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ABSTRACT: Unresolved questions exist concerning diagnosis of ADHD. First, some studies suggest a potential overdiagnosis. Second, compared with the male-female ratio in the general population (3:1), many more boys receive ADHD treatment compared with girls (6-9:1). We hypothesized that this occurs because therapists do not adhere to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) and International Classification of Diseases (10th rev.; ICD-10) criteria. Instead, we hypothesized that, in accordance with the representativeness heuristic, therapists might diagnose attention-deficit/hyperactivity disorder (ADHD) if a patient resembles their concept of a prototypical ADHD child, leading therapists to overlook certain exclusion criteria. This may result in overdiagnosis. Furthermore, as ADHD is more frequent in males, a boy might be seen as a more prototypical ADHD child and might therefore receive an ADHD diagnosis more readily than a girl would.
We sent a case vignette to 1,000 child psychologists, psychiatrists, and social workers and asked them to give a diagnosis. Four versions of the vignette existed: Vignette 1 (ADHD) fulfilled all DSM-IV/ICD-10 criteria of ADHD. Vignettes 2-4 (non-ADHD) included several ADHD symptoms but stated other ADHD criteria were nonfulfilled. Therefore, an ADHD diagnosis could not be given. Furthermore, boy and girl versions of each vignette were created.
In Vignettes 2-4 (non-ADHD), 16.7% of therapists diagnosed ADHD. In the boy version of these vignettes, therapists diagnosed ADHD around 2 times more than they did with the girl vignettes.
Therapists do not adhere strictly to diagnostic manuals. Our study suggests that overdiagnosis of ADHD occurs in clinical routine and that the patient's gender influences diagnosis considerably. Thorough diagnostic training might help therapists to avoid these biases.
Journal of Consulting and Clinical Psychology 12/2011; 80(1):128-38. · 4.85 Impact Factor
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ABSTRACT: An accurate diagnosis is an important precondition for effective psychotherapeutic treatment. The use of structured interviews provides the gold standard for reliable diagnosis. Suppiger et al. (2009) showed that structured interviews have a high acceptance among patients. On a scale from 0 (not at all satisfied) to 100 (totally satisfied) patients rated overall satisfaction with a structured interview at M=86.55. Nevertheless, therapists rarely seem to use structured interviews in clinical practice. The aim of this study was to assess how frequently therapists use structured interviews in daily practice. Secondly, we hypothesized that therapists underestimate patient acceptance of structured interviews. As a third goal, we explored further reasons why therapists choose not to use structured interviews. We conducted an online survey of 1,927 psychiatrists and psychotherapists in Switzerland and asked them how frequently they used structured interviews and how they estimated patient satisfaction with these interviews. Furthermore, we asked therapists why they chose to use or not use structured interviews. Therapists reported using structured interviews on average with about 15% of their patients. Furthermore, therapists estimated significantly lower patient acceptance than patients themselves indicated (M(therapist)=49.41, M(patient)=86.55). Our data suggest lack of familiarity with these instruments as well as an overestimation of the utility of open clinical interviews as further reasons for not using structured interviews.
Behavior therapy 12/2011; 42(4):634-43. · 2.85 Impact Factor
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ABSTRACT: Bipolar disorders (BD) are often misdiagnosed. Clinicians seem to use heuristics instead of following the recommendations of diagnostic manuals. Bruchmüller and Meyer (2009) suggest that 'reduced sleep' is a prototypic criterion that increases the likelihood of a bipolar diagnosis. This study examines if this criterion specifically elevates the likelihood of a bipolar diagnosis or if the finding of the study mentioned above is rather due to the total number of criteria. Furthermore, we want to replicate the finding that patients offering a causal explanation for their manic symptoms are misdiagnosed more often. Additionally, we examine therapeutic attributes that might influence diagnostic decisions as well as treatment consequences following a (mis-)diagnosis.
204 Psychotherapists were presented with a case vignette describing someone with a BD and were asked to make a diagnosis. Symptoms and the total number of criteria varied systematically within the vignettes but each still fulfilled enough diagnostic criteria to be diagnosed as bipolar.
Almost 60% of the clinicians made misdiagnoses. A correct diagnosis did not depend on the specific criterion of 'reduced sleep' but on the total number of criteria. The causal explanation as well as therapeutic attributes did not significantly influence diagnostic decisions. However, the study showed that a misdiagnosis can lead to severe consequences concerning the treatment recommended by clinicians.
The validity of case vignettes is discussible.
It seems as if specific symptoms might not be of so much relevance as assumed. Instead, clinicians seem to follow the additive model when making diagnoses.
Journal of affective disorders 11/2010; 130(3):405-12. · 3.76 Impact Factor
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ABSTRACT: Bipolar disorders are misdiagnosed in many cases. We hypothesized that this occurs because therapists do not base their diagnostic decision solely on criteria set out by ICD-10 or DSM-IV. We expected that instead, patients offering a plausible causal explanation for their symptoms (i.e. having fallen in love) are less likely to be diagnosed as bipolar. In the same way we expected that patients who report decreased need for sleep are more likely to be diagnosed as bipolar than those who do not present with this additional symptom. We sent a case vignette describing a person with bipolar disorder to 400 psychotherapists. This vignette was varied with respect to these two pieces of information, but each case described included all necessary criteria to diagnose a bipolar disorder according to DSM-IV or ICD-10. This variation, along with the theoretical approach of the therapist affected the likelihood of a bipolar diagnosis.
Journal of affective disorders 01/2009; 116(1-2):148-51. · 3.76 Impact Factor
