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Teens and Parents Often Differ in Reporting on Mental Health Symptoms


When a teen needs help with mental health challenges, it may not be easy getting started. “Initial psychiatric evaluations with teens can be tense at times, especially when there is a disagreement about the reason for the appointment,” notes Kalpana Miriyala, M.D., a child and adolescent psychiatrist and assistant professor at Marshall University in Huntington, W.Va. The teen may feel picked on and that the psychiatrist or other mental health provider is aligning with the parents.

A new study presented at the APA Annual Meeting in New York City found frequent disagreement between parent and child in reporting on mental health symptoms. The study, led by Miriyala, was conducted to assess agreement between parent and child using special surveys that were designed to assess symptoms based on the parents’ and teens’ perceptions.

The study involved youth age 11 to 17 in treatment for mental health conditions, primarily for diagnoses of ADHD, major depression or generalized anxiety. The teens and their parents were given surveys before their appointments at a university child and adolescent psychiatry clinic.

Seventy pairs of completed surveys showed wide variation. Two-thirds of the questions had low agreement between parents and teens, six questions showed good agreement and only three questions showed excellent agreement. Symptom categories with the lowest agreement were inattention, anger, irritability, and psychosis. The highest degree of agreement was in questions addressing substance abuse.

Two questions addressed suicide. There was very high agreement on a question asking if suicide has been attempted. A question asking if there have been thoughts of suicide (child survey) or talk of suicide (parent survey) had very low agreement. It was answered positively more often by the parent than by the child.

The study emphasizes the importance of gathering information about each domain from both sources when evaluating adolescents, the authors note. The questionnaire allows each the privacy to report their observations across a wide spectrum of symptoms without feeling negated. It allows the psychiatrist or other provider to give real-time feedback and to bring up points of disagreement in a sensitive manner.

“Sometimes both parents and teens are surprised at how much they agree upon things and this helps lower the tension in the room,” Miriyala notes. “Areas of agreement can be starting points as targets for therapy that are acceptable to both.”


Do Parents and Children Report the Same Psychiatric Symptoms? Comparison of DSM-5 Level 1 Self and Parent-Reported Cross Cutting Symptom Measures. Presented at the 2018 American Psychiatric Association Annual Meeting by Mark Peterson, Marshall University.


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