Lavigne J V, Binns H J, Christoffel K K, Rosenbaum D, Arend R, Smith K, Hayford J R, McGuire P A
Department of Child Psychiatry, Children's Memorial Hospital, Chicago, IL 60614.
Pediatrics. 1993 Mar;91(3):649-55.
This study examined how well private-practice pediatricians can identify emotional/behavioral problems among preschool children. Children aged 2 through 5 (N = 3876) were screened during a visit to 1 of 68 pediatricians who rendered an opinion about the presence of emotional/behavioral problems. Subsequently, children who scored above the 90th percentile for behavioral problems on the Child Behavior Checklist, along with children matched on age, sex, and race who had screened low, were invited for an intensive second-stage evaluation. There were 495 mothers and children who participated in that evaluation, which included a behavioral questionnaire, maternal interview, play observation, and developmental testing. Two PhD-level clinical child psychologists rendered independent opinions about the presence of an emotional/behavioral disorder. The psychologists identified significantly higher rates of problems overall--13.0% when the criterion was independent agreement that the child had an emotional/behavioral problem and a regular psychiatric diagnosis was assigned, vs 8.7% based on pediatricians' ratings. Prevalence rates based on psychologists' independent ratings were significantly higher than pediatricians' for both sexes, 4- through 5-year-olds, and whites, but not for 2- through 3-year-olds, African-Americans, and all minorities. Prevalence rates based on psychologists' ratings were significantly higher than the pediatricians' for all subgroups when V-code diagnoses were included in the psychologists' ratings. Overall, pediatricians' sensitivity was 20.5%, and specificity was 92.7%. At least 51.7% of the children who had an emotional/behavioral problem based on the psychologist's independent agreement had not received counseling, medication, or a mental health referral from the pediatrician.(ABSTRACT TRUNCATED AT 250 WORDS)
本研究考察了私人执业的儿科医生识别学龄前儿童情绪/行为问题的能力。对68位儿科医生诊所中的2至5岁儿童（N = 3876）进行了筛查，这些医生就儿童是否存在情绪/行为问题给出了意见。随后，那些在儿童行为量表上行为问题得分高于第90百分位的儿童，以及在年龄、性别和种族上匹配但筛查结果为低分的儿童，被邀请参加强化的第二阶段评估。共有495名母亲和儿童参与了该评估，评估内容包括一份行为问卷、对母亲的访谈、游戏观察和发育测试。两名拥有博士学位的临床儿童心理学家就儿童是否存在情绪/行为障碍给出了独立意见。总体而言，心理学家识别出的问题发生率显著更高——当标准是独立认定儿童存在情绪/行为问题并给出常规精神科诊断时，发生率为13.0%，而基于儿科医生的评级则为8.7%。基于心理学家独立评级的患病率在男女、4至5岁儿童、白人中均显著高于儿科医生的评级，但在2至3岁儿童、非裔美国人及所有少数族裔中并非如此。当心理学家的评级中纳入V编码诊断时，基于其评级的所有亚组患病率均显著高于儿科医生的评级。总体而言，儿科医生的敏感性为20.5%，特异性为92.7%。至少51.7%的根据心理学家独立认定存在情绪/行为问题的儿童未接受儿科医生的咨询、药物治疗或心理健康转诊。（摘要截选至250词）
