A symptom-level examination of parent-child agreement in the diagnosis of anxious youths

Objective: To examine parent-child agreement, at the symptom level, in the assessment of anxiety in youths. Differences between agreement at the diagnostic and symptom levels were explored as well as differences in agreement across symptom categories. Differences in the direction of disagreement across symptom categories were also examined. Method: Participants were 98 children, 7 to 14 years old (54 boys) who met diagnostic criteria for separation anxiety disorder, social phobia, or generalized anxiety disorder and their parents. Diagnostic and symptom data were obtained using the Anxiety Disorders Interview Schedule for Children and Parents. Results: Parent-child agreement at the symptom level was stronger than agreement at the diagnostic level for all three disorders. Parent-child agreement was stronger for observable symptoms than for unobservable symptoms and weaker for school-based symptoms than for non-school-based symptoms. In cases of discrepant symptom reports, the direction of disagreement varied according to the type of symptom. Conclusions: These findings buttress the need for a multi-informant approach in the assessment of childhood anxiety. Further, given the low parent-child agreement at the symptom level in the assessment of child anxiety, clinicians may do well to consider employing the "or rule" at the symptom level when integrating discrepant reports.