Psychiatric comorbidity in autism spectrum disorder: Correspondence between mental health clinician report and structured parent interview.
Nicole Stadnick, Colby Chlebowski, Mary Baker-Ericzén and 3 others
PMID 27407039WHAT IT FOUND
Clinician diagnoses missed many psychiatric conditions in children with autism.
Structured parent interviews found ADHD in 78% of cases, while clinicians reported it in only 36%. Agreement between the two methods was poor across all diagnostic categories.
Key findings
01Structured parent interviews identified significantly higher rates of comorbid psychiatric conditions than clinician reports, including ADHD (78% vs 36%), disruptive behavior disorders (57% vs 17%), anxiety (57% vs 23%), and mood disorders (31% vs 11%).
02Agreement between clinician-reported diagnoses and structured interview results was poor for all diagnostic categories, with kappa values ranging from 0.05 to 0.18.
03Clinicians were more likely to report no non-ASD diagnosis compared to the structured interview, with 28% of children having no diagnosis from clinician report versus 8% from the interview.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
There is no definitive gold standard for psychiatric diagnosis, so it is unclear which source is more accurate. Clinicians were limited to listing three diagnoses, while the structured interview had no such cap. The structured interview relied solely on parent report, whereas clinicians may have used multiple sources. The study was conducted in publicly funded mental health services in California, which may not reflect other settings.
Declared interests
The study was supported by the National Institute of Mental Health. No other conflicts of interest were declared.
The easy way to misread this
Do not conclude that structured interviews are definitively more accurate than clinician judgment. The study demonstrates poor agreement and higher detection by the interview, but it cannot prove which diagnosis is correct because there is no independent gold standard.