Assessing psychotropic medication side effects among children. A reliability study.

The Dosage Record Treatment Emergent Symptom Scale (DOTES) is a rating scale for measuring the presence and intensity of psychotropic medication side effects. Studies to evaluate its reliability have not been published. The purposes of this pilot study are to (1) develop a protocol for training raters to use the DOTES, (2) assess inter-rater agreement, 3) examine the reasons for disagreement among raters to clarify training procedures and symptom definitions, and (4) further refine this instrument for use in clinical and research settings. Five nurses were trained to use the DOTES to rate the absence or presence and intensity of specific medication side effects. After training, Raters 1, 2, and 3 watched a videotape of a nurse interviewing a 13-year-old child and completed the DOTES rating scale. There was agreement on the intensities of 6 (67%) of the 9 symptoms identified as present and agreement on 17 (89%) of the 19 symptoms identified as absent. Process tracings were conducted on the ratings of Nurses 4 and 5 to elicit the criteria they used to determine their ratings. The results of the process tracings were used to identify ambiguities that led to disagreement among raters so that the training protocol and interview could be improved.