In article on The Clinical Implications of Informant Variance, with Special Attention to Mania, published in Child and Adolescent Psychopharmacology News,
Gabrielle Carlson, MD and Eric Youngstrom, PhD describe the
implications for clinical practice of concordance versus variance in the
information which clinicians obtain from patients, parents and teachers
about the behaviors and moods of their young patients. Describing
informant variance as both a curse and a blessing, they argue that
obtaining information from multiple sources is a key to accurate
diagnosis and that agreement or disagreement among sources of
information — especially about manic episodes — can be a useful
diagnostic clue.
The authors point out that some variance among
informants results from differences in the reporters’ perspectives —
that parents may notice symptoms of mania at lower thresholds than their
children, for example — and some from the fact that children behave
differently with different people and in different contexts — their
behavior with teachers at school may be different from their behavior
with parents at home, for example — so that different observers may see
different things. The informants’ attitudes, mental states and
experience may also affect what they report.
Drs. Carlson and
Youngstrom review the implications that agreement and disagreement among
informants have for the diagnosis of behavioral disorders, mood
disorders and bipolar disorder, noting the crucial importance of
properly assessing parents’ reports of manic episodes in relation to
teachers’ reports. They recommend that clinicians use all the sources of
information available to them, noting the advantages of interviewing
parents before interviewing patients and of assessing the credibility of
informants.
