Abstract
Data on clinician diagnostic practices suggest they may not align with evidence-based guidelines. To better understand these practices, a multidisciplinary survey of 1,678 child clinicians examined attitudes toward the utility of diagnosis and standardized diagnostic tools. Psychiatrists were more likely than other disciplines to value diagnosis, whereas psychologists were more likely than others to value standardized diagnostic tools. Private practitioners held less positive views in both domains than other practitioners. Both attitude scales predicted self-reported diagnostic practices, although views of diagnosis utility were more associated with diagnosing in general, whereas views of diagnostic tools were more predictive of standardized tool use.
Similar content being viewed by others
Notes
We thank an anonymous reviewer for this suggestion.
References
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Text Revision) (4th ed.). Washington, DC: Author.
Angold, A., & Fisher, P. W. (1999). Interviewer-based interviews. In D. Shaffer, C. P. Lucas, & J. E. Richters (Eds.), Diagnostic assessment in child and adolescent psychopathology (pp. 34–64). New York: Guilford Press.
Armitage, C. J., & Conner, M. (2001). Efficacy of the theory of planned behaviour: A meta-analytic review. British Journal of Social Psychology, 40(4), 471–499.
Basco, M. R., Bostic, J. Q., Davies, D., Rush, A. J., Witte, B., Hendrickse, W., et al. (2000). Methods to improve diagnostic accuracy in a community mental health setting. American Journal of Psychiatry, 157(10), 1599–1605.
Cashel, M. L. (2002). Child and adolescent psychological assessment: Current clinical practices and the impact of managed care. Professional Psychology Research and Practice, 33(5), 446–453.
Chorpita, B. F., & Donkervoet, C. (2005). Implementation of the Felix consent decree in Hawaii: The impact of policy and practice development efforts on service delivery. In R.G. Steele & M.C. Roberts (Eds.), Handbook of mental health services for children, adolescents, and families (pp. 317–332). New York, US: Kluwer Academic/Plenum Publishers.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum.
Cortina, J. M. (1993). What is coefficient alpha? An examination of theory and applications. Journal of Applied Psychology, 78, 98–104.
Dillman, D. A. (2000). Mail and internet surveys: The tailored design method (2nd ed.). New York: John Wiley & Sons.
Frazer, P., Westhuis, D., Daley, J. G., & Phillips, I. (2009). How clinical social workers are using the DSM-IV: A national study. Social Work in Mental Health, 7(4), 325–339.
Garb, H. N. (1998). Studying the clinician: Judgment research and psychological assessment. Washington, DC: American Psychological Association.
Garb, H. N. (2005). Clinical judgment and decision making. Annual Review of Clinical Psychology, 1(1), 67–89.
Garland, A. F., Kruse, M., & Aarons, G. A. (2003). Clinicians and outcome measurement: What’s the use? The Journal of Behavioral Health Services and Research, 30(4), 393–405.
Gilbody, S. M., House, A. O., & Sheldon, T. A. (2002). Psychiatrists in the UK do not use outcomes measures: National survey. British Journal of Psychiatry, 180(2), 101–103.
Godin, G., & Kok, G. (1996). The theory of planned behavior: A review of its applications to health-related behaviors. American Journal of Health Promotion, 11, 87–98.
Hatfield, D. R., & Ogles, B. M. (2007). Why some clinicians use outcome measures and others do not. Administration and Policy in Mental Health and Mental Health Services Research, 34(3), 283–291.
Hawley, K. M., Cook, J. R., & Jensen-Doss, A. (2009). Do noncontingent incentives increase survey response rates among mental health providers? A randomized trial comparison. Administration and Policy in Mental Health, 36, 343–348.
Hunsley, J., & Mash, E. J. (2005). Introduction to the special section on developing guidelines for the evidence-based assessment (EBA) of adult disorders. Psychological Assessment, 17(3), 251–255.
Jampala, V. C., Zimmerman, M., Sierles, F. S., & Taylor, M. A. (1992). Consumers’ attitudes toward DSM-III and DSM-III—R: A 1989 survey of psychiatric educators, researchers, practitioners, and senior residents. Comprehensive Psychiatry, 33(3), 180–185.
Jensen, A. L., & Weisz, J. R. (2002). Assessing match and mismatch between practitioner-generated and standardized interview-generated diagnoses for clinic-referred children and adolescents. Journal of Consulting and Clinical Psychology, 70(1), 158–168.
Jensen-Doss, A., & Hawley, K. M. (2010). Understanding barriers to evidence-based assessment: Clinician attitudes toward standardized assessment tools. Journal of Clinical Child and Adolescent Psychology, 39, 885–896.
Jensen-Doss, A., Hawley, K. M., Lopez, M., & Osterberg, L. D. (2009). Using evidence-based treatments: The experiences of youth providers working under a mandate. Professional Psychology: Research and Practice, 40(4), 417–424.
Jensen-Doss, A., & Weisz, J. R. (2008). Diagnostic agreement predicts treatment process and outcomes in youth mental health clinics. Journal of Consulting and Clinical Psychology, 76(5), 711–722.
Klein, D. N., Dougherty, L. R., & Olino, T. M. (2005). Toward guidelines for evidence-based assessment of depression in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), 412–432.
Kline, P. (1986). A handbook of test construction. London: Methuen.
Kutchins, H., & Kirk, S. A. (1988). The business of diagnosis: DSM-III and clinical social work. Social Work, 33(3), 215–220.
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.
Lowe, J., Pomerantz, A. M., & Pettibone, J. C. (2007). The influence of payment method on psychologists’ diagonistic decisions: Expanding the range of presenting problems. Ethics & Behavior, 17(1), 83–93.
Mash, E. J., & Hunsley, J. (2005). Evidence-based assessment of child and adolescent disorders: Issues and challenges. Journal of Clinical Child and Adolescent Psychology, 34(3), 362–379.
McMahon, R. J., & Frick, P. J. (2005). Evidence-based assessment of conduct problems in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), 477–505.
Mead, M. A., Hoenshil, T. H., & Singh, K. (1997). How the DSM system is used by clinical counselors: A national study. Journal of Mental Health Counseling, 19, 383–401.
Miller, L. S., Bergstrom, D. A., Cross, H. J., & Grube, J. W. (1981). Opinions and use of the DSM system by practicing psychologists. Professional Psychology, 12, 385–390.
Pelham, W. E., Jr., Fabiano, G. A., & Massetti, G. M. (2005). Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), 449–476.
Pogge, D. L., Wayland-Smith, D., Zaccario, M., Borgaro, S., Stokes, J., & Harvey, P. D. (2001). Diagnosis of manic episodes in adolescent inpatients: Structured diagnostic procedures compared to clinical chart diagnoses. Psychiatry Research, 101(1), 47–54.
Pomerantz, A. M., & Segrist, D. J. (2006). The influence of payment method on psychologists’ diagnostic decisions regarding minimally impaired clients. Ethics & Behavior, 16(3), 253–263.
Rettew, D. C., Lynch, A. D., Achenbach, T. M., Dumenci, L., & Ivanova, M. Y. (2009). Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews. International Journal of Methods in Psychiatric Research, 18(3), 169–184.
Setterberg, S. R., Ernst, M., Rao, U., & Campbell, M. (1991). Child psychiatrists’ views of DSM-III—R: A survey of usage and opinions. Journal of the American Academy of Child & Adolescent Psychiatry, 30(4), 652–658.
Silverman, W. K., & Ollendick, T. H. (2005). Evidence-based assessment of anxiety and its disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), 380–411.
Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston, MA: Allyn & Bacon/Pearson Education.
Weisz, J. R., & Addis, M. E. (2006). The research-practice tango and other choreographic challenges: Using and testing evidence-based psychotherapies in clinical care settings. In C.D. Goodheart, A.E. Kazdin, & R.J. Sternberg (Eds.), Evidence-based psychotherapy: Where practice and research meet (pp. 179–206). Washington, DC US: American Psychological Association.
Youngstrom, E. A., Findling, R. L., Youngstrom, J. K., & Calabrese, J. R. (2005). Toward an evidence-based assessment of pediatric bipolar disorder. Journal of Clinical Child and Adolescent Psychology, 34(3), 433–448.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jensen-Doss, A., Hawley, K.M. Understanding Clinicians’ Diagnostic Practices: Attitudes Toward the Utility of Diagnosis and Standardized Diagnostic Tools. Adm Policy Ment Health 38, 476–485 (2011). https://doi.org/10.1007/s10488-011-0334-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-011-0334-3