This case vignette approach for analysing survey data uses clinician ratings based on a review of all the information of each subject. This information includes not only the questionnaires and
structured interviews but also any additional comments made by the interviewers, and the transcripts of informants’ comments to open- ended questions particularly those which ask about the child’s significant problems. The case vignette approach was extensively tested among community and clinical samples in the pre-pilot and pilot phases of the survey.
structured questions. This is particularly valuable for relatively unusual symptoms such as obsessions and compulsions - even when parents or young people say “yes” to items about such symptoms, their own description of the problem often makes it clear that they are not describing what a clinician would consider to be an obsession or compulsion. Secondly, the clinical raters consider how to interpret conflicts of evidence between informants. Reviewing the transcripts and interviewers’ comments often helps decide whose account to prioritise. Reviewing all of the evidence, it may be clear that one
respondent gives a convincing account of symptoms, whereas the other respondent minimises all
symptoms in a defensive way. Conversely, one respondent may clearly be exaggerating. Thirdly, the clinical raters aim to catch those emotional, conduct and hyperactivity disorders that slip through the ‘operationalised’ net. When the child has a clinically significant problem that does not meet operationalised diagnostic criteria, the clinician can assign a ‘not otherwise specified’ diagnosis such as ‘anxiety disorder, NOS’ or ‘disruptive behaviour disorder, NOS.’
Finally, the clinical raters rely primarily on the transcripts to diagnose less common disorders such as anorexia nervosa, Tourette syndrome, autistic disorders, agoraphobia or schizophrenia. The relevant symptoms are so distinctive that
respondents’ descriptions are often unmistakable. The following three case vignettes from the pilot study provide illustrative examples of subjects where the clinical rating altered the diagnosis. In each case the “computer-generated diagnosis” is the diagnosis arrived at by a computer algorithm based exclusively on the answers to fully structured questions. In these three illustrative instances, the computer-generated diagnoses were changed by the clinical raters.
Subject 1: overturning a computer-generated diagnosis. A 13 year-old boy was given a computer diagnosis of a specific phobia because he had a fear that resulted in significant distress and avoidance. In his open-ended description of the fear, he explained that boys from another school had threatened him
to avoid them. The clinical rater judged his fear and avoidance to be appropriate responses to a realistic danger and not a phobia.
Subject 2: including a diagnosis not made by the computer. A 7-year-old girl fell just short of the computer algorithm’s threshold for a diagnosis of ADHD because the teacher reported that the problems with restlessness and inattentiveness resulted in very little impairment in learning and peer relationships at school. A review of all the evidence showed that the girl had officially recognised special educational needs as a result of hyperactivity problems, could not concentrate in class for more than 2 minutes at a time even on activities she enjoyed, and had been offered a trial of medication. The clinician concluded that the teacher’s report of minimal impairment was an understatement, allowing a clinical diagnosis of ADHD to be made.
Subject 3: both adding to and subtracting from computer generated diagnoses. A 14-year-old girl received computer-generated diagnoses of simple phobia, major depression and oppositional-defiant disorder. The transcripts of the open-ended comments provided by the girl and her mother included convincing descriptions not only of a depressive disorder but also of anorexia nervosa of one year’s duration. The supposed phobia was an anorexic fear of food, and the oppositionality had only been present for a year and was primarily related to battles over food intake. Consequently, the clinical rater made the additional diagnosis of anorexia nervosa and overturned the diagnoses of simple phobia and oppositional-defiant disorder.
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This chapter covers three main topics: the sampling design, the organisation of the survey and survey response.