Diagnosing comorbid psychiatric disorders in substance abusers: validity of the Spanish versions of the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV

OBJECTIVE: The authors' goal was to assess the validity of DSM-IV diagnoses obtained with the Spanish versions of the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) and the Structured Clinical Interview for DSM-IV (SCID) compared with the longitudinal, expert, all data (LEAD) procedure in a group of substance abusers. METHOD: A total of 105 substance abusers recruited at a drug abuse treatment center in Barcelona, Spain, were assessed. The PRISM and SCID were administered blindly by independent research interviewers. LEAD diagnoses were made by two senior psychiatrists who were blind to PRISM and SCID diagnoses. The kappa statistic was used to measure concordance between the LEAD procedure and the PRISM and SCID. RESULTS: Affective and anxiety disorders were diagnosed more frequently by the PRISM and SCID than by the LEAD procedure. Use of the PRISM resulted in more diagnoses of substance-induced depression, and use of the SCID resulted in more diagnoses of primary major depression than the LEAD procedure. Kappas between the LEAD procedure and the PRISM in current major depression, past substance-induced depression, and borderline personality disorder were better than those obtained between the LEAD procedure and the SCID. The concordance among the three methods for diagnoses of current dependence disorders was good or excellent for alcohol, anxiolytic, cocaine, and heroin dependence and fair for cannabis dependence. Abuse diagnoses showed poor concordance. CONCLUSIONS: Using the LEAD procedure as a "gold standard," the authors conclude that the Spanish version of the PRISM seems to be a better instrument than the Spanish version of the SCID for diagnosing major depression and borderline personality disorders in substance abusers.     

Korean version of the diagnostic interview for genetic studies: Validity and reliability

The Diagnostic Interview for Genetic Studies (DIGS), developed in 1994 by the National Institute of Mental Health (NIMH), was translated into Korean and tested for reliability and diagnostic validity. Concurrent validity was tested using the Structured Clinical Interview for DSM-IV (SCID) and clinical diagnoses in 53 patients, most of whom had either schizophrenia or bipolar disorder. Inter-rater reliability was tested in 24 patients. Test-retest reliability was also tested in 17 patients. Overall and specific diagnostic validity for the Korean version of DIGS (DIGS-K) was excellent for most diagnoses. Inter-rater and test-retest reliability for overall and specific diagnoses also ranged from fair to excellent. For schizoaffective disorder, the test-retest reliability of DIGS-K was in a fair range, although the level was lower than that of other diagnoses. However, its diagnostic validity and inter-rater reliability was below fair range. In conclusion, DIGS-K appears to be a reliable interview for major psychiatric disorders.     

Concordance of DSM-IV Axis I and II diagnoses by personal and informant's interview

The validity and reliability of using psychological autopsies to diagnose a psychiatric disorder is a critical issue. Therefore, interrater and test-retest reliability of the Structured Clinical Interview for DSM-IV Axis I and Personality Disorders and the usefulness of these instruments for the psychological autopsy method were investigated. Diagnoses by informant's interview were compared with diagnoses generated by a personal interview of 35 persons. Interrater reliability and test-retest reliability were assessed in 33 and 29 persons, respectively. Chi-square analysis, kappa and intraclass correlation coefficients, and Kendall's tau were used to determine agreement of diagnoses. Kappa coefficients were above 0.84 for substance-related disorders, mood disorders, and anxiety and adjustment disorders, and above 0.65 for Axis II disorders for interrater and test-retest reliability. Agreement by personal and relative's interview generated kappa coefficients above 0.79 for most Axis I and above 0.65 for most personality disorder diagnoses; Kendall's tau for dimensional individual personality disorder scores ranged from 0.22 to 0.72. Despite of a small number of psychiatric disorders in the selected population, the present results provide support for the validity of most diagnoses obtained through the best-estimate method using the Structured Clinical Interview for DSM-IV Axis I and Personality Disorders. This instrument can be recommended as a tool for the psychological autopsy procedure in post-mortem research.     

Diagnostic interview for genetic studies (DIGS): inter-rater and test-retest reliability of the French version

The National Institute of Mental Health developed the semi-structured Diagnostic Interview for Genetic Studies (DIGS) for the assessment of major mood and psychotic disorders and their spectrum conditions. The DIGS was translated into French in a collaborative effort of investigators from sites in France and Switzerland. Inter-rater and test-retest reliability of the French version have been established in a clinical sample in Lausanne. Excellent inter-rater reliability was found for schizophrenia, bipolar disorder, major depression, and unipolar schizoaffective disorder while fair inter-rater reliability was demonstrated for bipolar schizoaffective disorder. Using a six-week test-retest interval, reliability for all diagnoses was found to be fair to good with the exception of bipolar schizoaffective disorder. The lower test-retest reliability was the result of a relatively long test-retest interval that favored incomplete symptom recall. In order to increase reliability for lifetime diagnoses in persons not currently affected, best-estimate procedures using additional sources of diagnostic information such as medical records and reports from relatives should supplement DIGS information in family-genetic studies. Within such a procedure, the DIGS appears to be a useful part of data collection for genetic studies on major mood disorders and schizophrenia in French-speaking populations. Received: 23 March 1998 / Accepted: 12 March 1999     

Longitudinal, expert, all data procedure for psychiatric diagnosis in patients with psychoactive substance use disorders

The Longitudinal, Expert, All Data (LEAD) procedure has been proposed as a criterion for the assessment of the procedural validity of diagnostic instruments. The authors evaluated the procedure's test-retest reliability and whether it enhanced diagnosis based on a single interview. Data were collected using interviews and questionnaires to assess current and lifetime substance use disorders and common comorbid disorders in 100 patients recruited from a substance abuse treatment program. An initial diagnostic interview was conducted by a primary expert who, at the end of treatment, formulated LEAD diagnoses for each patient, based on the results of the research assessment and all available clinical records. Secondary experts used a similar procedure in a subsample of 40 patients to provide a measure of test-retest reliability. Overall reliability of LEAD diagnoses was good, though it varied from excellent for substance use disorders to poor for some comorbid psychiatric disorders. As a consequence of the LEAD procedure, the total number of substance use diagnoses increased significantly, with no effect on diagnostic reliability. Based on these findings, we conclude that, while the overall reliability of the LEAD procedure is comparable to other diagnostic methods, there was considerable variability among groups of diagnoses. The additional cost of the procedure would appear to be justified only when diagnostic sensitivity is at a premium and principally for the diagnosis of psychoactive substance use disorders. Before it is widely used as a diagnostic criterion measure, the utility of the LEAD procedure should be evaluated in a variety of patient samples and under varying circumstances.     

DSM—IV临床定式访谈（SCID）在心理解剖诊断中的应用

目的本研究主要评估SCID在心理解剖中进行精神疾病诊断时的可靠性、灵敏度和特异度问题。方法对精神疾病住院患者进行SCID访谈（为患者SCID诊断）,对患者亲属进行SCID访谈（为心理解剖SCID诊断）。计算两种SCID诊断的重测信度,评分者信度以及心理解剖SCID诊断的灵敏度和特异度。结果患者SCID诊断,除焦虑障碍外,临床常见精神障碍的重测信度及评分者信度都高于0．75;心理解剖SCID诊断的酒精相关障碍、精神病性障碍、双相障碍、抑郁障碍及焦虑障碍的重测信度及评分者信度都大于0．75;在所有轴Ⅰ的疾病中,除酒精滥用和恶劣心境外,心理解剖SCID诊断与患者SCID诊断一致性系数均大于0．6。心理解剖SCID诊断的特异度都大于88％,但敏感度都低于特异度。结论研究表明SCID诊断具有较高的重测信度和评分者信度。心理解剖SCID诊断具有较好的灵敏度和特异度,与患者SCID诊断的一致性良好。     

The Reliability and Validity of Kiddie‐Schedule for Affective Disorders and Schizophrenia ‐ Present and Life‐time Version ‐ Persian Version

Background: The validity and reliability of a Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia‐Present and Lifetime Version (K‐SADS‐PL‐P) was evaluated. Method: The K‐SADS‐PL‐P was administered to 102 inpatients (mean age = 15.3 yrs, SD = 1.81) in a child and adolescent psychiatric ward. The psychometric properties were evaluated in comparison to the results of clinical diagnosis. Results: The K‐SADS‐PL‐P showed good‐to‐excellent concurrent validity in diagnosing current major disorders. Test‐retest reliabilities of most of the current diagnoses were also good to excellent. Conclusion: The Persian version of the K‐SADS‐PL provides reliable and valid youth psychiatric diagnoses.     

Lifetime prevalence and age of onset of psychiatric disorders: recall 4 years later

The blind test-retest reliability of lifetime prevalence and age of onset of psychiatric diagnoses, based on the SADS-L interview and RDC over a three-to-five year period, was examined in 143 probands and their relatives. Reliability of lifetime prevalence of major depression was excellent; reliability of antisocial personality, panic disorder, drug abuse, GAD, depressive personality, and alcoholism was good; reliability of obsessive-compulsive disorder and phobia was acceptable but lower. The reliability of hyperthymia or cyclothymia was not acceptable. Reliability for major depression did not vary substantially by age or sex of the informant, but recall of major depression was significantly higher in the probands than in their relatives. The test-retest reliability for the age of onset of major depression and panic disorder was excellent, and for phobia, GAD and alcoholism, was acceptable. Both probands and relatives recalled the age of onset of their depression fairly accurately. However, there was a reduction in agreement over time. Recall after 3-4 yr was better than 5-6 yr. There was a tendency for older respondents to systematically increase the age of onset of their depression across the two interviews, although the increase was only a few years. Recall of age of onset did not differ significantly by sex of respondent or whether the respondent was a proband or relative. These findings are discussed in light of several available studies of reliability of lifetime prevalence of psychiatric diagnoses.     

Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale

OBJECTIVE: To assess the psychometric properties of the Spanish version of the Hospital Anxiety and Depression Scale(HADS). METHOD: We administered HADS to 685 participants (256 controls and 429 patients with five different diagnoses). The reliability of the instrument was assessed by a test-retest study. Construct validity studies were carried out through item-subscale correlation and factor analysis for the whole group and by each of the five different diagnoses. Three instruments were used as external criteria to assess concurrent validity. RESULTS: HADS test-retest reliability presented correlation coefficients above 0.85. The internal consistency was high, with a Cronbach's alpha of 0.86 (anxiety) and 0.86 (depression). Factor analysis showed a clear two-factor structure for all groups. The results showed high concurrent validity with the Beck Depression Inventory and State-Trait Anxiety Inventory and with the mental domains of the Short-Form Health Survey. CONCLUSION: The Spanish version of the HADS demonstrated good reliability and validity when used in medical patients.     

Predictive validity of the K-SADS-PL 2009 version in school-aged and adolescent outpatients

Background: The schedule for affective disorders and schizophrenia for school-age children (K-SADS) is one of the most commonly used standardized diagnostic interviews in child and adolescent psychiatry. Validity studies are scarce, and limited to concurrent validity with other measures and clinical diagnoses.

Aims: To evaluate the K-SADS interview in an outpatient child and adolescent psychiatry (CAP) setting with a Longitudinal Expert All Data (LEAD) procedure.

Methods: CAP residents performed a K-SADS-PL interview with the revised 2009 version containing the new PDD section on 239 clinically referred outpatients of 6–17 years old and their parent(s). A consensus LEAD diagnosis by two senior clinicians 1.2 (SD?=?0.6) years later was based on clinical records including the K-SADS and subsequent information from further assessments, information from teachers and other informants, outcome of treatment, and at least three visits after the K-SADS.

Results: Predictive validity for K-SADS vs LEAD diagnoses were good-to-excellent for broader categories of anxiety disorders (κ?=?0.94), depressive (κ?=?0.91), behavioural (κ?=?0.91) and tic (κ?=?0.81) disorders, good for ADHD (κ?=?0.80), and good-to-moderate for autism spectrum disorders (κ?=?0.62). Bipolar, psychotic, and eating disorders were too few to be analysed.

Conclusion: The K-SADS diagnoses elicited from an interview with the child and one from parents on one occasion have an excellent validity for most major child psychiatric disorders. ADHD can be reliably diagnosed at one visit, but clinicians need to stay alert for possible undiagnosed ADHD. Diagnosing autism with K-SADS-PL 2009 version at one visit is not advisable.     

RELIABILITY AND VALIDITY OF THE SPANISH VERSION OF THEGMS–AGECAT PACKAGE FOR THE ASSESSMENT OF DEMENTIA AND COGNITIVE DISTURBANCES

This report confirms the reliability and validity of the Geriatric Mental State–Automated Geriatric Examination for Computer Assisted Taxonomy (GMS–AGECAT) package in a Spanish elderly population. No changes in the original English version are considered necessary. A representative sample (N=1080) of the elderly (65+ years) community in Zaragoza, Spain, stratified by age and sex was assessed. A two-phase screening was designed: phase I (lay interviewers): Spanish versions of GMS–AGECAT and Mini-Mental (MMSE); phase II (psychiatrists,N=324): the same instruments and History and Aetiology Schedule (HAS). Diagnosis: DSM-III-R criteria. Stringent test–retest reliability coefficients were calculated by comparing lay interviewers’ (phase I) vs psychiatrists’ (phase II) ratings. DSM-III-R psychiatric diagnoses in phase II were the gold standards for the validity study. Test–retest reliability coefficients of the cognitive sections of GMS were: case/no case distinction, mean kappa=0.71; dementia/no dementia distinction, mean kappa=0.80. GMS validity coefficients: detection of cases, sensitivity=98.4%; specificity=76.5%. Test–retest reliability coefficients of AGECAT: case/no case distinction, mean kappa=0.59; organic syndrome, dementia, mean kappa=0.68. Validity coefficients of AGECAT (psychiatrists’ outputs): case/no case distinction, sensitivity=90.6%; specificity=89.3%; dementia/no dementia distinction, sensitivity=86.4%; specificity=94.3%.     

The Cambridge Cognitive Examination (CAMCOG): validation of the Hebrew version in elderly demented patients

BACKGROUND AND PURPOSE: The CAMCOG is the second most popular cognitive testing instrument in use by Israeli clinicians. The present study examines the reliability and validity of a Hebrew version of the CAMCOG in a group of dementia sufferers in a clinical setting. METHOD: Study participants included 36 dementia sufferers and 19 control non-demented, depressed elderly subjects, consecutive referrals to an outpatient psychogeriatric service and an 'open' ward of a psychiatric hospital. Operational clinical criteria for dementia and its subtypes and for the various forms of depression were used as the 'gold' standards. The CAMCOG was translated into Hebrew and then back to English. Seven items needed modifications for local usage. RESULTS: Interrater and test-retest scores calculated as exact agreement rates ranged from good to excellent for all items, although test-retest reliability scores were generally lower than interrater scores. Kappa statistics ranged from good to excellent for all but one item in the interrater scores and for two items in the test-retest scores. A strong convergent validity was found with the MMSE score (r=0.89, p<0.01). The 79/80 cutoff point provided moderate sensitivity (57.9%), excellent specificity (97.2%) and a strong predictive value (83.6%). CONCLUSION: The Hebrew version of the CAMCOG was found to be an appropriate instrument to discriminate between demented and non-demented depressed controls in a clinical setting. In light of the demographic, cultural and linguistic heterogeneity of the Israeli elderly population, further studies should examine the psychometric characteristics of the CAMCOG in a more varied sample and also using other cutoff points in order to establish if an increase in its discriminatory power is obtainable.     

Validity, reliability and objectivity of the family history method in psychiatry: a meta analysis.

BACKGROUND: The family history is a widely used method in psychiatry; but data on the method's objectivity, reliability and validity shows partly diverging results. METHOD: In October 2005, a Medline search was conducted that yielded 7 studies regarding objectivity/reliability and 13 studies regarding validity. Results for six main groups of psychiatric diagnoses and any mental disorder were combined qualitatively for objectivity/reliability, and quantitatively for validity. RESULTS: Objectivity was generally high (kappa in the 0.80 range). Reliability was high for any mental disorder, schizophrenia, substance abuse and depression (kappa in the 0.70 range), and low or medium for anxiety (kappa between 0.30 and 0.50). Results on validity displayed an OR=148 for the family history for schizophrenia; OR=64 for mania/bipolar disorder; and OR's between 8 and 194 for substance abuse, between 3 and 37 for depression, between 5 and 350 for personality disorders, between 2.5 and 49 for anxiety, and between 2.4 and 9 for any mental disorder. CONCLUSION: There is clear evidence that the family history provides results that are better than chance for all disorders examined. But variance among diagnostic groups and among studies is considerable.     

Reliability and validity of Japanese version of the Mini-International Neuropsychiatric Interview

The Mini-International Neuropsychiatric Interview (MINI) is a short, structured diagnostic interview used as a tool to diagnose 16 axis I (Diagnostic and Statistical Manual) DSM-IV disorders and one personality disorder. Its original version was developed by Sheehan and Lecrubier. We translated the MINI into Japanese, and investigated the reliability and validity of the Japanese version of MINI. Eighty-two subjects participated in the validation of the MINI versus the Structured Clinical Interview for DSM-III-R (SCID-P). One hundred and sixty-nine subjects participated in the validation of the MINI versus an expert's professional opinion. Seventy-seven subjects were interviewed by two investigators and subsequently readministered by a third interviewer blind to the results of initial evaluation 1-2 days later. In general, kappa values indicated good or excellent agreement between MINI and SCID-P diagnoses. Kappa values indicated poor agreement between MINI and expert's diagnoses for most diagnoses. Interrater and test-retest reliabilities were good or excellent. The mean durations of the interview were 18.8 min for MINI and 45.4 min for corresponding sections of SCID-P. Overall, the results suggest that the MINI Japanese version succeeds in reliably and validly eliciting symptom criteria used in making DSM-III-R diagnoses, and can be performed in less than half the time required for the SCID-P.     

Reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) mania and rapid cycling sections

OBJECTIVE: To investigate the reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) mania and rapid cycling sections. METHOD: The 1986 version of the KSADS was modified and expanded to include onset and offset of each symptom for both current and lifetime episodes, expanded prepubertal mania and rapid cycling sections, and categories for attention-deficit/hyperactivity disorder and other DSM-IV diagnoses. To optimize diagnostic research, skip-outs were minimized. Subjects participated in the ongoing "Phenomenology and Course of Pediatric Bipolar Disorder" study. Mothers and children were interviewed separately by research nurses who were blind to diagnostic group status. In addition, ratings of off-site child psychiatrists, made from the narrative documentation given for each WASH-U-KSADS item, were compared with research nurse ratings. This work was performed between 1995 and 2000. RESULTS: There was 100% interrater reliability, five consecutive times, as both interviewer and observer after 10 to 15 trials. The kappa values of comparisons between research nurse and off-site blind best-estimate ratings of mania and rapid cycling sections were excellent (0.74-1.00). High 6-month stability for mania diagnoses (85.7%) and for individual mania items and validity against parental and teacher reports were previously reported. CONCLUSIONS: The WASH-U-KSADS mania and rapid cycling sections have acceptable reliability.     

Validation of the Children's Interview for Psychiatric Syndromes (ChIPS) with psychiatrically hospitalized adolescents

OBJECTIVE: To examine the concurrent validity of the Children's Interview for Psychiatric Syndromes (ChIPS) for adolescent inpatients. METHOD: Participants included 97 adolescents ages 12 to 18 admitted to an adolescent inpatient unit. Participants were administered the ChIPS and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (present questions only). Participants also completed self-report measures of adjustment (e.g., the Reynolds Adolescent Depression Scale-2). RESULTS: More diagnoses were made with the ChIPS (mean 4.44) compared to the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (mean 3.04; p <.001). The percentage of agreement ranged from 59% to 98%. Kappa coefficients indicated agreement ranging from slight for oppositional defiant disorder (kappa = .18) to substantial for substance use (kappa = .66); the majority of kappa values ranged from .26 to.60. When ChIPS endorsements were examined relative to construct-specific self-report measures of impairment, adolescents diagnosed by the ChIPS with a disorder scored significantly higher than adolescents who were not diagnosed with a disorder. CONCLUSIONS: The findings indicate moderate agreement between ChIPS diagnoses and Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version diagnoses. ChIPS diagnoses appear consistent with self-report measures of adjustment.     

The Calgary Depression Rating Scale for Schizophrenia: development and interrater reliability of a German version (CDSS-G).

A German version of the Calgary Depression Rating Scale for Schizophrenia (CDSS-G) approved by the author of the original scale is presented comprising a semi-structured interview for 9 items to sensitively and specifically assess depression in schizophrenia and related disorders. The process of translation is outlined and the finally derived CDSS-G was investigated with respect to interrater reliability in three studies. To keep comparability with the CDSS source version a standard procedure was used. Two trained raters jointly assessed ten schizophrenic patients (study I). In a second study, videotapes with the CDSS-G were presented to clinically inexperienced raters (study II, N = 14/15) to test the agreement on the CDSS-G in this sample. Finally, in a third study clinically experienced researchers participated in a rater training (study III, N = 34). They carried out CDSS ratings on three patients with mild depressive symptoms. The dependence of interrater reliability on depression severity was investigated for all studied patients. Both intraclass correlation coefficients (ICC) and weighted kappa coefficients (kappa(w)) were calculated. The results revealed a high ICC = 0.97 in study I for the total CDSS-G score. Single item ICC values were all above 0.70. The results of study II revealed somewhat lower agreement on CDSS-G items and total scores in psychiatric novices with however acceptable values of kappa(w)>0.50 for the total scores. Study III yielded satisfactory results (0.66相似文献   

The Spanish version of the FibroFatigue Scale: validation of a questionnaire for the observer's assessment of fibromyalgia and chronic fatigue syndrome

OBJECTIVE: To examine some of the psychometric properties of the Spanish version of the FibroFatigue Scale (FFS). METHODS: FFS was administered to 120 patients diagnosed with fibromyalgia and chronic fatigue syndrome. Internal consistency was evaluated by using Cronbach's alpha, test-retest reliability with weighted kappa and construct validity by correlations among FFS, the Fibromyalgia Impact Questionnaire (FIQ), the EuroQol 5D (EQ-5D) and the Hospital Anxiety and Depression Scale (HADS). The interrater reliability was tested using analysis of variance with patients and raters as independent factors. RESULTS: Internal consistency (alpha) was .88, test-retest reliability was .91, and interrater reliability was .93. Significant correlations were obtained between overall FFS and the FIQ (.55, P<.01), the EQ-5D (-.48, P<.01) and the HADS depression subscale (.25, P<.01), but not with the HADS anxiety subscale. CONCLUSION: These results support the reliability and validity of the data obtained with the Spanish version of the FSS.     

Computerized psychiatric diagnoses based on euclidean distances: a Chinese example.

Current diagnostic methods in psychiatry use sequential logical decision rules that generate a single diagnosis. Insufficient attention has been paid to parallel methods that can simultaneously determine the relative probability of many diagnoses. This study installed 45 items from various symptom scales on a portable computer and applied a euclidean distance formula to generate immediate diagnoses based on responses to the items. The reliability and validity of the method were assessed using Chinese psychiatric inpatients. Interrater reliability was excellent (kappa = 0.91) and 3-week test-retest reliability was fair (k = 0.50). The concordance of this method with clinicians' diagnoses and with diagnoses based on standardized Chinese diagnostic criteria was excellent (k = 0.73 and 0.76). Concordance with DSM-III-R diagnoses and ICD-10 diagnoses was fair (kappa = 0.55 and 0.65). The clinical utility of such parallel methods of psychiatric diagnosis deserves further evaluation.     

Interrater reliability of the Anxiety Disorders Interview Schedule for DSM-IV: child and parent version

OBJECTIVE: The present study determined interrater agreement on diagnoses achieved using the parent and child versions of the Anxiety Disorders Interview Schedule for Children for DSM-IV (ADIS-C/P) and examined informant, age, and gender influences on reliability. METHOD: Diagnoses established for 153 seven- to 16-year-old children during live administration of the ADIS-C/P were compared to diagnoses identified by a second rater after viewing a video recording of the interviews. RESULTS: When information from both parent and child interviews was used, the level of agreement between raters for principal diagnosis (kappa = .92) and the individual anxiety disorders (kappa = .80-1.0) was excellent. Agreement on common comorbid disorders was good (kappa = .65-.77). Agreement was also good to excellent when diagnoses were assigned based on separate child or parent interviews, aside from children's report of externalizing disorders. Age and gender did not consistently impact interrater agreement. CONCLUSIONS: The data indicate that the present version of the ADIS-C/P provides consistent diagnostic results across different clinicians and indicates improvements in the reliability of diagnoses following criterion changes in DSM-IV.