Jensen P S, Salzberg A D, Richters J E, Watanabe H K
Child and Adolescent Disorders Research Branch, National Institute of Mental Health, Rockville, Maryland 20857.
J Am Acad Child Adolesc Psychiatry. 1993 Mar;32(2):397-406. doi: 10.1097/00004583-199303000-00022.
To clarify the relationship between scales and structured diagnostic interview diagnoses, the authors used a two-stage screening method to study 201 military families with one or more children ages 5 to 17.
Parents and children were interviewed with the Diagnostic Interview Schedule for Children (DISC 2.1); parents also completed the Child Behavior Checklist (CBCL) while the children completed other self-report symptom scales.
Results indicate only a modest ability of scales to discriminate among discrete DISC-derived DSM-III-R diagnoses. Inclusion of diagnostic information from both parents and children resulted in more diagnoses than from either informant alone, and the additional diagnoses consisted mostly of internalizing disorders contributed by child-derived DISC information. In general, correlations were larger between scales and diagnoses within the same informant (regardless of diagnostic construct) than across informants (but within the same diagnostic construct). Child self-report measures tended to outperform the CBCL as screeners against the overall "caseness" criterion on the DISC. However, child self-report scales were relatively nonspecific and showed little ability to selectively identify internalizing disorders such as anxiety and/or depression. Compared with single informant diagnoses, combined-informant diagnoses were generally superior in demonstrating broader relationships to both parent and child symptom scales.
Additional research is needed in order to build careful crosswalks between the various approaches to assessing childhood psychopathology, to decide on optimal rules for combining information to establish diagnoses, and to validate the currently available assessment alternatives.
为阐明量表与结构化诊断访谈诊断之间的关系，作者采用两阶段筛查方法对201个有一名或多名5至17岁子女的军人家庭进行了研究。
使用儿童诊断访谈量表（DISC 2.1）对父母和子女进行访谈；父母还完成了儿童行为清单（CBCL），而子女完成了其他自我报告症状量表。
结果表明，量表在区分源自DISC的离散DSM-III-R诊断方面能力有限。纳入父母和子女双方的诊断信息所得到的诊断比仅采用一方信息时更多，且额外的诊断大多是源自子女DISC信息的内化障碍。总体而言，同一信息提供者（无论诊断结构如何）的量表与诊断之间的相关性大于不同信息提供者（但在相同诊断结构内）之间的相关性。在针对DISC的总体“病例”标准进行筛查时，儿童自我报告测量方法往往比CBCL表现更好。然而，儿童自我报告量表相对缺乏特异性，在选择性识别焦虑和/或抑郁等内化障碍方面能力较弱。与单一信息提供者诊断相比在显示与父母和儿童症状量表更广泛的关系方面，综合信息提供者诊断通常更具优势。
需要开展更多研究，以便在评估儿童精神病理学的各种方法之间建立细致的对应关系，确定组合信息以建立诊断的最佳规则，并验证当前可用的评估方法。
