Youth and caregivers often disagree during psychiatric assessments, according to a study published on Wednesday in JAMA Psychiatry.
Investigators at the University of California San Diego School of Medicine analyzed reports from 11,868 youth and their caregivers aged 9 to 17.
Participants were part of the Adolescent Brain Cognitive Development study. Youth and their caregivers answered identical diagnostic questions during separate clinical interviews, and researchers derived diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
Disagreement was the norm. When a diagnosis was reported, it came from only one informant in about 65% to 98% of cases, depending on the specific psychiatric diagnosis and developmental stage.
Youth reported major depressive disorder, sleep problems, substance use, suicidal thoughts and attempts, and nonsuicidal self-injury at higher rates than caregivers did.
Teens also reported depression more frequently as they grew older. Conversely, caregivers were more likely to report conduct disorders, eating disorders, and generalized and social anxiety disorders.
Information gaps were widest at younger ages. They narrowed as teens grew older. Agreement generally improved across developmental stages, but it remained limited.
Evaluations must gather information directly from adolescents instead of depending only on caregiver reports, according to Laika D. Aguinaldo, PhD, MSW, assistant professor of psychiatry at UC San Diego School of Medicine and corresponding author of the study.
“Teens were more likely to disclose private, internal experiences, but parents were more likely to report more externally visible mental health problems,” Aguinaldo said.
“If we’re really thinking about suicidal thoughts, self-harm, substance use and sleep, most parents don’t actually know that their kids are experiencing these mental health problems, which is why we need to ask both the teen and the parent,” Aguinaldo said.
“If you only ask one, you might miss the opportunity to identify a young person who needs help and to intervene early,” Aguinaldo said.
Youth mental health treatment surged after the pandemic, including increases in diagnoses, therapy, and psychiatric medication use.
First-time prescriptions for psychiatric medications among children and teens have increased by 35% compared to pre-pandemic levels, according to a recent study published by the American Academy of Child & Adolescent Psychiatry.
Therapy is usually the first treatment option. Medication may be recommended when symptoms are severe or persistent. Resources remain available through primary care pediatricians, who can refer patients to psychiatrists or psychologists for further evaluation.
Which treatments will clinicians prioritize as youth and caregiver reports continue to diverge?