Consequences of differential diagnostic criteria on identification rates of children with emotional or behavioral disorders

What constitutes an appropriate diagnostic workup for children with emotional or behavioral disorders (EBD) varies in both school and clinic settings. Current definitions of EBD suggest that a symptom checklist should be required, but there is some disagreement about what constitutes a functional impairment and what role out-of-school assessments should play. The purpose of this study was to determine the impact of different diagnostic criteria on EBD identification by systematically varying the respondent for the symptom checklist (parent and/or teacher) and the type of functional impairment (poor academic achievement and/or poor social skills) required for diagnosis. The sample included 3,694 children in second grade. who were pare of a longitudinal sample of Head Start graduates. Clinical cutoff points on behavior problem checklists from parents and teachers, on social skills ratings from parents and teachers, and on individual measures of academic achievement were serially applied to the sample to determine the rate of EBD identification with various combinations of instruments. The 13 different diagnostic combinations identified from 1.1% to 27.5% of the sample. Four of these combinations resulted in significant ethnic or gender bias. Findings are discussed with reference to current diagnostic criteria used for EBD In school or clinic settings.