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January 1995, Vol 52, No. 1 >
Article | January 1995

Test-Retest Reliability of the Diagnostic Interview Schedule for Children (DISC 2.1): Title and subTitle BreakParent, Child, and Combined Algorithms

Peter Jensen, MD; Margaret Roper, MS; Prudence Fisher, MS; John Piacentini, PhD; Glorisa Canino, PhD; John Richters, PhD; Maritza Rubio-Stipec, MA; Mina Dulcan, MD; Sherryl Goodman, PhD; Mark Davies, MPH; Donald Rae, MS; David Shaffer, MD; Hector Bird, MD; Benjamin Lahey, PhD; Mary Schwab-Stone, MD
Arch Gen Psychiatry. 1995;52(1):61-71. doi:10.1001/archpsyc.1995.03950130061007
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Background:  Previous research has not compared the psychometric properties of diagnostic interviews of community samples and clinically referred subjects within a single study. As part of a multisite cooperative agreement study funded by the National Institute of Mental Health, 97 families with clinically referred children and 278 families identified through community sampling procedures participated in a test-retest study of version 2.1 of the Diagnostic Interview Schedule for Children (DISC 2.1).

Methods:  The DISC was separately administered to children and parents, and diagnoses were derived from computer algorithms keyed to DSM-III-R criteria. Three sets of diagnoses were obtained, based on parent information only (DISC-P), child information only (DISC-C), and information from either or both (DISC-PC).

Results:  Test-retest reliabilities of the DISC-PC ranged from moderate to substantial for diagnoses in the clinical sample. Test-retest κ coefficients were higher for the clinical sample than for the community sample. The DISC-PC algorithm generally had higher reliabilities than the algorithms that relied on single informants. Unreliability was primarily due to diagnostic attenuation at time 2. Attenuation was greatest among child informants and less severe cases and in the community sample.

Conclusions:  Test-retest reliability findings were consistent with or superior to those reported in previous studies. Results support the usefulness of the DISC in further clinical and epidemiologic research; however, closely spaced or repeated DISC interviews may result in significant diagnostic attenuation on retest. Further studies of the test-retest attenuation phenomena are needed, including careful examination of the child, family, and illness characteristics of diagnostic stability.

REFERENCES

1 +
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987;.
2 +
Chambers W, Puig-Antich J, Hirsch M, Paez P, Ambrosini P, Tabrizi M, Davies M.  The assessment of affective disorders in children and adolescents by semi-structured interview . Arch Gen Psychiatry . 1985;;42:696-702.
3 +
Guttermann E, O'Brien J, Young G.  Structured Diagnostic Interviews for Children and Adolescents: current status and future directions . J Am Acad Child Adolesc Psychiatry . 1987;;26:621-630.
4 +
Schwab-Stone M, Fisher P, Piacentini JC, Shaffer D, Gioia P, Davies M.  The Diagnostic Interview Schedule for Children—Revised Version (DISC-R), II: test-retest reliability . J Am Acad Child Adolesc Psychiatry . 1993;;32:651-657.
5 +
Piacentini J, Shaffer D, Fisher P, Schwab-Stone M, Davies M, Gioia P.  The Diagnostic Interview Schedule for Children—Revised Version (DISC-R), III: concurrent criterion validity . J Am Acad Child Adolesc Psychiatry . 1993;;32:658-665.
6 +
Shaffer D, Schwab-Stone M, Fisher P, Cohen P, Piacentini J, Davies M, Edelbrock C, Regier D.  The Diagnostic Interview Schedule for Children—Revised Version (DISC-R), I: preparation, field testing, interrater reliability, and acceptability . J Am Acad Child Adolesc Psychiatry . 1993;;32:643-650.
7 +
Cohen P, O'Connor P, Lewis S, Velez N, Malachowsky B.  Comparison of DISC and K-SADS-P interviews of an epidemiological sample of children . J Am Acad Child Adolesc Psychiatry . 1987;;26:662-667.
8 +
Costello E, Edelbrock C, Costello A.  Validity of the NIMH Diagnostic Interview Schedule for Children: a comparison between psychiatric and pediatric referrals . J Abnorm Child Psychol . 1985;;13:579-595.
9 +
Edelbrock C, Costello AJ, Dulcan MK, Conover NC, Kalas R.  Age differences in the reliability of the psychiatric interview of the child . Child Dev . 1988;;56:265-275.
10 +
Fisher P, Shaffer D, Piacentini J, Lapkin J, Kafantaris V, Leonard H, Herzog D.  Sensitivity of the Diagnostic Interview Schedule for Children, 2nd edition (DISC-2.1), for specific diagnoses of children and adolescents . J Am Acad Child Adolesc Psychiatry . 1993;;32:666-673.
11 +
Schwab-Stone M, Fallon T, Briggs M, Crowther B.  Reliability of diagnostic testing for children ages 6-11 years: a test-retest study of the Diagnostic Interview Schedule for Children—Revised . Am J Psychiatry . 1994;;151:1048-1054.
12 +
Lewis SA. Gorsky A, Cohen P, Hartmark C.  The reactions of youth to diagnostic interviews . J Am Acad Child Adolesc Psychiatry . 1985;;24:750-755.
13 +
Helzer JE, Robins LN, McEvoy LT, Spitznagel EL, Stolzman RK, Farmer A, Brockington IF.  A comparison of clinical and Diagnostic Interview Schedule diagnoses . Arch Gen Psychiatry . 1985;;42:657-666.
14 +
Helzer J, Robins L, Croughan J, Welner A.  Renard Diagnostic Interview: its reliability and procedural validity with physicians and lay interviewers . Arch Gen Psychiatry . 1981;;38:393-398.
15 +
Rice JP, Rochberg N, Endicott J, Lavori PW, Miller C.  Stability of psychiatric diagnoses: an application to the affective disorders . Arch Gen Psychiatry . 1992;;49:824-830.
16 +
Andreasen NC, Grove WM, Shapiro RW, Keller MB, Hirschfeld RMA, McDonald-Scott P.  Reliability of lifetime diagnosis . Arch Gen Psychiatry . 1981;;38:400-405.
17 +
Anthony JC, Folstein M.  Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis . Arch Gen Psychiatry . 1985;;42:667-675.
18 +
Bird H, Gould M, Staghezza B.  Aggregating data from multiple informants in child psychiatry epidemiological research . J Am Acad Child Adolesc Psychiatry . 1992;;31:78-85.
19 +
Piacentini JC, Cohen P, Cohen J.  Combining discrepant diagnostic information from multiple sources: are complex algorithms better than simple ones? J Abnorm Child Psychol . 1992;;20:51-63.
20 +
Jensen PS, Bloedau L, Davis H.  Children at risk, II: predictors of clinic utilization . J Am Acad Child Adolesc Psychiatry . 1990;;29:804-812.
21 +
Rubio-Stipec M, Canino G, Shrout P, Dulcan M, Freeman D, Bravo M.  Psychometric properties of parents and children as informants in child psychiatry epidemiology in the Spanish Diagnostic Interview Schedule for Children (DISC-2) . J Abnorm Child Psychol . 1994;;22:1-18.
22 +
Boyle MH, Offord DR, Racine Y, Sanford M, Szatmari P, Fleming JE, Price-Munn N.  Evaluation of the Diagnostic Interview for Children and Adolescents for use in general population samples . J Abnorm Child Psychol . 1993;;21:663-681.
23 +
Hodges K.  Structured interviews for assessing children . J Child Psychol Psychiatry . 1993;;34:49-68.
24 +
Shrout PE, Spitzer RL, Fleiss J.  Quantification of agreement in psychiatric diagnosis revisited . Arch Gen Psychiatry . 1987;;44:172-177.
25 +
Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WW, Locke BZ.  The NIMH Epidemiologic Catchment Area Program: historical context, major objectives, and study population characteristics . Arch Gen Psychiatry . 1984;;41:934-941.
26 +
Kraemer HC.  Charlie Brown and statistics: an exchange . Arch Gen Psychiatry . 1987;;44:192-193.
27 +
Novack AH, Bromet E, Neill TK, Abramovitz RH, Storch S.  Children's mental health services in an inner-city neighborhood . Am J Public Health . 1975;;65:133-138.
28 +
Offord DR, Boyle NH, Szatmari P, Rae-Grant NI, Links PS, Cadman DT, Byles JA, Crawford JW, Blum HM, Byrne C, Thomas H, Woodward CA.  Ontario Child Health Study, II: six-month prevalence of disorder and rates of service utilization . Arch Gen Psychiatry . 1987;;44:832-836.
29 +
McGee R, Feehan M, Williams S, Anderson J.  DSM-III disorders from age 11 to age 15 years . J Am Acad Child Adolesc Psychiatry . 1992;;31:50-59.
30 +
Rohde P, Lewinsohn PM, Seeley JR.  Comorbidity of unipolar depression, II: comorbidity with other mental disorders in adolescents and adults . J Abnorm Psychol . 1991;;100:214-222.
31 +
Robins L.  Epidemiology: reflections on testing the validity of psychiatric interviews . Arch Gen Psychiatry . 1985;;42:918-924.
32 +
Jenkins CD, Hurst MW, Rose RM.  Life changes: do people really remember? Arch Gen Psychiatry . 1979;;36:379-384.
33 +
Jensen PS, Traylor J, Xenakis SN, Davis H.  Child psychopathology rating scales and interrater agreement, I: parents' gender and psychiatric symptoms . J Am Acad Child Adolesc Psychiatry . 1988;;27:442-450.
34 +
Landis JR, Koch GG.  The measurement of observer agreement for categorical data . Biometrics . 1977;;33:766-771.

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1 +
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987;.
2 +
Chambers W, Puig-Antich J, Hirsch M, Paez P, Ambrosini P, Tabrizi M, Davies M.  The assessment of affective disorders in children and adolescents by semi-structured interview . Arch Gen Psychiatry . 1985;;42:696-702.
3 +
Guttermann E, O'Brien J, Young G.  Structured Diagnostic Interviews for Children and Adolescents: current status and future directions . J Am Acad Child Adolesc Psychiatry . 1987;;26:621-630.
4 +
Schwab-Stone M, Fisher P, Piacentini JC, Shaffer D, Gioia P, Davies M.  The Diagnostic Interview Schedule for Children—Revised Version (DISC-R), II: test-retest reliability . J Am Acad Child Adolesc Psychiatry . 1993;;32:651-657.
5 +
Piacentini J, Shaffer D, Fisher P, Schwab-Stone M, Davies M, Gioia P.  The Diagnostic Interview Schedule for Children—Revised Version (DISC-R), III: concurrent criterion validity . J Am Acad Child Adolesc Psychiatry . 1993;;32:658-665.
6 +
Shaffer D, Schwab-Stone M, Fisher P, Cohen P, Piacentini J, Davies M, Edelbrock C, Regier D.  The Diagnostic Interview Schedule for Children—Revised Version (DISC-R), I: preparation, field testing, interrater reliability, and acceptability . J Am Acad Child Adolesc Psychiatry . 1993;;32:643-650.
7 +
Cohen P, O'Connor P, Lewis S, Velez N, Malachowsky B.  Comparison of DISC and K-SADS-P interviews of an epidemiological sample of children . J Am Acad Child Adolesc Psychiatry . 1987;;26:662-667.
8 +
Costello E, Edelbrock C, Costello A.  Validity of the NIMH Diagnostic Interview Schedule for Children: a comparison between psychiatric and pediatric referrals . J Abnorm Child Psychol . 1985;;13:579-595.
9 +
Edelbrock C, Costello AJ, Dulcan MK, Conover NC, Kalas R.  Age differences in the reliability of the psychiatric interview of the child . Child Dev . 1988;;56:265-275.
10 +
Fisher P, Shaffer D, Piacentini J, Lapkin J, Kafantaris V, Leonard H, Herzog D.  Sensitivity of the Diagnostic Interview Schedule for Children, 2nd edition (DISC-2.1), for specific diagnoses of children and adolescents . J Am Acad Child Adolesc Psychiatry . 1993;;32:666-673.
11 +
Schwab-Stone M, Fallon T, Briggs M, Crowther B.  Reliability of diagnostic testing for children ages 6-11 years: a test-retest study of the Diagnostic Interview Schedule for Children—Revised . Am J Psychiatry . 1994;;151:1048-1054.
12 +
Lewis SA. Gorsky A, Cohen P, Hartmark C.  The reactions of youth to diagnostic interviews . J Am Acad Child Adolesc Psychiatry . 1985;;24:750-755.
13 +
Helzer JE, Robins LN, McEvoy LT, Spitznagel EL, Stolzman RK, Farmer A, Brockington IF.  A comparison of clinical and Diagnostic Interview Schedule diagnoses . Arch Gen Psychiatry . 1985;;42:657-666.
14 +
Helzer J, Robins L, Croughan J, Welner A.  Renard Diagnostic Interview: its reliability and procedural validity with physicians and lay interviewers . Arch Gen Psychiatry . 1981;;38:393-398.
15 +
Rice JP, Rochberg N, Endicott J, Lavori PW, Miller C.  Stability of psychiatric diagnoses: an application to the affective disorders . Arch Gen Psychiatry . 1992;;49:824-830.
16 +
Andreasen NC, Grove WM, Shapiro RW, Keller MB, Hirschfeld RMA, McDonald-Scott P.  Reliability of lifetime diagnosis . Arch Gen Psychiatry . 1981;;38:400-405.
17 +
Anthony JC, Folstein M.  Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis . Arch Gen Psychiatry . 1985;;42:667-675.
18 +
Bird H, Gould M, Staghezza B.  Aggregating data from multiple informants in child psychiatry epidemiological research . J Am Acad Child Adolesc Psychiatry . 1992;;31:78-85.
19 +
Piacentini JC, Cohen P, Cohen J.  Combining discrepant diagnostic information from multiple sources: are complex algorithms better than simple ones? J Abnorm Child Psychol . 1992;;20:51-63.
20 +
Jensen PS, Bloedau L, Davis H.  Children at risk, II: predictors of clinic utilization . J Am Acad Child Adolesc Psychiatry . 1990;;29:804-812.
21 +
Rubio-Stipec M, Canino G, Shrout P, Dulcan M, Freeman D, Bravo M.  Psychometric properties of parents and children as informants in child psychiatry epidemiology in the Spanish Diagnostic Interview Schedule for Children (DISC-2) . J Abnorm Child Psychol . 1994;;22:1-18.
22 +
Boyle MH, Offord DR, Racine Y, Sanford M, Szatmari P, Fleming JE, Price-Munn N.  Evaluation of the Diagnostic Interview for Children and Adolescents for use in general population samples . J Abnorm Child Psychol . 1993;;21:663-681.
23 +
Hodges K.  Structured interviews for assessing children . J Child Psychol Psychiatry . 1993;;34:49-68.
24 +
Shrout PE, Spitzer RL, Fleiss J.  Quantification of agreement in psychiatric diagnosis revisited . Arch Gen Psychiatry . 1987;;44:172-177.
25 +
Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WW, Locke BZ.  The NIMH Epidemiologic Catchment Area Program: historical context, major objectives, and study population characteristics . Arch Gen Psychiatry . 1984;;41:934-941.
26 +
Kraemer HC.  Charlie Brown and statistics: an exchange . Arch Gen Psychiatry . 1987;;44:192-193.
27 +
Novack AH, Bromet E, Neill TK, Abramovitz RH, Storch S.  Children's mental health services in an inner-city neighborhood . Am J Public Health . 1975;;65:133-138.
28 +
Offord DR, Boyle NH, Szatmari P, Rae-Grant NI, Links PS, Cadman DT, Byles JA, Crawford JW, Blum HM, Byrne C, Thomas H, Woodward CA.  Ontario Child Health Study, II: six-month prevalence of disorder and rates of service utilization . Arch Gen Psychiatry . 1987;;44:832-836.
29 +
McGee R, Feehan M, Williams S, Anderson J.  DSM-III disorders from age 11 to age 15 years . J Am Acad Child Adolesc Psychiatry . 1992;;31:50-59.
30 +
Rohde P, Lewinsohn PM, Seeley JR.  Comorbidity of unipolar depression, II: comorbidity with other mental disorders in adolescents and adults . J Abnorm Psychol . 1991;;100:214-222.
31 +
Robins L.  Epidemiology: reflections on testing the validity of psychiatric interviews . Arch Gen Psychiatry . 1985;;42:918-924.
32 +
Jenkins CD, Hurst MW, Rose RM.  Life changes: do people really remember? Arch Gen Psychiatry . 1979;;36:379-384.
33 +
Jensen PS, Traylor J, Xenakis SN, Davis H.  Child psychopathology rating scales and interrater agreement, I: parents' gender and psychiatric symptoms . J Am Acad Child Adolesc Psychiatry . 1988;;27:442-450.
34 +
Landis JR, Koch GG.  The measurement of observer agreement for categorical data . Biometrics . 1977;;33:766-771.

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