Gabrielle Carlson, MD and Eric Youngstrom, PhD Discuss Implications of Informant Variance

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.