The Diagnostic Interview Schedule for Children (PC-DISC v.3.0): Parents and Adolescents Suggest...

Journal of Abnormal Child Psychology, Vol. 23, No. 5, 1995

The Diagnostic Interview Schedule for Children (PC-DISC v.3.0): Parents and Adolescents Suggest Reasons for Expecting Discrepant Answers

Michelle Bidaut-Russell , 1,2 Wendy Reich, 1 Linda B. Cottler, 1 Lee N. Robins, 1 Wilson M. Compton, 1 and Richard E. Matt ison I

To identify reasons for discrepancies between parent and child reports of child/adolescents's psychiatric symptoms, parents and adolescents (51 pairs) were asked to guess what the other would answer to questions from the PC-DISC about the adolescent's psychiatric symptoms, and to explain why they expected disagreement when the answer they provided for the other was different from their own. Adolescents' explanations for expecting (1) parental denial of symptoms the adolescent reported were: the parent was unaware of, forgot about, assumed the adolescent could not have, or trivialized the symptom; and (2) parental report of symptoms the adolescent denied were: the parent misread or exaggerated the adolescent's symptom, had too high expectations for the adolescent's behavior, put a negative label on or did not trust the adolescent. Parents' reasons for expecting their children to (1) deny symptoms the parents reported were: the adolescent did not remember how s/he felt, lied, did not recognize or minimized the importance or frequency of the symptom; and (2) report symptoms the parents denied were: the adolescent lied, exaggerated the importance of or interpreted the symptom differently.

Assessment of psychiatric disorders in children and adolescents depends upon reports from different sources, including parents and youth them-

Manuscript received in final form July 29, 1994. Support tor this work was provided by National Institute of Drug Abuse grant number DA-05585 (Dr. Cottler, P.I.), and National Institute of Mental Health grants numbers MHo31302 (Dr. R. C. Cloninger, P.I.) and MH-17104 (Dr. Cottler, P.I.).

1Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110.

2Address all correspondence, including reprint requests, to MicheUe Bidaut-Russell, Ph.D, MPH, MPE, Department of Psychiatry, Box 8134, Washington University School of Medicine, 4940 Children's Place, St. Louis, Missouri 63110.

641

0091-4)627/95/1000-0641507.50/0 © 1995 Plenum Publishing Corporation

642 Bidaut-Russell et al.

selves. However, by using multiple sources, potentially conflicting reports will occur (Achenbach, McConaughy, & Howell, 1987). In addition, the lack of a "gold standard" to assess the validity of either a particular symptom, aggregate, or diagnosis as well as the potential instability of answers from different sources further complicate this issue. Several studies have compared parent and child reports of child psychiatric symptoms or child psychiatric diagnoses as assessed by diagnostic interviews, including the Di- agnostic Interview for Children and Adolescents (DICA; Herjanic & Reich, 1982; Reich, Herjanic, Welner, & Gandy, 1982; Welner, Reich, Herjanic, Jung, & Amado, 1987), the Diagnostic Interview Schedule for Children (DISC; Edelbrock, Costello, Dulcan, Calabro Conover, & Kalas, 1986; Loe- ber, Green, Lahey, & Stouthamer-Loeber, 1989; Weissman et al., 1987), and the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS, Chambers et al., 1985; Orvaschel, Puig-Antich, Cham- bers, Tabrizi, & Johnson, 1982). These studies have documented low to moderate agreement on child problems. In general, these reports have found that parents report more behavior symptoms about their children than the children report about themselves, whereas children report having more affective and neurotic symptoms than their parents report about them (Edelbrock et al., 1986; Herjanic & Reich, 1982).

Parents and children often disagree upon the presence, severity, and meaning of child psychiatric problems (Andrews, Garrison, Jackson, Addy, & McKeown, 1993; Chambers et al., 1985; Edelbrock, Costello, Dulcan, Kalas, & Conover, 1985; Kashani, Orvaschel, Burke, & Reid, 1985; Or- vaschel et al., 1982; Reich et al., 1982). Various factors, including gender of the child (Andrews et al., 1993; Herjanic, Herjanic, Brown, & Wheatt, 1975; Reich et al., 1982), age of the child (Edelbrock et al., 1985; Reich et al., 1982), and mental status of the parent (Weissman et al., 1987) have been shown to be related to disagreement between parent and children reports. Although it is possible to speculate about the various reasons for parent-child disagreement, none of these studies, however, has asked parents and children to account for their differences. Child psychiatric diagnoses are usually made on the basis of any positive symptoms reported by either the child and/or the parent, and treatment is determined by diagnoses. If one party reports a symptom and the other does not for reasons other than being uninformed about it or hiding it, maximizing positive responses may not be the optimum strategy.

We attempted to identify some of the reasons for parent-child disagreement by questioning a group of parent-adolescent pairs. We decided to focus our study on adolescents because the problem of parent-youth agreement is thought to be different for adolescents and younger children. For example, Edelbrock et al. (1985) have suggested that, for adolescents,

Suggested Reasons for Expecting Discrepant Answers to PC-DISC Questions 643

this problem centers on them hiding information or facts from the parents, while for younger children it lays in the difficulties they may have in understanding complex abstract concepts and in reporting them accurately because of immature cognitive abilities. For the present study, we chose to focus on symptoms of eight common children/adolescent psychiatric disorders, using questions from the computer-assisted version of the DISC (PC-DISC), the official National Institute of Mental Health (NIMH) structured interview for children. First, we tested the frequency of agreement on the different questions we used, and the direction of discrepancies between child and parent reports of psychiatric symptoms. Second, we asked the subjects to suggest reasons for why they presumed discrepancies between what they answered and what they thought the other member of their dyads would answer. It was hypothesized that the exploration of the participants' views might uncover many different reasons for differences such as: whether one member of the dyad misunderstands or misinterprets behaviors, is reluctant to provide information, is uninformed about the oc- currence, or refuses to believe the evidence.

METHOD

Subjects

The study subjects consisted of 51 adolescent-parent pairs from the St. Louis Metropolitan area. To obtain a range of symptom severity, the pairs were selected from two different populations: (a) a clinical population consisting of families with adolescents treated in the Division of Child Psy- chiatry at Washington University School of Medicine between January 1992 and May 1993, and (b) a community population consisting of families of adolescents attending a single suburban middle school/high school in 1992- 1993. Eighty families (clinical population) and 150 families (community population) were chosen randomly from master lists, and then invited by letter to participate in a study about adolescents' behaviors and feelings. Follow-up phone calls to inform study subjects about the study and to set up interviews were discontinued after 25 pairs of parents and adolescents from the clinical sample and 26 pairs of parents and adolescents from the community sample were interviewed. Mental retardation was the only ex- clusion criteria. Although the rate of refusal was 35% for the clinical sample and 42% for the community sample, such a high rate did result from taking even a weak refusal as a true refusal and from not using any con- version technique because of the time factor and voluntary sample.


All youths interviewed were teenagers except for two who were 12.5 years of age. Mean age was 15.1 + 1.8. The majority of the youths interviewed were white (78.4%) and male (58.8%); 20% were African-Ameri- cans and one subject was Asian. Most of the parents interviewed were biological mothers (80%); the remainder were comprised of biological fa- thers (12%), adoptive mothers (4%), a stepmother (2%), and an uncle (2%). For the purposes of this report, adult informants are all referred to as "parents" and youth informants as "adolescents."

Instrument

For the present study, adolescents were asked 12 questions (see Ap- pendix A) from selected sections (depression/dysthymia, attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, panic disorder, overanxious disorder/generalized anxiety disorder, bulimia, and substance abuse) of the computer-assisted version of the Diagnostic Inter- view Schedule for Children, version 3.0 (PC-DISC). PC-DISC is the revised and computerized version of the National Institute of Mental Health Diag- nostic Interview Schedule for Children (Costello, Edelbrock, & Costello, 1985; Costello, Edelblrock, Dulcan, Kalas, & Klaric, 1984; Costello, Edel- brock, Kalas, Kessler, & Klaric, 1982). It is designed for use by lay interviewers or clinicians to make diagnoses, and is scored by a set of computer algorithms according to Diagnostic and Statistical Manual of Mental Disor- ders (3rd ed. rev.) (DSM-III-R; American Psychiatric Association, 1987) criteria (Shaffer et al., 1993). Symptoms used to make diagnoses are those reported by a child, his or her parent, or by both the parent and child. PC-DISC does not make lifetime diagnoses; with only a few exceptions, only symptoms present within the past 6 months are ascertained. For the present study, questions selected addressed relatively common internalizing symptoms (feeling sad/worthless, feeling frightened/panicked, having a lot of headaches, worry about overweight), common externalizing symptoms (trouble staying seated, losing one's temper, skipping class, belonging to a gang), and substance use symptoms (ever drinking alcohol on one's own, ever smoking cigarettes, and ever smoking marijuana). Parents were asked to answer the same 12 questions about their children (e.g., "In the past 6 months, were there times when [ADOLESCENT'S NAME] seemed to be very sad?") from the parent version of the PC-DISC interview.

After the adolescent and the parent gave their responses, each was asked to guess what the other's answer to the 12 questions would be. To assist in this process, a modification of the Discrepancy Interview Protocol (Cottler et al., 1994) was used. For example, after the adolescent was asked


about being sad, he or she was asked: "If I asked your [mother/father]: In the past 6 months, were there times when [ADOLESCENT'S NAME] seemed to be very sad? What do you think s/he would say?" The corre- sponding ques t ion for the pa ren t was fol lowed by: " I f I asked [ADOLESCENT'S NAME]: [ADOLESCENT'S NAME], In the past 6 months, were there times when you were very sad? What do you think s/he would say?" If the guessed answer differed from what the parent or adolescent had answered for the adolescent's symptom, the subject was then asked why he or she expected the other person to answer differently. No information about actual or guessed answers was shared with the other person. Answers were recorded verbatim.

Procedures

Face-to-face interviews took place between May and August 1993. Af- ter informed consent was obtained, a parent and his or her child were interviewed simultaneously in separate rooms. Ten interviewers participated in this study. All the interviewers were blind to the psychiatric status of the adolescents interviewed, and each had received extensive training for the administration of the PC-DISC questions and the discrepancy questions.

Although none of the 12 questions asked was used to assess psychiatric disorders in the children, those in the clinical sample had chart diagnoses of depressive disorders (60%), oppositional-defiant disorders (28%), attention deficit hyperactivity disorder (24%), conduct disorder (20%), anxiety disorders (16%), nonorganic psychoses (16%), polysubstance abuse (8%), alcohol abuse (4%), and parent-child problems (4%). Fifteen (60%) children had two or more psychiatric diagnoses. Half of the diagnoses (52%) had been made within the last 6-month period covered by the PC-DISC interview.

Data Analyses

The McNemar's chi square test was used to compare the parent's and the adolescent's reporting of symptoms. A p < .05 was considered significant evidence that the parent's assessment differed from the adolescent's assessment in a nonrandom fashion. Overall agreement between parent and adolescent answers was determined by the kappa (~) statistic (Cohen, 1960). According to Landis and Koch (1977), kappa values greater than .75 represent excellent agreement, values below .40 represent poor agree-


ment, and values between .40 and .75 represent fair to good agreement. Means are reported with their standard deviations.

RESULTS

Of the 51 adolescent-parent pairs interviewed about the adolescents' symptoms, 48 pairs answered all 12 questions (three parents did not know the answer to one question). The parent and adolescent answers were identical for all 12 questions in only three pairs, and identical for six or fewer questions in three other pairs. In 11 pairs (22.9%), the answers of both the parents and the adolescents were the same for all but one question. In nine pairs (18.8%), the parents' and the adolescents' answers were identical for 10 questions; in 12 pairs (25%), they were identical for nine questions; in five pairs (10.4%), they were the same for eight questions; and in five pairs (10.4%), they were the same for seven of the 12 questions. The median number of questions answered the same way by both the parents and the adolescents was 9 out of the 12 possible.

The level of agreement between parent and adolescent reporting positive adolescent symptoms is displayed in Table I. As shown in the table, feeling sad, losing one's temper, and alcohol use were the 3 symptoms of the 12 assessed with highest prevalence whether the adolescent's or the parent's response was counted. In contrast, belonging to a gang and worrying about being fat or becoming fat were the two symptoms with the lowest reported frequency. Adolescents more often than their parents said that they had drunk alcohol on their own, smoked cigarettes or marijuana, worried about their being overweight, had a lot of headaches, and fre- quently lost their temper. Parents more often than the adolescents reported the adolescent feeling sad or worthless, having trouble staying seated, cutting class, and feeling frightened or panicked. However, with the exception of alcohol use, none of these differences between parents' and adolescents' reporting was statistically significant. The number of pairs with discrepant responses ranged from 2 (gang membership) to 19 (trouble staying seated), with a mean of 11 + 5. The kappa values for agreement between parent and adolescent ranged from -.02 (no improvement over chance agreement) to .85 (excellent agreement). The highest agreements between parents' and adolescents' reports were found for gang membership, cutting class, drinking alcohol, smoking cigarettes and using marijuana.

Table II shows the results of our attempt to determine if a parent knows what his or her child will say, and if an adolescent knows what his or her parent will say about the adolescent's feelings or behavior. Thus, for example, when we discuss discrepancies predicted correctly by parents,

Table L Agreement Between Parent and Adolescent Responses to Interview

Symptoms Child

Parent % o f Pairs + - reporting a % of 95%

+ AA ~ B positive Discrepant Confidence - C ~ symptom a pairs Kappa interval

..].

Feeling sad + 21 5 66 25 .48 a (0.25 to 0.72) - 8 17

Feeling + worthless - 12 24

+

10 5 53 33 .29 c (0.03 to 0.55)

Trouble staying seated - 14 30

+ 2 5 41 37 -.02 (-0.25 to 0.21)

+ / Losing temper + 19 ~ 8 65 27 .45 d (0.20 to 0.69)

- 6 | 18

-i-

Cutting class + 15 3 43 13 .70 d (0.50 to 0.90) - 4 29

+

Belonging + 7___[ 1 18 4 .85 d (0.65 to 1.05) to a gang - 1 ] 42

Feeling + - frightened or + 1 4 30 27 -.01 (-0.25 to 0.22) panicked - 10 35

Having a lot + - of headaches + 4 12 41 33 .12 (-0.15 to 0.39)

- 5 30

Worrying about + - being fat or + 4 4 22 13 .45 a (0.11 to 0.79) becoming fat - 3 40

+

Ever drinking + 20 10 63 21 .56 d (0.35 to 0.77) alcohol b - 1 18

..l-

E v e r smoking + 19 7 55 17 .64 d (0.44 to 0.85) cigarettes - 2 23

+

Ever smoking + 7 { 6 27 13 .58 d (0.31 to 0.85) mari juana 1 37

aSymptom reported by either the adolescent only, the parent only, or both in each pair. bReported significantly more by adolescents than by parents. ~ p < .05.

< .001.

648 Bidaut-Russel l et aL

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we are talking about the ability of a parent to predict that what he or she is reporting about his or her child will be different from the answer the adolescent will give. Overall (columns 5 and 6 in Table II), adolescents were better than parents at predicting that parent-adolescent answers would be discrepant for six questions: feeling worthless, cutting class, worrying about being fat or becoming fat, ever drinking alcohol on one's own, ever smoking cigarettes, and ever smoking marijuana. Parents were better than their children at predicting the other member of the dyad's opposite answer to one question only: having trouble staying seated. For five questions, parents and adolescents tied in correctly predicting discrepancies.

Adolescents, whether they reported a symptom was present or absent, did a poor job at guessing their parents' opposite answer. For example, only a small percentage (12 to 20%) of the adolescents were able to predict correctly that their parents would not report them losing their temper, having a lot of headaches, feeling sad, or having trouble staying seated (column 1 of Table II). Adolescents were good at predicting their parents' positive answers to one question only: that asking if the adolescent often lost his or her temper (column 3). Parents did an even poorer job at predicting their children's perceptions when they differed from their own (columns 2 and 4). Data were not presented when the number of discrepant pairs in which the adolescent or parent was able to correctly guess the other's answer was smaller than 5.

Although in many cases parents and adolescents did a poor job of predicting what the other member of their dyads would say, the comments of those who did indeed predict the other's opposite answer are quite informative (see Appendix B). Sixty-six comments were made, mostly (72.8%) by the clinical sample and their parents. Most respondent (87%) gave only one answer. To simplify, we have attempted to group comments into categories of related answers. The reasons given by the adolescents for their parents denying the symptoms the adolescents had reported can be grouped into three main categories. First, the parent was unaware of the adolescent's feeling or behavior, either because the adolescent did not tell the parent about it (n = 12), or did not show his/her feelings (n = 3), lied to the parent (n = 1), or because the parent did not pay attention to the adolescent (n = 1). Second, the parent knew but forgot (n = 1), or trivialized (n = 2) the adolescent's symptoms. Third, the parent assumed the adolescent could not behave like that (smoking marijuana) (n = 1). The reasons given by the adolescents concerning a parent reporting symptoms in his or her child that the adolescent denied were grouped into five different categories: (a) The parent misread the adolescent's feelings (feeling sad/worthless) (n = 4) or interpreted the adolescent's behavior differently (losing temper) (n = 3); (b) the parent put a negative label on the ado-


lescent [(feeling worthless (n = 1), smoking marijuana (n = 1)]; (c) the parent's expectations for the adolescent's behavior were too high (trouble staying seated) (n = 3); (d) the parent exaggerated the problem [(feeling frightened or panicked) (n = 1), (losing temper) (n = 1)]; and (e) the parent did not trust the adolescent (hanging around a group of kids who get into a lot of trouble) (n = 1).

The reasons given by the parents for expecting their children to deny symptoms the parents thought were present consisted of the following: (a) The adolescent did not recognize his/her true feeling or behavior (n = 11); (b) the adolescent did not remember how s/he felt (n = 1); (c) the adolescent minimized the importance or frequency of the feeling/behavior (n = 3); (d) the adolescent lied (smoking marijuana) (n = 1). Finally, parents gave three main reasons to explain why they thought their children would report a symptom the parent denied: (a) The adolescent interpreted the symptom differently (feeling sad) (n = 3); (b) the adolescent exaggerated the importance of his/her feeling (n = 3) or behavior (n = 3); and (c) the adolescent lied (having a lot of headaches) (n = 1).

DISCUSSION

This is the first time, to our knowledge, that parents and adolescents have been systematically asked for and have given what they consider to be the reasons for discrepant answers. This study indicates that there was some degree of disagreement between parent and child in answering each of the 12 questions asked from the PC-DISC interview, although agreement was substantial. A particularly striking finding was the poor job both parents and adolescents did at predicting what the other member of their dyads would say.

An important question in adolescent psychiatric clinical and epidemio- logical studies is whom to believe when parent and child disagree; thus, we felt it was particularly important to evaluate not only the level of the agreement but the direction of discrepancies. In the present study, for example, despite a good kappa (.56), report of alcohol drinking by the adolescent but not by the parent accounted for 32% of the symptom's frequency. It is clear that one cause of disagreement between adolescent and parent is that some adolescents deliberately conceal such behavior from their parents. No structured interview, however well worded, could achieve good agreement under these conditions. Therefore, rather than focusing on agreement between parent and adolescent, we show that it is important to evaluate more carefully the different sources of information. For example, adolescents who conceal the truth regarding drinking alcohol from


their parents would have less reason to lie to an interviewer who promises confidentiality. In this case, the parent's wrong answer would reflect his or her lack of knowledge, and there would be no reason not to believe the adolescent rather than the parent.

The reasons for discrepancies given by parents and adolescents probably indicate the common difficulty of communicating with each other concerning problematic behaviors or emotions. As expected, the tendency to exaggerate or minimize a symptom, misperception, misinterpretation, and lack of awareness were some of the reasons given. Two other suggested reasons, parental expectation and lack of trust, are of particular interest. Some adolescents felt that their parents had too high expectations about them, while others suggested that a parent's report would be strongly influenced by how the parent saw the adolescent. If true, such parental behavior may have important consequences: For example, if the parent sees the adolescent in a positive way s/he may then be more likely to deny negative symptoms in the adolescent; however, if the adolescent is seen in a negative way the parent may report more symptoms in the adolescent than s/he really has. While some parents suggested that their adolescents lied and some adolescents admitted lying to their parents, some adolescents said they were either afraid to talk to or felt ignored by their parents. It thus seems that parent-adolescent relationship is an additional factor to consider when trying to identify reasons for discrepancies. However, it may be difficult to determine what is the optimum threshold of communication between parent and adolescent that would minimize discrepant answers. The answer to "what is a normal or good level of communication between parent and child" is highly subjective. In addition, it would be quite unre- alistic to expect an adolescent to tell his or her parent all about his or her problems or a parent to be able to always either sense, know about, ac- knowledge, or talk easily to his or her child about what may be a behavioral or emotional problem.

While adolescents were better than parents at predicting the denial of symptoms by the other member of their dyads, the adolescents' better pre- dictions were based mainly on having done things secretly that the parents would probably disapprove of, e.g., drinking alcohol. It seems unfortunate that neither parents nor adolescents were very good at predicting the others' answers to the questions on depression, and that adolescents in discrepant pairs thought their parents knew about their feelings of sadness and worthlessness. While some adolescents, for various reasons, may not be willing to tell their parents about their feelings, our study suggests that the adolescent tends to assume that the parent realizes something is wrong. If true, the adolescent may expect the parent to do something about it. However, if the parent is unaware of the adolescent's feeling, s/he will have

652 Bidaut-Russdl et al.

problems in fulfilling the adolescent's expectations, and thus unknowingly may increase the potential for disagreement.

This study had several limitations. First, it focused on symptoms rather than on diagnoses. However, although disagreement on a particular symptom may have had little influence on the final diagnosis, particularly when a positive report from either the child or the parent was counted, the sources for disagreement can be seen more easily at the symptom level. Second, the small size of the study sample was quite limiting. For example, it may be in part responsible for the lower kappas and the opposite direction of reporting of symptoms of losing temper and cutting class as compared to those reported by Loeber et al. (1989). The differences in direction and frequency of parent and adolescent reports observed for most symptoms might have become significant had the study sample been larger. Also, it would also have been quite informative to look at the influence of various variables including age and sex of the offspring, clinical versus community status, psychiatric diagnosis, family functioning, differences in parental fig- ure, and gender of the reporting parent among others, had the sample been larger. Third, sampling bias may have occurred, and the results of this study might have been different had different population samples been used. Al- though we could not determine it, the people who refused to participate in the study may have differed in some meaningful way from those who agreed to participate. Bias may also have resulted from the parents of adolescents in the clinical sample giving answers influenced by their discussions of their children's mental health with mental health professionals. Finally, the fact that, for reasons of confidentiality, we could not confirm within each discrepant pair whether the reasons given by the adolescent or the parent for their presumed discrepancies were true constitutes another limi- tation of the study. Although these reasons were just guesses, it is the first time, however, that such reasons were directly assessed. Considering all the limitations mentioned above, the findings of this study should thus be considered preliminary.

In summary, this study points out the difficulties some adolescents have in communicating with their parents, and the difficulties some parents have in assessing and understanding their children's feelings and behaviors. After showing that the reasons for disagreement between parents and adolescents are many and complex, the next logical step would be to try to come up with a method to incorporate these findings into a better research interview. However, this is a difficult task, and well beyond the scope of this article. Further studies to help increase our understanding of discrepancies between parent and adolescent reports of psychiatric symptoms could include learning about how adolescents assess their own mental health, and to whom these adolescents would be willing to talk if they felt


they had such symptoms, while assessing the parent-adolescent relationship to probe the likelihood of good communication.

APPENDIX A

Questions asked of the adolescent: 1. In the past 6 months, were there times when you were very sad?

(depression/dysthymia) 2. Have you been more down on yourself than usual, when you felt

you couldn't do anything right? (depression/dysthymia) 3. Do you have trouble staying in your seat at home? For example,

when you are eating at the table or watching TV or doing your homework? (attention deficit hyperactivity disorder)

4. Since [NAME EVENT/MONTH OCCURRING 6 MONTHS AGO] have you often lost your temper, like shouting, breaking things or hitting people? (oppositional-defiant disorder)

5. Have you skipped class or played hooky from school [taken off from work without asking] in the past year? (conduct disorder)

6. Do you belong to a gang or hang around with a group of kids who get into a lot of trouble? (conduct disorder)

7. In the past 6 months, have there been times when you felt very frightened or panicked and didn't know why? (panic)

8. In the last 6 months , have you had a lot of headaches? (overanxious disorder/generalized anxiety disorder)

9. In the past 6 months, have you done things that make you think you might be worried about being fat or becoming fat? (bulimia)

10. Have you ever in your life drunk beer, wine, wine coolers, hard liquor or any other alcoholic drinks on your own? (alcohol abuse)

11. Have you ever in your life smoked cigarettes? (substance abuse) 12. Have you ever in your life smoked marijuana (pot, weed) or

Hashish (hash)? (substance abuse)

APPENDIX B

Reasons for discrepancies given by adolescents and parents who predicted correctly that the other would disagree: (Note: Numbers in paren- theses given under Reasons headings indicates the frequency of responses when given more than once).

654

Feeling Sad/Worthless (Depression)

Bidaut-Russell eta/.

Child's prediction

Child's Parent's of parent's Answer Answer answer Reasons

Yes No No No Yes Yes

I don't show my sad feelings. (3) I was down but not very sad, I was thinking about

a friend who got killed. Mom thinks she knows when I am depressed, but I

don't think it shows. Morn doesn't know. Morn says there must be a reason why I am cranky,

but sometimes there is no reason. Mom always says that I am in a bad mood, but I am not. I don't know.

Parent' prediction

Child's Parent's of child's Answer Answer answer Reasons

Yes No

No Yes

Yes He may have been inwardly sad, but he displayed anger.

He broke up with his girlfriend, he was probably sad but didn't show it much.

He is more frustrated/worried about his future than sad, due to college-making decisions.

She has mood swings due to premenstrual syndrome (hormonal changes), and her emotions go up and down.

No She doesn't understand her own feelings. S/he won't admit her/his feelings. (2) She is on medication and doesn't remember how bad

she felt.

Trouble Staying Seated (Attention Deficit Disorder)

Child's prediction



Because my mother just does not pay attention. My mother wants me to stay sit for longer periods of

time. My mother thinks that I get up a lot when doing

my homework; she says she wasn't like that when she was young.

I have that problem with long periods of time, then my mother complains.


Parent's prediction


Yes No Yes

No Yes No

She gets up only when she has a reason, but she would say she is antsy.

He would think that I am unfair; he would say that's the way he is.

She is hyperactive, she doesn't recognize her own behavior.

She would say" "It doesn't happen all the time." He thinks the problems with sitting still only happens

at school. He doesn't seem to notice. He doesn't like to admit things. He's just on the go, he has too much to do. He won't set priorities; he won't do important things

first. He wants to help other people without regard to his own needs.

Losing Temper (Oppositional-Defiant Disorder)

Child's prediction



My mother does not know I lie about things. My mother would take that question to mean arguing,

while to me it means fighting. I don't know what it sounds like when I lose my

temper, but my Mom does. I raise my voice but it is only talking, my Morn takes

it to mean arguing. It seldom happens, very few times.

Parent's prediction


Yes No

No Yes

Yes It's part of growing up, normal behavior. He is strict with himself.

No He doesn't see it as a problem; he thinks it's normal. He doesn't admit it. She may not realize it.

656

Cutting Class/Belonging to a Gang (Conduct Disorder)

Bidaut-Russell et al.

Child's prediction



My mother never found out. Some of my friends have been in trouble before but

not anymore, my mother still thinks these kids are in trouble.

Parent's prediction


No Yes No He thinks that I exaggerate; he does not look at his friends "in that light."

Feeling Frightened or Panicked (Panic Disorder)

Child's prediction


Yes No

No Yes

No I did not tell anyone. It does not happen often.

Yes My mom sometimes overreacts.

Child's Answer

Parent's Answer

Parent's prediction of child's

answer Reasons

Yes No

No Yes

Yes She tends to dramatize. She started a new school, it was new to her, she

felt frightened. No He does not want to admit his fears.

Having a Lot of Headaches (Overanxious Disorder/Generalized Anxiety Disorder)

Child's prediction


Yes No No I never told my morn about it. I did not say anything because my mother would be

unsympathetic.


Parent's prediction


Yes No Yes She says she has headaches in order to manipulate me. I know she has headaches even though she does

not tell me.

Worrying About Being Fat or Becoming Fat (Bulimia)

Child's prediction


Yes No No Because I don't tell my morn.

Ever Drinking Alcohol (Alcohol Abuse)

Child's prediction


Yes No No Because I don't tell my mom. (4)

Ever Smoking Cigarettes

Child's prediction


Yes No No My father/mother doesn't know. (2) I'm not sure my mother would remember.

Ever Smoking Marijuana (Drug Abuse)

Child's prediction


Yes No No I never told my mother about it. Morn is very naive and sheltered. I've only done it once.

No Yes Yes My mother thinks I'm worse than I am.


Parent's prediction


No Yes No He says he doesn't believe in drugs, but marijuana showed up in a drug test.

R E F E R E N C E S

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