Informant (Dis)Agreement on Ratings of Challenging Behaviors and Social Communication in Preschool Children With Autism Spectrum Disorder

Purpose Cross-informant ratings are considered best practice for assessing children with autism spectrum disorder (ASD). However, informant disagreement often occurs, which can pose significant challenges to various aspects of clinical services. This study explored the degree of parent and speech-language pathologist (SLP) agreement on ratings of challenging behaviors and social communication skills in preschool children with ASD. Method Fifty-eight informant ratings of challenging behaviors and social communication skills were collected from parents and SLPs on the same 29 preschool children with ASD ( M = 49.93 months, SD = 11.67 months) using the Pervasive Developmental Disorder Behavior Inventory. Parent versus SLP group rating comparisons were assessed with paired t tests and Cohen's d effect sizes. Intraclass correlation coefficients were calculated to examine interrater reliability between individual parent and SLP ratings. Bland–Altman plots were generated to evaluate informant agreement across the entire range of Pervasive Developmental Disorder Behavior Inventory composite scores. Results Group comparisons indicated that parents rated arousal regulation problems as more severe than SLPs, with no other group differences observed. Parents and SLPs exhibited poor agreement on ratings of challenging behaviors; however, moderate to good agreement was observed for social communication ratings. Conclusions These results highlight the importance of including parents in the assessment and treatment planning process for preschool children with ASD, as parents may report key behavioral concerns that clinicians may not otherwise observe. Understanding behaviors that may be more prone to informant disagreement has implications for promoting a shared understanding of behavioral concerns and treatment targets between parents and clinicians.

Cross-Informant Disagreement on Behavioral Symptoms in Adolescent Attention-Deficit/Hyperactivity Disorder and Its Impact on Treatment Effects

In assessing adolescent behavior difficulties, parents, teachers, and the adolescents themselves are key informants. However, substantial disagreement has been found between informants. Specifically, children with attention-deficit/hyperactivity disorder (ADHD) tend to overestimate their competencies, also known as “positive (illusionary) bias.” This study compared parent, teacher, and adolescent ratings of ADHD and other behavioral symptoms in a sample of 114 adolescents with ADHD. Further, the effect of cross-informant disagreement (CID) on treatment outcomes was investigated in a subsample of 54 adolescents who had undergone a training and coaching intervention. Overall, there was moderate agreement among informants. Parent and adolescent ratings were more strongly correlated with each other than with teacher ratings. The strongest discrepancy was found between teacher and adolescent ratings on prosocial behavior. This discrepancy explained 12% of the variance in parent-rated ADHD symptom severity after the intervention. The treatment was less effective in participants with high teacher-adolescent disagreement on prosocial behavior (d = 0.41) than with low disagreement (d = 0.98). These findings suggest that professionals working with adolescents with ADHD should consider multiple sources of information before initiating treatment and pay attention to cross-informant disagreements because these may indicate a risk of diminished treatment effects.

Evaluating Parental Disagreement in ADHD Diagnosis: Can We Rely on a Single Report From Home?

Objective: Few studies assessed factors associated with the agreement/disagreement between fathers and mothers when rating ADHD symptoms of their offspring. Method: Teachers and both parents assessed a referred sample of 98 children and adolescents aged 6 to 16 years ( M age = 9.79, SD = 2.59) using the Swanson, Nolan, and Pelham (SNAP-IV) rating scale. The agreement was assessed for each of the items of the scale and correlated with variables measuring children’s features, socioeconomic adversity, family functioning, and parental psychopathology. Results: Mean agreement between parents was moderate for the inattentive and good for the hyperactive-impulsive construct. Mothers tended to report more symptoms than fathers. The agreement was lower in those families where parents had discrepant educational levels. Conclusion: Our findings suggest a significant cross-informant disagreement between parents on symptoms of ADHD. Discrepant parental education has a relevant role in explaining parental disagreement in reporting ADHD symptoms.