"If we can find instances in which informant discrepancies hold value, and reliably distinguish these informant discrepancies from discrepancies that hold no value, then informant discrepancies become tools that we can use to better understand patients."
Child and adolescent mental health patients lead complex lives. Indeed, mental health concerns arise out of an intricate interplay among biological, psychological, and socio-cultural factors that pose risk for, or offer protection against, the expression of maladaptive reactions to environmental or social contexts. However, not all contexts elicit expressions of mental health concerns to the same degree. Consequently, patients may experience mental health concerns within some contexts, such as home or school, but not others, such as within peer interactions. In other words, patients vary as to the contexts in which they experience mental health concerns. In fact, patients commonly vary in the contexts in which they express such concerns as social anxiety, attention and hyperactivity, conduct problems, and substance use. Further, clinicians might "miss" identifying mental health concerns if their assessments do not account for the possibility of mental health concerns expressing themselves in some contexts and not others. Thus, clinicians often collect reports from multiple informants, such as self-reports from patients and also significant others in patients' lives, such as parents and teachers.
Clinicians use multiple informants’ reports to make mental health care decisions, such as assigning diagnoses and planning treatment. Collecting these reports generates a great deal of information about a patient’s mental health. However, each informant’s report yields its own conclusion, and the conclusions from any two informants’ reports often differ from one another. For instance, an adolescent patient receiving a clinical assessment prior to treatment may be identified as experiencing “low” mood based on a parent or teacher report whereas the adolescent self-reports her mood as “elevated”. We call these inconsistent conclusions “informant discrepancies”. Historically, these informant discrepancies have created considerable uncertainty as to how best to care for patients. That is, we typically think of informant discrepancies as problems requiring a solution. Perhaps the uncertainties we encounter with informant discrepancies arise because we think they lack structure, they lack a defining pattern, and many of us instinctively look for patterns in what we observe. When we look to the sky and see clouds, we often try to make them out, and see if their shapes reflect objects that we commonly see on the ground. Thus, why would we view informant discrepancies as anything other than a hindrance to making clinical decisions or conducting sound research, if we cannot think of a good reason for their occurrence?
When our laboratory observes discrepancies in reports we collect from patients and their parents and teachers, we try to see what makes these discrepancies tick. Importantly, commonly used informants of child and adolescent mental health, such as parents and teachers, often vary in where they observe children and adolescents, such as home and school contexts. Thus, informants differ in their opportunities for observing child and adolescent concerns. Consequently, sometimes a teacher reports problems in a patient that a parent does not because the patient exhibits problems at school, but functions just fine at home. Sometimes, the opposite occurs and the discrepancies you observe between parent and teacher reports indicate that a patient expresses concerns at home but not school. Other times, the discrepancies do not hold any value; they simply indicate that mistakes occurred in the process of gathering clinical information about the patient.
If we can find instances in which informant discrepancies hold value, and reliably distinguish these informant discrepancies from discrepancies that hold no value, then informant discrepancies become tools that we can use to better understand patients. We can turn what appear to be weaknesses of mental health assessments into key strengths. In fact, a movement is underway in the health care field broadly that involves developing ways to deliver health care to meet the needs of patients who often vary widely in how they express symptoms, respond to treatment, or even in why they developed health concerns in the first place. In mental health care, informant discrepancies could assist in the development and implementation of techniques to care for patients of varying clinical concerns. Along these lines and with an emphasis on assessments of adolescent social anxiety and family functioning, our laboratory examines how informant discrepancies reveal meaningful information about the contexts in patients express mental health concerns. By integrating traditional multi-informant clinical assessments with state-of-the art behavioral observation, performance-based, and physiological modalities for assessing patient functioning, we develop and test assessment paradigms that incorporate contextual information into personalized mental health assessments. Our long-term goal involves examining whether these personalized methods of care improve clinical decision-making and patient outcomes.