How does a parent's assessment of a child's psychiatric symptoms compare
with the child's own assessment? Not well, at least as far as anxiety and
depression are concerned, past studies have revealed.
Further, a parent's assessment of a child's mania symptoms also appears to
have poor concordance with what the child reports, a new study divulges.
The study was conducted by Barbara Geller, M.D., a professor of psychiatry
at Washington University in St. Louis. Results were reported in the July
American Journal of Psychiatry.
The study included 93 boys and girls who were aged 7 to 16 years and had a
current DSM-IV diagnosis of mania for at least two weeks, with at
least one of the two cardinal symptoms of mania—elated mood and
grandiosity—to avoid diagnosing mania by symptoms that overlapped with
those for attention-deficit/hyperactivity disorder. The Washington University
in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia, a
semi-structured interview instrument that asks about mania symptoms, was
separately administered to parents about their children and to children about
themselves. Different research nurses interviewed the parent and child in each
family to avoid any bias from interviewing children after already interviewing
Parent-child concordance was poor to fair for all cardinal and noncardinal
mania symptoms, the researchers found. Symptoms endorsed by just the child
included substantial proportions of bipolar symptoms that have been shown to
best differentiate mania from attention-deficit/hyperactivity disorder, such
as elation, grandiosity, flight of ideas, racing thoughts, or a decreased need
for sleep. Also noteworthy, the investigators found no significant differences
in parent-child concordance by age of the child informant.
But just because parent-child agreement in the rating of children's mania
symptoms was not all that good, is there reason to think that the children
were more competent at rating their mania symptoms than their parents were?
The answer is yes, Geller told Psychiatric News.
"For certain symptoms, such as decreased sleep need and racing
thoughts," she said, "parents may not know that a child is up most
of the night or that a child has racing thoughts. Also, children may be aware
that they are feeling super-happy when parents are more concerned with the
child's elation interfering with school or church activities."
These results have implications for clinical psychiatrists, Geller
believes. "Children must be seen separately, asked questions in
vocabulary and grammar that are age-appropriate, and must be interviewed by
highly skilled child practitioners," she said.
The study was financed by the National Institute of Mental Health.
The study, "Relationship of Parent and Child Informants to
Prevalence of Mania Symptoms in Children with a Prepubertal and Early
Adolescent Bipolar Disorder Phenotype," is posted online at<http://ajp.psychiatryonline.org/cgi/content/full/161/7/1278?>.▪
Am J Psychiatry20041611278