3%], compared with a PPV of 23.2% [95% CI 18.9-27.9%] if only the parent reported hyperactivity). A lack of parental concern was highly indicative of the absence of significant mental health problems, with an NPV for the presence of at least one psychiatric problem of 94.6% (95% CI 94.1-95.0%) and a specificity of 94.4% (95% CI 94.0-94.9%).

CONCLUSION

If parents express concern about a child's emotions or behavior, there is a 50:50 chance that the child has a psychiatric disorder. Parents are highly accurate in ruling out mental health problems in their child.

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